Intra-Household WASH Inequities and Factors Associated with Individual-Level Access in Vulnerable Households under the Cash Transfer Program, Kenya

Abstract

Vulnerable groups, including those living in extreme poverty, older persons (OP), people with disabilities (PWD), orphaned children (OVC), and the chronically ill, encounter considerable and frequently neglected obstacles to obtaining safe, reliable and sufficient Water, Sanitation, and Hygiene (WASH) services. The Kenyan government’s Cash Transfer Program, which targets vulnerable households of OP (70+), PWD, and OVC, aims to alleviate poverty and social exclusion. This study assessed WASH access among vulnerable households participating in a cash transfer program and identified factors associated with individual-level WASH access among OP and PWD. The study, conducted in Makueni County, Kenya, utilized both qualitative and quantitative approaches, administering individual questionnaires to 223 participants. Data analysis involved descriptive and inferential statistical methods. Findings revealed low levels of access to basic WASH services among OP, PWD, and OVC households: 43.0% for basic water, 11.3% for basic sanitation, and 19.3% for basic hygiene. Many older persons faced challenges in accessing water, sanitation, and bathing facilities independently, particularly among those aged 71–80, among whom 38% were unable to collect water and over 80% required assistance with sanitation and bathing. Age was significantly associated with all measured WASH accessibility outcomes, whereas other factors, such as income, distance, and facility proximity, influenced specific aspects of WASH access. These results highlight the limited access to basic WASH services among vulnerable households enrolled in the cash transfer program. The inability to independently use WASH facilities underscores the disparity between available infrastructure and its practical usability for household members, particularly those with functional limitations such as OP and PWD. The study advocates for intra-household WASH monitoring using disaggregated data and the development of inclusive WASH facility designs and targeted subsidies for WASH supplies to ensure no vulnerable individuals are left behind.