Incentivizing clean water collection during rainfall to reduce disease in rural sub-Saharan Africa with weather dependent pricing
In much of rural sub-Saharan Africa, households tend to shift water collection during rainfall periods away from cleaner groundwater sources, which they often have to pay for, towards free alternative sources. This increases disease risk and decreases sustainability of service provision. New approaches are needed to incentivize households to maintain clean water use and mitigate this environmental health challenge. We propose a pricing mechanism for ‘water ATMs’ – now possible with their pre-payment and remote monitoring capabilities – derived from measured reductions in collection over rainfall periods. Appropriate price elasticity ranges (−0.5 to −1) and relative risk of diarrhoeal disease from this intervention (0.4 to 0.8) determined from the literature are used to estimate the cost per capita and cost per disability-adjusted life year (DALY) averted. These are estimated to be between US$5 and 50 per DALY averted in the scenarios studied here, which would compare favourably against other water quality interventions. Cost and value would depend on elasticity of demand and potential health gains across different communities. Considerations for implementation are discussed. The potential for accurate subsidy transfers to service providers is outlined, along with the added resilience to climate change.Alemayehu, B., Ayele, B., Melak, F. and Ambely, A. (2020) ‘Exploring the association between childhood diarrhea and meteorological factors in Southwestern Ethiopia’, Science of The Total Environment 741: 140189 <https://doi.org/10.1016/J.SCITOTENV.2020.140189>.
Andres, L., Thibert, M., Lombana Cordoba, C., Danilenko, A., Joseph, G., Borja-Vega, C. (2019) Doing More with Less: Smarter Subsidies for Water Supply and Sanitation [online], World Bank, Washington, DC <https://doi.org/10.1596/32277>.
Anthonj, C., Fleming, L., Godfrey, S., Ambelu, A., Bevan, J., Cronk, R., Bartram, J. (2018) ‘Health risk perceptions are associated with domestic use of basic water and sanitation services: evidence from rural Ethiopia’, International Journal of Environmental Research and Public Health 15(10): 2112 <https://doi.org/10.3390/ijerph15102112>.
Armstrong, A., Hope, R. and Munday, C. (2021) ‘Monitoring socio-climatic interactions to prioritise drinking water interventions in rural Africa’, npj Clean Water 4(1): 1–3 <https://doi.org/10.1038/s41545-021-00102-9>.
Arouna, A. and Dabbert, S. (2010) ‘Determinants of domestic water use by rural households without access to private improved water sources in Benin: a seemingly unrelated Tobit approach’, Water Resources Management 24: 1381–98 <https://doi.org/10.1007/s11269-009-9504-4>.
Baguma, D., Loiskandl, W. and Jung, H. (2010) ‘Water management, rainwater harvesting and predictive variables in rural households’, Water Resources Management 24(13): 3333–48 <https://doi.org/10.1007/S11269-010-9609-9>.
Bain, R., Cronk, R., Hossain, R., Bonjour, S., Onda, K., Wright, J., Yang, H., Slaymaker, T., Hunter, P., Prüss-Ustün, A., Bartram, J. (2014) ‘Global assessment of exposure to faecal contamination through drinking water based on a systematic review’, Tropical Medicine & International Health 19(8): 917–27 <https://doi.org/10.1111/TMI.12334>.
Baral, R., Debellut, F., Agyemang, S., Clark, A., Pecenka,. C. (2020) ‘Cost of illness for childhood diarrhea in low-and middle-income countries: a systematic review of evidence and modelled estimates’, BMC Public Health 20(619): 1–12 <https://doi.org/10.1186/s12889-020-08595-8>.
Behnke, N., Klug, T., Cronk, R., Shields, K., Lee, K., Kelly, E., Allgood, G., Bartram, J., (2017) ‘Resource mobilization for community-managed rural water systems: evidence from Ghana, Kenya, and Zambia’, Journal of Cleaner Production 156: 437–44 <https://doi.org/10.1016/J.JCLEPRO.2017.04.016>.
Bonsor, H., Shamsudduha, M., Marchant, B., MacDonald, A., Taylor, R., (2018) ‘Seasonal and decadal groundwater changes in African sedimentary aquifers estimated using GRACE products and LSMs’, Remote Sensing 10(6): 904 <https://doi.org/10.3390/RS10060904>.
