Module1 Final

Sandec: Department of Water and Sanitation in Developing Countries
Sandec Training Tool 1.0 Module 1
Water and Sanitation in Developing

Countries Overview
Summary
Summary
Safe drinking water and hygienic sanitation facilities are a precondition for health
and for success in the fight against poverty, hunger, child death and gender inequality. They are central to the human rights and personal dignity of every
woman, man and child on earth (WHO,
Unicef 2004).
At the United Nations Millennium
Summit in September 2000, all 189
heads-of-state adopted the Millennium
Development Goals (MDGs), which set
clear, numerical, time-bound targets for
making real progress by 2015 in tackling
the most pressing issues faced by developing countries. Among those targets is
the Millennium Development Target 10
(as expanded by the 2002 World Summit
on Sustainable Development): to cut in
half by 2015 the number of people without sustainable access to safe drinking
water and basic sanitation (Lenton et al.
2004).
In 2007, 2.6 billion people still lacked
adequate sanitation facilities, whereby
most of these people are located in the
Eastern Asian, Southeastern and Southern Asian region. The World Health Organisation (WHO) estimates that globally
1.8 million people die each year from diarrhoeal diseases, 200 million people are
infected with schistosomiasis and more
than 1 billion people suffer from soil-
transmitted helminth infections (WHO

2004). A Special Session on Children of
the United Nations General Assembly in
2002 reported that nearly 5,500 children
die every day from diseases caused by
contaminated food and water. The adverse impacts of poor sanitation can extend well beyond the direct impacts on
health. Health risks and epidemics from
waterborne diseases can greatly reduce
tourism and agricultural exports, with
economic costs much greater than the
costs invested in water supply and sanitation to address these problems (UN CSD 2004).
To achieve the goals set for 2015, emphasis will have to be placed on the urban and peri-urban population, as it is
the more rapidly increasing fraction of
the population. According to recent estimates, over 900 million people can be
classified as slum dwellers, since they
lack one or more of the following conditions: access to improved water, access
to improved sanitation facilities, sufficient living space, dwellings of sufficient
durability and structural quality, and security of tenure. In todays world, almost
one out of three urban dwellers already
lives in a slum. It is such urban poor, living in slums that suffer most from deficient environmental sanitation infrastructure and services (Garau et al. 2004).
The following document provides definitions, gives an overview of the current situation, and discusses in detail the
aforementioned water supply and environmental sanitation challenges in developing countries. Furthermore, (new)
approaches to overcome the service
backlog are listed and briefly discussed.
Figure 1: The Sandec Training Tool focuses on

the water supply and environmental sanitation
services in developing countries.
Publishing details
Publisher: Eawag/Sandec (Department of
Water and Sanitation in Developing Countries), P.O. Box 611, 8600 Dbendorf,
Switzerland. Phone +41 (0)44 823 52 86,
Fax +41 (0)44 823 53 99
Editors: Chris Zurbrgg and Sylvie Peter
Concept and Content: Karin Gdel
Layout: Yvonne Lehnhard
Copyright: Sandec/Eawag compiled this
material, however most of the content
and figures are not Eawag/Sandec property and can be downloaded from the Internet. The modules of this training tool are
not commercial products and may only be
reproduced freely for non-commercial purposes. The user must always give credit in
citations to the original author, source and
copyright holder.
These lecture notes and matching Powerpoint presentations are available on the
Sandec Training Tool CD, which can be ordered from: info@sandec.ch
Cover photo: Low income area in Manila,
Philippines. (Sandec 1990)
Sandec Training Tool: Module 1
Content
Content
1 Definitions and Objectives

1.1
1.2
1.3
1.4
What is environmental health?

4
What is water supply and environmental sanitation?
5
What resource and waste systems are we tackling?
6
What are the objectives and new principles of water supply and sanitation systems?
7
2 Environmental Health
2.1
2.2
2.3
2.4
Introduction
What is the global burden of disease?
What are the main transmission routes of pathogen related diseases
How can we disrupt the transmission routes of pathogens?
8
9
10
11
3 Millennium Development Goals
12
3.1 What are the Millennium Development Goals?

3.2 What does Goal 7 include?
3.3 What is improved water supply and basic sanitation?
12
13
14
4 Global Situation
15
4.1
4.2
4.3
4.4
4.5
4.6
Introduction
15
Where are the differences in global water supply coverage?
17
Where are the differences in global sanitation coverage?
18
What is the global slum situation?
20
How close / how far away are we from reaching the goals globally?
21
Where is the greatest need for improvement? Summary of global situation 22
5 Urban Challenges
5.1 What are the major deficiencies and challenges in urban water and sanitation
provision?
23
5.2 What are the challenges faced by households and communities?
24
Illegal status of many settlements
24
Community capacity to develop autonomous solutions
25
Household capacity to pay
5.3 What are the challenges at city or town level?
27
Weakness and incapacity of local utilities
27
Rapid population growth and urbanisation
28
The mega cities and their history
29
Small cities
30
The special problems of sanitation in small cities of low-income countries 30
Weak city and municipal governments
32
5.4 What are the challenges at the international level?
33
Lack of international funds for urban water and sanitation
33
The political under-pinning of good provision for water and sanitation
35
5.5 Deficiencies Summary
36
6 (New) Approaches
38
6.1
6.2
6.3
6.4
6.5
6.6.
39
41
43
45
46
48
Political approaches
Institutional approaches
Financial and economic approaches
Social approaches
Planning approaches (Module 7)
Technical approaches
References
51
References
Weblinks <www>
51
52
1.1 What is environmental health?

The goals of environmental health are the following:
Maintain a natural and built environment free from undue hazards, and
Provide essential environmental services to households and communities.
Good health presupposes that the water we drink, the air we breathe and the
food we eat are free from contaminants
and pathogens, and that facilities, services and hygienic behaviour provide for a
clean environment in which to live, with
measures to break the cycle of disease
and contamination. Most often it is the
poor and vulnerable that cannot protect
themselves and pay the price of poor
health.
Health is best protected by safeguarding the environment by pollution prevention and provision of an environmental
service to each household or community.
Individual health benefits from enough
clean and safe drinking water. This can
be attained by clean water sources or
reliable water treatment. Similarly, individual and community health can only
be reached if waste is collected, recycled, treated or disposed of in a sanitary
manner.
Environmental factors to reach these
objectives:
Maintain a natural environment free
from undue hazards,
Figure 2: The natural and built environment with its natural resources water, air and soil (blue);
all services and facilities required to keep the environment clean and protect health (green). The
Sandec Training Tool focuses on water supply and environmental sanitation services, facilities and
human behaviour (inside yellow line).
Further questions
How can we distinguish between built
and natural environment in urban areas?
Ensure a built environment free from

undue hazards, and
Provide essential environmental services to households and communities.
(Cairncross 2002, p. 1)
At what spatial level should the required

services and measures be provided to
have a reasonable and most beneficial impact on environmental health? Household,
neighbourhood, city, region, nation?
Anyone changing the natural or built environment has an impact on environmental health!
(Cairncross 2002, p. 1)
1.2 What is water supply and environmental sanitation?

Interventions to reduce peoples exposure to disease by providing a clean environment in which to live, and the
measures to break the cycle of disease. It involves both behaviour and facilities, which jointly work together to
form a hygienic environment. (Simpson-Hebert and Woods, 1998)
This comprises:
access to a safe supply of water for domestic use
access to water for washing and hygiene practice
safe management of human excreta and wastewater
solid waste management and (stormwater) drainage
Water supply
In terms of water supply, the basic needs
include access to safe water supply for
domestic use, i.e. water for drinking,
food preparation, bathing, laundry, dishwashing, and cleaning. In many cases,
domestic water may also be used for animals and watering vegetable plots or gardens. Definitions of access (distance to
the nearest water-point and per capita
availability) and safe (water quality) may
vary from one country to another (DFID
Manual 1998, p. 4), however, the overall
valid standard is to provide at least 20 litres per person and day from a source
within one kilometre of the users dwelling (WHO/Unicef 2000, p. 77).
Sanitation
There are many possible definitions of
sanitation. For the purpose of thie Sandec Training Tool, the word sanitation
alone is taken to mean the safe management of human excreta and wastewater.
It therefore includes both the hardware
(e.g. latrines and sewers) and the software (regulation, hygiene promotion)
needed to reduce faecal-oral disease
transmission. It encompasses potential
reuse, ultimate disposal of human excreta or discharge of wastewater. (DFID
Manual 1998, p. 4)
Environmental sanitation
Environmental sanitation aims at improving the quality of life of the individuals and at contributing to social de-
Figure 4: The water supply and environmental sanitation systems provide barriers between pollutants, the natural and built environment as well as humans. The waste and resource sub-systems
of water and environmental sanitation (green); the natural environment (blue); the built environment (brown).
velopment. It has been defined by the

Water Supply and Sanitation Collaborative Council as Interventions to reduce
peoples exposure to disease by providing a clean environment in which to
live, with measures to break the cycle of
disease (Simpson-Hebert and Woods,
1998). This usually includes disposal or
hygienic management of liquid and solid
human waste, control of disease vectors
and provision of washing facilities for
personal and domestic hygiene. Environmental sanitation comprises both behaviour and facilities to form a hygienic environment. (Schertenleib, p. 1)
Further questions
Can we simplify our goal of water and
environmental sanitation by ensuring that
every household is provided enough clean
water? What about the human liquid and
solid waste fractions? How are they handled, where do they go and how does this
affect health?
Can facilities alone solve water and sanitation problems? Can improved hygiene
practices (behaviour) alone solve all problems?
1.3 What resource and waste systems are we tackling?

Sandecs Training Tool deals with the following systems and main resources:
Water supply and household water handling: drinking water (Module 3)
Sanitation systems and technologies: wastewater, excreta and greywater (Module 4)
Faecal sludge management: excreta and faecal sludge (Module 5)
Solid waste management: solid waste (Module 6)
Since most waste products should be regarded as resources rather than waste,
an integrated viewpoint is crucial (cf. Figure 3).
Water supply and household water

handling (Module 3)
Water in sufficient quantity and good
quality is essential for life. Water supply
distribution systems often suffer from
unreliable operation and lack of maintenance. This results in intermittent supply or unsafe water due to potential secondary contamination during collection,
transport and storage.
A lack of safe drinking water quality
leads to a high risk of waterborne diseases, such as cholera, typhoid fever, hepatitis A, amoebic and bacillary dysentery,
and other diarrhoeal diseases.
If the water source is contaminated,
adequate water treatment methods and
avoidance of secondary contamination
are required to ensure a safe drinking water quality. (Sandec, <www>)
Sanitation planning and infrastructure (Modules 4 and 7)

Cities, as engines of economic growth
and social development, require large
quantities of natural resources to meet
the inhabitants economic and social
needs. Good infrastructure and reliable
service provision are keys to a sustained
urban development. To respond to the
lack of sanitation infrastructure affecting
especially the urban poor, many governments, development agencies and NGOs
have launched programmes to provide
the poor and vulnerable population with
sanitation options. However, the sanitation systems are often only considered
partially. For example on-site based sanitation solutions (latrine or septic tankbased) frequently do not include excreta and faecal sludge emptying, transport
or treatment services and facilities. Additionally, local business opportunities,
as well as demand and potential use of
waste resources, such as water, nitro-
Figure 3: The figure shows the sources of waste in the household and neighbourhood (green)
and the waste and resource flows (brown). All waste and resource flows require an integrated
management (green) within a settlement: regulatory system and its enforcement, as well as
operation and maintenance for safe transport, treatment, safe disposal, and/or reuse (blue).
gen or biosolids, are given little attention. Failures or unsustainable solutions

put huge financial burden on municipalities. (Sandec, <www>)
Excreta and faecal sludge management (Module 5)

In cities of developing countries, large
amounts of excreta and faecal sludge
collect in on-site sanitation facilities,
such as private or public latrines, aqua
privies and/or septic tanks. As opposed
to industrialised countries, where excreta is disposed of via cistern-water flush
toilets, city-wide sewerage systems and
central wastewater treatment plants, all
of which are widespread technologies in
industrialised countries but unaffordable
or inappropriate in developing countries.
If faecal sludges (FS) are collected at
all from on-site sanitation technologies, they are most often disposed of
in an uncontrolled manner without prior treatment, thus, posing severe health
risks and polluting the environment. If
treatment facilities are available in larg-
er cities, haulage distances or the time

required for transport due to traffic congestions may be prohibitive for efficient
sludge emptying services. Within city
boundaries, land is often highly valued
and may thus not be available for waste
treatment. This will consequently lead
to nearest possible uncontrolled dumping, be it on open grounds, into drainage
ditches, water courses or into the sea.
(Sandec, <www>)
Solid waste management (Module 6)

