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Water, Sanitation and Hygiene

• 2.6 billion people or 39 per cent of the world’s population live without access to improved sanitation. The vast majority live in Asia and sub-Saharan Africa.
• In the developed regions almost the entire population (99 per cent) used improved facilities as compared to 52 per cent in developing regions.
• At current rates of progress the world will miss the MDG sanitation target by almost 1 billion people, which claims to: “halve, by 2015 the proportion of people without sustainable access to safe drinking water and basic sanitation,” by 13 per cent. And the MDGs are not the end of the sanitation challenge. Even if the target is met some 1.7 billion people will still not have access to improved sanitation facilities.
• Rural/urban disparities are particularly apparent in sub-Saharan Africa, and the Caribbean, Southern Asia and Oceania where improved sanitation coverage is highest among the urban population despite the vast majority living in rural areas.
• 751 million people share their sanitation facilities with other households or only use public facilities.

Open defecation

• A global decline in open defecation has been recorded. The proportion of the world’s population that practices open defecation has declined by more than one third from 25 per cent in 1990 to 17 per cent in 2008.
• However some 1.1 billion people still defecate in the open. Ten countries, (India, Indonesia, China, Ethiopia, Pakistan, Nigeria, Sudan, Nepal, Brazil, and Niger) are home to 81 per cent of them.
• Open defecation is largely a rural phenomenon, most widely practiced in Southern Asian and Sub-Saharan Africa. Even in these two regions, declines in open defecation have been recorded, with a fall from 66 per cent of the population in 1990 to 44 per cent in 2008 in Southern Asia, and a corresponding decline in Sub-Saharan Africa from 36 per cent to 27 per cent.

WATER

• 5.9 billion people, or 87 per cent of the world’s population, and 84 per cent of the population living in the developing world now use drinking water from safer, improved sources. At current trends the world will meet or even exceed the water MDG target.
• 3.8 billion people, or 57 per cent of the world’s population, get their drinking water from a piped connection that provides running water in their homes or compound.
• Sub-saharan Africa and the Oceania are the areas that are lagging behind. Just 60 per cent of the population in Sub-Saharan African and 50 per cent of the population in Oceania use improved sources of drinking-water.
• In China, 89 per cent of the population of 1.3 billion has access to drinking-water from improved sources, up from 67 per cent in 1990. In India, 88 per cent of the population of 1.2 billion has access, as compared to 72 per cent in 1990.

RURAL AND URBAN DISPARITIES

• Global coverage data suggest large urban/rural disparities in terms of the use of improved drinking water sources and basic sanitation. While use of improved sanitation in rural areas has increased from 35 per cent to 45 per cent since 1990, there are still over 1.8 billion people in rural areas living without improved sanitation services. In comparison, 96 per cent and 76 per cent of people living in urban areas use improved drinking water sources and improved sanitation, respectively.

GLOBAL DISEASE BURDEN

• Eighty-eight per cent of cases of diarrhoea worldwide are attributable to unsafe water, inadequate sanitation or insufficient hygiene. Diarrhoeal disease is the second leading contributor to global disease burden.
• 2.2 million deaths of children are preventable through improvements in the provision of safe drinking water, basic sanitation and hygiene practices.
• Childhood malnutrition causes about 35 per cent of all deaths of children under the age of five years worldwide; it is estimated that 50 per cent of childhood malnutrition is associated with repeated diarrhoea or intestinal nematode infections as a result of unsafe water, inadequate sanitation or insufficient hygiene.
• In 60 countries in the developing world, more than half of primary schools have no adequate water facilities and nearly two thirds lack adequate sanitation.

ECONOMIC/COST AND BENEFITS

The economic benefits of investing in drinking water and sanitation come in several forms:

• Healthcare cost savings by health agencies and individuals;
• Productive days gained per year (for those 15–59 years of age) and increased school attendance. Each year, children lose 272 million school days due to diarrhoea, and an estimated one in three school-aged children in the developing world are infested with intestinal worms;
• Time savings (working days gained) resulting from more convenient access to services;
• A 2004 WHO study shows that achieving the water and sanitation MDG target could bring economic benefits, ranging from US$ 3 to US$ 34 per US$ 1 invested, depending on the region.

