Water, women and disability: Using mixed-methods to support inclusive WASH programme design in Vanuatu

Abstract

Background: Adequate access to water, sanitation and hygiene (WASH) is imperative for health and wellbeing, yet people with disabilities, people with incontinence and people who menstruate often experience unmet WASH requirements.Methods: In 2019 we completed a mixed-methods study in two provinces of Vanuatu, (SANMA and TORBA). The study comprised 1) a population-based disability survey using the Washington Group Short-Set 2) a nested case-control study to explore associations between WASH, disability and gender, and 3) an in-depth qualitative assessment of the experiences of WASH users with additional requirements: people with and without disabilities who menstruate, or experience incontinence.Finding: 11,446 households (response rate 85%) were enrolled into the survey. All-age disability prevalence across the two provinces was 2.6% (95% Confidence Interval 2.5-2.8), increasing with age. 814 people with, and 702 people without disabilities participated in the case-control study. People with disabilities were statistically more likely to experience barriers in seven of eight intra-household indicators. WASH-related stigma, reliance on informal caregivers, and under-resourcing of WASH personnel were critical issues for people who menstruate or experience incontinence.Interpretation: People with disabilities, people with incontinence and people who menstruate in Northern Vanuatu face continued challenges in accessing safe, affordable and appropriate WASH that meets their requirements. Outputs from this study have supported progression towards gender and disabilityinclusive WASH programming in the area and highlighted the value of mixed-methods research.Funding: The research was funded by the Australian Government's Water for Women fund and donations from the Australian public.

Interrogating and Reflecting on Disability Prevalence Data Collected Using the Washington Group Tools: Results from Population-Based Surveys in Cameroon, Guatemala, India, Maldives, Nepal, Turkey and Vanuatu

“…Low disability prevalence estimates have been observed in several other Pacific Island countries with similar demographic profiles [29,30]. In contrast, the prevalence was highest among Syrian refugees in Turkey, driven largely by the high prevalence of anxiety and depression as may be expected in a conflict-affected, displaced population [23,31]. Mitra and Yap (2021) reported similar variability in outputs [21].…”

“…Estimates using the wider threshold for each module were substantially higher across all surveys compared to the standard threshold (maximum 71.0%, 67.7-74.2 for the ESF in Cameroon). We have previously reported positive correlation between reporting "some" difficulty and having mild or worse clinical impairments benefiting from intervention in respective domains, and mixed findings on the relationship between reporting "some" difficulty and reporting participation restrictions [20,23]. Considering the high proportion of each sample reporting "some" or greater difficulty across domains who may potentially benefit from support or accommodation, presentation of this threshold (potentially described as the population at risk of disability) alongside the standard estimate may be valuable.…”

“…The datasets include data from five of the six WHO regions and include two nationally representative samples. In Vanuatu, a population census was completed of all eligible participants across the two included provinces [23]. In Turkey, the sample was selected from one population sub-group only (Syrian refugees) using the municipality refugee database as the sampling frame [24].…”

“…In Turkey, the sample was selected from one population sub-group only (Syrian refugees) using the municipality refugee database as the sampling frame [24]. All remaining surveys used two-stage cluster-based sampling from the most recent census, with clusters first selected with probability proportionate to size, and modified compact segment sampling within these to reach the desired cluster size [20,23,25,26].…”

“I'm scared to talk about it”: exploring experiences of incontinence for people with and without disabilities in Vanuatu, using mixed methods

“…Furthermore, this group is generally over-represented in the poorest wealth quintile and often have less adequate access to WASH services than people without disabilities [20] . We previously reported the additional barriers people with disabilities often face in accessing WASH [21] . People with disabilities may also require assistive devices (e.g.…”