Dying for the toiletThe cost of missing the sanitationMillennium Development Goal?An extra 1o million children’s livesOn 14 September 2005 the biggest ever meeting of worldleaders will start at the United Nations Summit in New York.Lives of the world’s poorest people depend upon their actions.
The UN summit had beenbilled as a review of theimplementation of theMillennium Declaration(2000) of halving extremepoverty by 2015 whichwould revitalisecommitment to achievingthe associated MillenniumDevelopment Goals(MDGs). The review is nowdue but the preparatorydiscussions for the summitthreatened to remove allreference to theMillennium DevelopmentGoals, ignoring globalpoverty in favour ofnational interests.Much is at stake at the UNsummit. If the world’sgovernments do not agreeaction to get the MDGsback on track, millionsmore lives will be lost.WaterAid has reviewed thetarget for sanitation, not aglamorous subject but onethat is vitally important forhuman survival.Diarrhoeal diseases are the biggest single killer of childrenunder five in poor countries. A child dies every 15 secondsfrom diarrhoea caused largely by poor sanitation and watersupply. Providing basic sanitation could therefore save thelives of children.Some 2.6 billion people, 42% of the world’s populationare without hygienic toilets. All governments havecommitted to halving the proportions of their populationslacking sanitation by 2015. These plans themselves arefor only a modest step forward. Even if they wereachieved, one person in four would still be without anysafe place to go to the toilet in 2015.But even these limited ambitions are way off track.WaterAid calculates that the present poor progressmeans that the sanitation target will not be met until2026, some 11 years late.By then the human price paid for this failure will be tocondemn an extra 10 million children to death.The failures to provide adequate water and sanitationservices are not only abuses of people’s rights, they arealso economic illiteracy. These children will not only havehad their right to life denied, they will also have missedthe opportunity to contribute to their country’sdevelopment. By the time the sanitation target is metthese 10 million children could have contributed$61 billion to their national economies.This is the direct cost of those whose lives will be lost.For those who survive there are further costs. Theillnesses caused by poor sanitation impact on people’sability to attend school or work, reducing their incomeearning potential and resulting in further unnecessaryexpenditure on health.And this is only the global trend. Sub-Saharan Africa lagseven further behind. At the present rate, the sanitationtarget will not be met in sub-Saharan Africa until 2105, bywhich time an additional 133 million African children willhave lost their lives.In individual countries the situation may be worse still.Based on its 1990-2002 progress, Zambia will not meet itssanitation MDG until 2130 by which time this nation, whosepresent population is fewer than 12 million, will have lost anextra two million children to diarrhoeal diseases.There are two main reasons why the sanitation target is sooff track. Most countries have no single institution which isresponsible for sanitation and there is rarely a nationalbudget dedicated to sanitation. Of 14 countries examined byWaterAid, only two were found to have a dedicated sanitationbudget. Despite sanitation having helped reduce mortality intheir own countries, aid donors too do not prioritisesanitation for spending in today’s developing countries.
Annual child diarrhoeal deaths (millions)Additional child deaths from diarrhoeadue to failure to meet the sanitation MDG2.001.501.000.500.0054 millionchild deathseven if targetis met= Annual Diarrhoeal Deaths on Present Trend= Annual Diarrhoeal Deaths if on MDG Target TrendCumulative totalof 10 million extrachild deaths from1990-20261990 1995 2000 2005 2010 2015 2020 2025As a result, even though more than twice as many peoplelack sanitation as lack safe drinking water, spending onsanitation is only a fraction of spending on water. TheGlobal Water Partnership estimated that to meet theMDGs annual spending on water and sanitation needs todouble from $14 billion to $30 billion with all the extramoney being spent on sanitation.Access to sanitation is of huge importance to globalhealth, wealth and human dignity. And meeting thesanitation target would also contribute to other MDGs tohalve extreme poverty and hunger, reduce childhooddeaths and achieve gender equality.WaterAid’s experience suggests that turning thesanitation situation around will require better planning,budgeting and coordination combined with greatertransparency and accountability. WaterAid is thereforecalling for national governments to draw up plans andassociated budgets for increasing access to sanitation;for donors to coordinate their own activities in line withthese national plans, and for there to be publishedannual reports of the progress made.At the World Summit on Sustainable Development in2002 world leaders pledged themselves to reach thesanitation target. But beyond the rhetoric reality tells adifferent story. Inaction in the real world means that thesanitation targets will only be met years late. For thewhole world the average delay will be 11 years. But ifpresent trends continue the target will only be met insub-Saharan Africa 100 years from now in 2105. Thesedelays have devastating human costs – 10 million extradead children by 2026, some 133 million extra deadAfrican children by 2105.Governments at the forthcoming United Nations Summitmust get to grips with action, not indulge in more talk.1.380.76Case study 1Honufa is 20 years oldand lives in a slum inDhaka, Bangladesh.She no children nowas her son diedrecently fromdiarrhoea.