Running Head: SAFE WATER AND SANITATION AND HYGIENE 1

Safe Water and Sanitation and Hygiene:

A Global View

Susan L. Hensler

Delaware Technical and Community College

NUR 310 Global Health

April 30, 2017

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Abstract

Millions of people in developing countries do not have easy access to safe drinking water and

often, basic hygiene and sanitation infrastructure is nonexistent. Higher morbidity and mortality

rates from diarrheal diseases caused by fecal contamination of drinking water are frequently seen

in areas without awareness of or access to simple hygiene measures or sanitation systems. The

increased burden of disease results in a decline in personal and global productivity and a

diminished quality of life. International organizations are striving to meet both short and long

term global goals toward improving the health of all populations with community education

programs that focus on hygiene and through the development of sanitary infrastructure and

accessible potable water. Lack of water and sanitation often extends to healthcare facilities and

improvements are required to gain public trust in a fledgling healthcare system. Nurses play a

fundamental part with clinical interventions like immunization and education. Climate change

and a growing global population is causing a shift in the worlds water supply and low

maintenance, cost-effective technologies are required for safe water, sanitation and hygiene to be

made readily available to all. Global health care is a growing field with many options available

for both career and volunteer opportunities.

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Safe Water and Sanitation and Hygiene:

A Global View

Living in a country where safe water and sanitation services are taken for granted, it is

difficult to grasp the notion of a life without running water, sewage, or sanitary systems. The

socioeconomic impacts of the lack of safe water, sanitation, and hygiene (WaSH) affect millions

of people globally both financially and through increased morbidity and mortality. International

organizations such as the World Health Organization (WHO), UNICEF, and the International

Medical Corps provide both immediate and long-term interventions like educating communities

on the benefits of handwashing and administering vaccines for disease prevention. Equally

important are the long-term infrastructure improvements like constructing sources to obtain safe

drinking water and building latrines. The implementation of low maintenance, cost-effective

technologies is an important element in improving the health and wellbeing of the global

population.

Socioeconomic Factors

Basic hygiene and sanitary environments brought about by proper disposal of human

waste and garbage collection are not available to over 35% of the worlds population, or roughly

2.5 billion people globally. Safe water is not available to over 780 million people worldwide

(Centers for Disease Control and Prevention, 2015). Although the United Nations Millennium

Development Goal (MDG 7) was met by halving the proportion of the worlds population
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without access to safe water, the 48 least-developed countries continue to fall short of the target

and still do not have access to safe drinking water or sanitation (World Health Organization,

2016).

The lack of Water, Sanitation, and Hygiene (WaSH) affects women more than men. Girls

are primarily responsible globally for water collection, and consequently miss more school than

boys. Additionally, schools lack appropriate sanitation facilities for menstruating girls and even

more days are missed (World Health Organization, 2016). This lack of education results in a

decrease in marketable skills and loss of financial productivity for women.

The socioeconomic interventions of investing in WaSH are an estimated gain of 1.5% of

the global GDP due to decreased health care costs and improved personal productivity (World

Health Organization, 2015).

Public Health Interventions

Clean water and sanitation are a crucial component in improving the context of public

health. Poor sanitation and contaminated water are linked to the transmission of diseases such as

cholera, diarrheal diseases, dysentery, hepatitis A, polio, and typhoid (World Health

Organization, 2016) and evidence shows that simple handwashing can reduce the diarrheal rate

by half and the respiratory disease rate by about 25% (International Medica Corps, n.d.).

Consequently, changing the mindset of communities by generating awareness of the benefits of

handwashing with soap and water after defecation and before meals is a simple, cost-effective

investment in population health.

Long-lasting Protective Interventions

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The World Health Organization reports over 1.4 million children die each year from

diarrheal diseases related to unsafe drinking water polluted by fecal matter or other

contaminants. Long-term solutions include the availability of safe water and the provision of

properly designed latrines, which has been proven to effectively reduce diarrheal diseases

resulting from fecal cross-contamination (World Health Organization, 2008).

The WHO/UNICEF Joint Monitoring Programme for Water-supply and Sanitation (JMP)

which monitors the progress of the MDGs has outlined areas for the improvement of water

supplies in developing countries. The three categories identified by the JMP are water piped into

individual dwellings or yards, improved sources like public taps or standpipes, and water

collected from unimproved sources that are not protected from contamination (Hunter,

MacDonald, & Carter, 2010). To determine whether a potential water supply has long-term

feasibility, six factors must be considered: the quality and quantity of the water, easy access to

and reliability of the source, the cost to the user, and the management of the supply to the

community (Hunter, MacDonald, & Carter, 2010).

