Journal of African Development

Introduction

The rapid urbanization of the Global South has contributed to the proliferation of slum settlements—densely populated urban areas marked by inadequate housing and a lack of essential public services. Among the most urgent challenges facing these communities are deficits in water, sanitation, and hygiene (WASH). Without access to clean water, safe sanitation, and proper hygiene, slum dwellers face heightened risks of infectious diseases, stunted development, and perpetuated poverty^[1][2]. This article examines the evolution, current state, impact, and challenges of WASH initiatives in slum areas, drawing from recent studies, international agency reports, and community-level interventions.

The WASH Context in Slum Areas

Scope and Scale

Across low- and middle-income countries, hundreds of millions reside in slums. Most slum settlements are characterized by:

• Overcrowded housing and high population density
• Insufficient safe water points and open or shared sanitation facilities
• Inadequate sewage, solid waste removal, and drainage infrastructure
• Poor environmental hygiene, facilitating the spread of enteric and vector-borne diseases^[3][4]

Health Burden

Poor WASH conditions in slums account for disproportionate disease burden, including:

• Diarrheal diseases (responsible for over 1 million deaths per year globally)^[5]
• Cholera, typhoid, dysentery, and parasitic infections
• High rates of childhood malnutrition and stunted growth^[6][7]

Barriers to WASH Implementation in Slums

Economic and Social Factors

• Poverty: Limited household income impedes access to clean water and hygiene products even when available^[1].
• Social exclusion: Marginalization of slum populations from city-level infrastructure planning^[8].

Infrastructure and Spatial Challenges

• High population density: Limits the siting and maintenance of sanitation facilities^[9].
• Unstable or peripheral locations: Slums are commonly built on flood-prone, unregulated land, complicating infrastructure delivery^[10][9].
• Lack of roads: Hinders regular emptying of communal latrines and waste collection^[9].

Institutional and Policy Barriers

• Fragmented governance: Overlapping mandates between agencies, poor coordination, and limited resources hamper effective WASH delivery^[11][8].
• Absence of legal tenure: Slum dwellers often lack land rights, discouraging large-scale infrastructure investment.

Successful WASH Initiatives: Approaches and Impact

Community-Based Interventions

• Participatory hygiene promotion: Mobilizing slum residents to advocate, educate, and maintain local WASH infrastructure has proven effective. Example: Handwashing campaigns, peer education, and "talking compounds" in Uganda^[2].
• Clean-up campaigns: Collective waste removal and maintenance activities reduce contamination exposure.

Infrastructure Upgrades

• Piped water systems: Retrofitting slums with piped water increased usage in some Ugandan slums from 38% to 86%; the use of unsafe sources dropped from 30% to 2%^[2].
• Community toilets and improved latrines: Construction of shared facilities, with maintenance committees, reduces open defecation but presents challenges in overcrowded environments^[4][9].
• Solid waste management: Training community youth and health workers boosts satisfaction with waste services, from 40% to over 90% in some interventions^[2].

Integration with Health and Education

• School WASH clubs: Providing health education, improved toilets, and clean water in schools supports behavioral change and community ripple effects^[2].
• Capacity building: Training local leaders in water treatment, safe storage, and maintenance prolongs intervention impact.

Measured Outcomes

Table 1: WASH Improvement Outcomes in Central Uganda Slum Communities^[2]

Health and Well-being: The Impact of WASH

WASH improvements enhance not only physical health but also psychological and social well-being among slum dwellers^[12]. Recent studies show:

• Better WASH practices and water security are significantly associated with improved mental health and quality of life.
• Toilet availability increases the sense of dignity and security, especially for women and children.
• Health outcomes such as reduced diarrheal morbidity, lower cholera risk, and decreased child mortality have been documented in slum communities with upgraded WASH systems^[13][12].

