Technical Areas

The WASHplus project engages in activities that lead to improvements in both water, sanitation, and hygiene (WASH) as well indoor air pollution (IAP). For greater impact WASHplus explores opportunities to integrate WASH into existing program such as HIV/AIDS, nutrition, and education. 

WASH and Neglected Tropical Diseases (NTDs)

WASH and NTD Integration - More than 1 billion people worldwide suffer from one or more painful, debilitating tropical diseases that disproportionately impact poor and rural populations. Many of these diseases have received less attention and funding when compared with others such as HIV, yet they still cause severe sickness and disability, compromise mental and physical development, contribute to childhood malnutrition, reduce school enrollment, and hinder economic productivity.

WASH and Nutrition

Integrating Water, Sanitation, and Hygiene into Nutrition Programming - Undernutrition is the underlying cause of 3.5 million child deaths each year (Black, 2008, The Lancet). A vicious cycle exists between diarrhea and undernutrition: children with diarrhea eat less and are less able to absorb the nutrients from their food; malnourished children are more susceptible to diarrhea when exposed to fecal material from their environment. Further, often the most vulnerable children do not have access to the health services that can mean the difference between life and death in the case of acute diarrhea.

Water, Sanitation, and Hygiene (WASH)

The leading environment-related risk factors for mortality in children, those that are causally related and/or associated with diarrheal disease, newborn infection, malnutrition, and pneumonia, include inadequate water supply, unsafe drinking water, and poor sanitation and hygiene behaviors. WASHplus aims to develop, introduce and deliver high-impact interventions in water, sanitation and hygiene (WASH) and indoor air pollution (IAP), at sufficient scale to achieve increased access to improved water sources to meet domestic needs, improvement in drinking water quality taken from those sources as well as at the point-of-use, increased access to and use of sanitary facilities for human excreta disposal, and increased and improved handwashing with soap.

WASHplus builds on well-established programs and relationships and the expertise to take proven approaches to scale with partners. The project tests and offers innovative products and services through targeted operations research (OR). It institutionalizes WASH programs in countries by advocating and engaging governments to adopt policies, improve regulations, strengthen institutions, and dedicate budgets. The project emphasis is on integration programming – recognizing the individual household as the fundamental building block for any national scale WASH effort. It applies commercial sector expertise to create sustainable public-private partnerships and advance new credit strategies and financial packages with a focus on women. WASHplus is also creating a “program learning” cradle, through actionable monitoring and evaluation and robust knowledge management to ensure that new learning is shared with WASH partners and stakeholders in country, and globally.

WASH and HIV Integration

The negative impact of low access to safe drinking water, insufficient quantities of water for basic hygiene, and inadequate to sanitation are magnified for HIV-infected, immuno-compromised individuals. Further, HIV-infected individuals require more water. The added burden affects not only the HIV infected, but the entire family, increasing risk of diarrheal disease and lost productivity and impacting quality of life. Therefore, people living with HIV and households (PLHIV) affected by HIV and AIDS have a substantially greater need for WASH services: more water, safe water, easy access to water and sanitation, and proper hygiene.

There is an urgent need for improved WASH practices in home-based care (HBC). Although HBC providers receive training in many aspects of care and support at the household level, including training in the principles of basic WASH, little emphasis and/or detailed information has been given about how HBC providers can help household members to overcome, or change, the many daily obstacles to improved WASH behaviors in the home. New practices can be adopted and current practices can be modified or changed in small ways that are acceptable/feasible to households. When tools are combined with some technical support for training and programmatic integration, uptake of the approaches has high potential for success, especially if activities are integrated into existing programs.


  • WASH & HIV/AIDS Bookshelf - A collection of resources related to the intersection of water supply, sanitation, and hygiene (WASH) and HIV.
  • WASH & HIV/AIDS Toolkit - A collection of job aids, policy recommendations, country reports and other WASH & HIV/AIDS resources from the Hygiene Improvement Project and others.

WASH in Schools Integration

Addressing improvements to water, sanitation, and hygiene education (WASH) in schools has been elevated to the global stage in recent years.  However, more often than not, these conversations have been missing a key element: the education sector.  Although the WASH and education sectors have different approaches, their end goals are the same: educating youth, keeping them healthy in a safe learning environment and creating productive members of society. Improving WASH (including deworming) services at schools helps improve access to quality education and increase economic potential for these and other reasons:

  • WASH in schools reduces absenteeism
  • Improving WASH improves cognitive and reading ability
  • WASH in schools improves girls' education
  • Investing in WASH in schools can lead to increases in income and economic growth through a more educated and healthier workforce.

Schools that teach their students about the importance of the three key practices: drinking safe water, using clean sanitation facilities, and washing hands with soap at critical times, and provide the simple enabling infrastructure, can become beacons of hygiene promotion in the communities they serve. Students from such “WASH-friendly” schools are champion promoters in their homes and can influence parents and siblings to adopt better hygiene practices.

Indoor Air Pollution (IAP)

Exposure to biomass smoke increases the risk of acute lower respiratory infections in childhood, particularly pneumonia, which continue to be the single leading cause of death in children under five years.  Indoor air pollution from household energy is ranked fourth in the list of serious threats to health in less developed countries for all ages—after malnutrition, unsafe sex, and unsafe water. The inefficient burning of wood and charcoal for cooking and heating also increases pressures on local natural resources, and exacerbates deforestation.

Past household energy interventions often failed because they did not adequately take into account the needs and preferences of the users; and that sustained improvements in health are dependent on behavior change as well as access to improved products and services, and in some cases financing options. Too few household energy interventions offer options for different consumer preferences and contexts.

In addition to promoting the scaling up of successful past efforts (e.g., commercialization of high performing, user-friendly ceramic-lined stoves) in many underserved urban and rural areas, WASHplus will design and implement pilots and programs to explore and promote feasible yet effective options for reducing exposure.  These may include incorporating strategies to support improved practices, e.g., awareness raising and social marketing, including improved behaviors around fuel, ventilation, kitchen management and proximity of children while cooking; rigorous quality control and emissions testing to ensure that only quality stoves and fuels are promoted; and capacity building for entrepreneurs.

In addition to improving WASH and IAP quality practices and approaches, WASHplus supports the integration of WASH into existing HIV/AIDS, maternal and child health and nutrition and education programs.


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