Sanitation infrastructure that is practical, efficient, and cost effective presents a challenge.

Sewage and wastewater treatment facilities generally require large amounts of land, water, and

energy to be effective and are not a realistic option in developing countries. Sewage treatment

alternative currently in use in developing countries do not kill fecal pathogens, attract insects and

are malodorous. Research continues for new technology for toilets that require no sewer
SAFE WATER AND SANITATION AND HYGIENE 6

hookups, electricity, or water and harness the byproducts from fecal sludge to be used as fuel or

fertilizer (Bill and Melinda Gates Foundation, 2017).

Although evidence demonstrates that safe water and proper sanitation are the best long-

term solutions for cholera control, the distribution of an oral vaccine has shown to be a cost-

effective immediate option during times of endemics or outbreaks (Hsiao, 2016). Global climate

changes have generated concerns about potential increases in the incidence and redistribution of

cholera. New vaccines are being developed and stockpiled with an eye toward meeting the

anticipated demands (Velleman & Wilson-Jones, 2016).

Clinical Interventions

Many health care facilities in emerging countries are not equipped with safe water,

hygiene, and proper sanitation facilities. As a result, healthcare associated infection rates are high

and community members often avoid medical care rather than risk further illness. Facilities

without the ability to provide healthcare workers with proper hygiene are hard to staff and are

found to have a diminished morale among the heathcare providers (World Health Organization,

n.d.). Furthermore, setting a good example is important: WHO data indicates that patients who

observe proper hygiene being performed by healthcare providers in clinics, demonstrated better

hand hygiene while in their own setting (World Health Organization, n.d.). International funding

dedicated to improving water and sanitation services offer hope of improved clinical conditions.

Clinical interventions like administration of oral vaccines such as those for cholera and

polio are easy and effective for healthcare providers to administer in times of emergent outbreaks
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to prevent the rapid spread of diseases (Velleman & Wilson-Jones, 2016) and do not necessarily

require water and sanitation to be safely given.

Counseling and Educational Interventions

Lack of resources is not the only obstacle to WaSH. For those living in developing

countries, lack of basic hygiene knowledge is a major element of the burden of disease. Often,

individuals in developing countries do not understand the correlation between hygiene and

disease, and education of both personal hygiene and public sanitation methods can play a large

role in improving their lives. Education provided by international organizations is often geared

toward training individual community members who in turn volunteer to share the message of

hygiene with their community at large (Harris, 2015).

Nurses can be instrumental in demonstrating and reinforcing personal and communal

hygiene and sanitation methods. For education to be effective and of lasting value, nurses must

be sensitive to the diversity and the cultural customs and values of the community in which they

are teaching (Breakey, Corless, Meedzan, & Nicholas, 2015).

Recommendations for Future Interventions

The World Health Organization estimates that due to climate change, population growth,

and urbanization, by 2025, half the worlds population will be living in areas affected by water

shortages (World Health Organization, 2016). With the long dry seasons that much of Africa and

Asia experience, safe, non-contaminated surface water is often nonexistent and drilling for

groundwater is often the only viable option. These underground reservoirs however, are not the
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perfect solution since they require rainfall to be replenished. Viable sources for safe drinking are

not always easy to locate and with large populations being served by a single standpipe, wells

often run dry (Hunter, MacDonald, & Carter, 2010).

Although the 2015 MDG 7 target on water supply was met, progress toward global

sanitation improvements has fallen short. Sanitation is often placed below healthcare, education,

and safe water as a priority, receiving less attention and funding. Estimates for successfully

tackling the logistics and improvements to sanitation infrastructure for developing countries

range from $6.7 billion to $75 billion per year, a significant increase from the $5.3 billion global

disbursement from multilateral agencies (Bartram, Cumming, & Brocklehurst, 2010).

Global Career Pathways

More opportunities than ever before exist for an individual interested in a global health

career. The job outlook in global health is excellent with a wide scope of career paths from which

healthcare workers can choose. Finding a global health career can be very competitive.

Individuals with oversees experience and a graduate degree in international or global health may

have greater success finding their dream job. Many colleges and universities offer public health

careers tracks such as health care finance, infectious disease and epidemiology, and public

nutrition (Liaison International, 2017). Because of the morbidity and mortality associated with

childbirth, diarrheal disease, and infectious disease in low and middle income countries, maternal

and child health is considered a high priority field of service (Liaison International, 2017).

