Having access to sufficient quantities of safe water, access to a private and clean place to defecate, living in an environment free from human excreta and other harmful waste, and being able to behave hygienically, are basic requirements essential for health and dignity for all. In development sectors, water, sanitation and hygiene are often brought together under the term WASH.These three broad areas are clearly interlinked; for example, without effective sanitation water sources may be at risk of microbiological contamination; many sanitation systems rely on water for flushing, cleaning and transporting human waste; and without improved hygiene behaviours, such as hand-washing after defecation and before eating, the health benefits of access to sanitation will be negated. The WASH sector comprises a diverse range of approaches, including (but not limited to) water supply, water treatment, household and community sanitation, school water and sanitation, solid waste management, sewerage, and hygiene promotion.The links between access to water and sanitation and achieving development goals for environmental sustainability, health, education, poverty reduction and gender equality have been established (WaterAid 2007). Yet the WASH sector is neglected by donor and developing country governments, in relation to other sectors. For instance, although global aid for health and education has been progressively increasing the proportion of aid being allocated to WASH has decreased. In 1997, water and sanitation received 10 per cent of aid that was allocated to specific sectors, but by In total, women spend around six to seven years of their lives menstruating. A key priority for women and girls is to have the necessary knowledge, facilities and cultural environment to manage menstruation hygienically, and with dignity. Yet the importance of menstrual hygiene management is mostly neglected by development practitioners within the WASH (water, sanitation and hygiene) sector, and other related sectors such as reproductive health. This article explores the reasons why menstrual hygiene management is not generally included in WASH initiatives, the social and health impacts of this neglect on women and girls, and provides examples of successful approaches to tackling menstrual hygiene in WASH in the South Asia region.

BackgroundCoping strategies have, in some countries, become so prevalent that it has been widely assumed that the very notion of civil services ethos has completely – and possibly irreversibly – disappeared. This paper describes the importance and the nature of pilfering of drugs by health staff in Mozambique and Cape Verde, as perceived by health professionals from these countries. Their opinions provide pointers as to how to tackle these problems.MethodsThis study is based on a self-administered questionnaire addressed to a convenience sample of health workers in Mozambique and in Cape Verde.ResultsThe study confirms that misuse of access to pharmaceuticals has become a key element in the coping strategies health personnel develop to deal with difficult living conditions. Different professional groups (mis)use their privileged access in different ways, but doctors diversify most. The study identifies the reasons given for misusing access to drugs, shows how the problem is perceived by the health workers, and discusses the implications for finding solutions to the problem.Our findings reflect, from the health workers themselves, a conflict between their self image of what it means to be an honest civil servant who wants to do a decent job, and the brute facts of life that make them betray that image. The manifest unease that this provokes is an important observation as such.ConclusionOur findings suggest that, even in the difficult circumstances observed in many countries, behaviours that depart from traditional civil servant deontology have not been interiorised as a norm. This ambiguity indicates that interventions to mitigate the erosion of proper conduct would be welcome. The time to act is now, before small-scale individual coping grows into large-scale, well-organized crime.

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