USAID Water, Sanitation and Hygiene (WASH):
Strategic Approach to COVID-19 Response

FOR EXTERNAL USE | CLEARED BY USAID COVID-19 TASK FORCE ON 04/17/2020

Table of Contents:
Overview: Strategic WASH Response to COVID-19…………………………………………………………………………………..3
WASH in the Health System: Communicate Risk and Prevent & Control Infection………………………………….4
WASH in Complex Emergencies: Prevent COVID-19 and Maintain Critical WASH Systems……………………….4
WASH, Recovery, and Resilience: Prevent Backsliding and Second-order Social, Economic andGovernance Impacts of COVID-19…………………………………………………………………………………………………………...6
Conclusion……………………………………………………………………………………………………………………………………………….6
ANNEX: ILLUSTRATIVE WASH ACTIVITIES FOR COVID-19 PREVENTION, RESPONSE, RECOVERY ANDRESILIENCE……………………………………………………………………………………………………………………………………………...7

Document Cleared: 04/17/20
Created by: USAID Water Leadership Council
Responsible Office: RFS/CW

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USAID WASH - Strategic Approach to COVID-19
Response
Across the globe, USAID is supporting countries affected by COVID-19. We are working directlywith governments, multilateral organizations, NGOs, the private sector and other organizations
responding on the ground to combat the virus. This includes working with frontline workers toslow the spread, care for the affected, and equip local communities with the tools needed tofight back against COVID-19. USAID and the State Department have made available nearly$508 million to combat COVID-19.
Among USAID’s priority approaches is the provision of emergency water, sanitation andhygiene (WASH) services and supplies, and long-term support to maintain continuity of WASH
services. WASH is essential for slowing down the spread of COVID-19. Frequent and proper
handwashing with soap is one of the most important measures that can be used to prevent the
spread of the COVID-19 virus. Reliable water and sanitation services in health facilities andhouseholds are critical to ensuring both sufficient quantities of safe drinking-water and the ability
to maintain hygiene (including hand hygiene, laundering, cleaning and disinfection). WASH
services are at risk of being disrupted by the outbreak, the response to it, and downstream
effects. Ensuring services such as drinking water and sanitation are continuously available iscritical to governance, economic growth, and preventing development backsliding. As such,
USAID’s approach looks at both immediate needs and opportunities to bolster the system now
and into the future.

Overview: Strategic WASH Response to COVID-19
In addition to protecting Americans at home and abroad from pandemic illness, USAID is
responding to COVID-19 by bringing together multiple sectors in order to address criticalemergency response, recovery, and long-term resilience that helps prevent the next outbreak.
1. Within the health system, priorities include Infection Prevention and Control (IPC),
including WASH, health systems strengthening, and global health security.
2. In complex emergencies, USAID is focusing on mitigating the spread of COVID-19 andsupporting the public health consequences of the pandemic in target locations, as wellmaintaining critical WASH services.
3. USAID recognizes that COVID-19 may have both short- and long-term impacts on thewell-being, economic growth, and stability of governments, communities andhouseholds. As a result, the Agency is simultaneously focusing on mitigating secondorder impacts of the pandemic, such as by preventing backsliding in WASH systems
through continuity of operations support to utilities and service providers.
USAID’s COVID-19 Task Force, which sits in the Agency Front Office, oversees andcoordinates all Agency activities and communications in response to the COVID-19 pandemic.

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The Water Leadership Council, representing senior leadership from the Bureaus for Resilienceand Food Security (RFS), Global Health (GH), DCHA (the future Bureau for Humanitarian
Assistance (BHA)), and all Regional Bureaus, serves as a link between the Task Force and the
WASH technical level and oversees COVID-19 WASH technical approaches. At the working
level, USAID’s COVID-19 WASH response is coordinated by the Intra-Agency WASH technicalworking group, which includes WASH advisors from the same Bureaus represented on the
Leadership Council. This working group is responsible for supporting Missions in their WASHrelated COVID-19 response activities and for tracking evidence and best practices to ensure
recommendations remain current, and are woven across USAID’s Agency-wide technicalresponses.

WASH in the Health System: Communicate Risk and Prevent & Control Infection
The primary goal of USAID’s health system response to COVID-19 is to reduce the burden of
disease abroad, avoid the collapse of health care in targeted countries, and strengthen global
health security. The Global Health Bureau (GH) is leading on all related activities, including
WASH.
Priorities for WASH within the health system focus largely on:● Communications to ensure households, communities and health care workers
understand the risk of COVID-19 and the importance of handwashing with soap,● Continuity of services, particularly as the increase in patients due to COVID-19 is
projected to increase the burden on Health Care Facilities (HCF), and● Preventing and controlling infections in health facilities (IPC), including among healthcare workers and health facility staff, through the expansion of WASH services,behaviors, and products such as soap.
It is important to note that behavior change activities must use methods that do not bring large
groups together or otherwise increase risk of COVID-19 transmission.
As of April 17, 2020, nearly $100 million in emergency health assistance from USAID’s Global
Health Emergency Reserve Fund has been made available to over 30 countries, including for
support on WASH. Many of USAID’s high priority countries for WASH are recipients of thisfunding, including: Afghanistan, Ethiopia, Kenya, Mozambique, Nigeria, Senegal, Tanzania,
India, Indonesia, Nepal, and Haiti. Additional GHP and emergency funds are anticipated.

