https://orcid.org/0000-0003-0437-3755
Figures
Abstract
There is increasing awareness that exposure to animal faeces contributes to the global burden of diarrheal disease, as well as other zoonotic diseases. This recognition has prompted a re-evaluation of water, sanitation, and hygiene (WASH) interventions to address animal-related transmission pathways. However, current efforts focus primarily on animal faeces within household environments, neglecting other critical human-animal interactions that favour contamination such as animal handling. We advance growing efforts to link One Health and WASH from a risk perspective, reviewing implications for humans, animals, as well as the environment, which has been overlooked. We then discuss how a comprehensive OH-WASH approach can move beyond risks to also enable opportunities to promote health, equity, climate resilience, and other benefits. This framing offers possibilities to reduce disease transmission and enhance biosecurity, while addressing interconnected challenges facing low- and middle-income countries including food insecurity and agricultural livelihoods, animal health and welfare, and ecosystem degradation from excessive nutrients found in excreta.
Citation: Dickin S, Dagerskog L, Dione M, Thomas L, Arcilla J (2025) Towards a one health approach to WASH to tackle zoonotic disease and promote health and wellbeing. PLOS Water 4(5): e0000376. https://doi.org/10.1371/journal.pwat.0000376
Editor: Amy J. Pickering, University of California Berkeley, UNITED STATES OF AMERICA
Published: May 29, 2025
Copyright: © 2025 Dickin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: SD and LD received support from a network grant from Formas, grant number 2021-02686. LFT is supported the German Ministry for Economic Development & Co-ordination through the One Health Research Education & Outreach Centre in Africa (OHRECA). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
1. Introduction
There is growing interest in identifying and acting on the linkages between animals and water, sanitation and hygiene (WASH). The WHO guidelines on sanitation and health recommend sanitation interventions should be coordinated with animal waste management activities [1]. The presence of animals and their excreta in domestic areas is thought to contribute to an overlooked burden of zoonotic disease and food safety risks. Recent evaluations of conventional WASH interventions in low-income countries support this view, as expected improvements in health outcomes were not achieved [2]. At the same time, experts working in animal health have long been aware of zoonotic disease risks, as over 36% of emerging infectious zoonotic diseases (EIZDs) are associated with animals kept for food production, including large and small ruminants, pigs, poultry and camels [3].
The move to better integrate animals into WASH has focused largely on identification of risk pathways, emphasizing exposure to poorly managed animal faeces. Several interventions aim to test possible solutions such as corralling chickens or protected play areas for children to reduce exposure to animal faeces [4,5]. Emerging approaches to integrate One Health and WASH apply this risk framing to improve biosecurity and address antimicrobial resistance (AMR) [4,6]. Such approaches have not looked extensively at other components of One Health models, including gender equity considerations, agricultural livelihoods, animal health, and ecosystem degradation [7,8]. For instance, interventions to address disease transmission such as separating animal and human living environments or limiting types of animals raised must also consider the implications for livelihoods, nutrition and food security as livestock ownership is seen as a form of wealth and status, as well as an alternate source of income in emergencies. Livestock are located in close proximity to households and animals such as cows, goats, and chickens roam freely within the home environment including shared living spaces [9]. Relying solely on risk framings can also be less effective to change behaviour, and in the case of ecological sanitation, messages on health risks were less effective than messages on agricultural benefits [10]. Narrowly health-focused programs can also undermine environmental sustainability or social equity concerns [11]. Furthermore, approaches to manage animal and human excreta to promote ecosystem health, sustaining soil fertility while protecting coastal zones, and biodiversity have yet to be carefully considered.
In this review we contribute to the development of One Health approaches to WASH, and propose a OH-WASH framing that integrates human, animal, and ecosystem health, from both the perspective of addressing risks more comprehensively, as well as harnessing opportunities to promote health, equity and climate resilience. The One Health approach views human and animal health as interdependent and bound to the health of ecosystems in which they exist, with a focus on coordination and collaboration across sectors and disciplines [12]. We describe how a OH-WASH framework offers synergies and co-benefits for actors seeking to work more holistically address zoonotic disease and promote planetary health, largely focusing on low- and middle-income contexts.
2. OH-WASH for human health and wellbeing
From the perspective of human health and wellbeing, livestock ownership is critically important in many regions for livelihoods, food security, as well as socio-cultural practices [13]. Around 50% of households in Africa and South-East Asia have domestic livestock [14]. Livestock production can improve human nutrition outcomes, particularly child nutrition, through increased food production, higher household income, and women’s empowerment [15]. For instance, in Ethiopia poultry ownership reduced the risk of stunting due to increased consumption of eggs [16]. However, livestock production does not mean animal products will be consumed, as eggs may be all sold at markets for needed income [17].
