This article was originally published in British Medical Journal Group's Global Health here.
Unsafe water, sanitation and hygiene (WASH) causes millions of deaths and disability-adjusted life-years annually. Despite global progress towards universal WASH. Much of WASH programming continues to fail to improve health outcomes or be sustainable in the longer term, consistently falling short of internal performance indicators and sometimes negatively impacting the well-being of local stakeholders. Although sector experts in high-income countries have often provided explanations for such failures, the opinions of those implementing WASH programming at the ground level are rarely published. This study captures the perceptions of frontline WASH professionals in Malawi, South Africa, Tanzania and Zimbabwe on why they believe WASH failure persists. Through participatory analysis, it determines the core reasons for WASH failure as perceived by participants.