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

Abstract

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.