Unpacking Intersecting Complexities in Water, Sanitation, and Hygiene Programs for Challenging Contexts

Progress is needed within the global water, sanitation, and hygiene (WASH) sector to ensure access to WASH services for all. In fact, a quadrupling of current global rates of progress is needed to achieve the Sustainable Development Goal for WASH (SDG 6) by 2030, with an even greater increase in rates required for communities most overlooked in conventional WASH programs. These communities are referred to as ‘challenging contexts’ throughout this thesis, and they can include informal settlements, refugee camps, and environmentally-challenging areas (e.g., flood-affected communities), among others. Ensuring access to WASH for all, particularly in challenging contexts, requires that practitioners in WASH programs understand, account for, and embrace the multidimensional and interconnected complexity that defines all contexts. Over-simplification of complexity – and failure to understand how factors of complexity are interconnected, referred to as ‘intersecting complexities’ in this thesis – has resulted in WASH programs that are not appropriate for the communities they hope to serve. Grounded in systems thinking and guided by inclusive practice, this thesis explored the following research opportunity: to investigate the multidimensional and interconnected complexity of WASH and determine how this complexity can be used to strengthen programs and ensure access for communities in challenging contexts. The methodology guiding this research incorporated several overlapping research approaches – specifically intersectionality, decolonising approaches, participatory approaches, and strengths-based approaches – which were all grounded in reflexive practice. The research opportunity was explored through a multimethod sequential research design that encompassed four work packages, each containing multiple methods. Methods were qualitatively driven and allowed for the development of novel concepts as well as continued testing of these concepts. Evaluation of the research opportunity began with a review of existing literature on intersecting complexities in WASH programs for challenging contexts. This review helped to develop the novel lens of intersecting complexities through which to examine persistent lags in access to WASH services in challenging contexts. The review uncovered that intersecting complexities have not been adequately understood or accounted for in WASH programs to date, resulting in WASH solutions that have been inappropriate for communities in challenging contexts. Primary concerns were WASH solutions that were unaffordable, not inclusive, and/or unsustainable. Furthermore, the review highlighted multiple dimensions of intersecting complexities present across different types of challenging contexts. The lens of intersecting complexities was presented along with six dimensions of contextual complexity identified through the review: environmental, spatial, economic, political and/or institutional, social and/or cultural, and temporal. These dimensions are interconnected and subjective, and early consideration of complexities across these dimensions may positively impact WASH programs for challenging contexts. The lens of intersecting complexities was further developed to create an approach for practitioners in WASH programs. Methods included interviews, workshops, and focus group discussions with global practitioners to ensure a variety of perspectives. Findings demonstrated that practitioners already perceive the multidimensionality and interconnectedness of complexity affecting WASH programs; however, these findings showed only that practitioners think about complexity unconsciously and retroactively (i.e., after a WASH project is complete). Practitioner perspectives also demonstrated the importance of a further dimension of contextual complexity (informational) as well as the additional complexity of interpersonal dynamics (relationships, power dynamics, and priorities across multiple stakeholder levels in a WASH program). Findings further showed that practitioners understand the implications that intersecting complexities have for various scales and stages of a WASH program. The Intersecting Complexities Approach was developed based on these findings; the approach aims to guide practitioners through conscious and proactive consideration of intersecting complexities, strengthening the design of WASH programs. Following development of the Intersecting Complexities Approaches, it was validated through collaboration with Engineers Without Borders Australia (EWB) and a case study of their Sanitation in Challenging Environments (SCE) Program in Cambodia. The history of the SCE Program was explored, and lessons learnt demonstrated the importance of WASH programs for communities most overlooked in conventional WASH programming (e.g., challenging contexts) to achieve SDG 6 by 2030. This work further underscored the importance of localisation and/or decolonisation of international programs. The application of the Intersecting Complexities Approach was then investigated through workshops and reflexive practice with EWB’s team in Cambodia; these methods helped to validate previous findings and adapt the approach for the team. Findings of these validation and adaptation processes showed the importance of appropriate and flexible approaches for practitioners to ensure appropriate WASH services for communities in challenging contexts. The research presented in this thesis demonstrates the importance of understanding and accounting for intersecting complexities in WASH programs, ensuring that solutions are appropriate for communities most overlooked in challenging contexts. However, ensuring appropriate solutions requires that practitioners have appropriate approaches to do so. The Intersecting Complexities Approach has been shown to assist practitioners unpack intersecting complexities and consider them in decision-making processes. Doing so can help ensure effective WASH programs for all. Additionally, changes are needed in the systems that govern WASH programs, including decolonisation of programs, promotion of inclusive mindsets, and reconsideration of conventional funding models.