Ensuring access to safe water, sanitation, and hygiene (WASH) services plays an important role in safeguarding the health, well-being, and resilience of individuals and communities. WASH has the potential to prevent 6.3% of deaths and 9.1% of the disease burden in developing countries.[1]

Each year, approximately 801,000 children under 5 years of age die from diarrheal diseases that result from poor-quality WASH.[2] An estimated 50% of undernutrition is not due to lack of food, but to diarrheal disease and worm infections caused by inadequate WASH.[3]

Fewer than half of health facilities in the developing world have access to safe drinking water, improved sanitation, and hygiene on the premises.[4] This contributes directly to the spread of diseases, including diarrhea, pneumonia, and even Ebola, as well as to life-threatening infections, such as sepsis, which accounts for 11% of global maternal mortality[5] and 7% of neonatal mortality[6] and is frequently acquired when women are forced to give birth in WASH-unsafe environments.

Child and maternal health, HIV/AIDS, neglected tropical diseases, food security, nutrition, pandemic preparedness, and other development efforts can be more effective during initial implementation and more sustainable over the long term if they include WASH.

Cora Tucker (17) works in the construction of a bathroom in Bilwi, RAAN, Nicaragua, 2014. Credit: WaterAid/Rodrigo Cruz

6.3% | 9.1%

WASH has the potential to prevent 6.3% of deaths and 9.1% of disease burden


children the age of 5 die from diarrheal diseases that result from poor-quality WASH


of undernutrition is not due to lack of food, but to diarrheal disease and worm infections caused by inadequate WASH


Ensure that funding for WASH programming is sustained during the current budgetary climate and ensure that WASH financing is integrated across multiple development sectors. In addition to critical U.S. Agency for International Development (USAID) initiatives and programs, Congress should provide robust funding for the Global Health Programs and Development Assistance budget, given that WASH is interdependent with the programs provided under these accounts.

Ensure initiatives that depend on WASH for their success include WASH measures. This includes legislation such as maternal and child health, emergency disease outbreak and disaster responses, youth initiatives, and primary health care and health systems strengthening.

Improve aid effectiveness by supporting the implementation of the Water for the World Act, which will help to improve monitoring and evaluation across USAID programming and includes WASH indicators that are linked to positive health outcomes and increased engagement of civil society groups representing the needs of women and girls, who are disproportionately impacted by lack of WASH.

Nallely Obando, 2 years old, drinks water from a tap, Belen, North Caribbean Coast Autonomous Region, Nicaragua, November 2015. Credit: WaterAid/Fermín López
Ammika and Hem Bahadur washing their hands in their tapstand after working in their farm. Hardeni, Udayapur, June 2016. Credit: WaterAid/ Mani Karmacharya


In September 2015, the United Nations General Assembly approved the Sustainable Development Goals (SDGs) which, for the first time, elevates WASH to a top priority by creating a stand-alone goal (Goal 6) calling for providing universal access to safe drinking water, sanitation, and hygiene and ending open defecation by 2030. Universal access to water supply and sanitation would save more than $11.6 billion in the health care sector and people would gain over 5.6 billion productive days per year.[7] Moreover, achieving universal access to sanitation would return $220 billion to the global economy each year in saved health care costs and increased productivity. Every $1 spent on water and sanitation generates a little over $4.30 in increased productivity and decreased health care costs.[8]

The U.S. government and Congress have shown strong leadership to improve water, sanitation, and hygiene access globally, initially through the Senator Paul Simon Water for the Poor Act of 2005. They renewed that commitment by unanimously passing the Water for the World Act of 2014 into law in December 2014. The health gains made possible by these important pieces of legislation are tremendous. In conjunction with sufficient funding from donors and national governments and an ongoing commitment to lasting programs, these bills will mean that women and girls no longer get sick from dirty water or poor sanitation, that fewer workdays and schooldays are missed, and that income and productivity increases and funds accrued can benefit the health and education of the household. WASH has also been reflected in a number of administration and congressional initiatives, from the Global Food Security Act to the Centers for Disease Control and Prevention’s (CDC) Global Health Security Agenda.

Programs implemented by USAID and its partners strengthen the capacity of developing country governments to address WASH challenges that impact the health of communities. The launch of USAID’s Child Survival Call to Action in 2012 was a positive step toward prioritizing the link between WASH and health outcomes, especially related to diarrheal diseases and maternal health. The campaign’s broad support from the G8 community and UNICEF makes this an encouraging partnership for the U.S. government and an opportunity to elevate the link between WASH and health on the global scale, consistent with evidence in support of WASH as a critical primary health intervention. The Child Survival Call to Action and the Feed the Future initiative are important tools for the U.S. government to promote global health, but in order to realize the full benefit of these tools, integration of WASH services is essential.


  1. USAID, Water and Development Strategy 2013-2018
  2. CDC, Global WASH Facts


Lisa Bos, World Vision,
Lisa Schechtman, WaterAid America,


[1] “Global WASH Fast Facts.”

[2] Liu, L.; Johnson, H.L.; Cousens, S.; Perin, J.; Scott, S.; Lawn, J.E.; Rudan, I.; Campbell, H.; Cibulskis, R.; Li, M.; Mathers, C.; Black, R.E. “Global, Regional, and National Causes of Child Mortality: an Updated Systematic Analysis for 2010 with Time Trends Since 2000.” Lancet, vol. 379, no. 9832, 2012, p. 2151-61.

[3] “Water and Health.”

[4] “Water, Sanitation and Hygiene in Health Care Facilities: Status in Low- and Middle-Income Countries and Way Forward.”

[5] “Global Causes of Maternal Death: a WHO Systematic Analysis.”

[6] “Levels and Trends in Child Mortality.”

[7] “Water and Sanitation for All.”

[8] “Global Costs and Benefits of Drinking-Water Supply and Sanitation Interventions to Reach the MDG Target and Universal Coverage.”

©2017 Global Health Council