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Water, Sanitation and Hygiene (WASH)


Why is WASH  important?
Diarrhoea is the second largest cause of under-five mortality globally. With 600,000 children dying in each year and over 1.7 billion cases, diarrhoeal diseases are also associated with a higher risk of stunting (low weight for age and developmental delay) and take a huge toll on society.

Diarrhoeal diseases linked to a lack of safe water, sanitation and basic hygiene kills approximately 1,400 children under five die every day. This amounts to over half a million children per year.

Millennium Development Goals
Goal 7, Target 7c of the Millennium Development Goals (MDGs) aims at halving by 2015 the proportion of the global population without sustainable access to safe drinking water and basic sanitation.

  • The MDG target on water was to halve by 2015 the proportion of the global population who in 1990 did not have sustainable access to safe drinking water, and therefore extend access to 88 per cent of people by the target date. 

  • The MDG target on sanitation is to halve the proportion of the global population without access to improved sanitation, from 51 per cent in 1990 to 25 per cent by 2015.

  • The MDG targets are expressed in percentages, not numbers. Since 1990, the global population increased from approximately 5.3 billion to 7 billion by 2012, thus the percentages outlined in the targets refer to an increasing number of people.

UNICEF and the World Health Organization (WHO) are responsible for monitoring and reporting progress on the MDGs related to water and sanitation. The two organizations have established a Joint Monitoring Programme (JMP) for Water Supply and Sanitation, and produce a progress report every two years.


  • An improved drinking-water source is one that by its construction is adequately protected from outside contamination, in particular from faecal matter
  • An improved sanitation facility is one that hygienically separates human excreta from human contact.
  • Open defecation refers to when people defecate in fields, forests, bushes, open bodies of water, beaches, and other open spaces


  • In the 2012 JMP report, UNICEF and WHO announced the good news that at the end of 2010 the MDG target for drinking water had been reached and surpassed , five years ahead of the deadline. 

  • In 2010, 89 per cent of the world’s population, or 6.1 billion people, used improved drinking water sources, 1 percentage point more than the MDG target 

  • Between 1990 and 2010, over 2 billion people gained access to improved drinking water.

  • 55 per cent of those using improved water sources had piped water on premises

  • At the end of 2011, an estimated 768 million people did not use an improved source for drinking-water.

  • 185 million people relied on surface water to meet their daily drinking-water needs.

  • UNICEF and WHO project that at the current rate of progress, by 2015, 92 per cent of the people in the world will have access to improved drinking water supplies, 4 percentage points over the MDG target. 

  • The UN General Assembly has declared that water is a human right, which means every person should have access.

Countries of note
10 countries are home to two-thirds of the global population without access to improved drinking water sources:

  • China (108 million)
  • India (99 million)
  • Nigeria (63 million)
  • Ethiopia (43 million)
  • Indonesia (39 million)
  • Democratic Republic of the Congo (37 million)
  • Bangladesh (26 million)
  • United Republic of Tanzania (22 million)
  • Pakistan (16 million)
  • Kenya (16 million)


The world is off track to meet the MDG sanitation target, which requires reducing the proportion of people without access to improved sanitation from 51 per cent in 1990 to 25 per cent by 2015. UNICEF and WHO estimate that in 2015 some 2.4 billion people – one-third of the world’s population – will remain without access to improved sanitation, missing the MDG target by 8 per cent – or half a billion people.

  • Since 1990 almost 1.9 billion people gained access to an improved sanitation facility.

  • In 2011 almost two thirds (64%) of the world population used improved sanitation facilities.

  • At end of 2011, 2.5 billion people lacked access to an improved sanitation facility. 

  • Of these, 761 million use public or shared sanitation facilities

  • Another 693 million use facilities that do not meet standards of hygiene. 

  • Greatest progress has been made in East Asia, where sanitation coverage has increased from 27 per cent in 1990 to 67 per cent in 2011. This amounts to 626 million people gaining access to improved sanitation facilities over the 21 year period.

Countries of note
593 million people in China and 251 million in India gained access to improved sanitation since 1990. The world's two most populous countries together account for just under half the global progress on sanitation

  • China: Accounts for more than 95% of the progress on sanitation in Eastern Asia. However, it has 14 million people who practice open defecation, 8th on the list of the top 10 countries
  • India: With 626 million people who practice open defecation, has more than twice the number of the next 18 countries combined. It accounts for 90 per cent of the 692 million people in South Asia who practice open defecation. It also accounts for 59 per cent of the 1.1 billion people in the world who practice open defecation

Open Defecation
Open defecation refers to when people without sanitation facilities are forced to defecate in fields, forests, bushes, open bodies of water, beaches, and other open spaces. The United Nations is spearheading a drive to end open defecation by 2025.

  • 1 billion (15% of the world population) still practice open defecation. The majority (71%) of those without sanitation live in rural areas and 90% of all open defecation takes place in rural areas.
  • Globally, open defecation rates declined from 24% in 1990 to 15% in 2011. This signifies a drop of 250 million people to 1.04 billion in 2011. 
  • Eastern Asia, South East Asia and the Latin America and Caribbean regions have seen a steady decline since 1990. 
  • In South Asia the population practicing open defecation peaked around 1995 – after which it declined. 
  • Only in sub-Saharan Africa is the number of people defecating in the open still increasing, largely due to population growth.

