The Earth was home to 6 billion people in 2000: 1.1 billion of them lacked safe water and 2.4 billion lacked adequate sanitation. As a consequence, water- and sanitation-related diseases are widespread. Nearly 250 million cases are reported every year, with more than 3 million deaths annually—about 10,000 a day. Diarrheal diseases impact children most severely, killing more than 2 million young children a year in the developing world. Many more are left underweight, stunted mentally and physically, vulnerable to other deadly diseases, and too debilitated to go to school.
This situation in today’s world is humiliating, morally wrong, and oppressive. The global community has made advances in many fields but it has failed to ensure these most basic needs of deprived people. Worse still, if unprecedented global action is not taken, the lot of the poor is expected to worsen in the foreseeable future.
In spite of hard work and laudable progress, the number of people without access to both water supply and to sanitation in developing countries remained practically the same throughout the 1990s: the increase in population served was just enough to keep pace with population growth. According to the Global Water Supply and Sanitation Assessment 2000 Report, the majority of the world’s population without access to improved water supply or sanitation services lives in Africa and Asia. Two-thirds of people without access to improved water supply and more than three-quarters of those without access to improved sanitation live in Asia.
No figures are available on hygiene. However, experience has shown that clean water alone leads to only minor health improvements. The essential factor is sound personal hygiene, with adequate public sanitation and clean water as supporting components. While each of the three components alone has some health benefit, their combined effect is far greater. Hygienic behavior is virtually impossible without a source of safe water and a safe means to dispose of human and other wastes. Access to water and sanitation services is closely related to each nation’s economy. The economic gap between rich and poor countries has widened over the last 20 years. Many of the least developed countries have been caught in a downward economic spiral. Their governments can find it hard to sustain basic social programs, including water and sanitation. Furthermore, aid programs often lack the flexibility essential in such cases. This crisis is most apparent in Sub-Saharan Africa. In Asia, the Middle East, North Africa, Latin America, and the Caribbean, the situation is generally better, although growing cities represent a critical challenge.
The dissolution of the USSR has caused the quality of water services in large parts of Central Asia to slip backward. Throughout this region, institutional reform has become critically important to the goals of decentralization and encouragement of private initiative. In addition, collaborative mechanisms are badly needed to help promote common awareness and joint action across the diverse political, economic, and cultural philosophies and practices that these nations embrace.
The Population Council predicts that world population will grow to 7.8 billion over the next 25 years, with most of the increase in urban areas. The urban population will roughly double, to approximately 4.5 billion people. After 2020, all population growth—and most poverty—in the developing world will occur in urban areas, as the rural population declines. Universal water supply and sanitation coverage by 2025—a now widely acknowledged goal—will mean that in urban areas an additional 1.9 billion people will need water supply and 2.1 billion will need sanitation services. In rural areas, 1 billion people will need water supply and 2.1 billion will need sanitation.
Field experience and studies suggest that a minimum quantity of safe water is required for a person to drink, prepare food, ensure personal cleanliness, and use a sanitary latrine. Drinking and cooking take 10 to 15 liters per day. Water needs for hygiene and sanitation are less precise, and vary from one culture to another. But a person who practices personal hygiene and uses a latrine needs an absolute minimum of 20 liters per day. Further health benefits accrue when communities move from public tap to house connections. Those with house connections usually use 40 or more liters per head. The total volume of water required to meet basic needs for all is thus relatively small, even for a city of 1 million, compared to agricultural and industrial uses, and even to household use by the wealthy. Thus the problem in domestic use is not water quantity.
Sanitation is one of the most important interventions in improving the human condition. Yet many agencies neglect hygiene and sanitation because they are not included in agency mandates. What constitutes good hygienic practice varies from culture to culture although the common aim is to break the fecal-oral transmission route of disease. Disposing of human wastes in a manner that does not contaminate the environment and that further limits the likelihood of disease transmission from person to person is a fundamental requirement. Minimum sanitation standards should be established at the national level.
Following the local meetings, the national consultations reviewed the communities’ answers, which started a dialogue (sometimes for the first time) among government, community representatives, and NGOs. Next, Vision 21 held five regional consultations. Contributors from the national meetings joined participants from countries that were not yet part of the national Vision 21 exercise. The final part of the process was a global consultation, where the final version of Vision 21 was endorsed by a gathering of stakeholders representing all the regions. All these people shared their aspirations and their strategies for practical action toward universal access to hygiene, sanitation, and water supply. Thus, Vision 21 opened the door to an approach that has the potential to reach everyone. What seemed idealistic has proved to be achievable.
The constraints for improvement are neither financial nor technical—they are political, social, and managerial. Business as usual has proven unable to produce adequate water services. Democratic thinking and action, one of the most essential changes, is a prerequisite for development.
To find solutions for the imminent crisis in hygiene, sanitation, and water supply the Water Supply and Sanitation Collaborative Council (WSSCC) undertook a democratic consultation process that developed Vision 21 (see Box). If the goal of hygiene, sanitation, and water supply for all people is to be achieved, people’s roles must change. The most important actors will be individuals and groups in households and communities with new responsibilities for their own hygiene, sanitation, and water services, as part of a collective strategy.
Public authorities will need to provide enabling conditions, clearing large-scale obstacles, securing empowerment of people through self-reliance, supporting individuals and families in their efforts, and carrying out the work that households and communities cannot manage for themselves. Similarly, water-sector professionals must combine their technical skills with an ability to communicate with those they serve.
The fundamental premise is that people’s initiative and management of their own quality of life must be at the center of planning and action. Visions and plans articulated at local levels are the building blocks for progress at the next levels of national, regional, and global action.
This approach demands collaborative action by empowered people in households and communities, and by authorities that support new roles for civil society. Fresh attitudes and commitments, reflected in new policies and activities, are needed at every level of society and governance. The foundation of the new approach is recognition that water and sanitation are basic human rights. Together, water and sanitation services can improve living conditions for all, and most particularly for children and women. They form a major component in poverty reduction. Such recognition can lead to systems that encourage genuine participation by men and women, resulting in the acceptance and practice of hygiene, coupled with safe water and sanitation at the household level.
Earlier estimates of annual expenditures on water and sanitation ranged from US$10 to US$25 billion, most on higher level services in urban centers whose cost is not recovered from the users. The Global Water Partnership’s more recent estimate is that an annual investment of US$30 billion might be needed for water supply and sanitation.
The WSSCC suggests that if the principles elaborated in the Vision 21 document are seriously applied, the total cost for providing a basic level of service over the next 25 years (in addition to the costs borne by households or communities) totals US$225 billion, or approximately US$9 billion per year. This estimate is within the range of current expenditures. It reflects the potential for cost recovery possible through political determination, to which participation is the key.
For further information see Vision 21: A Shared Vision for Hygiene, Sanitation, and Water Supply and a Framework for Action. Water Supply and Sanitation Collaborative Council: Geneva, March 2000.; Global Water Supply and Sanitation Assessment 2000 Report. World Health Organization, United Nations Children’s Fund (UNICEF), and Water Supply and Sanitation Collaborative Council: 2000.
Hans van Damme (hansvandamme@planet.nl) is special adviser to the Water Supply and Sanitation Collaborative Council and former coordinator of Vision 21, the Water for People component of the World Water Vision.