3.3 Inclusive and Equitable Design

Access to adequate sanitation is a human right: it applies to everyone. However, persons with disabilities often face a daily struggle to protect this right. Sanitation services and facilities – and particularly on-site facilities and user interfaces (or toilets) –  are too often designed without taking into account of the diversity of needs of different user groups. Particularly in the rapid response phase, where time and money are limited, simple, uniform and easy-to-implement designs are often the preferred option. However, there is a wide range of different abilities and needs in any affected community. Consequently, if this range of abilities and needs is not properly addressed during the assessment, planning and design stage, people will be excluded from otherwise well-intentioned sanitation facilities and services.

The main barriers to meaningful participation and the inclusion of persons with disabilities in society and their access to humanitarian relief interventions are attitudinal, environmental, institutional and communicational. If the barriers and needs are not actively identified, persons with disabilities risk being excluded, which among other effects determines their ability to react to future shocks or increase health risks.

Around 16% of the global population – or one in seven people – are women, men, girls and boys with disabilities (WHO). In addition, more than 46% of older people (60 years and over) have disabilities (WHO/World Bank 2011). This number is increasing due, in part, to population ageing and an increase in the prevalence of non-communicable diseases (WHO).

Making WASH programmes more inclusive is not only about more accessible facilities but also about enabling Participation and Decision-Making and providing opportunities to challenge stigmatisation.

As part of the community, persons with disabilities or their representative organisations (Organisations of People with Disabilities (OPDs)) and older people have an important contribution to make to an emergency response (e.g. as influencers or gatekeepers);  they must be actively involved in all stages of the Humanitarian Project Cycle (HPC) to enable access to a WASH response for all.

In 2016, the International Community committed to making humanitarian assistance inclusive of persons with disabilities (as required by international humanitarian law and human rights law) by signing the ‘Charter on Inclusion of Persons with Disabilities in Humanitarian Action’ (WHS/CBM 2016) and committing to interventions that are non-discriminatory, participatory and based on cooperation and coordination.

To be inclusive all potential user groups need to be adequately considered in the design of sanitation facilities. User groups include people with long-term physical, mental, intellectual or sensory impairments, people with reduced mobility, people of different ages, sick or injured people, children, pregnant women and people who menstruate with specific requirements regarding safety and safe menstrual hygiene management among others. People may simultaneously belong to multiple user groups (intersectionality) and some potential user groups may be hidden or less visible due to existing stigma. Hence it is crucial to identify different user groups and the potential barriers they face during the initial Assessment phase.

It is essential that facilities are built from the perspective of the persons concerned and they should be consulted and actively involved in the subsequent program design and implementation process.

Often only minor adaptations or design improvements are needed to make sanitation facilities more inclusive. If considered in the design stage, additional costs of between 3–7 % can create barrier-free systems. To meet the physical accessibility requirements of persons with disabilities (for example, when constructing water and sanitation facilities), it is estimated that between 0.5-1% should be added to budgets. To provide specialised non-food items (NFIs) and mobility equipment to persons with disabilities, estimates suggest at least an additional 3-4%. (ADCAP 2018).

All those working in emergency response must commit to identifying the needs of persons with disabilities and overcoming the barriers that they face in accessing humanitarian interventions. This can be done through:

• • Direct consultation and involvement of representative organisations e.g. those that represent people with various disabilities, including intellectual and psychosocial, as well as families and caregivers throughout the project.

• • Carrying out needs or barrier Assessments to identify and understand the barriers that persons with disabilities and older people face in accessing sanitation services, recognising that these barriers go beyond physical accessibility and are linked to the availability, accessibility, affordability, appropriateness and quality of sanitation services.

• • Understanding that a key barrier is the attitude of humanitarian actors towards persons with disabilities and older people. Training or partnerships with OPDs can help to change those attitudes.

• • Integrating disability-sensitive measures into training and implementation, awareness-raising and disability rights at different levels with various stakeholders such as OPDs, community, government, or non-governmental organisations.

• • Ensuring that Monitoring and Evaluation systems include data about disability and inclusive feedback mechanisms are established.

The participation of persons with disabilities and/or their OPDs is essential to understand the barriers that women, men, girls and boys with disabilities face in accessing sanitation and to address them accordingly. Sanitation programmes need to be inclusive, but persons with disabilities must also be actively Involved in Decision-Making, in line with ‘nothing about us without us!’ and the general principles of the UN Convention on the Rights of Persons with Disabilities (UN-CRPD).

When designing and implementing sanitation infrastructure, special consideration also needs to be given to the culturally appropriate design of the facilities, particularly if people from different cultural, ethnic and/or religious groups are living together. People can choose to use a toilet facility or not; they may not use it if they consider it inappropriate, inconvenient or failing to correspond to the user’s customs and habits. Culturally appropriate design, therefore, considers aspects such as an appropriate user interface (for sitters or squatters), the type of anal cleansing material that users find acceptable (e.g. toilet paper, water, sticks or stones), gender aspects and privacy (e.g. gender-segregated facilities for women and men) whether different cultural groups are unwilling to use the same latrines as well as existing taboos related to toilet use, handling of waste or potential reuse options. Cultural beliefs and norms may also affect the siting (people may not want to be seen visiting the toilet) and the orientation of facilities (e.g. religious rules that the toilet should face away from the prayer point) and may limit technology options (e.g. reuse-oriented technologies may not be considered in contexts where handling and reuse of excreta is culturally not acceptable or the construction of urinals in Muslim societies may not be an option). Cultural issues can be manifold and need to be addressed during the Assessment stage to understand and respond adequately to people’s needs, habits and practices.