Why water, sanitation and hygiene are vital to eliminate NTDs

A boy washes his face using water from a tap.

In communities where water is scarce, supplies are often reserved for drinking or farming, meaning hygiene and sanitation can be sidelined.

But water, along with sanitation and hygiene initiatives (collectively known as WASH), are crucial to Sightsavers’ work to eliminate neglected tropical diseases.

NTDs are parasitic and bacterial infections that affect more than 1 billion people worldwide. These painful conditions can cause severe and lifelong physical and visual impairments and are most prevalent in rural regions, poor urban locations and areas of conflict.

Poor hygiene is linked to people contracting and spreading these infections, including a number of NTDs such as trachoma – the leading infectious cause of blindness in the world – intestinal worms, and schistosomiasis.

Key WASH-related behaviours that prevent these NTDs include using latrines and washing hands and faces with water and soap. Other protective measures include boiling or filtering water for drinking or bathing, and safely handling fruit and vegetables.

In places where there’s no running water, Sightsavers also supports communities to build tippy taps: a simple home-made device which enables people to wash their hands and faces after using the toilet or handling animals, and therefore dramatically reducing the risk of infection.

A boy washes his face using a tippy tap, a hygienic handwashing device in areas where clean water is scarce.

The tippy tap: a vital tool to stop disease spreading

This simple home-made device enables people to wash their hands and faces in areas where there is no running water.

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2.2 billion
people lack access to safe clean water globally
19 countries
run WASH initiatives with Sightsavers' support
Seven countries
run SBC initiatives with Sightsavers' support

Social behaviour change (SBC)

Social behaviour change, which aims to improve people’s health by influencing their knowledge, attitudes and social norms, underpins many WASH initiatives. For instance, open defecation or sharing a living space with livestock may be ingrained in some communities, but these practices are potentially harmful because they help trachoma and other NTDs to spread.

A young boy stands outside a toliet he helped his family build outside their home.
Charles Mwiti stands by a toilet at his home outside Meru, Kenya. Through a Sightsavers’ WASH initiative, Charles helped build the toilet and learned proper sanitation techniques to prevent NTDs.

There is no ‘one-size-fits-all’ solution for the WASH approach, as customs and practices are culturally unique so the method needs to be tailored to each area. We often work in collaboration with national ministries of health and education to spread the message about face washing through existing school health clubs, as well as by training teachers and providing activities to engage children. We also support ‘community-led total sanitation and hygiene’ (CLTSH) activities, which encourage communities to assess their own sanitation needs and take action to avoid open-air defecation. Our work encourages communities to demand good-quality water and sanitation infrastructure.

WASH and managing NTD symptoms

As well as helping to prevent the spread of infectious diseases, WASH is crucial to treat and care for people affected by them. Having safe water sources is important to care for patients. For example, in the Democratic Republic of Congo, health workers are teaching people with lymphatic filariasis (LF), who are affected with swelling of the limbs, to care for their symptoms. Access to clean water is critical for these patients to keep their limbs clean and decrease the chance of infection.

A nurse helps wash a woman who has lymphatic filariasis wash her swollen leg.
Marie Claire Mwika, an LF patient, has her leg washed by nurse Lokoto Samngoy in Makulo, Democratic Republic of Congo.

Working with children: soap and superheroes

With children, the simple act of hand and face washing with soap can help reduce the risk of trachoma by 60 per cent. That’s why in 2014 Unilever and Sightsavers created the Super School of Five, inspired by Lifebuoy soap’s ‘School of Five’ hand washing campaign. This innovative programme features five cartoon superheroes who help children to remember the five key times in the day when they should wash their hands and faces.

The impact has been huge – an evaluation of participating schools in Turkana, Kenya, found face and hand washing increased by 40 per cent, a level of change that was still in place 20 months after the programme ended.

A mural at a school in Zambia telling children when to wash their hands. It includes illustrations and the words 'At 5 occasions: breakfast, lunch, dinner, toilet and bathing'.

WASH and our key programmes

Both the Ascend West and Central Africa programme and the Accelerate trachoma elimination programme ensure their activities include WASH. For example, the Accelerate programme reaches some of the most disenfranchised communities in trachoma-endemic areas with WASH services and supports intensified hygiene-related behavioural change in seven countries, to help break the transmission of trachoma.



We are proud that we were able to use our WASH expertise to help governments respond to the COVID-19 pandemic. The Ascend programme worked with ministries of health and national task forces across West and Central Africa to identify areas of need, ensuring we provided support where requested from national COVID-19 plans. We worked together with governments and partners to roll out hygiene-related behaviour change campaigns, for instance, by creating COVID-19-related posters and billboards in local languages. You can see an example from Nigeria, below:

A poster saying 'Coronavirus has not gone away. Keep your friends and family protected. Stay at least 1 metre apart'. There are illustrations of a man and woman with a vehicle separating them, illustrating one metre.

Using WASH data to combat NTDs

Historically, there has been limited crossover between the WASH and NTD sectors. But in recent years, recognition is growing around the importance of cross-sector working to address the environmental factors that help NTDs to spread.

Water and sanitation play a prominent part in the UN’s Sustainable Development Goals, and as eliminating NTDs is also included as an important target, this has encouraged the WASH and NTD communities to work together.

Sightsavers is supporting 12 countries in Africa to merge WASH data with other information about NTDs so that they can more effectively allocate resources and plan future programmes.

Extensive WASH and NTD data from local districts in countries where we work is now being collected and stored in a central database. This includes data on access to safe drinking water, sanitation and waste management; hand and face washing stations; and hygiene levels in schools and health facilities. Data from both areas is then analysed together, creating knowledge on how to create more effective NTD and WASH programmes, and greater collaboration between key players.

By showing that working together on WASH can control multiple diseases, we hope that more support for multi-sector initiatives will emerge, alongside increased investment to improve WASH-related infrastructures.

More stories on WASH

A boy washes his face at a well in Turkana, Kenya. Good hygiene is key to reducing the incidence of Trachoma and other eye conditions.
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Find out more about NTDs

Neglected tropical diseases