research topics in water supply and sanitation

Loading metrics

Open Access

Peer-reviewed

Research Article

Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America

Roles Data curation, Formal analysis, Methodology, Project administration, Writing – original draft, Writing – review & editing

Affiliation Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America

Roles Data curation, Formal analysis, Funding acquisition, Methodology, Supervision, Writing – original draft, Writing – review & editing

Roles Data curation, Methodology, Writing – original draft, Writing – review & editing

Affiliation Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America

Roles Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

Affiliations Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, CDC Foundation, Atlanta, Georgia, United States of America

Roles Data curation, Methodology, Writing – review & editing

Roles Data curation, Formal analysis, Investigation, Validation, Writing – original draft, Writing – review & editing

Affiliations Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America

Roles Conceptualization, Funding acquisition, Supervision, Writing – review & editing

Roles Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing

Roles Data curation, Formal analysis, Supervision, Writing – review & editing

Affiliation Infectious Diseases Institute, Makerere University, Kampala, Uganda

Roles Data curation, Formal analysis, Methodology, Supervision, Writing – review & editing

Roles Data curation, Formal analysis, Investigation, Methodology, Writing – review & editing

Roles Project administration, Supervision, Writing – review & editing

Affiliation Safe Water and AIDS Project, Kisumu, Kenya

Roles Data curation, Formal analysis, Investigation, Methodology, Supervision, Writing – review & editing

Roles Data curation, Formal analysis, Investigation, Supervision, Writing – review & editing

Affiliation Washington State University, Nairobi, Kenya

Roles Project administration, Resources, Supervision, Writing – review & editing

Roles Data curation, Formal analysis, Project administration, Writing – review & editing

Affiliation Universidad del Valle de Guatemala, Guatemala City, Guatemala

Roles Data curation, Formal analysis, Methodology, Project administration, Supervision, Writing – review & editing

Affiliation Washington State University, Pullman, Washington, United States of America

Roles Investigation, Supervision, Writing – review & editing

Roles Writing – review & editing

Affiliation Epidemiology Department, Ministry of Health, Santo Domingo, Dominican Republic

Roles Data curation, Investigation, Supervision, Writing – review & editing

Affiliation Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts, United States of America

Affiliation Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America

Roles Data curation, Formal analysis, Investigation, Writing – review & editing

Affiliations Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America, Belize Ministry of Health and Wellness, Belmopan, Belize

Affiliation Belize Ministry of Health and Wellness, Belmopan, Belize

Roles Data curation, Formal analysis, Project administration, Supervision, Writing – review & editing

Affiliation UNICEF, Kinshasa, Democratic Republic of Congo

Affiliation UNICEF, Ouagadougou, Burkina Faso

Roles Data curation, Formal analysis, Investigation, Project administration, Writing – review & editing

Roles Investigation, Project administration, Supervision, Writing – review & editing

Affiliation UNICEF, New York, New York, United States of America

Roles Data curation, Investigation, Project administration, Supervision, Writing – review & editing

Affiliation Department of Hygiene and Public Health, Ministry of Health, Kinshasa, Democratic Republic of Congo

Affiliation CARE Canada, Ottawa, Ontario, Canada

Affiliation CARE International in Uganda, Kampala, Uganda

Roles Project administration, Resources, Writing – review & editing

Affiliation Division of Global Health Protection, Centers for Disease Control and Prevention, Kampala, Uganda

Affiliation Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya

Affiliation Division of Global Health Protection, Centers for Disease Control and Prevention, Guatemala City, Guatemala

•  [ ... ],

Roles Conceptualization, Investigation, Project administration, Resources, Supervision, Writing – original draft, Writing – review & editing

• [ view all ]
• [ view less ]
• David Berendes, 
• Andrea Martinsen, 
• Matthew Lozier, 
• Anu Rajasingham, 
• Alexandra Medley, 
• Taylor Osborne, 
• Victoria Trinies, 
• Ryan Schweitzer, 
• Graeme Prentice-Mott, 

• Published: June 15, 2022
• https://doi.org/10.1371/journal.pwat.0000027
• Reader Comments

Continuity of key water, sanitation, and hygiene (WASH) infrastructure and WASH practices—for example, hand hygiene—are among several critical community preventive and mitigation measures to reduce transmission of infectious diseases, including COVID-19 and other respiratory diseases. WASH guidance for COVID-19 prevention may combine existing WASH standards and new COVID-19 guidance. Many existing WASH tools can also be modified for targeted WASH assessments during the COVID-19 pandemic. We partnered with local organizations to develop and deploy tools to assess WASH conditions and practices and subsequently implement, monitor, and evaluate WASH interventions to mitigate COVID-19 in low- and middle-income countries in Latin America and the Caribbean and Africa, focusing on healthcare, community institution, and household settings and hand hygiene specifically. Employing mixed-methods assessments, we observed gaps in access to hand hygiene materials specifically despite most of those settings having access to improved, often onsite, water supplies. Across countries, adherence to hand hygiene among healthcare providers was about twice as high after patient contact compared to before patient contact. Poor or non-existent management of handwashing stations and alcohol-based hand rub (ABHR) was common, especially in community institutions. Markets and points of entry (internal or external border crossings) represent congregation spaces, critical for COVID-19 mitigation, where globally-recognized WASH standards are needed. Development, evaluation, deployment, and refinement of new and existing standards can help ensure WASH aspects of community mitigation efforts that remain accessible and functional to enable inclusive preventive behaviors.

Citation: Berendes D, Martinsen A, Lozier M, Rajasingham A, Medley A, Osborne T, et al. (2022) Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19. PLOS Water 1(6): e0000027. https://doi.org/10.1371/journal.pwat.0000027

Editor: Silvia Monteiro, Universidade de Lisboa Instituto Superior Tecnico, PORTUGAL

Received: February 17, 2022; Accepted: May 21, 2022; Published: June 15, 2022

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: Data is available in Supporting Information S1 Data .

Funding: This work was funded through CDC cooperative agreements as part of emergency response to the COVID-19 pandemic (DB, MLo, JM, and TH received funding within CDC; AMwa, MLa, MKN, DC, KOM, PYO, OEH, AMat received funding on partner side-outside of CDC). The funders had no role in study design, data collection, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

As of November 5, 2021, there have been more than 248 million confirmed cases of coronavirus disease 2019 (COVID-19), of which almost 60 million (a conservative estimate) were in Southeast Asia, Africa, and the Western Pacific regions [ 1 ]. Multiple waves of COVID-19 cases continue to threaten low- and middle-income countries (LMICs) [ 2 ]. As of the same date, almost 8 billion doses of COVID-19 vaccines have been administered globally, though comparatively few in LMICs; less than 6% of people in low-income countries have received at least one dose of a COVID-19 vaccine [ 3 ]. International collaborative vaccination efforts, such as the COVID-19 Vaccines Global Access (COVAX) project, have procured and shipped 236 million doses to date [ 4 ]; however, goal levels for COVAX represent doses sufficient for only about 20% of those in LMICs. Reaching high vaccine coverage takes time in these populations: prevention and community mitigation measures to combat COVID-19—such as screening, isolation, quarantine, social distancing, masking, hand hygiene, and regular cleaning (with disinfection as-needed) of surfaces—remain critical to prevention and control of further waves of COVID-19 in LMICs [ 5 , 6 ].

Functional water, sanitation, and hygiene (WASH) infrastructure and consistent practice of key WASH behaviors are critical for prevention of respiratory and enteric infections [ 6 , 7 ]. Regular hand hygiene is a foundational, individually-actionable, and non-pharmaceutical strategy for combatting transmission of COVID-19 [ 8 , 9 ], whether through handwashing with soap and water or using an alcohol-based hand rub (ABHR) with at least 60% alcohol content. Sources, treatment, and storage of water in quantities sufficient for basic needs (drinking, washing hands) is essential, especially if an individual must isolate or quarantine after infection or recent exposure. Similarly, isolation or quarantine may require functional, well-managed sanitation facilities, including enhanced cleaning and disinfection measures for shared facilities [ 10 ].

COVID-19-focused community mitigation guidance for LMICs that incorporates WASH can be developed from existing WASH standards [ 7 ]. The Joint Monitoring Program (JMP) of the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) have published normative criteria for water, sanitation, and hygiene ladders whose “basic” or “safely-managed” criteria can act as minimum standards for WASH access in households [ 11 ], schools [ 12 ], and healthcare facilities (HCFs) [ 13 ]. In humanitarian emergencies, Sphere guidance includes minimum standards for core WASH services that may apply to the COVID-19 pandemic, including minimum water quantities for drinking and personal use (e.g., hygiene) and standards for hygiene promotion and hygiene items [ 14 ]. For displaced populations, the United Nations High Commissioner for Refugees (UNHCR) has identified critical WASH practices to prevent the spread of COVID-19 in refugee locations with high population density and shared WASH services [ 15 ].

Before the pandemic, access to essential WASH services in LMICs was poor. Worldwide, 60% of households and 53% of schools had basic hygiene, defined as a handwashing station (HWS) with soap and water, but for United Nations-categorized least developed countries (LDCs), only 28% of households and 26% of schools had this infrastructure [ 11 , 16 , 17 ]. About 74% of HCFs in LDCs had hand hygiene at points of care [ 18 , 19 ]. Although water quantity is not directly measured, 74% of households globally—but only 37% in LDCs—had onsite water sources available when needed [ 11 ]. Onsite water sources were present in 74% of HCFs and 69% of schools globally, but only 50% and 53%, respectively, in LDCs [ 12 , 13 ]. Private (unshared) sanitation (categorized as at least basic sanitation) at households was 78% globally, but only 37% in LDCs [ 11 ]. According to publicly-available data from UNHCR, in 119 sites that submitted data in March 2020, only 34% of refugee households had access to private sanitation; most sanitation facilities were shared (median: 14 people per facility) [ 20 ].

The COVID-19 pandemic adds new considerations to deploying and managing WASH in LMICs ( Table 1 ). For example, hand hygiene technologies—ABHR, handwashing with soap and water, soapy water, or use of chlorinated water—each present benefits but also challenges to ensuring quality control, use at appropriate times, user acceptability, and feasibility of maintenance under high-use conditions. Although there is no evidence to date that SARS-CoV-2 is transmitted through water or feces [ 21 , 22 ], public water sources and sanitation facilities may require additional COVID-19 mitigation measures to reduce crowding and ensure frequently-touched surfaces are cleaned regularly. Increased and competing demand for water for hygiene may also challenge water availability at public sources and storage capacity at households.

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pwat.0000027.t001

Combining existing WASH guidance with community mitigation guidance for COVID-19, we partnered with organizations and governments in LMICs in Latin America and the Caribbean (LAC) and Africa to assess WASH conditions and practices and deploy and manage WASH interventions to mitigate COVID-19. We focused assessments and interventions by setting (HCFs, community institutions, and households), primarily focused on hand hygiene initially. Results from these and other evaluations will strengthen the evidence base for WASH mitigation measures for COVID-19 in LMIC settings and identify new challenges or persisting gaps where further improvements are needed. By building partner capacity to conduct mixed-methods monitoring and evaluation, these projects may also improve sustainability of WASH services.

Selection of locations and assessment approach

Countries were prioritized based on existing partnerships, CDC country office collaboration, and anticipated risk of COVID-19 transmission and consequences based on existing country resources. Within countries, HCFs were selected by governmental and non-governmental partners based on risk for COVID-19 transmission, program viability, and in-country partner presence. Community institutions that were perceived to be high risk for COVID-19 transmission (e.g., had population mixing in densely-populated areas) were prioritized based on country partner or governmental guidance. In districts or regions with international borders or points of entry (POE), and therefore highly mobile populations, the CDC Population Connectivity Across Borders (PopCAB) toolkit [ 23 ] helped identify priority community settings associated with mobile populations, including additional POE and checkpoints, schools, markets, and other priority non-HCF community institutions. Household-level assessments were prioritized through partnerships with organizations that had existing health- or WASH-focused programs in low-resource locations of high-COVID-19 transmission risk, for example densely-populated informal settlements and internally displaced persons (IDP) camps. For all settings, priority locations selected and methods used varied slightly by the population served (e.g., refugee, IDP population, or general community). All settings (HCFs, community institutions, households) underwent WASH assessments and collection of qualitative data [focus group discussions (FGDs) or key informant interviews (KIIs)]; methods in HCF and community institutions were similar because new tools required for community institutions were generally derived from HCF-specific tools ( Table 2 ).

https://doi.org/10.1371/journal.pwat.0000027.t002

Quantitative: WASH assessments, knowledge, attitudes, and practice surveys, hand hygiene observations

Where feasible, baseline assessments of WASH conditions used existing tools for assessing WASH in the given setting that were modified to focus on hand hygiene needs for COVID-19. In HCFs, tools included the water and sanitation for health facility improvement tool (WASH FIT), which identifies WASH gaps in HCFs and prioritizes interventions using national and international standards and can be used on a continuous cycle of improvement by facility staff [ 24 ]. A second tool was the CDC assessment form for HCFs, which focuses on facility services and staff, water supply, sanitation, and hand hygiene resources (appropriate hand hygiene technologies present: ABHR or handwashing stations with soap and water for HCFs specifically [ 22 ]) at points-of-care [ 25 ]. In community institutions, WASH assessments were adapted from HCF-specific tools to target water supply and hand hygiene resources (appropriate hand hygiene technologies present: ABHR, handwashing stations with soap and water, or chlorinated water solutions [only when the other technologies were not available) for community locations [ 22 ]) at location entrances and exits [prioritized for hand hygiene by WHO during COVID-19 pandemic [ 26 ]] and outside toilets. For households, WASH assessments were adapted from JMP questions to assess household hygiene and water ladders [ 11 ] and knowledge, attitudes, and practices (KAP) survey questions were adapted from existing CDC and partner WASH KAP tools with an increased emphasis on handwashing and water access. Questions were added to household WASH and KAP assessment tools on knowledge of COVID-19 prevention and perceptions of local response and mitigation measures. WASH assessments were conducted in all HCFs, community institutions, and households selected. KAP surveys were conducted in all households selected.

Hand hygiene observations were conducted in HCFs and community institutions. In HCFs, observers followed a single provider for three to five patient encounters and noted whether hand hygiene was performed (and the technology used, if performed) before and after patient contact as described for those moments in WHO hand hygiene observation guidance [ 27 ]. To minimize bias, observers were introduced as observing quality of patient-provider care interactions (similar to structured observations using a mystery shopper method [ 28 ]) or as observing general hygiene practices (Guatemala). In community institutions, hand hygiene observations were conducted at locations where hand hygiene materials were present and expected to be used: location entrances and exits and outside latrines [ 26 ]. Similar to HCFs, practicing/not practicing hand hygiene and the technology used were noted, along with the approximate age of the participant (child, adolescent, adult) to target future messaging. In HCFs, a goal of 3–5 patient contacts for each of 90 providers in HCFs per site (generally 3–5 providers at each HCF in a site). If the goal number of patient contacts could not be attained after 30 minutes following a given provider, the observer was instructed to move on to the next provider at that HCF. In community institutions, observers stood in an inconspicuous location, as far away from a given hand hygiene station as possible while still being able to observe it, and randomly observed someone entering/exiting the facility or a random latrine known to be in use and visually followed the individual until either they had performed hand hygiene or passed by the hand hygiene station, whichever came first. For these observations, approximately half of available locations (e.g. individual markets, POE) were selected for hand hygiene observations with a goal of observing a total of 20 hand hygiene events per location. Hand hygiene observations were in locations not serving IDPs or refugee populations.

Qualitative: Focus Group Discussions (FGDs), Key Informant Interviews (KIIs)

Qualitative data—whether collected by FGDs or KIIs—were collected in all settings with differing target participants ( Table 2 ). In most HCFs, FGDs were originally planned, but due to social distancing concerns and limits on the number of individuals in a single space, KIIs usually replaced FGDs (though FGDs were successfully conducted in Belize). KIIs were conducted with healthcare providers, maintenance staff, and administrators to assess behavioral motivators and barriers to practicing hand hygiene before and after patient contact and challenges to managing hand hygiene at the facility. In community institutions, KIIs were conducted with staff and managers to understand barriers and motivators to hand hygiene in that setting and any existing management structures for hand hygiene, if they existed. FGDs were conducted separately with vendors and shoppers at markets to assess challenges to hand hygiene adherence. In households, FGDs were conducted with recipients of handwashing stations and hygiene kits and community volunteers to assess motivators and barriers to hand hygiene. Qualitative tools used in community institutions and households were designed from those used in HCFs. In general, KIIs were conducted at 50% of targeted HCFs and community locations. FGDs in markets were set at five for vendors and five for shoppers.

Schematics.

Schematics were a methodology used in community institutions, but not HCFs or households. Facilitators helped location managers to create drawings showing key locations where hand hygiene should be placed (e.g., entrances/exits, latrines, vendors, public gathering or eating locations), which was subsequently used to identify current hand hygiene resources and future needs.

Guidance for interventions.

Interventions were initiated after—and based on—baseline WASH assessments. Areas of intervention can be found in Table 3 . The guidance used or developed for the specific interventions settings is listed below:

https://doi.org/10.1371/journal.pwat.0000027.t003

HCFs . JMP service ladders and concurrent normative WASH guidance exist for HCFs as of 2017 [ 13 ]. Additionally, WHO guidance describes WASH-related practices that are important for mitigating the spread of SARS-CoV-2 in HCFs, including engaging in frequent and proper handwashing with soap and water or use of ABHR, implementing regular environmental cleaning and disinfection practices, managing excreta safely, and safely managing healthcare waste produced by COVID-19 cases [ 22 ].

Community institutions . Schools are the only community institution where normative WASH assessments exist via JMP-established service ladders [ 12 ]. In POE, although governments may provide guidance for national POE, there are no global recommendations for WASH at POE. In 2020, CDC, the WHO and other organizations developed operational considerations and recommendations for COVID-19 mitigation in community institutions in LMIC settings, including markets, schools, humanitarian settings, and high-density urban areas [ 10 , 29 – 36 ]. These recommendations were based on existing CDC and partner guidance where available (e.g., USAID guidance for safe and functioning food markets; WHO guidance for disinfecting environmental surfaces) and emphasized the importance of increasing access to hand hygiene and enhancing environmental cleaning and other control measures in high-use areas such as shared toilets.

Household . Following existing normative WASH standards, ensuring access to at least basic hygiene infrastructure (handwashing materials on premise with both water and soap) is an important global hygiene standard [ 11 , 16 ]. Guidance on behavioral messaging focused on key times to practice hand hygiene both generally (e.g., after the toilet, before eating, after coughing or sneezing or blowing one’s nose) [ 9 ] and during the pandemic (e.g., after being in public spaces) [ 8 , 37 ].

Broadly, the WASH assessments conducted and presented in this manuscript were exempt from formal institutional review board (IRB) approvals in Uganda, Kenya, Guatemala, Burkina Faso, and the Democratic Republic of the Congo because they were part of ongoing emergency public health response measures by CDC and local partners to the COVID-19 pandemic. Data collection in Belize and the Dominican Republic required IRB review given it was nested within ongoing data collection efforts. In Belize, protocols for data collection were approved by Baylor College of Medicine and the Belize Ministry of Health and Wellness. In the Dominican Republic, protocols for data collection were approved by the National Council of Bioethics in Health, Santo Domingo; the IRB of Pedro Henriquez Urena National University, Santo Domingo; and Mass General Brigham Human Research Committee, Boston, USA. No deviations to protocols occurred after approvals. Verbal or written informed consent (as suggested by the local partner or review board based on cultural acceptability and other factors) was obtained from healthcare workers prior to observations. Additional information regarding ethical, cultural, and scientific considerations to inclusivity in global research is included in S1 Text . All data are available in S1 Data .

