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Water and sanitation crisis claims lives through diseases and associated illnesses. About 3.6 million people die each year from water-related diseases. This synthesis draws key lessons from evaluations and completion reports of ADB-financed rural water supply and sanitation projects, particularly, insights into ways for improving project contributions to the attainment of health outcomes.

While significant progress has been achieved in the implementation of rural water supply and sanitation (WSS) projects, in terms of coverage and achievements of health outcomes, experiences have led to lessons which can help in ensuring good project designs and sustaining project benefits. These include:

• Ensuring synergies among WSS, wastewater, and solid waste management, together with hygiene and health promotion programs, to attain desired health outcomes and impact;
• Acknowledging, catalyzing, and enabling gender roles in health management;
• Ensuring inclusiveness in the design of a project, with appropriate schemes that would ensure that the poor are not excluded from the health benefits of WSS projects;
• Establishing baseline data and realistic targets for health outcomes;
• Addressing water resource capacity, demand forecast, and supply management, and taking population growth rates into account to prevent or minimize water shortages; and
• Building capacity of beneficiaries, and building partnership with appropriate organizations, to ensure sustained supply of safe water for lasting development effectiveness.

Attaining Health Outcomes through Synergies of Rural Water Supply, Sanitation, and Hygiene by Independent Evaluation at Asian Development Bank