The Applications of Implementation Science in Water, Sanitation, and Hygiene (WASH) Research and Practice
Open accessAbstract
BACKGROUND: Delivery of high quality, at-scale, and sustained services is a major challenge in the water, sanitation, and hygiene (WASH) sector, made more challenging by a dearth of evidence-based models for adaption across contexts in low- and middle-income countries. OBJECTIVE: We aim to describe the value of implementation science (IS) for the WASH sector and provide recommendations for its application. METHODS: We review concepts from the growing field of IS-defined as the "scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and hence, to improve the quality and effectiveness of health services"-and we translate their relevance to WASH research, learning, and delivery. DISCUSSION: IS provides a suite of methods and theories to systematically develop, evaluate, and scale evidence-based interventions. Though IS thinking has been applied most notably in health services delivery in high-income countries, there have been applications in low-income settings in fields such as HIV/AIDS and nutrition. Expanding the application of IS to environmental health, specifically WASH interventions, would respond to the complexity of sustainable service delivery. WASH researchers may want to consider applying IS guidelines to their work, including adapting pragmatic research models, using established IS frameworks, and cocreating knowledge with local stakeholders. https://doi.org/10.1289/EHP7762.
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The motivation to build and use toilets in the homes of children depends on having successful, well-maintained toilets within the study schools.
“The motivation to build and use toilets in the homes of children depends on having successful, well-maintained toilets within the study schools (Dakhode & Gaidhane 2021;Haque & Freeman 2021).”
From The level of implementation of water, sanitation, and hygiene (WASH) practices among the public basic schools in Ghana (2024) · cites this paper as Haque & Freeman 2021
The Introduction says that underused and deteriorating toilets undermine progress toward safe sanitation, and the Discussion discusses community-level sanitation behavior change. Neither passage addresses whether well-maintained toilets in study schools affect children's households’ motivation to build or use toilets; searches for school toilets and household sanitation found no such passage. (LLM, conf=0.76)
Experimental — accuracy not yet measuredMany students littered their compounds with polythene bags and papers due to the unavailability of waste bins, thereby creating an unhygienic environment.
“It was highlighted during data gathering that many students littered their compounds with polythene bags and papers due to the unavailability of waste bins, thereby creating an unhygienic environment (Haque & Freeman 2021).”
From The level of implementation of water, sanitation, and hygiene (WASH) practices among the public basic schools in Ghana (2024) · cites this paper as Haque & Freeman 2021
The Introduction and “Challenges of WASH Provision” passages discuss WASH services and sanitation behavior, but do not report observations of students littering. Searches for polythene bags, papers, waste bins, students, and littering found no passage supporting the claimed cause or unhygienic environment. Page numbers were not available in our copy. (LLM, conf=0.75)
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The role of women in water management and conflict resolution in Marsabit, Kenya.
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“Broken water taps and pumps are also attributable to contextual factors, such as managing and incentive structures, hydrogeology, and access to energy (Alexander et al. 2015; van den Broek and Brown 2015; Whaley and Cleaver 2017; Yerian et al. 2014).”
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Self-citationReporting of context and implementation in studies of global health interventions: a pilot study
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Adapting Translational Research Methods to Water, Sanitation, and Hygiene
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Self-citationOn Rights-Based Partnerships to Measure Progress in Water and Sanitation
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Regulation of water and sanitation services: getting better service to poor people
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Flagged first, then by citations
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Sorted by citations
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Systems Thinking for Effective Interventions in Global Environmental Health
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Self-citationWater, sanitation and hygiene (WASH): the evolution of a global health and development sector
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Water, Sanitation, and Hygiene in Urban Areas: A Review
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Self-citationTowards a one health approach to WASH to tackle zoonotic disease and promote health and wellbeing
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Reinforcing Feedbacks for Sustainable Implementation of Rural Drinking-Water Treatment Technology
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Mixed Methods Process Evaluation of a Sanitation Behavior Change Intervention in Rural Odisha, India
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Food and water security and safety for an ever-expanding human population
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Self-citationInvited Perspective: Environmental Health Interventions Are Only as Good as Their Adoption
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Challenges and strategies for implementers and evaluators working in conflict settings
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Missing in action: The UN Water Action Agenda needs an overhauled commitment-setting process
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Systems thinking for hygiene in settings with high risk of infectious disease transmission
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Power and interest levels in safely managed sanitation services in Zambia: A stakeholder mapping
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Penerapan Hygiene dan Sanitasi di Kitchen Aston Jember Hotel & Conference Center
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What works in sanitation promotion?
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Hygiene and Sanitation Implementation in Kitchen Aston Jember Hotel & Conference Center
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Calidad del agua subterránea y riesgo sanitario en el Centro Poblado Santiago, Ica, Perú
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The Burden of Disease: The Economics of Drinking Water
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Pragmatic water and health research in a complex emergency: Learnings and way forward
Gallandat, K., Saidi, J. M., Rumedeka, B. B., Machuel, D., Seon, A., Malembaka, E. B., Bugeme, P. M., German, E. L., Bompangue, D. N., Hutchins, C., et al. (2026) · PLOS Water · doi:10.1371/journal.pwat.0000646
- Authors
- Haque, S. S., & Freeman, M. C.
- Affiliations
- Emory University (US)
- Corresponding author
- Freeman, Matthew C.
- Venue
- Environmental Health Perspectives
- Publisher
- American Chemical Society (ACS)
- Published
- 2021-06
- Volume
- 129
- Issue
- 6
- Pages
- 65002-65002
- ISSN
- 0091-6765 (ISSN-L)
- 1552-9924
- PMC
- PMC8207965
- OpenAlex
- W3167667674
- Cited by
- 48
- References
- 102
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 10 · 2023: 8 · 2022: 13
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- Locations
- Environmental Health Perspectives (publishedVersion, public-domain)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Environmental Health Sciences (T32ES012870)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Physical Sciences › Environmental Science › Water Science and Technology › Water Resource Management and Quality
- Keywords
- implementation science, water, sanitation and hygiene, WASH interventions, evidence-based practice, scaling up interventions, sustainable service delivery, low- and middle-income countries, environmental health, stakeholder engagement, contextual adaptation
- MeSH terms
- Implementation Science, Hygiene, Sanitation, Water, Water Supply
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