|Global Water Supply and Sanitation Assessment 2000 Report (UNICEF - WSSCC - WHO, 2000, 90 p.)|
|1. The Global Water Supply and Sanitation Assessment 2000|
The percentage of people served with some form of improved water supply rose from 79% (4.1 billion) in 1990 to 82% (4.9 billion) in 2000. Over the same period the proportion of the world's population with access to excreta disposal facilities increased from 55% (2.9 billion people served) to 60% (3.6 billion). At the beginning of 2000 one-sixth (1.1 billion people) of the world's population was without access to improved water supply (Figure 2.1) and two-fifths (2.4 billion people) lacked access to improved sanitation (Figure 2.2). The majority of these people live in Asia and Africa, where fewer than one-half of all Asians have access to improved sanitation and two out of five Africans lack improved water supply. Moreover, rural services still lag far behind urban services. Sanitation coverage in rural areas, for example, is less than half that in urban settings, even though 80% of those lacking adequate sanitation (2 billion people) live in rural areas - some 1.3 billion in China and India alone. These figures are all the more shocking because they reflect the results of at least twenty years of concerted effort and publicity to improve coverage.
One positive finding of the Assessment 2000 is that sanitation coverage appears to be higher than would be expected from the findings of earlier assessments. This is because the consumer-based survey data in the Assessment 2000 account for households that provided their own sanitation facilities, especially in Asia and Africa. These facilities were not covered by the provider-based data used in previous assessments.
Although an enormous number of additional people gained access to services between 1990 and 2000, with approximately 816 million additional people gaining access to water supplies and 747 million additional people gaining access to sanitation facilities, the percentage increases in coverage appear modest because of global population growth during that time. Unlike urban and rural sanitation and rural water supply, for which the percentage coverage has increased, the percentage coverage for urban water supply appears to have decreased over the 1990s. Furthermore, the numbers of people who lack access to water supply and sanitation services remained practically the same throughout the decade.
The water supply and sanitation sector will face enormous challenges over the coming decades. The urban populations of Africa, Asia, and Latin America and the Caribbean are expected to increase dramatically. The African urban population is expected to more than double over the next 25 years, while that of Asia will almost double. The urban population of Latin America and the Caribbean is expected to increase by almost 50% over the same period.
Although the greatest increase in population will be in urban areas, the worst levels of coverage at present are in rural areas. In Africa, Asia, and Latin America and the Caribbean, rural coverage for sanitation is less than one-half that of urban areas. In those three regions alone, just under 2 billion people in rural areas are without access to improved sanitation, and just under 1 billion are without access to improved water supply.
This report uses international development targets to highlight the challenges faced by the sector in reducing the coverage gap (see Box 1.1).
To achieve the 2015 target in Africa, Asia and Latin America and the Caribbean alone, an additional 2.2 billion people will need access to sanitation and 1.5 billion will need access to water supply by that date. In effect, this means providing water supply services to 280 000 people and sanitation facilities to 384 000 people every day for the next 15 years.
Projected urban population growth, especially in Africa and Asia, suggests that urban services will face great challenges over the coming decades to meet fast-growing needs. At the same time, rural areas also face the daunting task of meeting the existing large service gap. To reach universal coverage by the year 2025, almost 3 billion people will need to be served with water supply and more than 4 billion with sanitation.
Poor water supply and sanitation have a high health toll (Boxes 1.2 and 1.3), whereas improving water and sanitation brings valuable benefits to both social and economic development (Box 1.4). The simple act of washing hands with soap and water can reduce diarrhoeal disease transmission by one-third. Hygiene promotion, therefore, is an important priority.
BOX 1.1 INTERNATIONAL DEVELOPMENT TARGETS FOR WATER SUPPLY AND SANITATION COVERAGE
Indicative targets for water supply and sanitation coverage were developed by the Water Supply and Sanitation Collaborative Council (WSSCC) as part of the process leading up to the Second World Water Forum, The Hague, 17 - 22 March 2000. The targets were presented in the report VISION 21: A shared vision for hygiene, sanitation and water supply and a framework for action (1). The targets to be achieved are:
· By 2015 to reduce by one-half the proportion of people without access to hygienic sanitation facilities, which was endorsed by the Second World Water Forum, The Hague, March 2000.
The VISION 21 report stresses the indicative nature of these targets and the need to consider them in local context. Such targets are nevertheless helpful in assessing the magnitude of the task ahead in meeting the water and sanitation needs of the poor. These targets build upon the target of universal coverage established for the International Drinking Water Supply and Sanitation Decade 1981 - 1990, which was readopted as the target for the year 2000 at the World Summit for Children in 1990.
