Access to Water and Sanitation – the Millennium Development Goals (MDGs)

Compiled by:
Risch Tratschin (seecon international gmbh)

Executive Summary

To improve the quantitative and qualitative access to drinking-water sources and sanitation facilities is part of the Millennium Development Goals (Target 10), because it is crucial to human development. By 2010, still 2.5 billion people do not have access to improved sanitation facilities and 780 million people do not have access to improved sources of drinking-water (UNICEF WHO 2012). The practice of open defecation is declining, but still too many people have no access to any kind of sanitation facilities.

Introduction

Today’s water and sanitation crisis is rather an issue of access than of scarcity. It is mainly rooted in poverty, power and inequality, not in physical availability (UNDP 2010). More people in the world own cell phones than have access to a toilet. And as cities and slums grow at increasing rates, the situation worsens. Every day, lack of access to clean water and sanitation kills thousands, leaving others with reduced quality of life (WATER.ORG 2011).

Four of every ten people in the world do not have access to even a simple pit latrine; and nearly two in ten have no source of safe drinking water. This silent humanitarian crisis kills some 3,900 children every day, thwarts progress toward all the Millennium Development Goals, especially in Africa and Asia; and robs the poorest — particularly women and girls — of their health, time and dignity (UNMP-TWS 2005).

Access to water and sanitation refers not only to its quantity but also to its quality. How far the quality and especially the functionality are considered to evaluate the access is a controversial question (see below).

Considering that the growing world population together with climatic changes might worsen the water scarcity for some regions, the promotion of access to water and sanitation is a steadily increasing challenge.

Why Is Access to Water and Sanitation Crucial?

Water is needed for all aspects of life. Without safe drinking water, humans, animals and plants cannot survive. And still, half of the people in the developing world are suffering from diseases associated with inadequate provision of water supply and sanitation facilities (see also water sanitation and health). Every year, 1.4 million children die from diarrhoea (see also water-related diseases) which corresponds to one child every 20 seconds. Further, 443 million school days are lost annually worldwide due to diarrhoeal diseases (WATERAID.ORG 2011). Six million people suffer from preventable blindness, most commonly caused by trachoma. The disease is strongly related to the absence of safe water for washing face and hands (UNMP-TWS 2005). Furthermore, inadequate sanitation causes economic losses (WSP 2010) and is seen to be one of the most important development drivers (UNDP 2010).

Access to water and sanitation, the prevention of polluting water, and improved hygiene are essential in improving the living standards of anyone on this planet. Furthermore, adequate water resources are essential for food production and thus for proper nutrition.

Millennium Development Goals (MDGs)

In September 2000, the United Nations Millennium Declaration (UNGA 2000) was adopted. This Declaration calls for halving by the year 2015 the number of people who live on less than one dollar a day; to find solutions to hunger, malnutrition and disease, promote gender equality and the empowerment of women, guaranteeing a basic education for everyone, and support the Agenda 21 principles of sustainable development. The objective of the Declaration is to promote a comprehensive approach and a coordinated strategy, tackling many problems simultaneously across a broad front.

To help track progress, the United Nations Secretariat and the specialised agencies of the UN system, as well as representatives of the IMF, the World Bank and the OECD, defined a set of eight time-bound and measurable goals and targets for combating poverty, hunger, disease, illiteracy, environmental degradation and discrimination against women (UN 2010).

The Millennium Development Goal 7: Ensuring Environmental Sustainability

The MDG 7 aims at ensuring environmental sustainability and addresses the challenges in regards to the access to water and sanitation. MDG 7 is a key prerequisite for overall MDG achievement. It represents the concept that instead of focusing attention on negative environmental impacts of development investments, it is urgent to instead focus on how we can make environmental sustainability work for MDG achievement (SEI 2005).

The MDG 7c (sometimes also referred to as Target 10 of the MDGs) wants to “halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation” compared to 1990 (UN 2010). The target population is calculated based on the estimated total population in 2015 (SEI 2005).

Indicators for the MDG 7c

In order to measure the implementation progress of MDG 7c, target indicators were introduced (WHO UNICEF 2010; UN 2003). These are the two following, both split up between urban and rural regions:

 

  • “proportion of population using an improved sanitation facility, urban and rural”
  • “proportion of population using an improved drinking-water source, urban and rural”

 

Because definitions of improved sanitation facilities and drinking-water sources can vary widely within and among countries and regions, and because progress has to be measured at global level and across time, the Joint Monitoring Programme on Water and Sanitation (JMP) has defined by categories what means improved and what unimproved water sources and sanitation facilities (WHO UNICEF 2010).

