Water & Sanitation response to Covid-19

Washing hands with soap and water is the single most efficient measure against COVID-19, but 40 per cent of the global population does not have access to clean water and soap in their homes.

How are countries responding to the COVID-19 crisis and what should they be doing? SIWI, in collaboration with UNICEF, is monitoring the situation closely and offers both short- and long-term advice for governments, regulators and utilities.

 

Photo: Bruno Pascual

The Covid-19 crisis clearly demonstrates the dangers of unequal access to sanitation services. Here are five ways governments can improve the situation.

The pandemic is making it evident that investments in the provision of basic water, sanitation and hygiene services must be a key priority in the coming years, not least since the progress that has been made so far is now threatened by climate change and rising poverty levels.

There are however also things that should be done immediately to limit the impact of the coronavirus outbreak. In collaboration with UNICEF, SIWI is monitoring the response thus far from governments, international organizations, NGOs and others. We urge decision-makers to make sure that the five areas we highlight receive special attention.

By following these steps, governments, regulators, health authorities and water and sanitation utilities can limit the effects of Covid-19, in everybody’s interest. It is especially important to focus on measures that improve the lives of people living in poverty – this lays the foundation for the long-term resilience of a society.

In addition to these immediate measures, governments also need to increase focus on long-term water management to meet the fierce competition over water caused by economic growth, swelling populations, and climate change. Good water governance is increasingly seen as crucial to development but what does the term really mean? SIWI recently presented a definition in the article ‘Unpacking Water Governance: A Framework for Practitioners’, in the academic journal Water.

Learn more about our work with water governance here.

Photo: Antoine Delepiere

FIVE AREAS TO FOCUS ON

Raise public awareness about hand hygiene. Clean water and soap are essential to preventing infections, and the benefits of proper handwashing should be emphasized in communication campaigns. Both households and institutions must be targeted with messages that are developed in line with new insights from behavioural change research. It is also important to combat misinformation and fake news.

Strengthen infection prevention and control. Infection prevention and control (IPC) measures can limit human-to-human transmission and protect individuals from exposure to Covid-19. For households, it is important to have access to handwashing infrastructure as well as basic hand hygiene products such as soap and alcohol-based hand rubs. Another top priority is to ensure that health clinics, schools, detention centres and other institutions have uninterrupted access to safe and sufficient water as well as basic sanitation.

Guarantee that everyone has access to a minimum level of water and sanitation. During the pandemic people should not be cut off from these services regardless of whether they are temporarily unable to pay their bills. Prioritize access for people who are  living in vulnerable conditions such as shelters, refugee camps or detention centres.

Ensure the continuity and safety of water and sanitation services. Make sure that there are handwashing facilities in, for example, health centres, schools and public spaces. Public toilets must remain open, with proper hand washing facilities (including soap and disinfectants) so that people are not forced to defecate in the open.

Provide practical and financial support to water and sanitation service providers. Given the importance of water and sanitation services, and the extra pressure on utilities caused by the current crisis, the sector may need extra support. Sanitation workers must be protected from the additional risks associated with the pandemic.

In collaboration with UNICEF, SIWI is monitoring the international response to the Covid-19 pandemic and its impact on water, sanitation, and hygiene (WASH). There are both encouraging trends and more worrying developments.

At this critical time, good water and sanitation policies must target both consumers and service providers. Decision-makers should encourage safe hygiene behaviour and ensure that everyone has access to a minimum daily volume of drinking water and basic sanitation. This may also require providing support to water and sanitation utilities so that WASH services are available and affordable.

SIWI has identified five areas that governments need to prioritize to achieve this and now tries to monitor to which extent these recommendations are followed. There are interesting examples that other countries can learn from. Some initial findings are published in Water, Sanitation and Hygiene (WASH) COVID-19 response from governments, regulators and utilities, which is produced together with UNICEF.

Photo: UNICEF

Raising public awareness

Around the globe, there has been a strong rise in messages and campaigns about safe hygiene practices, particularly handwashing. It is important to share information but also to use reminders and nudges to make the new habits stick. Unfortunately, the pandemic has also triggered a wave of false and sometimes dangerous rumours, which must be addressed.

Strengthen infection prevention and control (IPC)

IPC measures directed at households and institutions are instrumental to stopping the spread of the virus. All households should have a handwashing facility and easy, affordable access to basic hygiene products so that they can keep the home clean and disinfected. It is important to raise awareness of why people with symptoms should isolate themselves and why family members should avoid sharing towels, cups, and cutlery. In institutions, it is vital to secure uninterrupted access to water and sanitation services, with equipment for protection and prevention.

