wash wash wash (or watsan, wash) is an acronym that stands for "water, sanitation and hygiene". it is used widely by non-governmental organizations and aid agencies in developing countries. the purposes of providing access to wash services include achieving public health gains, improving human dignity in the case of sanitation, implementing the human right to water and sanitation, reducing the burden of collecting drinking water for women, reducing risks of violence against women, improving education and health outcomes at schools and health facilities, and reducing water pollution. access to wash services is also an important component of water security. universal, affordable and sustainable access to wash is a key issue within international development and is the focus of the first two targets of sustainable development goal 6 (sdg 6). targets 6.1 and 6.2 aim at equitable and accessible water and sanitation for all. in 2017, it was estimated that 2.3 billion people live without basic sanitation facilities and 844 million people live without access to safe and clean drinking water. wash consists of water, sanitation and hygiene, in clockwise order from top left: a woman pumps water from a handpump in her village in sindh, pakistan; a girl collects clean water from a communal water supply in kawempe, uganda; a simple hand washing setup for when there is no running water, shown in omaruru, namibia; school toilets at an elementary school in boquete, panama. the wash-attributable burden of disease and injuries has been studied in depth. typical diseases and conditions associated with lack of wash include diarrhea, malnutrition and stunting, in addition to neglected tropical diseases. lack of wash poses additional health risks for women, for example during pregnancy, or in connection with menstrual hygiene management. lack of sanitation contributes to about 700,000 child deaths every year due to diarrhea, mainly in developing countries. chronic diarrhea can have long-term negative effects on children, in terms of both physical and cognitive development. still, collecting precise scientific evidence regarding health outcomes that result from improved access to wash is difficult due to a range of complicating factors. scholars suggest a need for longer-term studies of technology efficacy, greater analysis of sanitation interventions, and studies of combined effects from multiple interventions in order to better analyze wash health outcomes. access to wash needs to be provided at the household level but also in non-household settings like schools, healthcare facilities, workplaces (including prisons), temporary use settings, mass gatherings, and for dislocated populations. in schools, group handwashing facilities and behaviors are a promising approach to improve hygiene. lack of wash facilities at schools can prevent students (especially girls) from attending school, reducing their educational achievements and future work productivity. challenges for providing wash services include providing services to urban slums, failures of wash systems (e.g. leaking water distribution systems), water pollution and the impacts of climate change. planning approaches for better, more reliable and equitable access to wash include: national wash plans and monitoring (including gender mainstreaming), integrated water resources management (iwrm) and, more recently, improving climate resilience of wash services. adaptive capacity in water management systems can help to absorb some of the impacts of climate-related events and increase climate resilience.: 25 stakeholders at various scales, i.e. from small urban utilities to national governments, need to have access to reliable information about the regional climate and any expected changes due to global climate change. components the concept of wash groups together water supply (access to drinking water services), sanitation, and hygiene because the impact of deficiencies in each area overlap strongly (wash is an acronym that uses the first letters of "water, sanitation and hygiene"). wash consists of access to drinking water services, sanitation services and hygiene. drinking water services further information: drinking water § global access women line up at a bore hole to fill their containers with water (labuje idp camp, kitgum, kitgum district, northern region of uganda)a "safely managed drinking water service" is "one located on premises, available when needed and free from contamination". the terms '"improved water source" and "unimproved water source" were coined in 2002 as a drinking water monitoring tool by the jmp of unicef and who. the term "improved water source" refers to "piped water on premises (piped household water connection located inside the user's dwelling, plot or yard), and other improved drinking water sources (public taps or standpipes, tube wells or boreholes, protected dug wells, protected springs, and rainwater collection)". access to drinking water is included in target 6.1 of sustainable development goal 6 (sdg 6), which states: "by 2030, achieve universal and equitable access to safe and affordable drinking water for all". this target has one indicator: indicator 6.1.1 is the "proportion of population using safely managed drinking water services". in 2017, 844 million people still lacked even a basic drinking water service.: 3 in 2019 it was reported that 435 million people used unimproved sources for their drinking water, and 144 million still used surface waters, such as lakes and streams. in general, water resources used to generate drinking water can include surface water, groundwater or rainwater, after collection, distribution and treatment if required. people without access to safe, reliable domestic water supplies face lower water security at specific times throughout the year due to cyclical changes in water quantity or quality. for example, where access to water on-premises is not available, drinking water quality at the point of use (pou) can be much worse compared to the quality at the point of collection (poc). correct household practices around hygiene, storage and treatment are therefore important. there are interactions between weather, water source and management, and these in turn impact on drinking water safety. groundwater main articles: groundwater and groundwater recharge groundwater provides critical freshwater supply, particularly in dry regions where surface water availability is limited. globally, more than one-third of the water used originates from underground. in the mid-latitude arid and semi-arid regions lacking sufficient surface water supply from rivers and reservoirs, groundwater is critical for sustaining global ecology and