Brown, J. and Clasen, T. (2012) ‘High adherence is necessary to realize health gains from water quality interventions’, PLoS ONE 7(5): e36735 <https://doi.org/10.1371/JOURNAL.PONE.0036735>.
Cardone, R. and Fonseca, C. (2003) Financing and Cost Recovery: Thematic Overview Paper 7, IRC, The Hague.
Cheesman, J., Bennett, J. and Son, T.V.H. (2008) ‘Estimating household water demand using revealed and contingent behaviors: evidence from Vietnam’, Water Resources Research 44(11) <https://doi.org/10.1029/2007WR006265>.
Clasen, T., Thao, D., Boisson, S., Shipin, O. (2008) ‘Microbiological effectiveness and cost of boiling to disinfect drinking water in rural Vietnam’, Environmental Science and Technology 42(12): 4255–60 <https://doi.org/10.1021/ES7024802>.
Cook, J., Kimuyu, P. and Whittington, D. (2016) ‘The costs of coping with poor water supply in rural Kenya’, Water Resources Research 52(2): 841–59 <https://doi.org/10.1002/2015WR017468>.
Coulibaly, L., Jakus, P.M. and Keith, J.E. (2014) ‘Modeling water demand when households have multiple sources of water’, Water Resources Research 50(7): 6002–14 <https://doi.org/10.1002/2013WR015090>.
Cuthbert, M., Taylor, R., Favreau, G., Todd, M., Shamsudduha, M., Villholth, K., MacDonald, A., Scanlon, B., Kotchoni, D., Vouillamoz, J., Lawson, F., Adjomayi, P., Kashaigili, J., Seddon, D., Sorensen, J., Ebrahim, G., Owor, M., Nyenje, P., Nazoumou, Y., Goni, I., Ousmane, B., Sibanda, T., Ascott, M., Macdonald, D., Agyekum, W., Koussoubé, Y., Wanke, H., Kim, H., Wada, Y., Lo, M., Oki, T., Kukuric, N., (2019) ‘Observed controls on resilience of groundwater to climate variability in sub-Saharan Africa’, Nature 2019 572(7768): 230–4 <https://doi.org/10.1038/s41586-019-1441-7>.
Daly, S., Lowe, J., Hornsby, G., Harris, A. (2021) ‘Multiple water source use in low- and middle-income countries: a systematic review’, Journal of Water and Health, 19(3): 370–92 <https://doi.org/10.2166/wh.2021.205>.
DuChanois, R., Liddle, E., Fenner, R., Jeuland, M., Evans, B., Cumming, O., Zaman, R., Mujica-Pereira, A., Ross, I., Gribble, M., Brown, J. (2019) ‘Factors associated with water service continuity for the rural populations of Bangladesh, Pakistan, Ethiopia, and Mozambique’, Environmental Science & Technology 53: 31 <https://doi.org/10.1021/acs.est.8b07173>.
Edwards, C. (2011) ‘Cost-effectiveness analysis in practice’, in J. Cameron et al. (eds), Valuing Water, Valuing Livelihoods, Chapter 10, pg. 181-190. London: IWA Publishing.
Elliott, M., Foster, T., MacDonald, M., Harris, A., Schwab, K., Hadwen, W. (2019) ‘Addressing how multiple household water sources and uses build water resilience and support sustainable development’, npj Clean Water 2(1): 1–5 <https://doi.org/10.1038/s41545-019-0031-4>.
Fischer, E.M. and Knutti, R. (2016) ‘Observed heavy precipitation increase confirms theory and early models’, Nature Climate Change 6(11): 986–91 <https://doi.org/10.1038/nclimate3110>.
Foster, T. (2013) ‘Predictors of sustainability for community-managed handpumps in sub-Saharan Africa: evidence from Liberia, Sierra Leone, and Uganda’, Environmental Science and Technology 47(21): 12037–46 <https://doi.org/10.1021/ES402086N>.
Foster, T. (2017) ‘A critical mass analysis of community-based financing of water services in rural Kenya’, Water Resources and Rural Development 10: 1–13 <https://doi.org/10.1016/J.WRR.2017.04.003>.
