Are current approaches for measuring access to clean water and sanitation inclusive of people with disabilities? Comparison of individual- and household-level access between people with and without disabilities in the Tanahun district of Nepal

Abstract

BackgroundThe critical importance of safe and affordable access to water, sanitation and hygiene (WASH) is highlighted in Goal 6 of the Sustainable Development Goals, which seeks to achieve universal and equitable access for all by 2030. However, people with disabilities–who comprise 15% of the global population–frequently face difficulties meeting their WASH needs. Unmet WASH needs amongst people with disabilities may not be captured through current approaches to tracking progress towards Goal 6, which focus on household- rather than individual-level access.ObjectiveTo evaluate access to safe water, sanitation and hygiene (WASH), at the individual- and household-level, amongst people with disabilities in the Tanahun district of Nepal.MethodsA population-based survey of disability was conducted from August-October 2016 to evaluate access to improved water and sanitation facilities between households with members with disabilities (n = 198) and those without (n = 1,265) in the Tanahun district of Nepal. A nested case-control then compared individual-level access between cases aged 15 and above with disabilities (n = 192) and age-sex-location matched controls without disabilities (n = 189), using the newly developed 21-item “Quality of WASH Access” questionnaire. Multivariate regression was used to compare household- and individual-level indicators between people and households with and without disabilities. In-depth interviews with 18 people with disabilities and their caregivers was conducted to assess the acceptability and appropriateness of the “Quality of WASH Access” questionnaire.FindingsThere were no significant differences between households with and without members with disabilities in access to an improved sanitation facility or water source. However, at the individual-level, people with disabilities experienced significantly greater difficulties accessing water, sanitation and hygiene compared to people without disabilities (p<0.001 for all three scores). Amongst people with disabilities, water difficulty scores were associated with having a physical impairment and greater disability severity; sanitation difficulty scores were associated with lower socioeconomic status and physical or self-care limitations; and hygiene difficulty scores were positively associated with self-care limitations and lower socioeconomic status, and inversely associated with hearing impairments. Qualitative research found the “Quality of WASH Access” questionnaire was well understood by participants and captured many of the challenges they faced. Additional challenges not covered by the tool included: (1) time spent on WASH, (2) consistency of access, (3) sufficiency of access, and (4) dignity of access.ConclusionPeople with disabilities face substantial challenges to meeting their WASH needs, particularly in using services autonomously, consistently, hygienically, with dignity and privacy, and without pain or fear of abuse. These challenges are not captured through household-level data, and so individual-level WASH access are n...

Gender Equality and Social Inclusion in Relation to Water, Sanitation and Hygiene in the Oromia Region of Ethiopia

“…There were either no water points that can be easily accessed by SEG due to design flaws, or the water sources were too far for them to travel to. As a result, they regularly resort to collecting water from closer, unsafe water sources [ 32 , 35 , 36 , 50 ]. Similarly, adequate latrine access was limited for many SEG.…”

“…These progressive policies are welcomed and necessary but must also be followed with strong and coordinated implementation. Comparably, Ethiopia has committed to an inclusive society in alignment with the SDG’s mandate to “leave no one behind [ 32 , 33 , 34 ]” by establishing disability as a cross-cutting sector of development and uplifting the needs of PLWD through both Ethiopia’s GTP and the National Plan of Action of Persons with Disabilities (2012–2021). Nonetheless, SEG continue to experience marginalization and face limited access to WASH services and infrastructure [ 35 ].…”

La acción humanitaria y las personas con discapacidad

“…Como hemos señalado, las personas con discapacidad a menudo tienen especiales dificultades para acceder a servicios básicos como la atención médica (Hashemi et al, 2020) o la educación (UNESCO, 2020), o para disfrutar de manera efectiva de los derechos humanos al agua y el saneamiento (Banks et al, 2019;Groce, 2011b). Estas dificultades preexistentes se ven exacerbadas en situaciones de conflicto armado, tanto por la disrupción general de los servicios sanitarios y de atención social habituales como por las barreras añadidas, tanto físicas como de acceso a la información o a los servicios aun disponibles, muchas veces incrementadas por la necesidad de huir de sus hogares en busca de seguridad.…”

No One Left Behind? Comparing Poverty and Deprivation between People with and without Disabilities in the Maldives

“…However, children with disabilities face an increased risk of poor quality schooling, as education systems often do not have resources in place to support their learning (e.g., instruction in Braille, sign language) [44,45]. Similarly, indicators on household access to improved WASH can mask difficulties people with disabilities face in using these services independently, hygienically, consistently and with dignity [46][47][48]. Disability-specific indicators, such as stigma and access to assistive technology and rehabilitation are also be needed to track important deprivations for people with disabilities.…”