Despite the positive impacts livestock ownership can have on livelihoods, nutritional outcomes, and gender equity, livestock (if not managed well) are a potential source of disease-causing organisms, with transmission routes including exposure to faecal material, blood, saliva and birthing products or through animal source foods. There are also gendered differences in the burden of responsibility and associated benefits related to animals as well as household water, hygiene and caring work [18]. While variable across contexts, women often conduct care-taking for poultry and small ruminants while men do care-taking of larger animals. These differences in animal care-taking and WASH roles then also create a gendered difference in potential exposure pathways to zoonotic diseases, as well as to actual disease burden [19].
While the implementation of WASH services has focused on containment of human waste, there is growing awareness of the importance and potential for stopping zoonotic infections that cause a severe burden of human illness. The quantity of animal faeces from livestock (primarily cattle, chickens and sheep) produced every year is about four times that from humans, and twice as much livestock faeces is estimated to be produced on-site, close to home, compared to the quantity of human faeces managed in on-site sanitation systems [14]. Delahoy et al. [20] identified 65 potential zoonotic pathogens in animal faeces, and identified the five most important pathogens in animal faeces based on disease burden and role of animal hosts: Campylobacter, non-typhoidal Salmonella, Lassa virus, Cryptosporidium, and Toxoplasma gondii. In the case of diarrheal deaths, which are a central focus on WASH interventions, five enteropathogens that can be found in animal faeces (NTS, EPEC, ETEC, Campylobacter spp., and Cryptosporidium spp.) are responsible for around 58% of the annual global diarrheal deaths in children under five years old (Table 1) [21]. These pathogens are also likely contribute to the burden of environmental enteropathy and stunting among children under five [22]. There are other pathways impacting health that have received less attention, for instance Giardia infection is thought to contribute to micronutrient deficiencies separate from EED, while exposure to poultry can lead to acute respiratory infections [23]. In addition, some of these diseases are difficult to treat. An example of which is early childhood cryptosporidiosis that causes acute disease and mortality, and currently has no effective therapeutics [24]. For many of these pathogens, they show capacity to acquire antimicrobial resistance (AMR) traits, the spread of which are mediated through a range of social, cultural and environmental factors [25]. This development of resistance presents direct risks to human and animal health, as well as implications for food production systems [26,27]. AMR is currently estimated to be responsible for 1.14 million deaths a year and by 2050 this is projected to rise for 1.91 million per year [28].
Zoonotic disease transmission pathways operate through contamination of water sources, soils, and crops and food, as well as poor handling of manure and animals, with related faecal-oral pathways [29]. A number of studies highlight the importance of improved faeces management for human health to reduce environmental contamination [30–36]. In rural Burkina Faso, poultry and other livestock faeces were visible in all studied households, in both kitchen areas and household courtyards where children played; while direct soil ingestion by young children was observed in almost half of the households [34]. This is a finding common across rural contexts as animals such as chickens can be difficult to coral and inevitably leads to ‘hotspots of contamination’, compounded by the difficulty in modifying children’s behaviour [37]. A faecal contamination index showed that faecal contamination must stay below certain threshold for significant improvements of health, strengthening the case for integrated interventions that target both human and animal faeces [38].
One particular route of environmental contamination is the use of shared water sources, such as surface water or wells, that may be used for human and animal drinking water, as well as for dipping points for livestock [39–41]. In India, water sources were contaminated with cryptosporidium and giardia cysts from animals [40], while in rural Kenya, ruminant faeces were found to be a more important source of contamination compared to human faeces [34]. In Wakiso district, Uganda, 80% of households had a shared water source between humans and animals, and Extended Spectrum Beta Lactamase-producing Escherichia coli (ESBL-Ec) was found among humans, animals, as well as in the environment [42]. In addition to pathogens in animal faeces, leptospirosis transmitted from animal urine is another major zoonotic disease with an estimated 1 million cases and 60 000 deaths annually [43].
Aside from exposure to animal faeces and urine, behaviours related to assisting animal births, husbandry, slaughtering, and handling of animal products (e.g., eggs and milk) present risks but are rarely addressed in WASH programmes. This presents a challenge for conventional WASH interventions that are often focused only on the household environment, and not in marketplaces, public spaces and work places where these activities often take place. At the same time, the WASH sector has advanced behaviour change frameworks that offer potential to be mainstreamed more widely in these under-addressed domains [44,45].
