Abstract:
Globally, millions of people lack access to improved water, sanitation and hygiene (WASH).
Disabled people, disadvantaged both physically and socially, are likely to be among those
facing the greatest inequities in WASH access. This study explores the WASH priorities of
disabled people and uses the social model of disability and the World Health Organization’s
International Classification of Functioning, Disability and Health (ICF) framework to look at
the relationships between impairments, contextual factors and barriers to WASH access.
36 disabled people and 15 carers from urban and rural Malawi were purposively selected
through key informants. The study employed a range of qualitative methods including interviews,
emotion mapping, free-listing of priorities, ranking, photo voice, observation and
WASH demonstrations. A thematic analysis was conducted using nVivo 10. WASH access
affected all participants and comprised almost a third of the challenges of daily living identified
by disabled people. Participants reported 50 barriers which related to water and sanitation
access, personal and hand hygiene, social attitudes and participation in WASH
programs. No two individuals reported facing the same set of barriers. This study found that
being female, being from an urban area and having limited wealth and education were likely
to increase the number and intensity of the barriers faced by an individual. The social model
proved useful for classifying the majority of barriers. However, this model was weaker when
applied to individuals who were more seriously disabled by their body function. This study
found that body function limitations such as incontinence, pain and an inability to communicate
WASH needs are in and of themselves significant barriers to adequate WASH access.
Understanding these access barriers is important for the WASH sector at a time when there
is a global push for equitable access
