muench wrote: This is really interesting but still doesn't convince me that it would mean less funding for the WASH sector. It would only mean fewer engineers in certain WASH cluster meetings? Are these WASH cluster meeting the place where funding decisions are made or rather the place where people inform each other about what everyone is doing, i.e. more of a coordination meeting but without real decision-making power? Please provide more examples if possible.

True, they are primarily coordination meetings. But especially in the early phases after a disaster they often play a quite important role in setting priorities of intervention (both thematic and geographic) and this information is fed back to the funding organisations' decision making bodies and is usually a crucial factor for the second round of funding after 3-6 months.

But I think just looking at emergencies (where distribution of sanitary pads very often is really needed regardless of which sector does it) doesn't show the whole picture. Yes I can't really back up my gut feeling / anecdotal evidence with hard data, but looking at the year to year data from washfunders.org (2006-2016; no idea how accurate those are), I see a more or less stable funding base. So it is reasonable to assume that additional topics take away funds from "older" ones. But maybe anyone knows a better source on global WASH funding data?

Hi Kris,

You are much closer to the ground than I am and have much more experience with those WASH clusters. So your impressions and gut feeling are really important. Nevertheless it would be super interesting if someone could back that up with numbers - one way or another.

For example you said:

alienating various important contributors to WASH projects

Could you provide some examples of that? (and not juse the case of someone staying away from WASH cluster meetings because they feel there is too much talk about taboo topics that he or she is not comfortable with; as that wouldn't count as diverting funding away).

You had said in an earlier post:

As a result some engineering minded experts stopped coming to these meeting, which made matters even worse. I also suspect that quite a few of our local colleagues felt very uneasy participating in these discussions. This is of course not necessarily a good thing (and should be slowly improved), but these cultural barriers are a fact and alienating these people who can give vital contributions to other topics has a very negative impact.

This is really interesting but still doesn't convince me that it would mean less funding for the WASH sector. It would only mean fewer engineers in certain WASH cluster meetings? Are these WASH cluster meeting the place where funding decisions are made or rather the place where people inform each other about what everyone is doing, i.e. more of a coordination meeting but without real decision-making power? Please provide more examples if possible.

Regards,
Elisabeth

True, I don't have hard evidence on that and in fact it probably does bring in some new (commercial) funding sources. However I suspect these come in to leverage on existing funds, e.g. you give $1 extra earmarked for MHM, but as a result indirectly divert another $9 from existing sources to this cause, thus having a leveraged $10.

Never the less the point of diverting attention and alienating various important contributors to WASH projects (which is more obvious despite also lacking in hard evidence), will in my opinion ultimately result also in decreased funding for core WASH topics.

Hi Dani,
Oh, thanks for clarifying! I wasn't actually referring to your post in particular but good to know that it was tongue in cheek to say "last last taboo".

Hi Kris,

You said:

Diverting attention and funding away from these software (and related hardware) projects towards topics like MHM etc. seems like a really wrong turn to take as the WASH sector though.

Is this really the case though? Perhaps it is just a feeling but not backed up by evidence? Perhaps these additional topics like MHM are not diverting attention and funding away but rather increasing the pie of attention and funding? Like when a couple has two children and they get a third: their love for all 3 children is the same; not less for the first two because the third has arrived (OK admittedly, the household income would have to be spread over more kids, so potentially less money per child!). But I would have the hope that additional topics also bring additional funding sources onto the scene, perhaps agencies who were previously not investing in sanitation at all now do invest in MHM-related stuff?
Do you (or others) have any specific examples or anecdotal evidence for this?

Regards,
Elisabeth

muench wrote: When I first read Kris' post I actually didn't think he wanted to go down the route of hardware versus software again. We all know that we need both, hardware and software. Could it be that in some circles the pendulum has now swung too far towards software? Perhaps because it is also cheaper? Or could it be that WASH should always be very much software driven and the actual infrastructure investments are not made within the WASH groups but at the local government level?

Yeah, the discussion derailed a bit on the hardware/software topic. But I think that is partly because for much of the typical WASH software the link to hardware is quite inherent (hand-washing for example requires some sort of water supply, even if it is just an unsustainable tippy-tap). The "new" software topics however do so less or at least lend themselves more to apparent quick fixes like sanitary-pad, adult diaper etc. distribution that require no direct thought about a WASH hardware intervention at all (the WASH hardware issues rather arise as a consequence). Thus making it a software/hardware issue is somewhat natural.

