Water, Sanitation and Hygiene (WASH) are especially important in the elimination of Neglected Tropical Diseases (NTDs) like Trachoma which causes blindness. In this interview, Girija Sankar, CBM’s Head of NTD Programmes discusses the importance of water in beating NTDs.
What is WASH and why is it important?
WASH stands for water, sanitation, and hygiene. WASH is important because water is essential for our health and wellbeing.
We take water, sanitation, and hygiene for granted in the Global North because we have access to clean and safe water wherever we go, in our homes and in public places. We have access to toilets, to clean water to keep ourselves clean.
But it is not always the case elsewhere. 785 million people lack access to basic water facility in the Global South in developing country contexts.
What does it mean to a person with a disability to lack access to water and clean sanitation facilities?
Whatever challenges we have with access to water, sanitation, and hygiene facilities, they are that much more compounded and complicated for people with disabilities.
When service providers construct toilets or other provide hardware solutions for sanitation, they often do not think about the people with disabilities who might not be able to access them. As a reference organisation in disability inclusive development, we must ensure that whatever work we do in NTDs is inclusive of persons with disabilities. It is a fact that a lot of NTDs cause disabilities like blindness or the swelling of the limbs for those with lymphatic filariasis. Already people with NTDs are living with disabilities; if we add other disabilities to these NTD-related disabilities, it just makes it that much harder for community members to be able to use already scarce WASH facilities and resources. It is incumbent on us to be mindful of persons living with disabilities when we provide WASH solutions.
Why is water so important to beating Neglected Tropical Diseases (NTDs)?
Having access to clean water and sanitation and promoting hygiene can take care of so many infectious diseases and recurring health conditions. NTDs such as trachoma require access to clean water and sanitation to prevent transmission. You need clean water to take care of the wounds for people with lymphatic filariasis. Access to sanitation facilities helps with preventing the transmission of diseases like soil transmitted worm infections and other parasitic infections. Safe and filtered water sources are essential for stopping the transmission of Guinea worm disease. So, for all these reasons, WASH is extremely critical to the health and wellbeing of people who live in resource challenged contexts.
How can we help people to improve WASH in the management of NTDs?
WASH is critical to limit or break the transmission of 16 out of 20 NTDs. This is something that is not appreciated enough. Over 1 billion people are at risk of NTDs, and we also know that 2.2 billion people worldwide lack access to clean drinking water and over 2 billion people do not have access to basic toilet facilities. 3 billion people lack hand washing facilities at home. So, when you juxtapose some of these numbers you realize that people who live at risk of NTDs do not have access to water, sanitation and hand washing facilities. If we address one challenge – access to WASH – we also end up addressing the other – transmission of NTDs.
In communities where WASH facilities are provided but no change in use is recorded, what approach would best help these communities to adopt the facilities?
It requires consistent and constant work with communities because change does not come by easily. It is one thing to construct a toilet facility, but it is another thing entirely to make sure that it is well maintained. Once constructed, we need to identify community members for the maintenance and upkeep of the facilities. Often when that does not happen, they just fall into disrepair.
Sometimes facilities are constructed without the necessary access to water. Even if you have a tippy tap outside the facility, it might not work if there is no water in it for handwashing after using the toilet.
It takes consistent behaviour change communication, working with the community and with community leaders. Investment in WASH infrastructure does not just stop with the capital investment of construction but continues with supporting the operational, upkeep and maintenance costs of the facilities. Understanding why community members do not want to use, rather than assuming that they are just not using it because it is something new, is also important. If change comes by slowly, that is OK.
What is CBM (Christian Blind Mission) doing to improve access to WASH for NTD endemic communities?
During the time of Mass Drug Administration (MDA) for any NTDs, we provide information messages through radio to the community members on the importance of participating in the health campaign but also on the importance of WASH.
We also invest in WASH hardware (facilities) and software (information, education and practises) in countries like Ethiopia where we have worked for many years now with local partners and the Ministry of Health to construct sanitation facilities. This is in relation to the elimination of trachoma, which is one of the NTDs. The transmission of trachoma can be prevented with access to clean sanitation facilities. We have also invested in similar efforts in Pakistan.
“I encourage people to take a moment when they are sipping water from their refrigerator or from the tap at home today and think about how easy it is for them to have water. We do not think about whether the water is clean. We just know that it is clean. Take a moment and reflect on how challenging it is for other people on the planet to take a sip of water at home. Let us educate ourselves on the differential and inequitable access to services that we take for granted in countries like Germany, the USA, or the UK. Appreciate the privileges that we enjoy and raise awareness on the need for others.”
Girija Sankar, CBM’s Head of NTD Programmes
What is the cost benefit analysis for improving access to WASH in NTD endemic communities?
Every U.S. dollar in WASH investments is expected to return over 5 U.S. dollars in health benefits due to decrease in health care costs for individuals, societies, and attendant productivity.
So, it goes without saying that any investments in WASH will potentially also affect the prevalence of NTDs.
What are the most recent milestones or breakthroughs that CBM has achieved in the treatment and management of NTDs?
We are remarkably close to confirming the elimination of trachoma as a public health problem in Burundi.
We have significantly scaled up support for trachoma in the Democratic Republic of Congo (DRC). In Nigeria, we are making a big push to scale up efforts to eliminate onchocerciasis as a public health problem. We successfully completed treatments for trachoma in 25 intervention units and for lymphatic filariasis in two units.
In South Sudan, we have successfully conducted the very first round of Mass Drug Administration and Trichiasis surgery services in Unity State in South Sudan. This is the first time that it has happened in over 10 years, so that is a significant achievement. Also in South Sudan, we have scaled up the geographical coverage of treatments against onchocerciasis. We are looking to increase our support for trachoma elimination in Egypt.
What is your role in ensuring all this is achieved?
As the head of NTDs. I have the responsibility for the success of our work to eliminate NTDs. In my role, I make sure that our team has the resources and support they need to, in turn, support the countries where we work to advance disease elimination. It is my responsibility identify at gaps in knowledge, resources, technical expertise and ensure that we can fill them within CBM so that we can put our best foot forward to work with and support Ministries of Health to eliminate diseases and reduce preventable disabilities.
Where have you recorded the best success and what do you specifically recall about that community/project?
I visited with our colleagues and partners in the DRC in October 2021 and was really impressed with the implementing partners on the ground including the Ministry of Health, and the surgeons who are leading the campaign to train and provide surgeries against advanced stage trachoma. I was inspired by the dedication of our country office colleagues, the TT (Trachomatous Trichiasis) case finders and the case finder supervisors that I met in Sud-Ubangi province.
Every day I am motivated and encouraged by the team that I work with both within the Inclusive Eye Health initiative and with the Country Office teams. The work that I do really is to make sure that this smart, energetic, dedicated group of people have all the resources that they need to prevent diseases and improve the wellbeing of communities at risk of NTDs.