Very interested to read the Cumming et al paper regarding the limited health benefits from WASH interventions (very disappointing but not unexpected) and their conclusions re ‘more ambitious WASH interventions’ – this in the context of this blog’s interests in CW+ and ‘Utilitisation’.
‘The implications of three major new trials for the effect of [WASH] on childhood diarrhea and stunting’, Cumming et al, 2019 From the Abstract: ‘We judge these trials to have high internal validity, constituting good evidence that these specific interventions had no effect on childhood linear growth, and mixed effects on childhood diarrhea. These results suggest that, in settings such as these, more comprehensive or ambitious WASH interventions may be needed to achieve a major impact on child health.’
And in the context of our CW+ and ‘utilitisation’ work, what also caught my eye was in the conclusions: ‘With growing evidence of the burden of enteric pathogen carriage, and the associated growth and developmental consequences in low-income settings, calls have been made for ‘transformative WASH’ or ‘WASH++’ interventions. Although not clearly defined, nor as yet evaluated, we support this call for transformative WASH because it encapsulates the guiding principle that – in any context – what is needed is a comprehensive package of interventions tailored to address the local exposure landscape and enteric disease burden.’
OK, WASH++, perhaps CW++ but even CW+ requires at least a growing lower-middle-income economy to deliver it sustainably … that is unless higher-income countries ever get round to accepting that if we are to deliver rural SDG6.1 then long-term ‘transfers’ will be required, to complement national tariffs and taxes (and overcome the overly long ‘fourth T’ of timing, that is delaying capital maintenance beyond serviceability).