WASH in Complex Emergencies: Prevent COVID-19 and Maintain Critical WASH
Systems
Populations that are already in the midst of a complex humanitarian crisis, and countries thatare extremely fragile and could easily tip into a humanitarian crisis with an external shock, haveparticular needs with respect to the COVID-19 pandemic. USAID’s COVID-19 humanitarian
responses target current humanitarian settings where USAID’s Office of Foreign Disaster4

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Assistance (OFDA) or Food For Peace (FFP) -- the future Bureau for Humanitarian Assistance(BHA) -- are already working, and where health and WASH actors are implementing and are at
risk for severe COVID-19 impacts and widespread transmission.
USAID’s priorities for COVID-19 responses in complex emergencies are to:● Mitigate widespread transmission of COVID-19,● Address public health consequences, and● Maintain essential WASH and health services for crisis affected populations.
WASH activities primarily target vulnerable and population-dense settings such as urban areas
or IDP camps, and focus on supporting the health response, such as through the provision ofsoap for handwashing and ensuring continuity of WASH services in humanitarian settings.
In target locations, there are limited alternatives to water and sanitation services, so a loss offunctionality would have severe health impacts on vulnerable populations. As such, Continuity ofOperations Plans activities are especially important. Priority actions might include prepositioning
critical stocks or identifying contractors to deliver services if NGO field staff are unavailable.
Construction of new community water or sanitation infrastructure is not part of the emergency
response to COVID-19, due to the long time-frames required for construction to be completed.
Any WASH activities taking place in crowded settings, such as behavior change campaigns andhygiene product distribution, must balance impacts against the potential for increasing the riskof COVID-19 transmission due to physical contact with beneficiaries. Any distribution of WASH
non-food items should be targeted to high risk populations and be limited to evidence-based
items for protection against COVID-19 (e.g. soap for handwashing, disinfection kits for selfquarantine/self-isolation households).
DCHA Bureau, including both OFDA and FFP, the future Bureau for Humanitarian Assistance(BHA), is leading on emergency WASH activities in response to COVID-19. In addition toprogramming supplemental funding, DCHA is contributing to WASH and COVID-19 in complex
emergencies by allowing current emergency programs to adapt their WASH programming toaddress the challenges of COVID-19 for their context. USAID will continue to expand and adapt
their emergency response as the situation changes.
As of April 17, 2020, USAID has provided $110 million in humanitarian assistance from USAID’s
International Disaster Assistance (IDA) account to countries at high-risk from the pandemic,
prioritizing populations affected by ongoing humanitarian crises, particularly displaced people.
Several countries receiving supplemental IDA funds are also primary recipients of USAID’s
Water Directive funds, including: Afghanistan, DRC, Nigeria and South Sudan.

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WASH, Recovery, and Resilience: Prevent Backsliding and Second-order Social,
Economic and Governance Impacts of COVID-19
It is expected that there will be various first- and second-order impacts of COVID-19 across a
range of sectors, including governance, the economy, education, energy, tourism, and foodsecurity, with both short-term and long-term repercussions not only on the economy andhousehold livelihoods but also on overall stability in fragile states. Ensuring services such as
drinking water and sanitation are continuously available is critical to governance, economic
growth, and preventing development backsliding.
WASH services, supplies and hygiene behaviors are at risk of being disrupted by the outbreak,the responses to it, and the downstream effects of the pandemic. There is a high potential fordownstream impacts on water and sanitation services as provider staff may become unable towork, user payments may slow or stall, supply chains of critical materials may be disrupted andfinance will likely become difficult to access. Sustaining availability of WASH services isessential to protecting against transmission of COVID-19 and preventing secondary economic
disruption. The Bureau for Resilience and Food Security (RFS) is leading on water andsanitation service delivery activities that aim to protect development gains and build resilience
now, and into the future.
In addition, DCHA/FFP (future BHA) is contributing to recovery and resilience efforts by allowing
Food for Peace development food security activities (DFSAs) to adapt their WASH
programming to address the challenges of COVID-19 in their countries and activities.
DCHA/FFP will continue to expand and adapt their WASH response in DFSAs as the situation
changes and as opportunities become available.
USAID’s extensive WASH development programming will also contribute to the response andmitigation of downstream impacts, through investments in sustainable water and sanitation
service delivery. Where appropriate, these activities may be adapted to provide more targeted
support for the response through development interventions.