But you are totally correct that that wasn't my intention. I rather think that core WASH software topics are extremely important, but also wicked hard to solve. How to change long lasting behaviour in regards to hand-washingpersonal hygiene or toilet use? Is the (in my opinion) somewhat flawed CLTS approach really the best we can come up with (at scale)? Diverting attention and funding away from these software (and related hardware) projects towards topics like MHM etc. seems like a really wrong turn to take as the WASH sector though.

This does not mean that these aren’t topics that need solutions, but for the many reasons outlined above, I believe it should be not (mainly) the WASH sector to take them up because we have other very difficult problems to solve.

So just as a side note, I'm the one who posted about incontinence being the "last last taboo", but that was in jest, as you are completely right that it was used as a tag line for sanitation, then menstruation, so I was just poking fun

I am writing this post as a long-term forum user, not in my role as moderator.

Dear all,

This has been a short but intense discussion so far, and I thank everyone involved. It might be that Kris' choice of thread title was indeed a bit "provoking".* The detailed posts by Dani and in Sarah were hugely interesting and summed up a range of issues really well. I found it a little bit of a pity that Sarah's post was perhaps unnecessarily "aggressive" towards Kris as a person, but I assume this was not really directed against Kris himself but Sarah maybe venting some frustration about having had similar endless discussions over the years with other people.

Please let me point out to anyone not so familiar with this forum that Kris has been an awesome contributor to this forum for many years (5 years and 6 months to be precise). He is always very kind, friendly and welcoming to newcomers. He really doesn't deserve to be "attacked" over starting a topic that is controversial. In fact I think it was quite gutsy of him to speak so openly and shows that he has faith and trust in the open and supportive culture of this forum.

I actually had to look up what "ad-hominem" rhetoric means (thank you Wikipedia: "in which an argument is rebutted by attacking the character, motive, or other attribute of the person making the argument"). True, it is not fair to say to him "easy for you to say we don't need to discuss MHM all the time, you don't menstruate". - Having said that, all the points Sarah made were certainly very interesting and well taken! Just don't be not nice to Kris, please.

When I first read Kris' post I actually didn't think he wanted to go down the route of hardware versus software again. We all know that we need both, hardware and software. Could it be that in some circles the pendulum has now swung too far towards software? Perhaps because it is also cheaper? Or could it be that WASH should always be very much software driven and the actual infrastructure investments are not made within the WASH groups but at the local government level?

I don't know that much about how WASH clusters work, who pays for people's time, who goes there etc.. All I know is that in wealthy countries we don't have them, we don't speak of WASH even. It is all about water utilities and services provided here. Could it be that in developing countries, the WASH sector is quite dominated by NGOs (who had to step in as the governments were failing its people)? And could it be that these NGOs need to create media attention about new topics (also here in the wealthy countries) in order to get more funding?
I must admit when I saw the posts about incontinence and WASH (forum.susana.org/93-inclusion-and-disabi...t-last-taboo-in-wash) I also thought "isn't this more of a topic for the health sector?". Should it be posted in the HIFA Dgroup, too? OK, but if they don't tackle it, we might have to. And Dani and Sarah have given further explanations, so thank you.

Then I saw this discussion on twitter after the WEDC conference about "the last taboo". Why is it so important what "the last taboo" is? First it was sanitation, then MHM, now incontinence, someone also said menopause. I could think of many more taboos but is it our job inherently to chase down "the last taboo" or is it just because it's a catchy headline that attracts media attention?`

It reminded me a bit of that headline "if there were more toilets in India, fewer women would get raped" - which also has some flaws but was something catchy. We had a lengthy and really good discussion about violence against women and toilets here: forum.susana.org/162-public-awareness-ra...ence-gender-and-wash

Anyway, just some more food for thought and discussion, prompted by Kris' post.

So thank you to Kris for putting up a topic that you feel strongly about, particularly if it is controversial, thank you to Sarah for giving a detailed explanation on many aspects and thank you for everyone to be friendly and supportive towards each other and not jumping to assumptions about someone's hidden intentions or character.

