水、环境卫生与个人卫生项目中持续存在的失败问题：一项定性研究
The persistence of failure in water, sanitation and hygiene programming: a qualitative study.
作者信息
Barrington Dani J, Sindall Rebecca C, Chinyama Annatoria, Morse Tracy, Sule May N, Beale Joanne, Kativhu Tendai, Krishnan Sneha, Luwe Kondwani, Daudi Malolo Rossanie, Mcharo Onike, Odili Anthony C, Ravndal Kristin T, Rose Jo, Shaylor Esther, Wozei Eleanor, Chikwezga Faida, Evans Barbara E
机构信息
School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
School of Civil Engineering, University of Leeds, Leeds, UK.
出版信息
BMJ Glob Health. 2025 Feb 24;10(2):e016354. doi: 10.1136/bmjgh-2024-016354.
INTRODUCTION
Unsafe water, sanitation and hygiene (WASH) causes millions of deaths and disability-adjusted life-years annually. Despite global progress towards universal WASH, much of WASH programming continues to fail to improve health outcomes or be sustainable in the longer term, consistently falling short of internal performance indicators and sometimes negatively impacting the well-being of local stakeholders. Although sector experts in high-income countries have often provided explanations for such failures, the opinions of those implementing WASH programming at the ground level are rarely published.
METHODS
In 2020, we purposively recruited 108 front-line WASH professionals in Malawi, South Africa, Tanzania and Zimbabwe to participate in 96 in-depth interviews, explaining why they believe WASH failure persists. Through participatory analysis, including framework analysis with additional axial coding and member-checking of our findings, we determined the core reasons for WASH failure as perceived by participants.
RESULTS
Interviewees reported poor engagement and commitment of intended users, unrealistic and idealistic expectations held by funders and implementers, and a general lack of workforce and financial capacity as significant contributors to WASH failure. Our analysis shows that these issues stem from WASH programming being implemented as time and budget-constrained projects. This projectisation has led to reduced accountability of funders and implementers to intended users and a focus on measuring inputs and outputs rather than outcomes and impacts. It has also placed high expectations on intended users to sustain WASH services and behaviour change after projects officially end.
CONCLUSIONS
Our findings imply that WASH programming needs to move away from projectisation towards long-term investments with associated accountability to local governments and longitudinal measurements of WASH access, as well as realistic considerations of the needs, abilities and priorities of intended users. Funders need to reconsider the status quo and how adjusting their systems could support sustainable WASH services.
引言
不安全的水、环境卫生和个人卫生（WASH）每年导致数百万人死亡和伤残调整生命年。尽管全球在普及WASH方面取得了进展，但许多WASH项目在长期内仍未能改善健康状况或实现可持续性，始终未达到内部绩效指标，有时还会对当地利益相关者的福祉产生负面影响。虽然高收入国家的行业专家经常对这些失败做出解释，但很少有关于在基层实施WASH项目的人员的意见发表。
方法
2020年，我们有目的地招募了马拉维、南非、坦桑尼亚和津巴布韦的108名一线WASH专业人员，参与96次深入访谈，解释他们认为WASH失败持续存在的原因。通过参与式分析，包括采用额外轴向编码的框架分析以及对研究结果的成员核对，我们确定了参与者所认为的WASH失败的核心原因。
结果
受访者报告称，目标用户参与度低和承诺度差、资助者和实施者抱有不切实际和理想化的期望，以及普遍缺乏劳动力和资金能力，是导致WASH失败的重要因素。我们的分析表明，这些问题源于将WASH项目作为受时间和预算限制的项目来实施。这种项目化导致资助者和实施者对目标用户的问责制降低，并且侧重于衡量投入和产出而非成果和影响。它还对目标用户在项目正式结束后维持WASH服务和行为改变寄予了很高期望。
结论
我们的研究结果表明，WASH项目需要从项目化转向长期投资，对地方政府承担相关问责，并对WASH服务的可及性进行纵向衡量，同时要切实考虑目标用户的需求、能力和优先事项。资助者需要重新审视现状，以及调整其系统如何能够支持可持续的WASH服务。
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