Water, Sanitation, and Hygiene

World Vision integrates behavior-change programming into its WASH work in communities, schools, and healthcare facilities to influence healthy social perceptions and norms that can transform communities and achieve sustained impact. Our behavior-change guidance for programs draws from the Behavior Centered Design approach and behavior-change evidence summaries handwashing, latrine use, safe child feces disposal, menstrual hygiene management) to adapt evidence-based best practices to local contexts. We also promote modifying physical environments (and systems for operation and maintenance) to support and sustain new behaviors. Behavior-change programming is guided by local contexts and promotes the adoption of essential WASH behaviors. One way we deliver behavior-change messages is by engaging with and mobilizing community leaders and influencers, including faith leaders, educators, mothers in leadership positions, and community health workers. We have also partnered with iDE to use Human-Centered Design to ensure that our products and services appeal to those in our program areas and best meet their individual needs.

We also look at behavior change beyond individuals and households. We seek to understand behavioral barriers in community norms and government structures that hinder equitable services by local governments and the private sector. We then develop comprehensive plans to mobilize communities to increase government support for sanitation and hygiene so that equity and sustainability are both achievable.

In schools, our programming integrates WASH interventions with approaches from the education sector to jointly support both SDG 6 (clean water and sanitation for all) and SDG 4 (quality education for all). In addition to ensuring clean water, World Vision prioritizes sanitation service levels beyond basic access. This includes equitable and disability-accessible sanitation facilities sufficient for the school population, disability-accessible handwashing stations with soap, and facilities to manage menstrual hygiene privately and with dignity. We also endorse the implementation of school WASH clubs, which promote accurate WASH knowledge and behaviors among students. In 2022, World Vision reached nearly 1 million students with access to basic handwashing facilities at 3,616 schools, as well as 489,937 schoolchildren with access to basic sanitation facilities at 945 schools. We also established 3,535 school WASH clubs.

World Vision partners with Sesame Workshop to implement two school-based WASH behavior-change programs — WASH UP! and Girl Talk. Using fun and engaging multimedia materials, WASH UP! features Sesame character Raya, who teaches children to practice and share healthy WASH habits, including handwashing with soap, drinking clean water, using safe toilet behavior, conserving water, and more. Raya also serves as a role model for school-aged girls. World Vision and Sesame Workshop first piloted the WASH UP! program in rural communities in Zambia, and it has since expanded to 17 countries, reaching more than 353,000 boys and girls in more than 4,100 WASH UP! clubs. Together, World Vision and Sesame Workshop developed a follow-up curriculum called Girl Talk, which educates boys and girls about puberty, with a focus on girls’ menstrual health and hygiene. This program has been successfully piloted in Zimbabwe and will expand to at least three new countries by the end of 2023.

World Vision’s focus on WASH in healthcare facilities plays a critical role in preventing and controlling infections and outbreaks, improving the quality of care, promoting healthcare best practices, and saving lives. Our work aligns with the universal health coverage targets of SDG 3 (good health and well-being) — particularly targets 3.1 and 3.2, aimed at reducing maternal and neonatal mortality.

World Vision’s WASH work in healthcare facilities is often delivered through BabyWASH, an initiative that integrates WASH with interventions in nutrition; early childhood development; and maternal, newborn, and child health to improve health outcomes for mothers and children and increase chances of survival during a child’s first 1,000 days of life.

World Vision also promotes best practices for implementing WASH services in healthcare facilities for the greatest impact and long-term sustainability. These include partnering closely with government services and other organizations, coordinating between the WASH and health sectors, behavior-change programming for healthcare workers and patients, creating demand for health services (e.g., using targeted messaging and interventions to encourage use of healthcare facilities when needed), and establishing or strengthening operation and maintenance systems for long-term sustainability.

Read more about World Vision’s WASH work in healthcare facilities here.

Delivering essential services during a rapidly changing global health crisis requires flexibility and innovation at all levels. World Vision’s response remained dynamic, adapting to the challenges of the pandemic as it evolved.