Collection, transport, recycling, treatment, and safe disposal are crucial elements in solid waste management.
Decentralised approaches, such as solving problems as close to the source of
waste generation as possible, are considered promising approaches to reduce
the waste stream. Enabling a wide variety of enterprises (small local enterprises,
informal sector), neighbourhood or community-based organisations and NGOs
to engage in waste management as well
as involving all stakeholders in planning
and decision-making are considered key

issues contributing to improvements.
Often more than 50% of the total municipal waste is organic. Enhancing resource recovery of this fraction as close
to the source as possible (household or
neighbourhood) can alleviate significant
problems in the subsequent transport
and disposal processes. Communitybased organisations (CBO) or small and
medium enterprises (SME) show promising potential to fulfil certain waste management functions such as collection,
sorting or recycling. (Sandec, <www>)
Further questions
Where are the resources generated and
what are their flow streams? Which
spatial entities are affected (household,
neighbourhood, city etc.)?
Where (cf. Figure 3) would you expect

the major differences between a city and a
rural area?
How does the industrialised country

context (social, economic, technical, and
institutional) differ from the developing
country context?
What water and sanitation facilities and

services are you familiar with?
Additional info
The Sandec homepage www.sandec.ch
comprises more information on Sandecs
research and teaching activities and
provides many useful links and publications
on water and environmental sanitation.
Modules 3, 4, 5 and 6 provide further information on the aforementioned waste

and resource systems and technologies.
DFID Guidance Manual on Water Supply

and Sanitation Programmes (1998);
London School of Hygiene & Tropical
Medicine (LSHTM) and Water, Engineering
and Development Centre (WEDC),
Loughborough University, UK. www.lboro.
ac.uk/well/resources/Publications/guidance-manual/ (last accessed 01.04.08)
Downloads available on the CD of Sandecs Training Tool and from the Internet.
1.4 What are the objectives and new principles of water supply
and sanitation systems?
Progress in providing improvements in water and environmental sanitation systems in the developing
world is not sufficiently effective and rapid to achieve coverage of the unserved.
New and more sustainable systems and approaches have to be implemented covering all site-specific facets!
Water supply and environmental sanitation systems must: protect and promote health, protect the environment, be simple, be affordable, be culturally acceptable and work for everyone.
(New) principles of water and

sanitation in developing countries?
How does this affect water supply

and environmental sanitation?
The principles governing the new approach are the following:

1. Human dignity, quality of life and environmental security at household level
should be at the centre of the new approach. It should also be responsive
and accountable to local and national
needs and demands.
2. In line with good governance principles, decision-making should involve
participation of all stakeholders, especially the consumers and service providers.
3. Waste should be considered a resource, and its management should
be holistic and form part of integrated
water resources, nutrient flows and
waste management processes.
4. The domain in which environmental sanitation problems are resolved
should be kept to the minimum practicable size (household, community,
town, district, catchment, city), and
waste diluted as little as possible.
(WSSCC/Eawag 2000, p.12)
Water supply and sanitation systems

have to:
Protect and promote health it should
avoid exposure of humans to pathogens and vectors.
Protect the environment prevent air,
soil, water pollution, return nutrients/
resources to the soil, and conserve
water and energy.
Be simple - system operation must
be feasible using locally available resources (human and material). Where
technical skills are limited, simple
technologies should be favoured.
Be affordable total costs (incl. capital, operation, maintenance costs)
must be within the users ability to
pay.
Be culturally acceptable it should be
adapted to local customs, beliefs and
needs.
Work for everyone it should address
the health needs of children, adults,
women, and men.
Further questions
How does legislation interact with the
new principles?
How can stakeholders be included in the

decision-making process if no consensus
can be reached?
How is environmental pollution interr

elated with public health? Provide examples.
Additional info
Module 2 describes in detail how water
and sanitation affect environmental health.
Module 7 describes in detail new planning approaches based on the Bellagio

principles.
WSSCC/EAWAG (2000); Summary Report of Bellagio Expert Consultation

on Environmental Sanitation in the 21st
Century 1 - 4 February 2000, Water
Supply and Sanitation Collaborative Council
(WSSCC) and Eawag, Switzerland. www.
eawag.ch/organisation/abteilungen/sandec/publikationen/publications_sesp/downloads_sesp/Report_WS_Bellagio.pdf (last
accessed 01.04.08)
2.1 Introduction
Developing regions carry a disproportionately heavy health burden with regard to communicable diseases
and injuries.
Safe water supply alone is not enough to protect peoples health. Adequate sanitation facilities and good
hygiene practices are just as important.
The health impact of improved water supply and sanitation is proven to be high.
Water shortage, poor quality water or unreliable supply have profound effects on
peoples well-being. Providing safe water alone is not enough, as water can
quickly become unsafe and faecal-oral
transmission of diseases can occur in
other ways. If people do not have access to adequate and appropriate sanitation facilities or the opportunity to develop good hygiene practices, diseases can
spread through polluted water or other
pathways in the home environment. At
any one time about half of population in
developing countries suffers from one or
more of the six main diseases associated
with inadequate water supply and sanitation: diarrhoea, ascariasis, dracunculiasis, hookworm infection, schistosomiasis, and trachoma.
Improving the health of the poor is a
frequently cited goal of water and sanitation projects. At project level, the relationship is difficult to establish, however,
over the longer term, significant healthassociated benefits are visible from improvements in water supply and sanitation provision, particularly if these are
associated with changes in hygiene be-
Figure 5: Environmental disease burden in deaths per 100 000 people. (Prss-stn et al., 2006,
p. 10)
haviour. The Water and Sanitation for

Health programme (Esrey et al., 1990)
found among the 144 reviewed epidemiological studies that the health impact of
improved water supply and sanitation facilities was high, measured by significant
reductions in morbidity rates (sickness)
and higher child survival rates. (DFID
Manual 1998, p. 5/6)
Further questions
The percentage of water, sanitation and
hygiene deaths is highest in Africa. But
what about India and China, the home of
the worlds population? The number of
people affected by water, sanitation and
hygiene diseases could be a lot higher
there than in Africa.
What facilities, services and behaviours

have the greatest impact on improving
health? How can we measure this?
2.2 What is the global burden of disease?

Environmental health hazards account for 21% of the overall disease burden worldwide. Children suffer a disproportionate share of the environmental health burden.
Almost half of the environmental health-related disease burden can be attributed to unsafe water and sanitation.
By improving drinking water and sanitation services, diarrhoeal disease morbidity could, for example, be
reduced by 25 45%.
Burden of disease
Diarrhoea causes two million deaths

every year, mainly among children under the age of five. This is equivalent
to one child dying every fifteen seconds, or the massacre of an entire primary school every half an hour. This
accounts for about a third of total child
death under the age of five in developing countries.
About a billion cases of diarrhoea
every year have been registered. Water, sanitation, and hygiene interventions have shown to reduce on average sickness from diarrhoeal diseases
by a quarter to a third.
About a third of the population in the
developing world is infected by intestinal worms, which can be controlled by improving sanitation, hygiene and water. These parasites can
lead to malnutrition, anaemia, retarded growth and a drop in school performance, depending on the severity
of the infection.
69 million people are estimated to
have contracted blindness from trachoma. The more rigorous studies
show that provision of adequate quantities of water can reduce this disease
by 25%. Since the disease-transmitting fly breeds in scattered human excreta, sanitation is also an effective
measure to control this disease.
200 million people in the world are infected by schistosomiasis (bilharzia), of which 20 million suffer from
Expected reduction (median %)
Some facts
Figure 6: The global disease burden, classified by risk factors, reveals that 21% are associated to
environmental health. In this category, almost half the disease burden can be attributed to unsafe
water and sanitation. (WHO, 2002) in (Cairncross et al., 2003, p. 2)
Reduction (%)
The World Health Organization has estimated (WHO 2000) that environmental health hazards account for 21% of the
overall disease burden worldwide, affecting mainly developing countries, especially the poorest regions of the world.
Environmental improvements are often
more cost-effective health measures
than the curative efforts of the health
sector. After all, prevention is better than
cure. (Cairncross et al., 2003, p.6)
Improved
drinking
water
Improved
sanitation
Improved Household
water
hygiene
treatment
Figure 7: Reduction in diarrhoeal disease morbidity resulting from improvements in drinking

water and sanitation services. (Fewtrell et al.,
2005 in WHO/UNICEF, 2005, p.13)
severe consequences. This disease is

still widespread in 74 countries of the
world. Studies show a median 77%
reduction from well-designed water
and sanitation interventions.
Eradication of the guinea worm has
progressed dramatically over the
last ten years. The number of cases dropped by 95% from 890,000 in
1989 to currently less than 50,000.
The disease is found mainly in the Sahel region of Africa. In India, Pakistan,
Senegal, and Cameroon, transmission
of the disease was completely interrupted recently, and several African
countries follow closely.
(Cairncross 2002, pp. 3)
78
77
55
29
27
26
4
Ascariasis Diarrhoeal
disease
(4)
(19)
Dracuncu- Hookworm Schistoliasis

infection somiasis
(2)
(1)
(3)
Trachoma Child
(7)
mortality
(6)
Disease (number of studies)

Figure 8: Impact of improved water supply,
sanitation and hygiene on morbidity and mortality for six common diseases: evidence from
42 studies. (After Esrey et al., 1991 in WHO,
2005, p.20)
Further questions
The effect of drugs curing waterborne
diseases can be greater than the effect of
improved sanitation in the short run. But
what is more effective in the long run? Protecting the water cycle from pathogens or
killing the (waterborne) pathogens in the
human body?
2.3 What are the main transmission routes

of pathogen related diseases
Diseases related to water supply and sanitation are mostly transmitted via a faecal-oral mechanism by pathogens found in human excreta.
Transmission following some typical routes is summarised in the so-called F Diagram.
Most diseases associated with water

supply and sanitation, such as diarrhoea,
are spread by pathogens (disease-causing organisms) found in human excreta
(faeces and urine). The faecal-oral mechanism, in which some of the faeces of
an infected individual are transmitted to
the mouth of a new host through one of
a variety of routes, is by far the most significant transmission mechanism: it accounts for most diarrhoea and a large
number of intestinal worm infections.
This mechanism works through a variety
of routes, as shown by the so-called F
Diagram (cf. Figure 15). (WHO, 2005,
p. 10)
Some pathogens also follow slightly
different routes, such as leaving or entering the host through the skin or using insects as alternate host. This is explained
in detail in chapter 3.1.
In addition to the hygiene-related
transmission routes, diseases may also
be caused by poorly managed sanitation. If latrines or sewerage systems are
poorly managed, surface or groundwater
can be contaminated and thus affect the
quality of drinking water.
Figure 9: The F-diagram summarizes the main routes of diarrhoeal disease, i.e. by faecal pathogens contaminating fields, fluids, fingers, flies or food. Most toilets will stop the fluids and
fields transmission routes. The VIP toilet may also break the flies route. No type of toilet can,
however, prevent hand contamination (Adapted from (DFID/WELL 1998), p. 84)..
Further questions
Could animals play a role in transmission routes?
What are possible transmission routes from faeces to fields, or from faeces to fluids?
Sandec Training Tool: Module 1 10
2.4 How can we disrupt the transmission routes of pathogens?

Washing hands after defecation or constructing safe sanitation facilities are primary barriers that prevent
pathogens from entering the environment.
Washing hands before eating or protecting food from flies are secondary barriers that prevent pathogens from
infecting a new host or contaminating food.
The most effective ways of reducing disease transmission is to erect primary barriers to prevent pathogens from entering
the environment. This can be done by:
Washing hands with soap after defecation or after cleaning childrens bottoms after their defecation.
Constructing sanitation facilities to
prevent the spread of diseases by
flies and contamination of drinking
water, fields and floors.
Primary interventions with the greatest impact on health often relate to the
management of faeces at the household level. This is because (a) a large percentage of hygiene-related activity takes
place in or close to the home and (b)
first steps to improving hygienic practices are often easiest to implement at the
household level. However, to achieve full
health benefits and in the interest of human dignity, other sources of contamination and disease also need to be managed, such as:
Sullage (dirty water that has been
used for washing people, clothes,
pots, pans etc).
Drainage (natural water that falls as
rain or snow).
Solid waste (also called garbage,
refuse or rubbish).
Secondary barriers are hygiene practices preventing faecal pathogens, which
have entered the environment via stools
or on hands, from multiplying and reaching new hosts. Secondary barriers thus
include washing hands before preparing food or eating, and preparing, cooking, storing, and re-heating food in such
a way as to avoid pathogen survival and
multiplication. They also include protecting water supplies from faecal contaminants and water treatments, such as
boiling or chlorination. Other secondary barriers include keeping playgrounds
free from faecal material, preventing children from eating earth and controlling
flies. (Curtis et al., 2000, p. 25)
Figure 10: Barriers and interventions to disrupt transmission of diseases. (Adapted from (WHO,
2005, p. 10).
I now know how critical it is to wash hands with soap before eating so
as to prevent germs from entering my body. This will protect me from
infections such as diarrhoea. Manoj Patel, 2005.
Further questions
Washing hands with soap requires enough clean water. What can a person do with hygiene
knowledge but without water?
How can flies be kept away from water and food?
How can the behaviour of slum dwellers be influenced? How can we ensure
correct use of facilities and their good maintenance?
Additional info
Environmental health and hygiene issues: Module 2
Water treatment and safe storage: Module 3
Sanitation systems and technologies: Module 4
DFID Guidance Manual on Water Supply and Sanitation Programmes (1998); London School
of Hygiene & Tropical Medicine (LSHTM) and Water, Engineering and Development Centre
(WEDC), Loughborough University, UK. www.lboro.ac.uk/well/resources/Publications/guidance-manual/ (last accessed 01.04.08)
Curtis, Cairncross et al. (2000): Review: Domestic hygiene and diarrhoea - pinpointing the
problem. Tropical Medicine & International Health 5(1): 22-32.
Cairncross, S., Kolsky, P. (2002) Environmental health and the poor. Our shared responsibility. WELL and WEDC University of Loughborough. Only webpublished. www.lboro.ac.uk/well/
resources/Publications/Advocacy%20document%20-%20Front%20cover%20+%20insides.
pdf (last accessed 08.05.08)
11
3.1 What are the Millennium Development Goals?

