Water for Basic Needs

Introduction

Human life, as with all animal and plant life on the planet, is dependent upon water. Not only do we need water to grow our food, generate our power and run our industries, but we need it as a basic part of our daily lives - our bodies need to ingest water every day to continue functioning. Communities and individuals can exist without many things if they have to - they can be deprived of comfort, of shelter, even of food for a period, but they cannot be deprived of water and survive for more than a few days. Because of the intimate relationship between water and life, water is woven into the fabric of all cultures, religions and societies in myriad ways.

Water for basic needs (households, services) represents a relatively small amount of the total quantities withdrawn for other uses. Yet, although many fortunate people throughout the world are able to take water for granted where it is available, for an estimated 1.1 billion people - water rules their daily lives with the cruel irony that it is often both the most precious and sought after of commodities, requiring grinding daily labour to acquire.

At this point in the twenty first Century we are surrounded by the marvels of modern communications, electronics and bio-mechanics; we have charted the human genome and yet we have not mustered the skills, resources and will to provide all members the global population with something as basic as safe water supply and adequate sanitation.

What are basic human needs for water - how much do our bodies need? "Basic needs" go beyond what we need to drink or ingest through our food for daily survival (about 5 litres per person per day [Gleick, 1999]) - it includes the need for water to maintain a basic standard of personal and domestic hygiene sufficient to maintain health. It is not sufficient merely to have access to water in adequate quantities - the water also needs to be of adequate quality to maintain health and it must be free of harmful biological and chemical contamination. Water gathered from unprotected sources often does not meet these criteria and places the users at risk. Often water which is of a sufficiently high quality at the point of collection is contaminated before it is used because it has to be carried and stored before use or because of unhygienic practices.

Water provision cannot be separated from two other inter-related factors - sanitation and health. This is because one of the primary causes of contamination of water is the inadequate or improper disposal of human (and animal) excreta. This often leads to a cycle of infection (resulting primarily in diarrhoeal diseases) and contamination which remains one of the leading cause of illness and death in the developing world.

Providing for daily water needs is a burden on households with inadequate services in a number of ways, in addition to the direct health threats. Often water has to be carried long distances to the house which takes time and effort, a burden borne mainly by women and children. In urban and urban fringe areas water is often only available from vendors at a price which is usually several times more expensive than the water provided through formal services and of poor quality.

Inadequate water supplies are both a cause and an effect of poverty. Invariably those without adequate and affordable water supplies are the poorest in the society. The effects of inadequate water supply - disease, time and energy expended in daily collection, high unit costs, etc. - exacerbate the poverty trap. Provision of basic daily water needs is yet to be regarded by many countries as a human right.

This chapter will explore the growing awareness over the last few decades of the enormity of the problem, the development of thought and practice as we have attempted to meet the challenge, the state of affairs in the world at present and the options for the future.

Setting Standards for Basic Water Needs

The minimum amount of water required to meet basic needs vary depending upon what is included as "basic needs". The figures vary from 20 to 50 litres per person per day. Setting specific quantities as standards should be generally avoided, recognising the importance of context and the need for each country or region to set appropriate goals. Standards need to be set with great care as they can be counter productive and result in communities facing "all or nothing" alternatives rather than an interim improvement of their current services.

Preferable to rigid standards are a set of development goals which allow both the possibility of monitoring progress and the opportunity for iterative improvements of current service levels towards the goals.

An example where standards were shown to be counter-productive was in South Africa where insistence on both affordability and a pre-determined standard of 25 l per person per day were mutually exclu-sive resulting in some poorer communities not being serviced - policy has subsequently changed. [Rural and Peri-Urban Water Supply and Sanitation in South Africa Appropriate Practice Conference - 14 - 17 March 1999]

Water, Sanitation, & Health

Water, sanitation and health are closely inter-related. In wealthier communities this connection is taken for granted but in poor developing communities the connection is a stark daily reality.

Water and health are related in a number of ways.

• Firstly, there is the direct impact of consuming contaminated water - this is known as 'waterborne disease' and includes diarrhoea, typhoid, viral hepatitis A, cholera, dysentery.




• Secondly, there is the effect of inadequate quantities of water being available for personal hygiene or the of un-hygienic practices which contaminate water and cause diseases. Without enough water, skin and eye infections (including trachoma) are easily spread, as are the faecal–oral diseases. These diseases are known as 'water-washed diseases'.