 WHO UNICEF 2010)

To categorise different sanitation facilities and drinking-water sources is the only way to measure access to water and sanitation globally and over time. This is the categorisation introduced and used by the JMP. Source: WHO UNICEF (2010)

In line with the MDG indicator definition which stipulates “use of improved facilities” as a proxy for “access to improved facilities”, the JMP measures and reports on the actual use of improved facilities. The household surveys on which the JMP relies also measure “use” and not “access”–since access involves many additional criteria other than use. Measurability of many of these criteria at the national scale – which is the scale required by the JMP –poses a huge challenge (AMCOW 2010).

Also the meaning of “improved” is still an issue: Opposed to the terminology of “basic sanitation” established by the 2002 World Summit on Sustainable Development (WSSD) and used in the MDG target 10, the JMP uses the terminology of “improved sanitation”. The definition of WSSD is broader and links access to sanitation also to improved human health and reduced infant and childhood mortality, while the JMP monitoring had to choose other priorities (monitoring based on existing household survey; comparability of data across time and countries) (UNMP-TWS 2005).

Other experts have criticised that the MDG criteria focus too much on the presence of technical solutions and neglect the importance of their functionality. For the sanitation facilities they suggest a more sophisticated set of indicators by promoting the “function-based sanitation ladder”, which foresees seven steps reaching from the basic excreta containment (step 1), the pathogen elimination (step 4) to the integrated resource management (step 7) (ECOSANRES 2010).

The AMCOW criticises that the MDG indicator is biassed against countries struggling with high population growth that started out with low baseline coverage in 1990. They propose to look beyond coverage rates and to take into account absolute numbers of people affected by change (AMCOW 2010).

Gap and Progress Related to Access to Water

Regional distribution of the 780 million people not using improved drinking-water sources in 2010, population (million). Source: UNICEF WHO (2012)

In 2010, about 11% of the world’s population (780 million people) did not have access to an improved source of drinking-water and had to use unprotected wells or springs, canals, lakes or rivers for their water needs (UN 2012). Sub-Saharan Africa accounts for over 40% of that number (333 million people), Southern Asia for 20% (170 million) and Eastern Asia for another 16% (128 million) (UNICEF WHO 2012).

Worldwide use of improved drinking-water sources in 2010, displaying the huge challenges in Sub-Saharan Africa. Source: UNICEF WHO (2012)

Over the 1990-2010 period, most of the progress was made in Eastern Asia (35% more people) and South-eastern Asia (23% more). Although coverage also expanded in Sub-Saharan Africa by 12% it remains very low, with only 61% of the population using improved sources of drinking-water. The progress is heavily influenced by improvements achieved in large, populous countries. Almost half of the world population gaining improved access to improved sources of drinking water between 1990 and 2010 live in China and India (UNICEF WHO 2012; UN 2010).

Proportion of the population using piped drinking water on premises, other improved drinking-water source or an unimproved source, by MDG region, in 1990 and 2010. Source: UNICEF WHO (2012)                            

In all regions, progress was made primarily in rural areas. In the developing regions as a whole, drinking water coverage in urban areas, which stood at 96% in 2010, has remained almost unchanged since 1990. At the same time, rural drinking water coverage increased from 60% in 1990 to 81% in 2010, narrowing the gap between rural and urban areas (UNICEF WHO 2012; UN 2010).

Gap and Progress Related to Access to Sanitation

Regional distribution of the 2.5 billion people not using improved sanitation facilities in 2010, population (million). Source: UNICEF WHO (2012)

In 2010, improved sanitation facilities are used by only 63% of the world population. Among the 2.5 billion people in the world who do not use improved sanitation facilities, by far the greatest number are in Southern Asia (1005 million people), but there are also large numbers in Eastern Asia (484 million) and Sub-Saharan Africa (599 million).

The global picture masks great disparities between regions: while virtually the entire population of the developed regions uses improved facilities, in developing regions only around half the population uses improved sanitation (UNICEF WHO 2012).

Worldwide use of improved sanitation facilities in 2010, putting highlights on the urgency of sanitation improvements in Southern Asia, Sub-Saharan and Central Africa. Source: UNICEF WHO (2012)

Absolute and relative numbers of progress show different realities. For example, 173 million Africans gained access to an improved sanitation facility between 1990 and 2008, but the population without an improved sanitation facility increased by 175 million in the same period. When looking at the relative numbers which consider the population growth (from 639 million to 987 million, +54%), it appears that the ratio of people using improved sanitation also increased from 36 to 41%, but that of people without improved sanitation decreased from 64 to 59% (AMCOW 2010).