In 2022 alone, World Vision facilitated building 742,744 handwashing facilities to reduce the spread of infectious diseases, ultimately empowering 3.36 million people for improved hygiene. A total of 11,820 faith leaders were trained to promote healthy hygiene and sanitation practices. Overall, the global pandemic shed a spotlight on the importance of hygiene, and World Vision kept that momentum going even after the acute stage of the pandemic ended.

As part of our commitment to reach everyone, everywhere we work, with sustainable water services, World Vision intentionally builds partnerships with subnational government representatives and institutions to develop universal service coverage plans for WASH services. As of the end of 2022, World Vision has supported 100 subnational governments in developing a plan for universal WASH service coverage. These plans increase the likelihood of local governments’ long-term involvement and investment long after World Vision’s work in these communities has concluded.

At the national level, World Vision also helps government agencies develop and improve WASH service policies, standards, and oversight. Our technical guidance for programs states that World Vision WASH programming must align with government standards, and where policies and standards are insufficient or non-existent, World Vision must work to help set those standards and ensure policies are formed, implemented, and monitored. In each country where we work, World Vision partners with the lead government agencies of Hygiene and Sanitation, Water, and Health to highlight WASH as a key development issue, build the capacity of national and local governments to support WASH improvements, and help ensure adequate policies and public services for WASH improvements to be maintained.

Everywhere that World Vision works, we seek to empower community leadership and prioritize local water system maintenance and repair in support of sustainable service delivery. World Vision helps to strengthen overall water system management by promoting and supporting small-scale rural utility businesses and the use of private operators, training and equipping private repair technicians, and organizing private spare parts suppliers to help ensure spare parts are available when repairs are needed. When appropriate, we also support communities in forming WASH committees or water-user associations with fee-collection systems to pay for water point maintenance and repair. Committee/association members are trained in water point operation and maintenance before infrastructure work begins. These women and men also receive training on water system management and learn to promote safe hygiene and sanitation practices around the water point and in their community.

World Vision also works to empower citizen participation in decision-making at all levels of WASH governance, using the Citizen Voice and Action (CVA) local advocacy model. CVA equips citizens to understand their rights and express their needs in constructive dialogue with government institutions. By amplifying the voices of the most vulnerable, CVA and other social accountability initiatives aim to increase both the transparency and accessibility of information and empower communities to keep their government and other authorities accountable to deliver on their promises for child well-being. Additionally, this approach empowers citizens to advocate for a greater commitment of public funding toward WASH services.

“Before creating CVA groups,” says Mukansanga Goreth, a 39-year-old woman from Rwanda’s Southern Province, “we often faced different challenges on our water pipeline caused by the bad behavior of some people from the community.” Following the CVA process, however, she notes, “we have the power and capability of coaching, giving advice to our neighbors about water management, and advocating for them.” As a result, community members are contributing to water system repair costs. “Now,” reports Mukansanga, “we have no shortage of water.”

The World Bank estimates that current investment in WASH is only one-third of what is needed to reach the aspirational goal of SDG 6. To bridge this gap, additional private and public funding must be mobilized. World Vision is committed to raising revenue of over $1 billion for investment into WASH systems and services and to leverage those efforts to mobilize additional financing to close the financing gap for achievement of SDG 6. We hope to encourage other donors and implementers to join us in a global vision for universal WASH access by 2030.

World Vision is also exploring alternative financing options to fund critical WASH infrastructure and services. Where suitable, we have worked with microfinance institutions to provide capital for families who cannot afford the up-front costs of a household water connection or toilet. In other places where we work, World Vision has been investigating the viability of private insurance policies as an approach for developing financially sustainable mechanized water systems. For communities that make claims for repairs, significant costs can be saved through this approach. At the same time, growing the business model’s attractiveness will encourage more insurance companies to offer water systems insurance policies, opening more insurance options for communities and incentivizing responsiveness by insurance companies.