Results, interventions, and monitoring and evaluation

Healthcare facilities.

WASH baseline assessments have been conducted at 114 HCFs across six countries ( Table 4 ) and observations of healthcare providers at 54 HCFs in five countries ( Table 5 ). HCF assessments have been completed in Belize (all government-supported hospitals and several priority outpatient clinics), Burkina Faso (Centre Nord and Est Regions, which served internally-displaced persons; HCFs prioritized by UNICEF and Ministry of Health), Dominican Republic (two large hospitals not in Santo Domingo: HCFs prioritized through participation in an acute febrile illness surveillance system to ensure geographic coverage and logistical feasibility of intervention delivery), Guatemala (five municipalities within Quetzaltenango Department: HCFs prioritized through participation in an acute febrile illness surveillance system to ensure geographic coverage and logistical feasibility of intervention delivery), Kenya (Nyando and Nyakach sub-counties in Kisumu County: all HCFs prioritized due to existing partner collaborations and displacement and concurrent flooding risks), and Uganda (community/non-refugee or IDP populations: Amuru and Tororo Districts: HCFs prioritized among non-refugee/IDP populations via PopCAB assessment; refugee/IDP populations: Adjumani, Arua, Madi-Okollo, and Terego Districts: HCFs prioritized by Ministry of Health, UNHCR, and local WASH partners).

https://doi.org/10.1371/journal.pwat.0000027.t004

https://doi.org/10.1371/journal.pwat.0000027.t005

HCF infrastructure.

Most HCFs had access to an onsite, improved water supply (100% of HCFs in Belize, Dominican Republic, and Kenya program sites, 95% in Guatemala sites, 80% in Uganda sites, 66% in Burkina Faso sites, Table 4 ). However, hand hygiene resources at points-of-care were less prevalent: two HCFs surveyed in Belize (18%), three HCFs in Uganda (25% of those surveyed in non-refugee/IDP populations), and two HCFs in Kenya (5%) had access to hand hygiene resources at all points-of-care. All HCFs assessed in Guatemala had hand hygiene resources at 75–99% of points-of-care; 47% in Burkina Faso, 46% in Belize, 33% in Uganda (non-refugee/IDP), 31% in Uganda (refugee/IDP), 5% in Kenya, and 0% in Dominican Republic met this criterion.

HCF hand hygiene adherence.

Healthcare providers in participating HCFs had moderate to low levels of hand hygiene adherence around patient contact (49% in Belize, 38% in Uganda, 30% in Guatemala, <25% each in Dominican Republic and Kenya, Table 5 ). In all sites, providers practiced hand hygiene more frequently after patient care (range: 25–62% by site) than they did before patient care (9–39%).

Interventions.

In all HCFs, interventions included HWS or ABHR at points-of-care and entrances and exits [ 26 ], and HWS at toilets ( Table 3 ), with an objective of 100% coverage per HCF. In HCFs serving refugee populations and IDPs, interventions also included distribution of environmental cleaning and hygiene kits (via antenatal clinics), as well as hygiene promotion sessions and trainings on COVID-19 prevention for health facility staff and patients. In HCFs serving general populations, partners implemented ABHR programs using the WHO Guide to Local Production of ABHR [ 38 ] to train local technicians in production and distribution models specific to their facility, district, or national needs. Findings from qualitative baseline assessments are also being used to develop behavior change interventions in HCFs.

Monitoring and evaluation.

To measure the feasibility, acceptability, use, and sustainability of interventions, monitoring and evaluation tools were developed from baseline assessments. Tools focused on monitoring functionality, availability of soap and water, and water quality at HWS; quantity and quality of ABHR at production facilities; and functionality of dispensers and levels of ABHR consumption by HCFs. Hand hygiene observations will be repeated periodically, with data shared with HCF leadership to provide a feedback loop to inform further trainings and encourage improved hand hygiene adherence. Similarly, repeat assessments will be conducted for water storage capacity and environmental cleaning supply quantities.

Community institutions

To-date, WASH assessments of community institutions have been conducted in Uganda (10 markets, 15 POE, 7 schools) and DRC (27 schools, Table 6 ). Hand hygiene observations have been conducted at all community institutions in Uganda, as well as five vendor- and five shopper-focused FGDs and 16 KIIs. Community institution assessments have been completed in Uganda (Amuru and Tororo Districts) and the DRC (North Kivu and Kasai-Central provinces). In Uganda, schools, POE, lodging locations, markets, and religious institutions were identified via the PopCAB assessment as priority locations with high population mixing in Amuru and Tororo Districts. In the DRC, schools were selected in Goma and Kananga to complement ongoing CDC work on cholera and in key areas identified for COVID-19 mitigation.

https://doi.org/10.1371/journal.pwat.0000027.t006

Markets in Uganda had poor access to water (44% had an improved water source onsite) and HWS (50% had any HWS, Table 6 ). Observed hand hygiene at key times was moderate and better than other community settings observed: 58% of people entering/exiting markets were observed to clean their hands and 63% of people cleaned their hands after using the latrine ( Table 7 ).

https://doi.org/10.1371/journal.pwat.0000027.t007

KIIs with market managers in Uganda revealed support for both HWS (for vendors and visitors whose hands get heavily soiled) and ABHR (for speed and convenience) onsite and suggested that hand hygiene should be enforced by a monitor at market entrances. Managers felt staff and customers would need education on effective hand hygiene and suggested using posters with strong visual aids.

FGDs among vendors and shoppers found that hand hygiene stations at entrances/exits, though considered essential, were not easily accessible for vendors. Additional stations within the market were recommended to improve access. Additionally, most HWS installed in the early months of the pandemic were no longer functioning due to lack of management plans or identified responsibilities. Both vendors and shoppers believed that hand hygiene was effective for preventing COVID-19 and were motivated to practice hand hygiene to protect themselves, their children, and friends from disease, as well as to feel and appear clean.

Many, but not all, POE had access to an improved water source onsite (71%) and HWS (60%), including at entrances and exits (71%, Table 6 ). However, only 19% of people entering or exiting the POE cleaned their hands and only 42% of people cleaned hands after using the latrine ( Table 7 ).

Based on KIIs, ABHR was identified as a more convenient method for hand hygiene due to the high volume of travelers and number of contact events between POE staff and travelers. However, poor access to and high cost of ABHR, as well as the layout of some POE, challenged consistent access to hand hygiene for staff and travelers. Although some POE received ABHR from local HCF, increasing and sustaining ABHR access and improving access to HWS was viewed as a critical priority.

In Uganda, all schools had access to an improved water supply onsite (100%) and most had handwashing stations (86%), including at entrances/exits (71%, Table 6 ). In DRC, although 67% of schools had either temporary or permanent HWS, only 30% had an improved water source available on the premises ( Table 6 ).

Observed hand hygiene adherence was poor in schools in Uganda: 17% of students or staff entering/exiting the school were observed to clean their hands and only 39% were observed to clean hands after using the latrine ( Table 7 ).

Based on data from KIIs in Uganda, head teachers felt that it would be best for students to use HWS but that ABHR would be good for visitors and teachers, and particularly for head teachers since they interact with many visitors. ABHR was prohibited from use by children in schools in Kenya by the Ministry of Education due to concerns over their ability to safely and appropriately use it [ 39 ].

Market and POE interventions focus on improving access to HWS and locally-produced ABHR, as well as hygiene education materials, at key locations (entrances and exits and outside latrines) for staff or visitors ( Table 3 ). Amount of hand hygiene resources required for staff and travelers will vary based on the location size, existing infrastructure or layout, and local regulations. School interventions will focus on ensuring access to hand hygiene at entrances, exits, within classrooms, and within 5 meters of toilets/latrines; hand hygiene promotion; and ensuring sufficient water supply for increased hand hygiene and cleaning needs.

Monitoring will focus on functionality of hand hygiene stations (including resources available, usability, and water quality) and ABHR quality and use (where present; Table 3 ). Periodic evaluations will include intercept interviews with users to assess acceptability of hand hygiene, KIIs and FGDs with staff or managers to assess feasibility of management, observations to assess use, water quality testing of free chlorine residual, and targeted evaluations assessing appropriateness of use cases for ABHR in communities. Tools used will be adapted from baseline assessments.

To-date, household WASH assessments and KAP surveys have been conducted at 405 households in Burkina Faso ( Table 6 ). Assessments have been completed in households in areas prioritized by the Ministry of Health in Burkina Faso (Diabo Commune, Est Region; Boroum Commune, Centre Nord Region).

Access to WASH at household level.

Almost all households (96%) in sites in Burkina Faso used water from an improved source; however, few (2%) had a handwashing station present ( Table 6 ).

Household reported hygiene knowledge, motivators, and barriers.

In sites in Burkina Faso, 49% (199/405 household surveyed) reported using water only (no soap) during regular handwashing. In Kenyan informal settlements, FGD participants highlighted that placement of HWS near a doorway served as a reminder to wash hands, but this benefit may not exist where HWS are shared among several households. In such cases, disrepair or abandonment might occur due to perceptions of diminished responsibility. FGD participants discussed the need for inter-household agreements to rotate costs of supplying water and soap.

Initial interventions—freestanding, temporary HWS in high traffic areas to maximize the number of households reached per HWS—quickly broke down due to misuse, damage, or theft because resources for full-time operators were not available. Interventions subsequently shifted to household- or compound (groups of households sharing a space)-level HWS. Objectives were to achieve access to at least basic hygiene in households or compounds; to identify barriers, motivators, and gaps to hand hygiene adherence in communities for message development and dissemination; and to monitor utilization and sustainability of approaches to hand hygiene access and messaging. Households received hand hygiene kits (e.g., HWS, 20-L water storage containers, and bars of soap) complemented by awareness campaigns organized with local community health workers to improve knowledge of COVID-19 mitigation measures. In some contexts, hygiene kits were distributed through maternal, newborn and child health activities in HCFs: expectant mothers received a hygiene kit plus face masks, ABHR, and communications materials at their first prenatal visit. Community health workers subsequently provided hygiene promotion messages during prenatal household visits.

To sustain interventions, periodic monitoring and evaluation will be conducted via repeat visits or text/phone-based assessments of functionality of HWS and interviews about acceptability and feasibility of HWS designs and maintenance ( Table 3 ). Tools were adapted from baseline assessments with additional questions focusing on barriers to maintaining hand hygiene stations and adherence.

Discussion, future directions, challenges and limitations, and conclusions

The need for at least basic levels of WASH in HCFs, community institutions, and households has only increased during the COVID-19 pandemic. The focus on WASH in HCF just before 2020, accompanied by existing guidance and standards for WASH in schools and households, provided multiple appropriate WASH assessment tools that could be readily adapted for COVID-19-focused assessments. However, in other community institutions such as markets or POE, CDC and WHO created new operational guidance based on existing WASH guidance for other settings and added COVID-19-specific considerations.

Data from baseline assessments conducted to-date demonstrate poor access to hand hygiene resources at key public locations—points-of-care in HCFs, entrances/exits and at toilets in community institutions—despite most, except schools in DRC and markets in Uganda, having access to an improved, onsite water supply. Other enabling factors for hand hygiene, such as sufficient water quantity and management plans for restocking supplies and repairing HWS, may need to be prioritized. Local ABHR production may be a cost-effective complement to HWS in appropriate settings and projects are currently scaling the WHO protocol [ 38 ] to district, regional, and national levels in five countries.

Where hand hygiene resources were available, healthcare providers and community members had low adherence overall. Healthcare providers were more likely to clean hands after than before patient contact, suggesting that behavioral interventions to improve compliance should increase emphasis on protecting the patient in addition to protecting oneself. Hand hygiene in healthcare contexts requires a multimodal approach, including systems-level change to improve access to hand hygiene materials but also training and education, monitoring of practices, reminders and nudges, and establishment of a culture to reinforce practices [ 40 – 42 ]. Community members were more likely to clean hands after the toilet than at entrances/exits, suggesting a need for greater communication of other key times to wash hands, especially during the pandemic [ 22 , 26 , 37 ]. However, models such as the Integrated Behavioral Model for WASH (IBM-WASH) suggest that multiple levels, beyond the individual, should be considered in uptake of WASH behaviors: these include societal, community, interpersonal, and habitual levels [ 43 , 44 ]. For example, the context of the pandemic itself may factor into the drivers of hand hygiene uptake, but these behaviors need to be matched to the appropriate technology as well. Further research into methods to prolong outbreak-associated (short-term) behavior change is needed, though evidence suggests that awareness/knowledge-based methods may have limited effect if not addressing multiple societal levels [ 43 – 47 ].

Similar to community and HCF locations, household use of improved water sources was high but access to HWS was poor. HWS targeted to multiple households—via shared or otherwise freestanding community infrastructure—suggest cost-efficient ways to temporarily increase community coverage; however, the absence of management considerations may cause infrastructure to become unusable. Community HWS attached to retail points, schools, and other community institutions can help improve responsible management; however, household- or compound-focused interventions may be more feasible, manageable, and help achieve basic hygiene access for longer term prevention capacity [ 16 ].

Future directions

The new WASH-focused guidance necessitated by the COVID-19 pandemic—including guidance for public places: placement, management, and behavior change communication about hand hygiene in markets, POE, and other community institutions, and who is responsible for these aspects—must be implemented, monitored, evaluated, and improved to maximize feasibility and acceptability while maintaining effectiveness. Though human rights to accessing WASH services in public places has been emphasized by the United Nations General Council [ 48 ] and individual nations may have guidance, systematic, global guidance for WASH standards in public places is a gap. The microbiological quality of water for handwashing is not currently incorporated into the hygiene ladder [ 16 ] and thus is an area of new guidance. Although limited evidence suggests that non-potable water with low-to-moderate E . coli contamination still may be effective when used for handwashing [ 49 ], the potential for dual-use of water from handwashing stations being consumed because of limited access to basic and safely-managed water services [ 11 ] suggests that potable levels of water quality may be necessary in many areas. Within our sites, water for handwashing will be tested at the source and at the handwashing station for free residual chlorine (except if only soapy water for handwashing is present, as this may affect accuracy of chlorine residual measurements). If free residual chlorine levels are <0.2mg/L, an additional sample will be collected for assessment of presence or absence of fecal indicator bacteria.

Sanitation management—for example, development of standard operating procedures (SOPs) to clean and manage public toilets in densely-populated locations and improvement of personal protective equipment (PPE) use by manual pit emptiers to protect themselves and their customers while entering households—should be prioritized as essential services [ 7 ]. Access to public toilets may be the only means of sanitation access for many globally, and should be managed so as to avoid added risk from communal spaces [ 7 ], with similar arguments for improving the hygienic practices of pit emptiers. SOPs for public facilities have often focused on managing fecal waste, but improvements to cleaning and disinfection guidance, social distancing while queuing, and other changes may be necessitated.

ABHR is an effective complement to HWS in HCFs and has logistical and financial savings if produced locally; however, appropriate supply chains for and appropriate use in community settings must be evaluated. In community settings, CDC recommends ABHR when handwashing with water and soap are not practically available [ 9 ] because soap and water may be more effective at removing a broader array of microbes, as well as other unknown chemical or organic materials, that may be present on hands [ 50 ]. Furthermore, ABHR is effective against microbes specifically, but is less likely to effectively inactivate them if hands are visibly dirty [ 51 ]. Before expanding ABHR in these settings in the short to medium term, evaluations should ensure targeted community settings are appropriate for use of ABHR, with concurrent messaging if necessary to guide users on when to use soap and water vs. ABHR.

In our program sites, access to ABHR in community institutions does not have clear supply chains. In previous work in Uganda, locally-produced ABHR at POE followed HCF supply chains because of Ebola preparedness efforts, but markets, schools, or other key community locations were not included. To ensure sustainable access to ABHR in LMICs, there is a need to evaluate whether HCF-based local production and distribution to non-HCF locations is feasible or if non-HCF-based production and distribution models are needed.

Challenges and limitations

Sustaining hand hygiene behavior change remains the largest challenge to-date, requiring consistent access to functional hand hygiene stations at key locations, behavioral nudges or reminders to perform hand hygiene at key moments, and local, regional, and national support for hand hygiene integrated across programs [ 16 ]. Installation of hand hygiene facilities must include plans for their management and repair, including identifying supplies and repair parts and personnel responsibilities for restocking, cleaning, maintenance, and repair [ 52 ]. As in many outbreak situations, rapid deployment of HWS in project sites without concurrent maintenance plans led those stations to quickly deteriorate or become unusable within a year despite longer advertised lifespans [ 53 ], which wastes resources and reduces access to hand hygiene. Lack of consistent access to hand hygiene resources may inhibit changes to behavior and development of hand hygiene as a habit [ 47 , 54 ]. To ensure sustained hand hygiene access and behavior change, support must come from multiple disciplines (e.g., healthcare, education, WASH partners, community) integrating hand hygiene into new and existing work plans, rather than isolated or temporary initiatives [ 16 ].

There are several limitations to consider within the context of these assessments and guidance. Notably, data are site- and context-specific and may not be generalizable to other settings. Although inclusiveness of WASH services by persons with disabilities are priorities for the WASH SDGs, including design of HWS [ 16 ], and are being accounted for in design of interventions, they were consistently not enumerated in baseline assessments. Additionally, WASH interventions are one of many tools, including masking, social distancing, and vaccination, that should be implemented for comprehensive community mitigation of COVID-19.

Conclusions

Within the COVID-19 pandemic, hand hygiene, water supply, and sanitation—all core components of WASH—have greater importance. In LMICs, we adapted common WASH tools for COVID-19 mitigation via rapid, mixed-methods assessments and adapted WASH guidance for settings without existing WASH standards (e.g., community markets, POE), with a focus on hand hygiene initially. We found inadequate hand hygiene access and behavioral adherence across LMIC contexts and settings—HCFs, community institutions, and households—and a need to improve personal and community capacity to follow guidelines for COVID-19 mitigation. These changes may include a need for greater water supply (for handwashing) and improved management of public sanitation facilities. Management of hand hygiene stations represents an area of elevated importance within the ongoing pandemic, for example, keeping HWS functional and well-stocked and ensuring continuous access to ABHR where available. New evaluation of these areas, and subsequent development and refinement of standards and assessment tools, will help ensure that WASH aspects of community mitigation of COVID-19 are accessible, functional, and usable for all.

Supporting information

S1 text. inclusivity in global health questionnaire (checklist)..

https://doi.org/10.1371/journal.pwat.0000027.s001

S1 Data. Data for manuscript.

https://doi.org/10.1371/journal.pwat.0000027.s002

Acknowledgments

The authors wish to acknowledge the efforts of all local implementation and evaluation partner staff, CDC country office staff, Ministries of Health, and participants.

Disclaimer: The findings and conclusions of this paper are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention (CDC).

