Unfinished Business: Water, Sanitation and Hygiene in Remote Indigenous Communities in Australia's Northern Territory

Publication Type:
Conference Proceeding
2017, pp. 62 - 63
Issue Date:
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Improving water, sanitation and hygiene (WASH) outcomes for the ~60,000 Indigenous people living in remote communities in Australia's Northern Territory (NT) remains an important but unresolved policy challenge. Despite major national reforms aimed at bolstering Australia's water security over the last decade, the WASH situation in remote Indigenous communities (RICs) has attracted little attention. This study sheds new light on this issue by assessing the status of WASH indicators (access, behaviours, health outcomes) and identifying obstacles that constrain progress. Up-to-date information on access to WASH services in RICs in NT is scant. We piece together historical data to deduce that there is now almost universal access to improved water sources and sanitation facilities. At least 90% of dwellings currently have a piped water supply and a private sanitation facility. In the 72 largest communities, the quantity of water used by households is far greater than the Australian average, and regular testing reveals the water supplied is of good microbiological quality. The main infrastructure shortfalls - in terms of access, reliability and safety - can be found in the more than 400 small homeland communities, most of which have a population of less than 50. Notwithstanding nearly universal access to services, the burden of WASH-related diseases remains substantial. Indigenous children in remote communities are twice as likely to be hospitalised for intestinal infection as non-Indigenous children. Environmental enteropathy and prevalence of intestinal parasitic infestation (e.g. Strongyloides) provide further markers of excreta-related disease transmission. Trachoma remains endemic in many RICs despite repeated mass drug administrations. Skin infections are also prevalent, and these are thought to underlie disproportionately high rates of acute glomerulonephritis and acute rheumatic fever, both of which lead to chronic and life-threatening kidney and heart diseases. The WASH landscape in RICs therefore presents a paradox: widespread access to WASH infrastructure but a continued high burden of WASHrelated diseases. The underlying reasons for the situation are complex and inseparable from the entrenched socio-economic disadvantage that characterise many households in RICs. However, evidence points to several proximate causes that contribute to the high burden of WASH-related diseases: (i) problematic hygiene practices; (ii) non-functional health hardware within the home (taps, toilets); and (iii) high household occupancy rates. We conclude that past and current service delivery investments have helped to reduce WASH access disparities between Indigenous and non-Indigenous Australians, but they have failed to close the WASH-related disease gap. If future WASH investments in RICs are to yield optimal health dividends, the broader ecosystem must also be tackled, namely hygiene practices, maintenance of household-level hardware, and overcrowding.
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