Proportion of the population using an improved, shared or unimproved sanitation facility or practising open defecation, by MDG region, in 1990 and 2010. Source: UNICEF WHO (2012)

Among sanitation practice, the one that poses the greatest threat to human health is open defecation. Over the 1990-2008 period, open defecation declined in all regions and has decreased worldwide from 25% to 15%. Open defecation is still most widely practised in Southern Asia and Sub-Saharan Africa – by 41% and 25% of the population, respectively. In contrast, open defecation is now practised by only 4% of the population in Northern Africa and Eastern Asia and 3% in Western Asia. In five of the seven developing regions for which data are available, less than 15% of the population practises open defecation (UNICEF WHO 2012; UN 2010).

Outlook

(Adapted from UNICEF WHO 2012)

Over 2 billion people gained access to improved water sources and 1.8 billion people gained access to improved sanitation facilities between 1990 and 2010. The MDG drinking water target, which calls for halving the proportion of the population without sustainable access to safe drinking water between 1990 and 2015, was met in 2010, five years ahead of schedule. However, the report also shows why the job is far from finished. Many still lack safe drinking water, and the world is unlikely to meet the MDG sanitation target. Over 780 million people are still without access to improved sources of drinking water and 2.5 billion lack improved sanitation. If current trends continue, these numbers will remain unacceptably high in 2015: 605 million people will be without an improved drinking water source and 2.4 billion people will lack access to improved sanitation facilities.

Continued efforts are needed to reduce urban-rural disparities and inequities associated with poverty; to dramatically increase coverage in countries in sub-Saharan Africa and Oceania; to promote global monitoring of drinking water quality; to bring sanitation ‘on track’; and to look beyond the MDG target towards universal coverage.The report on the MDGs from 2010 forecasts that the world will meet or even exceed the MDG drinking-water target by 2015. By that time, an estimated 86% of the population in developing regions will have gained access to improved sources of drinking water compared to 77% in 1990. However, the progress is not well balanced regionally. Water quality is still a challenge in many parts of the world. And the gap between rural and urban safe water supply is still substantial in some regions.

With half the population of developing regions without sanitation, the 2015 target appears to be out of reach. But the Millennium Development Goals are still attainable. The critical question today is how to transform the pace of change into dramatically faster progress. As the Millennium Declaration represents the most important promise ever made to the world’s most vulnerable people, it is the world community’s duty not to disappoint those in need all over the world.

References Library

AFRICAN MINISTERS’ COUNCIL ON WATER (AMCOW) (Editor) (2010): A Snapshot of Drinking Water and Sanitation in Africa – 2010 Update. A Regional Perspective Based on New Data from the WHO/UNICEF JMP for Water Supply and Sanitation. Abuja: African Ministers’ Council on Water. URL [Accessed: 29.03.2011].

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UN MILLENNIUM PROJECT TASK FORCE ON WATER AND SANITATION (UNMP-TWS) (Editor) (2005): Health, Dignity and Development: What Will it Take?. London: United Nations Development Programme. URL [Accessed: 28.03.2011].

UNW-DPAC (Editor) (2010): The MDG Target on Water and Sanitation Reader. UN-Water Decade Programme on Advocacy and Communication (UNW-DPAC). Zaragoza: UN Office to Support the International Decade for Action ‘Water for Life’ 2005-2015. URL [Accessed: 31.03.2011].

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UNICEF (Editor); WHO (Editor) (2012): Progress on Drinking Water and Sanitation. Update 2012. New York/Geneva: United Nations International Children’s Emergency Fund (UNICEF)/World Health Organisation (WHO). URL [Accessed: 19.04.2012].

Further Readings Library

Reference icon

UN-WATER (Editor) (2013): The Post 2015 Water Thematic Consultation Report. New York: United Nations Water (UN-Water). URL [Accessed: 26.08.2013].

This report is the result of a stakeholder consultation organised by the United Nations and partners to lay the groundwork for a new development agenda after 2015. The contributions are organised around three main topics: access to drinking water, sanitation and hygiene; water resources and wastewater management; and water quality improvements.


Reference icon

UNICEF (Editor); WHO (Editor) (2012): Progress on Drinking Water and Sanitation. Update 2012. New York/Geneva: United Nations International Children’s Emergency Fund (UNICEF)/World Health Organisation (WHO). URL [Accessed: 19.04.2012].