• 1. World Health Organization (WHO). World Health Organization Coronavirus (COVID-19) Dashboard. 2021. covid19.who.int
• View Article
• PubMed/NCBI
• Google Scholar
• 3. University of Oxford. Our World in Data: Statistics and Research: Coronavirus (COVID-19) Vaccinations. 2021. https://ourworldindata.org/covid-vaccinations?country=USA~KEN~UGA~GTM~COD~HND~DOM
• 4. Gavi. COVAX vaccine roll-out. 2021. https://www.gavi.org/covax-vaccine-roll-out
• 8. Centers for Disease Control and Prevention. COVID-19: How to Protect Yourself and Others. 2021. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
• 9. Centers for Disease Control and Prevention. Handwashing: Clean Hands Save Lives. 2021. https://www.cdc.gov/handwashing/index.html
• 10. Centers for Disease Control and Prevention. Cleaning and Disinfecting Your Home. 2021. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/disinfecting-your-home.html#DisinfectHome
• 11. UNICEF and World Health Organization. Progress on Household Drinking Water, Sanitation, and Hygiene 2000–2020. 2021.
• 12. WHO/, UNICEF. Special Focus on Covid-19 Who/Unicef Joint Monitoring Programme for Water Supply, Sanitation and Hygiene Progress on Drinking Water, Sanitation and Hygiene in Schools. 2020. https://washdata.org
• 13. World Health Organization (WHO), UNICEF. WASH in Healthcare Facilities: Global Baseline Report. 2019. http://apps.who.int/bookorders .
• 14. Sphere. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response. CHS Alliance, Sphere Association and Groupe URD. 2018. www.practicalactionpublishing.org/sphere
• 15. UNHCR. Emerging Practices: Wash and Covid 19 field practices. 2020. https://reporting.unhcr.org/sites/default/files/WASHEmergingPracticesCOVID-19_v5.pdf
• 16. UNICEF. State of the World’s Hand Hygiene: A global call to action to make hand hygiene a priority in policy and practice. New York; 2021.
• 17. WHO, UNICEF. Drinking water, sanitation and hygiene in schools: global baseline report 2018. WHO/UNICEF Joint Monitoring Programme for Water Supply SAH, editor. https://data.unicef.org/wp-content/uploads/2018/08/JMP-WASH-in-Schools-WEB.pdf ; 2018.
• 18. WHO/UNICEF. Hygiene Baselines pre-COVID-19 Global Snapshot Source: WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene. 2020; 1–7. https://www.wsp.org/sites/wsp/files/publications/WSP-Practical-Guidance-Measuring-Handwashing-Behavior-2013-Update.pdf
• 19. World Health Organization. Global progress report on wash in health care facilities. 2020.
• 20. UNHCR. WASH Dashboard Overview. 2021. https://wash.unhcr.org/wash-dashboard-for-refugee-settings/
• 21. Centers for Disease Control and Prevention. Healthy Water. 2021. https://www.cdc.gov/healthywater/
• 22. WHO. Water, sanitation, hygiene, and waste management for SARS-CoV-2, the virus that causes COVID-19. Interim Guid. 2020; 1–11. https://www.who.int/publications/i/item/water-sanitation-hygiene-and-waste-management-for-the-covid-19-virus-interim-guidance
• 23. Centers for Disease Control and Prevention. Population Connectivity Across Borders (PopCAB) Toolkit. 2021. https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/popcab-toolkit.html
• 24. World Health Organization. Water and sanitation for health facility improvement tool (WASH FIT). 2021. https://www.who.int/publications/i/item/9789241511698
• 25. Centers for Disease Control and Prevention. Global Water, Sanitation, and Hygiene (WASH): Data Collection Tools and Communication. 2020. https://www.cdc.gov/healthywater/global/healthcare-facilities/tools.html
• 26. World Health Organization. WHO: Interim Recommendation on Obligatory Hand Hygiene against transmission of COVID-19. 2020; 2–4.
• 29. Centers for Disease Control and Prevention. Framework for Implementation of COVID-19 Community Mitigation Measures for Lower-Resource Countries. 2020. https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/community-mitigation-measures.html
• 30. Centers for Disease Control and Prevention. How to mitigate COVID-19 transmission in densely populated areas globally. 2021.
• 31. Centers for Disease Control and Prevention. Operational Considerations for Preventing COVID-19 Transmission in Schools in non-U.S. Settings. 2021. https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/schools.html
• 32. UNICEF, UNESCO, WHO. Considerations for school-related public health measures in the context of COVID-19 and social measures in the context of COVID-19. 2020; 1–10. https://www.who.int/publications/i/item/considerations-for-school-related-public-health-measures-in-the-context-of-covid-19
• 33. Centers for Disease Control and Prevention. Mitigation measures for COVID-19 in households and markets in non-US low-resource settings. 2020. https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/global-urban-areas.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fglobal-covid-19%2Fmarkets.html
• 34. Centers for Disease Control and Prevention. Considerations for Outdoor Farmers Markets (archived). 2020. https://www.cdc.gov/coronavirus/2019-ncov/community/outdoor-farmers-markets.html
• 35. USAID. Responding to COVID-19’s Impact on Resilience and Food Security. 2020. https://www.usaid.gov/who-we-are/organization/bureaus/bureau-resilience-and-food-security/responding-to-covid-19-impact-on-resilience-and-food-security
• 36. World Health Organization. Cleaning and disinfection of environmental surfaces in the context of COVID-19. 2020. https://www.who.int/publications/i/item/cleaning-and-disinfection-of-environmental-surfaces-inthe-context-of-covid-19
• 37. Centers for Disease Control and Prevention. COVID-19: Handwashing. In: COVID-19 [Internet]. 2021. https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/handwashing.html
• 38. World Health Organization (WHO). Guide to Local Production: WHO-recommended Handrub Formulations Introduction: Who. 2010; 9. https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf
• 39. Waithera A. Students will not be allowed to handle hand sanitisers: Magoha. The Star. 2021. https://www.the-star.co.ke/news/2021-01-02-students-will-not-be-allowed-to-handle-sanitisers-magoha/
• 41. World Health Organization. WHO Guidelines on Hand Hygiene in Health Care. Geneva; 2009. https://www.ncbi.nlm.nih.gov/books/NBK144013/pdf/Bookshelf_NBK144013.pdf
• 50. Centers for Disease Control and Prevention. Show Me the Science—When & How to Use Hand Sanitizer in Community Settings. In: Handwashing: Clean Hands Save Lives [Internet]. 2020. https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html
• 52. Knight J, Kontos L, Forte JDC, Muktadir G, Gautam OP. Technical Guide for handwashing facilities in public places and buildings. Wateraid. 2020. https://washmatters.wateraid.org/sites/g/files/jkxoof256/files/technical-guide-for-handwashing-facilities-in-public-places-and-buildings.pdf
• 53. UNICEF. Handwashing Stations and Supplies for the COVID-19 response. UNICEF Fact Sheet. 2020; 1–14.

A cross-divisional department spanning

Water, Sanitation, Hygiene, and Health

• Baltimore Community Outreach and Engagement Projects
• Northeast Market Patron Survey
• Evaluating the Impacts of Energy Options on Baltimore’s Air Quality
• One Health and Asthma Prevention in Baltimore
• Safer Urban Agriculture in Baltimore
• Diversity and Equity Initiatives
• Environmental Health and Engineering Student Organization (EHESO)
• Message from the Chair
• Postdoctoral Opportunity in Neuroscientist/(Neuro)toxicologist
• Postdoctoral Opportunity in Public Health Policy
• Research Assistant
• Bachelor of Science in Environmental Engineering
• Program Objectives and Outcomes
• Why Hopkins?
• Application Fee Waiver Requirements
• Areas of Focus
• Graduate Student Resources
• Jensen Fellowship
• Postdoctoral Opportunity: Toxicology Policy, Law and Regulatory Analysis
• Quotes from our EHE Alumni
• Non-Degree Programs
• EHE Research Retreat
• Geyh-Bouwer Trainee Practice Award
• Mobile Air Pollution Measurement Laboratory
• Air Pollution and Cardiorespiratory Diseases
• Antimicrobial Resistance and Infectious Disease
• Biosecurity and Emerging Threats
• COVID-19 Research
• Carcinogens and Cancer
• Children's Environmental Health
• Chronic Disease Etiology and Prevention
• Community Sustainability, Resilience, and Preparedness
• Consumer Product Safety
• Energy Management and Alternative Technologies
• Environmental Chemistry, Microbiology and Ecology
• Environmental Engineering
• Environmental Epidemiology
• Environmental Inequities and Injustice
• Environmental Resource Quality
• Epigenetic Regulation in Environmental Diseases
• Food and Agricultural Systems
• Geomorphology, Geochemistry, and Hydrology
• About the Program
• Conceptual Framework
• Land Use and Energy Issues
• MPH Concentration in Global Environmental Sustainability & Health
• Projects and Research
• Recommended Reading
• Research on Land Use and Public Health
• What the Future Must Look Like
• Novel Exposure Assessment
• Risk Sciences and Public Policy
• Social and Behavioral Sciences
• Toxicology, Physiology, & Cell Biology
• Johns Hopkins University Water Institute
• Worker Health and Safety
• Teaching and Research Labs at WSE
• The INnovations to Generate Estimates of children's Soil/dust inTake (INGEST) Study
• Centers and Institutes
• Environmental Health and Engineering Doctoral Students
• Full-time Faculty Directory
• Postdoctoral Fellows
• News and Events
• Make a Gift

Water sanitation and hygiene are critical to health, survival, and development. Many countries are challenged in providing adequate sanitation for their entire populations, leaving people at risk for water, sanitation, and hygiene (WASH)-related diseases. Throughout the world, an estimated 4.5 billion people lack access to safely managed sanitation  (WHO/UNICEF).

In the  Department of Environmental Health and Engineering , we are developing and evaluating strategies to ensure that water is safe to drink and use in our daily lives both locally and abroad.

Research Highlights

Protecting drinking water from aging infrastructure and climate change.

In cities across the U.S., water systems are under threat as aging infrastructure is being stressed by climate change. To better understand where we should apply public health resources, Abel Wolman Professor in Water and Public Health  Kellogg Schwab, PhD, MSPH , and assistant scientist  Natalie Exum, PhD ’16, MS , received funding from a  Bloomberg American Health Initiative  Spark Award to study what’s going on in the pipes—and what’s coming out of our faucets.  Learn more (video).

A Mobile Data Collection Platform Helps Reveal the Prevalence of a Neglected Tropical Disease

In sub-Saharan Africa, an estimated 200 million people are infected with the parasitic worms that cause schistosomiasis. Released by freshwater snails, the worms penetrate the skin of people who bathe in water contaminated by human sewage. The disease can cause liver damage, kidney failure, bladder cancer and infertility if left untreated. Working with the  Performance Monitoring and Accountability 2020 project ,  Natalie Exum, PhD ’16, MS , an assistant scientist in  Environmental Health and Engineering , is putting mobile technology in the hands of local data collectors to help determine the disease’s prevalence in Uganda.  Learn More.

An Assessment of Drinking Water in the Peruvian Amazon

The Peruvian Amazon, one of the world’s most biodiverse regions, is subject to pressure from climate change, deforestation, mining, and urbanization, with translational impacts on water quality, ecosystems, and human health. Shifts in the water cycle due to changes in climate or land use threaten ecosystem stability, food security, economic status, and human health. Recent surges in developmental activities, including logging, agriculture, petrochemical operations, and mining, have caused increases in deforestation and external impacts. These changes can expose humans to pathogens and contaminants (e.g., heavy metals and pesticides) causing acute and chronic illness and water-related, vector-borne disease (e.g., malaria).

A team of Hopkins researchers traveled to the Peruvian rainforest to conduct an assessment of the quality of drinking water utilized by some of these villages to gain understanding of the overall safety of available potable water sources as a first step towards developing a broader water research platform. This study generated an enhanced evaluation of the sources and types of drinking water contaminants in the Peruvian Amazon.  Learn more.

Associated Faculty

A current interest of Ball's is the development and application of appropriate and sustainable technologies for developing nations, with focus on water resources, drinking water, and sanitation. 

More Information

Natalie is the Senior Technical Advisor for Water, Sanitation and Hygiene (WASH) for PMA2020's mobile health data collection platform. She also leads the PMA2020 Schistosomiasis module in Uganda, which is providing a national assessment of the disease incidence throughout the country along with the WASH conditions of households to understand how to most effectively interrupt the transmission cycle. 

Ferraro's research focuses on behavioral economics and the design and evaluation of environmental programs in the private and public sector.

Harman's research group studies water flow and transport from soil to hillslope to watershed scales. Our work combines theory development, field work, experimental studies, and numerical modeling. The work is organized around two broad themes: flow and transport in the landscape; and structure and evolution of the critical zone.

Heaney is currently studying the health impacts of recreational beach activities, particularly waterbourne and other infectious diseases. A goal of his lab is to advance understanding of the health consequences of joint exposures to pathogens and toxicants in environmental and occupational contexts, including food animal production, drinking and recreational water, and municipal and industrial waste management. 

Hobbs' research interests in this area encompass stochastic electric power planning models, multi-objective and risk analysis, mathematical programming models of imperfect energy markets, environmental and energy systems analysis and economics, and ecosystem management.

Carsten investigates the fate of contaminants in the built and natural environment using state-of-the-art analytical chemistry techniques (e.g. high-resolution mass spectrometry) with the focus on identifying transformation products and understanding underlying mechanisms of transformation in the urban water cycle.

Schwab's current research projects involve investigating innovative water reuse treatment options as well as improving environmental detection methods for noroviruses (the leading cause of non-bacterial gastroenteritis worldwide). He is also working with Hopkins colleagues to integrate mobile data collection to assess family planning along with water, sanitation and hygiene around the world.

The focus of Dr. Sillé's research is understanding the effects of environmental exposures on the development and function of our immune system. Her major research directions are:

1. Understanding the long-term effects of early-life arsenic exposures on immunity and (infectious) disease risk. - Currently studying the interaction between arsenic and tuberculosis,

2. Establishing an integrated platform for immunotoxicity testing of early-life chemical exposures,

3. Investigating the effects early-life exposures on immunological memory and vaccine efficacy.

Stone has studied chemical reactions at nanoparticle/water interfaces for more than 25 years. Synthetic chemicals directly added to environmental media merit special attention, i.e. chemicals used in agriculture, animal production, forestry, and aquaculture, as large volumes of water are used for cooling, paper-making, and water supply. He researches how natural constituents found in such waters interact with treatment chemicals. 

*Denotes faculty who are accepting PhD students.

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

• View all journals
• Explore content
• About the journal
• Publish with us
• Sign up for alerts
• Published: 11 May 2020

Rethinking water for SDG 6

• Claudia W. Sadoff   ORCID: orcid.org/0000-0002-7354-563X 1 ,
• Edoardo Borgomeo   ORCID: orcid.org/0000-0002-8351-9064 2 , 3 &
• Stefan Uhlenbrook   ORCID: orcid.org/0000-0002-3926-2599 1 , 4  

Nature Sustainability volume  3 ,  pages 346–347 ( 2020 ) Cite this article

3673 Accesses

90 Citations

3 Altmetric

Metrics details

• Civil engineering
• Water resources

The world is not on track to achieve Sustainable Development Goal 6 on clean water and sanitation by 2030. We urge a rapid change of the economics, engineering and management frameworks that guided water policy and investments in the past in order to address the water challenges of our time.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Not all risks are equal: a risk governance framework for assessing the water SDG

• Johanna Karolina Louise Koehler

International Environmental Agreements: Politics, Law and Economics Open Access 01 June 2023

Super-bridging fibrous materials for water treatment

• Mathieu Lapointe
• , Heidi Jahandideh
•  …  Nathalie Tufenkji

npj Clean Water Open Access 11 April 2022

National water shortage for low to high environmental flow protection

• Davy Vanham
• , Lorenzo Alfieri
•  &  Luc Feyen

Scientific Reports Open Access 22 February 2022

Access options

Access Nature and 54 other Nature Portfolio journals

Get Nature+, our best-value online-access subscription

24,99 € / 30 days

cancel any time

Subscribe to this journal

Receive 12 digital issues and online access to articles

111,21 € per year

only 9,27 € per issue

Buy this article

• Purchase on Springer Link
• Instant access to full article PDF

Prices may be subject to local taxes which are calculated during checkout

Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment (World Health Organization, 2015).

Onda, K., LoBuglio, J. & Bartram, J. Int. J. Environ. Res. Public Health 9 , 880–894 (2012).

Article   Google Scholar  

Langford, M. & Winkler, I. J. Hum. Dev. Capabil. 15 , 247–260 (2014).

Herrera, V. World Dev. 118 , 106–117 (2019).

The United Nations World Water Development Report 2019: Leaving No One Behind (UNESCO World Water Assessment Programme, 2019).

Sachs, J. D. et al. Nat. Sustain. 2 , 805–814 (2019).

Fukuda-Parr, S. & McNeill, D. Glob. Policy 10 , 5–15 (2019).

Davis, K., Fisher, A., Kingsbury, B. & Merry, S. E. (eds) Governance by Indicators: Global Power Through Classification and Rankings (Oxford Univ. Press, 2004).

Sustainable Development Goal 6 Synthesis Report 2018 on Water and Sanitation (United Nations, 2018).

Ortigara, A. R. C., Kay, M. & Uhlenbrook, S. Water 10 , 1353 (2018).

Kochhar, K. et al. IMF Staff Discussion Note SDN/15/11 (IMF, 2015).

O’Donnell, E. L. & Talbot-Jones, J. Ecol. Soc. 23 , 7 (2018).

Garrick, D. E., Hanemann, M. & Hepburn, C. Oxf. Rev. Econ. Policy 36 , 1–23 (2020).

Hope, R., Thomson, P., Koehler, J. & Foster, T. Oxf. Rev. Econ. Policy 36 , 171–190 (2020).

Smith, D. M. et al. Adaptation’s Thirst: Accelerating the Convergence of Water and Climate Action. Background Paper prepared for the 2019 report of the Global Commission on Adaptation (Global Commission on Adaptation, 2019).

Borgomeo, E., Mortazavi-Naeini, M., Hall, J. W. & Guillod, B. P. Earth’s Future 6 , 468–487 (2018).

Quinn, J. D., Reed, P. M., Giuliani, M. & Castelletti, A. Water Resour. Res. 53 , 7208–7233 (2017).

Download references

Author information

Authors and affiliations.

International Water Management Institute (IWMI), Colombo, Sri Lanka

Claudia W. Sadoff & Stefan Uhlenbrook

Environmental Change Institute, University of Oxford, Oxford, UK

Edoardo Borgomeo

Food and Agriculture Organization of the United Nations (FAO), Rome, Italy

IHE Delft, Institute for Water Education, Delft, Netherlands

Stefan Uhlenbrook

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Edoardo Borgomeo .

Rights and permissions

Reprints and permissions

About this article

Cite this article.

Sadoff, C.W., Borgomeo, E. & Uhlenbrook, S. Rethinking water for SDG 6. Nat Sustain 3 , 346–347 (2020). https://doi.org/10.1038/s41893-020-0530-9

Download citation

Published : 11 May 2020

Issue Date : May 2020

DOI : https://doi.org/10.1038/s41893-020-0530-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

This article is cited by

A bio-based nanofibre hydrogel filter for sustainable water purification.

• Meihui Jiang
• Chuyan Jing

Nature Sustainability (2024)

International Environmental Agreements: Politics, Law and Economics (2023)

Making China’s water data accessible, usable and shareable

• Brett A. Bryan
• Zhifeng Yang

Nature Water (2023)

• Lorenzo Alfieri

Scientific Reports (2022)

• Heidi Jahandideh
• Nathalie Tufenkji

npj Clean Water (2022)

Quick links

• Explore articles by subject
• Guide to authors
• Editorial policies

Sign up for the Nature Briefing: Anthropocene newsletter — what matters in anthropocene research, free to your inbox weekly.

