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CLOSE THIS BOOKSpecial Public Works Programmes - SPWP - Community Water Supply - A Community Participation Training Element for SPWP User Beneficiaries (ILO - UNDP, 1987, 100 p.)
SESSION 3: The Relationship of Water, Sanitation and Disease - Water-Washed and Water-Site-Related Disease

Special Public Works Programmes - SPWP - Community Water Supply - A Community Participation Training Element for SPWP User Beneficiaries (ILO - UNDP, 1987, 100 p.)

SESSION 3: The Relationship of Water, Sanitation and Disease - Water-Washed and Water-Site-Related Disease




At the end of this learning/discussion session, the participants should be able to:

1. Identify and discuss the relationship between certain infections and a lack of cleanliness or a lack of sufficient water.

2. Identify and discuss the relationship between certain diseases and a poorly drained water supply site.


one to two hours


chalkboard and chalk, or flipchart and pen


1. If the participants are not comfortable with reading, read the session material to them.

Be sure that you stop to discuss each point in order to make sure that all participants understand. If the participants want to have a discussion during this reading section, let them. Your job will be to see that the discussion remains on the topic.

2. DISCUSSION OPPORTUNITY: During this section, participants should be encouraged to role play. Role playing is a teaching method in which you ask people to pretend that they are in a different situation. These “actors” must act in the manner that they think is appropriate. Role plays may last from one or two minutes to five minutes or more.

Sometimes people feel shy about role playing. It is a good idea, therefore, for you to give a demonstration first. You should then give the “actors” 5 to 10 minutes to prepare their own roles before they perform in front of the group.

In order to set the scene for the role play suggested in Discussion Question 2, you can say something like this:

“Abdullai, will you please act the part of a father of a very sick child? You are worried and angry and can’t understand why your child is sick. You, yourself, have a very painful skin infection. You feel that everything is going wrong. You meet Mary on the road one morning and you tell her all your troubles.

“Mary, will you act the part of a community health worker? You must try to explain why Abdullai’s family is sick. You must convince him.

“Think about what you will want to say. Then, in 5 minutes, I will ask you both to come up to the front and show us your role play. Afterwards, we will all discuss the ideas you both illustrated when you were pretending to be the sick father and the health worker.”

NOTE: If the participants in your group do not feel comfortable doing a role play, you may ask them to discuss the question without acting it out.


Question 1: Encourage answers that lead to an understanding of the transmission of water-related diseases. Is there a connection between walking one-half hour to collect water and not having enough water for careful washing?

Question 2: Encourage participants to role play. Let them demonstrate a situation in which they would teach a villager about water-washed diseases and their transmission.

Question 3: Encourage the participants to discuss the appropriate means to get a water supply site closer to the village. Could they do it themselves? Who might offer help? What can the government do?

Question 4: List ideas on the chalkboard or flipchart. Be sure that participants understand the connection between the insect carriers of disease and the water where they breed. Encourage role playing.

NOTE: If available locally or at regional health centres, you should include information (statistics) on the links between water and disease for your area or country.

4. READING ASSIGNMENT: If this group does study assignments before each learning/discussion session, ask them to read the material in Session 4 before the next group meeting.



Read about water-washed and water-site-related diseases. Your discussion leader will answer any questions you may have.

Use the DISCUSSION OPPORTUNITY to talk with the other group members about water-washed and water-site-related diseases in your community.


Some diseases are caused when people do not use enough water for personal cleanliness. WATER-WASHED diseases are spread when people do not use water to:

1. bathe frequently
2. wash hands before meals and after defecation
3. wash clothes and household utensils
4. wash fruit and vegetables.

Here water-washed diseases mean illness that can be avoided - or washed off -by using clean water.

Do you remember reading about the mother who did not wash her hands after caring for a sick baby? She contaminated food after handling her baby’s faeces (excrement). If the mother had washed her hands, the disease would not have been spread. That was an example of a water-washed disease transmitted through the faecal-oral route.

Another case of water-washed disease could happen when excreta, such as animal manure, is used as fertiliser in gardens. Vegetables from such gardens may carry micro-organisms causing illness. If the vegetables are not carefully washed before they are eaten, disease may be spread. The gardener working in the garden may also have micro-organisms on his hands. He must always wash his hands after working and before eating.

Transmission of Water-Washed Diseases

Some water-washed diseases are infections of the skin and eyes. Trachoma, an eye disease, and scabies, a skin infection, are examples. These infections can be caused by lack of personal cleanliness. They can be reduced by using more water for personal washing. Sores can develop on the skin of people who do not wash their bodies.

Some water-washed diseases are carried by flies, lice, mites or ticks. Louse-borne fever and relapsing fever are examples. If you wash your body often, the fleas, lice, mites and ticks will not stay on your body and cannot cause disease.

In summary, the water-washed diseases are transmitted in two ways:

1. the faecal-oral route because of not washing hands, eating utensils and vegetables; and
2. by a lack of personal hygiene - not washing the face, the eyes and the body.


The main cause of water - washed diseases is a LACK OF WATER.

The main cause of water-borne disease (Session 2) is not lack of water, but DIRTY WATER.


WATER-SITE-RELATED diseases are those which are spread by insects that breed in or near water. Transmission occurs when the insect becomes infected with the disease from biting an infected person or animal, and then bites and infects another person. Examples of diseases spread this way are:

yellow fever
dengue fever
river blindness

Transmission of Water-Site-Related Disease

These diseases can be transmitted at the place where the people come to get their water. For example, if a well site is not properly drained and causes muddy puddles or swampy areas, mosquitos and flies may breed there. These insects can become carriers of disease and may infect many of the people who come to collect water.

Uncovered water standing in the community or home may also be breeding grounds for insects. Water standing in gutters, in coconut shells, tin cans, even in the household water containers can become breeding places for insects that spread disease.


In a certain village there is plenty of water available during the wet season because people catch rain from their roofs into tanks. There are few skin infections at this time.

During the dry season, however, the only source of water is a clean spring that is one-half hour walk away. During this time the women notice that their children have more sores and skin infections. Some are very painful. Even the adults notice more infections. When there are sores on their feet or hands, they are sometimes unable to work.

The villagers also find that there is still a lot of diarrhoeal disease during the dry season. They used to believe that most diarrhoea occurred during the wet season. Now they wonder why there is so much during the dry season too.

1. What do you believe are the causes of the dry season infections and disease in this village?

2. How would you explain the problem to the villagers? What would you say?

3. What could be done to help the people of this village?

4. What would you tell these villagers to do if there was an outbreak of malaria? What could they do to help prevent an outbreak of river blindness or yellow fever?