The Water and Sanitation Program - Environmental Health at USAID

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DRAFTFigure 2.380 Slum Dwellers as % Urban Population707260505840%30203633 3228 28241006 6A second area of special concern is the rapid growth of slums, as illustrated in Figure 2.3from UN-Habitat showing the proportion of urban population that will live in slums by 2020.Although the sample size of the JMP data does not allow for a robust estimate of thesanitation coverage levels in slums, it is clearly much lower than for the rest of the urbanpopulation. High density and inadequate urban planning makes the provision of sanitationservices in slums a particularly difficult challenge that is growing in importance.• Decentralization. With increasing urbanization, the economic and political clout of citiesand other sub-national tiers of governments has increased and decentralization of serviceprovision and policy making is following suit, shifting to cities many responsibilitiespreviously the purview of central government. A major common problem is that manylocalities lack the financial, managerial and administrative capacity to provide the servicesand amenities demanded by households and enterprises. Urban poverty is a pressing concernand is often coinciding with greater decentralization, placing increasing responsibilities onlocal government for infrastructure and other basic services. This puts a premium onimproved management of municipal infrastructure.• Low Income Countries and Changing Aid Architecture. Since the late 1990s, there hasbeen a shift of official development assistance (ODA) out of infrastructure, due in part by theexpectation that private investment in infrastructure in developing countries would increasesignificantly. In recent years, low income countries have received less ODA for coredevelopment programs than they did on average during the early 1990s; as a result thecombined share of infrastructure and production dropped from 59% to 38% between 2001and 2004 1 . There appears to be a small change in trend in the last few years but it is too earlyto indicate a return to pre-1990 levels.1 IDA 15, Aid Architecture: An Overview of the Main Trends in Official Development Assistance Flows, February2007.4
DRAFTIn addition to the decline in ODA for infrastructure (including sanitation), two otherproblems affect low-income countries: large number of donors and lack of harmonizedapproaches. The number of bilateral and multilateral agencies which interact with recipientcountries has grown enormously. For instance, the average number of donors per countryrose from about 12 in the 1960s to about 33 in the 2001-2005 period. Furthermore, there arecurrently over 230 international organizations, funds, and programs. This is accompanied bysignificant earmarking of aid resources for specific uses or for special-purpose organizations,including global programs or “vertical” funds. Earmarking of ODA is still common in manybilateral assistance programs.At the same time, a new trend that has emerged is the assistance of Middle Income Countriesto poorer countries, although their focus has been mostly in energy, telecoms, and transport. 2China’s financing for African infrastructure is estimated to have exceeded $4 billion in 2006,a level comparable in scale to that of all OECD-DAC members. The Arab developmentfunds have been contributing around $500 million per year to African infrastructuredevelopment, particularly in the road sector. These new donors offer an opportunity to bringadditional resources to the sanitation sector, but harmonized approaches will be required tomaximize the long-term development impact of aid.2.3 Specific Challenges of the Sanitation SectorIn addition to the challenges described in the sections above, the sanitation sector has specificfeatures that make it most challenging among other infrastructure sectors. Some of these specificchallenges include:• Poor attention given to sanitation. Demand from users for better sanitation services is muchless than for other infrastructure services such as water supply, energy and roads. As aconsequence, the level of political attention to sanitation is much lower, with few exceptionsthat require further analysis of its political economy dimension. Sanitation, as opposed toother infrastructure sector, suffers from fragmented administrative responsibilities amongministries and government agencies (ministries and agencies of water supply, environment,public health, and local government are, to some degree, responsible for sanitation, as well asmunicipalities and other sub-national governments). In addition, sanitation is viewed bygovernment as a private household issue, as opposed to most other infrastructure services.Sanitation arouses deep feelings and attitudes of disgust and is not a topic that is discussedopenly in public in many cultures.• The cost of inaction. The lack of sanitation causes profound economic, health and socialimpacts, as illustrated in numerous studies that will not be repeated in detail in this strategicdocument. Diarrheal diseases have the largest contribution to the environmental burden ofdisease for children ages 0-14. Globally, about 3,900 children die everyday from diseasesassociated with lack of access to basic sanitation and unsafe water supply. However, theeffective use of oral rehydration therapy (ORT) has meant that deaths from diarrhea havegone done substantially but not the morbidity associated with it and the malnutrition effects.2 Schur, M., von Klaudy, S., Dellacha, G., 2006, The Role of Developing Country Firms in Infrastructure: A NewClass of Investors Emerges, In: PPIAF Publication, No. 3, April 2006.5
Page 1 and 2: The Water and Sanitation ProgramMed
Page 3 and 4: DRAFTEXECUTIVE SUMMARYThis document
Page 5 and 6: DRAFT1. IntroductionThis document p
Page 7: DRAFT• Rising Income Inequalities
Page 11 and 12: DRAFTo Ineffective solutions purcha
Page 13 and 14: DRAFTSanitation approach which incl
Page 15 and 16: DRAFTthese Conferences were to shar
Page 17 and 18: DRAFTdevelopment of a vibrant local
Page 19 and 20: DRAFT• Scaling up Change at Local
Page 21 and 22: DRAFTFigure 4.1: Performance of San
Page 23 and 24: DRAFTA second area of work for WSP
Page 25 and 26: DRAFTSector Development Program (IS
Page 27 and 28: DRAFTThe main steps in these roadma
Page 29 and 30: DRAFTuse is closely related and a d
Page 31 and 32: DRAFTThemesOutcomes and trendsGener
Page 33: DRAFTutility partnerships (especial

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