Water is key to poverty reduction and health

During World Water Day celebrations, it was humbling by the fact that over 663 million people on the planet still lived without access to safe drinking water; 2.4 billion people lacked access to basic sanitation services, such as toilets or latrines. With these challenges persisting around the world despite decades of hard work in the water and sanitation sectors, the key question we ask is are we at a point where we need to take a step back from current solutions and practices and do business differently?

The new Water Supply, Sanitation, and Hygiene Poverty Diagnostic (WASH PD) initiative suggests exactly that.

New findings from the WASH PD initiative (led by the World Bank Water Global Practice in collaboration with Poverty, Governance, and Health, Nutrition, and Population) for the first time advances our understanding in a systematic manner of the relationship between poverty and WASH at the country level. Our deep analysis of 18 countries—across six regions—provides us with new evidence of realities that must be acknowledged, and shows without a doubt that we must work together across sectors if we are to find solutions with sustained impacts on the ground.

Quick facts from around the world: 

  • In Mozambique, 90 percent of the poorest mothers lack access to antenatal care and 90 percent of underweight mothers only have access to unimproved sanitation
  • In Nigeria, 61 percent of the rural population lives more than 30 minutes away – and 34% lives more than 2 hours away – from a functioning water source
  • In Tajikistan, households in the Sugd Region report getting piped water 1 day per week
  • In Pakistan, despite improvements to nutritious food, reductions in open defecation and poverty, childhood stunting has stayed constant at 43 percent.  Construction of unimproved toilets and persistent water quality issues are not helping reduce this burden
  • In Indonesia, it is estimated that only 5 percent of urban wastewater is safely treated and disposed
  • In Tunisia, the richest 20 percent of households receive an estimated 27 percent of water subsidies, while the bottom 20 percent of households receive only 11 percent of the subsidies
  • In Ecuador, 93 percent of people in urban areas and 76 percent in rural areas has improved access to water services but still, 24 percent of the rural population drinks contaminated water

What we’re learning is telling:  Our initiative reveals critical gaps in policy, or between policy and implementation, which leads to poor service delivery. Working with Governance colleagues at the World Bank is stretching us beyond our water sector lens, and it is becoming abundantly clear that service delivery is many times hindered by inter-governmental fiscal and administrative systems and the interplay with politics. This may not come as a surprise to those who work with these issues on the ground, but now we have the numbers to prove it.

If we shift our focus from purely designing and implementing a project to the ‘service delivery problem’, the need for multi-sectoral thinking becomes apparent. For example, in Nigeria our analysis shows that nearly 30 percent of water points and water schemes fail within the first year. Forty-four percent of borehole construction projects are never started, and only 37 percent of borehole projects that get started are fully completed. The results are that 71 percent of Nigerian households in the lowest wealth quintile lack access to a protected water source. Read more


Uganda shows the way in monitoring and transperancy at SWA4A

Uganda showed the way to go with regards to monitoring matters yesterday at the “Sanitation and Water For All” partnership meeting in Johannesburg. Uganda, Liberia and Sierra Leone had taken giant strides to ensure that there were good monitoring systems in the WASH sector as well as transparency.

Uganda had taken the brave step to look at what is happening in its sector, documented results and reflected on what these results meant for the water and sanitation sector in the country.  This gave a true meaning of both monitoring and aid transparency.

Uganda has been publishing a document called the “Country Sector Annual Review” for a number of years now.  The review is powerful, its frank and it highlights progress made in the country without shying away from exposing the challenges faced in sustaining water supply and sanitation infrastructure and investments.  The report is particularly clear on the challenges Uganda faces with tariff collection and financing for operation and maintenance (O&M).  Sanitation still has some way to go before Uganda reaches full coverage.

The report focuses the Ugandan water and sanitation sector keenly on results.  The data is Uganda’s, the ownership of the implications are held by the country and the sector will continue to improve because they are asking hard questions about sustainability and coverage.

Because Uganda and a few other countries are showing what monitoring is about in practice.  Monitoring is about asking hard questions on results and having the courage to rethink your previous decisions and investments based on the analysis of these results. Uganda and these and other countries have a tremendous opportunity to actually improve sector performance because they have invested time and energy to determine what seems to be working in their countries and what aspects of their work and investments need to be reconsidered.  And they will ask these questions over and over again as future monitoring results will guide them, which in time should lead to better results for villages throughout their countries.

Uganda is also showing what transparency is all about.  Its  not fooled by the silliness of the International Aid Transparency Initiative (IATI) and it’s growing list of agencies that seem to think that transparency means throwing meaningless spreadsheet-numbing data onto a web page (filled with equally meaningless data from other agencies) and having donors and bloggers anoint them as truly transparent.

Transparency is not about unanalyzed data puke.  Transparency is about being open, honest and forthright about the results of investments made – it’s about saying that these investments led to these results (good, bad, unclear at this stage…).  Anything less is simply fog!

