Effects of Inclusive Water, Sanitation, and Hygiene Interventions on Access Among Vulnerable Households Receiving Cash Transfers in Makueni County, Kenya

Individuals with limited mobility, including people with disabilities (PWD) and older persons (OP), often encounter obstacles in accessing water, sanitation, and hygiene (WASH) services because facilities do not meet their needs. Kenya’s cash transfer program seeks to enhance dignity, promote inclusion, and provide social protection for vulnerable households of OP (70+), PWD, and orphaned and vulnerable children (OVC). A combination of cash transfer with other supportive services, often referred to as "Cash plus," has been shown to improve non-monetary aspects of human development among targeted households. Conducted in Makueni County, Kenya, this quasi-experimental study assessed households’ ability to make WASH facilities accessible (usable) for OP and PWD, investigated how inclusive WASH interventions affected access for OP and PWD, and analyzed how the intervention influenced expenditure priorities of OP, PWD and OVC households enrolled in the cash transfer program. Quantitative data was collected using individual questionnaires, with a total of 223 respondents. The study found significant differences between the intervention and control arms in improved water storage practices (p=0.001); improved household water treatment practices (p=0.001); household toilet modifications (p=0.001); handwashing station modifications (P =0.001); and bathing facility modifications (p = 0.002). Further, the intervention group reported 5-times higher odds of toilet modification (aOR=5.02, 95% CI: 2.67-9.76, p<0.001); 4 times higher odds of handwashing facility modifications (aOR=4.12, 95% CI: 2.19-8.03, p<0.001) 4.6 times higher odds of bathing facility modifications (aOR=4.61, 95% CI: 2.319.57, p<0.001) and 3 times higher odds of ranking WASH among the top 3 expenditure priorities (aOR=3.18, 95% CI: 1.62-6.51, p=0.001). The results indicate that implementing inclusive WASH interventions can significantly improve households' capacity to practice safe WASH behaviors, support the adaptation of existing WASH facilities to improve usability by OP and PWD through basic modifications, and promote greater prioritization of household investment in WASH-related services and resources.

Inclusive WASH, WASH access for older persons, WASH access for people with disabilities

1. Ahmed, A., Hoddinott, J. F., & Roy, S. (2019). Food transfers, cash transfers, behavior change communication and child nutrition: Evidence from Bangladesh (IFPRI Discussion Paper 1868). International Food Policy Research Institute. [Google Scholar] [Crossref]

2. Attah, R., Barca, V., Kardan, A., MacAuslan, I., Merttens, F., & Pellerano, L. (2016). Can social protection affect psychosocial well-being, and why does this matter? Lessons from cash transfers in sub-Saharan Africa. The Journal of Development Studies, 52(8), 1115–1131. [Google Scholar] [Crossref]

3. Ateng’, B. A., & Odhiambo, J. A. (2022). Determinants of expenditure patterns of unconditional cash transfer receipts in Kenya. Journal of Economics and Sustainable Development, 13(4). [Google Scholar] [Crossref]

4. Bick, S., Davies, K., Mwenge, M., et al. (2025). WASH and learn: A scoping review of health, education, and gender equity outcomes of school-based water, sanitation, and hygiene in low-income and middle-income countries. BMJ Global Health, 10(5), e018059. https://gh.bmj.com/content/10/5/e018059 [Google Scholar] [Crossref]

5. Biran, A., Danquah, L., Chunga, J., Schmidt, W. P., Holm, R., Itimu-Phiri, A., Singini, W., Jones, H., Kuper, H., & White, S. (2018). A cluster-randomized trial to evaluate the impact of an inclusive, community-led total sanitation intervention on sanitation access for people with disabilities in Malawi. Faculty Scholarship, 717. [Google Scholar] [Crossref]

6. Casey, V., & Crichton-Smith, H. (2020). System strengthening for inclusive, lasting WASH that transforms people’s lives: Practical experiences from the SusWASH programme. WaterAid. [Google Scholar] [Crossref]

7. Chumo, I., Mberu, B., Kabaria, C., Stewart, H., & Hawkins, K. (2024). An ARISE survey policy brief: Water, sanitation and hygiene (WASH) metrics in informal settlements in Kenya. ARISE Consortium; African Population and Health Research Center. [Google Scholar] [Crossref]

8. Dako-Gyeke, M., Hervie, V. M., Abekah-Carter, K., et al. (2024). Addressing barriers to improved water, sanitation, and hygiene (WASH) access for the promotion of healthy ageing among older persons in Ghana. Environment, Development and Sustainability. [Google Scholar] [Crossref]

9. Dreibelbis, R., Winch, P. J., Leontsini, E., Hulland, K. R. S., Ram, P. K., Unicomb, L., & Luby, S. P. (2013). The integrated behavioural model for water, sanitation, and hygiene: A systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure restricted settings. BMC Public Health, 13, 1015 [Google Scholar] [Crossref]

10. Geremew, A., & Damtew, Y. T. (2020). Household water treatment using adequate methods in sub-Saharan countries: Evidence from 2013–2016 Demographic and Health Surveys. Journal of Water, Sanitation and Hygiene for Development, 10(1), 66–75. [Google Scholar] [Crossref]