There are still 780 million people without access to an improved drinking water source. And even though 1.8 billion people have gained access to improved sanitation since 1990, the world remains off track for the sanitation target. It is essential to accelerate progress in the remaining time before the MDG deadline, and I commend those who are participating in the Sustainable Sanitation: Five Year Drive to 2015. This report outlines the challenges that remain. Some regions, particularly sub- Saharan Africa, are lagging behind. Many rural dwellers and the poor often miss out on improvements to drinking water and sanitation. And the burden of poor water supply falls most heavily on girls and women. Reducing these disparities must be a priority.


Reference icon

ECOSANRES (Editor) (2010): The Sanitation Ladder – A Need for a Revamp?. Stockholm: Stockholm Environment Institute EcoSanRes Programme. URL [Accessed: 31.03.2011].


Reference icon

WHO (Editor); UNICEF (Editor) (2010): Progress on Sanitation and Drinking-Water. 2010 Update. Geneva: World Health Organisation (WHO) / New York: UNICEF. URL [Accessed: 14.04.2011].

This well illustrated report describes the status and trends with respect to the use of safe drinking-water and basic sanitation, and progress made towards the MDG drinking-water and sanitation target. It presents some striking disparities: the gap between progress in providing access to drinking-water versus sanitation; the divide between urban and rural populations in terms of the services provided; differences in the way different regions are performing, bearing in mind that they started from different baselines; and disparities between different socioeconomic strata in society. Each JMP report assesses the situation and trends anew and so this JMP report supersedes previous reports (e.g. from 2004, 2006 and 2008).


Reference icon

HAMMOND, A.; KRAMER, W.; KATZ, R. ; TRAN, J.; WALKER, C.; WRI (Editor) (2007): The Next 4 Billion. Market Size and Business Strategy at the Base of the Pyramid. Washington DC: World Resources Institute (WRI). URL [Accessed: 22.06.2011].

Four billion low-income people, a majority of the world’s population, constitute the base of the economic pyramid. New empirical measures of their behavior as consumers and their aggregate purchasing power suggest significant opportunities for market-based approaches to better meet their needs, increase their productivity and incomes, and empower their entry into the formal economy.


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OECD (Editor) (2004): Closing the Sanitation Gap – the Case for Better Public Funding of Sanitation and Hygiene. Round Table on Sustainable Development. Paris: OECD. URL [Accessed: 31.03.2011].

This 25-page document gives a well-balanced overview of the targets, means and progress on closing the gap of access to sanitation worldwide. It also elaborates on financial aspects required for closing the sanitation gap. While the body is only as long as 11 pages, an extensive footnote section provides further information.


Reference icon

PEREZ, E.; CARDOSI, J.; COOMBES, Y.; DEVINE, J.; GROSSMAN, A.; KULLMANN, C.; KUMAR, C.A.; MUKHERJEE, N.; PRAKASH, M.; ROBIARTO, A.; SETIWAN, D.; SINGH, U.; WARTONO, D.; WSP (Editor) (2012): What Does It Take to Scale Up Rural Sanitation?. (= Scaling Up Rural Sanitation). Water and Sanitation Program (WSP). URL [Accessed: 19.07.2012].

This working paper addresses lessons and best practices that were identified by the Water and Sanitation Program (WSP) to generate demand and supply for sanitation on the local and household level as well as strengthening governments in order to scale up sanitation projects.


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ROMA, E.; PUGH, I, (2012): Toilets for health. London: London School of Hygiene & Tropical Medicine. URL [Accessed: 27.11.2012].

This is a comprehensive report on why toilets matter. The report is rich in infographics, provides overview of the sanitation crisis and the related burden of disease in developing countries.


Reference icon

SEI (Editor) (2005): Sustainable Pathways to Attain the Millennium Development Goals: Assessing the Key Role of Water, Energy and Sanitation. Stockholm: Stockholm Environmental Institute. URL [Accessed: 30.03.2011].

This report highlights the importance of the environment in achieving all MDGs. It focuses on three core aspects of goal fulfilment, namely freshwater to eradicate hunger and sustain ecosystems, energy and sanitation for poverty alleviation, health improvements and environmental sustainability.


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UN (Editor) (2011): (The) Millennium Development Goals Report 2011. New York: United Nations (UN). URL [Accessed: 17.10.2011].

This document annually informs about the progresses concerning the Millennium Development Goals (MDG's) of the United Nations.

See document in SPANISH


Reference icon

UN MILLENNIUM PROJECT TASK FORCE ON WATER AND SANITATION (UNMP-TWS) (Editor) (2005): Health, Dignity and Development: What Will it Take?. London: United Nations Development Programme. URL [Accessed: 28.03.2011].