Regional notes on sanitation (JMP 2013 Update)


  • Eastern and Southern Africa
    In 16 of the 23 countries in Eastern and Southern Africa region (ESAR), less than half of the population uses improved sanitation. In seven of these countries, over a third of the population practices open defecation, with the rate as high as 77 per cent in 2011 for South Sudan. ESAR experienced massive population growth between 1990 and 2011 (from 244 million to 419 million). With this, the number of people practicing open defecation rose from 97 million to 106 million but this still meant that the region succeeded in greatly lowering the rate of open defecation - from 40 per cent of the population in 1990 to 25 per cent in 2011.
  • West and Central Africa
    In West and Central Africa, only 27 per cent of people have access to improved sanitation. In seven countries in this region, more than a half of the population defecates in the open. WCAR experienced massive population growth between 1990 and 2011 (from 244 million to 423 million). With this, the number of people practicing open defecation rose for the region as a whole, from 77 million to 106 million. However, this still meant that the regional rate of open defecation lowered - from 31 per cent of the population in 1990 to 25 per cent in 2011. At the national level, some countries also achieved significant reductions in open defecation, for example, Guinea and Senegal.
  • Middle East and North Africa
    In the Middle East and North Africa, there is a wide variety of access to improved sanitation, ranging from countries like Saudi Arabia and Bahrain in which the populations have almost universal access to sanitation, to Sudan in which only a quarter of residents do. At the regional level, open defecation rates are one per cent among the urban population, rising to 16 per cent among those living in  rural areas, and seven per cent overall.


  • East Asia and the Pacific
    The East Asia and the Pacific region has shown the greatest progress in access to sanitation, with coverage increasing by 36 percentage points since 1990. Approximately 1,373 million people now have access to improved sanitation facilities. Countries in East Asia and the Pacific continue to have relatively low percentages of open defecation, at an average of five per cent of the population. However, the average masks huge disparities. The rate of open defecation is seven per cent in rural areas, three and a half times the two per cent rate in cities.
  • South Asia
    In South Asia 41 per cent of people continue to practice open defecation. India is home to 615 million people who defecate in the open. In both India and Nepal, more than 40 per cent of the population practices open defecation. The overwhelming majority of those without access to sanitation facilities live in rural areas.


  • Latin America and the Caribbean
    In Latin America and the Caribbean, 81 per cent of people use improved sanitation. However, rates vary greatly by country. In eight countries in the region, more than 90 per cent of the population have access to improved sanitation facilities, while less than half do in Bolivia and just over a quarter (26 per cent) in Haiti. Throughout the region, the majority of those without access to improved sanitation and the majority of those practicing open defecation live in rural areas. Honduras, a notable success in reducing  the percentage of people practicing open defecation, has achieved a reduction from 33  per cent of the population in 1990 to seven per cent in 2011 – a drop of 26 percentage points – and is “on track” in MDG terms.

UNICEF’s Total Sanitation Programme

UNICEF has spearheaded a social change movement that that has led more than 25 million people to end the practice of open defecation and now use toilets. The Community Approaches to Total Sanitation (CATS) programme, encourages communities to take the lead and identify their own measures to end open defecation, and has been achieving results at scale. At the last count, over 50 countries have implemented CATS and many governments have mainstreamed a similar approach into their national policy.


  • UNICEF promotes Global Handwashing Day every year on October 15. (For more information about handwashing and GHD, visit http://globalhandwashing.org/)

  • It has been proven that handwashing with soap at critical moments – such as after using the toilet or before handling food – is an easy and affordable intervention that can reduce the incidence of diarrhoea among children under five by almost 50 per cent, and cut respiratory infections by as much as 25 per cent.

  • Handwashing by birth attendants before delivery has been shown to reduce mortality rates by 19 percent, while a 44 percent reduction in risk of death was found if mothers washed their hands prior to handling their newborns.

  • Soap is readily available, but most households use it only for laundry or bathing, rarely for handwashing. By promoting this simple intervention, and teaching children and their households the importance of handwashing, UNICEF is helping to save lives.

  • UNICEF also works to give girls the knowledge and facilities necessary for good menstrual hygiene, which is key to their dignity, their privacy, their educational achievement, and their health. 


  • Poor water and sanitation result in economic losses estimated at US$260 billion annually in developing countries, or 1.5% of their GDP. 

  • The costs of attaining universal coverage for drinking water globally are estimated to be US$174 billion over the five-year period 2010-2015. The main contributor to overall benefits of drinking-water systems and services is the value of time savings which accounts for almost 70% of total benefits in all regions.

  • The benefits from meeting the water supply and sanitation MDG targets combined equal over US$60 billion annually. The global economic return on water spending is US$ 2.0 per US dollar invested. If other social and environmental benefits are taken into consideration, the figure is considerably higher. 

  • In Africa alone, people spend 40 billion hours ever year just walking to collect water. Women carry two thirds of the burden in drinking water collection, leaving less time for other socioeconomic activities. 

  • Girl’s school attendance increased significantly for every hour reduction in water collection. For example, in Nepal attendance recently improved by over 30%.

Hutton 2013 Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage, World Health Organisation
Koolwal and van de Walle (2010) Access to water, women’s work and child outcomes. Washington DC: World Bank)



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