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Health, Dignity, and Development: What Will It Take? Task Force on Water and Sanitation

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Health, Dignity, and Development: What Will It Take? Task Force on Water and Sanitation ����������������� ����������������� ������������������ ������������� ��������������������������� ����������������������������� ������������� ��������������������� ���������������������������������� ���� ���������������������� First published by Earthscan in the UK and USA in 2005 Copyright © 2005 by the United Nations Development Program All rights reserved ISBN: 1-84407-219-3 paperback For a full list of publications please contact: Earthscan 8–12 Camden High Street London, NW1 0JH, UK Tel: +44 (0)20 7387 8558 Fax: +44 (0)20 7387 8998 Email: [email protected] Web: www.earthscan.co.uk 22883 Quicksilver Drive, Sterling, VA 20166-2012, USA Earthscan is an imprint of James and James (Science Publishers) Ltd and publishes in association with the International Institute for Environment and Development A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record has been requested This publication should be cited as: UN Millennium Project 2005. Health, Dignity, and Development: What Will it Take? Task Force on Water and Sanitation. Photos: Front cover Franck Charton/UNICEF; back cover, top to bottom, Christopher Dowswell, Pedro Cote/ UNDP, Giacomo Pirozzi/Panos Pictures, Liba Taylor/Panos Pictures, Jørgen Schytte/UNDP, UN Photo Library, Giacomo Pirozzi/UNICEF, Curt Carnemark/World Bank, Pedro Cote/UNDP, Franck Charton/UNICEF, Paul Chesley/Getty Images, Ray Witlin/World Bank, Pete Turner/Getty Images. This book was edited, designed, and produced by Communications Development Inc., Washington, D.C., and its UK design partner, Grundy & Northedge. The Millennium Project was commissioned by the UN Secretary-General and sponsored by the United Nations Development Programme on behalf of the UN Development Group. The report is an independent publication that reflects the views of the members of the Task Force on Water and Sanitation, who contributed in their personal capac- ity. This publication does not necessarily reflect the views of the United Nations, the United Nations Development Programme, or their Member States. Printed on elemental chlorine-free paper Foreword The world has an unprecedented opportunity to improve the lives of billions of people by adopting practical approaches to meeting the Millennium Devel- opment Goals. At the request of UN Secretary-General Kofi Annan, the UN Millennium Project has identified practical strategies to eradicate poverty by scaling up investments in infrastructure and human capital while promoting gender equality and environmental sustainability. These strategies are described in the UN Millennium Project’s report Investing in Development: A Practical Plan to Achieve the Millennium Development Goals, which was coauthored by the coordinators of the UN Millennium Project task forces. The task forces have identified the interventions and policy measures needed to achieve each of the Goals. In Health, Dignity, and Development: What Will It Take? the UN Millennium Project Task Force on Water and Sani- tation emphasizes that achieving the water and sanitation target and investing in water infrastructure and management are crucial to the achievement of all the Millennium Development Goals—a key point that is echoed in Investing in Development. Consider, for example, the sanitation crisis. Four in ten of our fellow women, men, and children have no choice but to defecate in buckets, in plas- tic bags, in open fields, and alongside footpaths, streets, and railroad tracks, not occasionally but every single day. This persistent yet largely unrecognized humanitarian crisis must end if we are to reduce disease, hunger, and gen- der inequality; improve the lives of slum dwellers; and achieve environmental sustainability. Conversely, progress toward these and other Millennium Devel- opment Goals—particularly the reduction of poverty and gender inequality— is vital to achieving the water and sanitation target and to improving the use of Earth’s water resources. iv Foreword Health, Dignity, and Development has been prepared by a group of leading experts who contributed in their personal capacity and volunteered their time to this important task. I am very grateful for their thorough and skilled efforts, and I am sure that the practical options for action in this report will make an important contribution to achieving the Millennium Development Goals. I strongly recommend it to anyone who is interested in how countries can make the dream of safe drinking water and basic sanitation a reality for their poorest citizens. Jeffrey D. Sachs New York January 17, 2005 Contents Foreword iii Task force members x Preface xii Acknowledgments xv Millennium Development Goals xviii Executive summary 1 Chapter 1 Water is life 3 The historical context 4 The institutional context 7 The focus of this report 10 Part 1 The Millennium Development target for domstic water supply and sanitation 13 Chapter 2 Why focus on water supply and sanitation? 