Evidence map›Paper›PMID 40000060›Full record

ArticleBMJ global health2025

The persistence of failure in water, sanitation and hygiene programming: a qualitative study.

Dani J Barrington, Rebecca C Sindall, Annatoria Chinyama, Tracy Morse, May N Sule, Joanne Beale, Tendai Kativhu, Sneha Krishnan, Kondwani Luwe, Rossanie Daudi Malolo and 8 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Dani J BarringtonSchool of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia dani.barrington@uwa.edu.au.ORCID http://orcid.org/0000-0002-1486-9247
Rebecca C SindallWASH R&D Centre, University of KwaZulu-Natal, Durban, South Africa.
Annatoria ChinyamaFaculty of Applied Sciences, National University of Science and Technology, Bulawayo, Zimbabwe.
Tracy MorseCentre for Water, Sanitation, Health, and Technology Development, Malawi University of Business and Applied Sciences, Blantyre, Malawi.ORCID http://orcid.org/0000-0003-4185-9471
May N SuleImperial College London, London, UK.ORCID http://orcid.org/0000-0002-1241-4812
Joanne BealeIndependent, London, UK.
Tendai KativhuFaculty of Applied Sciences, National University of Science and Technology, Bulawayo, Zimbabwe.
Sneha KrishnanJindal School of Public Health and Human Development, OP Jindal Global University, Sonipat, Haryana, India.ORCID http://orcid.org/0000-0001-5096-6119
Kondwani LuweCentre for Water, Sanitation, Health, and Technology Development, Malawi University of Business and Applied Sciences, Blantyre, Malawi.ORCID http://orcid.org/0000-0003-1932-4681
Rossanie Daudi MaloloCentre for Water, Sanitation, Health, and Technology Development, Malawi University of Business and Applied Sciences, Blantyre, Malawi.ORCID http://orcid.org/0000-0002-9456-643X
Onike McharoMwanza Intervention Trials Unit, Mwanza, Tanzania.
Anthony C OdiliWASH R&D Centre, University of KwaZulu-Natal, Durban, South Africa.
Kristin T RavndalSchool of Water, Energy and Environment, Cranfield University, Cranfield, UK.
Jo RoseDepartment of Health Science, University of York, York, UK.
Esther ShaylorOffice of Innovation, UNICEF, Copenhagen, Denmark.
Eleanor WozeiDepartment of Engineering and Environment, Uganda Christian University, Mukono, Uganda.ORCID http://orcid.org/0000-0001-9726-5053
Faida ChikwezgaCentre for Water, Sanitation, Health, and Appropriate Technology Development, Malawi University of Business and Applied Sciences, Blantyre, Malawi.
Barbara E EvansSchool of Civil Engineering, University of Leeds, Leeds, UK.ORCID http://orcid.org/0000-0001-9815-3141

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionUnsafe water, sanitation and hygiene (WASH) causes millions of deaths and disability-adjusted life-years annually. Despite global progress towards universal WASH, much of WASH programming continues to fail to improve health outcomes or be sustainable in the longer term, consistently falling short of internal performance indicators and sometimes negatively impacting the well-being of local stakeholders. Although sector experts in high-income countries have often provided explanations for such failures, the opinions of those implementing WASH programming at the ground level are rarely published.

methodsIn 2020, we purposively recruited 108 front-line WASH professionals in Malawi, South Africa, Tanzania and Zimbabwe to participate in 96 in-depth interviews, explaining why they believe WASH failure persists. Through participatory analysis, including framework analysis with additional axial coding and member-checking of our findings, we determined the core reasons for WASH failure as perceived by participants.

resultsInterviewees reported poor engagement and commitment of intended users, unrealistic and idealistic expectations held by funders and implementers, and a general lack of workforce and financial capacity as significant contributors to WASH failure. Our analysis shows that these issues stem from WASH programming being implemented as time and budget-constrained projects. This projectisation has led to reduced accountability of funders and implementers to intended users and a focus on measuring inputs and outputs rather than outcomes and impacts. It has also placed high expectations on intended users to sustain WASH services and behaviour change after projects officially end.

conclusionsOur findings imply that WASH programming needs to move away from projectisation towards long-term investments with associated accountability to local governments and longitudinal measurements of WASH access, as well as realistic considerations of the needs, abilities and priorities of intended users. Funders need to reconsider the status quo and how adjusting their systems could support sustainable WASH services.

Indexed as

HygieneSanitationWater SupplyFemaleHumansInterviews as TopicMalawiMaleQualitative ResearchSouth AfricaTanzaniaZimbabweDecision MakingEnvironmental healthGlobal HealthPublic HealthQualitative study

Identifiers

PMID40000060
PMCPMC11865792

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.