Interacting social, cultural and economic contexts can create challenges to promote effective and inclusive approaches to addressing animals in WASH programmes. People’s attitudes and behaviours towards animals can mediate risks in important ways. If animal faeces are not viewed as dangerous [48], they may be used as cooking fuel without adequate safe management practices in the case of cow dung, or as therapeutics, such as when animal faeces and urine are applied to wounds [49], or disposed of in the environment in the case of animal waste and dead animals [50]. Other human activities, such as mobility and conflict can shape disease patterns due to relocation or movement of people and animals to denser areas. This may concentrate animals around water sources to increase interactions and contacts, increase the concentration of pathogens in soil or water, and the new areas may be more favourable for disease transmission and expose animals to new infectious agents [51].
3. Implications of OH-WASH for animal health
Animals are closely connected to WASH systems, often carrying water for humans and sharing water sources [52]. Better recognition of these roles and ensuring these animals have access to clean water themselves can improve their health. Similarly, a limitation of conventional WASH is the predominant anthropocentric perspective. This disregards that both animal and human faecal material in the environment is an important risk to animal health, lowering productivity through increased exposure to pathogens causing mortality and morbidity, as well as condemnation of animal source products due to the presence of pathogens of zoonotic importance. Animal suffering, death and disease have negative impacts on nutritional gains, income or social capital on which their owners depend [53]. Preventing disease-induced livestock mortalities can avoid significant negative effect on farmers’ wellbeing, particularly in the physical and psychological domains [54].
Continued contamination by animal faeces without adequate cleaning and disinfection increases pathogen load in the environment, whilst also causing increased transmission opportunities through the production of conducive environments for pathogen entry. These pathogens impact animal welfare and productivity and increase the potential for zoonotic disease transmission. Poor cleaning and disinfection have been associated with higher risks of Campylobacter spp. infection in poultry flock infections [55,56]. Farm hygiene is an important risk factor for lameness [57,58], which in turn is an important risk factor for Mastitis [59] and transition period diseases such as milk fever and retained placenta [60]. Cleanliness of animals impacts their ability to be comfortable and thermoregulate, and bringing dirty animals onto a slaughter line poses a risk for cross-contamination leading to food-safety impacts [61,62]. Animal faecal material in the environment may not only originate from the livestock being raised. Outdoor, free-range or low-biosecurity husbandry practices provide opportunities for the contamination of a farm environment by the faeces or urine of peri-domestic wildlife or other domestic animals.
Improved WASH offers several opportunities to improve animal health as humans are the definitive hosts of important zoonotic helminths and protozoa such as Taenia solium, Taenia saginata, Trichinella spiralis, Anisakis and intestinal and liver-flukes that excrete infective eggs or larvae into the environment and are ingested by the relevant intermediate hosts including domestic and wild mammals, fish, crustaceans or molluscs [63]. The transmission of these parasites is enhanced in areas where toilet infrastructure is lacking and animals are able to access human faecal material directly, but contamination of water-sources and poor handling of wastewater even in well-resourced communities, is an important aspect of transmission [64]. Boone et al. [65] emphasizes the role of water as an important factor in the transmission of bovine cysticercosis to a herd, and Taenia spp. eggs have been identified in raw sewerage and sludge, surface and ground water [66]. Unsafe water and lack of sanitation and handwashing facilities, thus, have direct implications for animal health, which in turn creates a negative feedback loop for human health, livelihood, and nutritional outcomes.
WASH interventions in animal production settings also offer vital entry points combating AMR as they can reduce the emergence and spread of resistant bacteria to consumers, farmworkers, and the surrounding farm environment [67]. This is because whether from human or animal faecal material, the transfer of bacterial pathogens from host to host or host to the environment provides an opportunity for the transfer of antibiotic resistance genes that are easily disseminated through mobile genetic elements [68]. In this context, WASH interventions such as improving access to clean water and sanitation facilities or supporting farmers to implement basic biosecurity measures, e.g., appropriate animal housing provision and adequate cleaning procedures [69], can be supportive in tackling antimicrobial resistance. Both intervention types can be implemented at a system level, from which point they could influence risk factors embedded in social structures and address socioeconomic vulnerabilities [4].