The UN Millennium Project Task Force on Water and Sanitation published this extensive report in 2005 with two main aims: First, it highlights which specific policies and resources are needed to meet the MDGs and who needs to take reasonability for ensuring they are in place. And secondly, it identifies the specific policies and resources required to meet the MDGs as part of a larger UN Millennium Project. It also pinpoints actions required in other sectors, emphasising that advances in a number of other areas strongly affect the ability of countries to meet the MDG water and sanitation target (7c) and to optimise water use.


Reference icon

UNW-DPAC (Editor) (2010): The MDG Target on Water and Sanitation Reader. UN-Water Decade Programme on Advocacy and Communication (UNW-DPAC). Zaragoza: UN Office to Support the International Decade for Action ‘Water for Life’ 2005-2015. URL [Accessed: 31.03.2011].

Compiled by the UN-Water Decade Programme on Advocacy and Communication (UNW-DPAC), this reader is intended for all those interested in getting familiar with issues related to the achievement of target 7c of the MDGs. It provides basic references for easy reading and some of the latest and most relevant United Nations publications on issues related to the accomplishment of the Millennium Development Goals (MDGs) as they relate to water and sanitation. Link is provided when the publication is available online.


Reference icon

UNICEF (Editor); WHO (Editor) (2011): Drinking Water: Equity, Safety and Sustainability. New York and Geneva: United Nations Children's Fund (UNICEF) and World Health Organization (WHO). URL [Accessed: 05.03.2012].

The report investigates access to and use of drinking water in greater detail than is possible in the regular JMP progress reports, and includes increased disaggregation of water service levels and analyses of trends across countries and regions. It focuses on the three key challenges of equity, safety and sustainability.


Reference icon

WATERAID (Editor) (2012): Water Security Framework. London: WaterAid. URL [Accessed: 08.08.2012].

A water security framework which links sustainable WASH services to livelihood, environmental and food security water uses. It sets out fundamental priorities for improving the water security of poor and marginalised people as part of a community based approach to water resource management. The document consists of five parts: (I) Definition and measurement of water security; (II) Threats to community's water security; (III) The four main dimensions of water security; (IV) Community-based water resource management approaches; (V) WaterAid's minimum commitments to ensuring water security.


Reference icon

WHO (Editor); UNICEF (Editor) (2006): Meeting the MDG Drinking Water and Sanitation Target: The Urban and Rural Challenge of the Decade. Geneva and New York: World Health Organization (WHO) and United Nations Children's Fund. URL [Accessed: 04.10.2011].

The Millennium Development Goals (MDGs) have set us on a common course to push back poverty, inequality, hunger and illness. The world has pledged to reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation. Entering the International Decade for Action, Water for Life, 2005–2015, this report looks at the challenge of meeting the MDG target for drinking water and sanitation. Achieving the MDG drinking water and sanitation target poses two major challenges: a rapid pace of urbanization, which requires a major effort even to keep up the current coverage levels; a huge backlog of rural people unserved with basic sanitation and safe drinking water, which calls for an intensive mobilization of resources to reduce the vast coverage gap between urban and rural populations.


Reference icon

WHO (2012): UN-Water Global Annual Assessment of Sanitation and Drinking-Water (GLAAS). The Challenge of Extending and Sustaining Services. Geneva: World Health Organization (WHO). URL [Accessed: 17.04.2013].

This report is produced every two years by the World Health Organization (WHO) on behalf of UN-Water. It provides a global update on the policy frameworks, institutional arrangements, human resource base, and international and national finance streams in support of sanitation and drinking-water. It is a substantive input into the activities of Sanitation and Water for All (SWA).


Reference icon

GALAN, D.I.; KIM, S.; GRAHAM, J.P. (2013): Exploring Changes in Open Defecation Prevalence in Sub-Saharan Africa Based on National Level Indices. In: BMC Public Health 13, 1-12. URL [Accessed: 28.08.2013].

This study estimates the changes in open defecation prevalence between 2005 and 2010 across countries in Sub-Saharan Africa. It also explores the association between national level indices and changes in open defecation prevalence and assesses how many countries can achieve “open defecation free status” by 2015.


Reference icon

WHO (Editor); UNICEF (Editor) (2013): Progress on Sanitation and Drinking-Water. 2013 Update. New York/Geneva: United Nations International Children’s Emergency Fund (UNICEF)/World Health Organisation (WHO). URL [Accessed: 21.08.2013].

