Health Dialogue Article – Dialogue on Diarrhoea

IFGH: “Dialogue on Diarrhoea:  Hygiene, Sanitation and Water:  Forgotten Foundations of Health” 

Irish Forum for Global Health, March 2011

On Tuesday, March 15, members of the Irish Forum for Global Health (IFGH) and a panel of speakers participated in the event “Dialogue on Diarrhoea: Hygiene, Sanitation and Water: Forgotten Foundations of Health” at the Irish Aid Volunteer Office. David Weakliam, Chair of the IFGH, opened the event by questioning, “How is it we are not doing better?” The event aimed to answer that query through a discussion of the current state of water, sanitation and hygiene (WASH), challenges, and potential solutions. The dialogue, marking World Water Day on March 22, brought together a panel of five presenters with very different backgrounds, including representatives from Irish Aid, Concern Worldwide, Dublin City University, the London School of Hygiene and Tropical Medicine, and the private company Medentech. Niall Roche, an IFGH member, chaired the event and opened the discussion to the floor after panel presentations.

Presenting first on the panel, Dr Diarmuid McClean of Irish Aid urged honesty on the subject. He acknowledged that Irish Aid, among many other groups, has lost sight of the basics in practice. Challenges include water lacking a clear “home,” strong leadership, and an accountability structure. McClean questioned whether or not we have conceptually constrained ourselves, since WASH is not simply linked to health, but is also a foundation for agriculture, educational facilities, and promoting gender equality. He conceded that “we’re a little bit off track, but also in a very good position to rethink our focus and strategy in these areas”.

Connell Foley of Concern Worldwide similarly emphasised a need for stronger leadership in WASH. He noted that water and sanitation are included in Concern’s strategic plan, but that they have yet to see the level of positive results desired. Policy prioritisation of the issue will be essential for improvement, but what action is necessary to push WASH up on the agenda? WASH needs to be efficiently implemented at the local organization level. Foley noted additional obstacles to these programmes, including the particular difficulty of trying to change peoples’ behaviours. Foley suggested addressing policy challenges through strategic advocacy efforts, rigorous evidence in programming, and emotional engagement with the issue of water.

Arguing for additional research on sanitation as a part of the WASH solution, Dr Oliver Cumming of the SHARE Research Programme Consortium at the London School of Hygiene and Tropical Medicine noted that quality research will help provide a rationale for why we should invest in sanitation, how to invest at scale, and a clearer understanding of the effects of sanitation versus water. There is still no clear understanding of the relationships between access, use, and outcomes in WASH initiatives. Cumming further emphasised that the sanitation crisis is characterised by inequity. Sanitation has the potential to be especially transformative

for the lives of those in poverty. As part of these efforts, SHARE is conducting related research with a variety of partners, including slum dweller organisations.

Dr Brid Quilty presented information on Dublin City University’s “Water is Life: Amazzi Bulamu” project, another example of a research programme that incorporates a variety of partners, such as Irish Aid and the Higher Education Authority, and emphasises community engagement. As Dr. Quilty noted, the technology for treating our wastewater is not particularly new – instead, a large part of the challenge for WASH is a matter of infrastructures, the growing scale of populations, and the load put on the systems. However, these often forgotten basics really are “absolutely essential to our well being.” PhD students in the programme are conducting inter‐ disciplinary research examining water sourcing and sanitation in the rural Makondo region of Uganda.

Is there also room for the private sector in WASH solutions? Kevin O Callaghan, from the Wexford‐based company Medentech, discussed Aquatabs – a tablet product used to disinfect water. Aquatabs are flown to location during emergency situations, but the company is currently working to increase their regular presence in communities. These efforts have involved a price drop to promote the products in places where they are most needed but least affordable, such as Tanzania. O’Callaghan emphasized the importance of providing consumers with choices; Medentech is developing new products to meet different needs. He further discussed the value of working with organisations on the ground, as well as the importance of sustainability, integration, and public private partnerships.

During the presentations, an audience member asked if the difficulty of showing results in WASH has resulted in these foundations of health being pushed lower on political agendas. Several panel members responded in general agreement – causal relationships are difficult to prove in WASH programmes due to confounders, and there is some general malaise around the area of prevention as a whole.

Building on the ideas presented by the panel, one audience member questioned what can be done in terms of innovation in WASH. Connell responded that innovation needs to be in the implementation of WASH – not always in technologies. Later in the discussion, McClean noted that innovation is important, but focus should be even greater on enterprise.

Niall Roche questioned whether or not WASH having a “home” would be part of the solution. McClean replied that Irish Aid needs to work out where to place the issue and to determine who they can fund in this area. He also spoke to the importance of partnerships, stating that wider Irish solidarity will help Irish Aid to do its best work.

The panel and audience also discussed climate change and WASH – will there be a “greening” of development? A forum member noted that doing the right thing now seems to make economic and environmental sense, with more private companies acknowledging this trend. Cumming responded by noting that the connection between WASH and climate change is an area that needs further research.

One member of the audience noted that it is hard to separate water and nutrition – clusters do not always work on the ground. Another member remarked that when women are involved at the local level, there is generally greater prosperity. To this end, David Weakliam stated that Irish Aid needs to push a refocus on the community level. McClean of Irish Aid noted that this is a time of change for the organisation – growing dissatisfaction from African countries with outside assistance means that Irish Aid is rethinking its wider development aid strategies.

Nadine Ferris France of the IFGH questioned civil society’s involvement, specifically in advocacy and monitoring for WASH. Cumming indicated that this is a developing area, with the WASH Watch website monitoring government WASH commitments.

What can members of the IFGH, as a collective, do from a practical perspective? McClean suggested that we keep the issue of WASH alive after this dialogue and that Irish institutions continue research work on this topic. Dr. Quilty supported this sentiment, saying that the issue needs closer ties with education.

Foley additionally suggested that change come through collective action, community involvement, government accountability, and private sector involvement, with NGOs facilitating these collaborative efforts. “We have to keep looking at sustainable solutions, and I think they involve looking at bringing those other actors together.”

While panel and audience members emphasised different elements of the WASH challenge, there was general agreement on the need for partnerships and engagement of different stakeholders to tackle these issues. Cumming, for example, noted that research alone would not change the world. Instead, civil society, political actors, and private companies also have a role to play. Collaborative efforts and dialogues, like Tuesday’s “Dialogue on Diarrhoea,” are essential for reaching viable solutions. A transformation in the way these sectors interact could lead to more effective WASH programs, changing these foundations of health from “forgotten” basics into realities on the ground.

IFGH would like to thank Ashton Porter, Key Correspondent and student of the MSc Global Health at Trinity College for writing this article.

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