How can WASH practitioners best respond to the COVID-19 outbreak in developing countries?






Richard Carter, editor of Waterlines journal and WASH consultant, worked with the publishing team to put together a collection of WASH resources to guide community response to the global COVID-19 pandemic. These books and articles have been made temporarily FREE to access.


The virus known as SARS-cov-2 and the severe acute respiratory disease COVID-19 which it can cause, represent the most extensive global public health emergency of recent times. All countries face exceptional challenges at this time, although the nature of the crisis will vary by country and region.


In general, low- and lower-middle income countries tend to have a greater proportion of their populations in the younger age ranges; conversely, a smaller proportion of these countries are elderly. This is in contrast to the high-income countries, where populations are generally skewed toward the older age ranges. This matters, since the mortality rate from the disease is higher in older age groups. It seems that younger people generally (but not always) tend to experience milder symptoms, from which they may readily recover.

Health Care facilities

On the other hand, the number of hospital beds, the number of intensive care facilities, and the number of ventilators (needed for treatment of patients with severe symptoms) all tend to be lower in low- and lower-middle income countries than in the wealthier countries. It would not take many acute cases of the disease to quickly overwhelm health systems in such countries.

Social contact

A third contrast between lower-income and wealthier countries lies in the amount of social contact that the elderly have with their peers and with younger generations. This social contact tends to be higher in lower-income countries, while in wealthy countries it tends to reduce sharply with age.

A complex set of interactions

All these, and many other country-specific and community-specific factors, combine to explain the way that the virus would multiply in the population, were no measures taken to mitigate or suppress the infection. A recent paper (Walker et al, 26th March 2020) estimates that in the absence of interventions, COVID-19 would result in 7.0 billion cases of the disease and 40 million deaths globally in 2020. For comparison, the global population in March 2020 was 7.8 billion; and in the absence of COVID-19, the global number of deaths in 2017 was about 56 million.


As a consequence of projections such as these, all countries are implementing measures to mitigate, or to suppress, COVID19 transmission.


Mitigation strategies involve shielding the elderly and other vulnerable individuals (those with underlying health conditions which would render them most susceptible to the most severe symptoms), and reducing social contact in the rest of the population. Such measures are judged insufficient to prevent the health systems of all countries becoming overwhelmed; this would be felt especially in lower-income countries with lower-capacity health systems.


Suppression of infection is thought to be only achievable through a combination of targeted and wide-scale testing, isolation of cases, and strict application of so-called ‘social distancing’ – physical separation and non-contact with people outside the immediate household – together with regular individual hand-washing.

What can individuals do?

The best ways by which individuals can protect themselves are (a) to wash hands regularly, thoroughly, and frequently with soap and water; (b) to regularly clean household surfaces with chlorine-based disinfectant solution; (c) to maintain physical distance of at least two metres from people outside the immediate household; (d) to avoid meeting places where many people assemble; (e) to self-isolate at home if you or a member of your household display symptoms (initially a dry cough and fever, perhaps worsening to more serious breathing difficulties). Of course, several of these measures present real difficulties for both rural and urban households in lower-income countries.

What can those who serve them do?

Some widely important elements in interventions to reduce transmission of COVID-19 are: the availability of sufficient domestic water, near to the home, to permit good household hygiene; the widespread, frequent and effective practice of handwashing with soap and water; and the need for accessible, simple, clear messaging around hygiene and physical distancing.

All local governments, NGOs and private sector organisations which have programmes to provide household water and sanitation, and to promote hygiene, should continue and step up such work, subject to precautions about physical distancing and the avoidance of social contact. This may mean placing a greater emphasis on the use of radio, social media and telephone communication (for example) rather than physical meetings. Emphasising the importance of household- and personal (hand-) hygiene is clearly of particular importance.

These materials

We hope that the materials which we are making available here will be of particular use to organisations seeking scientific understanding of this new infection and guidance on how best to support the communities they serve.

See the collection here


Patrick GT Walker, Charles Whittaker, Oliver Watson et al. The Global Impact of COVID-19 and Strategies for Mitigation and Suppression. WHO Collaborating Centre for Infectious Disease Modelling, MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London (2020)


Much of the scientific evidence which I have used in this introduction rests on papers produced by the Imperial College (London) COVID-19 Response Team. They are available on-line here:–wuhan-coronavirus/

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Open Access: What Works for Africa’s Poorest

9781780448442Read about What Works for Africa’s Poorest from the editors David Hulme, David Lawson and Lawrence Ado-Kofie at the Global Development Institute in Manchester.

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Menstrual Hygiene Day 2017

IMHD 2Menstrual Hygiene Day (MH Day) is a global platform that brings together non-profits, government agencies, the private sector, the media and individuals to promote Menstrual Hygiene Management (MHM).

MH Day raises awareness of the challenges women and girls worldwide face due to their menstruation and highlights solutions that address these challenges.

It catalyses a growing, global movement for MHM and supports partnerships at global, regional, national and local level. MH Day also creates opportunities for advocacy for the integration of MHM into global, national and local policies, programmes and projects.

Read more on MHM from blog posts by our colleagues at Practical Action:




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Barefoot Guides- contributing initiatives for social change

BAREFOOT GUIDE LOGO colRead Ten years of Barefoot Guides for Social Change: Unlocking collective generosity and intelligence from the Barefoot Connection blog

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World Water Day 2017: Rereading, Reducing, Reusing

Linnane-WaterIsLife-FrontCoverOn the 22nd March every year, World Water Day is recognized across the globe, and the theme this year is ‘wastewater’. To mark the occasion at Practical Action, we are rereading a couple of our recent books centred on water and waste, Sustainable Sanitation for All and Water is Life, which can be read for free.

