Inequalities in Safe Water, Improved Sanitation and Hand Hygiene Among Poverty‐Vulnerable Households: Evidence From Sub‐Saharan Africa

Abstract

Access to safe drinking water, improved sanitation and hand hygiene (WASH) is fundamental to human health and sustainable development, yet large segments of the population in sub‐Saharan Africa continue to lack adequate access to these essential services. Moreover, even households already with access face the risk of water shortages due to climate change and related factors. Existing evidence on WASH inequality has largely focused on observed poverty and income‐based disparities, overlooking households that are vulnerable to future deprivations. This study contributes to the literature by examining economic inequalities in WASH uptake among poverty‐vulnerable households in sub‐Saharan Africa using harmonised Demographic and Health Survey data from 33 countries. We adopt a vulnerability‐to‐multidimensional‐poverty framework and employ a three‐stage feasible generalised approach to estimate vulnerability and identify households at risk of poverty. We employ concentration indices and decomposition techniques to quantify and explain inequality in WASH access among these households. Our results show that access to WASH is disproportionately concentrated among less vulnerable households, with inequalities being pronounced in urban areas but varying across sub‐regions. Vulnerability to multidimensional poverty emerges as the dominant driver of WASH inequality, accounting for a substantial share of observed disparities across all indicators. These findings underscore the importance of designing vulnerability‐sensitive and spatially differentiated policies to achieve equitable and sustainable progress toward universal access to WASH services.