Access to water and sanitation

Many countries try to protect low-income households, for example by ensuring that customers are not cut off from water services for failure to pay their bills. There are encouraging attempts to ensure that even unconnected households get access to clean water. Still, the most vulnerable groups are often forgotten, including people living in institutions, people with disabilities, migrant workers, refugees, and the homeless. Rural areas must not be left behind. Everyone should be guaranteed a minimum amount of drinking water.

Expand water and sanitation services

There are many ways to improve access to safe water and sanitation. Some countries are distributing hygiene and water purification kits to households and institutions or finding other ways to facilitate access to soap and disinfectants.  Additional water points are also created for vulnerable populations, through water tanks and water trucks. Other countries prioritize the expansion of handwashing facilities in health clinics, schools and public places.

Support to service suppliers

Governments are encouraged to ensure that water and sanitation utilities  can continue to function, despite the growing demands and the increased financial pressure caused by the current crisis. Water and sanitation utilities are often struggling to protect their workers when maintaining or expanding their services. Water utilities, small service providers and rural water community-based organizations need technical and financial assistance to continue operating in a safe and sustainable manner.

SIWI, with the support of UNICEF, is monitoring the global response to COVID-19 when it comes to water, sanitation, and hygiene.

The following publications have been published so far:

A conceptual note entitled “El sector del agua, el saneamiento y la higiene y su respuesta ante el COVID-19: Iniciativas en América Latina y el Caribe” has been originally published in Spanish and then translated into French and English. This note structures the WASH response at country level, and has also been widely adopted by national coordination platforms to develop response plans by governments, regulators and service providers, among others.

English  Spanish  French

Three updates mapping of the mapping have been conducted to follow-up response measures and initiatives implemented by countries in LAC, covering different periods:

Update 1: covering the period from the beginning of the crisis until April, 15th

English  Spanish 

Update 2: covering the period from April 15th to May 15th. A separate note is developed for the Caribbean region

English  Spanish 

Update 3: covering the period from May 15th to June 17th. A separate note is developed for the Caribbean region

English  Spanish 

Overview of Water, Sanitation, and Hygiene (WASH) COVID-19 Responses from Governments, Regulators, Utilities and other Stakeholders in 84 Countries. This technical document presents an overview of initiatives that countries and WASH stakeholders are implementing in the COVID-19 response to ensure WASH services for all; in particular to secure and sustain access to WASH services for vulnerable groups as well as in schools and in health care facilities. 

English

Water, Sanitation and Hygiene (WASH) COVID-19 Response from Governments, Regulators and Utilities: Overview of global initiatives. This document looks at how countries and WASH stakeholders have responded to the coronavirus outbreak and offers guidance to assure WASH services for all.

English

The Key role of water, sanitation and hygiene promotion in the response to COVID-19 in Brazil. In order to support well designed water, sanitation and hygiene (WASH) responses contributing to COVID-19 containment, this note provides an overview of measures taken at the federal and state levels in Brazil. 

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Portuguese

COVID-19 WASH Responses by Governments, Water Utilities and Stakeholders in Middle East and North Africa (MENA) Countries. This document shares examples of COVID-19 WASH response measures being taken in 21 countries in the MENA region, and based on a mapping exercise, draws out some common themes and trends, and potential gaps, in country responses.

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Wider Reading | 

SIWI is contributing to the Sanitation and Water for All (SWA) webinars and Ministerial dialogues as members of the Research and Learning Constituency. SIWI has signed SWA’s  Call for Action.

Learn more about UNICEF’s work to strengthen the water and sanitation response to the pandemic here and here, including how an emoji can make a difference

The World Health Organization gives advice here and urges us to join their campaign #Safe Hands Challenge.

UNHCR offers resources to improve the situation for refugees who often lack access to safe water and sanitation.

OHCHR provides a toolkit on the human right to water and sanitation.

UN-Waters has collected a broad range of Covid-19 related water information.

The Global WASH cluster offers a range of WASH specific resources on its webpage.

Together with UNDP SIWI hosts the Water Governance Facility, with plenty of guidance on best practice:

What does water governance really mean? SIWI presented a definition in the article Unpacking Water Governance: A Framework for Practitioners’, published in the academic journal Water. Learn more about our work with water governance here.

