Beyond accessibility to inclusion for all

Brick wall with door

The SDG imperative to leave no one behind pushes us to ask the question: which members of our society are currently not accessing WASH services and why? To understand exclusion we must first reflect on those barriers that privilege certain groups of people over others. For people with disabilities, barriers exist throughout society. These may include attitudinal, physical, communication and institutional barriers. They may be within our environments, in communities, public institutions, civil society organisations, and within ourselves.

How do we see inclusion?

Learning from the messages of international disability rights advocates, we can understand disability inclusion in WASH more broadly than just removing overt discrimination or integrating technical options within WASH facilities. It is as much a process as it is an outcome. Inclusive processes happen when people with disabilties are engaged and empowered as decision makers and agents of change within WASH interventions. Inclusive outcomes happen when WASH implementers take steps to understand the perspectives of people with disabilties, identify barriers which prevent them from accessing WASH, and take comprehensive actions to remove or reduce these barriers. In achieving the SDGs’ intentions, a systems change is necessary to realise more inclusive WASH services that benefits all. One that rests on duty bearers’ commitment to rethink services and facilities, and reshape arrangements to eliminate the barriers to access; including for and with people with disabilities. Beyond political will, what is essentially societal change requires time and resource investments.

Looking beyond household service levels

The World Health Organization (WHO) estimates that 1 in 7 people globally experience disability, within that 80% live in developing contexts, and are more likely in poverty. For women, the interplay between gender, disability and poverty – referred to as the triple jeopardy -  adds further layers of disadvantage. Yet existing data at all levels (national, service delivery, community, project) tend to underestimate the prevalence of disability to as low as 0.5-2%. This reflects the complexity in the way disability is defined and measured. Without accurate data, resources are prioritised elsewhere'

2017 mid-term results in Nepal on access to toilets (SSH4A Results Programme)

2017 mid-term results in Nepal on access to toilets (SSH4A Results Programme)

Within the WASH sector, a common challenge is that access to service levels is typically measured and reported at household level (see left bar chart), by the head of the household. This data in turn is aggregrated up to ODF area-wide declarations, which can mask the realities of individual household members. There is a clear need to invest in data collection methodologies to complement standard household-level data with individual-level data that can highlight differences in intra-household access and usage, at scale.

Seeing the diversity in disability

Through a new partnership with CBM Australia, we’re strengthening SNV’s organisational capacity to develop more inclusive WASH programming. During the Lao PDR January 2019 training, Capacity Building in Disability Inclusion in WASH, the SNV WASH team from 9 country programmes gained insights into the diversity within disability, across the spectrum of human experience. In WASH programmes, this reinforces the need to understand barriers beyond the physical environment and in recognising:

  • the diverse experiences of people with different types and severities of impairment;

  • how gender and other aspects of people’s identities interact with disability; and

  • how each person’s WASH needs evolve throughout the human life cycle as these are shaped by processes of ageing, illness, injury, pregnancy, as well as disability.

Without valuing this diversity, consulting directly with users who reflect such diversity, and involving them in policy and programming decisions – the assumptions we make about the accessibility of WASH services give an incomplete picture. For example, national guidelines, standards and monitoring teams often focus on accessibility in terms of access to public infrastructure for wheelchair users, rather than applying universal design principles to ensure all people have access, as appropriate to each context. In practice, people with disabilities themselves frequently report that social norms, attitudes and practices relating to disability have at least as big an impact on their access to WASH as inaccessible latrines.

Putting people first

There are many reasons why disability inclusion is not further mainstreamed in the WASH sector beyond accessibility, or development at large. These may include a lack of confidence or in mandates, and having multiple priorities. Perhaps though the strength in disability inclusion and the SDG imperative to achieve sanitation for all, is the increasing recognition that we are all in this together, and there is much that we can do today.

Within programmes, we are faced by the tension between first testing out approaches to “get things right,” and mainstreaming approaches from the onset. Putting people first though means mainstreaming inclusion efforts from the start alongside targeted interventions, thereby bringing multiple benefits:

  • It addresses a bias in service delivery, and mobilises people to influence and take ownership over the decisions and interventions that affect them.

  • Economically, it makes better sense. In 2018, the UNICEF estimated that retrofitting costs to WASH facilities to cover everybody may be 20% compared to 3% if planned from the start.

  • From a safeguarding perspective, we may be placing people under additional social pressure in the push for ODF if we wait to “get things right first” before including them.

  • It is good development practice! Accessible infrastructure and services benefit the whole of society, without leaving anyone behind.

Note: This blog was prepared by Gabrielle Halcrow, with acknowledgements to CBM Australia’s Asahel Bush. The January 2019 capacity building exercise in Lao PDR is an activity under the Australian Government's Water for Women Fund-supported SNV project, Beyond The Finish Line.

About the Author: Gabrielle Halcrow is SNV’s Multi-Country Programme Manager for Beyond Finish Line Programmes in Bhutan, Nepal and Lao PDR. She has a technical background in international and environmental health with 20 years of professional experience working with WASH, gender equality and public health programmes with local and state governments and international development organisations. In 2019 she is celebrating her 10th year as part of the SNV SSH4A programme team in Asia.