WASH safety plans could prevent pandemics in future
The ongoing global pandemic caused by the novel Coronavirus disease-2019 (COVID-19) would adversely impact the ongoing efforts towards achieving many of the Sustainable Development Goals (SDGs).
Globally, around 2.2 billion people lack safe drinking water, 4.2 billion people live without access to adequate sanitation, and 3 billion people lack basic handwashing facilities at home (WHO, 2019). For breaking human transmissibility of COVID-19, the practice of good hand hygiene has been suggested. Frequent disinfection is a must for arresting the contagion from spreading. Many of the 3 billion people lacking handwashing facilities live in South Asia and sub-Saharan Africa, whose population accounts for 85 percent of the world’s poor (WSSCC, 2020). As per the National Family Health Survey (NFHS), in India the population without handwashing facilities has been 39.8 percent (NFHS-4, 2015-16).
Over the last few weeks, several efforts have been taken by the Governments at different levels to check the spread of the coronavirus. Despite these efforts, health workers, sanitation workers, and persons involved in the supply of essential commodities are at the forefront and at high risk. The Government of India is taking several measures in this regard. Guidelines have been issued regarding Personal Protective Equipment (PPE) and disposal of waste generated during treatment, diagnosis and quarantine of COVID-19 patients. Supportive measures have been devised towards fighting COVID-19. Further, many State Governments have supported the sanitation and health workers with various welfare measures.
As per the World Health Organization (WHO), there is no current evidence for surrogate human coronaviruses or that they are present in surface or groundwater sources or transmitted through contaminated drinking-water. There have been no reports yet of faecal−oral transmission of the COVID-19 virus (WHO, 2020). It could, however, remain infectious in water contaminated with faeces for days to weeks. A number of measures can be taken to improve water safety, starting with protecting the water source, treating water at the point of distribution, collection, or consumption; and ensuring that treated water is safely stored at home in regularly cleaned and covered containers. In places where centralized water treatment and safe piped water supplies are not available, a number of household water treatment technologies are effective in removing or destroying viruses, including boiling and appropriately dosed free chlorine.
As per experts at the Netherland’s National Institute for Public Health and the Environment in Bilthoven, routine wastewater surveillance would help quantify the scale of infection in a community by finding how much viral Ribo-Nucleic Acid (RNA) is excreted in faeces, and extrapolate the number of infected people in a population from concentrations of viral RNA in wastewater samples; this could be used as a non-invasive early warning tool to alert communities to new COVID-19 infections (Nature, April 2020). The London School of Hygiene & Tropical Medicine has been collecting evidence since 1995 that hand-washing with soap is highly effective against diarrheal diseases. As part of an integrated public health policy, wastewater carried in sewerage systems should be treated in well-designed and well-managed centralized wastewater treatment works. A final disinfection step may be considered if existing wastewater treatment plants are not optimized to remove viruses. Infection-control measures, such as social distancing, will probably suppress the current pandemic, but the virus could return once such measures are lifted. Safely managed Water, Sanitation, and Hygiene (WASH) services are also critical during the recovery phase of a disease outbreak to mitigate secondary impacts on community livelihoods and wellbeing. If not managed, secondary impacts can increase the risk of further spreading water borne diseases, including potential disease outbreaks such as cholera, particularly where the disease is endemic.
The central Government’s next phase of the Swachh Bharat Mission (SBM 2.0), which is focused on the next set of related and critical outcomes for safe sanitation and hygiene, is a welcome step. This is an opportunity to develop WASH Systems Conceptual Framework and strengthen sanitation and hygiene in WASH systems thinking and approaches. This would require taking the next steps towards deploying disruptive toilet-to-treatment technologies, strengthening municipal capacities, driving behaviour change efforts and building local community ownership models towards safe sanitation and hygiene. Equally important is to channel more funds for sanitation and hygiene.
Education alone is not enough to sustain handwashing habits; investments in innovative and scalable approaches for promoting handwashing behaviours in healthcare and non-healthcare settings are needed to prevent the spread of infectious diseases like COVID-19. Investments in promoting hand hygiene, coupled with sanitation and clean water, must be made for the long haul.
A multi-stakeholder inclusive approach is needed to achieve sustainable sanitation for all at all times. The government, regulators, funding agencies, and the private sector need to work together to address the current gaps around implementation and create replicable approaches and models. The current capacities of government functionaries and private service providers are limited and need handholding support.
A concomitant political will is needed to ensure sustainable WASH outcomes and achieve SDG Target 6.2, which calls for providing everyone in the world with access to adequate and equitable sanitation and hygiene.