Careers in global health can be found and applied for on websites such as UNICEF,

USAID, and The World Health Organization. Salaries range from $30,000 to $90,000 for

individuals with roughly six to nine years of higher education. Volunteer opportunities for
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healthcare workers also exist with organizations such as the Peace Corps, and the International

Red Cross, and the World Health Organization.

References

Bartram, J., Cumming, O., & Brocklehurst, C. (2010, November 16). Hygiene, Sanitation, and

Water: What Needs to Be Done? Retrieved from PLOS Medicine:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000365

Bill and Melinda Gates Foundation. (2017). What We Do WATER, SANITATION & HYGIENE

STRATEGY OVERVIEW. (B. a. Foundation, Producer) Retrieved from

http://www.gatesfoundation.org/What-We-Do/Global-Development/Water-Sanitation-

and-Hygiene

Breakey, S., Corless, I., Meedzan, N., & Nicholas, P. (2015). Global Health Nursing in the 21st

Century. New York: Springer Publishing Company. Retrieved from

https://books.google.com/books?

id=DRu9BwAAQBAJ&pg=PA238&lpg=PA238&dq=role+of+the+nurse+in+global+heal

th+

+and+WaSH&source=bl&ots=b4AtA_zT4j&sig=yRR5SVEPEMcaezlez7gjxq39YFU&h
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l=en&sa=X&ved=0ahUKEwjrruCn7cnTAhXBSCYKHc8vCR4Q6AEINjAC#v=onepage

&q=role%20of%20the%20nurse%20in%20global%20health%20%20and

%20WaSH&f=false

Centers for Disease Control and Prevention. (2015, December 17). Global Water, Sanitation, &

Hygiene (WASH). Retrieved from Centers for Disease Control and Prevention:

https://www.cdc.gov/healthywater/global/sanitation/index.html

Harris, J. (2015, November 11). THE POWER OF CLEAN WATER Protecting a Community

from Disease in Zimbabwe. Retrieved from International Medical Corps:

https://internationalmedicalcorps.org/story-zimbabwe-the-power-of-clean-water-

protecting-a-community-from-disease-in-zimbabwe

Hsiao, A. (2016, Septermber 2). Lessons learnt from 12 oral cholera vaccine campaigns in

resource-poor settings. Retrieved from World Health Organization:

http://www.who.int/bulletin/volumes/95/4/16-175166/en/

Hunter, P., MacDonald, A., & Carter, R. (2010, November 9). Water Supply and Health.

Retrieved from PLOS Medicine: http://journals.plos.org/plosmedicine/article?

id=10.1371/journal.pmed.1000361
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Institute for Health Metrics and Evaluation. (2017). Afghanistan. Retrieved from IHME:

http://www.healthdata.org/afghanistan

International Medica Corps. (n.d.). Water, Sanitation and Hygiene. Retrieved from International

Medica Corps: https://internationalmedicalcorps.org/programs/water-sanitation-and-

hygiene

Liaison International. (2017). Global Health. Retrieved from ExploreHealthCareers.org:

https://explorehealthcareers.org/career/public-health/global-health/

University of Washington. (2017). Global Burden of Disease 2015 Factsheet. Retrieved from

Institiute for Health Metrics and Evaluation: http://www.healthdata.org/briefs/global-

burden-disease-2015-factsheet

Velleman, Y., & Wilson-Jones, M. (2016). Vaccines plus water, sanitation, and hygiene

interventions in the fight against cholera. Retrieved from The Lancet:

http://thelancet.com/journals/langlo/article/PIIS2214-109X(17)30081-5/fulltext

World Health Organization. (2008, June 25). How does safe water impact global health?

Retrieved from World Health Organization: http://www.who.int/features/qa/70/en/

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World Health Organization. (2015, August 27). Water sanitation hygiene. Retrieved from World

Health Organization: http://www.who.int/water_sanitation_health/events/wash-and-ntd-

strategy/en/

World Health Organization. (2016, November). Drinking-water Fact Sheet. Retrieved from

World Health Organization: http://www.who.int/mediacentre/factsheets/fs391/en/

World Health Organization. (n.d.). WHO/UNICEF Report: Water, Sanitation and Hygiene in

Health Care Facilities: status in low-and middle-income countries and way forward.

Retrieved from World Health Organization:

http://www.who.int/water_sanitation_health/publications/wash-hcf-10things.pdf?ua=1