During the past decade countries in the Latin American and Caribbean (LAC) region have lifted more than 50 million people out of poverty, yet half of the rural population in the region still lacks access to sanitation and approximately 20 percent to drinking water. In January 2012, policy makers, scholars, and practitioners from nine LAC countries came together in Santo Domingo, Dominican Republic to explore the opportunities and challenges of integrating in a more systematic and sustainable way the promotion of hygiene and sanitation behavioral change into water and sanitation investments. During the conference in Santo Domingo, it became evident that a common understanding is currently emerging from most countries in the sense that infrastructure by itself will not solve the global problems of inadequate access to improved sanitation and potable water, unless people adopt new behaviors. Therefore, there is a need to spread learning on best practices to implement cost effective water, sanitation and hygiene models, which bring about change at home and in the community at scale. This paper highlights key issues that arose in presentations and group discussions during the conference, which, can lead to substantial improvements in the provision of a multi-sector approach to hindering sustainable water and sanitation services for all.

During a 28-year field survey in India (1988–2016), groundwater arsenic contamination and its health effects were registered in the states of West Bengal, Jharkhand, Bihar and Uttar Pradesh in the Ganga River flood plain, and the states of Assam and Manipur in the flood plain of Brahamaputra and Imphal rivers. Groundwater of Rajnandgaon village in Chhattisgarh state, which is not in a flood plain, is also arsenic contaminated. More than 170,000 tubewell water samples from the affected states were analyzed and half of the samples had arsenic >10 μg/L (maximum concentration 3,700 μg/L). Chronic exposure to arsenic through drinking water causes various health problems, like dermal, neurological, reproductive and pregnancy effects, cardiovascular effects, diabetes mellitus, diseases of the respiratory and gastrointestinal systems, and cancers, typically involving the skin, lungs, liver, bladder, etc. About 4.5% of the 8,000 children from arsenic-affected villages of affected states were registered with mild to moderate arsenical skin lesions. In the preliminary survey, more than 10,000 patients were registered with different types of arsenic-related signs and symptoms, out of more than 100,000 people screened from affected states. Elevated levels of arsenic were also found in biological samples (urine, hair, nails) of the people living in affected states. The study reveals that the population who had severe arsenical skin lesions may suffer from multiple Bowens/cancers in the long term. Some unusual symptoms, such as burning sensation, skin itching and watering of eyes in the presence of sun light, were also noticed in arsenicosis patients.