Conclusion
The COVID-19 pandemic is a rapidly changing situation. The priorities and approaches in thisdocument reflect the best available evidence as of April 2020. USAID continues to monitor
emerging evidence and guidance, including from the World Health Organization and U.S.
Centers for Disease Control and Prevention. USAID will, as needed, further refine
recommended WASH approaches to COVID-19 prevention, control, response, recovery andresilience in context of local and national outbreaks, impacts, and evidence.
For further information please contact waterteam@usaid.gov.

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ANNEX: ILLUSTRATIVE WASH ACTIVITIES FOR COVID-19 PREVENTION, RESPONSE,RECOVERY AND RESILIENCE
Response Category
WASH in the Health
System: Communicate
Risk and Prevent &Control Infection

Illustrative Activities
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Review and update existing infection prevention plans including
clear lines of responsibility and oversight, and train all staff oncleaning and disinfection procedures for surfaces, equipment, andtextiles.
Ensure accessibility and promote use of handwashing facilities withwater and soap at point of entry screening, all waiting areas, and all
patient care areas.
Train medical staff to model proper handwashing behavior as they
prepare to begin each consultation while explaining to patients how
and why everyone should wash hands.
Identify essential IPC-WASH supplies and materials, such as soap
and disinfection materials, and ensure they are made available for
immediate use.
Train and empower cleaning staff as critical members of the healthworkforce to ensure that cleaning procedures are undertaken
regularly.
Support health facilities with longer term approaches for operating
and maintaining drinking water, sanitation, and handwashingfacilities to ensure they can maintain a hygienic environment for
staff and patients, linked to a quality improvement approach (e.g.
the “Clean Clinic Approach”1 or others).
Provide technical assistance to Ministries of Health in drafting,
implementing, financing and enforcing policies and plans for
ensuring WASH in health care facilities.
Ensure continuity of water and sanitation services at health facilities
by working with local utilities and water user associations.
Address supply chain issues for soap availability for vulnerable
populations
Extension of water supplies for handwashing to marginalized orinformal settlements by established and well-functioning water
service providers and utility companies.
Implement community-level social and behavior change (SBC)
campaigns aimed at promoting and supporting correct andconsistent adoption of key hygiene behaviors, especiallyhandwashing with soap.

https://washforhealthcare.mcsprogram.org/

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WASH in Complex
Emergencies: Prevent
COVID-19 and Maintain
Critical WASH Systems●

Support offices within Ministries responsible for healthpromotion/behavior change to identify messages and channels for
implementation of national campaigns to inform about and support
correct and consistent adoption of proper handwashing and otherhygiene key behaviors.

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Activities and messages in-line with approved country/Cluster Risk
Communication and Community Engagement (RCCE) guidance.
Scaling-up of hand washing at household, community, andinstitutional levels.
Provision of hand washing stations and soap at key public
locations.
Soap / hand washing kit distributions to COVID-19 vulnerable
populations.
Distribution of household IPC (disinfection) kits (e.g. bucket, bleach,cleaning cloths) to self-isolated or self quarantined HH wherecountry/national Health /cluster guidance specifically endorses
home IPC kits.
Operation and maintenance of existing water supply and sanitation
systems in targeted, high-risk areas (e.g. IDP camps) with focus on
standards and quality control.
Water supply and sanitation necessary for IPC in supported healthfacilities selected in coordination with Health Cluster / healthpartners in targeted, high-risk areas (e.g. IDP camps).

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WASH, Recovery, andResilience: Prevent
Backsliding and Secondorder Economic andGovernance Impacts of
COVID-19.

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Work with utilities and other service providers to develop business
continuity plans for operations to address decreasing revenue fromuser fees and reduced personnel.
Work with service providers and local and national authorities tomonitor supply chains (for critical inputs, like chlorine for water
treatment, or fuel for continued pumping) and potential impacts onservices.
Pre-position reserves of critical WASH supplies (e.g. chlorine forwater treatment) and strengthen supply chains.
Develop written operation and management guidance and provide
training for operation of infrastructure, water treatment plants,
chlorination dispensers, water points and water storage
infrastructure.
Address service provider financing gaps through disaster-sensitive
procedures for fiscal transfers and/or renegotiation of loan terms
during the crisis period.
Establish or strengthen financing mechanisms/facilities to support
the local private sector/NGOs in delivering safe water.

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Invest in increasing water availability through development of water
schemes and associated technical assistance for operations andmanagement, including water service provision for handwashing.
Preparation of action plans to significantly increase access to safe
water supply outside of the areas served by piped networks throughcontracts with local private sector or community-basedorganizations, as appropriate and based on context.

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