Challenges and the Way Forward

Sustainability and Maintenance

In many slum upgrades, initial gains erode without continued maintenance and community engagement. Approaches that succeed emphasize ownership, regular monitoring, and adaptive infrastructure that suits dense, informal environments^[9]. A holistic focus, integrating water supply, sanitation, drainage, and solid waste collection, is essential due to system interdependence.

Persistent Inequalities

• Gender and Age: Women and youths disproportionately bear the burden of water collection and sanitation needs, requiring targeted support^[4].
• Digital and Financial Inclusion: Innovations such as mobile payments for water and sanitation services are emerging, but slum communities often lag in access.

Coordination and Policy

• Strengthening partnerships among residents, local authorities, NGOs, and donors—ensuring accountability and alignment.
• Developing pro-poor, equitable service delivery frameworks that address legal, spatial, and financial obstacles^[14].

Visualization: Key Challenges to WASH in Slum Areas

Table 2: Selected Challenges to WASH Infrastructure in Slum Areas^[11][8][9]

Conclusion

Water, sanitation, and hygiene interventions in slums are vital for urban equity and health. While challenges remain—poverty, infrastructure, policy fragmentation, and sustainability—evidence shows that community-focused, context-adapted WASH initiatives can drive substantial improvements. The path to universal WASH coverage in slums requires:

• Integrated, multi-sector solutions
• Strengthening community partnerships
• Policy reforms focused on equity and inclusion

Achieving Sustainable Development Goal 6—clean water and sanitation for all—depends on a committed global and local effort to transform the most vulnerable urban spaces^[15].

References (MLA Style, as required above the title)

1. World Health Organization. "Water, sanitation and hygiene (WASH)." 2019.
2. Okesanya, O.J., et al. "Water, sanitation, and hygiene (WASH) practices in Africa." 2024.
3. "Barriers to water, sanitation, and hygiene in Sub-Saharan Africa." IWA Publishing, 2024.
4. Gates Foundation. "Initiatives for Access to Safe Water, Sanitation & Hygiene," 2024.
5. "Drinking Water Supply, Sanitation, and Hygiene Promotion Interventions in Two Slum Communities in Central Uganda." J Environ Public Health, 2018.
6. "Are better existing WASH practices in urban slums associated with a lower long-term risk of severe cholera? A prospective cohort study with 4 years of follow-up in Mirpur, Bangladesh." BMJ Open, 2022.
7. Dickson-Gomez, J., et al. "Water, Sanitation, and Hygiene Challenges in Informal Settlements." PMC, 2023.
8. "A Water, Sanitation, And Hygiene Revolution In Africa Using Smart Technologies." NEPAD, 2021.
9. "The Well-Being of Slum Dwellers Are Associated With WaSH-Related Factors: A Cross-Sectional Study From India." Health Sci Rep, 2025.
10. "Accessibility to WASH and waste management services in African urban settlements." IWA Publishing, 2023.
11. "Improving WASH in Slum Communities' Project." Amref Ethiopia.
12. "Water, sanitation, and hygiene service inequalities and their associated factors among urban slums and rural communities in Eastern Ethiopia." Frontiers in Public Health, 2024.
13. "Water, Sanitation, and Hygiene in Informal Settlements." WPI Capetown Resource Library.
14. Bose, D. "Overcoming water, sanitation, and hygiene challenges in informal settlements." ScienceDirect, 2024.
15. "Water, Sanitation, and Hygiene Practices in Urban Slums of Eastern India." Journal of Infectious Diseases, 2021.
16. "Review of drivers and barriers of water and sanitation policies for urban informal settlements in low-income and middle-income countries." PubMed, 2019.
17. "A Water, Sanitation, And Hygiene Revolution In Africa." NEPAD, 2021.
18. "Water, Sanitation, and Hygiene (WaSH) practices and morbidity." PMC, 2021.
19. Dickson-Gomez, J., et al. "Water, Sanitation, and Hygiene Challenges in Informal Settlements." PMC, 2023.
20. Mustapha, A., et al. "Pathway to Equity in Water, Sanitation, and Hygiene." PMC, 2024.