11. Handa, S., Peterman, A., Seidenfeld, D., & Tembo, G. (2016). Income transfers and maternal health: Evidence from a national randomized social cash transfer program in Zambia. Health Economics, 25(2), 225–236. [Google Scholar] [Crossref]

12. Hazel, J. (2013). Mainstreaming disability and ageing in water, sanitation, and hygiene programs. Water, Engineering and Development Centre, Loughborough University. [Google Scholar] [Crossref]

13. HelpAge International. (2018). Age-inclusive WASH: Guidance for practitioners. HelpAge International. [Google Scholar] [Crossref]

14. Hongmei Wang Fang Qiu Jiangtao Luo, (2019). Impact of unconditional cash transfers: A replication study of the short-term effects in Kenya. International Initiative for Impact Evaluation. [Google Scholar] [Crossref]

15. Langendorf, C., Roederer, T., de Pee, S., Brown, D., Doyon, S., Mamaty, A. A., Toure, L. W., Manzo, M. L., & Grais, R. F. (2014). Preventing acute malnutrition among young children in crises: A prospective intervention study in Niger. PLoS Medicine, 11(9). [Google Scholar] [Crossref]

16. Naik, A. D., Concato, J., & Gill, T. M. (2004). Bathing disability in community‑living older persons: Common, consequential, and complex. Journal of the American Geriatrics Society, 52(11), 1805–1810. https://doi.org/10.1111/j.1532-5415.2004.52513.x [Google Scholar] [Crossref]

17. Okesanya, O. J., Eshun, G., Ukoaka, B. M., Manirambona, E., Olabode, O. N., Adesola, R. O., … Chowdhury, A. B. M. A. (2024). Water, sanitation, and hygiene (WASH) practices in Africa: Exploring the effects on public health and sustainable development plans. Tropical Medicine and Health, 52, 68. https://doi.org/10.1186/s41182-024-00614-3 [Google Scholar] [Crossref]

18. Prüss-Üstün, A., Bartram, J., Clasen, T., Colford, J. M., Jr., Cumming, O., Curtis, V., Bonjour, S., Dangour, A. D., De France, J., Fewtrell, L., Freeman, M. C., Gordon, B., Hunter, P. R., Johnston, R. B., Mathers, C., Mäusezahl, D., Medlicott, K., Neira, M., Stocks, M., Wolf, J., & Cairncross, S. (2014). Burden of disease from inadequate water, sanitation, and hygiene in low- and middle-income settings: A retrospective analysis of data from 145 countries. Tropical Medicine & International Health, 19(8), 894–905. [Google Scholar] [Crossref]

19. Seidenfeld, D., Handa, S., Tembo, G., Michelo, S., Harland Scott, C., & Prencipe, L. (2014). The impact of an unconditional cash transfer on food security and nutrition: The Zambia Child Grant Programme. In J. Harris, L. Haddad, & S. S. Grutz (Eds.), Turning rapid growth into meaningful growth: Sustaining the commitment to nutrition in Zambia (p. 44). IDS. [Google Scholar] [Crossref]

20. Shiva, R., Saha, S., & Bori, S. (2025). IRC social inclusion in WASH systems strengthening: A framework. IRC. [Google Scholar] [Crossref]

21. UNICEF. (2021). Guidance on disability-inclusive WASH. UNICEF. [Google Scholar] [Crossref]

22. United Nations Children’s Fund . (2023). Disability-inclusive WASH practices: Guidance note. https://www.unicef.org/media/126126/file/Wash-and-disability-guidance-note-final.pdf [Google Scholar] [Crossref]

23. WHO & UNICEF. (2023). Progress on household drinking water, sanitation, and hygiene 2000–2022: Special focus on gender. WHO/UNICEF Joint Monitoring Programme. [Google Scholar] [Crossref]

24. Wilbur, J., Dreibelbis, R., & Mactaggart, I. (2024). Addressing water, sanitation, and hygiene inequalities: A review of evidence, gaps, and recommendations for disability-inclusive WASH by 2030. PLOS Water, 3(6), e0000257. https://doi.org/10.1371/journal.pwat.0000257 [Google Scholar] [Crossref]

25. Wilbur, J., Pheng, P., Has, R., Nguon, S. K., Banks, L. M., Huggett, C., Scherer, N., & Biran, A. (2022). A qualitative cross-sectional study exploring the implementation of disability-inclusive WASH policy commitments in Svay Reing and Kampong Chhnang Provinces, Cambodia. [Google Scholar] [Crossref]

26. World Health Organization. (2011). World report on disability. WHO. [Google Scholar] [Crossref]

• Factors Affecting Complementary Feeding Practices of Children 6-23 Months in Developing Countries. A Review
• Low-Cost Multi-Parameter Vital Sign Monitoring Using Arduino and IoT Alerts
• Socio-Demographic Variables and Practices of Pregnant Women in Akwa Ibom North East Senatorial District
• Breakfast Consumption Patterns and Dietary Diversity among Undergraduate Female College Students in Mumbai, Maharashtra