WASH and Disability


Why is it important to consider people with disabilities in WASH policy making, design and delivery?

Globally 700 million people live without access to safe water and 2.5 billion people lack access to improved sanitation (JMP, 2014). Despite the immensity of this problem there is evidence to suggest that individuals living with a disability, aged over 60 or suffering from chronic illnesses are at a disproportionately greater risk of not having adequate access to water and sanitation facilities (Human rights of older persons, 2011 & World Report on Disability, 2011). An estimated 15% of the world’s population have a disability and that 80% of those reside in developing countries (World Report on Disability, 2011). Disability is often both a cause of and a consequence of poverty. Among the poorest of the poor in low-income countries as many as 1 in 5 individuals are likely to be disabled (Jones, H. & Reed, R.A., 2006). These same households are 5.5 times more likely to lack improved water access and 3.3 times more likely to lack adequate sanitation, compared with households in the highest wealth quintile in the same country (Moe, C.L., & Reingans, R.D., 2006).

Aside from access to water and sanitation being a basic right (UNCRPWD, 2006) and improved inclusion having significant direct benefits for people living with disabilities, equal access also has numerous benefits for the broader community. Reducing the effects of water-borne/water-washed diseases is likely to be impossible without considering the needs of people with disabilities (Groce et al, 2011). Furthermore it is essential for communities aiming to become open defecation free (ODF), and globally will play a significant role in allowing us to go the ‘last mile’ in achieving Millennium Development Goal 7.

Case studies in various settings have found that people with physical, cognitive or mental impairments tend to face multiple barriers in accessing water and sanitation facilities. These barriers include environmental or technical challenges with the physical setting of the WASH facilities. Institutional barriers tend to overlook the needs of disabled people or prevent their participation in WASH related activities, design and delivery. Lastly socio-cultural barriers such as stigma lead to greater isolation, and are likely to limit an individual’s capacity and desire to participate fully in community life or conceptualise themselves differently.

Our key contributions to this area:

Undoing inequity: inclusive sanitation and hygiene programmes that deliver for all

The aim of the study is to develop and test an approach that aims to improve access to WASH for all, and thereby provide equal access to people who are marginalised and vulnerable. In Uganda and Zambia, WaterAid and its project partners will implement its inclusive WASH approach in order to improve access for all. The proposed research will report the lessons learnt from the intervention, and will measure the change in access to WASH following the intervention.

WASH and Disability study in Malawi

This study is being funded by the Australian Government (DFAT) and is a collaboration between staff at LSHTM, WEDC, Mzuzu University and the Centre for Social Research and the University of Malawi. The study aims to establish the prevalence of WASH access problems among people with disabilities in Malawi through a large scale quantitative survey. Through qualitative and quantitative work the study will also explore what kind of barriers (e.g. environmental, institutional and attitudinal) prevent current WASH access understand what are the current coping strategies or adaptive technologies that are in place. The findings from the baseline quantitative survey and the qualitative research will contribute to the development of a specialised training for Community-Led Total Sanitation (CLTS) implementer. The effectiveness of this approach to inclusive CLTS programming with then be evaluated through randomized control trial in Northern Malawi.

Current outputs of this work include the development of the following research tools

Quantitative Survey:

Qualitative research:

coverAs a way of disseminating findings a series of photo exhibitions featuring work from this project will held in London, Stockholm and Malawi over the coming year. The photos in the exhibition will be ones that were taken by 5 disabled research participants. Each of these participants were asked to take photos of the most challenging aspects of their daily lives. They weren’t told in advance that it was a study on WASH but it was interesting how these issues emerged as a major priority for all individuals. Showcasing this work is designed to act as a tool for engaging policy makers and implementers in the WASH and disability sectors on this issue. Follow this link to download the Exhibition Brochure.


For more information about LSHTM’s work on disability visit the website of the Centre for Evidence in Disability.


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