Regards,
Elisabeth

* (if Kris or someone wanted to propose a different thread title, this could still easily be done; sometimes thread titles are changed when the content of the thread changes)

@ Doreen & DaniBarrington:
Actually no, I would rather consider myself a software person (it's a bit mixed) and have probably personally benefited from the increased focus on software. But I think it needs software people (and especially women!) to raise this complex topic as it is otherwise too easily dismissed as coming just from this "disgruntled hardware guy". I guess I came a bit across like one

I really do agree that all these topics are "inherently linked" to WASH in some sense... but the link to the hardware actually seems to get lost in many cases. Software and hygiene in general definitely has its place in WASH (at best complementing hardware activities), but in many ways we as a sector overshot the target and many people seem to refuse to acknowledge that. This sounds like I am stating the obvious (which it is), but still we ended up in this place somehow and people get really defensive if this is topic is raised it seems...

There are definitely systematic reasons why this is the case, but I really feel like people should not "double down" on this and even further focus on fringe topics in the WASH sector (to clarify: the mentioned examples are of course not "fringe" in a general sense (!), but they are when looking at the WASH sector only, as explained on my previous posts).

I know that I am generalizing a bit, as there are for sure some good counter examples, but I believe it is a general trend and I think if you would/could do a honest survey of people actually working at the "receiving end" they would mostly agree with my impression.

Analysing this, I have come to the conclusion that despite my initial impression that this is a HR problem (in the sense of too many software people in the sector, that also have a personal/monetary interest in further specializing into such topics), it rather boils down to institutional factors.
The HR issues (and the indirect alienation of hardware people and persons from different cultural backgrounds) definitely play a role, and so is the more recent trend to hire people from the private sector into NGO HQ positions (they push for what they have learned, e.g. a soap marketing campaigns etc. But this has also positive effects), but the main factor is because for many institutions there are ill incentives to focus on software activities...
To some extend this is because of increased short term accountability demands (quite ironically); what sadly often boils down to coercion (CLTS) and interaction intensive hygiene promotion campaigns ("now with NFI/soap/sanitary pad distribution... no one likes it but it works"tm) does give some sort of measurable results in the short term (often with a huge confirmation bias) and no one has ever lost her/his job because three years down the road people stopped washing their hands (half finished ruins of toilets featured in a news article on the other hand...).
Add to that the commercial backing and media interest and you got a recipe for a very unsatisfactory outcome.

@ Dr. Sarah House:
Thanks a lot for taking the time to respond to this thread. In a sense I just took it as a occasion to raise a broader issue and do think incontinence is probably an often overlooked health issue (marginally related to WASH). I also agree with most of what you have written above otherwise.

It is just the latest in a long series of similar advocacy campaigns that especially combined with the quite misplaced sense of "suppressed minority" attitude rubbed me the wrong way. But I also have to sincerely apologize for what I now realize was an easy to misunderstand choice of a common phrase that was in no way meant as a direct insult!

It is however a pity that you seem to be unwilling to further participate in this so far quite civilized discussion, and while I will indeed probably not totally reverse my opinion on this, I am honestly open to good counter arguments. But if sadly many of the arguments seem well hidden below direct or indirect "ad-hominem" rhetoric maybe it is for the better to not participate further.

Dear JKMakowka,

I was sadly expecting a backlash against my blog, but I have to admit this is a new one...so I am ‘a “useful idiot” of commercial/institutional interests’? ... I have been called many things in my time, some I am aware of and some that I am sure I am not, but I think that’s a first. The level of bile in such statements takes away from any reasonable argument that you have, which is a pity.

I have been encouraged by others to reply to your message. Initially I thought I wouldn’t, as I have heard enough of similar negativity to considering the needs of different groups, including those who may be marginalised or discriminated, that I am honestly a bit tired of it at this stage. I am also not expecting that engagement in this issue will make a difference to your opinions.

But I have decided to send this one post – my first and last - in relation to some of the points you have raised.

I agree with you that the quality of technical responses has in some cases gone down over the decades... although in other cases it has clearly improved, such as has been shown by the amazing progress of the community-led sanitation approach that has led to whole countries having astounding improvements in coverage of sanitation (such as in Bangladesh and Nepal for example). The fact that the MDG for water was met was a significant global achievement; and the fact that there has now been an increase in attention on sanitation has been due to the tenacity of many people over many years to ensure that this - previously also taboo subject - was increasingly talked about. It wasn’t even in the MDG targets when they were originally established. Hygiene has always been the area with least attention although thankfully this is also now changing.