Funk, C., Peterson, P., Landsfeld, M., Pedreros, D., Verdin, J., Shukla, S., Husak, G., Rowland, J., Harrison, L., Hoell, A., Michaelsen, J. (2015) ‘The climate hazards infrared precipitation with stations: a new environmental record for monitoring extremes’, Scientific Data 2(1): 1–21 <https://doi.org/10.1038/sdata.2015.66>.
Garrone, P., Grilli, L. and Marzano, R. (2019) ‘Price elasticity of water demand considering scarcity and attitudes’, Utilities Policy 59: 100927 <https://doi.org/10.1016/J.JUP.2019.100927>.
Gross, E. and Elshiewy, O. (2019) ‘Choice and quantity demand for improved and unimproved public water sources in rural areas: evidence from Benin’, Journal of Rural Studies 69: 186–94 <https://doi.org/10.1016/J.JRURSTUD.2019.02.021>.
Hamilton, K., Reyneke, B., Waso, M., Clements, T., Ndlovu, T., Khan, W., DiGiovanni, K., Rakestraw, E., Montalto, F., Haas, C., Ahmed, W. (2019) ‘A global review of the microbiological quality and potential health risks associated with roof-harvested rainwater tanks’, npj Clean Water 2(1): 1–18 <https://doi.org/10.1038/s41545-019-0030-5>.
Hope, R. and Ballon, P. (2019) ‘Global water policy and local payment choices in rural Africa’, npj Clean Water 2: 21 <https://doi.org/10.1038/s41545-019-0045-y>.
Hope, R., Thomson, P., Koehler, J., Foster, T. (2020) ‘Rethinking the economics of rural water in Africa’, Oxford Review of Economic Policy 36(1): 171–90 <https://doi.org/10.1093/oxrep/grz036>.
Hopkins, O., Lauria, D., Kold, A. (2004) ‘Demand-based planning of rural water systems in developing countries’, Journal of Water Resources and Planning 130(1): 44–52 <https://doi.org/10.1061/ASCE0733-94962004130:144>.
Hoque, S.F. and Hope, R. (2018) ‘The water diary method – proof-of-concept and policy implications for monitoring water use behaviour in rural Kenya’, Water Policy 20(4): 725–43 <https://doi.org/10.2166/WP.2018.179>.
Hunter, P.R., Zmirou-Navier, D. and Hartemann, P. (2009) ‘Estimating the impact on health of poor reliability of drinking water interventions in developing countries’, Science of The Total Environment 407(8): 2621–4 <https://doi.org/10.1016/J.SCITOTENV.2009.01.018>.
Hutton, G. (2006) Economic and Health Effects of Increasing Coverage of Low Cost Water and Sanitation Interventions (No. HDOCPA-2006-33) [online], New York: Human Development Report Office (HDRO), United Nations Development Programme (UNDP) <https://EconPapers.repec.org/RePEc:hdr:hdocpa:hdocpa-2006-33> [accessed 14 July 2021].
Ingram, W. and Memon, F.A. (2020) ‘Rural water collection patterns: combining smart meter data with user experiences in Tanzania’, Water 12(4): 1164 <https://doi.org/10.3390/W12041164>.
Ingram, W. and Memon, F.A. (2021) ‘Measuring seasonal reductions in water collection from piped systems in rural sub-Saharan Africa using novel pre-payment “smart meters”’, in The Virtual Conference of AQUA≈360: Water for All - Emerging Issues and Innovations, Exeter, UK.
Jackson, L., Finney, D., Kendon, E., Marsham, J., Parker, D., Stratton, R., Tomassini, L., Tucker, S. (2020) ‘The effect of explicit convection on couplings between rainfall, humidity, and ascent over Africa under climate change’, Journal of Climate 33(19): 8315–37 <https://doi.org/10.1175/JCLI-D-19-0322.1>.
Katuva, J., Hope, R., Foster, T., Koehler, J., Thomson, P. (2020) ‘Groundwater and welfare: a conceptual framework applied to coastal Kenya’, Groundwater for Sustainable Development 10: 100314 <https://doi.org/10.1016/J.GSD.2019.100314>.
Kelly, E., Shields, K., Cronk, R., Lee, K., Behnke, N., Klug, T., Bartram, J. (2018) ‘Seasonality, water use and community management of water systems in rural settings: qualitative evidence from Ghana, Kenya, and Zambia’, Science of The Total Environment 628–9: 715–21 <https://doi.org/10.1016/J.SCITOTENV.2018.02.045>.
