Indicator 6.2.1 Proportion of population using (a) safely managed sanitation services and (b) a hand-washing facility with soap and water

Indicator 6.2.1: Proportion of population using (a) safely managed sanitation services and (b) a hand-washing facility with soap and water

Target 6.2: By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations

World Health Organization (WHO)

United Nations Children's Fund (UNICEF)

WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP)

Definition:

The proportion of the population with basic hygiene services is defined as the proportion of population with a handwashing facility with soap and water available at home. Handwashing facilities may be located within the dwelling, yard or plot. They may be fixed or mobile and include a sink with tap water, buckets with taps, tippy-taps, and jugs or basins designated for handwashing. Soap includes bar soap, liquid soap, powder detergent, and soapy water but does not include ash, soil, sand or other handwashing agents.

Concepts:

Household handwashing facilities may be located in the dwelling, yard or plot. A handwashing facility is a device to contain, transport or regulate the flow of water to facilitate handwashing. Handwashing facilities may be fixed or mobile and include a sink with tap water, buckets with taps, tippy-taps, and jugs or basins designated for handwashing. Soap includes bar soap, liquid soap, powder detergent, and soapy water but does not include ash, soil, sand or other handwashing agents. In some cultures, ash, soil, sand or other materials are used as handwashing agents, but these are less effective than soap and are therefore counted as limited handwashing facilities.

In 2008, the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) supported a review of indicators of handwashing practice, and determined that the most practical approach leading to reliable measurement of handwashing in national household surveys was observation of the place where household members wash their hands and noting the presence of water and soap (or local alternative) at that location. This provides a measure of whether households have the necessary tools for handwashing and is a proxy for their behaviour. Observation by survey enumerators represents a more reliable, valid and efficient indicator for measuring handwashing behaviour than asking individuals to report their own behaviour.

Percent (%) – Proportion of population

Data sources included in the WHO/UNICEF Joint Monitoring Programme (JMP) database are:

• Censuses, which in principle collect basic data from all people living within a country and led by national statistical offices.
• Household surveys, which collect data from a subset of households. These may target national, rural, or urban populations, or more limited project or sub-national areas. An appropriate sample design is necessary for survey results to be representative, and surveys are often led by or reviewed and approved by national statistical organizations.
• Other datasets may be available such as compilations by international or regional initiatives (e.g. Eurostat), studies conducted by research institutes, or technical advice received during country consultations.

Access to water, sanitation and hygiene are considered core socio-economic and health indicators, and key determinants of child survival, maternal, and children’s health, family wellbeing, and economic productivity. Drinking water, sanitation and hygiene facilities are also used in constructing wealth quintiles used by many integrated household surveys to analyse inequalities between rich and poor. Access to drinking water, sanitation and hygiene are therefore core indicators for many household surveys and censuses.

The JMP uses data on the observation of handwashing facilities with water and soap, typically available in Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS), as well as other household surveys. Any available surveys recording observation of handwashing facilities are included in the JMP database and JMP regression rules are applied to estimate the proportion of the population with a handwashing facility, as well as the proportion with a handwashing facility with water and soap.

Household surveys increasingly include a section on hygiene practices where the surveyor visits the handwashing facility and observes if water and soap are present. Observation of handwashing materials by surveyors represents a more reliable proxy for handwashing behaviour than asking individuals whether they wash their hands. The small number of cases where households refuse to give enumerators permission to observe their facilities are excluded from JMP estimates.

Direct observation of handwashing facilities has been included as a standard module in MICS and DHS since 2009. Following the standardization of hygiene questions in international surveys, data on handwashing facilities are available for a growing number of low- and middle-income countries. This type of information is not available from most high-income countries, where access to basic handwashing facilities is assumed to be nearly universal.

Some datasets reviewed by the JMP are not representative of national, rural or urban populations, or may be representative of only a subset of these populations. The JMP enters datasets into the global database when they represent at least 20% of the national, urban or rural populations. However, datasets representing less than 80% of the relevant population, or which are considered unreliable or inconsistent with other datasets covering similar populations, are not used in the production of estimates (see section 2.6, Data Acceptance in JMP Methodology: 2017 update and SDG baselines).

The population data used by the JMP, including the proportion of the population living in urban and rural areas, are those routinely updated by the UN Population Division (World Population Prospects: https://population.un.org/wpp/; World Urbanization Projects: https://population.un.org/wup).

National statistics offices; ministries of water, health, and environment; regulators of drinking water service providers.

The presence of a handwashing facility with soap and water available does not guarantee that household members consistently wash hands at key times. But direct observation of handwashing is challenging, and people tend to behave differently when being observed. The presence of a handwashing facility with soap and water available has been shown to be a reasonable proxy for handwashing. Enumerators ask households to show them where members of the household most often wash their hands and record the type of facility and whether soap and water are present at the time of the survey.

Since 2016 household surveys have refined the questions asked about handwashing facilities to include separate response categories for different types of handwashing facilities, including both fixed devices like sinks and taps, and mobile devices like jugs and portable basins. These surveys have shown that mobile devices are widely used in low-income countries. Older surveys that don’t include responses for mobile devices may therefore underestimate the population with access to handwashing facilities.

Households surveys in high-income countries rarely include questions about handwashing facilities, and as such, have very low data coverage. Some countries have data on the proportion of households with piped water supplies, hot water, showers or bathrooms but further work is required to determine how many of these also have basic hygiene services.

The production of estimates follows a consistent series of steps, which are explained in this and following sections:

1. Identification of appropriate national datasets

2. Extraction of data from national datasets into harmonized tables of data inputs

3. Use of the data inputs to model country estimates

4. Consultation with countries to review the estimates

5. Aggregation of country estimates to create regional and global estimates

Household surveys and censuses provide data on the presence of handwashing facilities and soap and water in the home. The WHO/UNICEF Joint Monitoring Programme (JMP) uses data from household surveys in which the enumerator observes the handwashing facility and confirms the presence or absence of soap and water at the facility. Datasets that include availability of soap in the household (i.e. not at the handwashing facility), or self-reported availability of handwashing facilities, soap and water may be included in the JMP database and country files, but in most cases are not used for making estimates.

In some parts of the world, households sometimes do not give permission for survey enumerators to enter the premises and observe handwashing facilities. These households are excluded from calculations of the proportion of households having handwashing facilities.

The JMP uses original microdata to produce its own tabulations and estimates by using populations weights (or household weights multiplied by de jure household size), where possible. However, in many cases microdata are not readily accessible so relevant data are transcribed from reports available in various formats (PDFs, Word files, Excel spreadsheets, etc.) if data are tabulated for the proportion of the population, or household/dwelling. National data from each country, area, or territory are recorded in the JMP country files, with water, sanitation, and hygiene data recorded on separate sheets. Country files can be downloaded from the JMP website: https://washdata.org/data/downloads.

The JMP estimates the proportion of population with a basic handwashing facility with soap and water on premises by fitting a regression model to all available and validated data points within the reference period, starting from year 2000.

For more details on JMP rules and methods on how data on the type of sanitation facility used and the disposal and treatment of excreta are combined to compute the safely managed sanitation services indicator, please refer to recent JMP progress reports and “JMP Methodology: 2017 update and SDG baselines”: https://washdata.org/reports/jmp-2017-methodology

2024-09-27

World Health Organization (WHO)

United Nations Children's Fund (UNICEF)

All targets under Goal 6, as well as targets 1.2, 1.4, 2.2, 3.2, 3.8, 3.9, 4a, 5.4 and 11.1

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