Advertisement

Attainment of water and sanitation goals: a review and agenda for research

• Original Article
• Published: 23 August 2022
• Volume 8 , article number  146 , ( 2022 )

Cite this article

• Sanjeet Singh   ORCID: orcid.org/0000-0001-6103-2346 1 , 2 &
• R. Jayaram 2  

5605 Accesses

4 Citations

1 Altmetric

Explore all metrics

One-fourth of the global population is without basic drinking water and half of the global population lacks sanitation facilities. The attainment of water and sanitation targets is difficult due to administrative, operational, political, transborder, technical, and policy challenges. Conducted after 5 years from the adoption of sustainable development goals by the United Nations reviews the initiatives for improving access, quality, and affordability of water and sanitation. The bibliometric and thematic analyses are conducted to consolidate the outcomes of scientific papers on sustainable development goal 6 (SDG 6). Africa is struggling in relation with water and sanitation goals, having 17 countries with less than 40% basic drinking water facilities and 16 countries with less than 40% basic sanitation facilities. Globally, the attainment of water and sanitation goals will be depended on economic development, the development of revolutionary measures for wastewater treatment, and creating awareness related to water usage, water recycling, water harvesting, hygiene, and sanitation. Behavioral changes are also required for a new water culture and the attainment of water and sanitation goals by 2030.

Similar content being viewed by others

The Sustainable Development Goal on Water and Sanitation: Learning from the Millennium Development Goals

The Human Right to Water and Sanitation: Reflections on Making the System Effective

Water for all: Exploring determinants of safe water access in developing regions

Avoid common mistakes on your manuscript.

Introduction

The world is rapidly moving towards a global water crisis (United Nations Department of Economic and Social Affairs, 2014 ). In this background, the “Water Action Decade” (2018–2028) has been initiated by UN General Assembly (United Nations Organisation-Sustainable Development Goals, 2021 ). Sustainable Development Goal (SDG) 6 aims at ensuring clean water and sanitation for all. According to the United Nations Department of Economic and Social Affairs (UN DESA), 2 billion people are struggling for safe drinking water; 4 billion people for sanitation requirements, and 3 billion people are facing challenges for basic hand wash facilities (United Nations Department of Economic and Social Affairs, 2021 ). Six billion people are in the practice of open defecation (UN-Regional Information Centre for Western Europe, 2021 ). A study on Global water status by UN-Water (2020–21) points out that 26% of the world population are struggling for drinking water, 46% for sanitation, and 44% of households are without proper wastewater treatment (United Nations, 2021 ). Anthropogenic wastewater can create serious concern on life on land and water bodies (López-Pacheco et al., 2019 ). The threat of anthropogenic wastewater and lagging performance in this respect is a serious threat to humanity.

The SDG 6 involves 8 targets and 11 indicators, focusing on clean and safe drinking water, reducing the open defecation practices, integrated water resource management by improvement of water quality; enhancing wastewater treatment, promoting water recycling, and eliminating all types of water wastages. The other targets of SDG 6 involve transboundary water co-operations; protection and restoration of water-related ecosystems; local community participation and building networks for the attainment of water and sanitation goals.

A country-wise analysis into the attainment of SDG 6 by Sustainable Development Report 2021 of the Cambridge University Press (Sachs et al., 2021 ) indicates a serious water crisis among African countries. Eight African countries are with less than 50% of basic drinking water facilities and 15 countries are in the categories below 60% attainment (SDG Index. Org 2021 ). The report exhibits that the average per capita GDP of poorly performing African countries is 762 dollars and the average share of agriculture in GDP is 28.46%. This points out the need for reducing excessive dependence on agriculture, improving economic activities, per capita GDP, and investments in African regions. Sanitation is another challenge in achieving the targets of SDG 6. Both Asian and European countries are on the way to attain sanitation goals. Twelve Asian countries and four South American countries are lagging in their performance related to sanitation goals. The African region is facing severe challenge in providing basic sanitation facilities to its citizen, especially 12 African countries are with below 20% attainment of basic sanitation facilities. Twenty-two countries are successful in providing basic sanitation to the entire population of the country. The average per capita GDP of these countries is 46460 dollars and the percentage of agriculture GDP in gross GDP is 3.19% (United Nations Organisation- Sustainable Development Goals, 2021 ). Seven European countries and Singapore have attained reasonable progress in creating proper facilities for the treatment of anthropogenic wastewater. The average per capita GDP of these countries is 64,560 dollars and the share of agriculture in gross GDP is 2.42%. Fifty countries are without any facilities for proper treatment for anthropogenic wastewater. Sixteen leading countries (countries providing basic sanitation, drinking water, and treatment for anthropogenic wastewater to at least 90% of the population) represent 3.71% of the global population. These countries has an average per capita GDP of 58,209 dollars; average per capita exports of 19,020 dollars; share of exports on GDP stood at 32.76% and share of agriculture in GDP is 2.98% (United Nations Organisation- Sustainable Development Goals, 2021 ). The leading economies like the United States of America, India, China, Japan, Brazil, France, Italy, and Canada are lagging in performance related to sanitation and treatment for anthropogenic wastewater. Urgent actions are needed for ensuring the provision for the treatment of anthropogenic wastewater. Any delay in performance of ensuring treatment for anthropogenic wastewater can negatively affect the access and quality of drinking water and can be a costly and dangerous choice for the goals of safe drinking water and sanitation of future generations (Bondur and Grebenuk, 2001 ; Gelsomino et al., 2006 ; Abdesselem et al., 2012 ). The comparison of ten countries, leading in GDP and performance of SDG 6 is shown in Fig.  1 .

Comparative performance of top 10 economies. Source: Sustainable Development Report 2021

Forty-six countries are outside the 80–100 bracket of achievement of ensuring basic drinking water provisions. Out of the 46 poorly performing countries, 28 countries are in the 60–80 bracket of achievement; 17 countries on the 40–60 bracket; and Chad is in the range of 20–40% achievement. 71 countries are outside the 80–100 bracket of achievement of ensuring basic sanitation provisions. 20 countries are in the 60–80 bracket; 16 countries are in the 40–60 bracket; 22 countries are in the 20–40 bracket and 13 countries are in 0–20 bracket of achievement.

These inequalities in the attainment of basic services of water and sanitation are alarming and smart initiatives towards sanitation goals are essential. The underdevelopment of economic activities, poor per capita GDP, poor per capita exports, and over dependencies in agriculture can be the major causes for the difference in the achievement of water and sanitation goals. The difference in culture, education, and skills, traditions, and habits may also be influential factors for the same.

The existing literature mainly concentrated on efforts to improve access, quality, and affordability of water. Several articles focused on challenges for achieving water and sanitation goals. The findings of this paper can be useful for academicians and scholars for researching SDG 6.

Future empirical studies are essential for concrete proof of the influence of the above factors on the attainment of water and sanitation goals. The analysis and discussion on SDG 6 are very important for the timely achievement of water and sanitation goals by 2030.

Research objectives

To understand the global status of achieving targets of SDG 6.

To consolidate the literature related to SDG 6 from the database of Web of Science.

To develop research themes for future research.

Research questions

What are the challenges for achieving the targets of SDG 6?

What are the initiatives for achieving the targets of SDG 6?

What is the indicator-wise performance of countries on achieving SDG 6?

This paper recommends research on the water and sanitation crisis faced by African countries. Further research can also be on measures for improving quality, access, and affordability for water and sanitation. Research can also be on solutions for problems and challenges faced in ensuring basic drinking water and sanitation for people across the world. The successful models and implementation strategies of leading nations can provide valuable insights for better implementation of policies and schemes. The policymakers and administrators can develop strategies for meeting various challenges associated with SDG 6, especially the challenges associated with the treatment of anthropogenic wastewater. Reforms of the industrial environment, investments, innovative technologies, strong political will, and leadership are essential for achieving the goals of anthropogenic wastewater treatment.

This paper has been divided into six chapters. The introduction of SDG 6 and performance at the global level is included in the first section. The review methodology and the major themes and sub-themes are discussed in the second section. Bibliometric results are discussed in the third section and a thematic analysis by rapid review is the fourth section of this paper. The future agenda for research is the fifth section and the conclusion of the paper is presented in the sixth section.

Review methodology

This review on SDG 6 is based on a single-source, Web of Science. Web of Science provides access to multiple databases, covering about 79 million records and 171 million platforms. Moreover, it covers over 256 disciplines. This single-source was used as it is one of the biggest databases of scientific papers and journals on sustainability and SDGs. The single-source-based model is successfully used in the review related to “Variations of the Kanban system” (Lage Junior and Godinho Filho, 2010 ); “review on environmental training in organisations” (Jabbour, 2013 ); and “systematic review on sustainable investments” (Talan and Sharma, 2019 ). The review frameworks and structure of this paper are adopted from the above three inspirational reviews, based on a single data source. Moreover, the review structure, and model adopted in the rapid review on “COVID-19 and Environmental Concerns” (Gagan Deep Sharma et al . , 2020 ) is another motivation behind design and structure of this review. The keywords "Sustainable Development Goal 6" and "SDG 6" are used on 01/07/2021 for drawing papers. 234 papers are obtained on the first query and used for the review. Thematic analysis was conducted after reading the title, abstract, and details. The details of paper selection are highlighted in Fig.  2 . This paper has followed PRISMA guidelines for paper selection. The criteria for paper and journal selection are that, it should be dealing with water and sanitation-related SDGs and the paper should be written after the introduction of sustainable development goals. This paper has conducted a bibliometric review and rigorous and rapid thematic analysis. Relevant papers of any country are included in this study, and there are no inclusion and exclusion criteria for selecting papers on the basis of country but done on the basis of relevance with the topic.

Paper identification and screening process

Bibliometric analysis was conducted on selected papers. The details of the bibliometric analysis are described in the following paragraphs.

Journal analysis

The source analysis of the leading nine journals is shown in Fig.  3 . The journals are analyzed by h-index, g-index, and m-index, highlighting the source impact. “Science of the Total Environment” published articles related to water quality monitoring using citizen science, global water scarcity, microbial contamination in drinking water, water governance, seasonal drinking water quality, potential solutions for water security, inequality in access of water, water stress indicators, water crisis, and SDG 6 targets in Africa. “Water” focuses on water access, water supply networks, surface water extraction, groundwater vulnerability, integrated water resource management, water governance, water collecting systems, sanitation, fog water collection, remote-sensing technologies, water footprints, and domestic demand and supply of water. The themes published in “Sustainability” are related to water supply networks, use of citizen science monitoring for water-related goals, access to sanitation, citizen and educational initiatives, water supply tariffs, water service sustainability, cross country water co-operations, and water quality governance. The “Journal of Environmental Management” took interest in publishing topics related to fecal sludge management, sanitation, citizen science in sanitation, and water treatment systems. “Journal of Cleaner Production” published on industrial wastewater, groundwater quality, rainwater harvesting, smart waste management systems, and impact of urbanization on water infrastructure. The major themes published in “Journal of Water, Sanitation and Hygiene for Development” are hygiene in healthcare facilities, application of decision support system for attaining water and sanitation targets, urban sanitation, water quality, shared sanitation, toilet waste management, access and affordability of water, and need for behavioral changes for attaining water and sanitation targets. The topics published in “International Journal of Environmental Research and Public Health” are related to drinking water and health; sanitation and solid waste management. Fecal pathogen flow and health risks, and innovative sources for clean water are the topics published on the “International Journal of Hygiene and Environmental Health”. The major works on water and sanitation goals in the journal “Applied Sciences-Basal” are related to soil aquifer treatments, rural water supply, groundwater salinity, and fluoride content in groundwater.

Top journals and source impact

Analysis of authors

Kalin Robert M (University of Strathclyde, Scotland) is the leading researcher on topics related to SDG 6. Twelve documents (all 12 documents are open access) have been written by this author on topics related to SDG 6, with a total of 50 citations and an average citation of 4.17. These 12 documents are published in the years 2021 (2 articles), 2020 (7 articles), and 2019 (2 articles). The h-index of these articles is four. The other influential author of this research domain is Rivett Michael O (University of Strathclyde, Scotland). The author has written nine articles (all 9 documents are open access) with a total citation of 41 and an average of 4.6 citations per article. These nine articles are published in 2021 (2 articles), 2020 (4 articles), and 2019 (3 articles). The h-index of these articles is four.

Both the authors had co-authored nine articles. Four articles had been published in the journal “Water” and obtained 18 citations. The articles in “Water” dealt with groundwater vulnerability (Addison et al., 2020a , b ), integrated water resource management (Banda et al., 2019 ; Banda et al., 2020 ), and stranded asset-based investment strategies for SDG 6 (Kalin et al., 2019 ); three articles are on Applied Science-Basel and got six citations. The articles in this journal focused on focusing on sustainable rural water supply (Leborgne et al., 2021 ), groundwater salinity and rural water supply challenges (Rivett et al., 2020 ), and Human and health implications of Fluoride content in groundwater (Addison et al., 2020a , b ), one article on Sustainability are without any citations. The articles focused on the cost of sustainable water supply through network kiosks (Coulson et al., 2021 ) and the article published on Science of the Total Environment (17 citations). This article is related to salinity in aquifers and technologies beyond hand-pumps (Rivett et al., 2019 ).

The individual publications of Kalin Robert M include an article on rural water supply tariffs, published in the journal “Sustainability” with six citations (Truslove et al., 2020 ); one article each on Environmental Science Water Research Technology (1 citation) dealt with barriers to hand pump serviceability in Malawi (Truslove et al., 2020 ); and Journal of Hydrology Regional Studies (2 citations), article related to transboundary aquifers (Fraser et al., 2020 ).

Analysis of countries

The existing literature mainly focused on countries struggling with water and sanitation goals, especially African countries. The contribution of the top five countries has been evaluated on the parameters of several documents, funded documents, total citations, average citations, co-authorship links, and h-index in Fig.  4 . The research collaborations of countries are shown in Fig.  5 . The country collaboration map also shows the most prominent countries. The most prominent countries are in dark blue, and by this, the most influential countries are the United States of America and England. The United States of America is the most influential country in terms of document publications, citations, funded documents, co-authorship links, and h-index (Table 1 ).

Summary of contributions of top five countries on research related to SDG 6

Country collaboration map

Keyword analysis

The keyword analysis was shown in the conceptual structure map, as shown in Fig.  6 . The most prominent keywords are shown in sanitation (5 occurrences), water (3 occurrences), sustainable development goals (20 occurrences), SDG 6 (15 occurrences), water quality (5 occurrences), groundwater (7 occurrences), and drinking water (3 occurrences). The details of articles details and keywords are provided in the supplementary files.

Conceptual structure map

Scholarships

The leading funding agencies, offering sponsorship for research related to SDG 6 targets for basic drinking water, sanitation, and wastewater treatments are the UK Research Innovation (UKRI) of the United Kingdom, Bill Melinda Gates Foundation of the United States of America, and European Commission. UK Research Innovation (UKRI) of the United Kingdom funded projects on water quality, remote monitoring of water systems in rural areas, governance issues, seasonal drinking water quality, and water resources. Bill Melinda Gates Foundation of the United States of America funded projects on the fecal sludge management system, water quality, and sanitation. The funded projects of the European Union are related to industrial wastewater, ecosystem services, drinking water, sanitation, and crop-water productivity.

Thematic discussion

The major themes and sub-themes as shown in Fig.  7 have been described in this section. The major themes of research in SDG 6 are initiatives and challenges. The major niches for research on initiatives are the efforts for improving access, quality, and affordability. Similarly, the major sub-themes of research regarding challenges of SDG 6 are pollutants, transboundary contracts, politics, climate factors, open defecation, administrative challenges, operational challenges, and technical challenges.

Key themes, sub-themes, and associated keywords

Initiatives in favor of SDG 6 goals

Several initiatives has been researched and documented, towards the attainment goals of SDG 6. The initiative can be for improving access, quality, and affordability of clean water. These three concepts are taken as sub-themes under the initiatives in favor of SDG 6. There is positive news related to access to water, but the quality and affordability of water and sanitation remain a serious challenge and it defeats the objective of access to clean water (Coulson et al., 2021 ) (Mitlin and Walnycki, 2020 ). All these three factors are interlinked and should be existing for the successful attainment of SDG 6 (Diaz-Alcaide et al., 2021 ). Water and sanitation taxes, the density of population, revenue of the local government, and income of local people can also be crucial factors for the attainment of SDG 6 (Martinez-Cordoba et al., 2020 ). Similarly, active forums can play a significant role in the attainment of SDG 6 (Paerli and Fischer, 2020 ).

The SDG 6 should be achieved across all cross-sections of society including involuntarily displaced sections of society (Behnke et al., 2018 ). SDG 6 is heavily linked with health-related goals. The initiatives for quality health are related to the availability of clean water and sanitation goals (SDG 6). The prime focus should be on ensuring sanitation, cleanliness, and hygiene in healthcare facilities and proper waste management for prevention and control of infections (Torres-Slimming et al., 2019 ; Abu and Elliott, 2020 ; Abu et al., 2021 ). The improvement in the access and quality of water and sanitation services includes the development of an integrated water database, measuring the cost and affordability (Bressler and Hennessy, 2018 ).

Efforts for improving access

There are several challenges to ensuring access to clean water (Marshall and Kaminsky, 2016 ). One such challenge is the problems associated with fecal sludge management systems. Fecal sludge management is posing a severe threat to the goals of clean water and sanitation, which directly hinders the efforts for access to clean water and sanitation (Devaraj et al., 2021 ; Yesaya and Tilley, 2021 ). The major factors affecting access to clean water are collection time, distance from the household, water quality, affordability, and reliability of water sources, etc. (Diaz-Alcaide et al., 2021 ). The supply of water in the majority of places is intermittent water supply and has several challenges to provide complete access to clean water and achieving SDG 6. This points out the need for migration to a continuous supply of clean water and a hybrid hydraulic model in this regard was developed (El Achi and Rouse 2020 ).

The model of distribution is a challenge in the case of drinking water and the conflict on the model of distribution of water between formal and informal suppliers should be addressed with innovative hybrid models (Agbemor and Smiley, 2021 ). Alternative policies and partnership models would be the key to enhancing access to clean water. Replacement of public distribution models by community-based water supply models together with increased local monitoring of policies and implementations is recommended as a solution for improving access to clean water in Sub-Saharan Africa (Adams et al., 2019 ). A similar shift from the government-regulated water supply chain to unregulated systems is visible in the research outcomes (Fischer et al., 2020 ). The application of the decision support system for the selection of best water and sanitation technology can improve the access of clean water facilities and sanitation (Bouabid and Louis, 2021 ); similarly, the Earth observation and cloud computing for the attainment of SDG 6 targets (Li et al., 2020 ). The promotion of public standpipes, community boreholes, and household water treatments can be some measures towards access to clean and safe water (Abubakar, 2019 ). Rainwater harvesting can be a suitable and economical alternative for improving access to clean water (Dao et al., 2017 ; Alim et al., 2020 ; Bui et al., 2021 ).

The key water management strategies recommended for improving access to water are importing virtual water; water reallocation; strengthening of law and integrated basin management, creation of water market and wastewater network and treatment facilities, and reusing wastewater (Banihabib et al., 2020 ). The other suggestions for improving access for water are water foot prints (Berger et al., 2021 ); integrated water resource management and fresh water health index (Bezerra et al., 2021 ); shared sanitation (Foggitt et al., 2019 ); aquifer recharge and treatment measures (Gronwall and Oduro-Kwarteng, 2018 ); asset audit and using stranded assets for ensuring access of water (Kalin et al., 2019 ); fog water collections is an alternative strategy for improving the access for clean water (Lucier and Qadir, 2018 ; Qadir et al., 2018 ); however, the main challenges in fog water harvesting are lack of expertise, support, affordability, and inequalities (Qadir et al., 2018 ); water service franchising and distribution of bottled water (Walter et al., 2017 ; Lyne, 2020 ); rain water harvesting, water treatment, better distribution and water recharging (Udmale et al., 2016 ); desalination and wastewater reuse (Van Vliet et al., 2021 ); use of smart pumps can enhance the usage and monitoring of water sources and thereby move close towards the goal of improving access for clean water (Swan et al., 2018 ).