4. Implications of OH-WASH for environmental health
The environment forms a critical dimension of the One Health-WASH nexus, mediating zoonotic disease risks through interconnected climate, water, soil and nutrient cycles [12]. One study estimates that nature treats approximately 41.7 million tons of human waste annually, a form of “sanitation ecosystem services” [70]. Poorly managed waste streams, including untreated wastewater, pit latrines, septic tanks, exposed manure piles, and over-fertilized fields contribute large inputs of nutrients and pathogens into the environment [71]. This results in groundwater contamination and severe pressure on rivers and streams, impacting biodiversity and other life-supporting functions [72]. While the WASH sector focuses more on pathogen pollution, other types of contaminants such as nitrates pose drinking water risks for vulnerable groups, such as children [73,74]. Further, environmental settings such as waterways play an important role in the evolution, transmission and dispersal of AMR components [75]. These routes have often been overlooked, particularly in urban informal settlements [4,76].
In coastal zones, wastewater and animal excreta leads to direct exposure to bathing humans and potential harmful effects on marine organisms [77]. In addition to impacts on marine life, this can lead to the contamination of seafood—an example of which is norovirus accumulating in bi-valve molluscs and have become a common culprit of acute gastroenteritis if consumed raw or lightly cooked [78]. Even if wastewater is treated, large quantities of nutrients often make their way into coastal zones, where nitrogen (N) inputs from wastewater sources have been estimated to 6.2 Tg annually, which corresponds roughly to 45% of the amount of N from agricultural sources [79]. This affects coral reefs and seagrass beds globally, with two important coastal habitats particularly vulnerable to nutrient pollution [79], including up to 95% of coral reefs in hotspots such as Fiji [80]. These challenges are connected as ecological changes from nutrient enrichment led to increased disease exposure for 93% of 41 different pathogens studied, likely due to increased resources for pathogens and intermediate hosts or vectors [81].
Terrestrial ecosystems face similar contamination challenges, with implications for household environments and farms. Zoonoses transmitted through environmental contamination do not require direct contact with animals, so exposure may be more frequent or undetected and harder to address [82]. Soil moisture is a mediator of presence of helminth eggs in the household soil, highlighting the importance of considering environmental conditions in interventions [83]. For instance, oocysts thrive in moist environments, and rainfall has been linked to toxoplasmosis infections [84]. As water sources on household premises are increasingly being promoted as part of SDG 6.1, good drainage is an important consideration as keeping soils dry can help reduce vector-breeding and may reduce helminth eggs in the household soil [83]. Promoting soil health more broadly is important as it can limit opportunities for pathogens [85].
In light of these risks, new partnerships between sanitation and ecosystem conservation actors are being explored to mobilize political will to increase investments into sanitation programs to promote the health of ecosystems [86,87]. Better management of both human and animal waste streams can improve soil quality and water quality, and allow aquatic ecosystems to function as a carbon sink. There may be some synergic benefits for biodiversity, as nature-based solutions such as constructed wetlands can provide ecosystem services, although they are sub-optimal habitats for wildlife compared to natural wetlands [88]. Improved environmental monitoring could additionally be integrated in the monitoring of water quality across OH-WASH domains, moving beyond diarrheal disease to a wider suite of indicators [74].
Climate change, including changing temperature and rainfall conditions, will directly and indirectly affect many of these risks. Rising temperatures are expected to increase the risk of many zoonotic diseases, such as the incidence for salmonellosis, campylobacteriosis, and Escherichia coli enteritis [89], while changing rainfall and temperature conditions have also been linked to cryptosporidiosis [90]. Furthermore, these changes are closely linked to human and animal behaviour as increased water scarcity can lead to changes in hygiene behaviours and animal-human interactions, such as increased use of shared water points.