Water and sanitation improvements contribute to all of the eight Millennium Development Goals.
The MDGs provide a benchmark, measuring progress towards the human right to water.
At the United Nations Millennium Summit in September 2000, 189 heads-ofstate adopted the Millennium Development Goals (MDGs), which set clear,
numerical, time-bound targets for making real progress by 2015 in tackling the
most pressing issues faced by developing countries. The Millennium Development Goals provide a benchmark, measuring progress towards the human right
to water.
Cutting in half the proportion of the
worlds population without access to
clean drinking water and basic sanitation is not only one of the eighteen targets embedded in the MDGs, but also a
critical factor for meeting all the goals, including eradicating extreme poverty and
hunger; achieving universal primary education; promoting gender equality and
womens empowerment; reducing child
mortality; improving maternal health;
combating major diseases; and improving environmental sustainability (cf. Table 1).
At the Johannesburg World Summit
for Sustainable Development (WSSD) in
August 2002, the overall MDGs were reaffirmed. The Johannesburg Plan of Implementation explicitly recognises that
water and sanitation are fundamental to
poverty eradication and sustainable development. Importantly, WSSD reiterated the MDG to halve by 2015 the number
of people who are unable to reach or to
afford safe drinking water. A new target
on halving the number of people who
have no access to basic sanitation by
2015 not forming part of the MDGs
was also set. In addition, the Plan made
a strong call for more integrated approaches to Water Resources Management by setting a new time-bound target
to develop integrated water resources management and efficiency plans by
2005, and support developing countries
through actions at all levels.
Further questions
How can water and sanitation targets
get on the top of the agenda if people
suffer extreme poverty and hunger?
How can all eight MDGs get the attention of local governments?
Human rights and human action

The human right to water entitles everyone to sufficient, safe, acceptable, physically accessible, and affordable water for personal and domestic use. (U.N. General Comment No. 15 on
the right to water, 2002)
Ensuring that every person has access to at least 20 litres of clean water each day is a minimum requirement for respecting the human right to water. (UNDP 2006, p. 4)
Access to basic sanitation is a crucial human development goal in its own right, but sanitation is also a means to far wider human development ends. (UNDP 2006, p 111)
Mahatma Gandhi once commented that the difference between what we do and what we
are capable of doing would suffice to solve most of the worlds problems. That observation
has a powerful resonance for the Millennium Development Goals. The unprecedented combination of resources and technology at our disposal today renders the argument that the 2015
targets are beyond our reach both intellectually and morally indefensible. We should not be
satisfied with progress that falls short of the goals set. (UNDP 2006, p. 5)
MDG goals
Contribution of improved drinking water and sanitation
Goal 1: Eradicate Extreme

Poverty and
Hunger
The security of household livelihoods rests on the health of its members;

adults who are ill or must care for sick children are less productive.
Illnesses caused by unsafe drinking water and inadequate sanitation generate high health costs relative to income for the poor.
Healthy people are better able to absorb nutrients in food than those suffering from water- related diseases, particularly helminths, which rob their
hosts of calories.
The time lost because of long-distance water collection and poor health
contributes to poverty and reduced food security.
Goal 2:
Achieve Universal Primary
Education
Goal 3: Promote Gender

Equality and
Empower
Women
Goal 4: Reduce Child

Mortality
Goal 5: Improve Maternal Health
Goal 6: Combat HIV/AIDS,

Malaria and
Other Diseases
Goal 7: Ensure
Environmental
Sustainability
Goal 8: Global
Partnership for
Development
Improved health and reduced water-carrying burdens improve school attendance, especially among girls.
Having separate sanitation facilities for girls and boys in school increases
girls attendance, especially after they enter adolescence.
Reduced time, health and care-giving burdens from improved water services give women more time for productive endeavours, adult education and leisure.
Water sources and sanitation facilities closer to home put women/girls at

less risk of assault while collecting water or searching for privacy.
Improved sanitation and drinking water sources reduce infant and child
morbidity and mortality.
Accessible sources of water reduce labour burdens and health problems
resulting from water portage, reducing maternal mortality risks.
Safe drinking water and basic sanitation are needed in health-care facilities
to ensure basic hygiene practices following delivery.
Safe drinking water and basic sanitation help prevent water-related diseases, including diarrhoeal diseases, schistosomiasis, trachoma and helminths.
Drinking water supplies and improved water management in human settlement areas reduce transmission risks of malaria and dengue fever.
Adequate treatment and disposal of wastewater contributes to better ecosystem conservation and less pressure on scarce freshwater resources. Careful use of water resources prevents contamination of groundwater and helps
minimize the cost of water treatment.
Development agendas and partnerships should recognize the fundamental role that safe drinking water and basic sanitation play in economic and social development.
Table 1: The eight Millennium Development Goals and contributions towards improved drinking
water and sanitation (WHO/Unicef 2004, p. 7)
3.2 What does Goal 7 include?

Goal 7 Ensure environmental sustainability with its water and environmental sanitation
targets 10 and 11:
Halve by 2015 the number of people without sustainable access to safe drinking water and basic sanitation.
Achieve by 2020 a significant improvement in the lives of at least 100 million slum dwellers.
Sustainable development can be ensured only by protecting the environment

and using its resources wisely. Most
countries have adopted principles of sustainable development and agreed to international accords on protecting the environment. But good intentions are not
enough. (World Bank Group, <www>)
The seventh goal, which aims at ensuring environmental sustainability, is especially important as regards water and
sanitation. If environmentally sustainable
principles and solutions are not placed
at the top of our agenda, no development will work in the long run. Shortterm solutions may contribute to attaining the goals in the short run, but from
where a sustainable development trajectory can no longer be followed or only
with great difficulties and higher costs.
(Millennium Development Goals Indicators, <www>)
Goal 7 includes two clear, numerical
and time-bound targets, which call for increasing water and sanitation provision
as well as significant improvements in
the lives of slum dwellers (see Table 2).
However, the global target matters

less than the national targets set by individual countries. Significant progress in
China and India alone could, for instance,
attain the global target without any
progress in sub-Saharan Africa. To reach
those in greatest need, what matters is
massive country-by-country service expansion to unserved remote rural areas and densely populated urban slums.
Such dramatic and unprecedented service expansion will require: 1) identification of the regions, countries and communities most in need; 2) analysis of the
obstacles to expanding access in those
areas and 3) devising the most promising strategies for overcoming those obstacles. (UNMP 2005, p. 21)
Historical context of MDGs

The goals and targets relating to water and
sanitation outlined in the United Nations
Millennium Declaration and in the Millennium Development Goals and Targets were
not developed in a vacuum. Over the last
30 years, numerous major conferences
and international agreements have provided the broad background for todays water
resources policies and decision-making. In
the last decade, many international conferences have discussed and agreed on steps
required to speed up the implementation
of Agenda 21:
Sixth session of the Commission for

Sustainable Development (CSD-6) in 1998
Second World Water Forum in the

Hague in 2000
International Conference on Freshwater

in Bonn in 2001
Target 10
Target 11
Halve by 2015 the number of

people without sustainable
access to safe drinking water
and basic sanitation.
Achieve by 2020 a significant
improvement in the lives of at
least 100 million slum dwellers
Table 2: The two clear, numerical, time-bound

MDG targets for water and sanitation (World
Bank Group, <www>)
Third World Water Forum in Kyoto in

2003
International Conference on Water for

the Poorest in Stavanger in 2003
The United Nations Millennium Declaration
and the preparatory process leading up to
the World Summit on Sustainable Development (WSSD) further affirmed the role
of water as a key to sustainable development and the urgency of immediate action.
(Source unknown)
Further questions
How can we measure access to sustainable and safe drinking water and sanitation? How
can different regions be compared? Are 20 litres of drinking water the same everywhere?
How can the global water and sanitation agenda be integrated into the national and regional agendas?
3.3 What is improved water supply and basic sanitation?

Improved access to drinking water
sources:
Access to basic and access to improved sanitation:
The Global Water Supply and Sanitation

Assessment 2000 Report (GWSSAR)
defines reasonable access to water as
at least 20 liters per person per day from
a source within one kilometer of the users home.
Access to safe drinking water is estimated by the percentage of the population using improved drinking water
sources (cf. Table 3). Improved drinking
water technologies provide safe drinking
water. (WHO/Unicef 2004, p. 4)
The GWSSR defines basic sanitation

as private or shared but not public sanitation facilities that separate waste from
human contact and can be accessed
within acceptable walking distance.
Access to sanitary means of excreta
disposal is estimated by the percentage
of the population using improved sanitation facilities (cf. Table 4). Improved sanitation facilities ensure privacy and hygienic use. (WHO/Unicef 2004, p. 4)
Table 3: List of improved and unimproved

drinking water technologies (WHO/Unicef
2004, p. 4)
Table 4: List of improved and unimproved sanitation facilities (WHO/Unicef 2004, p. 4)
Improved drinking
water sources:
Unimproved drinking water sources
Improved
sanitation facilities
Unimproved
sanitation facilities
Unprotected well
Unprotected
spring
Connection to a
public sewer
Public or shared
latrine
Connection to a
septic system
Open pit latrine
Bucket latrine
Household
connection
Public standpipe
Borehole
Rivers or ponds
Protected dug
well
Vendor-provided
water
Protected spring
Bottled water*
Rainwater
collection
Tanker truck
water
*Bottled water is not considered improved

due to limitations in the potential water
quantity and not quality.
Pour-flush latrine
Simple pit
latrine**
Ventilated improved pit latrine
Further questions
Does improved always mean the same
as adequate? Has one public standpipe
less than 1 km away the same importance
in a village than in a very densely populated
slum? Cf. Chapt. 4.3. Box: Urban/rural and
improved/adequate
Why is vendor-provided water not

considered as an improved drinking water
source?
Additional info
WHO/Unicef (2004) Meeting the MDG
Drinking Water and Sanitation Target. A
Mid-Term Assessment of Progress. Copyright: World Health Organization and
United Nations Childrens Fund. www.
unicef.org/progressforchildren/2006n5/index.html (last accessed 08.05.2008)
Download available on the CD of Sandecs
Training Tool and from the Internet.
**Only some of the poorly defined latrine

categories are included in sanitation coverage estimates.
4 Global Situation
4.1 Introduction
A lack of access to clean water and sanitation is equivalent for example to walking more than 1 km for water,
defecating in ditches, plastic bags, on kerbsides, collecting water from drains, ditches or streams.
People are not unaware of the dangers; they just have no other choice.
It is difficult for people in rich countries

to grasp the meaning of water insecurity
in a developing country. Concerns about
a water crisis periodically make the headlines. However, almost everyone in the
developed world has access to safe water available at the turn of a tap as well
as access to private and hygienic sanitation. Hardly anybody dies for want of
clean water or sanitation and young
girls are not kept home from school to
fetch water.
The water and sanitation situation in
the developing world has progressed as
in other areas of human development
(Figure 12). Yet, at the start of the 21st
century, one in five people in the developing world or some 1.1 billion people
lack access to clean water. Some 2.6 billion people, almost half the total population of developing countries, do not have
access to adequate sanitation. (UNDP
2006, p. 31)
Four voices from four countries
The water is not good in this pond. We collect it because we have no alternative.
All the animals drink from the pond as well as the community. Because of the
water we are also getting different diseases. Zenebech Jemel, Chobare Meno, Ethiopia
Of course I wish I were in school. I want to learn to read and write.... But how can
I? My mother needs me to get water. Yeni Bazan, age 10, El Alto, Bolivia
The conditions here are terrible. There is sewage everywhere. It pollutes our
water. Most people use buckets and plastic bags for toilets. Our children suffer
all the time from diarrhoea and other diseases because it is so filthy. Mary Akinyi,
Kibera, Nairobi, Kenya
They [the factories] use so much water while we barely have enough for our basic
needs, let alone to water our crops. Gopal Gujur, farmer, Rajasthan, India
(UNDP 2006, p. 1)
Lessons from history

Countries tend to have a short memory when
it comes to water and sanitation. Today, the
urban population of Europe and the United
States live free from fear of waterborne infectious diseases. At the turn of the 20th century,
the picture was very different. The vast expansion of wealth that followed industrialisation increased incomes, but improvements in more
fundamental indicators such as life expectancy, child survival and public health lagged far
behind. The reason: cities exposed people to
greater opportunities to amass wealth but also
to water contaminated with human waste. The
mundane reality of unclean water severed the
link between economic growth and human development. It was not until a revolution in water and sanitation restored that link that wealth
generation and human welfare started to move
in tandem (Figure 11).
That revolution heralded unprecedented advances in life expectancy and child survival and better public health fuelled economic advances. As people became healthier and
wealthier with the provision of clean water and
sanitation, a virtuous circle of economic growth
and human development emerged. But the increasing returns generated by investments in
clean water also helped to create and progressively widen the deep cleavages in wealth,
health and opportunity that characterise the
world today.
Life expectan cy
(years)
90
Infant mortality
(per 1,000 live births)
180
80
160
70
140
60
120
50
100
40
1896-1905:
Investments in
sanitation peak
30
20
10
18 47: St ar t
of l eg islativ e
driv e on w ater
80
60
40
20
0
0
1841
1860
1880
1900 1912
Source: University of California, Berkeley,
and MPIDR 2006.
In ve st me nt i n sanitation ( p er c apita)
60
50
40
30
20
10
Photo 1: Inadequate solid waste management

may block drains causing overflow of a wastewater and stormwater mix, and spreading of
contaminats (pathogens, chemicals). Picture
taken in Lome, Togo. (Source: Eawag/Sandec)
Figure 11: A great leap from water reform to

sanitation reform in 19th century Great Britain:
Infant deaths fall as sanitation improves (UNDP
2006, pp. 29)
18 84 18 86 18 91 18 96 19 01 19 06
85 90 95 19 00 05 10
Source: Bell and Millward 1998.
4 Global Situation
What do the numbers mean?