Efforts for improving quality and affordability

A framework for water quality and usage monitoring is developed (Charles et al., 2020 ). Similarly, water quality indices can be used for improving the quality of water by restricting the pollutants in water (Bouhezila et al., 2020 ); a scorecard is developed for monitoring the major dimensions of access, availability, quality, acceptability, and affordability of clean water sources (Ezbakhe et al., 2019 ).

A study covering 63% of green star hotels in Egypt had claimed that green hotel practices like energy saving, optimized water consumption, waste management, and waste reduction can positively contribute to the attainment of SDG 6. This can significantly improve the quality of drinking water (Abdou et al., 2020 ). Water quality monitoring is a major challenge (Cronin et al., 2017 ). Appropriate measures for reduced discharge of untreated pharmaceutical contents in wastewater and better treatment of the same can be some measures towards improving the quality of water and waste management (Acuna et al., 2020 ). The use of citizen science can be a strong alternative for efficient monitoring of SDG 6 and thereby quality improvement economically and conveniently (Bishop et al., 2020 ; Capdevila et al., 2020 ; Fraisl et al., 2020 ; Freihardt, 2020 ; Hegarty et al., 2021 ).

The other measures for improving water quality include monitoring sanitation progress through total service gap (Kempster and Hueso, 2018 ); rural–urban water link, wastewater treatment, and reuse, efficient water quality monitoring, innovative ways of fecal management, and change in community behaviors (Kookana et al., 2020 ); local groundwater balance model for groundwater monitoring (Lopez-Maldonado et al., 2017 ); chlorination of drinking water at the point of the collection can be some measures towards the quality improvement of water (Pickering et al., 2019 ); policy implementation, proper monitoring, and data management are key to improvement of quality (Roy and Pramanick, 2019 ); monitoring, treatment, and education and training of water-related technology (Sogbanmu et al., 2020 ).

The issue of affordability of clean water is closely connected with water-related emotional distress. Research has found that emotional challenges can be developed due to poor affordability to water, despite the access and quality (Thomas and Godfrey, 2018 ).

Challenges for the attainment of SDG 6

Several studies across the globe have identified the challenges for access to safe and clean water; clean water, sanitation, and hygiene are in heavily associated with health-related goals (Anthonj et al., 2018 ).

Challenges associated with pollutants, transboundary contracts, climate, open defecation, and politics

The major challenge for the attainment of SDG 6 can be untreated pharmaceutical contents in wastewater (Acuna et al., 2020 ). The discharge of untreated pollutants to water can be a serious threat to access and quality of water (Bouhezila et al., 2020 ). The other challenges associated with pollutants can be a high concentration of fluoride content in weathered basement aquifers, which increases the risk of dental fluorosis (Addison et al., 2020a , b ; Banda, et al., 2020 ); increased levels of Cadmium and Chromium in water sources can also pollute the water sources and increase the risk of non-communicable disease like cancer (Ahmed and Bin Mokhtar, 2020 ); nitrate and phosphate levels can pollute the water (Hegarty et al., 2021 ). The salinity of the water is a major challenge for clean water (Rivett et al., 2019 ; Rivett et al., 2020 ); contamination of water resources through human and animal fecal matter (Buckerfield et al., 2020 ); E. coli contamination (Usman et al., 2018 ; Charles et al., 2020 ) chlorine content, usage of latrine waste as fertilizer and wastewater discharge (Mraz et al., 2021 ); nitrogen and phosphorous content (Van Puijenbroek et al., 2019 ). The fecal contamination, poor sanitation services, and the presence of no fecal matter in fecal sludge (Hurd et al., 2017 ; Quarshie et al., 2021 ).

Politics is an important determinant in ensuring access to clean water, especially in tension-laden areas. The relations of Palestine and Israel can be crucial in the attainment of SDG 6 goals in Palestine (Al-Shalalfeh et al., 2018 ). Hydro-political risks are another issue affecting the SDG 6 and strong transboundary co-operations are essential for the peaceful access of water in the future (Farinosi et al., 2018 ; Hussein et al., 2018 ; Wright-Contreras, 2019 ; Fraser et al., 2020 ; Jimenez et al., 2020 ; Strokal, 2021 ; Yalew et al., 2021 ). Unfavorable climatic factors are major challenges to water and sanitation-related goals (Hurd et al., 2017 ; Fleming et al., 2019 ; Darwish et al., 2021 ). Negative environmental impacts and population pressures are serious threats for SDG 6 (Salmoral et al., 2020 ). Open defecation is a serious challenge for SDG 6, and the major factors promoting open defecation are found to be the poor promotion of programs at the field level, intimidation of adults, and lack of support in families (Akov and Satwah, 2019 ).

Administrative, technical, and operational challenges

Integrated water resource management is the key to the successful attainment of SDG 6. Despite best efforts for improving access and quality of water, ensuring an integrated water management system is still a challenge (Al-Noaimi, 2020 ). The other administrative challenges can be poor water management and investments, corruption (Adams et al., 2019 ); poor institutional capabilities and fear of failure in monitoring (Rayasam et al., 2020 ) infrastructure-related challenges, and funding and policy challenges (Nhamo et al., 2019 ; Romano and Akhmouch, 2019 ).

The major technical and operational challenges can be the unprotected sources of water and poor coverage of piped water connections (Usman et al., 2018 ; Abubakar, 2019 ). Scarcity of water, rapidly growing populations, unsustainable development, poor management in the usage of water, lack of technical, financial, and institutional performances (Al-Noaimi, 2020 ). Another serious issue to be addressed is the inequality in access to drinking water (Anthonj et al., 2020 ). The issues of capacity shortages and poor law enforcement (Darwish et al., 2021 ); poor accountability and complex governance structure (Gronwall, 2016 ); administration challenges, conflicting goals of other indicators, challenges in local implementation of global goals (Herrera, 2019 ).

The other technical issues include the unaffordability of water and poor coordination of responsibilities (Jama and Mourad, 2019 ); poor latrine constructions and seasonal flooding (Jewitt et al., 2018 ); political will, poor economic background, poor environmental and manpower development, attitude and lack of will of administrative and legislative systems; and poor technological tools are challenges proper water governance (Mycoo, 2018 ); technical, scale and operational efficiencies of water utilities are a serious challenge for goals of clean water (Ngobeni and Breitenbach, 2021 ); installation failures, damages, poor maintenance, non-availability of spare parts and affordability issues and financial constrains (Truslove et al., 2020 ; Coulson, et al., 2021 ); issues associated with poor infrastructure (Udmale et al., 2016 ); affordability, markets, and behavior are the strongest barriers for attainment of SDG 6 (Wight et al., 2021 ) The poor human development, capacity challenges for monitoring sanitation and lack of sufficient data for monitoring and wrong conclusions are creating challenges for SDG 6 (Rahaman et al., 2021 ; Komakech et al., 2019 ; Kirschke et al., 2020 ); behavioral issues, barriers, and habits are posing severe threat to attainment of SDG 6 goals (Mathew et al., 2020 ).

Research suggestions

By reviewing the existing literature, future research can be on improving access, affordability, and quality of drinking water provisions and sanitation. The research on wastewater treatment is an unexplored area. More, specifically, the future research can be in drinking water provisions of African countries; sanitation provisions of African and low-income countries, and the research can be in the wastewater treatment provisions of any countries except a few, those had attained the targets. The detailed agenda for future research has been included in the following section.

Future research agenda

The existing literature points out the various ways of water wastage and pitfalls in water distribution. This badly affects the access to clean drinking water provisions. Future research can be for various methods for improving access to clean water by controlling wastage of water and improving water supply chains. Several studies had been country-based and the wider acceptance of those concepts and theory validation can be done by extending those country-based studies to similar countries facing challenges on clean water. Future research can be on reducing discharge pollutants, innovative solutions for facilitating treatment for anthropogenic wastewater. Future research can also be on measures for reducing these pollutants and initiating policy measures, the scope for technology changes to control the water pollution.

Research on behavioral changes, affordability, and awareness can be conducted to stop the open defecation practices. Future research can be on developing awareness programs, hygiene and sanitation camps. Empirical studies on the role of education and economic development in solving water and sanitation goals can throw light on the connection between literacy, exports, income, and other related variables on the achievement of water and sanitation goals.

Research can be on international politics and transboundary contracts for improving accessibility to water. The policy initiatives for peaceful contracts, improving the proportion of transboundary contracts can be the future actions for the sustainability of water sources.

The water and sanitary goals are at the mercy of climate in many places. This condition should be changed and future research can be developing climate-resistant initiatives and policies for water security and sanitation. Proper policy initiatives and reform models can be developed in the future to tackle several administrative, technical, and operational challenges. Future research can be for solutions for challenges and constraints related to funding, technology, and skill management associated with water and sanitation goals.

Several technological solutions and innovative strategies for water and sanitation improvement has been documented in the existing literature and future research can be on techno-economic feasibility and practicality in solving the challenges associated with SDG 6. Researches can also be on industrial adaptability to these technological changes. The highlights of the future agenda for research are shown in Fig.  8 .

Conclusions

Access to clean and safe drinking water, sanitation, and proper hygiene are very essential for sustainable living. However, a significant section of the global population is outside the basic facilities for drinking water, sanitation, and hygiene. SDG 6 focuses on the targets of ensuring basic drinking facilities, sanitation, and treatment facilities for wastewater for all. This paper has been tailored to understand the status of water and sanitation-related targets of SDG 6 by consolidating the literature from Web of science and other external sources. Both thematic analysis and bibliometric analysis of existing literature on SDG 6 have been conducted and the future scope for research is discussed. This research on the status of water and sanitation-related goals has found that the provision for drinking water had been reached to the majority of the global population except in few countries of the African region. The poor achievement of targets related to the treatment of wastewater and sanitation is also a global concern.

Even though the implementations are at the country level, this paper invites the need for global attention for solving the challenges of poorly performing regions, especially the African continent, which struggles for provisions of water, sanitation, and wastewater treatment. Out of 54 countries in the continent, 45 countries are lagging to provide basic drinking water solutions. In the case of sanitation, there are 13 countries where more than 70% of the population are outside the provisions for basic sanitation facilities. Similarly, there are 16 African countries with provision of wastewater treatment below 2%. The Asian countries are relatively better performing in respect of providing provisions for drinking water, except Afghanistan and Yemen. Thirteen Asian countries are struggling for providing basic sanitation facilities for the population. All Asian countries except Israel, Bahrain, and Singapore are well behind in the achievement of providing proper facilities for the treatment of anthropogenic wastewater. All the European countries are in above 75% achievement brackets in respect of provisions for basic drinking water facilities and basic sanitation facilities. The 18 European countries are in the 80–100 achievement bracket and the remaining 26 countries are lagging in respect of providing basic provisions for the treatment of anthropogenic wastewater. All the North American and Latin American countries are in 80–100 brackets in providing provisions for basic drinking water and in respect of sanitation, except Bolivia (60.7% achievement) and Nicaragua (74.4% achievement). However, the performance of North American and Latin American countries in providing provisions for wastewater treatment is not robust except Chile (71.9%) and Canada (67.4).

The underachievement of targets related to wastewater treatment is still a global concern except for a few countries. What are the challenges and reasons for this underachievement of water and sanitation goals? This review of scientific papers from the Web of Science database points out the major challenges as water and sanitation taxes, high density of population, resource constraints of local government, poor fecal sludge management practices, long wait for collecting water, pollutants and poor wastewater treatment, transboundary contracts and politics, climatic factors, open defecation, and administrative, technical, and operational challenges.

The literature provides several solutions to water and sanitation targets by engagement of active forums; use of integrated water database; recharging and treatment of; decision support systems; rainwater harvesting; desalination and wastewater reuse; smart pumping; water reallocation; strengthening of law and integrated basin management, creation of water market and wastewater network; asset audit; fog water collections; and chlorination of drinking water.

The outcomes of this paper can be a strong motivation for developing policies for the improvement of skill sets and education of the local population, which can economically empower the poor and enhance their affordability to water and sanitation solutions. Similarly, the awareness related to sanitation, hygiene, water recycling, need for reducing water consumption, and preservation are inevitable in inculcating a new culture among people. Moreover, this paper recommends strengthening the water and sanitation supply chain by streamlining water distribution, reducing wastages, and scientifically treating the wastewater. The performance of global economies towards the treatment of anthropological wastewater is discouraging. Strong policy actions based on research should be initiated to improve the provisions for the treatment of anthropological wastewater. Academicians and scholars can use the outcomes of this paper for enhancing their research networks and developing new themes for research. This paper had recommended several thematic, methodological, and policy propositions for the attainment of sustainable development goal 6-related targets by 2030. The future themes specified in this paper can be used for taking scholarships and funded projects related to water, sanitation, hygiene, and sustainability of water resources.

Scholarships and funded projects can be targeted in the research related to providing solutions for anthropological wastewater treatment, technologies, implementation plans, and associated policy reforms. Future research should consider the avoidable challenges and develop inclusive reforms by taking care of all stakeholders. Scholars can focus on the African continent and some pockets of Asia and Latin America, the regions faced by acute shortage for drinking water and sanitation. Future projects can be on the solutions for improving access, affordability, and improving quality of basic provisions for water and sanitation. Minor projects can also be on the achievement strategies on drinking water and sanitation by European and North American countries.

The research outcomes of this paper should be read along with the limitations of using secondary sources. Similarly, the scope for future research and scholarships are not offers but the outcomes of thematic and bibliometric analysis.

Abdesselem K et al (2012) Wastewater discharge impact on groundwater quality of Béchar city. An anthropogenic activities mapping approach, Southwestern Algeria. Procedia Eng. https://doi.org/10.1016/j.proeng.2012.01.1200

Article   Google Scholar  

Abdou AH, Hassan TH, El Dief MM (2020) A description of green hotel practices and their role in achieving sustainable development. Sustainability. https://doi.org/10.3390/su12229624

Abu TZ, Elliott SJ (2020) When it is not measured, how then will it be planned for? WASH a critical indicator for universal health coverage in Kenya. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph17165746

Abu TZ, Elliott SJ, Karanja D (2021) When you preach water and you drink wine’: WASH in healthcare facilities in Kenya. J Water Sanit Hyg Dev. https://doi.org/10.2166/washdev.2021.238

Abubakar IR (2019) Factors influencing household access to drinking water in Nigeria. Utilit Policy 58:40–51. https://doi.org/10.1016/j.jup.2019.03.005

Acuna V et al (2020) Management actions to mitigate the occurrence of pharmaceuticals in river networks in a global change context. Environ Int. https://doi.org/10.1016/j.envint.2020.105993

Adams EA, Sambu D, Smiley SL (2019) Urban water supply in Sub-Saharan Africa: historical and emerging policies and institutional arrangements. Int J Water Resour Dev 35(2):240–263. https://doi.org/10.1080/07900627.2017.1423282

Addison MJ, Rivett MO, Phiri P, Mleta P, Mblame E, Banda M et al (2020a) Identifying groundwater fluoride source in a weathered basement aquifer in Central Malawi: human health and policy implications. Appl Sci Basel. https://doi.org/10.3390/app10145006

Addison MJ, Rivett MO, Phiri P, Mleta P, Mblame E, Wanangwa G et al (2020b) Predicting groundwater vulnerability to geogenic fluoride risk: a screening method for Malawi and an opportunity for national policy redefinition. Water. https://doi.org/10.3390/w12113123

Agbemor BD, Smiley SL (2021) Tensions between formal and informal water providers: receptivity toward mechanised boreholes in the Sunyani west district, Ghana. J Dev Stud 57(3):383–399. https://doi.org/10.1080/00220388.2020.1786059

Ahmed MF, Bin Mokhtar M (2020) Assessing cadmium and chromium concentrations in drinking water to predict health risk in Malaysia. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph17082966

Akov T, Satwah S (2019) Children unwelcome—socio-physical study of children’s community toilets usage in Mumbai’s slums. Eur J Sustain Dev 8(3):20–30. https://doi.org/10.14207/ejsd.2019.v8n3p20

Alim MA et al (2020) Feasibility analysis of a small-scale rainwater harvesting system for drinking water production at Werrington, New South Wales, Australia. J Clean Prod. https://doi.org/10.1016/j.jclepro.2020.122437

Al-Noaimi MA (2020) SDG goal 6 monitoring in the Kingdom of Bahrain. Desalin Water Treat 176:406–427. https://doi.org/10.5004/dwt.2020.25552

Al-Shalalfeh Z, Napier F, Scandrett E (2018) Water Nakba in Palestine: sustainable development goal 6 versus Israeli hydro-hegemony. Local Environ 23(1):117–124. https://doi.org/10.1080/13549839.2017.1363728

Anthonj C et al (2018) Health risk perceptions are associated with domestic use of basic water and sanitation services-evidence from rural Ethiopia. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph15102112

Anthonj C et al (2020) Geographical inequalities in drinking water in the Solomon Islands. Sci Total Environ. https://doi.org/10.1016/j.scitotenv.2019.1115241

Banda LC et al (2019) Water-isotope capacity building and demonstration in a developing world context: isotopic baseline and conceptualization of a Lake Malawi catchment. Water (switzerland). https://doi.org/10.3390/w11122600

Banda LC et al (2020) Seasonally variant stable isotope baseline characterisation of Malawi’s shire river basin to support integrated water resources management. Water. https://doi.org/10.3390/w12051410

Banihabib ME et al (2020) Prioritization of sustainable water management strategies in arid and semi-arid regions using swot coupled ahp technique in addressing SDGs. Acta Sci Pol Form Circum 19(2):35–52

Behnke N et al (2018) Improving environmental conditions for involuntarily displaced populations: water, sanitation, and hygiene in orphanages, prisons, and refugee and IDP settlements. J Water Sanit Hyg Dev 8(4):785–791. https://doi.org/10.2166/washdev.2018.019

Berger M et al (2021) Advancing the water footprint into an instrument to support achieving the SDGS—recommendations from the “Water as a global resources—research initiative (GRoW). Water Resour Manag 35(4):1291–1298. https://doi.org/10.1007/s11269-021-02784-9

Bezerra MO et al (2021) Operationalizing integrated water resource management in Latin America: insights from application of the freshwater health index. Environ Manag. https://doi.org/10.1007/s00267-021-01446-1

Bishop IJ et al (2020) Citizen science monitoring for sustainable development goal indicator 6.3.2 in England and Zambia. Sustainability. https://doi.org/10.3390/su122410271

Bondur VG, Grebenuk YV (2001) Remote indication of anthropogenic influence on marine environment caused by depth wastewater plum: modeling, experiments. Issledovanie Zemli Iz Kosmosa 6:49–68

Google Scholar  

Bouabid A, Louis G (2021) Decision support system for selection of appropriate water supply and sanitation technologies in developing countries. J Water Sanit Hyg Dev 11(2):208–221. https://doi.org/10.2166/washdev.2021.203

Bouhezila F, Hacene H, Aichouni M (2020) Water quality assessment in Reghaia (North of Algeria) lake basin by using traditional approach and water quality indices. Kuwait J Sci 47(4):57–71

Bressler JM, Hennessy TW (2018) Results of an Arctic council survey on water and sanitation services in the Arctic. Int J Circumpolar Health. https://doi.org/10.1080/22423982.2017.1421368

Buckerfield SJ et al (2020) Chronic urban hotspots and agricultural drainage drive microbial pollution of karst water resources in rural developing regions. Sci Total Environ. https://doi.org/10.1016/j.scitotenv.2020.140898

