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The Connections Between Poverty and Water Supply, Sanitation, And The Connections between Poverty and Water Supply, Sanitation, and Hygiene (WASH) in Panama Sanitation, and Hygiene (WASH) Supply, The Connections between Poverty and Water The Connections between Poverty Public Disclosure Authorized and Water Supply, Sanitation, and Hygiene (WASH) in Panama A Diagnostic Public Disclosure Authorized PANAMA Public Disclosure Authorized A Diagnostic Public Disclosure Authorized This work was financed by the World Bank Water and Sanitation Program and the Swedish International Development Cooperation Agency and was a multi-Global Practice initiative led by Water and Poverty with significant support from Governance and Health, Nutrition, and Population. The Connections between Poverty and Water Supply, Sanitation, and Hygiene (WASH) in Panama A Diagnostic © 2018 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington, DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. Please cite the work as follows: World Bank. 2018. The Connections between Poverty and Water Supply, Sanitation, and Hygiene (WASH) in Panama: A Diagnostic. WASH Poverty Diagnostic. World Bank, Washington, DC. Any queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522- 2625; e-mail: pubrights @ worldbank.org. Cover design: Bill Pragluski, Critical Stages LLC. Contents Acknowledgments vii Abbreviations ix Executive Summary 1 Context 1 Diagnostics 2 Recommendations 5 Notes 7 References 7 Chapter 1 Context and Motivation 9 Welfare Progress and Gaps 9 The WASH Poverty Diagnostic in Panama 13 Structure of the Report 15 Notes 16 References 16 Chapter 2 Poverty, Water, and Sanitation: Levels and Trends 19 Changes in Poverty 19 The Distribution of Poverty at the Subprovince Level 22 Inequities in Access to WASH Services 23 Notes 35 References 35 Chapter 3 Access to WASH and the Effect of Social Spending 37 Social Spending and Poverty Reduction 37 WASH and Health in Panama 39 WASH and Education in Panama 45 Notes 49 References 49 Chapter 4 Service Providers, Quality, and the Link to Poverty 51 Water Service Provision IDAAN’s Coverage Is Constrained to the Wealthier, Urban, and Nonindigenous Communities 51 Services Provided in Urban Areas Served by IDAAN: Elements of Safely Managed Sanitation 52 The Quality of Water Is Lower in the Most Densely Populated and Wealthier Areas: The Example of Panama City 55 Customer Service Could Be Improved in Densely Population and Richer Areas Where Most Complaints about Leaking Pipes Occur 56 Safely Managed Sanitation Reaches Less than Half of the Population IDAAN Meant to Cover 61 New Data on Rural Water and Sanitation Systems 65 Overall Rural Analysis 66 Primary Data Collection in 138 Indigenous Communities to Inform Comprehensive WASH Investments 66 Notes 74 References 75 The Connections between Poverty and Water Supply, Sanitation, and Hygiene (WASH) in Panama iii Chapter 5 Barriers to Sustainable Service Delivery in Rural Areas 77 The De Jure Architecture for Wash Service Provision in Rural Areas 78 Policy and Regulation Is Mainly Distributed between the Ministry of Health and the Ministry of Presidency 80 Planning, Financing, and Human Resources Responsibilities Are under Different Actors and Levels 81 Infrastructure Development and Provision Are Separate Functions, under Different Institutions, and at Different Levels, as Are Monitoring and Supervision 83 Supply and Demand Factors that Are Barriers to WASH Service Delivery to Indigenous Peoples 84 Financial Resources Have Increased Recently although They Remain Low and Uneven in Rural Areas 85 Institutional Fragmentation and Lack of Coordination Prevail in the System and Create Confusion and Inefficiencies 89 DISAPAS and JAARs Lack the Capacity to Fulfill Their Responsibilities 89 Lack of Voice in Planning and Investment 90 Notes 91 References 91 Chapter 6 Conclusions and Policy Recommendations 93 Conclusions 93 Policy Recommendations 94 References 99 Appendix A Contributions to World Bank Operations 101 Appendix B Quality of Service Provision by IDAAN, Definition and Indicators 105 Boxes Box 1.1: WASH Poverty Diagnostic 12 Box 1.2: Main Outputs of the Panama WASH Poverty Diagnostic 14 Box 2.1: Data Sources in Panama 21 Box 2.2: The Shift from MDGs to SDGs 32 Box 4.1: The Key