The fact that people are forced to defecate in ditches, plastic bags or on kerbsides. Not having access to clean
water is a euphemism for profound
deprivation. It means that people live
more than 1 kilometre from the nearest
safe water source and that they collect
water from drains, ditches or streams
that might be infected with pathogens
and bacteria possibly causing severe illness and death. In rural sub-Saharan Africa, millions of people share their domestic water sources with animals or
rely on unprotected wells, which are
breeding grounds for pathogens. The
problem is not restricted to the poorest
countries. In Tajikistan, nearly a third of
the population draws water from canals
and irrigation ditches, with risks of exposure to polluted agricultural run-off.
Apart from the health risks, inadequate
access to water means that women and
young girls spend long hours collecting
and carrying household water supplies.
(UNDP 2006, p. 3234)
People with no access to an improved water source

Share of total population (% )
100
90
90
80
80
70
70
60
60
50
50
40
40
30
Do all people in developing countries

have no choice? Or do some people have
choices but neglect the poor?
1990
2004
30
1990
20
2004
10
0
20
10
Sub- East Asia Sout h Arab

Latin Worl d
Saharan and
Asia States Americ a
Africa
and the
Caribbean
People with no access to improved water in 2004

(millions)
Total: 1.1 billion
Latin America and
the Caribbean
49.4
Sub- East Asi a Sout h Arab Latin Worl d

Saharan and
Asia States Americ a
Africa
and the
Caribbean
People with no access to improved sanitation in 2004

(millions)
Total: 2.6 billion
Latin America and
the Caribbean
119.4
Arab States
37.7
East Asia and

the Pacific
406.2
Arab States
80.1
East Asia and

the Pacific
958.2
Sub-Saharan
Africa
436.7
Sub-Saharan
Africa
314.0
Further questions
What does history teach us? Can industrialisation of China for example be compared with industrialisation of Europe/
North America at the beginning of the 20th
century?
People with no access to improved sanitation

Share of total population (% )
100
South Asia
228.8
South Asia
925.9
Source:Calculated based on UNICEF 2006a.
Figure 12: Shrinking slowly: the global water and sanitation deficit. (UNDP 2006, pp. 33)
Additional info
WHO/Unicef (2004) Meeting the MDG Drinking Water and Sanitation Target. A Mid-Term
Assessment of Progress. Copyright: World Health Organization and United Nations Childrens
Fund. www.wssinfo.org/en/40_MDG2004.html (last accessed 08.05.2008)
UNDP (2006) Human Development Report. Beyond scarcity: Power, poverty and the global
water crisis. Published for the United Nations Development Programme (UNDP), New York.
http://hdr.undp.org/en/reports/global/hdr2006/ (last accessed 08.05.2008)
Downloads available on the CD of Sandecs Training Tool and from the Internet
4 Global Situation
4.2 Where are the differences in global water supply coverage?

1.1 billion people do not have access to an improved source of drinking water!
The number of urban people unserved is still increasing over time: urbanisation!
Water supply coverage

In 2004, a total of 5.3 billion people
(83% of the worlds population) used
water from improved sources (Figure
13) up from 4.1 billion (78%) in 1990.
Due to population growth, the number of
people unserved has not changed substantially since 1990. About one sixth of
the world population or a total of 1.1 billion people remain without access to improved drinking water, of which 84% live
in rural areas.
Nearly 80% of the unserved population is concentrated in three regions:
sub-Saharan Africa, Eastern Asia and
Southern Asia. Coverage is above 78%
in all regions except sub-Saharan Africa and Oceania where it amounts to
56% and 50%, (Cf. Figure 13). In Latin America and the Caribbean, Northern Africa and Western Asia, coverage is
over 90%. There are huge disparities between regions: while access to drinking
water through a household connection
is as low as 16% in sub-Saharan Africa, 20% in Southern Asia, 21% in Oceania, and 28% in South-eastern Asia, it
is much higher in Eastern Asia (70%),
Northern Africa (76%), Latin America
and the Caribbean (80%), and Western
Asia (81%).
1990 to 2004, about two thirds gained
access to a household connection or a
yard tap (running water) whereas one
third gained access through other types
of improved facilities (protected wells,
public standpipes, etc.). It appears that
developing countries are focusing investment on centralized systems, with piped
distribution to users through household
connections or yard taps. (WHO/Unicef
2006, p. 89)
Figure 13: Coverage with improved drinking water sources in 2004. Sub-Saharan Africa continues
to make progress in providing services to the unserved, with a seven per cent point increase from
1990 to 2004. Yet current coverage levels are extremely low. At the current pace of development,
sub-Saharan Africa will fail to reach the MDG drinking water target. (WHO/Unicef 2006, p. 8)
Figure 14: Water stress in major river basins. High water stress indicates that the amount of
water withdrawn for human use represents an important percentage of the amount available after
meeting environmental requirements. In most basins with a water stress indicator of 0.7 or higher,
aquatic ecosystems are already suffering some degree of degradation, and there is little or no
scope to increase water withdrawals without causing irreversible damage. (UNMP 2005, p. 40)
Further questions
Is missing access to safe water supply a reason for:
...natural water shortage? Cf. Figure 14
...uneven distribution of water within a society?
...missing facilities?
Where is access to safe water supply most needed in developing countries? In rural or urban areas, in mountainous or coastal regions? Compare Figure 14
4 Global Situation
Urban and rural drinking water

The world as a whole is on track to meet
the MDG drinking water target. This
good news masks two serious challenges: the inequity in coverage between rural and urban areas, and the accelerating
urban population growth in developing
regions. And although the world is still
on track for reaching the target, the trend
appears to be deteriorating.
When analysing the urban and rural
coverage trends (Figure 15), it is clear
that most of the effort towards achieving
the MDG drinking water target will focus on urban areas. (Unicef/WHO 2006,
p. 14)
The urban population served by improved drinking water sources increased
from 1990 to 2004 by nearly 36%. Despite this major effort, the urban population unserved is increasing over time.
Since 1990, there has been a 24% increase in the number of rural inhabitants
with access to an improved drinking water source, and the backlog of rural un-
Figure 15: Trends in coverage: urban and rural population with and without access to an improved
drinking water source in 1990, 2004 and 2015 (projected) (Unicef/WHO 2006, p. 14)
served is decreasing over time. Despite

this enormous effort, the number of rural
population unserved is still exceedingly
high (27%). (Unicef/WHO 2006, p. 14)
Further questions
What is the reason for investing greater
efforts in providing urban drinking water as
opposed to rural provision?
Could a lack of access to safe drinking

water in rural areas be the reason for moving from rural to urban areas?
Is urbanisation accelerated if more attention is paid to the development of urban areas?
4.3 Where are the differences in global sanitation coverage?

2.6 billion people do not have access to basic sanitation
The deficit of urban unserved is increasing, i.e. urbanisation!!!
In 2004, only 59% of the worlds population had access to any type of improved
sanitation facility. In other words, 4 out
of 10 people around the world have no
access to improved sanitation. They are
obliged to defecate in the open or use
unsanitary facilities, with a serious risk of
exposure to sanitation-related diseases.
While sanitation coverage has increased
from 49% in 1990, an enormous effort
has to be made quickly to expand coverage to the MDG target level of 75%.
The global statistics on sanitation hide
the dire situation in some developing regions (Figure 16). With an average coverage in developing regions of 50%,
only one out of two people has access
to some sort of improved sanitation facility. The regions presenting the lowest
coverage are sub-Saharan Africa (37%),
Southern Asia (38%) and Eastern Asia
(45%). Western Asia (84%) has the
highest coverage among developing regions. (WHO/Unicef 2006, p. 16)
Figure 16: Coverage with improved sanitation in 2004. Over 80% of the people worldwide
without access to improved sanitation live in Southern Asia, Eastern Asia and sub-Saharan Africa.
(WHO/Unicef 2006, p. 16)
Further questions
Sanitation coverage is extremely poor in
large parts of the developing world. Living
without improved sanitation facilities (public or shared latrine, open pit latrine etc.)
used to be normal in rural areas. Why and
where is a higher standard of sanitation becoming increasingly important?
4 Global Situation
Urban and rural sanitation

With a global sanitation coverage rate of
59% reached in 2004, 611 million people
in urban areas and a staggering 2 billion
in rural areas still do not have access to
improved sanitation.
In rural areas, coverage with improved
sanitation facilities rose from 26% in
1990 to just 39% in 2004. If that trend
continues, coverage will have risen to
only 49% by 2015. In other words, about
half the rural population will still remain
without basic sanitation in 2015 (Figure 17).
Despite an increase of almost 40%
in the number of people served with
improved sanitation between 1990 and
2004, the deficit of urban unserved is
growing.
Only 39% of the worlds rural population have access to any type of improved
sanitation facility. Although the deficit
is shrinking over time, only 49% of the
global rural population will be served in
2015 if the projected trend is confirmed.
Further questions
Overall, far more people do not have
access to basic sanitation than access to
improved water supply. Why?
Is it more difficult or more expensive to

provide basic sanitation than water supply?
Or is the importance of sanitation under
estimated by investors? (Cf. Chpt. 5 Lack
of international funding).
Additional info
WHO/Unicef (2006) Meeting the MDG
drinking water and sanitation target: the
urban and rural challenge of the decade.
Report is the seventh in a series that
presents the findings of the WHO/Unicef
JMP (Joint Mentoring Programme). www.
wssinfo.org/en/40_mdg2006.html (last accessed 08.05.2008)
Figure 17: Trends in coverage: urban and rural population with and without access to improved
sanitation in 1990, 2004 and 2015 (projected) (WHO/Unicef 2006, p. 21)
Urban/rural and improved/adequate

The figures of this assessment may justify the need to pay less attention to water and sanitation in urban areas, as far more people in rural areas lack improved provision. But improved
provision is not the same as adequate provision. In urban areas, many people with improved
provision lack adequate provision.
One limitation of all national statistics (and thus of global statistics on which these are based)
is their failure to recognise the differences in context between (most) rural and (most) urban
areas. The same criteria for improved provision cannot be used in all settings. A water source
within 100 meters of all households is not the same in a village of 200 persons with 50 persons per tap as it is in a squatter settlement with 100,000 persons (and 500 persons per tap).
Assessment 2000 suggests that reasonable access to water should be broadly defined as
the availability of at least 20 litres per person per day from a source within 1 km of the users dwelling. For most urban settings, this is an inappropriate standard. In large, dense urban settlements, the availability of water source within 1 kilometre will mean long queues;
the persons responsible for fetching and carrying water may be spending several hours a day
on this activity. UN-HABITAT (2003), p. 4850
Photo 2: Construction of an emergency latrine (left). Public latrines may be the only option in
emergency situations or in areas of high population and habitat density. Often public latrines
lack good operation and maintenance as no one feels responsible for claenliness. (Sources:
Left: Harvey 2007, <www>; right: Eawag/Sandec)
4 Global Situation
4.4 What is the global slum situation?

In 2005, one out of three urban dweller was living in slum conditions, with a concentration in sub-Saharan
Africa and Southern Asia.
Slum conditions can be described as lacking at least one of the basic conditions of decent housing: adequate
sanitation, improved water supply, durable housing or adequate living space.
Definition of slums
A slum is a contiguous settlement where
the inhabitants are characterized as having inadequate housing and basic services. A slum is often not recognised and addressed by the public authorities as an
integral or equal part of the city.
Conditions that characterize slums:
Insecure residential status;
Inadequate access to safe water;
Inadequate access to sanitation and other infrastructure;
Poor structural quality of housing;
Overcrowding.
Photo 3: Slums built on swamp land near

a garbage dump in East Cipinang, Jakarta
Indonesia (Source: Jonathan McIntosh,
2004, Flickr <www>)
Almost half the worlds population already live in cities or towns. However,
due to urban migration and rapid population growth, the number of urban dwellers will continue to expand, from currently 3.2 billion people to nearly 5 billion
in 2030, with most of the growth taking
place in Africa and Asia.
In 2005, one out of three urban dweller lived in slum conditions, i.e. lacking at
least one of the basic conditions of decent housing: adequate sanitation, improved water supply, durable housing or
adequate living space. Even if the growth
rate of slum dwellers decreases, the rapid expansion of urban areas will make it
challenging to improve living conditions
quickly enough to meet the target.
Sub-Saharan Africa and Southern Asia
are still the regions where lack of adequate shelter among urban populations is
most acute. Looking beyond the region-
Figure 18: People living in slums. Number based on UN-Habitat estimates 2001. (UN-HABITAT,
Improving lives, p. 5)
al averages, the situation is even more

discouraging. In countries like Chad, the
Central African Republic and Ethiopia,
four out of five urban dwellers live in
slums. In most of Asia and Latin America, where the majority of urban dwellers
have access to improved water and sanitation, slum conditions are characterised
mainly by overcrowding and makeshift
shelters. The non-durability of housing
is, in fact, a problem for an estimated 117
million people living in cities of the developing world. Over half of these people
live in Asia. North Africa has the fewest
people living in non-durable housing. In
2005, about one fifth of the urban population in the developing world lived in
overcrowded houses (with more than
three persons sharing a bedroom); two
thirds of them were in Asia, with half in
Southern Asia. (UN-DESA 2007, p. 26)
Regardless of how slums are characterized, slum dwellers face higher developmental challenges such as higher
morbidity and infant mortality rates than
either non-slum dwellers or the rural
population. (UN-HABITAT 2003, Improving Lives, p. 5)
Further questions
Aside from improving water and sanitation, how can the lives of 100 million slum
dwellers be improved?
4 Global Situation
4.5 How close / how far away are we from reaching