For new WASH infrastructure, World Vision has applied blended financing strategies with promising results. We join local governments to co-invest in new infrastructure and support those governments in setting aside a dedicated budget line in their yearly budget for water system maintenance, ensuring that ongoing costs do not become a barrier to sustained WASH access. Traditionally, funding for operation and maintenance is raised through user fees, which are often set by the national government. Where applicable, World Vision assists in creating a mobile fee-collection system to ensure consistent and equitable collection of water-user fees. Under a USAID-funded program, World Vision and our partners have also co-piloted an innovative financial management system with pooled funding by WASH committees to help cover operation and maintenance costs that may be too expensive for a single committee to handle. Innovative financing measures such as these hold the potential for closing the WASH financing gap for the most vulnerable populations that World Vision serves.

The United Nations defines water security as “the capacity of a population to safeguard sustainable access to adequate quantities of acceptable quality water for sustaining livelihoods, human well-being, and socioeconomic development, for ensuring protection against waterborne pollution and water-related disasters, and for preserving ecosystems in a climate of peace and political stability.”

Many complex and interconnected factors contribute to water security. Building a water-secure future, therefore, requires interdisciplinary approaches and coordinated actions that target synergies across sectors, while managing the demand of all users. At a high level, key considerations in achieving global water security include the need for successful management of transboundary waters (where water sources are shared across political boundaries); fortified water infrastructure and systems that sustain them against external shocks caused by conflict or disasters; innovative financial mechanisms and good water governance with supporting policies; and adaptive management of water resources that consider increasing climatic and hydrological variability.

World Vision supports the resilience of households and communities by helping them prepare for, endure, and recover from recurrent crises that can affect water security. Recognizing that climate change has the potential to both reverse decades of progress on water access and impact local hydrological cycles, World Vision brings a “climate lens” to our WASH programming, helping households, communities, and governments thrive under today’s conditions while also planning for how those conditions may evolve. Preparing resilient WASH services takes many forms, including infrastructure siting in relation to flood zones, increasing water storage capacity for protracted droughts, maximizing the use of solar power to reduce dependencies on grid power, and helping households anticipate seasonal rain fluctuations and the resulting impact on water for domestic and livelihood needs. One example of this work is our groundwater monitoring program in Somalia.

Improving water security is highly relevant to World Vision’s WASH programming to ensure the viability of investments in WASH infrastructure. Simply stated, the life-changing impact of a community drinking water system requires the sustained availability of water in the surrounding environment, in both sufficient quantity and adequate quality. Protecting, rehabilitating, or otherwise sustaining the hydrological functions of project site ecosystems helps ensure that water resources can be plentiful and accessible when needed while protecting children and their communities from the effects of extreme events (floods and droughts).

In the 2021-2025 Global WASH Business Plan, World Vision outlined four key entry points for improved water security: 1) advocate for watershed protection and/or rehabilitation; 2) support water resource planning and water allocation decisions; 3) integrate climate change scenarios into infrastructure planning; and 4) develop evidence on climate resilient WASH programming.

Read more here about how World Vision applies these entry points to address the complex water security challenges facing the countries where we work.

Under the 2021-2025 Global WASH Business Plan, World Vision has a new indicator tracking the number of hectares affected by improved water resource management practices or technologies. We use this indicator to monitor our efforts to protect watersheds and invaluable water sources.

Broadly speaking, this includes land- or water-based management practices and technologies used, including those that address climate change adaptation and mitigation, such as the cultivation of food or fiber, aquaculture, fisheries, tourism, community planning, protected-areas management, and livestock management. More specifically, improved water resource management practices or technologies are those promoted by World Vision to protect, rehabilitate, or otherwise sustain the integrity of the ecosystem and associated hydrological systems within a defined catchment area. Some examples may include tree planting and erosion control, land stabilization, improved monitoring of forest and water resources, and agricultural best practices such as contour cultivation, agroforestry, and farmer-managed natural regeneration.

World Vision chose this indicator because when raw water resources are managed in a way that sustains the quantity and quality of available water, vulnerable children and their communities are more likely to be protected from infection and disease, leading to better overall health.

