The 200 year wait for water and sanitation

The summer of 1858 as gone down in British history as the year of ‘the great stink’, when the Thames became so clogged with effluent that Parliament refused to sit because of the smell. It was the turning point for water and sanitation in London, and once the MPs had calmed down and straightened their wigs, the city’s famous sewer system was commissioned. The Thames is healthier today than it has been for centuries, and so are the citizens of London.

I mention this because that was over 150 years ago, and if current progress doesn’t speed up, people in Sub Saharan Africa can expect to wait at least another 200 years for access to clean water and a toilet of their own.

That’s the conclusion of WaterAid, whose latest report looks at the progress of the Millennium Development Goals on water, sanitation and hygiene (WASH). The goals aimed to halve the number of people without water and sanitation by 2015. With four years to do, it is pretty hopelessly off track. Population growth has run ahead of progress, meaning that there are more people without facilities than there were at the start.

Today there are 2.6 billion people without access to decent toilets, and 900 million people without access to clean water. This poor hygiene means that, absurdly in the 21^st century, diarrhoea is still the biggest cause of death for children in Africa.

There are a number of reasons why progress is slow, but the big one seems to be competition. There is a lot of competition in aid and development – donors only have so much to give, and have to choose what to give it to. Money for education and health has risen, while money for WASH has dropped in the last 15 years. Governments in developing countries face the same challenge of knowing what to prioritise.

Then there’s competition around where to send aid money. One might presume that the poorest countries would be at the front of the queue, but a look at the top ten countries for aid spending on WASH says otherwise. The biggest recipient countries are often middle-income countries like Malaysia, Morrocco, or Vietnam, where the focus is on universalising access. That’s a legitimate goal, but it comes at the expense of other needier countries. The recurrence of Iraq in the top ten list points to another competing priority – reconstructing infrastructure after conflict. Again, a necessary task, especially if it was our bombs that destroyed that infrastructure in the first place, but it means more years of waiting for the poorest countries.

Even within countries, some are privileged over others. Urban areas are catered for much better than rural areas. Many disabled people find their access needs aren’t considered when new facilities are built, leaving them unable to use them.

These are all understandable concerns, but the choice between funding sanitation projects or funding health or education projects is a false one. Access to clean water and sanitation is the singe biggest intervention you can make to benefit someone’s health. Likewise if you reduce the likelihood of serious illness, you reduce the number of days missed from school, as well as dramatically increasing that child’s chances of living beyond five years of age. Water and sanitation are the foundations that other development projects can build on.