Water, Sanitation & Hygiene (WASH) Specialist

In this step, Tom Heath (Action Contre La Faim), Luca Fontana (MSF) and Pierre-Yves Oger (UNICEF) explain the role of water, sanitation and hygiene experts (WASH) in outbreak preparedness and response. They will cover the expertise these experts bring, as well as how their activities are prioritized and coordinated in the field.

1) What does a WASH professional do?

Water, sanitation and hygiene (WASH) professionals play a key role in prevention and control of infectious diseases, and to a lesser extent in preparedness activities. Cholera is the best example for which WASH professionals are involved in all three activities, but the same principles apply to all waterborne outbreaks spread by the faecal-oral route.

Prevention of cholera through WASH access is linked to the faecal-oral transmission of the disease and the possible identification of hotspots, defined as “geographically limited areas where environmental, cultural and/or socioeconomic conditions facilitate the transmission of the disease and where cholera persists or re-appears regularly. Hotspots play a central role in the spread of cholera to other areas”¹. To prevent cholera cases, WASH professionals must therefore target their long-term activities in these hotspots. Through epidemiological analysis, including incidence and prevalence of faecal-oral, waterborne and/or other water-related parasitic diseases, WASH teams monitor disease indicators and evaluate the results of their intervention activities.

2) What does a WASH professional brings to preparedness and response?

WASH professionals support outbreak preparedness activities to support future responses. Cholera is the disease for which it is more common to have dedicated activities. This is due to the spatial-temporal recurrence of the disease in some countries. The main components are coordination, capacity building and preparation for rapid responses. To improve coordination, cholera preparedness includes updating the national and regional response strategy; ensuring there is a coordination mechanism in place to allow the sharing of information and management of the response; strengthening of cross-border collaboration; and setting up good coordination with health sector and surveillance officers to allow effective transfer of information. Capacity building activities include the training of staff and government workers (this can include simulation exercises) and training of multi-sectoral response teams. To enable a rapid response, critical activities include:

1. Pre-positioning of materials and supplies (this includes items for setting up Cholera Treatment Centres; the management of its infection prevention and control (IPC) and community activities with a focus on water chlorination; hand washing; and information, education and communication (IEC) materials);

2. development/production of IEC materials to address key messages for cholera;

3. monitoring of water quality for water points in at risk area/hotpots; and

4. potentially supporting coordination with oral cholera vaccine campaigns.

Ebola preparedness is more complicated, as epidemiology of past outbreaks cannot be used for planning. Hence, usefulness of pre-positioned isolation units is far from obvious, as it is almost impossible to know where the first cases may appear. Pre-positioning of ready to move isolation material and training of staff are likely more adaptive to the situation. In the meantime, strengthening of universal infection prevention and control (IPC) precautions in health facilities, concurrently with the enhancement of the surveillance system, should be the priority. Reinforcement of basic hygiene measures with handwashing stations in schools and busy public places such as markets can also be considered by WASH professionals, while social mobilization and community engagement activities must also be implemented.

3) How are WASH activities prioritized?

It is not always practical to respond to every component of WASH activities in a response. WASH professionals focus on the immediate public health risk and building trust and accountability with the communities.

WASH responses are prioritised based on:

1. epidemiological findings;

2. assessment of risk factors;

3. transmission routes (especially beyond faecal–oral);

4. the expected impact of each intervention; and

5. available resources.

This information is adapted to identify where to focus WASH resources (geographic areas), who to target (children, women, frontline workers, the entire population), when to implement (current hotspots vs. areas at risk) and what interventions are necessary (based on the main routes of transmission and the expected impact).

4) How are WASH activities coordinated?

To support the coordination of responses, in countries where health clusters have been set up, a “WASH – Health” inter-cluster/Cholera Task force usually meet on a weekly basis. This meeting facilitates coordination between actors from the WASH and the Health sectors, and enables partnerships to be established with a health international non-governmental organization (INGO). The structure of this organisation is typically as per the below diagram (Figure 1). In addition, it is common for an ad-hoc WASH working groups to be established to define coherent and shared response strategies, harmonise intervention mechanisms and divide up activities by intervention area as best as possible.

Figure 1: Cholera Task Force Coordination Structure