WASH Accessibility for Persons with Disabilities and Older People in Bangladesh: A Way Forward

On 18 November 2023, Bangladesh Society for the Change and Advocacy Nexus (B-SCAN) organised a roundtable discussion in collaboration with icddr,b on the findings of the study titled 'Nationwide Assessment of Water, Sanitation and Hygiene (WASH) situation of persons with disabilities and older people in Bangladesh’ at the Daily Star Centre, Dhaka.
The population-based cross-sectional study, conducted from November 2022 to October 2023, covered all eight divisions and 32 districts of Bangladesh. It involved screening a total of 17,577 individuals from 6,457 urban and rural households, to identify persons with disabilities. The Washington Group's Short Set of Functioning-Enhanced (WG-SS Enhanced) questionnaire was used for the identification of persons with disabilities. People were classified as persons with disabilities if they were mentioned to have “a lot of difficulty” or “cannot do at all” in any one domain of the WG questionnaires or if they reported feeling depression or anxiety ‘daily’ and ‘a lot’. 
The key findings of the study reveal an overall disability prevalence of 8% in Bangladesh, with males at 7% and females 9%. The study also finds a significantly higher prevalence (47%) among older adults (70+ years) compared to those ≤59 years old (5.2%). To unravel the multifaceted challenges in WASH accessibility, a detailed survey enrolled 2,378 individuals with and without disabilities.
The study highlighted that approximately half of the persons with disabilities (48%) faced difficulties in personally collecting water from the sources, while 14% encountered difficulties accessing drinking water at home when needed. A majority (more than 90%) reported physical constraints as the primary barrier, while 16% indicated dependency on caregivers. Most households (77%) had access to basic sanitation facilities, but they lacked inclusive features such as wheelchair-friendly entry paths (97%) and height-adjustable pan/ commode (97%), easily accessible water (74%) As a result, around 25% of persons with disabilities and older people come in contact with urine or faeces while using toilets Additionally, the long-distance (perceived) of the WASH facilities from home, mostly in rural areas or urban slums, creates a further burden for persons with physical disabilities and older adults. Factors such as fear of embarrassment, physical or verbal abuse, fear of stray animals, and insecurity in using WASH facilities at night-time were identified as additional barriers, particularly for people with communication limitations or with mental health conditions (anxiety, depression). 
Moreover, the study findings uncovered significant hurdles faced by females with disabilities, with 12% requiring assistance for changing and disposing of menstrual products, which can elevate the risk of urinary and faecal incontinence among individuals with disabilities. This particular incontinence issue emerged as a pressing concern, especially for those with communication limitations, as evidenced by an average interference score of 6.5%.
icddr,b’s Associate Scientist Mahbub Ul Alam said, “The findings advocate for a more holistic approach to WASH accessibility in the context of Bangladesh, addressing not only physical infrastructure but also the diverse needs and barriers faced by persons with disabilities and older persons to create an inclusive environment.”
This study was part of a larger multi-country study implemented in Kenya, Indonesia, Zambia, Sierra Leone, and Bangladesh with funding and technical support from the London School of Hygiene & Tropical Medicine (LSHTM) and Foreign, Commonwealth & Development Office (FCDO). BSCAN implemented it in Bangladesh in collaboration with icddr,b.