World Vision’s global WASH programming aims to improve child well-being, health, nutrition, and education outcomes through access to sustainable and safely managed WASH services. Women and girls disproportionately bear the time and physical burdens of water collection, while the lack of adequate gender-sensitive sanitation and hygiene services increases the risk of harassment, violence, injury, and illness. The lack of accessible water, toilets, and hygiene facilities is also a major challenge for the elderly and people with disabilities, who may have difficulties traveling long distances or using toilets without assistive devices.

Similarly, Indigenous peoples and ethnic minorities tend to benefit less from development activities, including WASH services, because of social, cultural, and political barriers. The lack of adequate representation for Indigenous peoples at higher political levels further exacerbates these inequalities.

Adequate informed participation by women and other excluded groups remains a key challenge in global WASH programming design. This gap often results in WASH services that are inappropriate, inaccessible, and unaffordable. Omitting GESI-related issues in water governance undermines the effectiveness of programs, reduces efficiency through missed opportunities, and can limit trust and engagement with communities. However, when women, persons with disabilities, and other people who are marginalized or excluded participate in decision-making on WASH services, their rights to water and sanitation are more likely to be fulfilled through services that are accessible, safe, and affordable.

See World Vision’s guidance for addressing GESI in WASH programming to learn more.

World Vision’s approach to gender equality and social inclusion includes classifying programs and projects, including in WASH, along a continuum (see figure below) of responsiveness to GESI concerns. On the GESI-responsiveness continuum, the ideal GESI-transformative program is structured not only to address the immediate effects of inequality, but also to identify and tackle its root causes in order to bring about lasting transformation. World Vision strives to make all programs GESI-responsive, ultimately growing them from GESI accommodating to GESI transformative. Adopting a GESI-transformative approach to WASH has impacts beyond access to water; it sets the tone for inclusion and equality throughout the entire community.

World Vision is committed to GESI in our WASH programming and staffing. First, we have examined GESI-related challenges in our existing staffing and are specifically working to train and promote more women in leadership and throughout all levels of the organization. Second, Our GESI approach actively strives to examine, question, and change harmful social norms and power imbalances as a means of reaching GESI objectives. These objectives include access to infrastructure and participation in management structures and leadership roles, as well as more transformative elements, including systems change, equal decision-making, and overall improvement in well-being for all people. This GESI-transformative approach to WASH goes beyond infrastructure access to promote equitable and inclusive social norms and systems that support the well-being of all — especially the most vulnerable. As a foundational intervention, a GESI-transformative approach to WASH opens the door for transformation in other aspects of development, including education and economic empowerment.

The increased focus on GESI-transformative WASH is clearest in World Vision’s emerging Strong Women, Strong World program, empowered by a transformative gift from Clean Water Here. With an initial focus in four countries — Guatemala, Honduras, Kenya, and Zimbabwe — this program aims to integrate evidence-based WASH and economic empowerment interventions with a specific focus on removing barriers that prevent women and girls from engaging and thriving in their communities. It also reinforces essential supports that empower women, such as access to trainings and business capital, positive social norms and role models, and a more positive environment for girls in school.

This program includes intentional learning with World Vision’s partner Emory University, aimed at assessing more transformative impact.

Other ways World Vision addresses GESI-related issues in WASH include:  

• Through collaboration with Sesame Workshop, we implement WASH UP! Girl Talk, a program that models girls’ empowerment and provides education on menstrual health and hygiene, as well as facts about puberty. 

• World Vision’s Nurturing Care Group programs seek to change community-level norms by targeting entire geographic areas with GESI-transformative messages. 

• World Vision’s disability-inclusive WASH programming provides equitable sanitation and hygiene that is accessible for all. People of varying ability levels are included in the planning process for design and location of toilets at schools and healthcare facilities to ensure they are accessible to all. Community members with physical disabilities are supported with accommodations such as ramps and seats to make daily toilet use easier and more dignified.

Learn more about World Vision’s GESI work here.