Young child survival and development

Child Survival


Water and Sanitation

© UNICEF/India/2011/ Rajat Madhok
A young boy waits for his turn to take a bath in a slum in Moradabad, India. Extremely poor sanitory conditions can result in health hazards for children living in these slums.

The Issue

Drinking safe water, using clean toilets and washing hands with soap are indispensable for the survival, health, growth and development of children.  A lack of these essential practices is one of the main causes of child disease, malnutrition and death.  Over the past two decades, South Asia has dramatically increased the use of drinking water from improved sources, and has met the MDG target for water supply. Serious concerns remain about drinking water safety, even when drinking water is taken from improved sources. 

In South Asia, the pace of sanitation improvements has not kept up with population growth: in 2010 the region had about 1,057 million people without improved sanitation, some 30 million more than in 1990. Worse, 692 million people in South Asia have no toilet at all, and defecate in the open.  In India alone, some 625 million people practice open defecation. The good news is that the number of people practicing open defecation is gradually declining.  From 1990 till 2010, South Asia increased sanitation coverage from 22 per cent to 38 per cent.  During this 20-year period, 369 million people gained access to sanitation.  As of 2010, the region remains off track for the sanitation MDG target.   For the region to achieve the sanitation MDG target of 61 per cent would require an additional 500 million people to gain access to sanitation, a near-impossible task given the trend over the past 20 years.

There are vast disparities in sanitation coverage in South Asia.  Urban populations are twice as likely to use improved sanitation facilities as rural ones, 60 per cent versus 28 per cent.  Urban sanitation coverage in the region has stagnated in recent years.  The number of urban dwellers in South Asia not using improved sanitation facilities rose from 134 million in 1990 to 196 million in 2010. While the richest quintile has 92 per cent coverage, the poorest quintile has only 4 per cent coverage!  In water supply, the disparities are less pronounced: among the richest quintile 4 per cent lacks coverage, while among the poorest 18 per cent is not covered.  There are disparities by region and social status as well in many parts of the region. 
From 1990 till 2010, millions of South Asians gained access to improved drinking water sources, increasing coverage to 90 per cent, surpassing the MDG target for the region.  This still leaves some 170 million people not using drinking water from improved sources.  These unreached masses, mostly in rural areas, continue to rely on unprotected surface sources and unimproved sources. More people would be using improved drinking water sources if it was not for the fact that at any given time up to a quarter of South Asia’s public water supply systems are not operational due to breakdowns, poor maintenance, declining water sources (now exacerbated by climate change), and generally ageing infrastructure.

Taking drinking water from improved sources does not mean that the water in the homes is safe to drink.  A study done in Madhya Pradesh, India, found that 40 per cent of boreholes with handpumps supplied water with thermotolerant coliforms, an indication of human faecal contamination.  Even when water is safe at the point of supply, it can be contaminated during collection, in transport, during storage at home, or when retrieved from a storage vessel.  In addition, naturally high levels of arsenic and fluoride occur in ground water in areas of Bangladesh, India, Nepal, and Pakistan. The problem is greatest in Bangladesh, where 13 per cent of the country’s tubewells exceeds the government limit for arsenic in drinking water.  Efforts continue to improve the safety of drinking water at the point of supply, while households are encouraged to treat their drinking water (boiling, filtering, chlorinating, solar disinfection), to reduce the risk to the heath of family members. 
School sanitation coverage is under 60 per cent in most South Asian countries.  More schools have functioning water systems than working sanitation systems.  Where water supply and/or sanitation systems are not functioning, children are discouraged from attending school.  Where there are no separate toilets for boys and girls, or where menstrual hygiene management is lacking, girls miss classes.  Water supply coverage at schools ranges from 54 per cent (Afghanistan) to 94 per cent (India), while adequate sanitation facilities for girls can be found at 51 per cent of schools in Afghanistan to 87 per cent in Sri Lanka.

UNICEF in Action

Even though South Asia has just eight countries, it presents a very diverse programming environment for WASH.  Emerging middle-income countries like the Maldives and Sri Lanka have already achieved very high levels of basic services.  India, Nepal and Pakistan have the lowest level of sanitation coverage.  India is investing heavily from its own funds, to address the sanitation crises.  Afghanistan and Pakistan face fragile governance systems and limited access for security reasons. 

In each of these countries, UNICEF is supporting a country-specific mix of interventions, including catalyzing government action, supporting government programmes (technical assistance, capacity building, monitoring and evaluation, knowledge sharing) and selectively supplementing service delivery, where government capacities are especially weak.

UNICEF has learned a great deal in its 40 years of assisting developing countries in the area of WASH. The need for community approaches has been embraced by most stakeholders, as has the importance of meeting the needs of communities and households through a range of low-cost appropriate technologies, backed by effective supply chains.  Key WASH-related behaviors are influenced by the effective delivery of communication for behavior change.  Working with civil society and the private sector are essential elements of UNICEF’s work on WASH in South Asia. 

UNICEF lobbies governments to affirm the importance of safe drinking water, the use of toilets and handwashing with soap in the overall development agenda, and to ensure that adequate resources are made available.

UNICEF is a major force in promoting the aim of adequate child-friendly water and sanitation facilities in all schools, along with hygiene-education programmes. Hygiene education in schools will be an important influence on the region’s long-term improvements in WASH-related practices.


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