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Examples from around the world

There are examples from across the world of how governments, cities and service providers expand access to and knowledge about water and sanitation.

The Covid-19 pandemic is putting increasing pressure on water and sanitation everywhere. In the paper Water, Sanitation and Hygiene (WASH) COVID-19 response from governments, regulators and utilities SIWI in collaboration with UNICEF has explored global trends and highlighted examples worth following.

Here are some key results:

Raising public awareness

Many countries are now rolling out massive information campaigns about proper handwashing techniques. This is often done online but radio messages, printed materials and other forms of information are also important in order to reach people without access to the internet. One example is how in Sittwe, Myanmar, UNICEF has disseminated 7,000 posters and put up LED-powered display boards with information about Covid-19.

In line with current research on behavioural change, information alone is not enough, nudges and reminders are also important. One example is how the handwashing emoji is now gaining traction, which can be an effective way to influence behaviour.  Another example is how in Ethiopia every time you make a phone call a message about coronavirus prevention is played first.

Many people are still unaware of the importance of handwashing to prevent the spread of the coronavirus. In Indonesia, the government wanted to test public knowledge about Covid-19 and ran a U-report survey together with UNICEF. It turned out that only 8 per cent of respondents mentioned washing hands with water and soap as a good preventive measure.

Strengthen infection prevention and control (IPC)

Water, sanitation and hand hygiene, together with physical distancing, are central to preventing the spread of Covid-19, and a first line of defence against this serious threat to lives and health systems.

According to WHO, infection prevention and control (IPC) is a scientific approach and practical solution designed to prevent harm caused by infection to patients and health workers. It is grounded in the epidemiology of infectious disease social science and health system strengthening. IPC cannot be met without WASH services.

One in four health care facilities lacks basic water services and one in five has no sanitation services – impacting 2.0 billion and 1.5 billion people, respectively. 42 per cent of facilities globally have no provisions for hand hygiene at points of care and 40 per cent globally have no systems for waste segregation.

It is essential to ensure that handwashing infrastructure is available, safe and accessible, environmental cleanliness, availability of personal protective equipment, medical equipment processing, and healthcare waste management not least in health care facilities.

Photo: Antoine Delepiere

Access to water and sanitation

Many countries try to protect low-income households and ensure that they don’t lose access to water and sanitation if they fall behind on payments. In Kenya’s capital Nairobi water is distributed for free to informal settlements during the Covid-19 outbreak and other counties have instructed water utilities not to disconnect users for failure to pay their bills. The government of the Democratic Republic of the Congo has promised free water and electricity for citizens and small businesses in Kinshasa for a period of two months.

Colombia is actively reconnecting people who have been cut off from water services and trying to improve access for people living in vulnerable circumstances, including indigenous groups. In Gabon, the Clean Hands Operation is trucking water to 40 underserved areas, and in Peru, the the Water and Sanitation Services for Lima (SEDAPAL), has been giving out free safe drinking water to families who don’t have it in their homes.

Expanding water and sanitation services

The current pandemic has highlighted the need for safe water and sanitation in public places as well as domestic settings and many governments are now responding to this. Building new handwashing stations, with soap and clean water, is vital. In parts of India, foot-operated handwashing kiosks are increasing in popularity, such as those seen in the state of Keralaand at the Thiruvananthapuram Central railway station in Karnataka state.

Health clinics in low-income countries should also be prioritized, as 35 per cent currently lack proper handwashing facilities.

It is important to ensure proper waste management, at all stages. One example of this approach is how waste collection was doubled in the wilaya Algiers in Algeria, in response to new demands when people were confined to their homes.

Support to service providers

In many parts of the world water and sanitation utilities will need increased financial and practical support. The World Bank recently announced a new Health Emergency Preparedness and Response Multi-Donor Fund (HEPRF). Many countries have also announced active measures, for example Chile, who announced a special financial package which could also help water and sanitation operators.

The Global Water Operators’ Partnership Alliance has joined forces with UN Habitat to offer advice to water and sanitation providers and encourage them to share information.

 

Water, Sanitation and Hygiene (WASH) COVID-19 Response from Governments, Regulators and Utilities: Overview of global initiatives This document looks at how countries and WASH stakeholders have responded to the coronavirus outbreak and offers guidance to assure WASH services for all.