Coverage targets themselves have been criticized as failing to focus on the changes that contribute progressively to health and development and as being too simplistic, dividing the world into those who have and those who have not. The Assessment 2000 report represents a first step in moving towards a breakdown according to means of provision, in addition to overall coverage estimation.
BOX 1.2 HEALTH HAZARDS OF POOR WATER SUPPLY AND SANITATION
· Approximately 4 billion cases of diarrhoea each year (2) cause 2.2 million deaths, mostly among children under the age of five (3). This is equivalent to one child dying every 15 seconds, or 20 jumbo jets crashing every day. These deaths represent approximately 15% of all child deaths under the age of five in developing countries. Water, sanitation, and hygiene interventions reduce diarrhoeal disease on average by between one-quarter and one-third (4).
· Intestinal worms infect about 10% of the population of the developing world (2). These can be controlled through better sanitation, hygiene and water supply (5). Intestinal parasitic infections can lead to malnutrition, anaemia and retarded growth, depending upon the severity of the infection.
· It is estimated that 6 million people are blind from trachoma and the population at risk from this disease is approximately 500 million. Considering the more rigorous epidemiological studies linking water to trachoma, Esrey et al. (4) found that providing adequate quantities of water reduced the median infection rate by 25%.
· 200 million people in the world are infected with schistosomiasis, of whom 20 million suffer severe consequences. The disease is still found in 74 countries of the world. Esrey et al. (4), in reviewing epidemiological studies, found a median 77% reduction from well-designed water and sanitation interventions.
· Arsenic in drinking water is a major public health threat. According to data from about 25 000 tests on wells in Bangladesh, 20% have high levels of arsenic (above 0.05 mg/l). These wells were not, however, selected at random and may not reflect the true percentage (6). Many people are working hard in Bangladesh, West Bengal and other affected areas to understand the problem and identify the solution.
BOX 1.3 CHOLERA EPIDEMICS
Cholera is a worldwide problem that can be prevented by ensuring that everyone has access to safe drinking-water, adequate excreta disposal systems and good hygiene behaviours.
Major health risks arise where there are large concentrations of people and hygiene is poor. These conditions often occur in refugee camps, and special vigilance is needed to avoid outbreaks of disease.
Most of the 58 057 cases of cholera reported in Zaire in 1994 occurred in refugee camps near the Rwandan border. A decrease to 553 cases in Zaire in 1995 reflected the stabilization of refugee movement.
A cholera epidemic that began in Peru in 1990 spread to 16 other countries in Latin America. A total of 378 488 cases were reported in Latin America in 1991. Ten years later, cholera remains endemic following its absence from the continent for nearly a century.
BOX 1.4 HEALTH BENEFITS OF IMPROVED WATER SUPPLY AND SANITATION
Water supply and health
Lack of improved domestic water supply leads to disease through two principal transmission routes (8):
· Waterborne disease transmission occurs by drinking contaminated water. This has taken place in many dramatic outbreaks of faecal-oral diseases such as cholera and typhoid. Outbreaks of waterborne disease continue to occur across the developed and developing world. Evidence suggests that waterborne disease contributes to background rates of disease not detected as outbreaks. The waterborne diseases include those transmitted by the faecal-oral route (including diarrhoea, typhoid, viral hepatitis A, cholera, dysentery) and dracunculiasis. International efforts focus on the permanent eradication of dracunculiasis (guinea worm disease).
Adequate quantities of safe water for consumption and its use to promote hygiene are complementary measures for protecting health. The quantity of water people use depends upon their ease of access to it. If water is available through a house or yard connection people will use large quantities for hygiene, but consumption drops significantly when water must be carried for more than a few minutes from a source to the household (9).
Sanitation and health
Sanitation facilities interrupt the transmission of much faecal - oral disease at its most important source by preventing human faecal contamination of water and soil. Epidemiological evidence suggests that sanitation is at least as effective in preventing disease as improved water supply. Often, however, it involves major behavioural changes and significant household cost. Sanitation is likely to be particularly effective in controlling worm infections. Adults often think of sanitation in adult terms, but the safe disposal of children's faeces is of critical importance. Children are the main victims of diarrhoea and other faecal - oral disease, and also the most likely source of infection. Child-friendly toilets, and the development of effective school sanitation programmes, are important and popular strategies for promoting the demand for sanitation facilities and enhancing their impact.
Adequate quantities of safe water and good sanitation facilities are necessary conditions for healthy living, but their impact will depend upon how they are used. Three key hygiene behaviours are of greatest likely benefit:
· Hand washing with soap (or ash or other aid).
· Safe disposal of children's faeces.
· Safe water handling and storage.