Water for people.pdf - WHO Thailand Digital Repository

1 1 2 / C H A L L E N G E S T O L I F E A N D W E L L - B E I N GBasic Needs and the Right to Health(342,000/day) until 2015. Again, it is expected that all regionswith the exception of Africa south of the Sahara will havereached or will be close to reaching this target by 2015,provided the current level of investment is maintained.■ In absolute terms, the investment needs of Asia outstrip those ofAfrica, Latin America and the Caribbean combined.Putting aside the overriding constraints imposed by the lack ofsufficient resources, the challenges faced in achieving the statedgoals circle around the issues of institutional strengthening andfinancial and economic arrangements for drinking water supply, andthose of demand management and marketing for sanitationextension. Institution-building, either with a traditional public sectororientation or through more innovative public-private partnerships,is critical both to attract initial investments as well as to ensure thelong-term sustainability of infrastructure and services once theyhave been established.The extension of basic sanitation is mainly a household concern,as sophisticated piped sewage systems require an unrealistic level ofinvestment to meet the needs of the poor. Unlike water supply,sanitation suffers from a lack of natural demand, and to overcomethis, a marketing approach has been proposed, backed up byeffective health and hygiene education, geared to the capabilities ofoften illiterate community groups. WHO has developed andpromoted a methodology to change community hygiene behaviourand to improve water supply and sanitation facilities, the so-calledPHAST (Participatory Hygiene and Sanitation Transformation)methodology (Sawyer et al., 1998). It aims to enable communityworkers to assist communities in improving hygiene behaviours,preventing diarrhoeal diseases and encourages communitymanagement of water and sanitation facilities. Critical steps in thisprocess include demonstrating the relationship between sanitationand health, increasing the self-esteem of community members andempowering the community to plan environmental improvementsand to own and operate water and sanitation facilities.Recently, hygiene has made a comeback based on the rapidlyexpanding evidence that relatively small changes in hygienebehaviour will have large impacts in protecting individuals at thehousehold level. While access to improved water sources and basicsanitation are crucial preconditions to hygiene behavioural change,access alone will not bring about these changes automatically. Assuch, the water-sanitation-hygiene conglomerate may be a publicgood when it comes to enabling infrastructure, but in itsimplementation it operates at the household level. The householdfocus is critical in the extension of sanitation coverage and thisextension will often be achieved through community action withoutdirect involvement of the formal service providers.The sustainability of established water supply and sanitationsystems can be broken down into two aspects: functionalsustainability relates to the conditions upon which systems cancontinue to operate, with resources and capacities as the keyconstraints. Environmental sustainability takes into account, from across-generational perspective, both the environmental and healthimpacts of systems’ operation and the impact of outside changes onthe long-term viability of the system. In connection to the latter,there are worrying trends both in terms of water quantity (recedinggroundwater levels in different parts of the world) and quality(increased pollution levels and the further discovery of naturalcontaminants such as fluor and arsenic).Water supply and sanitation monitoringFor the International Decade for Drinking Water Supply andSanitation (IDWSSD), WHO was mandated by the UN system tomonitor progress in water supply and sanitation coverage. The WHOmonitoring relied exclusively on data and information provided bygovernments of its member states. These data were based on criteriathat varied from one country to another and within individualcountries over time. The data were frequently inaccurate and theinformation derived from them inconsistent and not representative ofthe situation on the ground. The statistics reflected the biases andsometimes interests of the agencies responsible for the supply ofdrinking water, not the real or perceived needs of the users.Following the Decade, WHO and UNICEF decided to combinetheir experience and resources in the JMP. Since then, fourassessments have been carried out. The objective of this endeavourhas been broadened from a simple monitoring task to a capacitybuildingeffort, with countries improving their institutional andhuman-resource capacities to plan and manage monitoring, throughtheir active participation in the programme. The first three reportsof the JMP (published in 1991, 1993 and 1996) still followed theconventional approach: coverage data linked to reporting onprogress in national monitoring capacities. The Global Water Supplyand Sanitation 2000 Assessment, presented in JMP’s fourth report(WHO/UNICEF, 2000), marked a departure from the earliermethodology in several ways.The 2000 Assessment used broader and better verifiable datasources, including information from national surveys, linked to amore comprehensive analysis beyond strict coverage. Specifically, itdiffered from previous assessments in three important ways.■ The assessment covers the entire world through presentation ofdata from six regions: Africa, Asia, Europe, Latin America and theCaribbean, North America and Oceania as defined by the UnitedNations Population Division; previous assessments were limited todeveloping countries.