Role of IDAAN 52 Box 4.2: Data Sources Used 54 Box 4.3: Panama Urban WSS Performance Benchmarking at a Glance 57 Box 6.1: Good Practices for the Provision of Adequate Access to Wash Services in Rural Areas 95 Box 6.2: Good Practices in WASH Service Provision to Indigenous Peoples 97 Figures Figure ES.1: Growth Rates, GDP and per Capita, in Panama and in Latin America and the Caribbean 1 Figure ES.2: Poverty Trends, 2008–15 2 Figure ES.3: Assessment of Water Systems in Indigenous Territories and Comarcas, 2016 6 Figure 1.1: Growth Rates, GDP and per Capita, in Panama and in Latin America and the Caribbean, 1990–2015 9 Figure 1.2: Poverty Trends, 2008–15 10 Figure 1.3: Poverty at Provincial Level, 2011–15 11 Figure 1.4: Changes in Overall Poverty, 2011–15 11 Figure 2.1: Trends in Poverty Rates in Panama and in Latin America and the Caribbean, 2008–15 19 iv The Connections between Poverty and Water Supply, Sanitation, and Hygiene (WASH) in Panama Figure 2.2: Trends in Extreme Poverty in Panama and in Latin America and the Caribbean, 2008–15 20 Figure 2.3: Inequality Trends (Gini Coefficient) in Panama and in Latin American and the Caribbean, 2009–14 20 Figure 2.4: Change in Access to Piped Water in the Dwelling, 2000–10 25 Figure 2.5: Change in Access to Sewage Connection in the Dwelling, 2000–10 25 Figure 2.6: Water Sources Nationally, 2010 and 2015 26 Figure 2.7: Water Sources in the Comarcas, 2010 and 2015 26 Figure 2.8: National Sanitation Coverage, 2010–15 27 Figure 2.9: Sanitation Coverage in Comarcas, 2010–15 27 Figure 2.10: Urban Sanitation Coverage, 2010–15 28 Figure 2.11: Rural Coverage in Comarcas, 2010–15 28 Figure 2.12: Access to Water by Income Quintile, 2015 29 Figure 2.13: Access to Sanitation by Income Quintile, 2015 30 Figure 2.14: HOI and Coverage of WASH Services in Panama for Children 31 Figure 2.15: The Circumstances that Explain the Unequal Distribution of Access to WASH for Families with Children 31 Figure 3.1: Contribution of Different Income Sources to Overall Poverty Reduction, 2011–15 38 Figure 3.2: Contribution of Different Income Sources to Extreme Poverty Reduction, 2011–15 38 Figure 3.3: Hypothetical (Simple) Impact of Removing Key Public Transfer Programs (Increase in Percentage Points) 39 Figure 3.4: Logic Model for the Connections between Health Outcomes and Access to WASH for RdO Participants 40 Figure 3.5: Sanitation Infrastructure, Percent 42 Figure 3.6: Type of Water Treatment, Percent, by Location 43 Figure 3.7: Net Primary and Secondary Enrollment Rates, Panama and Latin America and the Caribbean, 1990–2013 45 Figure 3.8: Educational Attainment among 15- to 19-Year-Olds in Panama, 2007–12 46 Figure 3.9: Association between WASH Index and 6th Grade Math Score, by Specification and Subgroup (Poor-Rich and Rural-Urban) 47 Figure 3.10: Illustrating the Menstruation Hypothesis 48 Figure 3.11: Associations between WASH and 6th Grade Math Score, Females vis-à-vis Males 48 Figure B4.3.1: Benchmarking Urban Water Coverage, 2015 57 Figure B4.3.2: Benchmarking Urban Sewerage Coverage, 2015 58 Figure B4.3.3: Water Continuity (Number of Hours), 2010 58 Figure B4.3.4: Residual Chlorine (Number of Samples Passing Residual Chlorine Tests) 58 Figure 4.1: Response to Complaint within 30 Days 59 Figure 4.2: Continuous Water Service (Percent of Corregimientos per District) 62 Figure 4.3: Water Service Continuity in Corregimientos of Colón, 2010 (Percent of the Population) 62 Figure 4.4: Containment and Treatment 64 Figure 4.5: Different Quality Levels 67 Figure 4.6: Quality of Service Provision in Subsample of Indigenous Communities 67 Figure 4.7: Handwashing and Use of Latrines 68 Figure 4.8: Use of Latrines 69 Figure 4.9: Use of Latrines, by Location 69 Figure 4.10: Value of Water System Score by Component, Average 70 Figure 4.11: Share of Communities by Water System Component 70 Figure 4.12: Distribution of Systems by Ranking and Age 71 Figure 4.13: Components that Are Most Frequently Failed 71 Figure 4.14: Legal Status of Providers 72 The Connections between Poverty and Water Supply, Sanitation, and Hygiene (WASH) in Panama v Figure 4.15: Latrine Usage Compared to Open-Air Defecation Reported in a 138-Community Sample (Based on Provider) 72 Figure 5.1: The De Jure Institutional Architecture for Rural Indigenous
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