One of the most quoted WASH statistics was recently “downgraded”. For every $1 invested in water and sanitation, not $8 but “only” $4 is returned in economic returns through increased productivity. This recalculation [1], says the World Health Organization, is mainly a result of higher investment cost estimates and the more complete inclusion of operation and maintenance (O&M) costs.
Providing a better insight into O&M costs has been one of the achievements of the WASHCost project of the IRC International Water and Sanitation Centre. WASHCost has published minimum benchmarks for costing sustainable basic WASH services in developing countries [2]. The project collected data from Burkina Faso, Ghana, Andhra Pradesh (India) and Mozambique.
The main message is that spending less than the minimum benchmarks will result in a higher risk of reduced service levels or long-term failure. NGOs claiming that “US$20 can provide clean water for one person for 20 years” have clearly forgotten to include annual recurrent costs for operation and maintenance, capital maintenance and direct support.
The real cost for 20 years of basic water supply from a borehole and handpump would be, per person, between US$ 20 and US$ 61 for construction plus US$ 3-6 every year to keep it working. In total for the 20 years this would amount to US$ 80 to US$ 181 per person.
Similarly, for the most basic sanitation service, a traditional pit latrine, the combined costs would be US$ 37 – 106 per person over 20 years.
While current figures indicate that access to improved drinking water has increased from 77 per cent to 87 per cent between 1990 and 2008, the real percentage of people with sustainable access to safe drinking water is likely to be significantly lower. This is one of the conclusions of a new report [1] that the UNICEF/WHO Joint Monitoring Programme for Water Supply and Sanitation (JMP) released on 20 December 2011.
If the maximum acceptable time needed to collect water is taken as 30 minutes per round trip, then drinking water coverage in Sub-Saharan Africa drops by eight percentage points, the report says. Similarly, if you include water quality as an indicator, then the 2008 JMP estimates of access to safe drinking water would go down by 16% for Nicaragua, 11% for Ethiopia, 10% for Nigeria and 7% for Tajikistan.
The new report analyses existing JMP statistics in more detail and includes increased disaggregation of water service levels and analyses of trends across countries and regions. It focuses on the three key challenges of equity, safety and sustainability. Disparities in terms of geography, wealth and gender are explored, as well as the role of household water treatment and safe storage in water safety, and the unique threats posed by climate change to the sustainability in rural and urban contexts.
National and global monitoring will require a major evolution, concludes the report, to meet demands for targets and indicators that take equity, safety and sustainability into account.
[1] WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), 2011. Drinking water equity, safety and sustainability. (JMP thematic report on drinking water ; 2011). New York, NY, UNICEF ; Geneva, World Health Organization. 62 p. : 40 fig., 2 tab. 23 ref. <Available at: http://www.unicef.org/media/files/JMP_Report_DrinkingWater_2011.pdf>
Related news:
Monitoring: new tools meet demand for more transparency in the water sector, E-Source, 05 Dec 2011
Angelica de Jesus, First consultation on developing post-2015 monitoring indicators, Berlin: Refocusing the monitoring approach, E-Source, 02 Aug 2011
Related web site: WHO / UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation – http://www.wssinfo.org/
The 64th World Health Assembly (WHA) has adopted a resolution on drinking-water, sanitation and health, and two other related resolutions on cholera and Guinea worm (dracunculiasis).
Yael Velleman at the WHA in Geneva with a copy of the WaterAid report "The sanitation problem - What can and should the health sector do". Photo: WaterAid
WaterAid had issued a call to leaders participating in the WHA in Geneva to prioritise sanitation and water in the fight against diseases including cholera and dracunculiasis. In support of their campaign, WaterAid published a new report The sanitation problem: What can and should the health sector do?. WaterAid’s Senior Health Policy Analyst Yael Velleman wrote an opinion piece in the Guardian and posted daily updates from the WHA.
Updated arrangements for the UN-Water Trust Fund have moved the responsibility for administering the Fund from the rotating UN-Water Chair to a permanent anchoring in the United Nations Office for Project Service (UNOPS). The new arrangements calls for an MoU between each of the 27 UN-Water member agencies to establish an MoU with UNOPS. The MoU between the World Health Organization (WHO) and UNOPS was concluded on 21 February 2011. WHO stated that this will significantly facilitate the flow of funds in support of, for example, the Global Analysis and Assessment of Sanitation and Water (GLAAS) from interested bilateral and multilateral agencies to WHO.
Aid commitments for sanitation and water fell from 8% of total development aid to 5% between 1997 and 2008, lower than commitments for health, education, transport, energy and agriculture, according to the latest UN-Water Global Annual Assessment of Sanitation and Drinking-Water (GLAAS) report, launched by UN-Water and the World Health Organization (WHO). This drop occurred despite compelling evidence that achieving the water and sanitation target of the Millennium Development Goals (MDGs) would lower health-care costs, increase school attendance and boost productivity.