But I think the reason the quality of the technical responses in some contexts is going down is not due to the reasons you state. I think it is due to reducing attention to accountability of organisations who implement programmes to ensure a minimum quality of response; inadequate capacity building and on-going mentoring / support of the people who are expected to implement them, who also may not have the most appropriate backgrounds or skills for some of the tasks; reduction in resources against increasing numbers of people needing support (in the humanitarian field); and a wastage of resources from inefficient and malfunctioning support systems making things much more expensive than they would otherwise be - I have seen some shocking examples of this. Interestingly you say you are a microbiologist working in WASH in humanitarian response – I don’t know your background, but do you have the technical skills to design a piped water supply scheme or design an appropriate toilet – the areas where you complain about having a lack of adequate attention?

As background to my comments, I am a Chartered Engineer - who still works as an engineer globally - and have:

a) Supported the implementation of water and sanitation services in a range of development, humanitarian and transitional/fragile contexts in remote rural, low-income urban, and IDP and disease outbreak settings.

b) Published a range of global technical guidance - for example I have been the lead author (or made significant contributions to) publications on: emergency water sources; sustainability of WASH in transitional contexts; a UN agency global cholera toolkit; technical briefs on a range of issues such as drainage and on accessibility to WASH for people with disabilities in humanitarian contexts; as well as menstrual hygiene; and violence related to WASH.

c) Have supported governments in low income and fragile / transitional country contexts to develop national and federal level strategies or guidance for example related to: WASH; sanitation and hygiene; water safety; School WASH; and have also led a team undertaking capacity building assessment to develop a national capacity building plan for a WASH sector.

So your accusations that my happiness to see the increased movement to also consider the needs of people who are often hidden and have less power and voice to ask for their needs to be met, is somehow because of a lack of commitment to technical issues and the basic access to water and toilets is... hmm... just a little bit flawed.

I wonder how you might feel when you are living in a cramped tent with male relatives and the toilet facilities are so badly designed or sited that you are frightened to go to them, when your menstrual period starts unexpectedly and you have leaked all over your clothes? But clearly you will never experience this. What if you start to have incontinence? I imagine by the time you do face it, you will probably be older and living in a context where you have easy access to water and sanitation and as many materials to soak up the leaking urine or faeces from your body as you need. You are unlikely to be walking across a continent with teenagers who have started wetting their beds again because of the trauma of conflict and no way to dry their clothes, underwear or bedding night after night. You are unlikely to experience the trauma of having been raped or giving birth at a young age resulting in fistula where urine/faeces continues to leak from your body, so much so that you are rejected by your family and expected to live on your own on the outskirts of the village.

So maybe it’s too much to expect an understanding on the challenges that these issues bring; and I presume this also probably leads you to use the word “fringe”. MHM is a “fringe” issue... even though it affects at least 50% of the world’s population – really?

I realise that not everybody has the skills to empathise with people who do not fit into their life experiences. I also agree that some purely technical people are needed who can do the more complicated or specialist design tasks (such as for urban water or wastewater treatment plants, large raised water towers, or large hafirs or dams). But in general, WASH is an issue that requires an understanding of people, their differing needs, priorities, skills and the issues that enable or disempower them to be able to engage. Otherwise we build toilets that some people will not use because they are scared to (or are not allowed to use when they are menstruating), water that people will not drink because they don’t trust the chemicals in it, and hand-washing stations that are not used, leading to disease or even death. Considering issues that are important to women and girls - as well as men and boys - and considering the needs of marginalised or vulnerable members of communities - and providing good quality technical solutions - are not zero sum games – you need to understand the users to make the technical appropriate, of value and cost effective.

I understand from your post that you work in the humanitarian context, so I don’t know how much you know about the Sustainable Development Goals (SDGs), but according to these we also now have to reach the most disadvantaged with good quality/safely managed services - it's not an either/or, we have to do both. Addressing inequalities is now core to our work which is a structural shift in the sector... rather than the result of a few individual “idiots” as you so professionally and eloquently state ... To get to universal coverage we need to be able to reach people who are living in difficult situations as well as the easy ones and it is no longer acceptable to just go for the “low hanging fruits”. The Joint Monitoring Programme (JMP) is also monitoring MHM - as well as inequalities in WASH - washdata.org/monitoring/inequalities and with SDG 6.2 we are being expected to reach the most vulnerable first (which was certainly not a result of commercial interests capturing their agenda - given the several years of civil society consultation that led to their development).