the goals globally?
The water supply target will be missed by only 100 million people.
The sanitation target will be missed by more than half a billion people.
The world urgently needs to step up activities, increase effectiveness and accelerate investments if the target
is to be met.
To reach the MDG drinking water and

sanitation target is an enormous challenge. The numbers speak for themselves. Achieving the target requires the
building of the drinking water infrastructure was to provide services to an additional 1.1 billion people and sanitation to
an additional 1.6 billion people by 2015.
It will also require action to prevent current and future infrastructure falling into
disrepair as a result of inadequate institutional arrangements, insufficient cost-recovery, poor operation and maintenance,
and an overall lack of sound management practices. Progress towards drinking water and sanitation solutions needs
to be accelerated and sustained to contribute to breaking the circle of poverty, lack of education, poor housing, and
ill health.
The approaches are well- known: the
final report of the United Nations Millennium Project Task Force on Water and
Sanitation recommends key actions ranging from addressing the huge backlog of
access to basic sanitation as compared
to drinking water, to institutional, financial, and technological innovation, with a
special emphasis on meeting the needs
of poor households. (Cf. Chapter 5)
Reaching the MDG drinking water
and sanitation target requires accelerating the whole cycle of services delivery,
comprising policy-making, mobilisation
of resources (financial and human), planning and design, construction, as well as
operation and maintenance, with a focus
on poor and underserved people worldwide. Sector progress has to evolve from
advances in fits and starts to a continuous and sustained development process.
Considering that two thirds of the time
span from the baseline year (1990) to the
MDG target has elapsed, business as
usual is not enough. The world urgently
needs to step up activities, increase effectiveness and accelerate investments
if the target is to be met. (WHO/Unicef
2006, page 67)
In 2015, even if the targets are met,

more than 800 million people will still
remain without water, and 1.8 billion
people without sanitation. Yet, despite
progress, the world is falling short of
what is needed, especially in the poorest
countries. Changing this picture will require sustained action over the next decade, allied to a decisive break with the
current business as usual model. (UNDP
2006, p. 4)
wa te r source i n 19 90, 20 04 a nd 2 015
Po pulation ( millions )
8000
700 0
50 00
Sanitation provision to an additional 1.6

billion in 10 years = 440,000 a day.
Life improvement of at least 100 million

slum dweller by 2020 = 18,000 a day.)
19 90, 20 04 a nd 2 015
Population ( millions )
800 0
79 4
919
6000
To meet the MDG targets 10 and 11:

Drinking water provision to an additional 1.1 billion people in 10 years = 300,000
a day.
700 0
600 0
10 69
500 0
1187
400 0
400 0
30 00
300 0
20 00
40 92
53 20
6300
64 25
10 00
0
19 90
Population s er ved
2015
2015
(projected)(if target
is met )
Population unser ved
Projec ted population

se rved
Population s er ved if
MD G target is me t

unse rved
Stil l unse rved if target
is m et
Ye ar
20 04
18 05
48 29
5414
2015
2015
2710
200 0
10 00
23 90
2612
25 69
19 90
3777
20 04
Ye ar
(projected ) (if target

is m et)
Population s er ved
Population unser ved

se rved
Population s er ved if
MD G target is me t

unse rved
Stil l unse rved if target
is m et
Figure 19: World population with and without access to an improved drinking water source (left)
and access to improved sanitation (right) in 1990, 2004 and 2015. (WHO/Unicef 2006, p. 6-7)
19 90
2015
Ta rget d at e
Wo rl d
Sout h As ia
Figure 20: Some regions are offtrack for reaching the Millennium
Development Goal target for water
and sanitation. (UNDP 2006, p. 57
2016
2022
Ac hiev ed
2019
2018
2014
La tin A meric a
and C arib be an
Ac hiev ed
2013
20 42
Ar ab S ta tes
2019
20 40
20 76
Su b- Sahara
Af ri ca
2000
19 90
2010 2020
2015
20 30
20 40
Wa ter
Sa nitation
S ource : Ca lculated based on UNIC EF 2 00 6b.
4 Global Situation
4.6 Where is the greatest need for improvement?

Summary of global situation
Developing regions with rapid population growth and urbanisation and, thus, densely populated urban areas,
are most affected by water, sanitation and slum problems.
The sewerage system is the sanitation choice in industrialised (densely populated) regions (Europe, Japan, USA)
But developing countries need to find other solutions: not only does the climate differ, but also the political,
social, institutional, financial, and technical conditions are by far not comparable!
The key differences in the water,

sanitation and slum situation
(Worldmapper, <www>)
The maps very clearly illustrate where
water and sanitation problems are the
most acute and where large population
fractions live in urban slums
The enormous differences cannot be
ignored. In Africa access to safe water
is critical. In India the sanitation situation
shows a bleak picture. In Africa slums
are widespread and still increasing in
magnitude.
Population growth and sewerage

system
India, China and Nigeria have large populations and also Europe and Japan have
comparably high population densities
(i.e where territory size is smaller on
the land area map than on the population map). The map illustrates that regions with large populations also show
a low access to basic sanitation. One
could therefore deduce that .providing
access to basic sanitation in fast growing
, densely populated areas seems to be
a major challenge. Countries in Europe
however, do not show the same pattern.
Here although population density is high,
population growth has stopped, and people have access to sewered sanitation
systems. What can we learn from this?
Does this mean that sewer systems can
solve the problems of countries with
high population densities?
Obviously no, as the preconditions in
developing countries are not comparable to those in Europe or North America.
Not only does the climate differ, but also
the political, social, institutional, financial, and technical conditions are by far
not comparable!
Further questions
Discuss possible reasons for the country-by-country differences by comparing
the size of one specific country on the four
maps such as for example India, Nigeria,
Brazil, Indonesia, eastern Europe.
Figures 21: The size of each territory shows

the proportion of all people:
a) without reliable access to safe water
b) without access to basic sanitation (toilets)
c) that start living in slums between 1990 and
2001
d) connected to public sewerage systems
e) Territory size proportional to land area
(normal map)
f) Territory size shows the relative proportion
of the worlds population living there.
Photo 4: Drying beds in hot climates where

the sludge from on-site sanitation facilities is
discharged for subsequent treatment. (Source:
Eawag/Sandec )
Photo 5: The Hyperion Wastewater Treatment Plant, where Los Angels excreta and
wastewater is treated and discharged into the
ocean. (Source: dsearls 2008, Flickr <www>)
Additional info
More worldmaps comparing global data with the territory size are available on: Worldmapper: The World as youve never seen it before www.worldmapper.org/ (last accessed
08.05.2008)
WHO/Unicef (2006) Meeting the MDG drinking water and sanitation target: the urban and
rural challenge of the decade. WHO/Unicef JMP (Joint Mentoring Programme). http://www.
wssinfo.org/en/40_mdg2006.html (last accessed 08.05.2008)
UN-DESA, United Nations Department of Economic and Social Affairs (2007) The Millennium Development Goals Report 2007. New York, June 2007. http://www.un.org/millenniumgoals/ (last accessed 19.5.2007)
5 Urban Challenges
5. Challenges in urban water and sanitation provision

Countries and regions vary widely in
their water and sanitation coverage and
in their progress towards meeting target 10. We have seen the global and regional differences in Chapter 4. The following section discusses why and where
water and sanitation coverage is not increasing.
Unequal distribution
There is more than enough water in the world for domestic, agricultural
and industrial purposes. The problem is that some people notably the
poor are systematically excluded. (UNDP 2006, p. 3)
Latrines for us! They exclaimed in astonishment. We go and perform
out in the open. Latrines are for you big people. (Mahatma Gandhi recounting untouchables grievances, Rajkot Sanitation Committee, 1896)
5.1 What are the major deficiencies and challenges in urban water and sanitation provision?
Factors leading to deficiencies in water and sanitation can be found on every level from local to
international.
The causes for the inadequacies are thus proximate (household/local), contributory (city & town) or underlying (global/international).
Many factors contribute to the inadequacies in water and sanitation provision as

described in Chapters 1 and 4 (more details in Modules 36), and to the very serious implications these have on health
and well-being as described in Chapter
2 (more details in Module 2). These factors are found at every level, from the
very local to the international.
For example, certain factors contribute to contaminated water and thus
cause high levels of diarrhoeal disease in
a squatter settlement. The most immediate or proximate causes (such as the
inhabitants use of drinking water contaminated by human faeces) and contributory causes (poor quality water and
sanitation provision, in part due to the
settlements illegal status) as well as underlying causes (weak and ineffective local governments, lack of investment by
national government and low priorities
given to water and sanitation by many international agencies) are all causes for
the disastrous situation.
If the goal is to reduce the health burden of infected people by contaminated
water (cf. Chapter 1), the numerous contributing factors make it difficult to focus on the limited resources. There has
been a tendency among many governments and international agencies to focus on relieving the symptoms for instance, on ensuring the availability of
Household &
community level
City and town level
Global level
Proximate causes:
Contributory causes:
Underlying causes:
Illegal status of
settlements
Weakness/ incapacity of
local utilities
Lack of international
funding
Community capacity
Rapid population growth
Lack of development
Town problem
Political underpinning
Table 5: Summary of deficiencies and challenges in urban water and sanitation provision on three
levels: household and community, city and town and global. Water and sanitation can be deficient
because of proximate, contributory and underlying causes. All of them need to be understood and
addressed.
oral rehydration salts for the rapid treatment of diarrhoeal diseases rather than
addressing the causes. There are good
reasons for doing so. The wider availability of oral rehydration salts and the knowledge of how to use them have contributed to a substantial reduction in death and
disease burdens caused by diarrhoeal
diseases (and at low unit costs). Indeed, there are various examples of cities where good quality, community-level healthcare services have contributed
much to reducing infant and child mortality, and rapid treatment of water-borne
diseases has played a key role. But rapid
and effective healthcare if someone falls
ill (or is insured) does not address the
causes of illness or injury. Rapid treatment may save the lives of many infants
and children, but does not address the
causes, the very high risk of infections

remains. Curative responses, effective
as they are, do not prevent re-infection
or eliminate days lost to illness. As far
as children are concerned, curative responses do not address the accompanying setbacks to their overall health and
development. (UN-Habitat 2003, Water
and Sanitation, p. 101)
Further questions
How can the water and sanitation sector advocate a reduction in expenditure for
immediate health care in order to finance
long-term water and sanitation facilities?
These facilities cannot decrease death
rates from one day to the next?
It is clear that expenditure for sanitation

facilities is more valuable in the long run.
But how can politicians and the suffering
families be convinced?
5 Urban Challenges
5.2 What are the challenges faced by households and

communities?
This section focuses on the causes of inadequate provision at community and household level, and examines
how poverty, population and habitat pressure, lack of individual and community capacity forces people to live
in areas without water- and/or sanitation facilities and services.
Illegal status of many settlements

Situation:
1/42/3 of the urban population
lives in slums (informal or illegal

settlements).
Challenges for water and sanitation:

Many public or private official
water and sanitation providers do

not operate in illegal settlements
(forbidden by law!).
Moving from illegal to legal
status is complicated and expensive!
Photo 6: Slums in Rio de Janeiro, Brazil. (Source: World Resources Institute 2008, Flickr, <www>)
From illegal to legal. One important

constraint to improving provision in many
illegal settlements is the complexity of
moving from illegal to legal status, and
the many public agencies whose agreement is needed to do so. This was highlighted in a study in Buenos Aires, where
there is a legal basis for providing legal
tenure to illegal settlements. However,
the process is complicated, expensive
70
60
50
40
30
20
10
Europe
Other Developed
Ocenia
LAC
Northern Africa
Western Asia
East Asia
South Eastern Asia
Figure 22: Slum population in percent of urban

population in different regions. (UN-Habitat
2003. The challenge of slums)
80
South & Central Asia
and requires the agreement of several

different agencies. For the inhabitants of
an illegal settlement, this involves a long
process of negations, journeys to the
registry office, acquaintance with provincial government processes and knowledge of how to complete the process.
For local governments, this presupposes
professional support (for instance lawyers and surveyors) they often lack. (UNHabitat 2003, Water and Sanitation, p.
105)
Sub-Saharan Africa
No water and sanitation provision by

law. It is common that a quarter to half
of the population in cities of Africa, Asia
and Latin America live in slums (informal
or illegal settlements), i.e. some aspects
of land occupation or housing development are illegal.
This is of utmost importance to water
and sanitation provision, as public or private official water and sanitation providers may be forbidden by law from operating in such settlements. Alternatively,
the preconditions necessary for them to
operate there may not be available (for
instance, house plots may not have formal addresses, inhabitants may lack legal documents allowing them to become
registered or householders may lack documents showing their plot boundaries
and owners of each plot). (UN-Habitat
2003, Water and Sanitation, p 104)
Further questions
Is it legal to discriminate the poorest (living in illegal settlements) from water and sanitation
provision?
What are the (immediate) benefits for one or several households from moving of illegal to
legal status? Will the water and sanitation providers suddenly start operating?
Additional info
UN-Habitat (2003) Improving the lives of 100 million slum dwellers. Guide to Monitoring Target 11. Progress towards the Millennium Development Goals, Nairobi, May 2003.
Download available. (last accessed 15.05.2008): www.unhabitat.org/pmss/getPage.asp?pa
ge=bookView&book=1157
UN-Habitat (2003) The challenge of slums: global report on human settlement, 2003 / United Nations Human Settlements Programme, Nairobi, Kenya.
5 Urban Challenges
Community capacity to develop autonomous solutions