Kendon, E., Stratton, R., Tucker, S., Marsham, J., Berthou, S., Rowell, D., Senior, C. (2019) ‘Enhanced future changes in wet and dry extremes over Africa at convection-permitting scale’, Nature Communications 10(1): 1–14 <https://doi.org/10.1038/s41467-019-09776-9>.
Komakech, H.C., Kwezi, L. and Ali, M. (2020) ‘Why prepaid technologies are not a panacea for inclusive and sustainable rural water services in Tanzania?’, Water Policy 22(5): 925–42 <https://doi.org/10.2166/WP.2020.070>.
Kraay, A., Man, O., Levy, M., Levy, K., Ionides, E., Eisenberg, J. (2020) ‘Understanding the impact of rainfall on diarrhea: testing the concentration-dilution hypothesis using a systematic review and meta-analysis’, Environmental Health Perspectives 128(12): 126001 <https://doi.org/10.1289/EHP6181>.
Kulinkina, A., Kosinski, K., Liss, A., Adjei, M., Ayamgah, G., Webb, P., Gute, D., Plummer, J., Naumova, E. (2016) ‘Piped water consumption in Ghana: a case study of temporal and spatial patterns of clean water demand relative to alternative water sources in rural small towns’, Science of The Total Environment 559: 291–301 <https://doi.org/10.1016/J.SCITOTENV.2016.03.148>.
Lapworth, D., Macdonald, A., Tijani, M., Darling, W., Gooddy, D., Bonsor, H., Araguás-Araguás, L. (2013) ‘Residence times of shallow groundwater in West Africa: implications for hydrogeology and resilience to future changes in climate’, Hydrogeology Journal 21(3): 673–86 <https://doi.org/10.1007/s10040-012-0925-4>.
Lawrence, A., Macdonald, D., Howard, A., Barrett, M., Pedley, S., Ahmed, K., Nalubega, M. (2001) Guidelines for assessing the risk to groundwater from on-site sanitation CR/01/142. British Geological Survey. Keyworth, UK.
Maidment, R., Grimes, D., Black, E., Tarnavsky, E., Young, M., Greatrex, H., Allan, R., Stein, T., Nkonde, E., Senkunda, S., Alcántara, E. (2017) ‘A new, long-term daily satellite-based rainfall dataset for operational monitoring in Africa’, Scientific Data 4(1): 1–19 <https://doi.org/10.1038/sdata.2017.63>.
McMullen, J.S. and Bergman, B.J. (2018) ‘The promise and problems of price subsidization in social entrepreneurship’, Business Horizons 61(4): 609–21 <https://doi.org/10.1016/J.BUSHOR.2018.03.009>.
McNicholl, D., Hope, R., Money, A., Lane, A., Armstrong, A., van der Wilk, N., Dupuis, M., Harvey, A., Nyaga, C., Womble, S., Favre, D., Allen, J., Katuva, J., Barbotte, T., Buhungiro, E., Thomson, P., Koehler, J. (2019) Performance-based Funding for Reliable Rural Water Services in Africa, Uptime Consortium, Working Paper 1. https://www.smithschool.ox.ac.uk/research/water/publications/Performance-based_funding_for_reliable_rural_water_services.pdf
Nauges, C. and van den Berg, C. (2008) ‘Demand for piped and non-piped water supply services: evidence from southwest Sri Lanka’, Environmental and Resource Economics 42(4): 535–49 <https://doi.org/10.1007/S10640-008-9222-Z>.
Nauges, C. and Whittington, D. (2010) ‘Estimation of water demand in developing countries: an overview’, The World Bank Research Observer 25(2): 263–94 <https://doi.org/10.1093/WBRO/LKP016>.
Nauges, C. and Whittington, D. (2017) ‘Evaluating the performance of alternative municipal water tariff designs: quantifying the tradeoffs between equity, economic efficiency, and cost recovery’, World Development 91: 125–43 <https://doi.org/10.1016/j.worlddev.2016.10.014>.
Null, C., Kremer, M., Miguel, E., Hombrados, J., Meeks, R., Zwane, A. (2012) Willingness to Pay for Cleaner Water in Less Developed Countries: Systematic Review of Experimental Evidence. International Initiative for Impact Evaluation (3ie), Systematic Review 006. Washington D.C.