Bui TT et al (2021) Rainwater as a source of drinking water: a resource recovery case study from Vietnam. J Water Process Eng. https://doi.org/10.1016/j.jwpe.2020.101740

Capdevila ASL et al (2020) Success factors for citizen science projects in water quality monitoring. Sci Total Environ. https://doi.org/10.1016/j.scitotenv.2020.137843

Charles KJ, Nowicki S, Bartram JK (2020) A framework for monitoring the safety of water services: from measurements to security. NPJ Clean Water. https://doi.org/10.1038/s41545-020-00083-1

Coulson AB et al (2021) The cost of a sustainable water supply at network kiosks in Peri-Urban Blantyre, Malawi. Sustainability. https://doi.org/10.3390/su13094685

Cronin AA et al (2017) Piloting water quality testing coupled with a national socioeconomic survey in Yogyakarta province, Indonesia, towards tracking of sustainable development goal 6. Int J Hyg Environ Health 220(7):1141–1151. https://doi.org/10.1016/j.ijheh.2017.07.001

Dao AD, Nguyen DC, Han MY (2017) Design and operation of a rainwater for drinking (RFD) project in a rural area: case study at cukhe elementary school, Vietnam. J Water Sanit Hyg Dev 7(4):651–658. https://doi.org/10.2166/washdev.2017.055

Darwish T et al (2021) Sustaining the ecological functions of the Litani river basin, Lebanon. Int J River Basin Manag. https://doi.org/10.1080/15715124.2021.1885421

Devaraj R et al (2021) Planning fecal sludge management systems: challenges observed in a small town in southern India. J Environ Manag. https://doi.org/10.1016/j.jenvman.2020.111811

Diaz-Alcaide S et al (2021) Mapping ground water access in two rural communes of Burkina Faso. Water. https://doi.org/10.3390/w13101356

El Achi N, Rouse MJ (2020) A hybrid hydraulic model for gradual transition from intermittent to continuous water supply in Amman, Jordan: a theoretical study. Water Supply 20(1):118–129. https://doi.org/10.2166/ws.2019.142

Ezbakhe F, Giné-Garriga R, Pérez-Foguet A (2019) Leaving no one behind: evaluating access to water, sanitation and hygiene for vulnerable and marginalized groups. Sci Total Environ 683:537–546. https://doi.org/10.1016/j.scitotenv.2019.05.207

Farinosi F et al (2018) An innovative approach to the assessment of hydro-political risk: a spatially explicit, data driven indicator of hydro-political issues. Glob Environ Change 52:286–313. https://doi.org/10.1016/j.gloenvcha.2018.07.001

Fischer A et al (2020) Risky responsibilities for rural drinking water institutions: the case of unregulated self-supply in Bangladesh. Glob Environ Change Hum Policy Dimens. https://doi.org/10.1016/j.gloenvcha.2020.102152

Fleming L et al (2019) Urban and rural sanitation in the Solomon Islands: how resilient are these to extreme weather events? Sci Total Environ 683:331–340. https://doi.org/10.1016/j.scitotenv.2019.05.253

Foggitt E et al (2019) Experiences of shared sanitation—towards a better understanding of access, exclusion and ‘toilet mobility’ in low-income urban areas. J Water Sanit Hyg Dev 9(3):581–590. https://doi.org/10.2166/washdev.2019.025

Fraisl D et al (2020) Mapping citizen science contributions to the UN sustainable development goals. Sustain Sci 15(6, SI):1735–1751. https://doi.org/10.1007/s11625-020-00833-7

Fraser CM et al (2020) A national border-based assessment of Malawi’s transboundary aquifer units: towards achieving sustainable development goal 6.5.2. J Hydrol Reg Stud. https://doi.org/10.1016/j.ejrh.2020.100726

Freihardt J (2020) Can citizen science using social media inform sanitation planning? J Environ Manag. https://doi.org/10.1016/j.jenvman.2019.110053

Gagan Deep Sharma et al (2020) COVID-19 and environmental concerns: a rapid review. Renew Sustain Energy Rev 148(January)

Gelsomino A et al (2006) Changes in chemical and biological soil properties as induced by anthropogenic disturbance: a case study of an agricultural soil under recurrent flooding by wastewaters. Soil Biol Biochem 38(8):2069–2080. https://doi.org/10.1016/j.soilbio.2005.12.025

Gronwall J (2016) Self-supply and accountability: to govern or not to govern groundwater for the (peri-) urban poor in Accra, Ghana. Environ Earth Sci. https://doi.org/10.1007/s12665-016-5978-6

Gronwall J, Oduro-Kwarteng S (2018) Groundwater as a strategic resource for improved resilience: a case study from peri-urban Accra. Environ Earth Sci. https://doi.org/10.1007/s12665-017-7181-9

Hegarty S et al (2021) Using citizen science to understand river water quality while filling data gaps to meet United Nations sustainable development goal 6 objectives. Sci Total Environ. https://doi.org/10.1016/j.scitotenv.2021.146953

Herrera V (2019) Reconciling global aspirations and local realities: challenges facing the sustainable development goals for water and sanitation. World Dev 118:106–117. https://doi.org/10.1016/j.worlddev.2019.02.009

Hurd J et al (2017) Behavioral influences on risk of exposure to fecal contamination in low-resource neighborhoods in Accra, Ghana. J Water Sanit Hyg Dev 7(2):300–311. https://doi.org/10.2166/washdev.2017.128

Hussein H, Menga F, Greco F (2018) Monitoring transboundary water cooperation in SDG 6.5.2: how a critical hydropolitics approach can spot inequitable outcomes. Sustainability (switzerland). https://doi.org/10.3390/su10103640

Jabbour CJC (2013) Environmental training in organisations: from a literature review to a framework for future research. Resour Conserv Recycl 74:144–155. https://doi.org/10.1016/j.resconrec.2012.12.017

Jama AA, Mourad KA (2019) ‘Water services sustainability: institutional arrangements and shared responsibilities. Sustainability (switzerland). https://doi.org/10.3390/su11030916

Jewitt S, Mahanta A, Gaur K (2018) Sanitation sustainability, seasonality and stacking: Improved facilities for how long, where and whom? Geogr J 184(3):255–268. https://doi.org/10.1111/geoj.12258

Jimenez A et al (2020) Unpacking water governance: a framework for practitioners. Water. https://doi.org/10.3390/w12030827

Kalin RM et al (2019) Stranded assets as a key concept to guide investment strategies for sustainable development goal 6. Water (switzerland). https://doi.org/10.3390/w11040702

Kempster S, Hueso A (2018) Moving up the ladder: assessing sanitation progress through a total service gap. Water (switzerland). https://doi.org/10.3390/w10121735

Kirschke S et al (2020) Capacity challenges in water quality monitoring: understanding the role of human development. Environ Monit Assess. https://doi.org/10.1007/s10661-020-8224-3

Komakech HC et al (2019) What proportion counts? Disaggregating access to safely managed sanitation in an emerging town in Tanzania. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph16183328

Kookana RS et al (2020) Urbanisation and emerging economies: issues and potential solutions for water and food security. Sci Total Environ. https://doi.org/10.1016/j.scitotenv.2020.139057

Lage Junior M, Godinho Filho M (2010) Variations of the Kanban system: literature review and classification. Int J Prod Econ 125(1):13–21. https://doi.org/10.1016/j.ijpe.2010.01.009

Leborgne R et al (2021) True 2-D resistivity imaging from vertical electrical soundings to support more sustainable rural water supply borehole siting in Malawi. Appl Sci Basel. https://doi.org/10.3390/app11031162

Li W et al (2020) Earth observation and cloud computing in support of two sustainable development goals for the river nile watershed countries. Remote Sens. https://doi.org/10.3390/rs12091391

Lopez-Maldonado Y et al (2017) Local groundwater balance model: stakeholders’ efforts to address groundwater monitoring and literacy. Hydrol Sci J 62(14):2297–2312. https://doi.org/10.1080/02626667.2017.1372857

López-Pacheco IY et al (2019) Anthropogenic contaminants of high concern: existence in water resources and their adverse effects. Sci Total Environ 690:1068–1088. https://doi.org/10.1016/j.scitotenv.2019.07.052

Lucier KJ, Qadir M (2018) Gender and community mainstreaming in fog water collection systems. Water. https://doi.org/10.3390/w10101472

Lyne I (2020) Bottling water differently, and sustaining the water commons? Social innovation through water service franchising in Cambodia. Water Altern 13(3, SI):731–751

Marshall L, Kaminsky J (2016) When behavior change fails: evidence for building wash strategies on existing motivations. J Water Sanit Hyg Dev 6(2):287–297. https://doi.org/10.2166/washdev.2016.148

Martinez-Cordoba P-J et al (2020) Achieving sustainable development goals. Efficiency in the Spanish clean water and sanitation sector. Sustainability. https://doi.org/10.3390/su12073015

Mathew DJ et al (2020) Awareness and practices of sanitary latrine usage and environmental cleanliness in rural Etawah, Uttar Pradesh. J Evol Med Dent Sci 9(18):1490–1493. https://doi.org/10.14260/jemds/2020/325

Mitlin D, Walnycki A (2020) Informality as experimentation: water utilities’ strategies for cost recovery and their consequences for universal access. J Dev Stud 56(2):259–277. https://doi.org/10.1080/00220388.2019.1577383

Mraz AL et al (2021) Why pathogens matter for meeting the united nations’ sustainable development goal 6 on safely managed water and sanitation. Water Res. https://doi.org/10.1016/j.watres.2020.116591

Mycoo MA (2018) Achieving SDG 6: water resources sustainability in Caribbean Small island developing states through improved water governance. Nat Res Forum 42(1):54–68. https://doi.org/10.1111/1477-8947.12141

Ngobeni V, Breitenbach MC (2021) Production and scale efficiency of South African water utilities: the case of water boards. Water Policy. https://doi.org/10.2166/wp.2021.055

Nhamo G, Nhemachena C, Nhamo S (2019) Is 2030 too soon for Africa to achieve the water and sanitation sustainable development goal? Sci Total Environ 669:129–139. https://doi.org/10.1016/j.scitotenv.2019.03.109

Paerli R, Fischer M (2020) Implementing the Agenda 2030-what is the role of forums? Int J Sustain Dev World 27(5):443–457. https://doi.org/10.1080/13504509.2020.1719546

Pickering AJ et al (2019) Effect of in-line drinking water chlorination at the point of collection on child diarrhoea in urban Bangladesh: a double-blind, cluster-randomised controlled trial. Lancet Glob Health 7(9):E1247–E1256. https://doi.org/10.1016/S2214-109X(19)30315-8

Qadir M et al (2018) Fog water collection: challenges beyond technology. Water (switzerland). https://doi.org/10.3390/w10040372

Quarshie AM et al (2021) Conceptual behaviour underpinning the occurrence of nonfaecal matter in faecal sludge in some urban communities, Ghana. J Environ Public Health. https://doi.org/10.1155/2021/2672491

Rahaman MM, Galib AI, Azmi F (2021) Achieving drinking water and sanitation related targets of SDG 6 at Shahidbug slum, Dhaka. Water Int. https://doi.org/10.1080/02508060.2021.1901189

Rayasam SDG, Rao B, Ray I (2020) The reality of water quality monitoring for SDG 6: a report from a small town in India. J Water Sanit Hyg Dev 10(3):589–595. https://doi.org/10.2166/washdev.2020.131

Rivett MO et al (2019) Responding to salinity in a rural African alluvial valley aquifer system: to boldly go beyond the world of hand-pumped groundwater supply? Sci Total Environ 653:1005–1024. https://doi.org/10.1016/j.scitotenv.2018.10.337

Rivett MO et al (2020) Paleo-geohydrology of Lake chilwa, Malawi is the source of localised groundwater salinity and rural water supply challenges. Appl Sci Basel. https://doi.org/10.3390/app10196909

Romano O, Akhmouch A (2019) Water governance in cities: current trends and future challenges. Water (switzerland). https://doi.org/10.3390/w11030500

Roy A, Pramanick K (2019) Analysing progress of sustainable development goal 6 in india: past, present, and future. J Environ Manag 232:1049–1065. https://doi.org/10.1016/j.jenvman.2018.11.060

Sachs J et al (2021) Sustainable development report 2021. Cambridge University Press. https://doi.org/10.1017/9781009106559

Salmoral G et al (2020) Water-related challenges in nexus governance for sustainable development: insights from the city of Arequipa, Peru. Sci Total Environ. https://doi.org/10.1016/j.scitotenv.2020.141114

SDG Index. Org (2021) Sustainable development report, sustainable development report. https://dashboards.sdgindex.org/profiles . Accessed 3 Apr 2022

Sogbanmu TO et al (2020) Drinking water quality and human health risk evaluations in rural and urban areas of Ibeju-Lekki and Epe local government areas, Lagos, Nigeria. Hum Ecol Risk Assess 26(4):1062–1075. https://doi.org/10.1080/10807039.2018.1554428

Strokal V (2021) Transboundary rivers of Ukraine: perspectives for sustainable development and clean water. J Integr Environ Sci 18(1):67–87. https://doi.org/10.1080/1943815X.2021.1930058

Swan A et al (2018) Using smart pumps to help deliver universal access to safe and affordable drinking water. Proc Inst Civ Eng Eng Sustain 171(6):277–285. https://doi.org/10.1680/jensu.16.00013

Talan G, Sharma GD (2019) Doing well by doing good: a systematic review and research agenda for sustainable investment. Sustainability (switzerland). https://doi.org/10.3390/su11020353

Thomas V, Godfrey S (2018) Understanding water-related emotional distress for improving water services: a case study from an Ethiopian small town. J Water Sanit Hyg Dev 8(2):196–207. https://doi.org/10.2166/washdev.2018.167

Torres-Slimming PA et al (2019) Achieving the sustainable development goals: a mixed methods study of health-related water, sanitation, and hygiene (WASH) for indigenous shawi in the Peruvian Amazon. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph16132429

Truslove JP et al (2020) Reflecting SDG 6.1 in rural water supply tariffs: considering ‘affordability’ versus ‘operations and maintenance costs’ in Malawi. Sustainability. https://doi.org/10.3390/su12020744

Udmale P et al (2016) The status of domestic water demand: supply deficit in the Kathmandu Valley, Nepal. Water (switzerland). https://doi.org/10.3390/w8050196

United Nations (2021) UN water, UN water. https://www.sdg6data.org/ . https://www.undp.org/sustainable-development-goals#clean-water-and-sanitation . Accessed 15 July 2021

United Nations Department of Economic and Social Affairs (2014) International decade for action ‘Water forlLife’ 2005–2015, United Nations Department of Economic and Social Affairs. https://www.un.org/waterforlifedecade/scarcity.shtml . Accessed 8 Aug 2021

United Nations Department of Economic and Social Affairs (2021) Ensure availability and sustainable management of water and sanitation for all, United Nations Department of Economic and Social Affairs. https://sdgs.un.org/goals/goal6 . Accessed 8 Aug 2021

United Nations Organisation-Sustainable Development Goals (2021) Water action decade, 2018–2028: averting a global water crisis, United Nations Organisation-Sustainable Development Goals. Available at: https://www.un.org/sustainabledevelopment/water-action-decade/ . Accessed 8 July 2021

UN-Regional Information Centre for Western Europe (2021) Clean water and sanitation, UN-Regional Information Centre for Western Europe. https://unric.org/en/sdg-6/ . Accessed 8 July 2021

Usman MA, Gerber N, Pangaribowo EH (2018) Drivers of microbiological quality of household drinking water—a case study in rural Ethiopia. J Water Health 16(2):275–288. https://doi.org/10.2166/wh.2017.069

Van Puijenbroek PJTM, Beusen AHW, Bouwman AF (2019) Global nitrogen and phosphorus in urban waste water based on the shared socio-economic pathways. J Environ Manag 231:446–456. https://doi.org/10.1016/j.jenvman.2018.10.048

Van Vliet MTH et al (2021) Global water scarcity including surface water quality and expansions of clean water technologies. Environ Res Lett. https://doi.org/10.1088/1748-9326/abbfc3

Walter CT, Kooy M, Prabaharyaka I (2017) The role of bottled drinking water in achieving SDG 6.1: an analysis of affordability and equity from Jakarta, Indonesia. J Water Sanit Hyg Dev 7(4):642–650. https://doi.org/10.2166/washdev.2017.046

Wight C, Garrick D, Iseman T (2021) Mapping incentives for sustainable water use: global potential, local pathways. Environ Res Commun. https://doi.org/10.1088/2515-7620/abf15c

Wright-Contreras L (2019) A transnational urban political ecology of water infrastructures: global water policies and water management in Hanoi. Public Works Manag Policy 24(2):195–212. https://doi.org/10.1177/1087724X18780045

Yalew SG, Kwakkel J, Doorn N (2021) Distributive justice and sustainability goals in transboundary rivers: case of the Nile Basin. Front Environ Sci. https://doi.org/10.3389/fenvs.2020.590954

Yesaya M, Tilley E (2021) Sludge bomb: the impending sludge emptying and treatment crisis in Blantyre, Malawi. J Environ Manag. https://doi.org/10.1016/j.jenvman.2020.111474

Download references

Author information

Authors and affiliations.

University Centre for Research and Development, Chandigarh University, Gharuan, Mohali, Punjab, 140413, India

Sanjeet Singh

University School of Business, Chandigarh University, Gharuan, Mohali, Punjab, 140413, India

Sanjeet Singh & R. Jayaram

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Sanjeet Singh .

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Singh, S., Jayaram, R. Attainment of water and sanitation goals: a review and agenda for research. Sustain. Water Resour. Manag. 8 , 146 (2022). https://doi.org/10.1007/s40899-022-00719-9

Download citation

Received : 27 October 2021

Accepted : 03 August 2022

Published : 23 August 2022

DOI : https://doi.org/10.1007/s40899-022-00719-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Sustainable development goals
• Water recycle
• Find a journal
• Publish with us
• Track your research

As the world’s largest multilateral source of financing for water in developing countries, the World Bank is committed to Water for People and Planet.

Water touches every aspect of development and it links with nearly every Sustainable Development Goal (SDG). It drives economic growth, supports healthy ecosystems, and is essential and fundamental for life itself.

Approximately 2 billion people around the world do not have safely managed drinking water services, 3.6 billion people do not have safely managed sanitation services, and 2.3 billion lack basic handwashing facilities. Gaps in access to water supply and sanitation, growing populations, more water-intensive patterns of growth, increasing rainfall variability, and pollution are combining in many places to make water one of the greatest risks to economic progress, poverty eradication and sustainable development.

The consequences of such stress are local, national, transboundary, regional, and global in today’s interconnected and rapidly changing world. Consequences will be disproportionately felt by the poorest and most vulnerable. Climate change expresses itself through water .  Nine out of ten natural disasters are water-related. Water-related climate risks cascade through food, energy, urban and environmental systems. If we are to achieve climate and development goals, water must be at the core of adaptation strategies.

To guide effective climate change adaptation, activities should reflect the importance of water management for reducing vulnerability and building climate resilience, prioritizing the following actions:

• Expand beyond traditional integrated water resources management (IWRM). Efforts to reduce greenhouse gas emissions also depend on access to reliable water resources, as all mitigation actions need water to succeed.
• Promote investment and solutions that incorporate management of " natural infrastructure"  – the ecosystem services provided by healthy watersheds and coasts – and their benefits for climate-resilient development of the food and energy sectors.
• Support actions at scale to build climate resilience by combining watershed management, sustainable infrastructure, and empowerment and learning through adaptive institutions.

Economic growth is a "thirsty business . "  Water is a vital factor of production, so diminishing water supplies translates into slower growth. Some regions could see their growth rates decline by as much as 6 percent of GDP by 2050 as a result of water-related losses in agriculture, health, income and prosperity. Ensuring a sufficient and constant supply of water under increasing scarcity is essential to achieving global poverty alleviation goals.

• Optimizing the use of water through better planning and incentives will help to improve welfare and increase economic growth. Economic instruments such as water permits and prices, if well implemented and enforced, can improve stewardship of water resources.
• Expanding water supply and availability where and if appropriate is vital. This includes investments in water storage, water reuse and recycling and, where viable, desalinization. These interventions must be accompanied by policies to promote water efficiency and improve water allocation.
• “Water proofing” economies to limit the impact of extremes and uncertainties is also among the top priorities. Better urban planning, expanding crop insurance to protect farmers, and citizen engagement will build resilience and minimize economic impacts of adverse events.

Water  is crucial in determining whether the world will achieve the SDGs. The world needs a fundamental shift in how it  understands, values and manages water.

• Understanding Water  means making evidence-based decisions about water using strengthened water data.
• Valuing Water  means recognizing the values that societies accord to water and its uses, taking these into account in political and business decisions including decisions about appropriately pricing water and sanitation services.
• Manage Water  means pursuing integrated approaches to water resource management across local, national, and regional levels.

Water is essential for inclusive growth.  Water belongs to everyone, yet many are excluded from its benefits. Ensuring that water is equitably and sustainably shared requires an inclusive approach. Women, youth, persons with disabilities, indigenous groups and other underrepresented and marginalized groups need access and voice in the water sector. The factors driving exclusion of these groups are increasing: it is estimated that climate change will force over 140 million people to migrate within their countries by 2050.

In water and sanitation utilities, fewer than one in five workers are women, and in the broader water sector, fewer than one in four engineers or managers are women. Increasing women’s participation at all levels of the water sector benefits women, the community, and organizations.  

​Around the world, about 500 million women, girls, and other menstruators struggle to access menstrual products or safe, private, hygienic spaces in which to use them. Lack of affordability or accessibility, along with the stigma associated with menstruation in many societies, has wide-ranging negative effects, severely limiting participation in public life.

​​Water knows no borders.  Transboundary cooperation is needed to share this vital resource, which is vital for the economic well-being of entire regions. More than three billion people rely on transboundary river basins for their needs, yet 60 percent of the world’s 310 international river basins lack frameworks to govern disputes. Climate and pollution risks in many transboundary basins, already high, are expected to increase.  

​The Bank works with clients to build strong institutions, dialogue processes, and information systems that can support transboundary resource management. Given the increasing pressure on common water supply sources, developing cooperative agreements will benefit everyone.

Smart investments in clean water and sanitation  prevent needless deaths and transforms lives. Healthier children become healthier adults who contribute more to the economy. This principle is at the core of the World Bank’s Human Capital Project.

Sanitation is critical to health, economic growth and the environment. Investing in sanitation is about safeguarding human health, investing in people and transforming lives. Approximately  446,000 children under 5 years die due to diarrhea  linked to inadequate WASH. This amounts to 9% of the 5.8 million deaths of children younger than 5. 

​​Safely managed water, sanitation, and hygiene (WASH) services are also an essential part of preventing and protecting human health during infectious disease outbreaks, including the recent COVID-19 pandemic. According to a WHO/UNICEF technical brief on WASH and waste management for COVID-19: “Frequent and proper hand hygiene is one of the most important measures that can be used to prevent infection with the COVID-19 virus. WASH services should enable more frequent and regular hand hygiene by improving facilities and using proven behavior change techniques.”  These efforts also help prevent other deadly infectious diseases, including cholera, dysentery, hepatitis A, and typhoid.

Political commitment and leadership, technological innovations, and breakthroughs in service delivery and financing models are all needed to support governments to deliver on their commitment to SDG 6.2 – achieving access to adequate and equitable sanitation and hygiene for all by 2030.

Learn more about the different business lines of the water sector in these infographics: 

View the water supply and sanitation infographic>>, view the water resource management infographic>>, view the water in agriculture infographic>>, view the dam safety infographic>>, view the social inclusion infographic>>, view the climate change and water infographic>>.

Last Updated: Jul 28, 2023

In response to the water and sanitation crisis, the World Bank Water Global Practice (Water GP) is committed to Water for People and Planet . The SDGs provide an opportunity for the World Bank Group and development partners to work together in support of this vision.

And, in 2019, the Water GP launched its new Strategic Action Plan. Our vision remains a Water Secure World for All, to be delivered through three inter-related pillars: (1)  sustain water resources , (2)  deliver services , and (3)  build resilience . The World Bank has played a key role in driving delivery when it comes to the SDGs. We continue to implement programs and projects across the world, convene a wide range of actors to achieve cross-sectoral solutions, and share our data, knowledge and know-how with others in service of a water-secure world for all .

With a portfolio of water investments of almost US$30 billion and a staff of hundreds of water experts across the world, the Water GP is uniquely positioned to address these themes, developing and sharing global knowledge while amplifying the impact of lending through technical assistance on the ground.

The World Bank has identified five priority themes to achieve the Sustainable Development Goal in the water sector (SDG 6). To address the challenges of increasing water scarcity and variability and to ensure that results are maintained in the future, a renewed focus on the multiple facets of resilience and sustainability is needed. However, without new efforts to improve inclusion , many will still be unable to reap the benefits of water and will be disproportionately impacted by water-related disasters.

Helping countries achieve greater sustainability and inclusion in the water sector requires investment in institutions , to complement the traditional focus on building infrastructure. Building the institutions and infrastructure needed for universal access and more sustainable water management practices also demands a vast increase in financing for the water sector, which can only be achieved by improving financial viability and leveraging donor funding to tap other sources of finance.

These five priority themes form the core of a partnership for a water-secure world, supported by the Global Water Security & Sanitation Partnership (GWSP) . This is a Multi-Donor Trust Fund, launched in 2017 that enables the Water GP to address the five themes across its global portfolio.

To more effectively bring critical resources to the front lines, the GWSP has been designed as a Water GP core asset—its “think-tank”—which expands and deepens the impact of its lending program.

In 2018, the 2030 Water Resources Group (2030 WRG)   — a public-private-civil society partnership — became part of the Water GP family. 2030 WRG supports government-accelerated reforms with the aim of ensuring sustainable water resources management for long-term development and economic growth.

To respond to COVID-19, action in the WASH sector is critical for both containing the virus and lowering its immediate impact and aftermath. Three priority areas are identified as part of the emergency response:

Emergency support to secure and extend water and sanitation service provision, including:

• Support to water supply and sanitation (WSS) service providers to prepare emergency plans and ensure continuity of service delivery through inter alia: provision of water treatment chemicals and spare parts, availability of fuel for pumps and treatment, maintaining staffing levels, providing protective equipment for utility staff and salary supplements to compensate for the additional work-loads.

Last Updated: Oct 03, 2022

In FY16-18, the World Bank contributed to providing more than 47 million people with access to an improved water source and provided more than 24 million people with access to improved sanitation facilities. Below are some specific results from the World Bank-supported projects in countries.

India: Andhra Pradesh and Telangana State Community Based Management

The World Bank-supported Andhra Pradesh and Telangana State Community Based Management (APCBTM) project in India benefitted 605,052 people by strengthening the capac­ity of community-based institutions. The project developed and equipped 116,164 hectares (ha) of land with irrigation and drain­age services. In addition, the project developed and rehabilitated tank irrigation infrastructure, supported farmers to improve their productivity, and increased cropping intensity by over 30%.

China: Water Conservation Project II

The Water Conservation Project II tackled water scarcity issues through a series of interlinked operations in the Chinese prov­inces of Hebei, Shanxi, and Ningxia – three of the most wa­ter-scarce provinces in the Northern region of the country. To reduce net water consumption, the project reduced water with­drawal for irrigated agriculture in Ningxia and Shanxi Provinces, and groundwater overdraft in Hebei Province. In addition, the project also provided incentives to farmers to lower the agricul­tural production costs and increase the agricultural yield and val­ue in all three of those provinces. Water withdrawal in Ningxia was reduced by 22.67 million cubic meters (MCM) per year; groundwater overdraft in Hebei was reduced by 16.52 MCM per year; groundwater withdrawal in Shanxi was reduced by 5.80 MCM per year. New or improved irrigation and drainage services reached 594,200 beneficiaries, of whom 48 percent are women. Altogether, 290 WUAs in the three provinces have been created or strengthened by the project, comprising over 800 staff and more than 760,000 members (around half are women).

Tajikistan: The Second Public Employment for Sustainable Agriculture and Water Resources Management Project

The Second Public Employment for Sustainable Agriculture and Water Resources Management Project is helping address critical issues in irrigation and water resource management with the overall goal of improving food security for Tajikistan’s most vulnerable communities. Thanks to the project, 6,525 km of an on-farm irrigation network have been manually cleaned, which created income opportunities for almost 24,000 citizens. In addition, irrigation and drainage services have been improved on almost 190,000 ha of arable land. 580 km of secondary and tertiary irrigation canals have been manually cleaned, 44 km of irrigation and drainage canals have been rehabilitated, three major pumping stations have been restored, and riverbank reinforcement works have been completed. Consequently, irrigation has been improved in 920 ha of land.

North Gaza Emergency Sewage Treatment Project

In Gaza , despite the extremely volatile environment, the long-awaited construction of the new North Gaza Wastewater Treatment Plant is now complete and ready for operation, thanks to the World Bank-supported North Gaza Emergency Sewage Treatment  (NGEST) Project. It will provide a long-term, sustainable wastewater management solution for over 400,000 Gazan citizens. The project also helped address the immediate threat to the 52,000 inhabitants living adjacent to the Beit Lahia sewage lakes that flooded the nearby village of Um Al Nasser, killing five, causing countless injuries, and displacing approximately 2,000 people.

Panama: The Metro Water and Sanitation Improvement Project

The Panama Metro Water and Sanitation Improvement Project helped improved the quality of water service for 80,382 beneficiaries in Colón and provided the National Water and Sewer Agency with a replicable model, using performance-based contracts, for effectively piloting and implementing new methods of doing business. The project increased water supply continuity from 13 percent in 2014 to 71 percent in 2017. The quality of service was also significantly improved. The project supported the extension of piped water to 2,115 households and rehabilitated water connections for 12,500 households.

Burkina Faso: The Urban Water Sector Project 

Significant results have been achieved through the IDA financed Urban Water Sector Project (UWSP: 2009–2018): about 700,000 people have gained access to improved water supply; about 440,000 people have gained access to improved sanitation; and about 120,000 students have benefited from improved school sanitation. And the utility’s performance has dramatically improved: ONEA  (Office National de l’Eau et de l’Assainissement), Burkina’s state-owned urban water and sanitation utility, is today  ranked  among the top performing water utilities in Sub-Saharan Africa, with full recovery through revenues of operation and maintenance cost and debt service and partial contribution to capital expenditures, with a staff productivity of 2.9 staff per 1000 connections and a bill collection ratio of 97.7 percent. These achievements, along with the strengthening of the ONEA’s governance, has contributed to paving the way for opportunities to tap into commercial capital and private engagement, for the expansion of needed investments required to respond to increasing water scarcity and fast urbanization.

Last Updated: Oct 06, 2022

Increase of payment rates in Armenia since 1998, where water supply hours have more than doubled, through appropriate private utility engagement in water supply.

FOCUS AREAS

Working together for a water-secure world for all, around the bank group, photo gallery.

STAY CONNECTED

Trust-funded programs.

Global Water Security & Sanitation Partnership (GWSP)

The GWSP supports client governments to achieve the water-related SDGs through innovative global knowledge and country-level support.

2030 Water Resources Group (2030 WRG)

2030 WRG helps countries achieve water security by 2030 by facilitating collective action on water between government, the private sector, and civil society.

Cooperation in International Waters in Africa (CIWA)

The CIWA assists riparian governments in Sub-Saharan Africa in cooperative water resources management and development.

South Asia Water Initiative

The SAWI aims to increase regional cooperation in the management of the major Himalayan river systems in South Asia.

Central Asia Water and Energy Program

The CAWEP builds energy and water security by leveraging enhanced cooperation in all five Central Asian countries plus Afghanistan.

Additional Resources

Focus areas.

This site uses cookies to optimize functionality and give you the best possible experience. If you continue to navigate this website beyond this page, cookies will be placed on your browser. To learn more about cookies, click here .

• Frontiers in Water
• Water and Human Systems
• Research Topics

Water Supply and Sanitation in Rural Communities

Total Downloads

Total Views and Downloads

About this Research Topic

Access to water and sanitation is still a problem especially in middle-income and developing countries. According to the Joint Monitoring Program report there are 2 billion people that still lack access to safely managed water services and 3.6 billion people lack safely managed sanitation services. In ...

Keywords : Water, Sanitation, Rural population, Human rights, Gender, Climate Change

Important Note : All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Topic Editors

Topic coordinators, recent articles, submission deadlines.

Submission closed.

Participating Journals

Total views.

• Demographics

No records found

total views article views downloads topic views

Top countries

Top referring sites, about frontiers research topics.

With their unique mixes of varied contributions from Original Research to Review Articles, Research Topics unify the most influential researchers, the latest key findings and historical advances in a hot research area! Find out more on how to host your own Frontiers Research Topic or contribute to one as an author.

Clean Water and Sanitation

By Hannah Ritchie, Fiona Spooner and Max Roser

Having access to and using safe drinking water, sanitation, and handwashing is a basic human need.

Individuals not using these facilities increases the risk of disease and malnutrition and is attributed to millions of deaths each year.

The world has made significant progress in increasing their availability. In the past, infectious diseases were the leading cause of death in most countries. They’ve fallen dramatically in high and middle-income countries – partly due to increased usage of clean water and sanitation.

But there is still more work to do. It is still a major problem in low-income countries.

On this page, you can find all of our data on water, sanitation, and handwashing.

Explore our data on Clean Water and Sanitation

Research & writing.

Clean Water

Clean and safe water is essential for good health. How did access change over time? Where do people lack access?

Hannah Ritchie, Fiona Spooner and Max Roser

Safe sanitation is essential to reduce deaths from infectious diseases, prevent malnutrition, and provide dignity.

Hygiene and Handwashing

How many people lack access to basic handwashing facilities?

More articles on Clean Water and Sanitation

The world is making progress on clean water and sanitation, but is far behind its target to ensure universal access by 2030.

Hannah Ritchie

Interactive Charts on Clean Water, Sanitation and Hygiene

Cite this work.

Our articles and data visualizations rely on work from many different people and organizations. When citing this topic page, please also cite the underlying data sources. This topic page can be cited as:

BibTeX citation

Reuse this work freely

All visualizations, data, and code produced by Our World in Data are completely open access under the Creative Commons BY license . You have the permission to use, distribute, and reproduce these in any medium, provided the source and authors are credited.

The data produced by third parties and made available by Our World in Data is subject to the license terms from the original third-party authors. We will always indicate the original source of the data in our documentation, so you should always check the license of any such third-party data before use and redistribution.

All of our charts can be embedded in any site.

Our World in Data is free and accessible for everyone.

Help us do this work by making a donation.

Suggestions or feedback?

MIT News | Massachusetts Institute of Technology

• Machine learning
• Social justice
• Black holes
• Classes and programs

Departments

• Aeronautics and Astronautics
• Brain and Cognitive Sciences
• Architecture
• Political Science
• Mechanical Engineering

Centers, Labs, & Programs

• Abdul Latif Jameel Poverty Action Lab (J-PAL)
• Picower Institute for Learning and Memory
• Lincoln Laboratory
• School of Architecture + Planning
• School of Engineering
• School of Humanities, Arts, and Social Sciences
• Sloan School of Management
• School of Science
• MIT Schwarzman College of Computing

Two MIT PhD students awarded J-WAFS fellowships for their research on water

Press contact :.

Previous image Next image

Since 2014, the Abdul Latif Jameel Water and Food Systems Lab (J-WAFS) has advanced interdisciplinary research aimed at solving the world's most pressing water and food security challenges to meet human needs. In 2017, J-WAFS established the Rasikbhai L. Meswani Water Solutions Fellowship and the J-WAFS Graduate Student Fellowship. These fellowships provide support to outstanding MIT graduate students who are pursuing research that has the potential to improve water and food systems around the world. 

Recently, J-WAFS awarded the 2024-25 fellowships to Jonathan Bessette and Akash Ball, two MIT PhD students dedicated to addressing water scarcity by enhancing desalination and purification processes. This work is of important relevance since the world's freshwater supply has been steadily depleting due to the effects of climate change. In fact, one-third of the global population lacks access to safe drinking water. Bessette and Ball are focused on designing innovative solutions to enhance the resilience and sustainability of global water systems. To support their endeavors, J-WAFS will provide each recipient with funding for one academic semester for continued research and related activities.

“This year, we received many strong fellowship applications,” says J-WAFS executive director Renee J. Robins. “Bessette and Ball both stood out, even in a very competitive pool of candidates. The award of the J-WAFS fellowships to these two students underscores our confidence in their potential to bring transformative solutions to global water challenges.”

2024-25 Rasikbhai L. Meswani Fellowship for Water Solutions

The Rasikbhai L. Meswani Fellowship for Water Solutions is a doctoral fellowship for students pursuing research related to water and water supply at MIT. The fellowship is made possible by Elina and Nikhil Meswani and family. 

Jonathan Bessette is a doctoral student in the Global Engineering and Research (GEAR) Center within the Department of Mechanical Engineering at MIT, advised by Professor Amos Winter. His research is focused on water treatment systems for the developing world, mainly desalination, or the process in which salts are removed from water. Currently, Bessette is working on designing and constructing a low-cost, deployable, community-scale desalination system for humanitarian crises.

In arid and semi-arid regions, groundwater often serves as the sole water source, despite its common salinity issues. Many remote and developing areas lack reliable centralized power and water systems, making brackish groundwater desalination a vital, sustainable solution for global water scarcity. 

“An overlooked need for desalination is inland groundwater aquifers, rather than in coastal areas,” says Bessette. “This is because much of the population lives far enough from a coast that seawater desalination could never reach them. My work involves designing low-cost, sustainable, renewable-powered desalination technologies for highly constrained situations, such as drinking water for remote communities,” he adds.

To achieve this goal, Bessette developed a batteryless, renewable electrodialysis desalination system. The technology is energy-efficient, conserves water, and is particularly suited for challenging environments, as it is decentralized and sustainable. The system offers significant advantages over the conventional reverse osmosis method, especially in terms of reduced energy consumption for treating brackish water. Highlighting Bessette’s capacity for engineering insight, his advisor noted the “simple and elegant solution” that Bessette and a staff engineer, Shane Pratt, devised that negated the need for the system to have large batteries. Bessette is now focusing on simplifying the system’s architecture to make it more reliable and cost-effective for deployment in remote areas.

Growing up in upstate New York, Bessette completed a bachelor's degree at the State University of New York at Buffalo. As an undergrad, he taught middle and high school students in low-income areas of Buffalo about engineering and sustainability. However, he cited his junior-year travel to India and his experience there measuring water contaminants in rural sites as cementing his dedication to a career addressing food, water, and sanitation challenges. In addition to his doctoral research, his commitment to these goals is further evidenced by another project he is pursuing, funded by a J-WAFS India grant, that uses low-cost, remote sensors to better understand water fetching practices. Bessette is conducting this work with fellow MIT student Gokul Sampath in order to help families in rural India gain access to safe drinking water.