Situation:
National governments often do not
allow international
agencies to fund CBOs (communitybased organisations) directly.
Challenges for water and sanitation

Planning, funding, implementing,
operating, and maintaining water and

sanitation systems require qualified
skills and expertise in different
disciplinary fields.
Since illegal settlements lack regular plot layouts, access roads,
solid waste collection, the tasks are
far more complex than in regulated
settlements.
House-owners tend to resist
improvements requiring investments,
and tenants do not wish to invest in
properties they do not own.
Skills and expertise are necessary. It

is not easy to obtain the agreement of
all community stakeholders in matters
of planning, installing, funding, and managing water supply, sanitation, and drainage. Considerable technical expertise is
necessary to design and install properly
functioning systems that do not require
major maintenance regularly.
Organised and regulated settlements
are necessary. It is also more difficult
to install water and sanitation systems
in settlements lacking clearly demarcat-
ed plots, access roads or paths to each

house. Maintaining drainage and sewage networks in settlements lacking solid waste collection services or with highly silted surface run-offs is extremely
challenging.
Tenant and owner agreements are
necessary. Difficulties also arise by the
differing interests of tenants and owners, especially if many of the landowners
do not live in the settlement.
Tenants face particular problems, especially if (as frequently the case) landlords are reluctant to allow them to organise themselves. In many cities too,
the political system hardly encourages
local organisations to develop.
Community funds are necessary. Finally, international agencies face difficulties in supporting community-based
systems. All the official aid agencies and
development banks have, by their very
structure, to work with and through national governments. No national government will favourably view an international
agency steering funds directly to community-based and successful water and
sanitation schemes. Various international
NGOs have also supported the provision
of community-based water and sanitation. However, these are the exceptions,
as current international funding systems
do not lend themselves to expanding this
type of funding. (UN-Habitat 2003, Water and Sanitation, p. 105106)
Photo 7: Slum in Nairobi, Kenya. (Source:

Korinsky 2008, Flickr <www>)
Further questions
Are problems solved as soon as funds
are steered directly to CBOs? Who is
working for CBOs: local experts?
Who provides training and education of

water and sanitation experts? Who finances schools, universities, training centres
etc.? The communities?
Additional info
WaterAid (2008) Think local, act local.
Effective financing of local governments to
provide water and sanitation services. WaterAid report written by Laura Hucks, London. http://www.wateraid.org/documents/
plugin_documents/11961_think_local_
screen.pdf (last accessed 03.09.08)

One of the key reasons why so many
people live in informal settlements is because they cannot afford to spend much
(if anything) on housing. The main reason why so many low-income households use poor quality water sources is
again that these are much cheaper
or free. External specialists may consider it reasonable to expect low-income
households to spend 5 per cent of their
income on water and sanitation, but for
many low-income groups this is a heavy
financial burden. (UN-Habitat 2003, Water and Sanitation, p. 106)
Urban low-income households

Lack of house connections, public
taps are located far away, queues are long etc.
Water from vendors is expensive, so used only for cooking and drinking.
Water and sanitation expenditure: up to 10% of total income
is used for good quality water and another per cent for public toilets!
Many households cannot afford clean water, so poor water quality is used.
Conflict of objectives
To reach financial sustainability, costs
should be recovered for water and sanitation provision.
To protect health and the environment, it is necessary to reach the poorest.
5 Urban Challenges
Differing water costs. The monetary costs of water vary

greatly from city to city. For water, the cost per litre to urban
consumers around the world varies by a factor of at least
10,000! At one extreme, there are instances where the
cost of water is the equivalent of USD 0.01 per cubic metre
(for instance, the cost of water in Calcuttas piped supply),
while at the other extreme there are urban households who
pay water vendors the equivalent of USD 100 per cubic metre (USD 0.1 per litre) bottled water can cost far more.
The poor pay more than the rich. Most urban poor groups
not only pay a higher percentage of their total income for
water and sanitation than higher-income groups but they often pay much higher prices per litre for water and access to
sanitation this is the case even if provision is much worse
than for richer groups. Water costs are particularly high for
most of those who use water vendors, whose water prices
from vendors range from 10 to 100 times the unit price for
house connections. As highlighted by the Asian Development Bank survey, the unit cost of water from public taps
may also be much higher than from house connections. In
its survey, this was the case in several cities, including Hanoi, Chennai, Kathmandu, and Karachi (cf. Table 6)
Is cheap water really cheap? It is difficult to differentiate
between the provision costs (or prices charged) and the inadequacies of provision as these are interrelated. One key
reason why so many urban dwellers defecate in the open is
because they have no toilets in their homes, and paying toilets regularly is too expensive. Low-income groups often
use poor quality water, as it is more easily accessed and
far cheaper than good quality water. Consequently, data on
how much low-income households pay for water or for toilets may be misleading, as there are other high incurring
costs that can be saved (e.g. long queues, fetching and carrying water from long distances, living with the economic
and health costs arising from inadequate provision).
Water costs per cubic metre (USD)

City
House connection
Public tap
Water vendor
Bandung
0.38
0.26
3.60
Bangkok
0.30
28.94
Chennai
0.30
0.58
Chonburi
0.38
19.33
Colombo
0.04
0.02
Dhaka
0.08
0.84
Hanoi
0.09
0.55
Karachi
0.10
Kathmandu
0.18
0.24
Lae
2.20
5.96
Mal
5.08
11.20
Manila
0.29
2.15
Mumbai
0.07
0.07
0.50
Phnom Penh
0.13
0.96
Port Vila
0.42
0.86
8.77
Seoul
0.25
14.13
21.32
Shanghai
0.08
0.06
Tashkent
0.01
0.02
Thimphu
0.03
0.05
0
1.14
2.61
Table 6: The water costs from house connections, public taps and water
vendors in Asian cities. (UN-Habitat 2003, Water and Sanitation, p. 71; original source: Consumer surveys from Asian Development Bank and reported
in McIntosh, Arthur C. and Cesar E. Yniguez (1997).
The good price of water. There is an obvious justification for seeking cost recovery when improving water and
sanitation provision as improved provision can pay for itself,
i.e. the quality of provision can be maintained without any
constraints on expanding provision. Achieving cost recovery is particularly important for CBO or NGO-based provision, as obtaining regular subsidies from an external source
is difficult or impossible. (UN-Habitat 2003, Water and Sanitation, p. 6667)
Photos 8: Top left: Boy

fetching water from a natural
water whole. (Source: Eawag/Sandec);
Top right: Water pipes
(Source: Eawag/Sandec)
Left: For lack of piped water,
most urban poor in Jakartas
slums buy water from jerry
cans on a daily basis, Jakarta, Indonesia 2007. (Source:
Cak-cak, Flickr <www>);
High water prices and public health

We feel it our duty to say that high-priced water is not in the interest of public health. Pure water in abundance, at a price within the reach of all, is one of the most powerful agencies for promoting the health of any community. It is for this reason that
we believe so strongly in municipal ownership. (North Carolina
Board of Health, 1898)
Further questions
Is sustainable water and sanitation provision with cost recovery more
important than cheap water for the poor?
Why do the rich not pay more for their house connection? Who has
paid for the very expensive infrastructure: water pipes, sewerage etc.
5 Urban Challenges
5.3 What are the challenges at city or town level?

There are two cities within one. One part profits from all the benefits of urban living, the other the slums
and squatter settlements have all the disadvantages with the poor living in worse conditions than their rural
relatives. Anna Tibaijuka, 2006 (Worldmapper, <www>)
This section will focus on what contributes to inadequate water and sanitation
provision at the level of the town or city:
weakness and incapacity of local utilities, rapid population growth and urbanisation, the mega cities, the small cities
and their specific water and sanitation
deficiencies.
Photo 9: Mumbai. (Source: Eawag/Sandec, 2007)
Weakness and incapacity of local utilities

Poor performance of companies or utilities responsible for water and usually sanitation provision.
Two principal constraints: cost recovery and inadequate operation and maintenance
One important change in perceiving the

problem of water and sanitation provision in urban areas over the last ten
years relates to the increased awareness of the poor performance of companies or utilities responsible for water
(and usually sanitation). This is best illustrated in the two Water Utilities Data
Books produced by the Asian Development Bank. They highlight not only the
inadequate performance of many utilities (including few sections of the urban
populations being served intermittently),
but also as regards the inadequate management of the services (poor billing arrangements, water prices far below the
provision costs, over-staffed utilities and
high proportions of unaccounted for water).
This review also highlights the difficulty
in balancing the need to maintaining the
prices low while ensuring sufficient revenues to offer good quality provision and
coverage. However, stress is also placed

on the fact that food management limits
this trade-off as many of the utilities with
the highest water prices are also those
affected by poor quality management
(including high ratios of staff compared
to the number of connections and high
levels of unaccounted for water). The
WHO/Unicef Assessment 2000 identified cost recovery and inadequate operation and maintenance as two of the main
constraints on the development of water supply and sanitation both largely
a consequence of the weakness or incapacity of water and sanitation agencies.
(UN-Habitat 2003, p. 108)
Further questions
How can costs be recovered without increasing the prices too much?
How can utilities improve their management, including operation and maintenance
of water and sanitation facilities?
Photo 10: Water pipes in McLeod Ganj,

Dharamsala India, 2008( Source: Jace, Flickr,
<www>)
5 Urban Challenges
Rapid population growth and urbanisation

The urban population increased from 220 million in 1900 to 732 million in 1950, and is estimated to have
reached 3.2 billion in 2005, thus more than quadrupling since 1950.
By 2030, three out of five people on earth will most likely reside in urban centres, and nearly half of the
worlds population will be living in cities of developing countries.
The twentieth century witnessed the rapid urbanisation of world

population. The global urban population increased from a mere
13 per cent in 1900 to 29 per cent in 1950 and, according to the
2005 Revision of the World Urbanisation Prospects, reached 49
per cent in 2005. Since the world is projected to continue its urbanisation trend, 60 per cent of the global population is expected
to live in cities by 2030. The worldwide growth of the urban population best reveals the scale of these dramatic developments:
the urban population increased from 220 million in 1900 to 732
million in 1950, and reached 3.2 billion in 2005, thus more than
quadrupling since 1950. According to the latest United Nations
population projections, 4.9 billion people are expected to be urban dwellers by 2030.
The spatial distribution of the population has always been a key
factor on the policy agenda of governments. The governments of
developing countries have often expressed concern about their
inability to provide basic services for their rapidly growing urban
populations, including safe drinking water, sanitation, affordable
housing, and public transport.
Today, almost half of humanity lives in cities. By 2030, three
out of every five person on earth is likely to reside in urban centres, and nearly half of the worlds population will be living in the
cities of developing countries (cf. Figure 22). Urbanisation provides both opportunities and challenges. The more developed regions are highly urbanised, thus indicating that urbanisation is a
natural concomitant of development. In the developing world, urbanisation has been rapid, but major areas, such as Africa and
Asia, still lag far behind the rest of the world in their levels of urbanisation. Countries in those regions are particularly faced by
the double challenge of increasing urbanisation and continued
rural population growth. If the twenty-first century is to respond
creatively to the many opportunities that the growth of urban areas brings, then the economic dynamics of cities have to be nurtured. (UN 2006, Urban and Rural Wallchart)
Figure 22: The urban and rural population of the world, 19502030
(UN Department of Economic and Social Affairs, <www>)
Figure 23: The maps illustrates the distribution of the world population in 1900 (top) and the predicted distribution in 2050 (below).
(worldmapper, <www>)
In the coming decade, out of every 100 additional person, 97 will be living in developing
countries. Hania Zlotnik, 2005
The choices that todays generation of young
people aged 1524 years make about the size and
housing of their families will determine whether Planet Earth will have 8, 9 or 11 billion people
in the year 2050. United Nations Population Fund, 2005
Massive urbanisation means hundreds of
already near-bankrupt cities trying to cope in 20
years with the kind of problems London or New
York only managed to address with difficulty in
150 years. John Vidal, 2004
Figure 24: Contribution of urban and rural population growth to total
population growth, 19502030 (UN Department of Economic and Social
Affairs, <www>)
5 Urban Challenges
A vision for the urban future

Dealing effectively with expected urban growth will require an open
mind. It is clear that policy-makers at all levels in developing countries
will have to accept urbanisation as a potential ally in development efforts. Evidence-based policy dialogue is needed to help to convince
them that urbanisation is not only inevitable but that it can be a positive
force. (UNFPA 2007, p. 69)
Further questions
How many more people can the world host and provide with water and sanitation?
How (fast) and when did urbanisation take place in Europe or North
America? What problems did these now developed regions face at that
time?
What are the reasons for moving to cities?
How can enough water be transported to densely populated areas/

cities?
Additional info
UNFPA (2007) State of world population 2007. Unleashing the Potential of Urban Growth. United Nations Population Fund.
Figure 25: In some countries, water coverage is slipping with rapid

urbanisation. (UNDP 2006, p. 57)
UN World Urbanization Prospects, WUP (2006) The 2005 Revision.

Executive Summary, Fact Sheets and Data Tables. Department of Economic and Social Affairs. Population Division. New York, 2006. http://
www.un.org/esa/population/publications/WUP2005/2005wup.htm (last
accessed 15.05.2008)
United Nations Population Fund (UNFPA) homepage: www.unfpa.org

(last accessed 03.09.08)
Downloads available on the CD of Sandecs Training Tool and from the
Internet.
The mega cities and their history

The urban population increased from 220 million in 1900 to 732 million in 1950, and is estimated to have
reached 3.2 billion in 2005, thus more than quadrupling since 1950.
By 2030, three out of five people on earth will most likely reside in urban centres, and nearly half of the
worlds population will be living in cities of developing countries.
Water and sanitation provision is expected to be particularly poor in very rapidly
growing cities, nevertheless, this is only
partly true. Many of the worlds most
rapidly growing cities over the last 50
years (the mega cities) have very good
water and sanitation services, and many
much slower growing cities of smaller
urban centres have very poor services.
The very large cities (the mega cities) are expected to face insurmountable problems regarding the acquisition of
fresh water. Many of the worlds largest
cities today are 50200 times larger than
they were 100 years ago and since the
per capita water use has also risen dramatically, this means that the total fresh
water use is 2001000 times higher than
100 years ago. Many of the worlds largest cities face serious problems in ob-
taining sufficient fresh water a cause

often attributed to poor water management. What is more surprising is the fact
that a number of large cities do not face
serious water shortages. The question is
thus: Why have cities that have grown so
much not run out of water? (UN-Habitat
2003, Water and Sanitation, p. 108)
For large cities not to run out of water
is partly due to the fact that the worlds
large cities are currently located in areas
with a rich agricultural potential, i.e. with
abundant fresh water sources. Most are
situated and have grown into important
cities prior to motorised transport, therefore, no major city could be too far from
its main sources of fresh food. Most of
the worlds largest cities today have a
long urban history. Though rural and
urban are still regarded as two oppo-
sites competing for resources, numerous major cities currently owe their initial
prosperity to rich agricultural and farming
sources. (UN-Habitat 2003, Water and
Sanitation, p. 112)
Further questions
Could mega cities with a long historical
background be considered part of the developed world? What is developed what is
not developed?
What happens to the rural sections,

where agriculture is/was predominant, if
everyone is moving to cities? Who is growing vegetables and crops?
Where does the rainwater run off in cities, as there is no bare soil to absorb it?
Where are the new urban centres located? Why?
5 Urban Challenges
Small cities
Small cities (< 500,000 inhabitants) in less developed regions are most affected by population growth and
urbanisation.
In Africa and Asia one-third of the population currently lives in small cities.
The population in small cities in Africa, Asia and Latin America will double in the next 15 years.
Large cities are never listed among the

most rapidly growing cities, although
they obviously did when they were smaller. Analyses of inter-census population
growth rates for all urban centres usually highlight some small urban centres
with annual population growth rates of 7
per cent. However, as regards water and
sanitation utilities, the absolute number
of people added to a citys population
each year is probably a more relevant
indicator of growth. (UN-Habitat 2003,
Water and Sanitation, p. 109)
In 2005, about 51 per cent of all urban
dwellers worldwide resided in small cities with less than 500,000 inhabitants.
Thus, the majority of urban dwellers lived in fairly small urban settlements. (UN 2006, Urban and Rural Wallchart)
Between 20 and 40 per cent of the
population in African and Asian countries live in small cities. And as villages grow, develop and turn into towns,
and as towns grow in size, the number
of people living in small cities in Africa,
Figure 26: Urban population by settlement size worldwide, 19752015. (UNFPA 2007, p. 10)
Asia and Latin America is expected to

double within 15 years, and double again
within 30 years. The current 60% rural
40% urban split in Africa and Asia is expected to shift to the current 25% rural
75% urban split found in Europe and the
Americas. Much of this anticipated shift
will result from the growth of small cities. (Pilgrim 2004)
The special problems of sanitation in small

cities of low-income countries
Small-city problems (< 500,000)
Weak governments.
No official water and sanitation utilities/institutions.
No professional staff.
Neglected by governments and donors.
Over the last two decades, much attention has been paid to water supply and
sanitation in both rural villages and urban centres. Given the fact that as many
people live in small cities as in villages and urban centres with the relatively poor level of service, a growing consensus was formed that they deserve
better. There is a particular need for innovative management models providing
good quality, affordable and sustainable
services capable of expanding. (Pilgrim

2004, p. 1)
There is far more documentation on
water and sanitation provision in large cities than in smaller ones or urban centres
too small to be considered cities. However, most of the worlds urban dwellers
do not live in large cities. For instance, by
2000, less than 4 per cent of the worlds
population and less than 8 per cent of its
urban population lived in the 16 mega
cities of 10 million or more inhabitants.

Nevertheless, there is far more literature on the water and sanitation problems of mega cities than on the tens of
thousands of urban centres with less
than half a million inhabitants, where the
number of inhabitants amounts to more
than six times as many people totally (and more than half the worlds urban population). (UN-Habitat 2003, Water and Sanitation, p. 39)
5 Urban Challenges
Small cities (towns) lack professional capacity. In general, the larger

the town, the lower the number of people working in agriculture and the more
important the market and administrative
functions. As market towns or points
on transport routes, towns (small cities)
play a key role in the provision of goods
and services for their own population
and their surrounding rural areas. Larger
towns (small cities) are also more likely
to play an important role in public services, such as healthcare and schools or
in commercial and industrial enterprises.
These activities make towns a focal point
for broader economic and social development. As a result, larger towns (small
cities) are able to attract competent professionals from various fields, including
managers and operators of water supply and sanitation systems. Most towns,
however, suffer from a lack of competent professionals and have difficulty attracting them. Towns are unable to cover their needs by themselves; they must
share the limited professional support
available locally to improve efficiency,
planning, management, and expansion.
(Pilgrim 2004, p. 3)
The Management Gap. In recent
years, great success has been achieved
in rural villages by using a bottom-up
approach based on community management and development of local supply
chains for goods and services. Urban
utilities have also benefited from this decentralisation process by consolidating
their operations in larger, more profitable urban centres. However, just as top-
Figure 27: The Management Gap adapted from Hopkins. An alternative perspective on water
supply and environmental sanitation. (Pilgrim 2004, p. 4)
down approaches, typified by the wide

mandate national/regional utilities found
in many developing countries, result in
a higher proportion of failure as settlements become smaller, so will the bottom-up approach that has worked for
rural villages fail, as systems become
larger and more complex.
Small cities are neither urban
nor rural. As a sub-sector, they fall between two, relatively well-established
approaches for providing water and sanitation services. Water supplies in small
cities require management skills that exceed rural community-based management approaches, but are too small for
standard urban utility-managed approaches, which require sufficient revenues to support a full complement of
professional staff and the potential for
full cost recovery. What is needed is a
management system for small cities that
fills the in-between gap, drawing on elements of both. In the absence of appropriate solutions, towns have tended to
be neglected by governments and donors. Figure 27 graphically presents the
management gap, which also illustrates
the fact that the boundaries of this management gap cannot be determined accurately. Evidence suggests that towns
between 2,000 to 500,000 inhabitants
lie within this grey area of management
despite regional and country differences.
(Pilgrim 2004, p. 34)
Further questions
Do governments and donors neglect
towns due to the lack of appropriate management solutions or vice versa?
How can water and sanitation professionals be trained if good management examples of a town water and sanitation system are lacking?
5 Urban Challenges
Weak city and municipal governments

Situation
Basic structures of government
agencies are only partially present or

non-existent.
New cities are mushrooming
everywhere: government institutions
have to be built from scratch.
Challenges
Development of accountable,
effective local governments.

New local government units within expanding cities are particularly
weak: illegal settlements with low-income households.
Two aspects are generally key to inadequate city governments: weak local government structures and institutions, under-funded and often understaffed (with
water and sanitation utilities of little or
no investment capacity), and higher levels of governments not willing to grant
local institutions the resources and revenue-raising powers they need to become
more effective. (UN-Habitat 2003, Water
and Sanitation, p. 113)
The developmental role of local governments. Within Europe and North
America (and in high-income nations
elsewhere), urban populations have become so used to the web of local institutions that serve, support and protect
them that they forget their importance.
This is not the case for most of the urban (and rural) populations living in low
and in most middle-income nations. The
basic structure of government agencies,
supervised by elected politicians able
to meet their responsibilities, is at best
only partially present and at worst nonexistent. Local governments are also often rooted in undemocratic structures
favouring local elites, patron-client rela-
tionships limiting the capacity of low-income groups that demand their rights,
and corruption. Perhaps the most pressing issue to improve water and sanitation
in urban areas is the development of accountable, effective local governments
or if this is impossible, other local institutions accountable and responsible to
those lacking adequate water and sanitation provision.
Local institutions need to provide the
rule of law through which the rights and
entitlements of all groups (including lowincome groups) and the public good are
protected which includes the right of
low-income (or other) groups to organise and to demand better provision. (UNHabitat 2003, Water and Sanitation p.
113114)
Weaknesses in local authorities. It is
difficult to assess the quality of local governments, since many aspects are not
easily measured, such as accountability, transparency and commitment to ensuring that all citizens are served by the
rule of law.
A research initiative in the early 1990s
sought to collect comparable statistics
from a range of cities on housing and basic service provision. The expenditure
per person on water supply, sanitation,
garbage collection, and other forms of infrastructure and services for a range of
cities reveals dramatic differences between cities of high, middle and lowincome nations. For many cities, infrastructure expenditure per person per
year is the equivalent of USD 1 or 2
compared to cities such as Stockholm,
Vienna, Tokyo, and Helsinki whose expenditure ranges from USD 1,000 to
2,200 per person.
One reason for the weakness of numerous urban governments may be
the emergence of so many new cities
where the government institutions have
to be built from scratch. If new cities are
mushrooming everywhere, this may explain the weak governments.

An often more serious problem are
new, particularly weak local government
units within expanding cities. Large cities often have local governments with
important differences among them in
terms of their competence, capacity and
size of their revenues.
For instance, governments of richer
areas of large cities such as central districts and middle and upper-income suburbs are often more effective and far
better funded than elsewhere. However,
some municipalities within large cities
have high concentrations of low-income
households with a much weaker revenue
basis. These often include some municipalities situated on the urban periphery
experiencing a particularly rapid growth
in illegal settlements.
Further questions
Do slums develop where local governments/institutions cannot cope with more
people? Where there is not enough space
for regular plots, no services, no jobs,...
Or do slums develop because people

cannot afford the (city) services?
How should local governments and authorities be strengthened? With more

money? With less migration restrictions?
With well-educated staff? With no corruption? With democracy?
Additional info
Pilgrim, N., Roche, B., Revels, C., Kingdom, B., Kalbermatten, J. (2004) Town Water Supply and Sanitation. Bank-Netherlands water partnership, Project No. 43,
Town Water Supply and Sanitation Initiative, The World Bank Washington, Sept.
2004.
5 Urban Challenges
5.4 What are the challenges at the international level?

It is worth recalling the time it took for
cities in high-income countries to develop their own government structures to
ensure overall water and sanitation provision, how conflict-ridden this process
was and how reluctant national governments were to support it as it implied
considerable loss of power for them.
For many nations, perhaps most notably sub-Saharan Africa, conditions have
not favoured the development of competent and effective city authorities. Since
colonial governments attached very little
importance to developing local government structures, there was little to build
on when they turned independent in the
1950s, 1960s or 1970s. The newly independent governments then had to cope
with dramatic urban changes (cf. Chap-
ter Population growth and urbanisation), since the restrictions on the rights
of citizens to live and work in urban areas were eliminated. In most cities, colonial governments had done little to put in
place a local government system to ensure an appropriate water and sanitation
provision for city populations. (UN-Habitat 2003, Water and Sanitation, p. 117)
Lack of international funds for urban water and sanitation

Africa: national investments are very low (compared to other regions).
Urban sanitation: very low annual investments (compared to urban water supply).
Funding limitations are often given as a

key cause for inadequate water and sanitation provision. This includes the lack of
funds from most international agencies
due to the low priority given to water and
sanitation in urban areas.
According to the estimates presented in the Assessment 2000, the average external support provided for urban
water supplies amounted to USD 3.6 billion a year between 1990 and 2000, and
USD 716 million a year for sanitation (cf.
Figure 28). More than half of the external support to urban water supply went
to Africa. Between 1990 and 2000, the
external support also accounts for nearly half of all investments made in urban
water supplies in Africa, Asia, as well as
Latin America and the Caribbean. The
external support was particularly noticeable in Africa, where it amounted to almost twice the value of the national investment. In Asia, the external support
accounted for about a third of all the investments in urban water supplies. However, according to this assessment, the
investments made by households independently from government aid (for instance, the construction of their own la-
trine) are unlikely to have been included

in these figures.
The sanitation figures reveal the minor importance given by the external
agencies. Total investments from external agencies in urban sanitation amounted to one-fifth of the investments in
urban water supply and, here, most investments were made in Latin America
and the Caribbean. A major portion may
have been invested in sewage treatment
plants in middle-income nations, rather
than in improving and extending sanitation provision among urban households
and low-income nations.
The issue whether privatisation has
brought significant new cash flows into
water and sanitation provision was also
raided. One of the justifications used by
the World Bank and various other international agencies to support privatisation of water and sanitation was their belief that this would attract new sources
of investment to expand provision. However, the amount of new funds from relatively few international companies did
not meet the expectations. (UN-Habitat
2003, Water and Sanitation p. 118120)
External support
National investments
8
7
6
5
4
3 billions
US$
2
1
0
Africa
Asia
External support
Latin
Total
America &
the
National investments
Caribbean
8
7
6
5
4
3
US$
billions
2
1
0
Africa
Asia
Latin
America &
the
Caribbean
Total
Figure 28: Top: Annual investments in urban

water supply by region, 19902000.
Below: Annual investment in urban sanitation
by region, 19902000. (WHO/Unicef 2000,
p. 16)
5 Urban Challenges
National expenditure patterns tell

their own story. It is difficult to capture
real public spending on water and sanitation partly because of the fragmentation
of financing across ministries, partly because of decentralisation and partly because donor financing is often off-budget. However, public spending in the
sector as a whole typically represents
less than 0.5% of the GDP, falling to
0.1% in Pakistan and Zambia (Figure 29).
Within the sector, expenditure on sanitation typically falls well short of that for
water. Sanitation investment averages
about 12%15% of the total in sub-Saharan Africa and Asia. Overall spending
is low not just relative to national income
but also to other areas of social spending, such as public health. When measured against military spending, the gap
widens to a large extent. For example,
India spends 8 times more of its national wealth on military expenditure than on
water and sanitation. Pakistan spends 47
times more. In sub-Saharan Africa, low
average incomes clearly constrain public spending capacity. At the same time,
Ethiopia, one of the poorest countries in
the world with some of the lowest coverage rates (and some of the highest child
death rates from diarrhoea), still manages to mobilise almost 10 times more
for military expenditure than for water
and sanitation. South Africa is one of the
few countries that spends less on military than on water and sanitation. (UNDP
2006, p. 62)
Figure 29: Water and sanitation: A low priority in many budgets (UNDP 2006, p. 62)
Meeting Target 10: What will it cost?