The findings from the UN-Water GLAAS report were tabled at the first annual High Level Meeting of Sanitation and Water for All, hosted by UNICEF on 23 April 2010 in Washington, DC. The High Level Meeting provided a forum for Ministers of Finance from developing countries, accompanied by Ministers responsible for sanitation and water from 20 developing countries, and representatives from 12 donor countries to gain a greater understanding of the linkages between water, sanitation, and economic growth, in order to commit the appropriate resources, as well as to promote a culture of mutual accountability, partnership and shared responsibility.
Global life expectancy could be increased by nearly five years by addressing five factors affecting health – childhood underweight, unsafe sex, alcohol use, lack of safe water, sanitation and hygiene, and high blood pressure, according to a new WHO report.
These are responsible for one-quarter of the 60 million deaths estimated to occur annually.
Global health risks describes 24 factors affecting health. These are mixture of environmental, behavioural and physiological factors, such as air pollution, tobacco use and poor nutrition.
The report also draws attention to the combined effect of multiple risk factors. Many deaths and diseases are caused by more than one risk factor and may be prevented by reducing any of the risk factors responsible for them.
The report mentions that unsafe water, sanitation and hygiene is one of the the leading global risks for burden of disease, accounting for 4% of disability-adjusted life years (DALYs), The others are childhood underweight (6% of global DALYs), unsafe sex (5%) and alcohol use (5%) [see fig. 7].
In developing countries, unsafe water, sanitation and hygiene comes second behind childhood underweight as the highest risk for burden of disease [see tab 2.].
In the annexes of the report there are more detailed tables on health risk factors by WHO region (Africa, Southeast Asia, the Americas, Eastern Mediterranean, Europe and Western Pacific).
Despite the existence of inexpensive and efficient means of treatment, diarrhoea kills more children than AIDS, malaria and measles combined, according to a report issued today by UNICEF and the World Health Organization (WHO).
The report, titled Diarrhoea: Why Children Are Still Dying and What Can Be Done (PDF), includes information on the causes of diarrhoea, data on access to means of prevention and treatment, and a seven-point plan to reduce diarrhoea deaths. “It is a tragedy that diarrhoea, which is little more than an inconvenience in the developed world, kills an estimated 1.5 million children each year,” said UNICEF Executive Director, Ann M. Veneman.
“Inexpensive and effective treatments for diarrhoea exist, but in developing countries only 39 per cent of children with diarrhoea receive the recommended treatment.” Dr Margaret Chan, Director-General of WHO, said: “We know where children are dying of diarrhoea. We know what must be done to prevent those deaths. We must work with governments and partners to put this seven-point plan into action.” Diarrhoea is a common symptom of gastrointestinal infection, which can have a variety of sources.
However just a handful of organisms are responsible for most acute cases of diarrhoea and one, Rotavirus, is responsible for more than 40 per cent of all diarrhoea-related hospital admissions of children under five. A new vaccine for Rotavirus has been found to be safe and effective but is still largely unavailable in most developing countries. Though most episodes of childhood diarrhoea are mild, acute cases can lead to significant fluid loss and dehydration. This dehydration can lead to death unless fluids are quickly replaced. Oral rehydration therapy is the cornerstone of fluid replacement and the new low-osmolarity formula of oral rehydration salts (ORS) is a simple, inexpensive and life-saving remedy that prevents dehydration in children suffering diarrhoea.
Some 88 percent of diarrhoeal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. As of 2006, an estimated 2.5 billion people around the world were not using adequate sanitation facilities, and about 1 in 4 people in developing countries practiced open defecation. Access to clean water and good hygiene practices are extremely effective in preventing childhood diarrhoea. Hand washing with soap has been shown to reduce the incidence of diarrhoeal disease by over 40 per cent, making it one of the most cost-effective interventions for reducing child deaths caused by this neglected killer.
October 15 is annual Global Handwashing Day when millions of children and adults in over 80 countries will take part in activities to highlight this key intervention. The overall health and nutrition of children is also critical to their susceptibility to diarrhoea and the damage it can cause. Undernourished children are at higher risk of suffering more frequent, severe and prolonged episodes of diarrhoea, and repeated bouts of diarrhoea also place children at greater risk of worsening nutritional status.
The seven point plan to save the lives of children stricken by diarrhoea includes two treatment and five prevention elements.
The two treatment elements are:
fluid replacement to prevent dehydration; and
zinc treatments, which decrease the severity and duration of the attack.
The five prevention elements are:
immunization against rotavirus and measles;
early and exclusive breastfeeding and vitamin A supplementation;
handwashing with soap;
improved water supply quantity and quality; and
promoting community-wide sanitation.
Campaigns targeting childhood diarrhoea in the 1970s and 1980s achieved success by educating caregivers and scaling up oral rehydration therapy to prevent dehydration. The campaigns delivered promising results but following that success, focus shifted to other health problems. There is now an urgent need to shift attention and resources back to treating and preventing diarrhoea.
