Water, Sanitation, and Hygiene (WASH) Programming: USAID Faced Challenges Providing Assistance to Countries with Greatest Need

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Why We Did This Audit

The World Health Organization estimated that diseases tied to inadequate water, sanitation, and hygiene (WASH) accounted for approximately 3.3 percent of global deaths in 2016. The Senator Paul Simon Water for the World Act of 2014 directs USAID to designate high priority countries based on the WASH Needs Index, which ranks countries based on factors including usage of improved water and sanitation sources and facilities, hygiene behaviors, child mortality from diarrheal disease, and rate of open defecation. Three opportunity indicators are applied to Index-ranked countries: host country capacity/commitment, availability of leveraged funding, and health and educational opportunities for women.

Our audit objectives were to determine (1) the extent to which USAID designated high priority countries consistent with the criteria and indicators in the Act, (2) the challenges USAID faced in allocating funding to high priority countries in accordance with the Act, and (3) the extent to which USAID complied with congressional reporting requirements under the Act.

Key Findings

USAID’s interpretation and introduction of criteria and application of indicators led to countries with low WASH needs being designated as high priority countries. Although USAID designated more than the minimum number of required HPCs during each fiscal year, key health statistics for some of these countries demonstrated a low WASH need. Moreover, USAID did not adequately document the HPC designation process.

USAID lacked authority to make final funding decisions and provided higher funding to HPCs with low demonstrated need. The final authority for making funding allocation decisions for WASH programming is shared between BRM and State, with the final authority resting with State. From FY 2016-2019, USAID did not meet the requirement of HPCs receiving at least 50 percent of WASH funding without designating countries with larger WASH budgets even though they were outside the Top 50 on the Index as HPCs.

USAID did not report complete and timely information to Congress. USAID complied with the requirement to notify congressional committees about the countries designated as HPCs but did not provide Congress with complete information about countries outside the Top 50 on the Index that received funding. The Agency also reported 17 months late about how criteria for the Index were weighted and how the Index affected funding priorities.

We made one recommendation to improve USAID’s compliance with the reporting requirement of the Act. The Agency agreed with the recommendation.



Establish and implement procedures to ensure that congressional reporting is timely and complete, including reporting on planned funding for countries outside of the Top 50 on the WASH Needs Index.

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