I also find it quite strange that you are making assumptions that because some people are trying to get incontinence on the agenda and two links have been posted on Sanitation Updates (which is how I presume you saw my blog), that we are somehow arguing to diminish attention on other issues such as “stop all work on sanitation and water – only work on this new issue”! I can only presume that this is due to limitations in your own understanding of how change happens; when a topic gets featured in such a professional newsletter or in the media, this is often the result of a lot of effort, from many and diverse groups of people, behind it to start getting it on the agenda and talked about, sometimes over periods of years, rather than being “pushed by commercial interests”. The increase in MHM in the media came after many years of many people’s efforts from around the world, after having identified it as an important overlooked and often taboo and hidden issue. Nobody is saying that incontinence is a bigger issue affecting more people than a lack of sanitation or water. What we are saying is that it’s a much bigger and distressing, but often hidden issue, for people who live with it, and has more impact on people’s lives than most people are aware of; and so it is an area we should be learning more about including appropriate hygiene responses... particularly in humanitarian settings. Appropriate responses are likely to cut across sectors, as with MHM. But our sector has a clear role as our responsibility is related to the safe disposal of urine and faeces as well as promoting hand and bodily hygiene (and the management of hygiene and menstrual blood which is also part of sanitation for half the world’s population); and in humanitarian situations we are also the sector that tends to distribute non-food items to help contribute to help people keep their health and dignity. Hence, why it is also our responsibility to be getting engaged in these issues.

From what I can see, it hasn’t been the commercial sector that has driven the increased attention in the areas you note. It has been the gaps and failures in approaches that have led to highly competent and driven professionals, such as the dynamic team at the London School of Hygiene and Tropical Medicine, who did a lot of innovative work over a number of years to increase the engagement of the commercial sector in increasing access to soap. Likewise it was a number of similarly hard working, highly competent and innovative individuals and organisations around the world who pushed for the engagement of the commercial sector in making household water treatment products more available. I think there is a wider consensus that the private sector has an important role to play in WASH. If commercial routes, such as through increasing markets to cheap soap (for example) have the chance to make it available to millions of people, rather than a few hundred as per the scale of NGO projects, which seems to be the level of focus of the work you are involved in that you describe, then that is a very positive thing.

In my case it was as a Civil Engineer on my first assignment working on a large labour intensive infrastructure upgrading project in the urban townships in Lusaka, Zambia back in the early 90s, when I had to respond to serious incidences of violence against women in the workforce that started my learning about people issues related to technical projects and WASH. The difficulties of handling this situation and in particular the strength, integrity and clarity of thought of a particular female assistant technician who was one of the women who was attacked (and could have been killed due to the seriousness of the attack against her), made me realise that I had not been trained as to how to handle such issues; but that I could see that there may be things that I could do differently that could potentially help minimise the risks to others. This started me on the process of realising that as technical people we need to have broader skills, open our eyes and listen to different people’s experiences, if we are to be successful in our technical and WASH work globally.

The increased interest in these areas that relate to equity and inclusion and which cover often hidden and taboo subjects that you seem to dislike, has happened because of the determination and significant efforts of a wide range of people from across cultures, countries and contexts - low, middle and high income. Just because you yourself may only see the arguments from international staff, does not mean that many women and men, including those from minority or marginalised groups are not already pushing for, and in some cases fighting for the same, from their own perspectives and in their own ways; sometimes putting themselves at significant risk to do so. But to see this you first need to be interested to learn from them, to recognise diversity and to listen.

If you really believe that men are being highly disadvantaged because there is not enough attention on urinals, it would be great if you and the others who are walking away from meetings, would stay and argue your case, as well as related to the decreasing attention on the quality of sanitation and water services, rather than just walking away when people do not have the same views as you. I agree it is important that issues of specific relevance to men should also be highlighted, including related to their roles in child caring and supporting household hygiene tasks and their need also for including in hygiene awareness related activities (as one example). It would also be amazing if some great male champions could come forward and start a discussion on the need to question the almost global culture that finds it acceptable for men to get their genitals out in public, including often when women and girls are present, in order to urinate anywhere they choose. And then after touching their genitals, to not wash their hands and continue their daily tasks, including handling money, eating, shaking someone else’s hand etc. There are clear hand hygiene issues here as well as being a dignity and protection issue. Perhaps you could become the global champion to raise this very ‘male’ issue and influence a range of dynamic and committed males and get a movement for change happening in this area? (By the way there are increasing numbers of fantastic male MHM champions around the world)

I doubt that my arguments will change your mind, or that of others who still hold similar views, but it’s a pity that we still have to continue to spend time on such discussions. In WASH, it is very clear that both the technical and people issues matter. This has been proven repeatedly through the decades, through the failure of projects and approaches that only considered the technical.
As noted above, I think there is still a place for people who only have technical skills, if they are also open to working with those who also have skills to work with people of differing needs and backgrounds to ensure the technical solutions are appropriate. But I also think your suggestion about considering leaving the sector is an appropriate option for those who feel uncomfortable considering the wider issues. I am sure fields such as marine biology, steel manufacture, laboratory analysis of blood samples, or a host of others, would be much more comfortable places for anyone who would rather not consider the people elements of our work.

