HDR 2006 Chapter 3: The vast deficit in sanitation
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| Human Development Report 2006 - Beyond Scarcity: Power, Poverty and the Global Water Crisis |
| Report Overview | Chapter 1: Ending the Crisis in Water and Sanitation | Chapter 2: Water for human consumption | Chapter 3: The vast deficit in sanitation | Chapter 4: Water scarcity, risk and vulnerability | Chapter 5: Water competition in agriculture| | Chapter 6: Managing transboundary waters | Links to the Millennium Development Goals | Notes and Bibliography | UNDP Fast Facts |
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Water Rights and Wrongs | Summary of Live Forum: HDR 2006 - From the Report to Action on the Ground |
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- Closing the vast deficit in sanitation
“The sewer is the conscience of the city”, wrote Victor Hugo in Les Miserables. He was describing 19th century Paris, but the state of sanitation remains a powerful indicator of the state of human development in any community.
Almost half the developing world lacks access to sanitation. Many more lack access to good quality sanitation. The deficit is widely distributed. Coverage rates are shockingly low in many of the world’s very poorest countries: only about 1 person in 3 in Sub-Saharan Africa and South Asia has access—in Ethiopia the figure falls to about 1 in 7. And coverage rates understate the problem, especially in countries at higher incomes. In Jakarta and Manila old sewerage systems have been overwhelmed by a combination of rapid urbanization and chronic underinvestment, leading to the rapid spread of pit latrines. These latrines now contaminate groundwater and empty into rivers, polluting water sources and jeopardizing public health.
Access to sanitation bestows benefits at many levels. Cross-country studies show that the method of disposing of excreta is one of the strongest determinants of child survival: the transition from unimproved to improved sanitation reduces overall child mortality by about a third. Improved sanitation also brings advantages for public health, livelihoods and dignity—advantages that extend beyond households to entire communities. Toilets may seem an unlikely catalyst for human progress—but the evidence is overwhelming.
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Why the deficit is so large
If sanitation is so critical to social and economic progress, why is the deficit so large—and why is the world off track for achieving the Millennium Development Goal (MDGs) target? Many factors contribute.
The first is political leadership or, rather, its absence. Public policies on sanitation are as relevant to the state of a nation as economic management, defence or trade, yet sanitation is accorded second or third order priority. Even more than water, sanitation suffers from a combination of institutional fragmentation, weak national planning and low political status.
Poverty is another barrier to progress: the poorest households often lack the financing capacity to purchase sanitation facilities. But other factors also constrain progress, including household demand and gender inequality. Women tend to attach more importance to sanitation than do men, but female priorities carry less weight in household budgeting.
How community-government partnerships can help
The daunting scale of the sanitation deficit and the slow progress in closing that deficit are seen by some as evidence that the Millennium Development Goal target is now unattainable. The concern is justified, but the conclusion is flawed. There are many examples of rapid progress in sanitation, some driven from below by local communities and some led by governments:
- In India and Pakistan slum dweller associations have collaborated to bring sanitation to millions of people, using the power of communities to mobilize resources. The National Slum Dwellers Federation in India and the Orangi Pilot Project in Pakistan, among many other community organizations, have shown what is possible through practical action.
- The Total Sanitation Campaign in Bangladesh has been scaled up from a community based project to a national programme that is achieving rapid increases in access to sanitation. Cambodia, China, India and Zambia have also adopted it.
- Government programmes in Colombia, Lesotho, Morocco and Thailand have expanded access to sanitation across all wealth groups. West Bengal in India has also achieved extraordinary progress.
- In Brazil the condominial approach to sewerage has reduced costs and brought sanitation to millions of people—and it is now being adopted elsewhere.
Each of these success stories has different roots. Widely divergent public policies have been developed to respond to local problems. But in each case the emphasis has been on developing demand for sanitation, rather than applying top-down supply-side models of provision. Community initiative and involvement have been critical. But equally critical has been the interaction between government agencies and local communities.
Local solutions to local problems may be the starting point for change. But it is up to governments to create the conditions for resolving national problems through the mobilization of finance and the creation of conditions for markets to deliver appropriate technologies at an affordable price. Community-led initiatives are important—even critical. However, they are not a substitute for government action. And private financing by poor households is not a substitute for public finance and service provision.
Overcoming the stigma of human waste
One of the most important lessons from the sanitation success stories is that rapid progress is possible. With support from aid donors, even the poorest countries have the capacity to mobilize the resources to achieve change. Perhaps the biggest obstacle can be summarized in a single word: stigma.
There are some uncomfortable parallels between sanitation and HIV/AIDS. Until fairly recently the cultural and social taboos surrounding HIV/AIDS impeded development of effective national and international responses, at enormous human cost. That taboo has been weakening, partly because of the scale of the destruction— but also because HIV/AIDS afflicts all members of society without regard for distinctions based on wealth.
In sanitation the taboo remains resolutely intact. This helps to explain why the subject does not receive high-level political leadership, and it seldom figures in election campaigns or public debate. One of the reasons that the stigma has been so slow to dissolve is that the crisis in sanitation, unlike the crisis in HIV/AIDS, is more discriminating: it is overwhelmingly a crisis for the poor, not the wealthy. Tackling the crisis will require more awareness of the scale of the costs generated by the deficit in sanitation, as well as a wider recognition that sanitation is a basic right.
Among the key policy challenges in sanitation:
- Developing national and local political institutions that reflect the importance of sanitation to social and economic progress.
- Building on community-level initiatives through government interventions aimed at scaling up best practice.
- Investing in demand-led approaches through which service providers respond to the needs of communities, with women having a voice in shaping priorities.
- Extending financial support to the poorest households to ensure that sanitation is an affordable option.
Further Readings
Read the Full Chapter 
Hdr 2006 chapter 3.pdf
Source
This article is based on the HDR 2006 Summary Report. HDR2006 English Summary.pdf
