Moving towards transformational WASH Reply
We agree with Karen Levy and Joseph Eisenberg that observational studies of water, sanitation, and hygiene (WASH) interventions with carefully designed counterfactuals can play a valuable role in generating evidence on effectiveness, particularly in urban settings. Randomised controlled trials for community-level WASH infrastructure interventions are not always feasible in urban settings, because of the political and logistical constraints of defining treatment and control groups; strong observational designs could help fill the gap.1 With increasing urbanisation in Asia and Africa, WASH intervention studies in low-income urban communities will be crucial for informing strategies to meet Sustainable Development Goal (SDG) target 6.1: to achieve universal and equitable access to safe and affordable drinking water for all. ; AJPi, BFA, CN, MR, and CPS report grants and other support from the Bill & Melinda Gates Foundation, during this study. JMC received salary support and University of California, Berkeley, received the prime award funding for the conduct of the WASH Benefits trials in Bangladesh and Kenya. JHH reports grants from the Bill & Melinda Gates Foundation, the Department for International Development (UK Government), and Swiss Agency for Development and Cooperation