Water, Sanitation, Hygiene (WASH)

WASH is the collective term for water access, sanitation, and hygiene. Clean water is only a part of the overall strategy towards lasting health changes in rural communities and emergency settings. In order to achieve the greatest health benefits, and virtually eliminate waterborne diseases, improvements to sanitation and hygiene must also be made alongside access to clean water. These three disciplines are grouped together seeing as one cannot be fully recognized without the other.


The right to water entitles everyone to have access to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic use. Water safety and quality are fundamental to human development and well-being. 

  • A basic drinking water service means that water from an improved source is available at the school. Improved drinking water sources are those that, by nature of their design and construction, have the potential to deliver safe water
  • In 2016, 69% of schools had basic drinking water services. However, this means nearly 570 million children lacked a basic drinking water service at their school.
  • Nearly half of schools in sub-Saharan Africa and over a third of schools in Small Island Developing States had no drinking water services (in 2016).


The right to sanitation entitles everyone to have physical and affordable access to sanitation, in all spheres of life, that is safe, hygienic, secure, and socially and culturally acceptable and that provides privacy and ensures dignity. 

  • Improved sanitation facilities are those designed to hygienically separate excreta from human contact, and that are regularly cleaned
  • Facilities are considered usable if they are available to students at all times, they are functional, and they are private
  • In 2016, 66% of schools had basic sanitation services. However, this means that over 620 million children worldwide still lacked a basic sanitation service at their school.
  • Only 17% of refugees have access to safely managed sanitation where they live, which is well behind the global average of 45% for the global population.


Hygiene refers to the conditions and practices that help maintain health and prevent the spread of disease including handwashing, menstrual hygiene management and food hygiene

  • A basic hygiene service means schools have a handwashing facility with soap and water available. Additional criteria for advanced service levels include group handwashing at critical times, as well as the provision of guidance and materials for MHM.
  • Hygiene promotion that supports behaviors, community engagement, and actions to reduce the risk of disease is fundamental to a successful WASH response.
  • More than a third of schools worldwide and half of schools in the least developed countries had no hygiene services, affecting more than 900 million children.
  • More than one in three primary schools and a quarter of secondary schools had no hygiene services as of 2016.

Access to a safe water supply and safe excreta management are among the most critical needs in emergency settings. Without them, there is an  increased risk of water-borne illnesses and WASH related outbreaks. People affected by crisis are more susceptible to illness and death from disease, particularly diarrhoea and infectious disease, and the risk is even higher for vulnerable populations such as children, pregnant women and the elderly. Children under the age of five living in countries affected by protracted conflict are, on average, nearly 20 times more likely to die from diarrhoeal disease caused by a lack of safe water, sanitation and hygiene than by direct violence. During humanitarian crises, diarrhoeal diseases account for 40% of deaths in the acute emergency phase and 80% of deaths in children under the age of two.

Excreta Management

An environment free of human excreta is essential for people’s dignity, safety, health and well-being. All people should have access to appropriate, safe, clean, private and reliable toilets. It is important to note that appropriateness is determined by cultural practices, people’s daily customs and habits and perceptions. Wherever toilets or sanitation systems are inadequate, untreated human waste pollutes the environment and spreads disease. This is especially pressing for those who are forced to flee their homes, and lack these services while in transit or in temporary refugee camps

WASH in Schools

Every child has the right to go to school in a clean and safe environment. When clean drinking water, toilets, and handwashing facilities are not available at school, children have to spend time out of class collecting water instead of in a classroom, which has serious effects on a student’s academic performance and school attendance. In 2016, one third of all primary schools lacked basic drinking WASH services, affecting the education of millions of schoolchildren, but particularly girls managing menstruation.

Menstrual Hygiene Management (MHM)

At least 500 million women and girls globally lack adequate facilities for menstrual hygiene management. Inadequate WASH facilities, particularly in public places such as in schools, can pose a major obstacle to women and girls. The challenge menstruating girls and women face is often less tangible than simple the availability of infrastructure and is rooted in social norms and beliefs. In addition, the taboos and stigmas attributed with menstruation in certain cultures results in an overall culture of silence around the topic, resulting in limited information about menstruation and menstrual hygiene. Only 6% of schools provide education on menstrual hygiene management.

An absence of single-sex bathroom facilities is also be a source of vulnerability for female students and teachers due to these risks, and provides a unique burden for those who need to manage their menstrual hygiene. When there is no toilet available, there is no place to manage menstruation privately and hygienically, and leads to higher absentee rates for adolescent girls, or in many cases results in them dropping out of school

The goal of menstrual hygiene management is to ensure that women and girls can manage their periods in a way that is not only healthy, but that enables their full participation in school, work and other activities.


This collection was developed with the support of Aysha Joan Liagamula Kayegeri, Common Wealth Expert.

1 March 2019 Manual/Handbook/Guide United Nations Children's Fund (UNICEF)

Guidance on Menstrual Health and Hygiene

This guidance was developed for UNICEF WASH, Education, Health, and Gender specialists or focal points in country offices who are working with their partners to develop programmes related to menstrual health and hygiene (MHH).

23 February 2018 Manual/Handbook/Guide Save the Children

Menstrual Hygiene Management: Operational Guidelines

Save the Children's Operation Guidelines aim to create specific steps that allow implementing agents to design, implement and monitor MHM programs that respect the sensitivities that surround MHM, as well as reduce the social stigma of menstruation and puberty.

23 April 2019 Report International Rescue Committee (IRC)

Integrating, collaborating and building capacity for menstrual hygiene management

In April 2019, IRC Uganda and the WSSCC organised a learning visit to get updated on Kenyan government policies supporting MHM as well as insights from good practices used by the NGO KWAHO in Kwale County. Besides clear MHM policies, collaboration, integration with other sectors, capacity building and the use of champions are some of the key lessons for Uganda.