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Equity

woman with toilet, India

Disparities in access to sanitation and hygiene are of increasing concern to the sector. These disparities are driven by a range of interrelated and complex factors, such as socio-economic status, gender and age. Addressing these disparities is critical in ensuring progress towards universal access to sanitation and hygiene.  

SHARE is funding research and synthesis to better understand equity and sanitation, such as the Menstrual Hygiene Matters: a free and comprehensive resource for improving menstrual hygiene for women and girls in middle and lower income countries. We are also conducting research into estimating disparities in sanitation-related disease burden, inclusive sanitation and have funded a Sanitation Mapper tool that plots sanitation coverage to reveal disparities in access.

 

Below is the full list of SHARE equity-related research and outputs, listed under three main thematic areas:

  1.      1. Gender and WASH
  2.      2. Wealth and WASH
  3.      3. Disability and Ageing and WASH
  4.  

You can find additional material related to these studies, including videos and power point presentations, by going to our Resource Library and searching for the ‘equity’ research theme:

GENDER AND WASH

Menstrual hygiene management practitioner's manual

Piloting the MHM manual

A systematic review of the health and social effects of menstrual hygiene management

Violence, gender and WASH - practitioners toolkit

Gender and sanitation - the experiences of the Shack Dwellers Federation of Namibia 

WEALTH AND WASH

Analysis of disparities in sanitation coverage 

A cross-sectional study to investigate disparities in water, sanitation and hygiene-related exposure and outcomes in an urban community of Kisumu, Kenya

Sanitation Mapper: an investigation into district-level sanitation monitoring interventions as tools for empowerment, advocacy and evidence-based decision-making 

Sanitation conditions and practices in Dar es Salaam 

DISABILITY AND AGEING AND WASH

Undoing inequity: inclusive sanitation and hygiene programmes that deliver for all


GENDER AND WASH

Menstrual Hygiene Management practitioner’s manual – What works? Synthesising existing knowledge to develop guidelines and an outline forum for practitioners

The SHARE-funded manual aims to address the knowledge gaps related to menstrual hygiene, and help break down the taboos which prevent women and girls from talking openly about the subject. The manual brings together examples of good menstrual hygiene practice from around the world, while providing guidance on building competence and confidence to break the silence surrounding the issue. It also encourages increased engagement in advocacy on menstrual hygiene. The resource is comprised of nine modules and toolkits covering key aspects of menstrual hygiene in different settings, including communities, schools and emergencies.

Outputs:

 

Piloting the MHM manual

This project supports a process of piloting, implementing and evaluating the manual “Menstrual Hygiene matters” in two SHARE countries: Tanzania and Bangladesh. The aim is to develop local capacity, through applying the resource within the country setting, with the active input from national WASH professionals, policy makers, academics, service users and local private sector manufacturers. 

Piloting the resource will ensure that the recommendations and toolkits are user-friendly, easy to understand, relevant, useful and practical. It will also test whether additional guidance is required for settings and aspects of MH not currently covered.

This project is ongoing and there are currently no outputs.

A systematic review of the health and social effects of menstrual hygiene management

This research aimed at identifying the health and social effects of menstrual hygiene management in published peer-reviewed scientific literature. Following the PRISMA guidelines, a structured search strategy was used to identify articles investigating the effects of MHM on health and psycho-social outcomes. 14 articles were identified which looked at health outcomes, primarily reproductive tract infections (RTI). 11 articles were identified investigating associations between MHM, social restrictions and school attendance. MHM was found to be associated with RTI in seven papers. However, methodologies varied greatly and overall quality was low. Meta-analysis of a subset of studies found no association between confirmed bacterial vaginosis and MHM. No other substantial associations with health outcomes were found. Although there was good evidence that educational interventions can improve MHM practices and reduce social restrictions there was no quantitative evidence that improvements in management methods reduce school absenteeism.

The management of menstruation presents significant challenges for women in lower income settings. However, the effect of poor MHM remains unclear. It is plausible that MHM can affect the reproductive tract but the specific infections, the strength of effect, and the route of transmission, remain unclear. There is a gap in the evidence for high quality randomised intervention studies which combine hardware and software interventions, in particular for better understanding the nuanced effect that improving MHM may have on girls’ attendance at school.

