After three very intense days of Monitoring Sustainable WASH Service Delivery Symposium, there were still several side events on Friday 12^th of April. I attended one on monitoring WASH in extra household settings, that is, in places such as markets, institutions or bus stops, as well as in social events such as religious gatherings. In the presentations and the group debate some relevant issues related to this topic where discussed. I synthesise here some of the most interesting ones.

First of all, is WASH beyond the households at all important?

Well, we have to take into account that people spend most time out of home (at school, at work, etc.) so it cannot be neglected if ODF status is to be achieved. Coverage in extra household setting seems to be very poor (although data is also limited) negatively affecting people in different ways:

• A review of studies showed that inadequate WASH services in schools negatively affect the learning process. Where little water was available, children drank less and their cognitive capacity was reduced. Also, lack of adequate sanitation facilities increased the incidence of diseases and decreased the rate of attendance, especially among girls that had started menstruating.
• Similarly, poor WASH in health facilities was seen to dramatically increase the risk of infections among patients. WaterAid and the London School of Health and Tropical Medicine are currently exploring the co-relation between childbirth mortality and lack of access to water and sanitation, both at the household and at the health centre level (related papers will be published soon).
• In markets, the main problems are related to the bacterial transmission due to the use of contaminated water for washing food.

In addition, WASH beyond the household has strong connotations regarding equality and human rights. On one hand, when we think about settings such as prisons or schools, we must realise that there are ‘vulnerable’ groups which do not have a choice to be elsewhere and are thus being forced to stay in an unhealthy environment. On the other hand, when we look at the most disadvantaged groups – such as squatters, migrant labour, nomadic groups, etc–, making water and sanitation accessible to them will in most cases involve principally collective facilities.

Along with the overall challenges in extra household WASH, the monitoring in the sector also has a long way to go. The way forward is still to be decided, but there is a clear case for increased cross-organisational and cross-ministerial cooperation. Nevertheless, some positive trends can be observed, such as the inclusion of schools and health centres in the post-2015 proposed indicators (I discussed this issue in my last post , and you can also see more on it here).

Later on, a member of WSSCC also shared her experience while visiting Rajghar area in Bangladesh, where the Community-Led Total Sanitation approach was first pioneered in 1999. The results were impressive: ODF status was achieved in the area, involving around 20 villages, an amazing impact. But the situation in markets was bad. They eventually took action to change this, but the point is that ODF verification in CLTS was and still is way far from including extra-households settings, especially in terms of marketplaces. Although there are cases such as Malawi, where sanitation beyond the household is included in the ODF verification protocol, CLTS as an approach might do good embracing it more explicitly.

The side event being short –as compared to the Symposium days– we could also relax for a while and walk a bit through Addis Ababa. Something you should not miss if you ever have the chance to come: the toilet of the Ethiopian Emperor Haile Selassie (at the Ethnographical Museum)! (see picture)

You might also like to read Jolly Ann Maulit's blog about the last day of the symposium

Andrés Hueso González ahuesog@upvnet.upv.es