The world is in danger of missing targets for providing clean water and sanitation unless there is a dramatic increase in the pace of work and investment between now and 2015, according to a new report from the World Health Organization (WHO) and UNICEF.
The situation is becoming particularly acute in urban areas, where rapid population growth is putting great pressure on the provision of services and the health of poor people.
More than 1.1 billion people in both urban and rural areas currently lack access to drinking water from an improved source and 2.6 billion people do not have access to even basic sanitation, the report shows. The health impact of this can be seen particularly in children. WHO estimates that in 2005, 1.6 million children under age 5 (an average of 4500 every day) died from the consequences of unsafe water and inadequate hygiene.
Children are particularly at risk from water-related diseases such as diarrhoeal and parasitic diseases. Lack of sanitation also increases the risk of outbreaks of cholera, typhoid and dysentery.
The populations of urban areas in the developing world are growing rapidly and, if the MDGs are to be met, a huge amount of work will have to be done simply to maintain the proportion of those living in cities with access to improved drinking water and adequate sanitation. Currently, 95% of city dwellers have access to an improved source of drinking water, while 80% have access to sanitation services.
Meeting the water and sanitation targets of the Millennium Development Goals (MDGs) will be one of the most effective means of raising the health and general living standards of many of the world's poor. But reaching the water and sanitation targets will require much greater efforts by policy makers, funding and training agencies, planning and construction. These solutions must focus on poor and underserved people worldwide, WHO warns. In 2000, the world pledged to reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation. According to the report, MDG Drinking Water and Sanitation Target - The Urban and Rural Challenge of the Decade, to meet the sanitation MDG will require a doubling of current efforts. A one-third increase in efforts will be needed to meet the MDG drinking water target.
"It is a tragedy that the world may not reach the water and sanitation MDGs. Safe drinking water and basic sanitation are so obviously essential to health that they risk being taken for granted," said Dr Anders Nordström, Acting Director-General of WHO. "Efforts to prevent death from diarrhoea and other diseases are doomed to failure unless people have access to safe drinking water and basic sanitation. This report underlines the importance of the new WHO strategy on public health and environment to radically reduce the global burden of disease through preventive health measures. Only by tackling the root causes of diseases such as water and sanitation can we reduce the 24% global burden of global disease caused by the environment."
Sub-Saharan Africa is still the main focus of concern. An estimated 80% of people without access to an improved drinking water source live in sub-Saharan Africa, Eastern Asia and Southern Asia. Due to population growth over the period from 1990–2004, the number of people without access to drinking water in Sub-Saharan Africa increased by 23%. Currently, just 56% of the population has access to an improved water supply. Just 37% of people in sub-Saharan Africa had access to basic sanitation in 2004, compared to a global average of 59%.
In rural areas, access to an improved source of drinking water and to basic sanitation services was very low in 1990 (the baseline year for measuring the MDGs): only an estimated 64% had access to a drinking water source, while 26% had access to sanitation services. While those percentages rose substantially by 2004 - to 73% and 39% respectively - these numbers still fall way short of what is needed to achieve the MDGs.
From the report comes one example of a success story in terms of raising coverage. In Ethiopia, the Amhara region had a coverage rate for access to sanitation services of only 3.8% in 2003, and only 100 latrines were being constructed annually in each district. In that year, the government initiated a social marketing campaign which increased community knowledge and understanding of sanitation and its linkages to health. Community demand for latrines sky-rocketed, and by 2005, the average number of latrines constructed per district was 26 400.
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