This in a true sense indicates that Uganda  is not worried if it’s indicators are the same as each other.  Its not worried  on how it’s data fits in with global monitoring frameworks. It’s  under the IATI radar.  It’s simply focused on improving performance so that water flows and people can take a dump in a functioning toilet.  The work is hardly perfect, and challenges of course remain in not only sustaining momentum for monitoring but also in ensuring that future investments in water and sanitation are done in a way that take seriously the lessons highlighted.  Donors, implementing agencies and governments will need to change and adapt in ways they may not be comfortable with in the short- (or long-) term.

But if monitoring advances and  Uganda continues to analyze and show results transparently then changes will most certainly come, as good practices will shine and bad practices will run out of excuses.  And that will be good for people throughout the country.  Exactly what good monitoring and transparency should actually do.

It’s early to put a judgement on CLTS in Ghana

Speaking at a knowledge sharing and learning workshop organized by Community Livelihood Improvement programme (CLIP), Charles (M&E Officer) at New Energy Tamale said it was too early assess the impact of CLTS in Ghana especially due to the fact that country was still struggling to attain the MDG for sanitation. He said although there seems to be an increase in the number of Open Defecation Free (ODF) Communities especially in the Northern region, those figures do not necessarily reflect what is on ground. He elaborated that if we say 50 out of 1000 communities have attained ODF, then this means the country on course but with a lot work to be done.

Data from the Ghana Statistical Service ranks the Northern Region the third highest behind the Upper East and the Upper West Regions on the open defecation list in Ghana with about 72% of the population in the region practicing open defecation.

Charles said CLTs was the best approach to eradicate Open defecation in the whole of Ghana but needs some time to fully assess its impact. He further said the government needs to honor its o.5% commitment of its Gross Domestic Product (GDP) to sanitation in order to reduce this statistic.

Participants during the workshop

Marketing sanitation through result based financing

Improved sanitation and hygiene services integrated with potable and adequate water supply services are a critical factor in deciding the health of a nation. Indeed, it estimated that lack of or inadequate provision of these services is capable of undermining the achievement of targets set for MDGs 1, 2, 4, 5 and 6. Whilst most countries are on course to achieving MDG target for water, the same cannot be said of sanitation and hygiene. or example Ghana’s achievement is at 13% whilst 20% of the population defecates openly. The economic and health impact of this situation cannot be underestimated. The Water and Sanitation Programme (WSP) estimates that Ghana loses GHC42 million annually in terms of health, lost in labour and productivity caused by lack of, and,  or inadequate sanitation and hygiene services.

Putting everyone back on-track the MDG target for sanitation requires development and implementation of innovative but effective programmes involving sector players with a capacity for replication across the country. This would require creating marketing strategy for sanitation which would reduce the gaps/ loop holes in project implementation. Dealing with this requires changing the way most projects have been funded and adopt a result based approach. A result based financing (RBF) approach would influence policy makers to prioritize sanitation sector investments through an incentive scheme

With result based financing funding is provided if pre- specified results have been achieved. This means that there are limited incentives to reduce the cost of providing services because funding is based on an input basis. The approach ensures that cash is given on delivery of results. Result based approach targets suppliers to provide them with an incentive to provide services to the poor .

The full amount of funds is paid to the service providers only when results have been achieved and verified by a third party. Subsidies are also provided to encourage provision of basic services to the poor in areas that are not commercially attractive.


›RBF instruments have the potential to improved the sanitation sector’s focus on results and performance verification.
›RBF instruments are new and largely untested particularly in the sanitation sector.
›Going forward we need to invest great care in the design of the instruments and evaluate the costs and benefits of such schemes in comparison to traditional forms of financing

A lot of effort is needed to combat water and sanitation in slum areas.

5 October 2011

floods in Bwaise, Uganda

Investment in water and sanitation in the rapidly urbanising cities of the developing world is key if we are to avoid uncontrollable poverty and ever worsening slums, says WaterAid in a news report.

“If we continue the way, we are the gross inequality between rich and poor could be almost impossible to reverse. But there is an opportunity to turn things around if we act now.

“Water and sanitation have proved time and time again to be a critical factor in health and economic development.

Cities in the developing world are expected to double in population size every 15 years, and two thirds of the world’s population will live in urban areas by 2030. The vast majority of these people will end up living in unplanned slums, with little or no access to fundamental services such as water, sanitation and electricity.

Water and sanitation are fundamental to health and development, especially in densely packed urban areas, where outbreaks of diseases such as cholera can quickly turn into epidemics. At present the diarrhoeal diseases caused by a lack of safe water and sanitation are the biggest killers of children under 5 in Africa, more than HIV/Aids, malaria and measles combined. In South Asia it is the second biggest killer.

Current investment into water and sanitation in the slums is inadequate and is failing to reach the poorest and most vulnerable people. Only 6% of World Bank sanitation-related commitments from 2000-2005 went to slums, with the vast majority going to more established urban areas. The manifesto advises that to tackle urban poverty, the very poorest people need to be at the heart of water and sanitation investments and planning. They should also be encouraged to participate in the design and implementation of these plans.