Water for people.pdf - WHO Thailand Digital Repository

1 2 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 HealthThe WHO Programme on Water, Sanitation and Health fullysupports the right to water, which, as indicated above, is inextricablylinked to the right of all humans to attain the highest possiblestandard of health. To achieve the goal of ensuring access for all toan adequate supply of safe drinking water, WHO proposes standardsand regulations for drinking water quality, through its Guidelines forDrinking Water Quality (WHO, 1997, 1996, 1993). Among thesubstantive elements of a rights-based approach to health, payingattention to those population groups considered most vulnerable insociety is a critical one. In this context, the principle of equity, i.e. thefact that the distribution of opportunities for well-being is guided bypeople’s needs rather than through their social privileges, isincreasingly serving as an important, non-legal generic policy concept.At the core of WHO’s work is the estimation of the burden ofwater-related ill-health, which reflects the link between the right towater and the right to health, and the promotion of safe watersupply and safe water management practices to affirm these rights.Basic needs, sustainable livelihoods and the human rights approachwill continue to be the guiding principles in water supply andmanagement. An update on the status of the human right to waterissue is presented in box 5.6.DecentralizationIntegration of health services and decentralization of their operationshas been going on for the past ten years as part of the ongoing publicsector restructuring. The goal is a more efficient health service that ismore responsive to health issues as they arise and better targeted atthe needs of vulnerable groups in society. The integration aims toreduce the disproportionate costs of so-called vertical programmes(malaria control programmes are among the examples) that were onceestablished as time-limited operations, but became entrenched assingular routine operations within the health sector.Decentralization also foresees a devolution of planning anddecision-making at the local level, with standard setting, quality controland expert technical cooperation remaining functions at higher levels. Inmany countries, the period of transition is characterized by problemsrelated to lack of adequate capacities at the local level and resistancewithin the system against the change imposed. In some instances, theactual decentralization is hampered by the fact that major resourcedecisions continue to be made at the national level, leaving little roomfor local health centres to adjust their programmes to local needs.This process has a number of implications that are specific towater-associated diseases. On the one hand, a number of thesediseases were covered by vertical programmes in the past, which usedto have strong epidemiological surveillance components (thoughusually at a high price). With integration, it has been observed thatpart of this surveillance capacity disappears, and what at first sightwould seem to be a decline in disease incidence often turns out to bethe result of a reduced surveillance effort that captures fewer cases.With decentralization, the often specialized knowledge related to thelinks between water parameters and disease situations may lose its‘home’. This hampers the development and design of watermanagement solutions and interventions, and creates a bias towardsmore strictly medical interventions. On the positive side, providedcapacity is present or has been built at local level, decentralizationallows for a more detailed epidemiological analysis of local diseasesituations and favours the design of local solutions to replaceuniversal or blanket interventions, such as, for example, spraying ofresidual insecticides for interrupting the transmission of malaria. Therewill, therefore, be greater opportunities as well for watermanagement solutions that address local health problems and fit withthe local state of water resources and aquatic environment.Devolution of operations to the local level may implydiscrepancies between the administrative boundaries and the naturalboundaries of watersheds. At the surveillance stage, suchdiscrepancies may create wrong impressions about the links betweenwater-related determinants of health; at the time of implementinginterventions, they may obstruct optimal water managementsolutions, because the site where action is needed lies outside of thejurisdiction of authorities that have to deal with the health problem.Such problems can be overcome, either by dealing with them at ahigher level of government, such as a provincial government, or byestablishing effective institutional arrangements between the healthauthorities and, for instance, river basin authorities.Medical and public health constraints and opportunitiesThe health sector is under pressure to control many of the waterassociateddiseases. For a number of diseases, prevention throughvaccination campaigns is not an option, simply because a vaccine doesnot (yet) exist. This is the case for malaria, dengue and thegastrointestinal infections. Even the existing cholera vaccine is of toolow an efficacy to contribute significantly to public health efforts.Insecticides for transmission interruption of vector-borne diseasesbecome increasingly less effective because of the development ofresistance in important vector species, while legally binding internationalinstruments such as the Stockholm Convention on Persistent OrganicPollutants are also limiting use in some cases. As soon as a curativeapproach is required, resistance of disease-causing organisms againstantibiotics and drugs becomes a phenomenon of growing importance,undermining the treatment of bacterial as well as of some parasiticinfections. Even where effective tools are still available, they are oftenout of reach of the poor, who either can not afford them or are notadequately covered by resources-strapped health services.It is against this backdrop of health sector constraints that thepotential of access to improved water sources and best watermanagement practice, basic sanitation and improved hygiene