Outputs:
• Sumpter, C. & Torondel, B. (2013) A systematic review of the health and social effects of menstrual hygiene management. PloSOne, 8(4)

Violence, gender and WASH practitioners toolkit

The literature on GBV in emergency and development contexts is disparate and requires consolidation as well as synthesis to highlight the key lessons for practitioners and how to implement them. The main objective of this project is to collect, review and synthesise best practices in reducing GBV in sanitation and hygiene programmes in both development and humanitarian contexts in developing countries so that they are made accessible to practitioners for replication in different contexts.

Outputs:

Violence, Gender and WASH: A Practitioner's Toolkit

Read more about the toolkit launch.

Gender and sanitation - the experiences of the Shack Dwellers Federation of Namibia 

The purpose of this research was to provide information about the influence of gender and age upon community decision-making within the Shack Dwellers Federation of Namibia (SDFN) and among other residents in poor urban settlements where SDFN is active. The research aimed to understand if, and how, household development at the settlement level differs by gender or age, and to review previous experiences with toilets. The research aims were met by the analysis of existing household level data, focus group discussions, and semi-structured household interviews.

Outputs:
Gold, J., Melkisedek, N., and NHAG CLIP team. 2013. Sanitation Issues in Namibia.  

WEALTH AND WASH

Analysis of disparities in sanitation coverage 

The objectives of this study are to model the following for 10 low-income countries in sub-Saharan Africa and South Asia:
1. The distribution of sanitation-related health burden by wealth quintile;
2. The distribution of health benefits for targeting different wealth quintile groups;
3. The spatial distribution of sanitation-related health burden and benefits.

This work used existing household survey data from the Demographic and Health Surveys for the 10 countries to estimate disparities in sanitation-related services, exposures, susceptibility, burden and impact of infrastructure improvements.

Outputs:

A cross-sectional study to investigate disparities in water, sanitation and hygiene-related exposure and outcomes in an urban community of Kisumu, Kenya

Access to sanitation in developing countries is generally highly inequitable, with the lowest levels of access often found among the poorest and most vulnerable groups. The primary purpose of this research is to test the assumptions and conclusions of a model developed earlier, through direct data collection. The research team will collect household and community level data to assess the association between measures of environmental exposure and susceptibility, and the distribution of disease burden in three settings. A cost-effectiveness analysis (CEA) will be undertaken to estimate the cost-effectiveness for reaching the poorest and most at risk populations. After completion of the research, findings will be jointly interpreted with SHARE partners (WaterAid and IIED) to identify policy and practice reforms that will lead to more effective interventions for the poorest households.

This work is ongoing. There are no outputs as yet.

Sanitation Mapper: an investigation into district-level sanitation monitoring interventions as tools for empowerment, advocacy and evidence-based decision-making

Inspired by the previous successful development of the WaterPoint mapper by WaterAid, this project aimed at developing a low cost and participatory sanitation monitoring tool (including a spreadsheet and mapā€based outputs), called the Sanitation Mapper. It enables collecting data and mapping the level of sanitation coverage in chosen areas, in order to better inform sanitation-related interventions. It was piloted in Bangladesh.

Outputs:

This research focuses on the urban poor in Dar es Salaam with unsafe, unhygienic and inadequate sanitation facilities and practices. It explores and documents many activities and processes, including existing household sanitation facility upgrading behaviour; the motivations, facilitators and barriers to upgrading among the urban poor; variations in preference for upgrading improvements in terms of sanitation facility design, operation, cleaning, and usage; and the determinants of demand. The study was conducted through an equity lens, exploring the relationship between indicators of household situation and wealth (e.g. household income, expenditures, housing type, gender of household-head, tenancy, neighbourhood access conditions), levels of investment made in current sanitation facilities, and sanitation upgrading preferences, motivations and constraints.

Outputs:

Jenkins MCW, O Cumming, B Scott & S Caincross (2013) Sanitation Preferences of Urban Population in Dar Es Salaam, Tanzania. Journal of WASH & Development (in press).   

DISABILITY AND WASH

Undoing inequity: inclusive sanitation and hygiene programmes that deliver for all

The aim of the study is to develop and test an approach that aims to improve access to WASH for all, and thereby provide equal access to people who are marginalised and vulnerable. In Uganda and Zambia, WaterAid and its project partners will implement its inclusive WASH approach in order to improve access for all. The proposed research will report the lessons learnt from the intervention, and will measure the change in access to WASH following the intervention.

Outputs: