Water and Sanitation
According to the policy report titled Off-track, off-target-Why investment in water, sanitation and hygiene is not reaching those who need it most (2011), Water Aid, http://www.wateraid.org/documents/Off-track-off-target.pdf:
• India has made a political commitment of reaching universal access to clean water by 2012. It has made the political commitment of reaching universal access to urban sanitation by 2012 and rural sanitation by 2017.
• The population in India without access to water is 147.3 million. The population in India without access to sanitation is 818.4 million (WHO/UNICEF Joint Monitoring Programme, 2010).
• Indian Government spent 0.57 percent of GDP on water and sanitation in 2008, which fell to 0.54 percent in 2009 and further to 0.45 percent in 2010.
• India provided over 200 million people with access to sanitation between 1995 and 2008; however, the progress has been highly inequitable, with the poorest households barely benefiting. Only five million from the poorest section benefited compared with 43 million and 93 million from the richest sections.
• Whereas every rural household in Sikkim and Kerala has access to sanitation, and states such as Tamil Nadu, Maharashtra, Gujarat, Haryana and West Bengal have seen big improvements to access since 2001, in Bihar 73% of rural households lack adequate sanitation, and across India almost a third of the rural population does not have access.
• The five countries with the largest absolute numbers of people without sanitation–India, China, Indonesia, Nigeria and Pakistan–are all middle income and account for over 1.7 billion people without sanitation.
• WaterAid research in India illustrates how scheduled castes are denied access to water facilities and how scheduled caste children are not allowed to drink water from common sources at school.
• India and China were top 10 recipients for clean drinking water, sanitation and hygiene (WASH) aid for nine and eight years respectively, which is consistent with the fact that these two countries are home to the greatest number of people without water and sanitation facilities.
• In India, the cost of construction of Individual Household Latrines (IHHLs) in the Total Sanitation Campaign is expected to be met by Above Poverty Line households, while for Below Poverty Line households, the cost is shared between the Government of India, the state and individual users, with the exact ratio depending on the unit cost of the facility.
• Diarrhoea, 88 percent of which is caused due to lack of access to clean drinking water, sanitation and hygiene (WASH), is now the biggest killer of children in Africa and the second biggest killer of children worldwide. It is responsible for 2.2 million deaths each year.
• Lack of access to water and sanitation is a major drag on economic growth, and costs African and Asian countries up to 6% of their Gross Domestic Product (GDP) each year.
• Poor people in South Asia are over 13 times less likely to have access to sanitation than the rich; and poor people in Sub-Saharan Africa are over 15 times more likely to practice open defecation.
• There is a rural-urban divide in access to clean water and sanitation. 94% of the urban population in developing countries has access to clean water, compared to 76% in rural areas, and 68% of the urban population has access to improved sanitation, compared with only 40% in rural areas.
• For families without a drinking-water source at home, it is usually women and girls who go to collect drinking water. Surveys from 45 developing countries show that this is the case in almost three-quarters of households.
• Historically, local natural monopolies have been in public ownership, and about 90% of the world’s piped water is delivered by publicly-owned bodies, at both national and municipal levels.
• Increasing overall WASH spending to 3.5% of GDP and sanitation to 1% are very large changes from current levels—but this is the scale of change that is needed if the MDG targets are to be achieved in all regions and LDCs are to get on course for universal access by 2020.
According to Providing Safe Water: Evidence from Randomized Evaluations by Amrita Ahuja, Michael Kremer and Alix Peterson Zwane, April, 2010
• Some 1.6 million children die each year from diarrhea and other gastrointestinal diseases for which contaminated drinking water is a leading cause.
• Young children are most at risk of death from unsafe water, and women and children are typically responsible for most water collection.
• Multiple randomized trials show that water treatment can cost-effectively reduce reported diarrhea. However, many consumers have low willingness to pay for cleaner water, with less than 10% of households purchasing household water treatment under existing retail models.
• Provision of information on water quality can increase demand, but only modestly. Free point of collection water treatment systems designed to make water treatment convenient, salient, and public, combined with a local promoter, can generate take up of more than 60 percent. The projected cost is as low as $20 per year of life saved, comparable to vaccines. In contrast, the limited existing evidence suggests many consumers are willing to pay for better access to water, but it does not yet demonstrate that this improves health.
• Providing dilute chlorine solution free at the point of water collection, together with a local promoter, can increase take up of water treatment from less than 10 percent to more than 60 percent.
• Evidence available from randomized studies suggests that consumers realize substantial non-health benefits from convenient access to water and are willing to pay for this.
• Separately identifying how water quantity and quality affect health is important because different water interventions affect water quality and quantity asymmetrically. For example, adding chlorine to water affects quality but not quantity. On the other hand, providing household connections to municipal water supplies to households that currently use standpipes is likely to have a bigger effect on the convenience of obtaining water, and thus on the quantity of water consumed, than on water quality.
• Increased availability and convenience of water facilitates more frequent washing of hands, dishes, bodies and clothes, thus reducing disease transmission. There is indeed strong evidence that hand washing is important for health.
• Frequent collection of self-reported diarrhea data through repeated interviews leads to health protective behavior change in addition to respondent fatigue and social desirability bias.
• Frequent data collection leads to lower reports of child diarrhea by mothers relative to infrequent surveying and also to higher rates of chlorination verified by tests for chlorine in water.