I wish you all the best with your ruminations and decisions as to your future career direction.

Dr Sarah House
(Civil and Public Health Engineer - BEng, DIS, MSc, D.Litt, CEng, MICE, C.WEM, FCIWEM – who believes that people who are disadvantaged and less voice have just as much right to access and use WASH services and to lives with dignity, as those with more power and louder voices)

Hi Kris and all,

I’m a researcher/practitioner who focuses on the interactions between humans and technologies, and I’m also on the ISO committee for the new non-sewered sanitation standard. I have a traditionally technical background (my PhD is in wastewater engineering) but have worked extensively with communities and enabling actors the past few years.

From reading your post, it sounds like you believe that WASH people should be ONLY technical? Does this extend to policy as well – is it ok for someone in “WASH” to be involved in policy so long as it is about infrastructure and not human behaviour? Like you, I haven’t been around the WASH sector several decades, but it seems to me that working in WASH teams with technical, policy, and health counterparts has enriched the programs I’ve been involved in…

I also don’t understand how menstrual hygiene, soap/handwashing and incontinence are separate from WASH, even “technical” WASH – apart from wearing menstrual hygiene and/or continence pads whilst going about their day-to-day lives, most of the time people interact with such products is within the WASH environment (i.e., a bathroom or toilet, where one exists). Which means that they are inherently linked to the technical, because water is needed for handwashing, and it’s important for the functioning of most sanitation systems that pads or tampons are not disposed of within them. So if we want our hardware (toilets) to continue working, we need to design them so that a) people don’t dispose of hygiene products down them; b) the system is capable of handling MHM/incontinence products through treatment processes; c) there is somewhere else for these items to be disposed of, designed into the WASH facilities; and/or d) there are non-technical mechanisms in place for dealing with solid waste, perhaps including municipal collection. Tackling a-d requires technical knowhow for sure, but also an understanding of behaviour, policy and how to work with local stakeholders. Also, most of the menstrual hygiene programs I have been involved in or know about do tackle the hardware issue alongside the provision of pads and tampons; I understand that has not been your experience, but I think it is dangerous to make such generalisations when there are so many people working to get functional, separate boy and girl toilets at schools, alongside improving menstrual hygiene management.

It worries me that in your context you say people are leaving WASH Cluster (I assume) meetings because they are uncomfortable with such “fringe” discussions – but perhaps what that actually indicates is the need for more social scientists in such circles, who are probably better able to understand and respond to cultural sensitivities than those people who are self-proclaimed as only technical? Also, I agree that issues such as MHM and incontinence should come under the Health Cluster (as well as WASH), but if they don’t, surely we have a moral imperative to ensure the provision of such goods are included in our relief programs? And if the Health Cluster does provide pads, etc., then surely we need to be working with them to ensure this doesn’t mess with the functionality of our technical solutions?

WASH is an incredibly complex system of technical, environmental, socio-cultural, public health, personal preference and economic concerns, and we need to be willing to work at the intersection of them to achieve universal water, sanitation and hygiene. Approximately 50% of the population menstruate at some point in their lives, and 25% of women and 10% of men will suffer incontinence. These aren’t fringe issues, and they are linked into how these people use technical WASH systems; we are doing the world a disservice as engineers if we don’t adequately consider them.

Dear Kris,

I am so happy you raise this topic because its something I have been contemplating for a while.

There are examples from different organisations that in many ways only focus on the software components not taking into consideration the need to ensure infrastructural development. Approaches need to be holistic and encompass the whole sanitation chain ensuring that people are in the forefront.
I agree that discussing and putting the topics you mentioned into the forefront is relevant and we need to ensure that that the core aspects such as infrastructural development to bridge the gap, institutional strengthening and capacity building approaches, marketing, demand creation, business models and scaling up sanitation also remain at the forefront.

