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KEY INTERVENTIONS: SITUATION REPORT − CHAPTER 3
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improved sanitation facilities; of these, 784 million used shared or public facilities, 732 million
used facilities that did not meet basic standards of hygiene and the remaining 1 billion people
practised open defecation on a daily basis.
3.5.2 Implications of the current situation on achieving progress on NTDs
The existence of water and sanitation infrastructure tells only a partial story. Access,
availability and reliability all play a role in whether people are able to use existing services
and to gain the expected benefits to health and well-being. For example, people in rural and
peri-urban areas will collect water from wells for storage at home; people with unreliable piped
water supplies in cities will also store water in their homes. Water storage facilities that are not
mosquito-proof will, collectively and cumulatively, add importantly to the breeding potential
for the Aedes vector of dengue. Furthermore, access, availability and reliability of water also
affects whether people have sufficient quantities of water to practise adequate household and
personal hygiene. Hygiene-promotion interventions that are delivered without addressing
access to water may therefore have a limited public-health impact. Annex 4 summarizes the
linkages between WASH and NTDs.
Open defecation is a particularly important risk factor for the transmission of many of the
NTDs, and progress towards the elimination of this practice should lead to a reduction in the
incidence of NTDs. The practice is not just a result of poverty – wealth quintile analysis shows
that in some countries open defecation is also practised by people from the wealthiest fifth
of the population. Eliminating open defecation alone will not solve the problem altogether;
ineffective management of the sanitation chain (i.e. what happens to faecal matter beyond the
latrine) contributes significantly to persistent contamination of the environment with human
excreta.
Case detection and drug treatment have been successful in reducing mortality rates and,
to some extent, morbidity. Yet, short-term achievements become short-lived if there is no
support for transmission risk reduction to sustain them, through environmental management
and lasting behavioural change, and through services that improve community development
overall to enable communities to sustain change. WASH plays a crucial role also in the latter.
3.5.3 Moving towards collaboration for elimination
A greater emphasis on joint planning, resourcing and delivery of WASH and disease control
interventions will yield important dividends for NTD control as well as other public-health and
human development goals.
The international policy framework for bringing together the WASH and public-health
spheres has evolved rapidly over the past 5 years. In 2010, the United Nations, through
resolutions of the General Assembly and of the United Nations Human Rights Council,
acknowledged access to safe drinking-water and sanitation as a human right, closely associated