• Thirdly, there are 'water based diseases' and "water-related vector-borne diseases" in which the aquatic environment provides an essential habitat for the mosquito vectors and intermediate snail hosts of parasites that cause human diseases. Malaria, schistosomiasis, lymphatic filariasis, onchocerciasis and Japanese encephalitis are examples of these diseases.




• Fourthly, there is chemically contaminated water such as water containing excessive amounts of arsenic or floride. Some contaminants are added to drinking water as a result of natural processes and some due to human activities such as industry and mining. Poor communities, especially in urban fringe areas, are particularly susceptible to dangers from polluted water from a variety of sources due to lack of or poorly enforced regulation of water pollution.

The impacts on health of these factors is at a very large scale and accounts for more illness and death than any other factor in developing countries [2001, WHO]. The following impacts are the most severe:

• There are approximately 4 billion cases of diarrhoea each year cause 2.2 million deaths, mostly among children under the age of five. Water, sanitation, and hygiene interventions reduce diarrhoeal disease on average by between one-quarter and one-third.




• Intestinal worms infect about 10% of the population of the developing world. These can be controlled through better sanitation, hygiene and water supply. Intestinal parasitic infections can lead to malnutrition, anaemia and retarded growth, depending upon the severity of the infection.




• It is estimated that 6 million people are blind from trachoma and the population at risk from this disease is approximately 500 million.




• 300 million people suffer from malaria - 1 million people die of malaria in sub-Saharan Africa each year.




• Arsenic in drinking water is a major public health threat. It is estimated that in Bangladesh, 100,000 cases of skin lesions caused by arsenic have occurred and there may be many more.




• Fluoride in low amounts in drinking water can be beneficial to dental health but excessive amounts can be toxic. An estimated 30 million people suffer from chronic fluorosis in China alone. Fluoride is also present in potentially toxic quantities in the groundwater throughout the Rift Valley.




• 200 million people in the world are infected with schistosomiasis, of whom 20 million suffer severe consequences.

The WHO and UNICEF promote three key hygiene behaviours as having the greatest potential health impact

• Hand washing with soap (or ash or other aid).




• Safe disposal of children’s faeces.




• Safe water handling and storage.

Current Status

The WHO/UNICEF/WSSCC Global Water Supply and Sanitation Assessment 2000 Report provides information on the current status of basic water and sanitation services throughout the world. The report charts the developments since 1990. The current status is provided in Table 1 below:

The figures indicate that the number of people who do not have any form of improved water supply facility stands at 1.1 billion globally. The number of people without basic sanitation is 2.4 billion. Most of the unserved populations are in Africa and Asia, with the highest numbers of unserved people in Asia although the proportion of unserved is higher in Africa. Although these are daunting figures (one sixth of the world's population without water and two fifths without sanitation), it must be noted that progress has been made during the past 10 years despite an increase of 15% in the global population. The international target of reducing to a half the percentage of people not served with these services before 2015 is therefore a continuous race against increasing population. Taking population growth into account, to halve the proportion of unserved people by 2015 will require 2.2 billion additional people having access to safe sanitation (397 000 per day) and 1.5 billion to improved water services (292 000 people per day).

Fig. 1 - Water supply, distribution of unserved populations Source:WHO/UNICEF, 2000	Sanitation, Distribution of unserved populations - Source:WHO/UNICEF, 2000

Fig.3 - Proportion (%) of population with water supply services Source: WHO/UNICEF, 2000

Investment

It is important to review the pattern of investment for new infrastructure in the water supply and sanitation sectors to gain a perspective of the magnitude of the challenges and to determine the sources of support. All the figures quoted below were taken from the 2000 Global Water Supply and Sanitation Assessment Report.

There are four main sources of funds and resources available for investment - those from government (national, regional and local governments), private sector, external support largely from international donor sources, and the input of individuals, families and local communities. The value of the latter category is difficult to quantify in monetary terms. It is estimated that the total annual national and external investment in water supply and sanitation in Africa, Asia and Latin America and the Caribbean over the 90's was about US$ 16 billion.