“Life is very hard here. You can see the condition ofthe houses all crammed together. There is no space.We have tube wells but the area around the well isfull of rubbish and shit and the sanitation conditionseverywhere are foul. Some of us have householdlatrines but they are overflowing and no one keepsthem clean. Every day there is disease in this slum.There is diarrhoea, dysentery, severe stomach painsand headaches. Children suffer the most. Everythingis packed into a tiny space here – you can imaginethe unhealthy situation we live in. I’ve lost a two yearold son from diarrhoeal disease and there are twoother women in this room that I know have also lostchildren to diarrhoea due to the unsanitaryconditions. We need a clean environment here.”Case study 2Rakiya Abdullah, 27,lives in Sagnarigu inthe Tamale region ofGhana whereWaterAid has recentlyhelped the communitybuild latrines.“I have two children aged four and seven. We havehad the latrine for six months now. It has made alot of changes to my life. Before everybody prayedthey wouldn’t need the toilet in the daytimebecause we didn’t have any public latrines and youhad to go to the bush but at this time of year therewere no plants to hide behind. Now I can gowhenever I want. Everybody with a latrine is veryhappy with them and everybody without one isyearning to have one.Before we had the latrine we defecated in the bushand this was a source of contamination as fliescould sit on it and then come in the house and siton our food. We got diarrhoea or cholera. We usedto attend hospital for treatment. The last time I wasill I had cholera and had to pay 300,000 cedis ($32– approximately one tenth the average annualincome in Ghana) for my hospital treatment. Thiswas a lot of money but we had to manage. I had tospend five days in hospital and my sister had tolook after my children.”
WaterAid’s calls to action:Action is required by both developing anddeveloped country governments.Developing country governments musttake the lead and recognise theimportance of sanitation for their socialand economic development. They need to:1. By the end of 2005, produce aninvestment and delivery plan forachieving their water and sanitationtargets, with a separate budget forsanitation2.From 2006/7 publish an annual reporton the performance of the water andsanitation sectorDeveloped country governments mustlikewise recognise sanitation’simportance – not least by recalling theirown development history. Governmentsgiving aid need to:3.From 2006/7, align their water supplyand sanitation support with thegovernment-led sector investmentand delivery plansThis should include providing thenecessary resources as part of their widercommitment to allocating 0.7% of theirincome to Official Development Assistanceand ensuring that they do not add to thestrain on developing country capacity byinsisting on their own projects andreporting systems or setting up separateapplication procedures for finance.Quick facts:• 42% of the world’s population – 2.6 billion have no safeplace to go to the toilet• A child dies every 15 seconds from diarrhoea causedlargely by poor sanitation and water supply• The Lancet medical journal reports that diarrhoeal diseasesare the greatest single killer of children in poor countries• The Millennium Development Goals include the target tohalve the proportion of people without sanitation by 2015• This target is itself only a step on the road to universalaccess. Even if it is achieved there will still be 1.8 billionpeople – one in four of the world’s population at that time– without any safe place to go to the toilet• At the current rate of progress the global target will not bemet until 2026 – 11 years too late• This will result in the deaths of an extra 10 million children• Had they lived these children could have contributed$61 billion to their countries’ economies• 443 million school days are lost annually worldwide dueto diarrhoeal disease• In sub-Saharan Africa, at the current rate of progress, thesanitation target will not be met until 2105 – resulting inthe deaths of an extra 133 million African children• The additional cost to Africa of these children’s lives wouldbe $1.7 trillion ($69 billion in today’s money)• The MDGs apply to individual countries. Zambia will notmeet its sanitation MDG until 2130• 384,000 people need to gain access to sanitation everyday to reach the MDG targets – a 90% increase onperformance in the 1990s• The Global Water Partnership (GWP) calculated that only$1 billion was being spent on sanitation per year indeveloping countries• The GWP also stated that annual spending on water andsanitation needs to double from $14 billion to $30 billionto reach the MDGs with all the extra money being spenton sanitation• The World Health Organisation has estimated that thefailure to invest in the water and sanitation MDGs will costdeveloping countries $84 billion per year in lost lives, lowproductivity of sick workers, increased health systemcosts, and education provision wasted on children absentbecause of waterhauling work or ill-healthPicture credits: Alixandra Fenton, WaterAid/Abir Abdullah and Jon Spaull.WaterAid – water for lifeThe UK’s only major charitydedicated exclusively tothe provision of safedomestic water, sanitationand hygiene education tothe world’s poorest peopleFor supporting calculations and references see the full‘Dying for the toilet’ report at www.wateraid.org/newsT: 020 7793 4500E: email@example.comCharity registration no: 288701