Institute for History, Leiden University, Leiden, The Netherlands.
Freelance, Nairobi, Kenya.
BMJ Glob Health. 2024 Oct 4;9(10):e015367. doi: 10.1136/bmjgh-2024-015367.
Despite some progress, universal access to safe water, sanitation and hygiene (WASH) by 2030-a remit of Sustainable Development Goal 6-remains a distant prospect in many countries. Policy-makers and implementers of the WASH sector are challenged to track a new path. This research aimed to identify core orienting themes of the sector, as legacies of past processes, which can provide insights for its future. We reviewed global policy, science and programmatic documents and carried out 19 expert interviews to track the evolution of the global WASH sector over seven decades. We situated this evolution in relation to wider trends in global health and development over the same time period.With transnational flows of concern, expertise and resources from high-income to lower-income countries, the WASH sector evolved over decades of international institutionalisation of health and development with (1) a focus on technologies (technicalisation), (2) a search for generalised solutions (universalisation), (3) attempts to make recipients responsible for environmental health (responsibilisation) and (4) the shaping of programmes around quantifiable outcomes (metricisation). The emergent commitment of the WASH sector to these core themes reflects a pragmatic response in health and development to depoliticise poverty and social inequalities in order to enable action. This leads to questions about what potential solutions have been obscured, a recognition which might be understood as 'uncomfortable knowledge'-the knowns that have had to be unknown, which resonate with concerns about deep inequalities, shrinking budgets and the gap between what could and has been achieved.
尽管取得了一些进展，但到 2030 年，实现安全饮用水、环境卫生和个人卫生（WASH）的普及，这是可持续发展目标 6 的任务，在许多国家仍然是一个遥远的目标。WASH 部门的政策制定者和执行者面临着开辟新道路的挑战。本研究旨在确定该部门的核心定位主题，作为过去进程的遗留问题，为其未来提供启示。我们审查了全球政策、科学和方案文件，并进行了 19 次专家访谈，以跟踪全球 WASH 部门在过去 70 年中的演变。我们将这一演变与同期全球卫生和发展的更广泛趋势联系起来。随着对高收入和低收入国家的关切、专业知识和资源的跨国流动，WASH 部门在卫生和发展的几十年国际制度化过程中不断发展，（1）关注技术（技术化），（2）寻求普遍适用的解决方案（普遍化），（3）试图使接受者对环境卫生负责（责任化），（4）围绕可量化成果制定方案（计量化）。WASH 部门对这些核心主题的新承诺反映了卫生和发展领域为使贫困和社会不平等问题非政治化以推动行动而采取的务实回应。这引发了一些问题，即哪些潜在的解决方案被掩盖了，这种认识可以被理解为“令人不适的知识”——那些必须被忽视的已知知识，这与对深刻不平等、预算缩减以及可以实现和已经实现的目标之间差距的担忧产生了共鸣。