Proportion of Spending on the Sector by National Governments
The median invested by governments for the construction of new facilities in relation to total public spending from 1990 to 2000 varies from region to region as follows:

| Africa: 5.3% | Asia: 3.6% | Latin America & Caribbean: 8.3% |

External Support Provided to Financing Water Supply and Sanitation
Part of the funding for construction of new water supply and sanitation infrastructure were provided, over the 90's, came from external support sources, in some cases, for example in Africa, these inputs exceeded investments made by national governments. This is illustrated by Fig. 4 below. The amounts provided by OECD countries have increased during the past decade with the largest contributors being Germany (US$ 3.4 billion 1990-2000) and Japan (US$ 9.5 billion 1990-2000)

Table 2: External financial support to water supply and sanitation
Source: OECD, 1998

Disparity Between Spending on Water Supply and Sanitation

Investment figures indicate that a higher priority has been given over the 90's for water supply as opposed to sanitation, both through national governments and by the international community.

Table 3: Table annual investments in water supply and sanitation indicating proportional disparity
Source: WHO/UNICEF, 2000

Comparison with Agenda 21 investment requirement estimates

The investment estimates made by the Rio Conference Secretariat to implement Agenda 21 proposals between 1993 - 2000 were 20 US$ billion average total annual cost, twice what was being spent at the time, which included 7.4 US$ billion from the international community. The actual expenditure, in terms of the 2000 Global Water Supply and Sanitation Assessment Report was 15.6 US$ billion with an average of 2.4 US$ billion derived from international sources over the period 1990 - 1996 (as per Table 2 above). This represents a 25% shortfall in total expenditure and a 67% shortfall in international spending.

Quality of service
The coverage figures quoted above do not indicate how reliable services are, both in terms of the availability of services and the quality of water provided through them. Unreliable services force consumers to use alternative, less safe sources and lead to problems with user satisfaction, cost recovery, vandalising of facilities, etc.

Dereliction and Intermittent Services
There are serious problems in developing regions with the sustainability and reliability of services. Dereliction rates and intermittent failure of services is estimated to be as high as one third (WHO/UNICEF, 2000). Whilst this figure represents an average, they may well underestimate the real dimension of the problem because records of failures and repairs are often not adequately kept and may be regarded as an embarrassment to authorities. What constitutes a "functioning" service varies in definition, and is often regarded as a system which operates at above 50% of its design capacity.

Table 4: Median percentage of rural water supplies which are functioning more than 50% of design capacity for more than 70% of the time on a daily basis
Source: WHO/UNICEF 2000

Lack of Disinfection

Many urban water supply systems in Africa, Asia, Latin America and the Caribbean do not disinfect the water supplied to consumers. This is most likely as a result of lack of technical capacity, cost, and operation and maintenance problems.

Lack of Treatment of Waste Water

The discharge of untreated sewage presents a particular health hazard, especially to poor communities in urban contexts who have to rely on unprotected water as their main sources of supply. In developing regions, waste water is treated in only a minority of situations, but even in industrialised countries treatment is not universal. See Figure 5.

Fig. 5: Median % of wastewater treated by effective plants Source: WHO/UNICEF 2000

Large Cities

The most striking trend during the past 10 years has been the comparatively rapid growth of population in urban areas. In 1990 43.5% of the world's population lived in urban areas - by 2000 the proportion had grown to 47%. This trend is likely to continue and will present particular challenges to governments, local authorities and communities in the future. Much of the growth is in informal settlements where service provision is particularly difficult, where the population is poorest and where health is particularly vulnerable to the effects of poor services and poor shelter.

A considerable problem facing many cities is that of unaccounted for water. This generally illustrates the efficiency of providers although not all of the unaccounted for water is wasted - some is utilised by consumers but not recorded as such or paid for.

Fig. 6: Mean unaccounted for water rates in large cities Source: WHO/UNICEF, 2000

Poverty reduction strategies

The current emphasis on poverty reduction which has been widely adopted by many international and bilateral development agencies, resulting in the formulation and adoption of broad, multi-sectoral country level poverty reduction strategies by many countries. It is vitally important that the issues of basic water and sanitation services be highlighted in such strategies, with specific attention being given to the different needs of the rural and urban poor.