This well illustrated report describes the status and trends with respect to the use of safe drinking-water and basic sanitation, and progress made towards the MDG drinking-water and sanitation target. It presents some striking disparities: the gap between progress in providing access to drinking-water versus sanitation; the divide between urban and rural populations in terms of the services provided; differences in the way different regions are performing, bearing in mind that they started from different baselines; and disparities between different socioeconomic strata in society. Each JMP report assesses the situation and trends anew and so this JMP report supersedes previous reports


Reference icon

DANGOUR, A.D.; WATSON, L.; CUMMING, O.; BOISSON, S.; CHE, Y.; VELLEMAN, Y.; CAVILL, S.; ALLEN, E.; UAUY, R. (2013): Interventions to Improve Water Quality and Supply, Sanitation and Hygiene Practices, and Their Effects on the Nutritional Status of Children. (= Cochrane Database of Systematic Reviews 2013, 8). Chichester: John Wiley & Sons. URL [Accessed: 05.09.2013].

Water, sanitation and hygiene interventions are frequently implemented to reduce infectious diseases, and may be linked to improved nutrition outcomes in children. The objective of this paper is to evaluate the effect of interventions to improve water quality and supply, provide adequate sanitation and promote handwashing with soap, on the nutritional status of children under the age of 18 years and to identify current research gaps.


Reference icon

SPEARS, D. (2013): How much International Variation in Child Height Can Sanitation Explain?. (= Policy Research Working Paper, 6351). Washington: The World Bank Water and Sanitation Program (WSP). URL [Accessed: 23.09.2013].

Physical height is an important economic variable reflecting health and human capital. Puzzlingly, however, differences in average height across developing countries are not well explained by differences in wealth. This paper provides the first documentation of a quantitatively important gradient between child height and sanitation that can statistically explain a large fraction of international height differences.


Reference icon

ALBUQUERQUE, C. (2013): Report of the Special Rapporteur on the Human Right to Safe Drinking Water and Sanitation, Catarina de Albuquerque. (=Report submitted to the General Assembly’s Human Rights Council, 24th session, July 11, 2013). Geneva: Office of the United Nations High Commissioner for Human Rights (OHCHR). URL [Accessed: 07.10.2013].

Focusing on sustainability in the realization the human rights to water and sanitation, the report examines how the rights to water and sanitation can and must be met for present and future generations. Using the human rights framework, the report analyses states’ common approaches to water and sanitation, particularly in adopting measures both during times of normalcy and during economic and financial crises, and shows how those approaches often fail to incorporate sustainability.


Reference icon

CLASEN, T.F.; ROBERTS, I.G.; RABIE, T.; SCHMIDT, W.P.; CAIRNCROSS, S. (2009): Interventions to Improve Water Quality for Preventing Diarrhoea. In: The Cochrane Library. Chichester: John Wiley & Sons. URL [Accessed: 30.09.2013].

Diarrhoeal diseases are a leading cause of mortality and morbidity, especially among young children in developing countries. While many of the infectious agents associated with diarrhoeal disease are potentially waterborne, the evidence for reducing diarrhoea in settings where it is endemic by improving the microbiological quality of drinking water has been equivocal. The aim of the present study is to assess the effectiveness of interventions to improve water quality for preventing diarrhoea.


Reference icon

CROSS, P.; COOMBES, Y. (2013): Sanitation and Hygiene in Africa: Where do we Stand?. Analysis from the AfricaSan Conference, Kigali, Rwanda. London: International Water Association (IWA) Publishing. URL [Accessed: 01.11.2013].

This book takes stock of progress made by African countries through the AfricaSan process since 2008 and the progress needed to meet the MDG on sanitation by 2015 and beyond. It addresses priorities which have been identified by African countries as the key elements which need to be addressed in order to accelerate progress.This book is essential reading for government staff from Ministries responsible for sanitation, sector stakeholders working in NGOs, CSOs and agencies with a focus on sanitation and hygiene and water and Sanitation specialists. It is also suitable for Masters courses in water and sanitation and for researchers and the donor community.


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BRADLEY, D.J.; BARTRAM, J.K. (2013): Domestic Water and Sanitation as Water Security. Monitoring, Concepts and Strategy. In: Philosophical Transactions of the Royal Society, 371. London: Royal Society Publishing. URL [Accessed: 01.11.2013].

As distinct from many other domains to which the concept of water security is applied, domestic or personal water security requires a perspective that incorporates the reciprocal notions of provision and risk, as the current status of domestic water and sanitation security is dominated by deficiency. This paper reviews the interaction of science and technology with policies, practice and monitoring, and explores how far domestic water can helpfully fit into the proposed concept of water security, how that is best defined, and how far the human right to water affects the situation.


