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Moving through the generations taking forward WASH... no longer just for the majority and those with the loudest voice

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I have just completed three days at the WEDC 40th International Conference held at Loughborough University in the UK. As always the conference was packed with a wide range of interesting paper presentations, posters, side-events and associated activities. Meeting colleagues new and old from across the globe is always a wonderful part of a WEDC conference and at the same time to become aware of the range of experience and learning that has been going on over the past few years. This year was no exception.

But amongst the positive experiences, a passing snide (arrogant/ignorant) comment made on the second day by a senior WASH professional from my generation (now in our 50s), related to the advocacy that I have been trying to do for increased attention on the often hidden and taboo subject of incontinence (where people cannot control the flow of their urine and faeces), made me reflect on the past, the present and the future. In particular to reflect on the progress that we have made as a sector in working to ensure that the WASH needs of all are met and how we are no longer mainly focussing on the needs and priorities of men, the majority and those with the loudest voice.

Two to three decades ago, hardly anyone talked about gender or issues related to equity and inclusion, about accessibility for people with disabilities or mobility limitations, about menstrual hygiene or about the needs of people from vulnerable or marginalised groups. Even trying to discuss issues relating to gender and about the differing experiences and needs of women, men, girls and boys, was often met with derision and your views were dismissed. Whereas at this conference today, there were a range of interesting papers and sessions focussing on issues as diverse as: gender empowerment through WASH from Bangladesh; a quantitative study on violence experienced by women related to WASH in India; the bathing needs of menopausal women from Ghana; the sanitation needs of people who are LBGTI; issues related to people with mental health conditions in CLTS processes; challenges related to access to and the design of toilets and urination by women; how the JMP should monitor inclusive WASH in schools; and revisiting subsidies: supporting the poorest through the CLTS process.

In the 2011 conference, the WEDC team held a very amusing and enjoyable side event on menstrual hygiene management (MHM) and there were one or two other papers on the same subject, but prior to this there were probably less than a handful of papers on this subject across all years that the conference had been running. This year in 2017, it was striking to see that there were multiple papers on MHM – very heartening considering that half the world’s population are female and hence the increasing recognition that WASH is also about their needs.

But an area still struggling to get recognition is that of incontinence, where people cannot control the flow of their urine and faeces and have to manage leakage on a constant or regular basis; even though the management issues are similar to that of menstrual hygiene, but with higher flows, stigma and isolation for those who live with it. The Impress Network from Leeds University together with Cranfield University, led a side event on incontinence, to try and raise awareness and increase interest in this challenging subject. Fascinating presentations by two MSc students from Cranfield University and the London School of Hygiene and Tropical Medicine (LSHTM) shared their preliminary, hot off the press, research findings having just returned to the UK a few days before from Zambia and Pakistan. These presentations highlighted the significant stigma, isolation and much heightened WASH needs for bathing and laundry for those who live with this condition. I learnt that the subject is even taboo and under-acknowledged by health professionals (even doctors and midwives), that the issue of incontinence and the higher bathing and laundry needs has also been raised by women going through the menopause in Ghana, and that the term ‘incontinence’ is not well understood around the world. Norwegian Church Aid also gave an inspiring presentation, sharing their practical experience of supporting people who are living with incontinence in humanitarian settings and there was also a very interesting presentation on different supportive technologies by the IMPRESS Network / Leeds University - from pads, to re-usable underwear, to catheters to higher tech solutions and reflection on the applicability and research needs related to low and middle income countries. It was great to have a chance to discuss with a range of participants on this hidden issue and to hear it mentioned in subsequent sessions in ways that I have not seen happen before. Let’s hope this is also the start to gaining the same momentum that attention on menstrual hygiene has rightly gained over the past decade, so that this group of people with particularly acute WASH needs will also be considered and supported.