Debt relief

Debt relief programs have released much needed funds for redirection into the provision of a range of basic health, education and infrastructure services in many of the least developed countries of the world in recent years. In some instances this has produced a hitherto unfamiliar pressure to spend funds rapidly within national fiscal time-frames without the necessary technical and administrative capacity. This often leads to a relaxation of hard learned lessons such as the critical importance of ensuring stakeholder participation. The need to fast-track expenditure also increases the rationale for the engagement of the private sector which brings with it greater capacity. It is of vital importance that extra available capital from factors such as debt relief is used to maximum benefit in the development of sustainable basic services.

Vision 21

• "A clean and healthy world: A world in which every person has safe and adequate water and sanitation and lives in a hygienic environment."

Vision 21, a unique initiative to address the needs of the unserved populations of the world compiled and published by the Water Supply and Sanitation Collaborative Council in March 2000, provides the principle current framework for action in the sector. Compiled out of a rigorous participatory process involving institutions, communities and individual experts from around the Globe, Vision 21 identifies four determining components and eleven core points.

Four components of the Vision are:

• Building on people’s energy and creativity at all levels, requiring empowerment and building the capacity of people in households and communities to take action, and applying technologies that respond to actual needs.




• Holistic approach, acknowledging hygiene, water and sanitation as a human right, and relating it to human development, the elimination of poverty, environmental sustainability and the integrated management of water resources.




• Committed and compassionate leadership and good governance, changing long-accustomed roles, leading to new responsibilities of authorities and institutions to support households and communities in the management of their hygiene, water and sanitation, and in being accountable to users as clients.




• Synergy among all partners, encouraging shared commitment among users, politicians and professionals; requiring professionals within the water and sanitation sector to combine technical expertise with an ability to work with users and politicians and with the sectors of health, education, environment, community development and food.




The targets set by Vision 21 are:

By 2015

• universal public awareness of hygiene




• percentage of people who lack adequate sanitation halved (target endorsed by the Second World Water Forum, The Hague, March 2000)




• percentage of people who lack safe water halved (endorsed in the United Nations Millenium Declaration)




• 80% of primary school children educated about hygiene




• all schools equipped with facilities for sanitation and hand washing




• diarrhoeal disease incidence reduced by 50%




By 2025

• good hygiene practices universally applied




• adequate sanitation for everyone




• safe water for everyone




• all primary school children educated about hygiene,




• diarrhoeal disease incidence reduced by 80%.

Key Factors for the Future

The key factors which will determine the development of the water supply and sector include:

Integration

Integration is needed in two main forms:

• The integration of the sector into broad poverty reduction strategies including the development of better understanding of the real relationship between poverty and sustainable service delivery and the role of basic services as components of poverty reduction strategies.




• Integration of sectors in the common assault on poverty, in particular greater integration between public health, basic water supply and sanitation delivery, and hygiene promotion.

Continued Rigorous Application of Best Practice

It is important that all of the valuable lessons learned over the past 30 years in the sector at great cost are continued to be practised. Disproportionate emphasis placed on some factors to the exclusion of others create false dichotomies which hamper integrated development, for example viewing options as "either-or" alternatives such as private sector engagement versus community participation - rather than "both-and" alternatives such as private sector engagement combined with community participation, water quantity and water quality. If the past 30 years has taught us anything it is that sustainable basic service delivery is complex and extremely difficult to achieve - the needs of the poor dictate that we do not have the luxury of having to learn lessons twice.

Political Engagement and Advocacy

It is critical to recognise the political nature and backdrop to all activity related to the provision of basic water supply and sanitation - if the targets are to be achieved, 280 000 people will need to be provided with improved water services per day and 384 000 with safe sanitation for the next 15 years. For this to be achieved we will need to develop and employ every possible advocacy and political tool at our disposal. The sector needs to be fundamentally politicised - not in a partisan way for the benefit of officials and politicians, but through the expression of the needs of the people, especially the poor.

Private Sector

Much expectation has been created with regards to the potential of the private sector and private investment to meet the backlog in basic water supply and sanitation. Some of this has been generated more from a perspective of economic dogma (and equally resisted on the same basis but from opposite perspectives). Whilst it is clear that alternatives to traditional public sector provision need to be found, successful, sustainable and equitable engagement of the private sector in services provision remains elusive, producing a mixture of partial successes and partial failures. Further lessons need to be learned to fully understand the criteria for success under the myriad complexities of local situations.

