| INTERNAL EVIDENCE | EXTERNAL EVIDENCE | |
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Health benefits Improvements lead to direct health benefits for individual households | 
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Safety benefits Improvements lead to direct safety benefits for individual households | 
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Reduced stress and increased wellbeing Improvements lead to reduced stress and increased wellbeing |
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In most discussions about improved access to drinking water and sanitation, health very quickly comes up as a primary outcome. This was the case even before the COVID-19 pandemic brought universal attention to the importance of handwashing. Health, after all, is about more than just washing away viruses: the World Health Organization defines it as a state of physical, mental, and social wellbeing, and water influences each of these dimensions. Our exploration of health and safety impacts therefore covers three different areas of direct health benefits, safety benefits, and the all-around wellbeing that comes with relief of daily household stresses.
People taking out loans hope for, and experience, direct health benefits
While many studies are inconclusive on positive health outcomes of water supply and sanitation improvements, the science is clear about the transmission pathways of waterborne diseases, and that safe water and sanitation are foundational to health. Worryingly, unfolding crises such as COVID-19 and the worsening climate crisis threaten to drown out health gains.
Health is an important motivator behind investing in water supply and sanitation improvements. Close to half of 3,226 survey respondents mentioned ‘better health’ as a reason for taking out their loan – second to ‘convenience’ (64%) and just ahead of ‘to save time’ (44%). Health is therefore on the minds of many households making investments, but not their only concern.
Our data supports other global evidence about the health benefits of these improvements, which are known to interrupt the fecal–oral transmission pathways that are major causes of disease and death. Households who have taken out loans report that their water is of higher quality, and that it’s now quicker to access water and sanitation (which is also better for their health). Evaluations and surveys report reductions in illness and hospitalization, less time spent caring for sick household members, and lower medical expenses.
It should be noted, though, that most of these data are self-reported by loan recipients. In health research, such survey answers based on recall are not considered to be strong forms of evidence, and they are hard to verify. Our evaluation data also provide a mixed picture, recording mostly positive but some inconclusive and negative health outcomes.
Household taps and toilets are safer
Safety is considered a significant driver of household water and sanitation investments. Reduced travel time for water- and sanitation-related activities is associated with increased feelings of safety. When it comes to toilets, aspects of design such as accessibility, privacy and lighting are important.
The evidence is strong that households investing in water supply and sanitation improvements feel safer as a result. Reduced travel to collect water and to use the bathroom is significant for these perceptions of safety. Long travel times are known to heighten risks of sexual assault and other types of violence. They can also involve dangers like rough terrain and dangerous animals, and can require the travelers to leave children vulnerable at home.
It’s not surprising, then, that new facilities are considered safer by 76% of households that have made water supply improvements and 79% of households that have made sanitation improvements. According to surveys like these, privacy is the main aspect of feelings of safety, along with concerns about outside dangers.
When respondents were asked what changes they had observed since making their investments, the most frequent answers were feelings that are rooted in both safety and privacy: 90% mentioned ‘improved comfort’ and 85% ‘improved pride/dignity’. In another survey, 10% reported feeling safer from violence after water supply improvements and 9% after sanitation improvements.
Household investments generally reduce stress and support mental wellbeing
Water-insecure communities experience higher levels of anxiety and depression, and are more prone to arguments and violence. Water supply and sanitation improvements, on the other hand, can boost factors associated with wellbeing – an emerging approach that is taking researchers beyond simple morbidity and mortality definitions of health outcomes.
Our evaluations describe fights over water and arguments in line for communal facilities before the installation of household improvements. Community management of water supply and sanitation can also contribute to higher stress levels, as a result of perceived unfairness in water distribution and potentially shame-inducing practices such as water borrowing.
More substantial evidence is needed, however, to show how much Water.org has helped in addressing these issues. While three-quarters of respondents who had made water investments reported less stress regarding management of their water, more than 11% reported higher stress, for unclear reasons.
Household improvements can also be looked at through the lens of social and emotional wellbeing. Comfort, pride and dignity, as mentioned above, contribute to a sense of wellbeing. So do feelings of improved social status, cited by 81% of respondents, and improved school attendance for children, cited by 69%. We are advancing our evaluations to better understand wellbeing dimensions in the future, including the wellbeing that comes with improved household finances, women’s empowerment and equity, and resilience to the water insecurity-exacerbating effects of climate change.
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