5. Implementing a synergic approach to WASH and One Health to optimize health, equity and climate resilience
A One Health perspective can strengthen outcomes of WASH interventions in many contexts globally where livestock and humans co-habit and small-scale agriculture is common, but will require additional measures that are yet to be mainstreamed. For instance, conventional WASH interventions largely focus on primary barriers, such as toilets and handwashing after visiting a toilet, before food preparation and before eating. In addition to these standard occasions, a OH-WASH perspective would promote handwashing after contact with animals and their excreta to further reduce health risks, drawing on behaviour change advances in the hygiene sector. Beyond this example, conventional WASH interventions generally lack the cross-sectoral strategies needed to effectively address zoonotic disease related to livestock husbandry and animal excreta, perpetuating risks to human health in many contexts (Fig 1). Thus, implementation of a OH approach to WASH will require collaboration among actors that have often worked separately, including WASH, veterinary public health, and agricultural policymakers and practitioners, as well as applying co-design approaches to integrate local knowledge and strategies in impacted communities [91,92]. Moving beyond conventional WASH, a range of OH-WASH measures are shown in Table 2, such as corralling animals to restrict movement, child protection measures such as safe play spaces, and improved practices for safe management and safe disposal of animal excreta. In the case of animal excreta, poor knowledge of techniques (e.g., covering animal housing and manure during storage) and lack of equipment (e.g., shovels, transport) [93,94] are often barriers and not included as part of WASH programmes. In order to test and evaluate novel OH-WASH measures, approaches and toolkits that can account for complexity are needed, expanding beyond the conventional methods used in the WASH sector [95]. Relevant approaches include human-centered design (HCD) methods that apply iterative cycles to evaluate desirability, feasibility, and viability can take into account ongoing feedback [95], while social innovation approaches can promote bottom-up ideas and draw on local strengths [96].
Implementing a OH-WASH approach should go beyond targeting particular pathogens, and instead focus on interruption of multiple pathways of transmission. While there are opportunities for programme ‘add-ons’, there are also opportunities to take more transformational approaches, such as preventing zoonotic pathogens and environmental contaminations of excess nutrients from entering the environment in the first place. One integrated implementation example is a comprehensive rural sanitation framework, called “Clean and Green”, that has been developed in Burkina Faso to enable the management of health risks, as well as optimizing use of resources related to key wastes and residues in the rural context, including human and animal excreta, wastewater, organic and solid waste [97,98]. The Clean and Green framework builds on the strength of the community led total sanitation (CLTS) approach in engaging communities, combined with a systems view of ecological sanitation, and suggests different tools for diagnostics, capacity building and monitoring to enable progress in reducing health risks and improved resource management. Another example that is at its pilot stage is animal sensitive CLTS, including improved management of animal excreta as part of an extended CLTS programme, as well as practicing safe composting, reducing runoff from rainwater, and improving the management of sick animals [99].
While this paper focuses on LMIC contexts, it is important to note that there are opportunities for wider collaboration to promote OH-WASH in high-income contexts. Recent prioritization of One Health priorities in the United States highlighted zoonotic influenza viruses and salmonellosis as priority concerns to address through a One Health approach [100]. Animals infected with avian influenza viruses (AIVs) can contaminate water bodies through faecal pathways, creating a source of infection or reinfection for wild and domestic bird populations [101]. Combined with hot spots of water and sanitation insecurity in marginalised communities in high-income countries [102], there are clear entry points for integrated action to reduce zoonotic disease risks.
5.1. Addressing social inequities through OH-WASH
In line with the One Health ethos, there is a need to emphasize social, cultural, and economic contexts and existing forms of knowledge to ensure OH-WASH approaches are inclusive and do not produce further inequities associated with the WASH or OH sector [18,103]. This offers the potential to move beyond risks to enable opportunities to promote health and wellbeing and livelihoods, and other benefits (Fig 2). This requires considerations of the needs of different groups in low- and middle-income country contexts, including mobile pastoralist populations, poor and resource-limited communities, and existing gender dynamics and power relations within interventions [17]. Some of these goals may be in conflict (e.g., the risks that chickens present to child health compared with the nutrition gains), and thus social innovation, co-creation, and other participatory processes can play a role in identifying and prioritizing contextually relevant challenges [104,105]. Interventions should work within existing cultural contexts with adapted solutions as much as possible, such as through efforts to reduce risks and conserve resources from being lost in already utilized animal excreta. For example, zaï farming practiced in Burkina Faso is a traditional form of conservation agriculture, with the potential for improved results through use of more nutrient rich amendments [106]. While many WASH interventions focus on the household, a OH-WASH lens is an important entry point to consider how risks are managed in other spaces to avoid a larger burden on vulnerable communities. This includes implementation of WASH at wet markets, slaughterhouses, and other interaction points with animals, which often lack adequate WASH and draining systems and where there is limited formal monitoring of progress. Prioritizing basic services in such locations could make key improvements to wellbeing in addressing zoonotic disease.
Gender equity is a particularly pertinent issue to consider within OH-WASH interventions as women already experience a heavier burden of WASH-related work and may experience an increased-time burden related to promoted animal faeces management and hygiene activities [7]. In parallel, women may receive less economic benefits from livestock if recognition and redistribution of care work and economic empowerment is not also included. In some cases, existing attitudes and practices present risks but are difficult to change [107,108]. To address these challenges, gender transformative approaches are receiving increased attention within One Health interventions [7], as well as in a WASH context [109], and these lessons provide a basis for gender transformative OH-WASH approaches that empower women and socially marginalized groups.