2024-25 J-WAFS Graduate Student Fellowship for Water and Food Solutions

The J-WAFS Graduate Student Fellowship is supported by the J-WAFS Research Affiliate Program , which offers companies the opportunity to engage with MIT on water and food research. Current fellowship support was provided by two J-WAFS Research Affiliates: Xylem , a leading U.S.-based provider of water treatment and infrastructure solutions, and GoAigua , a Spanish company at the forefront of digital transformation in the water industry through innovative solutions. 

Akash Ball is a doctoral candidate in the Department of Chemical Engineering, advised by Professor Heather Kulik. His research focuses on the computational discovery of novel functional materials for energy-efficient ion separation membranes with high selectivity. Advanced membranes like these are increasingly needed for applications such as water desalination, battery recycling, and removal of heavy metals from industrial wastewater. 

“Climate change, water pollution, and scarce freshwater reserves cause severe water distress for about 4 billion people annually, with 2 billion in India and China’s semiarid regions,” Ball notes. “One potential solution to this global water predicament is the desalination of seawater, since seawater accounts for 97 percent of all water on Earth.”

Although several commercial reverse osmosis membranes are currently available, these membranes suffer several problems, like slow water permeation, permeability-selectivity trade-off, and high fabrication costs. Metal-organic frameworks (MOFs) are porous crystalline materials that are promising candidates for highly selective ion separation with fast water transport due to high surface area, the presence of different pore windows, and the tunability of chemical functionality. In the Kulik lab, Ball is developing a systematic understanding of how MOF chemistry and pore geometry affect water transport and ion rejection rates. By the end of his PhD, Ball plans to identify existing, best-performing MOFs with unparalleled water uptake using machine learning models, propose novel hypothetical MOFs tailored to specific ion separations from water, and discover experimental design rules that enable the synthesis of next-generation membranes.  

Ball’s advisor praised the creativity he brings to his research, and his leadership skills that benefit her whole lab. Before coming to MIT, Ball obtained a master’s degree in chemical engineering from the Indian Institute of Technology (IIT) Bombay and a bachelor’s degree in chemical engineering from Jadavpur University in India. During a research internship at IIT Bombay in 2018, he worked on developing a technology for in situ arsenic detection in water. Like Bessette, he noted the impact of this prior research experience on his interest in global water challenges, along with his personal experience growing up in an area in India where access to safe drinking water was not guaranteed.

Share this news article on:

Related links.

• Kulik Research Group
• Abdul Latif Jameel Water and Food Systems Lab (J-WAFS)
• K. Lisa Yang Global Engineering and Research (GEAR) Center
• Department of Chemical Engineering
• Department of Mechanical Engineering

Related Topics

• Awards, honors and fellowships
• Graduate, postdoctoral
• Chemical engineering
• Mechanical engineering
• Desalination
• Climate change
• Sustainability
• Environment
• International development
• Computer modeling

Related Articles

MIT PhD students honored for their work to solve critical issues in water and food

MIT PhD students shed light on important water and food research

Five MIT PhD students awarded 2022 J-WAFS fellowships for water and food solutions

Previous item Next item

More MIT News

The power of App Inventor: Democratizing possibilities for mobile applications

Read full story →

Using MRI, engineers have found a way to detect light deep in the brain

From steel engineering to ovarian tumor research

A better way to control shape-shifting soft robots

Professor Emeritus David Lanning, nuclear engineer and key contributor to the MIT Reactor, dies at 96

Discovering community and cultural connections

• More news on MIT News homepage →

Massachusetts Institute of Technology 77 Massachusetts Avenue, Cambridge, MA, USA

• Map (opens in new window)
• Events (opens in new window)
• People (opens in new window)
• Careers (opens in new window)
• Accessibility
• Social Media Hub
• MIT on Facebook
• MIT on YouTube
• MIT on Instagram

Enter your search term

*Limited to most recent 250 articles Use advanced search to set an earlier date range

Sponsored by   

Saving articles

Articles can be saved for quick future reference. This is a subscriber benefit. If you are already a subscriber, please log in to save this article. If you are not a subscriber, click on the View Subscription Options button to subscribe.

Article Saved

Contact us at [email protected]

Forgot Password

Please enter the email address that you used to subscribe on Engineering News. Your password will be sent to this address.

Content Restricted

This content is only available to subscribers

REAL ECONOMY NEWS

sponsored by  

• LATEST NEWS
• LOADSHEDDING
• MULTIMEDIA LATEST VIDEOS REAL ECONOMY REPORTS SECOND TAKE AUDIO ARTICLES CREAMER MEDIA ON SAFM
• SECTORS AGRICULTURE AUTOMOTIVE CHEMICALS CONSTRUCTION DEFENCE & AEROSPACE ECONOMY ELECTRICITY ENERGY ENVIRONMENTAL MANUFACTURING METALS MINING RENEWABLE ENERGY SERVICES TECHNOLOGY & COMMUNICATIONS TRADE TRANSPORT & LOGISTICS WATER
• SPONSORED POSTS
• ANNOUNCEMENTS
• BUSINESS THOUGHT LEADERSHIP
• MINING WEEKLY
• SHOWROOM PLUS
• PRODUCT PORTAL
• MADE IN SOUTH AFRICA
• PRESS OFFICE
• COMPANY PROFILES
• VIRTUAL SHOWROOMS
• CREAMER MEDIA
• BACK COPIES
• BUSINESS LEADER
• SUPPLEMENTS
• FEATURES LIBRARY
• RESEARCH REPORTS
• PROJECT BROWSER

Article Enquiry

Water a hurdle in Africa’s development - expert

Email This Article

separate emails by commas, maximum limit of 4 addresses

WATER, WATER EVERYWHERE BUT... The scarcity of drinkable water is denting the development of Africa as a continent

As a magazine-and-online subscriber to Creamer Media's Engineering News & Mining Weekly , you are entitled to one free research report of your choice . You would have received a promotional code at the time of your subscription. Have this code ready and click here . At the time of check-out, please enter your promotional code to download your free report. Email [email protected] if you have forgotten your promotional code. If you have previously accessed your free report, you can purchase additional Research Reports by clicking on the “Buy Report” button on this page. The most cost-effective way to access all our Research Reports is by subscribing to Creamer Media's Research Channel Africa - you can upgrade your subscription now at this link .

The most cost-effective way to access all our Research Reports is by subscribing to Creamer Media's Research Channel Africa - you can upgrade your subscription now at this link . For a full list of Research Channel Africa benefits, click here

If you are not a subscriber, you can either buy the individual research report by clicking on the ‘Buy Report’ button, or you can subscribe and, not only gain access to your one free report, but also enjoy all other subscriber benefits , including 1) an electronic archive of back issues of the weekly news magazine; 2) access to an industrial and mining projects browser; 3) access to a database of published articles; and 4) the ability to save articles for future reference. At the time of your subscription, Creamer Media’s subscriptions department will be in contact with you to ensure that you receive a copy of your preferred Research Report. The most cost-effective way to access all our Research Reports is by subscribing to Creamer Media's Research Channel Africa - you can upgrade your subscription now at this link .

If you are a Creamer Media subscriber, click here to log in.

10th May 2024

Font size: - +

Water scarcity poses a significant hurdle to Africa's growth and development, with climate change and deteriorating infrastructure intensifying the challenges, says advisory and analytics firm Frost & Sullivan consultant Hannro Steenekamp .

He explains that South Africa’s ongoing water crisis, where about half of Johannesburg's population of over 5.5-million people have been without water or have experienced shortages for weeks, serves as a dire warning.

“Residents often wait in long lines for government water trucks, with the supply frequently running out before reaching everyone,” he says.

This crisis highlights the urgent need for solutions and the immense opportunity for businesses and innovation to make a difference.

He points out the demand for clean water in Africa is only set to skyrocket with population growth and development projects.

The fact that 387-million people in sub-Saharan Africa lack access to essential drinking water in 2020 – up from 350-million in 2000 – demonstrates the staggering scale of need.

Moreover, as of October 2022, roughly 226-million people in Eastern and Southern Africa lacked access to essential water services, and about 381-million lacked basic sanitation.

This issue is particularly acute in nine key countries – namely Angola, the Democratic Republic of Congo, Ethiopia, Kenya, Madagascar, Mozambique, Sudan, Tanzania and Uganda – where 80% of the continent’s underserved people live.

Steenkamp stresses these figures highlight the vast potential market for those providing water solutions.

Conversely, government limitations in tackling the multifaceted water infrastructure challenges underline the crucial role private sector investment and innovation can play.

He suggests decentralised desalination powered by solar energy is a promising solution, particularly in remote or water-stressed communities with access to coastlines or saline aquifers.

“This technology is becoming increasingly crucial for Africa's water supply mix. Another key opportunity is investing in scalable water technology startups focused on advanced treatment solutions,” he says.

These companies lower costs, reduce energy consumption and prioritise environmental sustainability, making them crucial in addressing water shortages. ​

Finally, South Africa's severe water infrastructure challenges are a stark reality.

This presents a significant chance for the private sector to invest in maintenance, skills development, and partnerships with public institutions.

Steenkamp recommends that companies seeking these opportunities should consider bold investments in novel water technologies such as desalination and advanced water treatment.

“Collaborations with research institutions play a vital supporting role,” he adds.

Further, strategic private-public partnerships with local governments and communities will underpin the success of large-scale water projects, ensuring sustainability and long-term viability.

Moreover, earning the support of local communities is crucial, and businesses must engage closely with stakeholders, demonstrating their commitment to addressing local needs and fostering trust.

Addressing these challenges has a vast potential impact. Success in these areas could mirror the progress in Ethiopia, where over 5 000 schools have been equipped with water, sanitation and menstrual hygiene facilities since 2014.

However, he stresses the warnings are clearly indicated in instances such as Cape Town's ‘Day Zero’ crisis in 2018, or Durban's loss of 35% of its water supply to theft, which is just a glimpse of the future.

South Africa's looming water crisis, with the potential for complete water depletion by 2030, highlights the importance of urgent action, he concludes.

Frost & Sullivan is a partner for, and will be attending and speaking at, this year’s Enlit Africa 2024, which will be held at the Cape Town International Convention Centre from May 21 to 23.

Edited by Nadine James Features Deputy Editor

Research Reports

Latest Multimedia

From batteries for boats and jet skis, to batteries for cars and quad bikes, SABAT Batteries has positioned itself as the lifestyle battery of...

We are dedicated to business excellence and innovation.

sponsored by

Press Office

Announcements

Subscribe to improve your user experience...

Option 1 (equivalent of R125 a month):

Receive a weekly copy of Creamer Media's Engineering News & Mining Weekly magazine (print copy for those in South Africa and e-magazine for those outside of South Africa) Receive daily email newsletters Access to full search results Access archive of magazine back copies Access to Projects in Progress Access to ONE Research Report of your choice in PDF format

Option 2 (equivalent of R375 a month):

All benefits from Option 1 PLUS Access to Creamer Media's Research Channel Africa for ALL Research Reports, in PDF format, on various industrial and mining sectors including Electricity; Water; Energy Transition; Hydrogen; Roads, Rail and Ports; Coal; Gold; Platinum; Battery Metals; etc.

Already a subscriber?

Forgotten your password?

MAGAZINE & ONLINE

R1500 (equivalent of R125 a month)

Receive weekly copy of Creamer Media's Engineering News & Mining Weekly magazine (print copy for those in South Africa and e-magazine for those outside of South Africa)

Access to full search results

Access archive of magazine back copies

Access to Projects in Progress

Access to ONE Research Report of your choice in PDF format

RESEARCH CHANNEL AFRICA

R4500 (equivalent of R375 a month)

All benefits from Option 1

Electricity

Energy Transition

Roads, Rail and Ports

Battery Metals

CORPORATE PACKAGES

Discounted prices based on volume

Receive all benefits from Option 1 or Option 2 delivered to numerous people at your company

Intranet integration access to all in your organisation

• Policy Statements
• Job Listings
• Year in Review
• Latest News
• Press Credentials
• Voice of The Food Industry Blog
• Top Sellers
• How to Place an Order
• Asset Protection and Grocery Resilience Conference
• Biotechnology Vocabulary
• Biotechnology Frequently Asked Questions
• Bioengineering aka GMO
• Gene Editing
• The FoodKeeper
• Sustainability
• Crisis Management
• Diversity, Equity & Inclusion
• Feeding Assistance Toolkit
• White House Conference on Hunger, Nutrition and Health
• Food Price Inflation
• UPC Random Weight Perishables
• FreshForward
• Frozen Foods
• Food for Health
• Independent Operator
• Product Code Dating
• GMO Labeling
• Labor & Employment
• Omnichannel
• SmartLabel® Implementation Recommendations
• Supplier Diversity
• Supply Chain Forum
• MarkeTechnics
• Supermarket Employee Day
• Store Manager Awards
• Grocery Store Chains Net Profit
• Average Total Store Size – Square Feet
• Food Retailing Industry Speaks
• Food Industry Glossary
• U.S. Grocery Shopper Trends
• The Evolving Grocery Experience
• Conferences
• Digital Seminars
• On-Demand Learning
• College and University Programs
• Future Leaders eXperience
• Food Retail Leader Certificate
• Retail Management Certificate
• Food Safety News
• Backgrounders
• SafeMark Food Safety Training
• Safe Quality Food Institute
• Partnership For Food Safety Education
• Food Protection Committee Portal
• FSMA Resource Center
• Traceability Rule
• Priority Issues
• Issue Papers
• State Associations
• Government Relations Newsletters
• FoodPAC and FMI LEAD Fund
• Government Relations Staff
• Voting Resources
• Advocacy Center
• FMI v. Argus Leader
• Newsletters
• Directories
• Executive Leadership Awards
• Share Groups
• Frequently Asked Questions
• FMI Foundation
• Family Meals
• Sponsorships & Advertising
• Best Practices
• Asset Protection
• Corporate Social Responsibility
• Food Safety
• Fresh Foods
• Government Relations
• Health and Well-being
• Private Brands
• Retail Operations
• Supply Chain

Stay Connected

What do epa’s new pfas drinking water regulations mean for the food industry.

By Dr. Shelby Furman, Director, Food and Product Safety Programs, FMI 

It is essential to ensure that water that is consumed is safe and free of contaminants. A contaminant in drinking water is defined as anything other than water molecules. These can be classified in four ways: physical, chemical, biological and radiological. Though not all contaminants in water are considered harmful, some contaminants have potential health effects and have been or are starting to be regulated by the U.S. Environmental Protection Agency (EPA).  

Of the standards set by the EPA, there is one regulation in particular that has made headlines recently: the National Primary Drinking Water Regulations (NPDWR) , which are legally enforceable standards and treatment methods that apply to public water systems (PWS). This regulation is intended to protect public health by limiting the levels of contaminants in public drinking water, such as microorganisms, disinfectants and inorganic/organic chemicals.  

A set of contaminants that are of particular interest are chemicals known as per- and polyfluoroalkyl substances (PFAS). These substances are man-made chemicals that are used for their water, oil and grease resistance properties. However, they also do not break down easily and have the ability to accumulate in the environment and the body, leading to a growing concern over their potential health effects.  

In April 2024, the EPA announced final regulations on six PFAS and established health-based, non-enforceable Maximum Contaminant Level Goals (MCLGs) that range from 0-10 parts per trillion (ppt): 

• PFOA (Perfluorooctanoic Acid)
• PFOS (Perfluorooctane sulfonic acid)
• PFHxS (Perfluorohexane sulfonate)
• PFNA (Perfluorononanoic acid)
• HFPO-DA (Gen-X chemicals)
• Mixture containing two or more of PFHxS, PFNA, HFPO-DA, and PFBS (Perfluorobutane sulfonic acid)

EPA also finalized legally enforceable Maximum Contaminant Levels (MCLs) that are more easily achievable, which range from 4-10 ppt. As a part of the regulation, by 2027, public water systems must have completed initial monitoring for the listed PFAS. The water systems must also provide the levels of PFAS in their drinking water beginning in 2027. By 2029, water systems must implement solutions to reduce the monitored PFAS if they exceed the Maximum Contaminant Levels. Beginning in 2029, public water systems that violate one or more of the MCLs must take action on reducing the level of PFAS in the water supply and must notify the public of such violation.

What impact does the NPDWR have on the food industry?

With this regulation, FMI members might have some questions about what this means for their operations. The ruling specifically regulates public water systems and does not require action from the food industry at this time. That said, operations relying on PWS should work cooperatively with utility officials to ensure compliance and uninterrupted service at their facilities. Food facilities have the responsibility to ensure the use of water that is safe and of adequate quality in their operations to comply with U.S. Food and Drug Administration Good Manufacturing Practice (GMP) requirements. FDA considers using water that meets the standards for household drinking water would also be acceptable for the production of food products, and facilities can rely on the standards in EPA’s NPDW regulations to satisfy the GMP requirements.

What impact does the NPDWR have on bottled water?

Bottled water is regulated by the FDA; therefore, EPA’s rule does not apply directly. Currently, FDA has not established standards for PFAS in bottled water. Because EPA has finalized these standards, FDA is now required to evaluate what PFAS standards are appropriate. The agency is in its initial phase of research and is currently conducting a targeted survey for PFAS in bottled water. Results from its 2016 targeted survey did not detect PFAS in bottled water.

FMI will continue to monitor regulatory changes and the impact on the food industry and will update our members promptly with any new information.

• Per- and Polyfluoroalkyl Substances (PFAS) FMI Backgrounder
• Final PFAS National Primary Drinking Water Regulation
• Fact Sheet: Treatment Options for Removing PFAS in Drinking Water
• Fact Sheet: Benefits and Costs of Reducing PFAS in Drinking Water
• Current Good Manufacturing Practice, Hazard Analysis, and Risk-Based Preventive Controls for Human Food

Related Posts

Celebrating Excellence: PepsiCo Receives FMI’s 2024 Food Safety Innovation Award

We are proud to recognize PepsiCo as the recipient of this year’s award for their comprehensive approach to food safety. PepsiCo is the first product supplier company to receive the award and joins a prestigious list of past award recipients.

Traceability Is Important, But It Must Be Done Right

Food safety is the single most important issue the food industry prioritizes every day. FMI supports strong traceability systems, but it must be done in a way that is practical, achievable, and produces measurable results in enhancing food safety.

• Privacy Policy
• Terms of Use

© FMI All rights reserved.

Website design by Matrix Group International, Inc. ®

Sign Up for the

FREE daily briefing on top stories in food retailing.

• fmi-icon-frozen-goods
• fmi-icon-workforce
• fmi-icon-certificate
• fmi-icon-pharmacy
• fmi-icon-food-safety
• fmi-icon-asset-protection
• fmi-icon-education force-icon-3
• fmi-icon-research
• fmi-icon-government-affairs
• fmi-icon-get-involved
• fmi-icon-industry-topic force-icon-3
• fmi-icon-labeling
• fmi-icon-corporate-social-responsibility
• fmi-icon-payments
• fmi-icon-crisis-management
• fmi-icon-private-brands
• fmi-icon-food-assistance
• fmi-icon-supplier-diversity
• fmi-icon-fresh-foods
• fmi-icon-supply-chain
• fmi-icon-general-merchandise
• fmi-icon-technology
• fmi-icon-health-wellness
• fmi-icon-total-store-collaboration
• fmi-icon-Health-Reform
• fmi-icon-wage-labor
• fmi-icon-independent-operator
• fmi-icon-wholesaler-topic
• fmi-icon-newsroom force-icon-3
• fmi-icon-tax-reform
• fmi-icon-about_icon force-icon-4
• fmi-icon-about_icon
• fmi-icon-cart
• fmi-icon-blog_icon force-icon-5
• fmi-icon-Communications
• fmi-icon-omnichannel
• fmi-icon-biotechnology-topic