The price of poverty 

The poor also pay a high ‘tax’ for their poverty, and entrepreneurs always seem to find a creative way to extort it—such as by charging exorbitant prices for use of public latrines. 

In Kumasi (Ghana), for example, where the poorest pay for each visit to the neighbourhood latrine, they spend more on sanitation services each year than do residents with toilet facilities in their homes. Residents of some impoverished communities spend 20 per cent or more of their income for small quantities of water of questionable purity, while their neighbours in wealthier, established neighbourhoods receive government-subsidized piped water. 

And then there is the health ‘tax’. In a study in Karachi, we found that people living in areas without sanitation or hygiene education spend 6 times more on medical bills than do people in areas with sanitation and hygiene knowledge. 

These are staggering, and unnecessary, expenses. Think what it would mean for a family if that money were available to spend on other essentials: healthier food and more of it, school books and pencils, investment in business. 

But such outlays do reveal a critical fact: Poor people are prepared to pay for access to safe water and hygienic sanitation. In one Brazilian city, residents were asked how much they were willing to pay for installation and maintenance of water and sewage services. The figures they cited were 4 times above the actual cost for water and more than 2 times for sewage. 

Providing sanitation systems is a daunting and expensive task, but it is not impossible. It requires political will and a clear-headed understanding of the implications of failing to act. So far in this decade, governments in Africa, Asia and Latin America have invested roughly $2.1 billion a year in water and sanitation services for rural and underserved urban areas—and still they fell behind. The cost of achieving universal coverage would be an additional $4.7 billion a year (in 1994 dollars) for a decade, or a total of $6.8 billion per year. 

The figure also includes $300 million a year for hygiene education programmes, which are just as important as latrines, given that they teach people the importance of such basic activities as washing their hands after defecating. Operating and maintaining sanitation systems would add another 5-20 per cent to the bill. 

A bill of $68 billion over 10 years may sound high. But it is only about 1 per cent of what the world will spend on military expenditures in this decade. Given the cost to human health of failing to provide sanitation, it is hard to understand how a humane society can say no. Given the payback in terms of development, I cannot think of a more lucrative investment. 

The cost would be less if governments mounted an attack on waste within existing water and sanitation systems. High costs, low efficiency and unreliability—these are the characteristics of many public utilities in developing countries. Maintenance does not make for good photo opportunities. 

Water systems are notoriously leaky in developing countries, where 30 to 60 per cent of the water treated and pumped never makes it to the consumer at the end of the pipe because of leaks and illegal tapping. Such losses cost Latin Americans between $1 billion and $1.5 billion each year—the amount needed annually to provide water and sanitation services to all the region’s currently unserved citizens by the year 2000. 

Using the right technology for the job is another affordable way to provide modern sanitation—and I am not suggesting second-rate systems for the poor. Designers and engineers, wedded to traditional construction methods and often caught in a tangle of questionable bidding practices, insist on using large-width piping and installing it deep in the ground. These are costly procedures appropriate for intensively developed areas with heavy vehicular traffic. But in communities where structures are small and most traffic is on foot, narrow pipes laid just under the surface of lots, fields and footpaths usually suffice, at a small fraction of the price. 

With a very small customer base, most sanitation utilities remain largely unaccountable to the community at large, and often they make little effort to go after customers who fail to pay their bills. Most government sanitation funds end up subsidizing services to the middle class and the rich in established neighbourhoods, ignoring those who can least afford it. This is unjust and, given the price it extracts from the country’s development, foolish. 

But I do not expect any sudden shifts in public policy. One thing I have learned during many years of working both inside and outside government is that the authorities do not act until forced by the people. 

Marginalized communities are invisible to bureaucrats, who often do not view the poor as part of their constituency. Unrepresented communities must organize themselves to demand the attention they deserve. And they will organize, once they understand what is needed and how to go about it. But they will need help.
 

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