meeting societal needs of drinking water and food production. the demand for groundwater is rapidly increasing with population growth, while climate change is imposing additional stress on water resources and raising the probability of severe drought occurrence. the anthropogenic effects on groundwater resources are mainly due to groundwater pumping and the indirect effects of irrigation and land use changes. groundwater plays a central role in sustaining water supplies and livelihoods in sub-saharan africa. in some cases, groundwater is an additional water source that was not used previously. sanitation services main articles: sanitation and improved sanitation sanitation systems are grouped into several types: the ladder of sanitation services includes (from lowest to highest): open defecation, unimproved, limited, basic, safely managed.: 8 a distinction is made between sanitation facilities that are shared between two or more households (a "limited service") and those that are not shared (a "basic service"). the definition of improved sanitation facilities is: those facilities designed to hygienically separate excreta from human contact.: 8 with regards to toilets, improved sanitation includes the following kind of toilets: flush toilet, connection to a piped sewer system, connection to a septic system, flush or pour-flush to a pit latrine, pit latrine with slab, ventilated improved pit latrine, composting toilet. access to sanitation services is included in target 6.2 of sustainable development goal 6 which is: "by 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations." this target has one indicator: indicator 6.2.1 is the "proportion of population using (a) safely managed sanitation services and (b) a hand-washing facility with soap and water". in 2017, 4.5 billion people did not have toilets at home that can safely manage waste despite improvements in access to sanitation over the past decades. approximately 600 million people share a toilet or latrine with other households and 892 million people practice open defecation. there are many barriers that make it difficult to achieve "sanitation for all". these include social, institutional, technical and environmental challenges. therefore, the problem of providing access to sanitation services cannot be solved by focusing on technology alone. instead, it requires an integrated perspective that includes planning, using economic opportunities (e.g. from reuse of excreta), and behavior change interventions. fecal sludge management and sanitation workers main articles: fecal sludge management and sanitation worker sanitation services would not be complete without safe fecal sludge management (fsm), which is the storage, collection, transport, treatment, and safe end use or disposal of fecal sludge.: 3 fecal sludge is defined very broadly as what accumulates in onsite sanitation systems (e.g. pit latrines, septic tanks and container-based solutions) and specifically is not transported through a sewer.: 5 sanitation workers are the people needed for cleaning, maintaining, operating, or emptying a sanitation technology at any step of the sanitation chain.: 2 hygiene main articles: hygiene and hand washing a school girl using a veronica bucket in ghana for handwashing. hygiene is a broad concept. "hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." hygiene is can comprise many behaviors, including handwashing, menstrual hygiene and food hygiene.: 18 in the context of wash, handwashing with soap and water is regarded as a top priority in all settings, and has been chosen as an indicator for national and global monitoring of hygiene access. "basic hygiene facilities" are those were people have a handwashing facility with soap and water available on their premises.: 18 handwashing facilities can consist of a sink with tap water, buckets with taps, tippy-taps and portable basins.: 18 in the context of sdg 6, hygiene is included in the indicator for target 6.2: "proportion of population using (b) a hand-washing facility with soap and water" in 2017, the global situation was reported as follows: only 1 in 4 people in low-income countries had handwashing facilities with soap and water at home; only 14% of people in sub-saharan africa have handwashing facilities. worldwide, at least 500 million women and girls lack adequate, safe, and private facilities for managing menstrual hygiene. approximately 40% of the world's population live without basic hand washing facilities with soap and water at home. according to the world health organization, over half of the people who live in rural areas in developing countries do not practice hand washing methods due to a severe lack of water and soap. purposes the purposes of providing access to wash services include achieving public health gains, improving human dignity in the case of sanitation, implementing the human right to water and sanitation, reducing the burden of collecting drinking water for women, reducing risks of violence against women, improving education and health outcomes at schools and health facilities, and reducing water pollution. access to wash services is also an important component of achieving water security. improving access to wash services can improve health, life expectancy, student learning, gender equality, and other important issues of international development. it can also assist with poverty reduction and socio-economic development. equitable access to drinking water supply it is important to reduce inequalities in access to water, sanitation and hygiene services.: 11 such inequalities are for example related to income level and gender. in 2019 in 24 countries where disaggregated data was available, basic water coverage among the richest wealth quintile was at least twice as high as coverage among the poorest quintile. for example in bangladesh, minority ethnic groups have lower levels of access to wash than the rest of the bengali population. this is due to "structural racial discrimination" in bangladesh. access to wash services also varies internally within nations depending on socio-economic status, political power, and level of urbanization. in 2004 it was found that urban households are 30% and 135% more likely to have access to improved water sources and sanitation respectively, as compared to rural areas. the human rights to water and sanitation prohibit discrimination on the grounds of "race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, disability or other status". these are all dimensions of inequality in wash services.: 13 dealing with inequalities of water access falls under international human rights law. in 2000, the second world water forum in the hague concluded that women