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ISLAM, M.S.; MAHMUD, Z.H.; GOPE, P.S.; ZAMAN, R.U.; HOSSAIN, Z.; ISLAM, M.S.; MONDAL, D.; SHARKER, M.A.Y.; ISLAM, K.; JAHAN, H.; BHUIYA, A.; ENDTZ, H.P.; CRAVIOTO, A.; CURTIS, V.; TOUR, O.; CAIRNCROSS, S. (2013): Hygiene Intervention Reduces Contamination of Weaning Food in Bangladesh. In: Tropical Medicine and International Health 18, 250-258. Chichester: John Wiley & Sons. URL [Accessed: 25.11.2013].

This study was conducted to measure the impact of a hygiene intervention on the contamination of weaning food in Bangladesh.


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UNESCO; UNESCO (Editor) (2015): The United Nations World Water Development Report 2015. Water for a Sustainable World. Paris: UNESCO. URL [Accessed: 23.11.2016].

Water resources, and the range of services they provide, underpin poverty reduction, economic growth and environmental sustainability. From food and energy security to human and environmental health, water contributes to improvements in social wellbeing and inclusive growth, affecting the livelihoods of billions. This report provides a summary on how water and related resources are managed in support of human well-being and ecosystem integrity in a robust economy.


Case Studies Library

Reference icon

AFRICAN MINISTERS’ COUNCIL ON WATER (AMCOW) (Editor) (2010): A Snapshot of Drinking Water and Sanitation in Africa – 2010 Update. A Regional Perspective Based on New Data from the WHO/UNICEF JMP for Water Supply and Sanitation. Abuja: African Ministers’ Council on Water. URL [Accessed: 29.03.2011].

This Snapshot of Drinking Water and Sanitation in Africa (2010 update) aims at informing on the status and trends in progress towards achieving the MDG drinking-water and sanitation target in Africa. It includes statistics, illustrations, tables and graphics specifically related to the African continent, based on the JMP 2010 report data and prepared in collaboration with the WHO/UNICEF JMP.


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ARNOLD, B.F.; NULL, C.; LUBY, S.; UNICOMB, L.; STEWART, C.; DEWEY, K.; AHMED, T.; ASHRAF, S.; CHRISTENSEN, G.; CLASEN, T.; DENTZ, H.N.; FERNALD, L.C.H.; HAQUE, R.; HUBBARD, A.; KARIGER, P.; LEONTSINI, E.; LIN, A.; NJENGA, S.M.; PICKERING, A.J.; RAM, P.K.; TOFAIL, F.; WINCH, P.; COLFORD, J.M. (2013): Cluster-Randomised Controlled Trials of Individual and Combined Water, Sanitation, Hygiene and Nutritional Interventions in Rural Bangladesh and Kenya. The WASH Benefits Study Design Rationale. In: BMJ Open.. London: British Medical Journal Group (BMJ Group). URL [Accessed: 23.09.2013].

Water quality, sanitation, handwashing and nutritional interventions can independently reduce enteric infections and growth faltering. There is little evidence that directly compares the effects of these individual and combined interventions on diarrhoea and growth when delivered to infants and young children. The objective of the WASH Benefits study is to help fill this knowledge gap.


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SPEARS, D.; GHOSH, A.; CUMMING, O. (2013): Open Defecation and Childhood Stunting in India. An Ecological Analysis of New Data from 112 Districts. In: PLOS ONE 9. San Francisco/Cambridge: Public Library of Science (PLoS). URL [Accessed: 23.09.2013].

Poor sanitation remains a major public health concern linked to several important health outcomes; emerging evidence indicates a link to childhood stunting. In India over half of the population defecates in the open; the prevalence of stunting remains very high. Recently published data on levels of stunting in 112 districts of India provide an opportunity to explore the relationship between levels of open defecation and stunting within this population.


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KOV, P.; SMETS, S.; SPEARS, D.; VYAS, S. (2013): Growing Taller Among Toilets. Evidence from Changes in Sanitation and Child Height in Cambodia, 2005-2010. Amston: Research Institute for Compassionate Economics (RICE). URL [Accessed: 23.09.2013].

Child height is an important indicator of human capital and human development. Recent medical evidence suggests that exposure to poor sanitation - and speci cally to widespread open defecation - can pose a critical threat to child growth. This paper identi es an effect of open defecation on child height from within-province changes in the local area open defecation to which children are exposed.


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HAMMER, J.; SPEARS, D. (2013): Village Sanitation and Children's Human Capital. Evidence from a Randomized Experiment by the Maharashtra Government. (= Policy Research Working Paper, 6580). Washington: The World Bank Water and Sanitation Program (WSP). URL [Accessed: 01.10.2013].