Nyaga, C. (2019) A Water Infrastructure Audit of Kitui County. USAID/SWS; University of Oxford, Rural Focus, University of Colorado.
Odhiambo, C. and Almedom, A. (1994) ‘The rationality factor: choosing water sources according to water uses’, Waterlines 13(2): 28-31. <doi:10.3362/0262-8104.1994.044>
Parker, A., Youlten, R., Dillon, M., Nussbaumer, T., Carter, R., Tyrrel, S., Webster, J. (2010) ‘An assessment of microbiological water quality of six water source categories in north-east Uganda’, Journal of Water and Health 8(3): 550–60 <https://doi.org/10.2166/WH.2010.128>.
Prüss-Ustün, A., Wolf, J., Bartram, J., Clasen, T., Cumming, O., Freeman, M., Gordon, B., Hunter, P., Medlicott, K., Johnston, R. (2019) ‘Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: an updated analysis with a focus on low- and middle-income countries’, International Journal of Hygiene and Environmental Health 222(5): 765–77 <https://doi.org/10.1016/j.ijheh.2019.05.004>.
Rietveld, P., Rouwendal, J. and Zwart, B. (2000) ‘Block rate pricing of water in Indonesia: an analysis of welfare effects’, Bulletin of Indonesian Economic Studies 36(3): 73–92 <https://doi.org/10.1080/00074910012331338983>.
Risebro, H. and Hunter, P.R. (2011) ‘Estimating health impacts of interventions with a focus on small scale drinking water interventions’, in J. Cameron et al. (eds), Valuing Water, Valuing Livelihoods, Chapter 9, pg. 167-180. London: IWA Publishing.
Rogers, P., de Silva, R. and Bhatia, R. (2002) ‘Water is an economic good: how to use prices to promote equity, efficiency, and sustainability’, Water Policy 4: 1–17.
Skofronick-Jackson, G., Kirschbaum, D., Petersen, W., Huffman, G., Kidd, C., Stocker, E., Kakar, R. (2018) ‘The Global Precipitation Measurement (GPM) mission’s scientific achievements and societal contributions: reviewing four years of advanced rain and snow observations’, Quarterly Journal of the Royal Meteorological Society 144: 27–48 <https://doi.org/10.1002/qj.3313>.
Thiam, S., Diène, A., Sy, I., Winkler, M., Schindler, C., Ndione, J., Faye, O., Vounatsou, P., Utzinger, J., Cissé, G. (2017) ‘Association between childhood diarrhoeal incidence and climatic factors in urban and rural settings in the health district of Mbour, Senegal’, International Journal of Environmental Research and Public Health 14(9): 1049 <https://doi.org/10.3390/IJERPH14091049>.
Thomas, E., Needoba, J., Kaberia, D., Butterworth, J., Adams, E., Oduor, P., Macharia, D., Mitheu, F., Mugo, R., Nagel, C. (2019) ‘Quantifying increased groundwater demand from prolonged drought in the East African Rift Valley’, Science of The Total Environment 666: 1265–72 <https://doi.org/10.1016/J.SCITOTENV.2019.02.206>.
Thomson, P. (2018) ‘Only rapid handpump repairs reduce diarrhoea morbidity: evidence from Kenya’, presentation at UNC Water and Health 2018 [Preprint] <https://www.antenna.ch/wp-content/uploads/2021/12/From-Emergency-to-Development-Autonomous-Chlorine-Production-for-Water-Utilities-in-Conflict-Regions-Insights-from-Ukraine.pdf>.
Thomson, P., Bradley, D., Katilu, A., Katuva, J., Lanzoni, M., Koehler, J., Hope, R. (2019) ‘Rainfall and groundwater use in rural Kenya’, Science of The Total Environment 649: 722–30 <https://doi.org/10.1016/J.SCITOTENV.2018.08.330>.
