Access for all to clean water is essential to eliminating neglected tropical diseases: Dr Poonam Khetrapal Singh

By Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia

Access for all to clean and safe water is fundamental to controlling and eliminating neglected tropical diseases (NTDs) from across the WHO South-East Asia Region. Alongside other interventions, access to clean and safe water is a powerful means to ensure all communities can combat and control NTDs and that in partnership with health authorities they can sustain their achievements and accelerate progress.

As per the Region’s Flagship Priorities, recent progress against NTDs has been substantial. In 2015 India was declared yaws-free. In 2016 the Maldives and Sri Lanka eliminated lymphatic filariasis (LF) as a public health problem; in 2017 Thailand achieved the same. Bangladesh, India and Nepal have meanwhile made substantial gains against visceral leishmaniasis, while in 2018 Nepal was validated to have eliminated trachoma as a public health problem, with the WHO SAFE strategy and its emphasis on access to clean water crucial to its success. Indonesia has reduced the prevalence of schistosomiasis to very low levels.

Further progress is needed. The most recent figures show that the Region is the world’s second most affected by NTDs, with remote and hard-to-reach communities bearing the bulk of the burden. It is no coincidence that these are the very same communities that are most disadvantaged when it comes to accessing clean and safe water, sanitation and hygiene (WASH).

As WHO’s recently released toolkit – ‘WASH and health working together: A ‘how-to’ guide for Neglected Tropical Disease programmes’ – outlines, WASH must be core to any NTD programme. National NTD programmes Region-wide should work with partners and across sectors to target affected populations and make full use of the tool.

Where communities lack access to clean and safe water, for example, sustainable solutions must be found. That could mean addressing stigma-based exclusion from improved drinking water sources or ensuring health care facilities and schools – particularly in rural areas – have improved water and hygiene services available. It could also mean ensuring access to handwashing facilities where appropriate, and that household waste is safely disposed of to prevent the transmission of diseases such as schistosomiasis and soil-transmitted helminthiases.

Behavioural change campaigns can also enhance WASH to help combat NTDs. All stakeholders should identify behaviours that exacerbate (or can alleviate) the impact NTDs have on individual sufferers, as well as their broader spread. Locally tailored messaging that empowers communities should then be developed to promote positive outcomes that will accelerate NTD-related progress alongside other goods.

Monitoring and evaluating the impact of interventions is key. To do this effectively, good baseline data is needed, with the provision of WASH services incorporated into disease mapping and the impact of WASH policies measured accordingly. Ongoing information on the effectiveness of policies is crucial to adapting interventions and ensuring the inattention that defines NTDs and exposes whole communities to stigma and marginalization is overcome.

On World Water Day, WHO highlights the critical role access to WASH is to the fight against NTDs specifically, and the social good it provides generally, as outlined in Sustainable Development Goal 6. The outcome we are pursuing really is crystal clear: water for all, whoever you are, wherever you are.