Human Rights

International determination and acknowledgement that basic water and sanitation constitute fundamental human rights need to be specifically made. In order to achieve the targets, every leverage needs to be brought to bare. Inferred and derived rights are now insufficient, explicit rights are needed.

Monitoring

There is little to be gained by setting global targets if the progress of the sector is not monitored. Monitoring of the sector is important for a number of reasons. Presenting reliable, verifiable figures increases political accountability and enables advocacy to be targeted responsibly and to greatest effect to improve the equity with which services are provided. It also assists governments and external support agencies to identify problem areas, measure the effectiveness of public/private partnerships and apply corrective measures to policy, planning and implementation, thus increasing the efficiency with which scarce resources are deployed.

Effective monitoring procedures and strategies are difficult to implement, however. They require both political will and resources. Often in over-stretched and under-resourced situations where there are large backlogs of unserviced consumers, monitoring is considered a luxury and not afforded adequate priority.

During the 1990s improved methods and approaches to data collection, analysis and access has lead to more effective monitoring. There has been a rise in the awareness of communities concerning their rights to information and the need for official transparency. There has been an increase in the people and groups involved in data collection and new methods of participatory appraisal and qualitative information collection have been developed.

Conclusion

One of the clearest indications of a shift in approach to the problems which face the many hundreds of millions of people who do not have access to acceptable levels of water supply and sanitation is the approach of the VISION 21 process. In the concluding remarks of the VISION 21 document, the process is described as a 'movement'. The terminology is that of the mobilisation of people at all levels, of the engagement of the grass-roots and of the development of a 'Framework of Action' which stresses the need for each region, country and area to find the most appropriate solutions and methods of meeting the targets. The political processes and the political support required to ensure that the targets are achieved are beginning to be recognised, together with the fact that they cannot be achieved through activities within the water supply and sanitation sectors only.

The Global Water Supply and Sanitation Assessment 2000 Report identifies four major challenges facing the water supply and sanitation sector in the years to come if the targets are to be reached:

• Keeping pace with a net population growth of more than a billion people over the next 15 years.




• Closing the coverage and service gap, with emphasis on sanitation which lags considerably behind water supply.




• Ensuring sustainability of existing and new services.




• Improving the quality of services.

The particular points of challenge will be in urban areas and in the provision of services in Asia where the numbers of unserved people exceeds that of Africa, Latin America and the Caribbean combined. The report concludes that it will not be possible to meet the VISION 21 targets (which imply 292 000 new water services and 397 000 new sanitation services per day) under the current rates of services provision and that 'dramatic' changes are needed, primarily at an institutional and social level underpinned by political commitment.

Concluding Remarks

Over the past decades a great deal has been learned and significant headway has been made in providing basic water and sanitation services to the poor of the world. Currently delivery rates at a global level are staying slightly ahead of population growth rates. As we face the prospect of mega-city growth in developing countries the challenge increases. Basing the quest for universal coverage within broad struggle against poverty provides the incentives to raise the issue to new strategic political levels and to integrate our efforts in the sector with those of related sectors. Vision 21 need not be an elusive dream but it will require extraordinary effort and commitment from everyone from the remotest urban ghetto and rural village to leaders of nations and the global community.

References

Gleick, Peter - The Human Right to Water - 1(5) Water Policy Journal 487-503 (1999).

Proceedings of the Rural and Peri-Urban Water Supply and Sanitation in South Africa Appropriate Practice Conference - 14 – 17 March 1999, East London, South Africa

Water for Health, World Water Day, 2001, WHO

Vision 21, 2000, Water Supply and Sanitation Collaborative Council (WSSCC)

Global Water Supply and Sanitation Assessment 2000 Report, 2000, WHO, UNICEF & WSSCC

Statistics on official development assistance to the water sector. Paris, Organisation for Economic Co-operation and Development, 1998 (Document prepared for Water and Sustainable Development Conference, Paris, March 1998).

The Fourth Country Level Collaboration Workshop in East and Southern Africa (ESA), THE MPUMALANGA STATEMENT - November 1999, Mpumalanga Province, South Africa

Universal Declaration of Human Rights (1948)

Dublin Principles - World Conference on Water and the Environment (Dublin, 1992)