1.8 billion people use a source of contaminated drinking water; 663 million still lack improved drinking water sources. Poor sanitation and unsafe water cause roughly 842,000 deaths a year (World Water Day, 2017). It is incredible that in the 21st century, basic human rights such as access to safe, dignified sources of drinking water and sanitation are still being denied to those in the poorest countries.

Water is Life (edited by Fagan et al) addresses some of the most fundamental issues with water supply management in rural Africa, focusing in detail on a region in Uganda. At the moment, a safe water source is an inaccessible dream for many people. The book begins by addressing the gender aspect: providing water for the family is the responsibility of the women, and in turn the children, whilst men tend to source water for stock animals or commercial purposes. The enormity of this task has far-reaching consequences, including the hazards of the job (the sheer quantity of water carried each day often causes injuries, back pain, headaches and nosebleeds), as well as the dangers involved, such as the possibility of being attacked or raped on the journey. In addition, precious time is wasted fetching water which could be spent on other, more productive, tasks, and girls’ education suffers as a result.

The book also focuses on a study which investigates the process of harvesting rainwater and the use of SODIS as a treatment. This kind of method could be hugely effective in purifying rainwater for drinking, but it is important to consider that this method may not reach the poorest areas: poorer households with grass-thatched houses are unable to harvest much rainwater.

Sustainable Sanitation for All explores the issues of the poorest and most vulnerable not yet being reached by current sanitation programming. Although enormous strides have been achieved by implementing Community-Led Total Sanitation (CLTS) programmes, with the result that simple toilets have been built by millions of households in Africa, Asia and Latin America, less attention has been paid to their sustainability. This means toilets can fall into disrepair, or people can abandon new habits of handwashing, or governments can cease to support and follow up CLTS programmes. The book, edited by Bongartz, Vernon and Fox, discourages a one-size fits all approach; it explores a wide range of countries and acknowledges the need to reach the poorest and most rural communities, as well as often neglected groups such as the elderly.

Sustainable Sanitation_Cover IMAGE

A delicate balance of thorough, in-depth research and shocking case stories make these texts well worth reading for anyone dealing with or interested in water, sanitation and hygiene issues. But what do they have to do with wastewater?

Very little water goes to waste in the rural situations described in Water is Life, and the per capita consumption of water in most countries of the global south is small compared with industrialized countries. With the global population growing exponentially, it is vital that we in industrial countries reduce and reuse our waste, even by doing small things, such as turning off the tap or not putting food down the sink. We can be inspired to do this by the case studies described in Sustainable Sanitation for All and Water is Life in which every drop really is precious.

To find out more about these books, click here:


World Water Day ‘Why Waste Water? Factsheet’

<> [accessed 22 March 2017].

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The Jeroen Ensink Memorial Prize Recipient 2016


Dr Jeroen H.J. Ensink  1974 -2015

The Jeroen Ensink Memorial Prize commemorates the life and work of Waterlines’ Editorial Board member Dr Jeroen H.J. Ensink.  Throughout his career, Dr Ensink sought to apply science and research to improve the lives of those who in the twenty-first century still live without access to safe drinking water and sanitation. He pursued this goal via different paths – as a practising public health engineer, as a young field researcher, as a doctoral student, as a senior investigator, and as a teacher and mentor – but always with the same clear and practical focus on solving the problem. Dr Ensink left behind him an impressive legacy of work but he also left a very personal mark on his many colleagues and friends in the water and sanitation sector.

Launched in 2016, this annual prize is to be awarded for an original non-commissioned paper submitted to Waterlines by a first-time author in the early stages of their career.

In 2016 a sub-committee drawn from the Editorial Advisory Board was evenly split in its recommendations in regard to two  papers that were published in Waterlines Volume 35 Number 2:

  • Payal Hathi, Dean Spears and Diane Coffey (2016) ‘Can collective action strategies motivate behaviour change to reduce open defecation in rural India?’ Waterlines35, 2, 118-135.
  • C Furlong, W T Gibson, A Oak, G Thakar, M Kodgire and R Patankar (2016) ‘Technical and user evaluation of a novel worm-based, on-site sanitation system in rural India’ Waterlines35, 2, 148-162.

Both papers addressed highly relevant sanitation issues, were well-written and presented, and provided important insights for policy and practice.  As the judging committee was split in its recommendation, the journal Editors provided the casting vote, and their recommendation was that the 2016 prize be awarded to Payal Hathi.

It is therefore with great pleasure that we announce the award of the 2016 Jeroen Ensink Memorial Prize to Payal Hathi. We also congratulate Claire Furlong and her team for a likewise excellent piece of research, just pipped to the post in this edition of the prize. In both cases, we realise that the authors form part of teams, and we likewise extend our congratulations to the co-authors.

Following Jeroen’s tragic death, the London School of Hygiene & Tropical Medicine established a Memorial Fund in his name to support students from sub-Saharan Africa and South Asia who are committed to improving public health in developing countries and wish to undertake the MSc Public Health for Development course.  Preference will be given to those applicants with experience and/or interest in the area of water, sanitation, hygiene and public health.

Applications and all necessary supporting documents must be received by 17.00 (GMT) on Sunday 2 April 2017 at the latest.

See more at:

Richard C. Carter and Sue Cavill

Waterlines Co-editors



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Women leading in the peace

Read the latest Oxfam Policy & Practice blog post from Caroline Sweetman on gender and development.

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