Full Report

Overview of Water, Sanitation, and Hygiene (WASH) COVID-19 Responses from Governments, Regulators, Utilities and other Stakeholders in 84 Countries.

English

In collaboration with the UNICEF Regional Office for Latin America and the Caribbean, SIWI has mapped how the countries of the region are responding to the Covid-19 pandemics.

The health emergency caused by the Coronavirus has affected all countries in the Latin America and Caribbean region to varying degrees since February. In the paper The Water, Sanitation and Hygiene Sector and Its Response to COVID-19: Initiatives in Latin America and the Caribbean, SIWI and the UNICEF regional office reviewed the regional response in the first weeks of the pandemic.

Initiatives in Latin America and the Caribbean. The conceptual note for structuring the WASH response at country level, initially proposed in April 2020, has been used to map the WASH response to COVID-19. It has also been adopted by national coordination platforms, in 9 countries in Latin America thus far, to structure response plans. It has proved to be useful to show the type of measures and initiatives implemented by countries, and to identify response gaps.

English  Spanish  French

The mapping has been conducted intensively since end of March. Initially, it included 15 countries but has now been extended to cover up to 26 countries, including 7 countries from the Caribbean. Three mapping updates have been conducted, covering the following periods: i) until April 15th, ii) until May 15th, and iii) until June 17th.

i)   English  Spanish 

ii)  English  Spanish 

iii) English  Spanish 

Here are some key findings:

Most countries try to protect low-income households. Measures include subsidized services, cash transfers and a guarantee that water services will not be cut off, even if people are unable to pay their bills. Many countries try to reach unconnected users but may not be able to cover the whole population in need.

People living without a home are often forgotten. This group includes for example the homeless and people living in shelters, refugee camps or detention centres. The current crisis could aggravate their vulnerability.

Hygiene promotion campaigns are common. Many governments focus on this and the distribution of basic products like soap but other measures such as the construction of hand washing facilities in schools, markets, health clinics and detention centres have been scarce. On the other hand, sanitation is rarely included in response plans.

Some countries offer technical and financial support measures for service providers. This may be needed for an extended period of time so that service providers can continue their operations even if other sources of income dry up.

Photo: Antoine Delepiere

In collaboration with the UNICEF Regional Office for Middle East and North Africa, SIWI is monitoring how the countries of the region are responding to the COVID-19 pandemic.

The countries of the Middle East and North Africa region have a younger population than Europe and the USA and have experienced fewer COVID-19 related deaths, despite being one of the first regions to report cases outside of Asia. It is however estimated that 98 million people lack access to a safely managed water service and a further estimated 288 million live without a safely managed sanitation service. This part of the world is also one of the most water scarce.

A concern in the region is that there may be a significant level of undetected cases in vulnerable groups, especially in camp settings and in war-torn countries, that could potentially overwhelm already stretched health services. Lockdown and curfew measures have been quite widespread in the region, and since then some countries have cautiously relaxed these confinement measures, only to see rising cases and deaths.

SIWI’s monitoring of the country responses has found the majority of measures being led by national/central government, sometimes with close support from the United Nations. A strong focus of the initial response has been in the promotion of handwashing and Infection Prevention and Control (IPC). In non-Gulf states, a focus has also been ensuring continuity of WASH services and IPC in Health Care Facilities, isolation centers, and refugee and IDP camps. The monitoring show that whilst people in municipalities have seen more of the measures introduced, less focus has been found for vulnerable groups living in areas not connected to piped water and sewerage networks. 

Photo: Antoine Delepiere

A general lack of technical and financial support to water and sewerage utilities in the short and medium term is also seen. As water utilities potentially find themselves with the inability to fully cost recover due to bill non-payment, they could face a potential crisis in the medium to longer term if technical and financial support is not scaled up soon.

SIWI’s monitoring of the WASH response will continue during the de-escalation and recovery phases, jointly with countries in the region, and updates will be published. The objective of the monitoring is to both support the country responses, as well as to build a body of evidence to understand what WASH preparedness and resilience building measures can be put in place to build resilience to future pandemics. You can read more about how SIWI is working with the security aspects of the pandemic.

 

COVID-19 WASH Responses by Governments, Water Utilities and Stakeholders in Middle East and North Africa (MENA) Countries. This document shares examples of COVID-19 WASH response measures being taken in 21 countries in the MENA region, and based on a mapping exercise, draws out some common themes and trends, and potential gaps, in country responses.

English

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