WASH and health working together: Why cross-sectoral collaboration is needed to accelerate and sustain progress for NTDs | International Coalition for Trachoma Control

Across the world, it is estimated that 4.2 billion people currently live without access to safely managed sanitation, such as a toilet or latrine, while three billion people do not have access at home to a handwashing facility with soap and water.

As the COVID-19 pandemic has shown, access to water, sanitation and hygiene (WASH) is inextricably connected to human health. Throughout 2020, health ministries have sought to reduce the transmission of COVID-19 by scaling up programs to promote general hygiene, such as handwashing, and have worked collaboratively across sectors to integrate key COVID-19 messages into WASH and health programs, while reorientating other programs, including neglected tropical disease (NTD) programs, to tackle the urgent health crisis.

As countries resume NTD programs, following interim guidance published by the World Health Organization (WHO) in July 2020, it is critical that the partnerships between health ministries and WASH stakeholders continue to be expanded and strengthened. This was emphasized at the 73^rd World Health Assembly in November 2020, when Member States overwhelmingly endorsed a new WHO road map for neglected tropical diseases 2021-2030, which calls for increased coordination and multisectoral action within and beyond the health sector, to accelerate progress on NTDs.

‘Ending the neglect to attain the sustainable development goals: a road map for neglected tropical diseases 2021–2030’ calls for the intensification of cross-cutting approaches by integrating interventions for several NTDs and mainstreaming them into national health systems, coordinated with related programs, including WASH. The road map includes specific indicators for WASH, including 0% of the population practicing open defaecation and 100% of population using at least basic water supply by 2025, and 100% of population with hand-washing facilities, including soap and water by 2030.

The trachoma community has long acknowledged the importance of cross-sectoral collaboration to achieve and sustain progress towards the elimination of trachoma as a public health problem. Facial cleanliness and environmental improvements, including the building and maintenance of latrines and clean water sources, have been key pillars of the WHO-endorsed SAFE strategy (surgery, antibiotics, facial cleanliness, environment improvements) since 1993. Furthermore, resources such as the International Coalition for Trachoma Control’s “All you need for F&E” toolkit and the Neglected Tropical Disease NGO Network and WHO’s “WASH and health working together: A how to guide for NTD programmes” have facilitated the development and strengthening of new and existing partnerships to achieve shared targets across WASH and NTDs.

Increased coordination and provision of clean water and sanitation have been effective in reducing the transmission of trachoma, complementing other interventions such as mass drug administration to manage active infection and increased provision of surgery to prevent avoidable blindness. In 2019, WHO reported a 91% reduction in the number of people at risk of trachoma, reducing from 1.5 billion in 2002 to 136.9 million as of May 2020. Furthermore, in 2018, increased general hygiene and environmental health contributed to the elimination of trachoma as a public health problem in the Islamic Republic of Iran. According to the dossier submitted for validation of elimination of trachoma as a public health problem, 98% of households had access to an improved source of water sources in urban areas and 90% in rural areas, while access to improved sanitation was estimated to be close to 100%.

While considerable global progress has been achieved towards the elimination of trachoma as a public health problem, challenges remain to ensure no one is left behind. By focusing efforts on those communities who are hardest to reach, whether indigenous or nomadic populations, or due to insecurity and fragility within a country, we must continue to integrate key messages around facial cleanliness and latrine use into a wider comprehensive approach to hygiene. This includes building the evidence for the most effective and scalable approaches to behaviour change for trachoma and ensuring that communities don’t just have access to WASH infrastructure, but actively practice hygienic behaviour to prevent trachoma, and support better health and wellbeing.

The NTD platform provides an opportunity for greater knowledge exchange and collaboration between NTD and WASH sectors to define research questions and build the evidence for indicators that move beyond the presence of latrines and access to clean safe water, but also inform indicators for scalable approaches to behaviour change to support sustainable, long lasting impacts beyond NTD elimination programs.

The WHO road map for NTDs 2021-2030 shows that progress on NTDs has cross-cutting benefits, including a reduction in poverty, and improvements in gender equality, economic growth, education and clean water and sanitation. Similarly, progress towards Sustainable Development Goal 3: Good Health and Wellbeing benefits from increased action towards Sustainable Development Goal 6: Clean Water and Sanitation.

To achieve the Sustainable Development Goals and targets set in the WHO road map for NTDs, programs must continue to recognize the interconnectedness of WASH and health and strengthen cross-sectoral collaborations and health systems, in pursuit of universal health coverage and a fairer more equitable world for all.

As we mark World Toilet Day, we acknowledge that access to clean water and sanitation are inalienable human rights that are fundamental to the health and dignity of human life. These are the foundations of resilient and healthy populations the world over.

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