If you’re wondering whether I’ve lost my mind, I haven’t: it kills by the millions. On average, 1.8 million people die every year from diarrheal disease caused by poor sanitation and contaminated water supplies. Ninety percent of these deaths are children under five.
The World Health Organization (WHO) registers more than 2 billion cases of diarrheal disease every year, with the most acute cases affecting children under two years old in the developing world. Lack of access to clean sources of water and proper sanitation deprives millions of people of health, dignity and quality of life.
Just a century ago, these same problems afflicted cities like New York, London and Paris. Each metropolis teemed with infectious diseases killing nearly the same number of children that die in sub-Saharan Africa today (check out a History Channel documentary on the topic here).
Essentially, sweeping reforms in water and sanitation allowed these world cities to continue developing. A recent British Medical Journal poll of over 11,000 doctors picked piped water and sewer infrastructure as the most important public health interventions since 1840. Given this success, why has the “sanitation revolution” not yet circled the globe?
Of the two problems, access to clean water has improved the most. Right now, 87% of the world’s population and 84% of the developing world has access to potable drinking water. According to UNICEF and the WHO, households in this group are connected to main water supplies, have secure access to dug wells or springs, or can reliably collect clean rainwater.
This means the world is on track to halve the number of households without access to safe drinking water by 2015 -- one of the high-profile Millennium Development Goals set forth in 2000. That said, water safety is not measured the same way across the board, and policymakers have clearly favored expanding access over ensuring water quality.
A prime example is Honduras. Currently, 86% of households there have access to so-called “improved” water, but only 15% of rural households have access to drinkable water, and only 43% of the total population has access to filtered water. Without filtration and treatment, water is regularly contaminated by microbial bacteria like E. Coli and hazardous waste.
Households with no access to water are left to fend for themselves. As a result, many people in these communities -- almost exclusively rural women and girls -- are forced to spend hours every day collecting water from distant, often toxic sources. This is time not spent caring for family, generating income or going to school.
The situation in slums surrounding cities in developing countries is doubly harsh. Many residents have no access to piped water -- and the water that is available often comes from government authorized cistern trucks that travel door-to-door or standpipes miles away. Local governments allow vendors to buy water at a subsidized price and resell it at a premium. Because demand always outstrips supply, these vendors operate free of regulations and inspections, usually charging a highly-inflated price for unsafe water. The cost of buying water regularly exceeds $1 a day, representing more than half an average day’s income for poor households.
While gains have been made with water, sanitation is lagging behind. At the current rate of growth, access to proper sanitation falls woefully short of Millennium Development Goal targets. To date, more than 2.6 billion people still lack access to improved sanitation services. As defined by UNICEF, this includes access to public sewers or septic tanks, as well as pour-flush or ventilated pit latrines.
The disparity between those who have access to sanitation and those who don’t is massive. Ninety-five percent of households without access are located in Southeast Asia, and in East and sub-Saharan Africa. In these regions, governments allocate only 1 to 2% of the annual budget to low-cost solutions, while spending much more on improving urban sanitation systems for wealthy customers.
Without access to sanitation, poor households have to get by however they can. They use fields, streams, plastic bags, buckets, and unventilated latrines. Few have soap. This results in the rapid spread of fecal-related diseases, causing life-threatening diarrhea and stigmatizing the poor as dirty and unwashed. This feedback cycle infiltrates every aspect of daily life for the poor, leading to environmental degradation, missed days of work and school, and lower income.
But there is hope. Governments have begun to catch onto the link between sanitation and economic development, and are investing accordingly. South Africa’s government, for example, has pioneered a “joined-up thinking” approach to national sanitation policy. This strategy assigns sanitation development and implementation to various actors, including NGOs, local councils and private companies with clearly defined roles and responsibilities. Because sanitation touches everyone, this multi-sector approach is designed to address the institutional and behavioral changes that need to be made.
After all, it isn’t that impoverished households don’t want to be cleaner. The desire for change -- especially at the community level -- has proven to be the most powerful weapon against poor sanitation. Beyond building toilets, these comprehensive local approaches have galvanized whole communities to take ownership of sanitation projects and make sure they succeed.
At Kiva, we believe that major impact starts with small financial interventions and community-level innovations. For this reason, we support Water.org and its efforts to provide micro-credit for households to improve their own water and sanitation systems.To learn more about what this organization is doing, click here.
While water and sanitation projects face unique challenges, the goal to expand access to both is necessary to achieve equitable and inclusive economic growth. Communities have a right to privacy, dignity, health and productivity.
We will continue to discuss issues related to water and sanitation during this blog series. We’ll also highlight a number of our field partners, like Sodis in Bolivia, that are working to finance related projects.
This is part of a larger series on Kiva’s strategic initiatives and innovative loan products, which are designed to expand opportunities for more borrowers. Kiva is excited to partner with companies and organizations innovating in the agricultural sector to support farmers and increase productivity -- read on for more.
Ian Matthews is an intern on Kiva’s Strategic Initiatives team, looking for new partners and loan products to extend opportunities and access to even more people around the world. Ian has an MSc in Global Politics from the London School of Economics and Political Science and has previously done field work in Honduras. Send him your feedback on this blog series at firstname.lastname@example.org.
photos courtesy of JJ Casas, Sustainable Sanitation, Barefoot College and Mike Bailey-Gates
Ian Matthews is an intern on Kiva’s Strategic Initiatives team, looking for new partners and loan products to extend opportunities and access to even more people around the world. Ian has an MSc in Global Politics from the London School of Economics and Political Science and has previously done field work in Honduras.