IntroductionPoor access to water, sanitation and hygiene (WASH) services threatens population health and contributes to gender and social inequalities, especially in low-resource settings. Despite awareness in the WASH sector of the importance of promoting gender equality and social inclusion (GESI) to address these inequalities, evaluations of interventions focus largely on health outcomes, while gender equality and other social outcomes are rarely included. This review aimed to collate and describe available research evidence of GESI outcomes evaluated in WASH intervention studies.MethodsWe applied a systematic mapping methodology and searched for both academic and grey literature published between 2010 and 2020 in 16 bibliographic databases and 53 specialist websites. Eligibility screening (with consistency checking) was conducted according to predetermined criteria, followed by metadata coding and narrative synthesis.ResultsOur evidence base comprises 463 intervention studies. Only 42% of studies measured transformative GESI outcomes of WASH interventions, referring to those that seek to transform gender relations and power imbalances to promote equality. A majority of studies disaggregated outcome data by sex, but other forms of data disaggregation were limited. Most included studies (78%) lacked a specific GESI mainstreaming component in their intervention design. Of the interventions with GESI mainstreaming, the majority targeted women and girls, with very few focused on other social groups or intersectional considerations.ConclusionThe review points to various areas for future primary and secondary research. Given the potential contribution of WASH to GESI, GESI considerations should be incorporated into the evaluation of WASH interventions. Regular collection of data and monitoring of GESI outcomes is needed as well as developing new and testing existing methods for monitoring and evaluation of such data.

Safely managed water, sanitation, and hygiene (WASH) are fundamental for human health and wellbeing and are thought to contribute to a range of positive outcomes related to education, livelihoods, dignity, safety, and gender equality. However, gender and other social categories (e.g. age, ethnicity, caste, disability, marital status) can mediate who benefits from WASH services and in which ways. As progress in gaining access to safe WASH services has not occurred equally, there has been a focus on mainstreaming gender equality and social inclusion (GESI) in interventions. Despite awareness in the sector of the importance of promoting gender and socially inclusive WASH services, evaluations of interventions focus largely on technical or health outcomes, while social outcomes are not included. This systematic evidence synthesis aimed to collate evidence on the impact of WASH interventions on GESI outcomes in low- and middle-income countries (LMICs). It also aimed to synthesise evidence on violence-related outcomes, and to advance understanding of barriers to, and facilitators of, change in violence-related outcomes in the context of WASH interventions.

Multi-stakeholder engagement is critical for making progress towards Sustainable Development Goal (SDG) 6 ‘Ensure access to water and sanitation for all’, which is currently off track to be achieved by 2030. The aim of this paper was to investigate mutual accountability and multi-stakeholder platforms in the WASH sector in a diverse range of countries. Data were collected by Sanitation and Water for All (SWA) Research and Learning Constituency partners and collaborators in five SWA member countries: Bangladesh, Indonesia, Kenya, Peru and Somalia. Data collection involved document review, key informant interviews and workshops, and an online questionnaire. Across all the case study countries, there were no clear examples of mutual accountability mechanisms being widely used in the WASH sector. However, the findings indicate that some of the case study countries have active WASH multi-stakeholder platforms involving a range of actors from government, civil society and the private sector; however, these typically function as coordination and communication platforms rather than supporting mutual accountability. Other case study countries did not have multi-stakeholder platforms involving a diverse range of actors, and instead had platforms established for single stakeholder groups such as the private sector or civil society, leaving certain groups out of activities. Overall, the study highlights the importance of establishing strong multi-stakeholder processes and platforms that bring together a range of actors including government, civil society, private sector, research actors, and WASH external support organizations. Such platforms could provide a foundation to enable mutual accountability between these actors by providing a space to set commitments and monitor progress and have potential to strengthen WASH systems both nationally and globally.

Access to safe water, sanitation, and hygiene (WASH) are human rights and play a fundamental role in protecting health, which has been particularly evident during the SARS-CoV2 (COVID-19) pandemic. People experiencing homelessness face frequent violations of their human rights to water and sanitation, negatively affecting their health and dignity and ability to protect themselves from COVID-19. This research aimed to identify barriers to safe water, sanitation and hygiene access for people experiencing homelessness in Mexico City during the COVID-19 pandemic. A survey of 101 respondents experiencing homelessness was conducted using mobile data collection tools in collaboration with El Caracol A.C., an NGO that contributes to the visibility and social inclusion of homeless people in Mexico. We report findings according to the following themes: general economic impacts of COVID-19; experiences with reduced access to WASH services due to COVID-19, challenges in accessing hand washing to follow COVID-19 public health advice; and coping mechanisms used to deal with reductions in access to WASH. We discuss the broader implications of the findings in terms of realization of the human rights to water and sanitation (HRtWS), and how people experiencing homelessness are left behind by the existing approaches to ensure universal access to water and sanitation under SDG 6.

ObjectivesWe report the results of a mixed-methods process evaluation that aimed to provide insight on the Afya conditional cash transfer (CCT) intervention fidelity and acceptability.Intervention, setting and participantsThe Afya CCT intervention aimed to retain women in the continuum of maternal healthcare including antenatal care (ANC), delivery at facility and postnatal care (PNC) in Siaya County, Kenya. The cash transfers were delivered using an electronic card reader system at health facilities. It was evaluated in a trial that randomised 48 health facilities to intervention or control, and which found modest increases in attendance for ANC and immunisation appointments, but little effect on delivery at facility and PNC visits.DesignA mixed-methods process evaluation was conducted. We used the Afya electronic portal with recorded visits and payments, and reports on use of the electronic card reader system from each healthcare facility to assess fidelity. Focus group interviews with participants (N=5) and one-on-one interviews with participants (N=10) and healthcare staff (N=15) were conducted to assess the acceptability of the intervention. Data analyses were conducted using descriptive statistics and qualitative content analysis, as appropriate.ResultsDelivery of the Afya CCT intervention was negatively affected by problems with the electronic card reader system and a decrease in adherence to its use over the intervention period by healthcare staff, resulting in low implementation fidelity. Acceptability of cash transfers in the form of mobile transfers was high for participants. Initially, the intervention was acceptable to healthcare staff, especially with respect to improvements in attaining facility targets for ANC visits. However, acceptability was negatively affected by significant delays linked to the card reader system.ConclusionsThe findings highlight operational challenges in delivering the Afya CCT intervention using the Afya electronic card reader system, and the need for greater technology readiness before further scale-up.Trial registration numberNCT03021070.