DONOR FUNDING AND PRIORITIZATION

• Sanitation and drinking water have historically been perceived as relatively low in priority, compared with other social sectors.
• Aid commitments to water and sanitation comprised US$ 7.4 billion or 5 per cent (US$ 7.4 billion) of reported development aid in 2008. These aid commitments to sanitation and drinking water were lower than all other commitments for the social sectors, which include health and education, and lower than those for government and civil society, transport and storage, energy and agriculture.
• In comparison with health and education, the sanitation and drinking water share of development aid has markedly decreased over the past decade.
• Historical data shows that sanitation and drinking water enjoyed more than 8 per cent of total Official Development Assistance (ODA) in 1997. At that time, other social infrastructure sectors, such as health, education, population and reproductive health, received lower proportions of aid compared with sanitation and drinking water. During the 11 years since 1997, however, the proportion of development aid allocated to sanitation and drinking water fell from 8 per cent to 5 per cent, while development aid allocated to health increased from 7 per cent to 11.5 per cent and that for education remained steady at around 7 per cent.
• Countries report expenditures between 0.04 per cent and 2.8 per cent of GDP for drinking water and between 0.01 per cent and 0.46 per cent of GDP for sanitation. The median government spending on sanitation and drinking water for 20 responding countries is 0.38 per cent of GDP.
• 35 out of 37 countries report that financial flows are insufficient to achieve the MDG target for sanitation.

WHY SANITATION IS LAGGING BEHIND

• Financing for sanitation comprises 37 per cent of total aid funding for sanitation and drinking water. The breakdown of country expenditures (from both internal and external sources) between sanitation and drinking water shows that funding for drinking water is often 3 or more times higher than that for sanitation.
• Although data indicate that large disparities exist in urban/rural coverage and in drinking-water/sanitation financing, they also show that governments have generally not applied or developed criteria or a formula to allocate funding equitably to and within urban/rural communities for sanitation and drinking-water.
• Sanitation and hygiene education is especially difficult to place as a priority area due to the lack of clear identification of institutional roles and responsibilities for sanitation, resulting in the merging of sanitation with drinking water services and the perception in some countries that sanitation is mainly a household issue.

WASH IN SCHOOLS AND CHILDREN’S HEALTH

• In a group of surveyed developing countries, less than half of all primary schools in the developing countries do not have adequate water facilities and nearly two thirds lack adequate sanitation -- even where facilities exist, they are often in poor condition.
• One study revealed that more than 40 per cent of diarrhoea cases in schoolchildren result from transmission in schools rather than homes. Damage to children’s mental and physical health and development is comprised due to disease such as diarrhea.
• Children bear the brunt of the global drinking water and sanitation crisis – the cause of 80 per cent of the sickness in the developing world. 

WASH IN SCHOOLS AND SCHOOL ATTENDANCE AND ACHIEVEMENT

• Worms affect an estimated 400 million school-aged children in the developing world. Chronic hookworm infestations are associated with reduced physical growth and impaired intellectual development, and children enduring intense infestations with whipworm miss twice as many school days as their infestation-free peers.
• The average IQ loss per worm infestation is 3.75 points, representing 633 million IQ points lost for the people who live in the world’s low-income countries.

WASH IN SCHOOLS AND GENDER EQUALITY

• Girls who have reached puberty and female school staff who are menstruating need gender-related privacy. If no privacy is provided, students may not use the facilities at schools, resulting in absenteeism rates that can reach 10–20 per cent of school time.
• A survey conducted in South Africa reveals that more than 30 per cent of the girls attending school had been raped at school. Many of the rapes occurred in school toilets, particularly those that are isolated from the protective environment of the school.
• Women who have been to school are less likely to die during childbirth; each additional year of education is estimated to prevent two maternal deaths for every 1,000 women. Research also shows that for every 10 per cent increase in female literacy, a country’s economy can grow by 0.3 per cent.

Updated – May 2010