Troeger, C., Forouzanfar, M., Rao, P., Khalil, I., Brown, A., Reiner, R., Fullman, N., Thompson, R., Abajobir, A., Ahmed, M., Alemayohu, M., Alvis-Guzman, N., Amare, A., Antonio, C., Asayesh, H., Avokpaho, E., Awasthi, A., Bacha, U., Barac, A., Betsue, B., Beyene, A., Boneya, D., Malta, D., Dandona, L., Dandona, R., Dubey, M., Eshrati, B., Fitchett, J., Gebrehiwot, T., Hailu, G., Horino, M., Hotez, P., Jibat, T., Jonas, J., Kasaeian, A., Kissoon, N., Kotloff, K., Koyanagi, A., Kumar, G., Rai, R., Lal, A., El, Razek., H, Mengistie, M., Moe, C., Patton, G., Platts-Mills, J., Qorbani, M., Ram, U., Roba, H., Sanabria, J., Sartorius, B., Sawhney, M., Shigematsu, M., Sreeramareddy, C., Swaminathan, S., Tedla, B., Jagiellonian, R., Ukwaja, K., Werdecker, A., Widdowson, M., Yonemoto, N., El Sayed Zaki M., Lim, S., Naghavi, M., Vos, T., Hay, S., Murray, C., Mokdad, A. (2017) ‘Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015’, The Lancet Infectious Diseases 17(9): 909–48 <https://doi.org/10.1016/S1473-3099(17)30276-1>.
Turman-Bryant, N., Nagel, C., Stover, L., Muragijimana, C., Thomas, E. (2019) ‘Improved drought resilience through continuous water service monitoring and specialized institutions: a longitudinal analysis of water service delivery across motorized boreholes in northern Kenya’, Sustainability 11: 3046 <https://doi.org/10.3390/SU11113046>.
Waddington, H. and Snilstveit, B. (2009) ‘Effectiveness and sustainability of water, sanitation, and hygiene interventions in combating diarrhoea’, Journal of Development Effectiveness 1(3): 295–335 <https://doi.org/10.1080/19439340903141175>.
Wagner, J., Cook, J. and Kimuyu, P. (2019) ‘Household demand for water in rural Kenya’, Environmental and Resource Economics 74(4): 1563–84 <https://doi.org/10.1007/S10640-019-00380-5>.
Whittington, D., Jeuland, M., Barker, K., Yuen, Y. (2012) ‘Setting priorities, targeting subsidies among water, sanitation, and preventive health interventions in developing countries’, World Development 40(8): 1546–68 <https://doi.org/10.1016/J.WORLDDEV.2012.03.004>.
Winpenny, J. (2011) Financing for Water and Sanitation: A Primer for Practitioners and Students in Developing Countries, EU Initiative Finance Working Group. https://www.gwp.org/globalassets/global/toolbox/references/financing-for-water-and-sanitation-euwi-fwg-2011.pdf
Wolf, J., Hunter, P., Freeman, M., Cumming, O., Clasen, T., Bartram, J., Higgins, J., Johnston, R., Medlicott, K., Boisson, S., Prüss-Ustün, A. (2018) ‘Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta-analysis and meta-regression’, Tropical Medicine & International Health 23(5): 508–25 <https://doi.org/10.1111/TMI.13051>.
World Bank Water Demand Team (1993) ‘The demand for water in rural areas: determinants and policy implications’, The World Bank Research Observer 8(1): 47–70 <https://doi.org/10.4324/9781351159289-30>.
World Health Organization (2018) Global Health Estimates 2016: Disease Burden by Cause, Age, Sex, by Country and by Region, 2000–2016, WHO, Geneva.
Zekri, S. and Dinar, A. (2003) ‘Welfare consequences of water supply alternatives in rural Tunisia’, Agricultural Economics 28(1): 1–12 <https://doi.org/10.1111/J.1574-0862.2003.TB00130.X>.
Maintaining groundwater collection over the rainy season with water ATM price reductions: a study in Kitui County, Kenya
Ingram, Will
Nyaga, Cliff
Mugo, Peter
Kavata, Annah
Gannon, Kate
Thomson, Patrick
Journal of Water, Sanitation and Hygiene for Development, Vol. 14 (2024), Iss. 9 P.808
https://doi.org/10.2166/washdev.2024.038 [Citations: 0]- A call to action: organizational, professional, and personal change for gender transformative WASH programming
- Providing municipal faecal sludge management services: lessons from Bangladesh
- Menstrual hygiene management: education and empowerment for girls?
- Webwatch
- Transgender-inclusive sanitation: insights from South Asia