Implementing handwashing campaigns for example will bring us nowhere if there are no appropiate sanitation facilities. Always suprises me to see NGOs with significant amounts of money primarily focusing on handwashing campaigns yet there are no toilets in the areas they are working in. This is counterproductive. We have to move past that.

BTW please don't leave the sector

Best regards,

Doreen

Hi Becky, thanks a lot for taking the time to reply! Not only because it allows me to explain a bit better what I mean, but also because I am somewhat under the impression that people are a bit afraid of replying as to not be branded as "ignoring the deplorable MHM situation of many women around the world"... neither is my intention nor is it helpful to have this kind of limits on discussion topics.

rcsindall wrote: I can guarantee that wandering around with urine-soaked trousers or menstrual blood staining your skirt does not feel dignified in any way. Incontinence affects 29% of people and menstruation affects approximately 50% of people at some point in their life so these are hardly niche issues.

I am 100% in agreement with that, however it is also beside the point I am trying to make. These are health issues marginally related to WASH (and actually even less related to "sustainable sanitation"), yet they seem to be discussed disproportionally often in various WASH exchange fora and very often tied to commercial interests (soap, sanitary pads, adult diapers?).

rcsindall wrote: In my experience, though these may be the ideas that are currently making headlines, that does not mean that they have eclipsed the provision of basic facilities. There are still a huge number of organisations that are working away with little fanfare on providing toilets and hand washing facilities and pit emptying services and faecal sludge treatment processes in an attempt to ensure that we meet SDG6. Alongside that there are plenty of people working on the financial and advocacy approaches that underpin this provision of services.

Yes luckily there are still some good core WASH projects ongoing, yet I feel that in recent years there has been a constant strain of resources (=funding) and attention away from these probably less "sexy" topics, towards those pushed by the media and commercial backing such as MHM. And it seems raising this as an issues (especially given the very much unsatisfactory progress on sanitation goals for the MDGs or SDGs), is somewhat of a taboo as the very vocal voices advocating for those topics still act (pretend?) like they are a suppressed minority that has to fight against some sort of WASH establishment trying to silence them (hence my objection to the article linked above).

As an example, I have been recently working in the refugee camps in northern Uganda where the provision of dignified sanitation facilities (or just sanitation facilities period) as well as sustainable water supply is a big issue. Yet, somehow important WASH coordination meetings between various organisations working in WASH objectively spend more time discussing MHM (and hand-washing) than finding solutions to the actually very severe water and sanitation issues.

Of course this is to a large part the typical "bike shedding" ( en.wikipedia.org/wiki/Law_of_triviality ) that always goes on in these meetings, but there is an additional layer of that if the topics are only marginally related (and should be better discussed in health meetings) and objections to discussing these topics are met with a very undignified response of "you are just trying to disregard the dire situation of women" (paraphrasing a bit), while in fact the women are the ones suffering most from the lack of water supply and sanitation facilities in the camps.

As a result some engineering minded experts stopped coming to these meeting, which made matters even worse. I also suspect that quite a few of our local colleagues felt very uneasy participating in these discussions. This is of course not necessarily a good thing (and should be slowly improved), but these cultural barriers are a fact and alienating these people who can give vital contributions to other topics has a very negative impact.
I know that I seem to contradict myself a bit on the last point (e.g. MHM being not a taboo anymore), but there we need to make a difference between the discourse in the (mostly) western experts (and donor!) circles and that in the usual countries of implementation. This divide is already very bad to begin with (for various reasons), but loudly advocating these topics and effectively silencing others ("the road to hell is paved with good intentions") makes this even worse.

rcsindall wrote: As for hygiene programmes, we know hand washing is a vital step in preventing the spread of disease. Regardless of who you believe started pushing for them to happen, it would be a backward step to ignore hygiene. There may be challenges with the outcomes these programmes achieve in terms of long-term behaviour change but that is a case for strong monitoring, evaluation and learning how to improve rather than simply ignoring the issue.

Yes, but all too often it ends up as "tippy taps" and a hygiene promotion campaign with soap distribution, which is 0% sustainable. I am not at all for ignoring these issues (just like MHM and incontinence, which do have their small place in WASH), but that people need to realise more that there are larger factors in play, and becoming the "useful idiots" unintentionally serving the interests of large commercial/institutional actors or just playing along with the media hype is far from a good place to be in nor does it help solving the much bigger issues of the silent majority.