African Water Development Report 2006 - United Nations Economic ...

Some of the shortcomings faced by the WHOstudy included:(a) Limited information on national health expenditures,services, and outcomes in Africancountries during the 1990s;(b) Serious gaps in data, particularly concerningprivate sector delivery and financing,health service utilization, equity and efficiencymeasures; and(c) General lack of data disaggregated by regionswithin a country, or among differentsocial groups of interest, such as the poor.Examination of these types of data limitations isvery relevant to monitoring effects and targetingthe implementation of health policy, especiallypublic spending, within a country. There are oftenurban, rural and regional differences in publicspending, availability of services and health outcomeswithin a country. For example, in examiningMinistry of Health spending in 22 Africancountries, Vogel found that 16 of these countriesspent more than half of their budgets in urbanareas, whereas their populations were predominantlyrural (5). Similarly, the richest people inAfrican countries tend to benefit much morefrom public spending on health than the poorest,though the poorest people usually have greaterneed than the richest (6). For example, in Côted’Ivoire in 1994, the under-five mortality rate forthe poorest 20 per cent of the population was 172,whereas for the richest 20 per cent it was 121, andthe prevalence rate of malnourished children was30 per cent among the poorest, and 20 per centand 15 per cent among the richest 20 per centof the population. The issue of poverty, equityand health deserves a higher place on the healthpolicy agenda of African countries and their internationalpartners, and should be backed up bymore evidence on how well spending on health istargeted to meeting the needs of the poor.Africa has the world’s most rapid rate of urbanization,at 5 per cent per annum. Given its currenteconomic situation, Africa cannot affordto spend its constrained resources on producingwater that is allowed to go to waste; yet there isa lot of water wastage. For example, the averagelevel of unaccounted-for water is about 50 percent in urban water supplies; and as much as 70per cent of the water used for irrigation is lostand not used by plants. Currently, most Africancountries consider water as supplied from any ofthe following sources as safe potable water:(a) Pipe-borne water (in homes or at publicstandpipes or from a neighbors tap);(b) Bore holes;(c) Protected wells and springs; and(d) Rainwater.Moreover, the WHO and UNICEF report includesunder “improved drinking water sources”all of household connection, public standpipe,borehole, protected dug well, protected springand rainwater collection.The water supply coverage for urban and ruralenvironments for Africa as a whole is shown inFigure 5.15. The progress made by African countriesin improving access to water supply in theperiod 1990-2000 is shown in Fig. 5.16 and thedisparity between uurban and rural access to ImprovedWater Source is shown in fig. 5.17.One example of progress in water improvementis Malawi, which increased from 48 per cent to62 per cent (85 per cent in urban and 58 per centin rural areas), access to potable water supply forits people since 1994. It is also estimated that64 per cent of the population has access to someform of sanitation, although only 9 per cent isserved through a sewage system or sewer connectingseptic tanks.WATER FOR MEETING BASIC NEEDSAccess to Safe Water Supply and SanitationServices99