Open defecation is exceptionally widespread in India, a country with puzzlingly high rates of child stunting. This paper reports a randomized controlled trial of a village-level sanitation program implemented in one district by the government of Maharashtra. The program caused a large but plausible average increase in child height, which is an important marker of human capital. The results demonstrate sanitation externalities: an effect even on children in households that did not adopt latrines.


Awareness Raising Material Library

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GEORGE, R. (2012): Dirty Little Secret: The Loo that Saves Lives in Liberia. London: The Guardian. URL [Accessed: 13.02.2012].

Diarrhoea kills more children than HIV/Aids, tuberculosis and malaria combined – and its main cause is food and water contaminated with human waste. Liberia's president is trying to change all that.


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ONLINENURSINGPROGRAMS (Editor) (2012): Poop - The Four-Letter Word no One's Talking About. Online Nursing Programs. URL [Accessed: 07.05.2012].

After you go to the bathroom, chances are you flush your waste. But globally, not all waste gets flushed. Check out this great graph about this topic. You can also download the GIF-File.


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UN Water; UN Water (Editor) (2013): Sanitation Factsheet. UN Water. URL [Accessed: 09.04.2013].

Thematic factsheet. Today 2.5 billion people, including almost one billion children, live without even basic sanitation. Every 20 seconds, a child dies as a result of poor sanitation. That's 1.5 million preventable deaths each year.


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USAID (Editor); WASH PLUS (Editor) (2013): Integrating Water, Sanitation and Hygiene into Nutrition Programming. Washington: United States Agency for International Development (USAID), WASHplus. URL [Accessed: 23.09.2013].

Diarrhea, pneumonia, and birth complications are the top three killers of children under age 5 worldwide. Diarrhea is also a leading cause of undernutrition in this age group, and one-third to one-half of all child mortality cases are linked to undernutrition. If mothers and other caregivers used basic hygiene practices and had better access to safe water and adequate sanitation this could greatly reduce under-5 deaths and improve child nutrition.


Important Weblinks

http://www.unmultimedia.org/ [Accessed: 31.03.2011]

The Secretary-General of the United Nations, Ban Ki-moon, addresses the global water and sanitation challenges in this speech available at the UN webcast (online stream)

http://blip.tv/ [Accessed: 31.03.2011]

Short video about the necessity of promoting MDG 7 by comparing two situations of water use and sanitation facilities, one in the USA and one in Egypt. These self-filmed stories emphasise the importance of reaching the MDGs in general by 2015.

http://www.devinfo.info/ [Accessed: 22.03.2011]

The DevInfo system has been endorsed by the UN Development Group and is being used in many countries to help track the MDGs and other national priorities. It delivers significant enhancements for easy access to information on human development. The system has been developed under UN partnership and is distributed royalty-free to all end users.

http://www.mdgmonitor.org/ [Accessed: 22.03.2011]

The MDG Monitor, initiated by the UN, is tracking the progress of the MDGs since 1990. The database can be browsed by selecting a MDG or a location and features several success stories and possibilities of supportive actions towards reaching the MDGs.

http://www.wssinfo.org/ [Accessed: 22.03.2011]

The homepage of the Joint Monitoring Programme (JMP) of WHO and UNICEF for Water Supply and Sanitation (WSS) offers three tools to build dynamically water supply and sanitation data representations in the form of maps, graphs and tables by choosing between geographical area, level of aggregation, type of data, year and urban/rural setting. Specific country files are available in the documents section.

https://improveinternational.wordpress.com [Accessed: 06.06.2013]

This is an ongoing compilation of statistics to show that failure rates for water systems, latrines, and hygiene promotion campaigns are still high after decades of intervention.

https://ble.lshtm.ac.uk/ [Accessed: 01.10.2013]

The Programming for Nutrition Outcomes is a free open-access educational resource, supported by the Department for International Development. This Master's-level module has been designed to explore the complicated problem of undernutrition, highlight its multi-sectoral causes and identify potential programmatic solutions.

http://abettertoilet.org/ [Accessed: 23.11.2013]

The sanitation technology paradigm is under review, as past approaches are not sufficient or affordable to close the sanitation coverage gap. In 2011, the Bill & Melinda Gates Foundation (BMGF) launched the bold Reinvent the Toilet Challenge (RTTC) program to promote the development of radically new innovations to address the sanitation challenge on a large-scale. The RTTC is premised on the fact that ground-breaking improvements are required in toilet design and fecal sludge management to close the urban sanitation gap. The RTTC is focused on reinventing the flush toilet, a break-through public health invention that has not changed substantially since the first flush toilet patent was issued in 1775.