But whilst a lot of progress has been made in the sector, which can be seen by the increasing interest and attention on issues related to people with less power and less voice, the snide comment made by a senior WASH professional on the issue of incontinence (even though he admitted that he neither had experienced incontinence nor had spoken to anyone who lives with it), did however highlight that for some, including those working at senior levels, there is still a long way to go. His comment highlighted that there are still remnants of mindset and attitude in some people, which continues to belittle issues that relate to women or to minority or marginal groups. Sometimes in the past I have felt that once my generation and that above me have moved on, there will be more chance that the sector will automatically consider the needs of all, including those in minority or disadvantaged situations. I was encouraged to see a degree of a mix of people attending some of the more equity and inclusion focussed topic sessions, but there is still some division between those who still focus mainly on the hard technical and those who are interested in the softer more people focussed aspects of WASH (although not as much as before). As an engineer by background and one that still enjoys engaging in the technical and engineering sides of WASH as well as the people aspects of the same, I would have also liked to have attended some more of the technical focussed sessions. I managed to attend a few, but because the subjects were grouped by theme it was often the case of “either – or” of the types of presentations participants could attend, which perhaps reduces the opportunity for broadening knowledge from each side and leaves us to some degree working in silos.    

Of the other diverse presentations and side events which I attended I also found a range very interesting and some prompted ideas and considerations of direct relevance to my current and future work. For example research on the outcomes (highlighting gaps) following the implementation of community level water safety plans (across several countries); to the use of community score cards for keeping track of on-going WASH services (in Timor Leste); to the use of WASH participatory action research (in Micronesia); to the use of mobile phone technologies for tracking the progress of construction; and real-time learning in a WASH programme (in Cambodia). I very much appreciated the approach by Plan International during their side event on the importance of undertaking formative research before designing hygiene promotion programmes, run together with WaterAid and the LSHTM, in the way they were open about the weaknesses of their current programmes and the journey they are on to improve. I think that the more organisations are prepared to openly share their weaknesses as well as their strengths, the greater our accountability, the faster the progress will be and the quicker we will stop making the same mistakes.   

One of my clear highlights of the conference was to know that two Loughborough University Distinguished Alumni awards have been awarded to George Yarngo, Assistant Minister for Community Services, Ministry of Public Works, Liberia and Mark Harvey, Head of the Infrastructure Division, DFID – huge congratulations to them both. Our paths have crossed a number of times during the past few decades and these awards are very well deserved. I have worked in Liberia on multiple occasions and have always been greatly inspired by working alongside Assistant Minister George Yarngo, knowing the difficulties faced in post-conflict contexts and seeing his unending commitment, leadership and tenacity to improving the WASH situation for all people across Liberia, coupled with his personal humility – a rare combination.     

Another highlight was to hear the career reflections of Andy Cotton and Ian Smout, who between them have given over 65 years of their lives to WEDC and the global WASH sector. Andy was one of my undergraduate civil engineering lecturers in the 80s and one of my earliest mentors, encouraging and supporting me as I moved to work in the international development field; and Ian later, as I worked at WEDC in the 90s, particularly encouraging and supporting my early efforts to try and get gender on the agenda in WEDC and the wider sector, when I was still trying to build my own knowledge and self-confidence on this issue, including as to how to respond to the barrage of negativity that often resulted at the time when raising this issue. It was touching to hear their career highlights and to think about how many people, like me, have directly benefitted from their support and encouragement, that has in turn indirectly benefitted so many of the poorest people around the world.   

There are many great people who have worked in this sector over the years, some still with us and some not, but I would like to sign off that the most inspiring thing about this conference was to see the younger generation of WASH professionals grasping the challenges for the most vulnerable, marginalised and disadvantaged people with both hands and running with it. If we can tackle the needs of those with least power and least voice, the world will be an infinitely better place, so although there is still a long way to go in practice in the field, this change in attitude and these areas getting increased attention in the global WASH sector is really great to see.

Sarah House is an independent WASH consultant.

Date: 31 July 2017