Johansson, E.M. … [et al.] (2009). Diarrhoea : why children are still dying and what can be done. New York, NY, USA, UNICEF and Geneva, Switzerland, World Health Organization. v, 58 p. ISBN 978-92-806-4462-3 (UNICEF). ISBN 978-92-4-159841-5 (WHO). Full report
There is also an online version of the report on 7pointplan.org
The World Health Organization has paved the way for children in Africa and Asia to be vaccinated against a diarrhoea-causing virus that kills some 500,000 children annually worldwide – 85 percent of them in African and Asian developing countries. WHO has recommended that the vaccine for rotavirus – the leading cause of severe and often fatal diarrhoea and dehydration in under-five children – be included in national immunization programmes worldwide.
As of 2007 the organization had said more research was needed on the vaccine’s efficacy in developing countries with high child mortality; new data from clinical trials has led WHO to recommend global use of the vaccine, according to a 5 June communiqué. The decision means poor countries in Asia and Africa can now apply for funding to include rotavirus vaccines in their national immunization programmes.
“This [vaccine] will significantly reduce mortality and morbidity of rotavirus disease,” Samba Ousmane Sow, associate professor of medicine at University of Maryland and coordinator of the Centre for Vaccine Development in Mali, told IRIN. “For rotavirus, as with many infectious diseases, mortality is often a question of geography,” he said. “For the many people in rural Africa who cannot easily access medical care, the best and most practical solution [against this lethal illness] is to bring the vaccine to them.”
A child with rotavirus disease – which causes fever, vomiting and diarrhoea – can rapidly become dehydrated. Death from rotavirus is most common where there is no quick access to medical care, so vaccination is the most effective way to prevent severe cases and deaths, experts say.
Transmitted primarily by the faecal-oral route, the virus affects the vast majority of children globally before age three, according to WHO. The virus attacks the villi – tiny projections on the wall of the small intestine. Destruction of the affected cells reduces digestion and absorption of nutrients, resulting in diarrhoea with a loss of fluids.
The virus is resilient and traditional hygiene measures that might prevent other sanitation-related illnesses are not sufficient to limit its impact, according to PATH, an international health non-profit and one of the organizations conducting vaccine trials with WHO and the Global Alliance for Vaccines and Immunization (GAVI). But given that there are many causes of diarrhoeal disease, the rotavirus vaccine must be part of a comprehensive control strategy, including improving water quality, hygiene and sanitation and providing oral rehydration solution and zinc supplements, WHO says in its communiqué.
[N]ow governments will have to prepare an investment plan for including rotavirus vaccine in their immunization programmes. The GAVI Alliance uses a co-financing approach, in which countries procure some vaccines with non-GAVI funds; the intention is for countries to gradually increase their share of vaccines’ cost, making immunization programmes sustainable. The GAVI Alliance board is expected to decide at its November 2009 meeting whether all 72 GAVI-eligible countries will now become eligible to apply for funding to include the rotavirus vaccine in their immunization programmes, GAVI’s Ariane Leroy told IRIN.
Clinical trials of the vaccine are ongoing in Asia and sub-Saharan Africa, but WHO’s Strategic Advisory Group of Experts has recommended the vaccine for all populations given available evidence, WHO says.
The case studies will highlight collaborations that are built and/or transactions that are entered into which address a global health concern. Global health concern refers to those diseases that have a disproportionate impact on developing countries, but need not be the sole focus of the collaboration or transaction. The intended audience for this initiative includes organizations and individuals who are currently involved or are interested in helping to fulfill global health objectives.
The World Health Organization’s Commission on the Social Determinants of Health presented its findings on 28 August 2008 to the WHO Director-General Dr Margaret Chan.
“(The) toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible,” the Commissioners write in Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. “Social injustice is killing people on a grand scale.”
[...]
Health inequities – unfair, unjust and avoidable causes of ill health – have long been measured between countries but the Commission documents “health gradients” within countries as well. [...] This slope linking income and health is the social gradient, and is seen everywhere – not just in developing countries, but all countries, including the richest. The slope may be more or less steep in different countries, but the phenomenon is universal.
Economic growth is raising incomes in many countries but increasing national wealth alone does not necessarily increase national health. Without equitable distribution of benefits, national growth can even exacerbate inequities.
[...]
Much of the work to redress health inequities lies beyond the health sector. According to the Commission’s report, “Water-borne diseases are not caused by a lack of antibiotics but by dirty water, and by the political, social, and economic forces that fail to make clean water available to all. [...] Consequently, the health sector – globally and nationally – needs to focus attention on addressing the root causes of inequities in health.
[...]
Billions of people live without adequate shelter and clean water. The Commission’s report pays particular attention to the increasing numbers of people who live in urban slums, and the impact of urban governance on health. The Commission joins other voices in calling for a renewed effort to ensure water, sanitation and electricity for all, as well as better urban planning to address the epidemic of chronic disease.
[...]
“Investment in basic services such as water and education will always remain constrained if not wasted unless accompanied by requisite investment in decent housing with basic sanitation”, Anna Tibaijuka, Executive Director of UN-HABITAT, one of the members of the Commission.