5.2. Improving ecosystem health and climate resilience through OH-WASH
Recovery and safe reuse of nutrients and organic matter present in human and animal excreta offers potential to promote food security in the context of climate change, while reducing the risk of direct environmental contamination of waterbodies. Attaining such co-benefits of better waste management are yet to be fully utilized as only 25–30% of nutrients in livestock excreta worldwide end up as manure on arable land [110]. However, global estimates have found 1–2 times as much nitrogen (N) and phosphorous (P) in livestock excreta compared to what is applied with chemical fertilizer [111].
Recovered water, nutrients, and organic matter from sanitation systems can also contribute to more robust ecosystem services such as supporting, regulating and provisioning ecosystem services. For example, organic matter reduces erosion risk by improving soil structure and water retention capacity [112]. Enhancing these services requires co-location of resources and suitable ecosystems, sanitation and technology choice, and funding possibilities for ecosystem enhancing resource recovery [112]. Reuse of of water for livestock watering has also been explored to promote circularity in Mekelle, Ethiopia [113]. In addition, resource recovery can also provide a renewable energy source from biogas, potentially reducing the use of firewood [114].
Achieving these benefits requires consideration of risks as heavy rainfall or flood events can increase risks of disease outbreaks and contamination of local environments from manure [115]. Climate services have been successfully provided to farmers in Mali and Niger through mobile phones or radio, to support manure application timing and other farming decisions, and have contributed to improving farmer incomes [116].
5.3. Policy gaps and enabling environments to support OH-WASH
A poor enabling environment can create barriers to synergic OH approaches to WASH, including possible political, ethical and legal factors that impede progress. WASH policies have had limited inclusion of containment and safe use of animal faecal wastes [14]. In a review of manure policies in low and middle income countries Teenstra et al. [117] found 30 countries with a manure policy, but the Ministries of Public Health had only been directly involved in half of them. The main manure policy drivers were energy production together with environmental and public health concerns, while fertilizer value and food security aspects were less prominent. Legislation was, in some cases, contradictive, especially when multiple ministries had been involved in the development and did not always fit common farm practices. Some countries are developing innovative policies to address these gaps. For instance, the new Kenyan protocol for rural sanitation and hygiene shows how animal-related risks can be included in national WASH programming [118]. To reach the second sanitation level of “safe and sustainable sanitation”, several animal related indicators must be achieved such as handwashing after contact with animals, animal products, animal waste and before/after milking; keep household drinking water away from animals; no animal wastes visible in compound; safe management of animal waste; safe separation of animals and children less than five. Korea developed the Livestock Manure Control Act, which makes it compulsory for livestock farmers to have adequate sludge processing facilities on their farms, reducing contamination of water supplies [119]. In situations where policies and legislations are inadequate to guide practice, the sanitation safety planning (SSP) framework developed by WHO could be adapted to a wider OH-WASH perspective to identify hazards and relevant safety measures also when handling animal excreta [120]. However, it has not been applied to this context yet. In parallel more research is needed on the trade-offs of different measures, as a systematic review highlighted the dearth of research on the health effectiveness of different biosecurity measures, especially in low- and middle-income countries [121].
6. Conclusions
In many low- and middle-income contexts where humans and animals interact closely, efforts to ensure a radically cleaner environment are needed to achieve reductions of zoonotic diseases. This constitutes a challenge as it is outside the scope of conventional WASH programmes that target human faeces, and has broader implications for livelihoods, animal health and ecosystems. We advance One Health approaches to WASH, moving beyond viewing animals as solely an additional transmission pathway, to account for broader benefits including those related to health of humans, animals and ecosystems as well as equity and climate resilience. Currently, there is limited evidence of integrated WASH measures or policies that engage strongly with all three dimensions of a One Health approach, whether in intervention design or in monitoring and evaluation indicators. In light of the associated complexity, locally-informed and context-specific OH-WASH solutions are needed, that carefully evaluate barriers, enablers and co-benefits of interventions at different scales [133]. This is not only a technical exercise but requires collaboration and understanding across sectors, discussions of conflicts that arise at the intersection of different disciplines, and ensuring that all perspectives are heard [134]. Greater uptake of OH-WASH perspectives offers a critical entry point to tackle ongoing cycles of WASH-related infections to achieve a range of cross-cutting benefits for planetary health.
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