15 Human values and human rights 15 Contribution to the Millennium Development Goals 17 Chapter 3 Target 10 and the global monitoring system 28 Target 10 on water and sanitation 31 The current system for monitoring and evaluation 33 Chapter 4 Where are the needs greatest? 38 Access to domestic water supply and sanitation services 39 Current levels of access and the rate of progress toward the goal 41 Low access to services and high incidence of water-related disease 42 vi Contents Identifying greatest needs globally 44 Pinpointing greatest needs within countries 45 Chapter 5 What’s holding us back? 62 Political constraints 62 Institutional constraints 64 Financial constraints 69 Technical challenges 74 Conclusion 77 Chapter 6 The special challenge of meeting the sanitation target 79 A collective or an individual service? 80 The nature of demand for improved sanitation 81 Reorienting public institutions for sanitation service delivery 83 Changing roles for government 85 New technologies or better use of existing technologies? 87 Alternative planning approaches for urban sanitation 88 Alternative planning approaches for rural sanitation 90 Galvanizing support for sanitation and hygiene 91 Chapter 7 Technology and infrastructure 93 Available technological options 93 Cost-reduction strategies 98 The need for innovation 100 Chapter 8 What would it cost? 102 Global estimates 102 National estimates: a method to assess needs 103 Chapter 9 Grappling with financing for the poorest 113 Principal target group: poor people in the poorest countries 114 Financial constraints in low-income countries 115 Affordability, sustainability, and water conservation 122 What about middle-income countries? 123 Part 2 Water resources for all the Millennium Development Goals 125 Chapter 10 Why does water resources development and management matter? 127 Poverty and hunger 128 Environmental sustainability 133 Health 136 Contents vii Gender equality 137 Exploiting potential synergies through combined approaches 138 Chapter 11 What actions are needed? 142 Investing in water resources development and management 146 Adopting integrated water resources management 147 Examples of context-specific actions 148 Chapter 12 Monitoring and support systems 151 Monitoring water resources 151 Global institutional support structures 156 Recommendations for the international community 157 Part 3 Achieving the Millennium Development Goals 161 Chapter 13 How to make the Goals a reality 163 A call to action 163 Ten critical actions 165 Chapter 14 An operational plan 174 Appendix 1 Insights from case studies 180 Notes 194 References 200 Boxes 1.1 Millennium Development target 10 4 1.2 Lessons from the International Drinking Water Supply and Sanitation Decade 9 2.1 Lack of sustainable access to basic sanitation—a polite way to say “open defecation” 16 2.2 Economic benefits from improving water supply and sanitation services 19 2.3 Maximizing the health benefits from water supply, sanitation, and hygiene interventions 20 2.4 Where does hygiene fit in? 24 2.5 Household water treatment and safe storage 24 2.6 How long are we going to live this way? 25 2.7 Modest dreams 26 3.1 What is sanitation? 30 5.1 Water is a political issue 63 viii Contents 5.2 Overcoming constraints and increasing access: the South African experience 77 6.1 Unheard voices of women 82 8.1 Assumptions used in arriving at the estimates in table 8.1 103 10.1 Water-related disasters: facts from the World Health Organization 127 10.2 Improving water management to spur economic development 128 10.3 Main water-related recommendations of the Millennium Project for meeting the poverty and hunger Goals 130 10.4 Main water-related recommendations of the Millennium Project Task Force on Environmental Sustainability 133 10.5 Living with urban environmental problems 134 10.6 Main water-related recommendations of the Millennium Project Task Force on Improving the Lives of Slum Dwellers 135 10.7 Malaria: facts from the World Health Organization 136 10.8 Main water-related recommendations of the Millennium Project Task Force on Education and Gender Equality 137 12.1 The evolution of interagency coordination in water resources and sanitation 157 Figures 3.1 Millennium Development Goals for water and sanitation reach the neediest in urban and rural areas 33 4.1 A typology of communities with low water supply and sanitation coverage 45 5.1 Access to water supply rises as national income rises 69 5.2 The richest are twice as likely to use drinking water from an improved source as the poorest 70 5.3 The richest are four
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