To estimate the resources necessary to
meet the Millennium Development target
for water and sanitation requires analysis
at two levels: the global and national level.
Global level estimates are helpful in giving
a sense of the magnitude of the financing
required. Global financing cost estimates
range from USD 51 billion to USD 102 billion for water supply, and from USD 24
billion to USD 42 billion for sanitation for
200115. There is no absolute cost figure, as much depends on the technologies
adopted and on country-specific preferences and conditions.
Taking an average would yield USD 68 billion for water and USD 33 billion for sanitation or USD 101 billion totally. This
amounts to USD 6.7 billion annually less
than half of what Europe and the United
States spend annually on pet food (USD 17
billion). (UNMP 2005, p. 29)
Further questions
Providing basic sanitation is less expensive than providing safer water supply.
Why are the investments for safe water
supply still so much higher than the investments for sanitation?
How can Africas great dependence on

external support be interpreted? What is
the difference in Asia, where far more people have to be served (China, India) and the
countries cover a large amount with national investments?
Additional info
Winpenny, J., Camdessus, M. (2003) Financing Water For All. Executive Summary. Report of the World Panel on Financing
Water Infrastructure. World Water Council
and Global Water Partnership. http://worldwatercouncil.org/fileadmin/wwc/Library/
Publications_and_reports/CamdessusSummary.pdf (last accessed 03.09.08).
5 Urban Challenges
The political under-pinning of good provision

for water and sanitation
The richest almost pay nothing for good water services although they are four times more likely to use
improved sanitation than the poorest.
Many water utilities are not free to improve and extend provision (for the poor); politicians often prevent
rises in water prices.
There are many factors constraining the

development of more effective government structures, especially where these
increase costs and limit choices for politically powerful enterprises and populations. Middle and upper-income groups
who have long received piped water supplies at lower than the cost price may be
able to pay more realistic prices. However, this does not mean that they will
by happy to do so. Good water management means limits on where industries
can locate and developers can build; they
can tap local water sources and dispose
of waste. However, in cities where most
industries are used to operate outside
any such management framework and
have been saving money by doing so,
they will not welcome such changes.
It is relatively easy to point to rational and cost-effective ways to improving
water and sanitation provision in most urban areas. What is more difficult, however, is to understand why these have
not been implemented. If significant
improvements for which lower-income
groups are able and willing to pay, why
have they not been promoted? Why have
politicians not promoted such solutions?
One obvious problem is the politically influenced water prizing system that
gives water utilities no incentive to improve or extend provision as they cannot
recover costs and may not be able to
cut off non-payers. Politicians often prevent rises in water prices, but this can result in low revenues and the inability of
water utilities to invest in maintenance
and system expansion. Privatisation also
seems to have been driven by the financial rewards it can bring to elites and the
improved provision it offers those already connected. (UN-Habitat 2003, Water and Sanitation, p. 123124)
It is not surprising that water and sanitation coverage, as well as service levels, are higher among the rich than the
poor. An analysis of 20 Demographic and
Health Surveys of the past five years reveal that only about 1 out of 6 households in the poorest 20 per cent of the
population uses improved sanitation facilities compared to 3 out of 4 households in the richest 20 per cent. Fewer
than 4 in 10 of the poorest households
use an improved water source, whereas
nearly 9 out of 10 of the richest households do so.
Figure 30: Top: Improved drinking water coverage by wealth quintiles; Below: Improved
sanitation coverage by wealth quintiles
(WHO/Unicef 2004, p. 20)
Further questions
25% of the rich do not have access to
basic sanitation: this could also include
some politicians? Why is sanitation still not
on the agenda of many local governments?
Additional info for Chapter 5

SEI Stockholm Environment Institute (2005): Sustainable Pathways to attain the Millennium Development Goals. Assessing the Key Role if Water, Energy and Sanitation. With contribution from the Stockholm International Water Institute. Stockholm, 2005. http://www.sei.se/
Why is it not possible to balance the water prices?
The rich pay what it costs: cost recovery

(and no subsidies) for piped water and the
poor also get piped water (subsidies for infrastructure) or lower water vendor prices.
UNDP (2006) Human Development Report. Beyond scarcity: Power, poverty and the global
water crisis. Published for the United Nations Development Programme (UNDP), New York.
http://hdr.undp.org/en/reports/global/hdr2006/ (last accessed 08.05.08)
UNMP (2005) UN Millennium Project Report on Water and Sanitation: Health, Dignity and Development: What Will it Take? Published by Stockholm International Water Institute, SIWI, and United Nations Millennium Project, New York. http://www.siwi.org/sa/node.
asp?node=160 (last accessed 19.5.2008)
UN-HABITAT homepage: www.unhabitat.org (last accessed 03.09.08, most publications

are not freely available!)
Download available on the CD of Sandecs Training Tool and from the Internet.
5 Urban Challenges
5.5 Deficiencies Summary

The water and sanitation deficiencies
discussed in Chapter 5 were presented
according to the places (levels) where
they occur and/or affect the people. The
proximate causes for deficiencies have
to be addressed at the household and
community level, the contributory causes at the city and town level and the underlying causes at the international level.
On each level, different people are involved, responsible and affected.
To acquire a better understanding of
the challenges in water and sanitation
provision, the discussion is summarised
in the following, often used, disciplinebased categories: political, institutional, financial/economical, and social. The
(new) approaches are also presented according to these categories in Chapter
6. Knowledge from many different disciplines is assembled. People responsible
for water and sanitation projects in developing countries need to understand
the political, institutional, economic/financial, and cultural/social setting and
should be made aware of technical possibilities.
Political constraint
One of the chief constraints to expanding water supply and sanitation coverage is the lack of political will, by which
we mean an absence of political leadership and government commitment to
allocating sufficient national resources
to the sector and to undertaking the reforms necessary to improve performance and attract investment.
There are many underlying reasons
for a lack of political will. For decisionmakers in finance ministries, for example, investments in water supply and
sanitation are perceived as having lower
returns than funds spent in other sectors
(for example, on roads or energy). Another reason is the failure of technical specialists, civil society actors and others to
make a compelling case to decision-makers about the social and economic benefits of access to water supply and sanitation services.
The capture of water and sanitation
planning and institutional processes by
powerful political interests also acts as
a barrier to service expansion. The kinds
of changes needed to prioritise improved
water supply and sanitation services to
poor households often threaten status
quo arrangements that confer substantial

benefits on politically influential groups.
For instance, well-off urban communities with piped water have a vested interest in maintaining current conditions.
They benefited from publicly financed infrastructure in the past, often still benefit
from consumption subsidies and tend to
oppose using public financing to expand
services to the poor or reallocating subsidies to those who really need them.
The resistance that often emerges
can be difficult to overcome, particularly
when vested interests exploit the plight
of the unserved to argue against policy
or institutional reforms. Building broadbased, informed coalitions, ideally led by
an influential political champion, is critical for mounting initiatives that prioritise the poor and redirect resources toward low-income households. (UNMP
2005, p. 26)
Institutional constraints
Two types of institutional constraints
stand in the way of expanding access to
water supply and sanitation services: the
lack of appropriate institutions at all levels and chronic dysfunction of existing
institutional arrangements. At the community level, potential users of services are often constrained by the absence
or underutilisation of institutions to facilitate collective or individual action. At the
national and subnational level, sanitation
often has no institutional home at all, creating a policy vacuum and a corresponding lack of prioritisation in budgetary decision-making.
Among existing institutions involved
in the extension, operation and maintenance of water supply and sanitation
services including formal organisations
such as utilities and local governments,
less formal associations, such as village
committees, and principles or practices
such as laws, regulations and customs
persistent problems at the heart of constraints to expanding access to service
include inadequate capacity, inappropriate incentives, lack of accountability
and absence of a sound regulatory system. For women, legal barriers to owning and inheriting land can also serve to
limit their access to water and sanitation
services as can their status as renters
with absentee landlords. (UNMP 2005,
p. 27)
Financial constraints
Poverty is a principal impediment to
increasing access to services, from the
household to the national level. Within communities, some households simply cannot afford the costs of improved
services without assistance from other families or from the state. Many poor
countries simply do not have the financial
resources either to provide water services to all or to sustain their operation.
Compared with wealthy households
that use network services, many poor
households pay a much higher proportion of their income for water and sanitation services delivered by informal vendors and service providers. The poor
also regularly pay much higher rates for
these informal services than the betteroff do for network services, despite the
fact that the informal services provide
poorer quality water, significantly smaller
quantities of water and considerably inferior sanitation services. Perversely, the
very fact that the poor pay more for water than do the rich is sometimes cited as
proof that even the poorest can afford
to pay for water. This line of reasoning is specious at best. Water is plainly
not affordable for people whose poverty
forces them to make a choice between
spending money on water and spending
money on other very basic needs, like
sufficient food or adequate shelter.
However, a variety of obstacles limit access to these sources of finance in
low-income countries. Water and sanitation utilities in the poorest countries,
for example, often have weak managerial
and financial capacities. They are unable,
for a variety of reasons, to generate sufficient cash flows to meet recurrent expenditure, much less to make the investments necessary to expand coverage to
unserved communities. Towns and municipalities in developing countries typically have limited access to loan financing facilities. Combined with limited tax
revenues and unreliable transfers from
central government, these local administrations are often unable to provide much
support to public service providers.
In some countries, governments have
been reducing investments in water supply and sanitation in the hope that private-sector investments will fill the gap.
Recent evidence suggests that this expectation is often overly optimistic anSandec Training Tool: Module 1 36
5 Urban Challenges
nual private-sector investment in water supply and sanitation for developing

countries has continued to decline each
year since its peak in 1997. The features
of investment in water and sanitation facilities including the lumpiness of
major infrastructure costs, the long payback periods of 20 years or more and
the political difficulty of charging costrecovery tariffs make it difficult to attract private investment. The frequency
with which water and sanitation concessions in both developing and industrialised countries have been postponed or
cancelled over the past several years (often due to currency shocks) is evidence
of how difficult it is to design and implement successful private-sector involvement in water and sanitation services.
Trends in official development assistance indicate that support for water supply and sanitation infrastructure is very
modest, both in relation to support provided to other infrastructure sectors and
in terms of what is necessary to meet
the Millennium Development Goals for
water and sanitation. Nor is support directed to those countries that need it
most. A recent report by the Development Cooperation Directorate of the
Organisation for Economic Cooperation
and Development shows that less than
60 per cent of the populations have access to an improved water source. Moreover, aid to water and sanitation is concentrated in certain countries, with the
ten largest recipients receiving 53 per
cent of the total. In addition, the prerequisite condition normally prescribed for
official development assistance that for
effective and accountable use of such
aid, certain reforms must be in place
has been a constraint to the countries
most in need for help in meeting Target
10. At the same time, few developing
countries give priority to investments in
infrastructure, including water and sanitation infrastructure, in their investment
programmes. (UNMP 2005, p. 2829;
Original: OECD-DAC 2004)
Case study: The constraints on extending water and sanitation in Bangalore (India)
(UN-Habitat 2003, Water and Sanitation, p. 116)
Water and sanitation provision in Bangalore has many deficiencies. A recent review of the
problems the city faced identified the following constraints on improving provision.
Insecure tenure. A large number of the poor live in unrecognised slums on private lands or as
tenants. They cannot get individual connections only where households can provide proof of
property ownership and a recent receipt for payment of property tax. Residents of recognised
slums may also be unable to provide such documentation if responsibility for water and sanitation provision has not been transferred from Karnataka Slum Clearance Board (which takes on
upgrading in slums that are officially recognised) to the municipal corporation. In settlements
at risk from eviction, households are discouraged from making the significant investments required to access an individual connection. High tenancy rates with absentee landlords are a particularly difficult impediment to household investments in improvements.
Limited ability of poor households to pay for both the one-off connection charge and the
monthly user charges. Connection charges are increased by road cutting charges and other
charges levied by the plumbers responsible for providing the connection.
Limited institutional capacities of the service delivery agencies to work with communities and time constraints on their capacity to do so. Service delivery agencies are staffed by
technical personnel with little expertise in working in partnership with CBOs. Community mobilisation is perceived as time-consuming and something that cannot be accomplished in a short
project cycle. In general, there are also few institutional capacities for participatory planning
and delivery, both within the utility and within communities seeking better provision.
Political interest in business as usual. The provision of free water has historically been
an important means by which leaders win popular support. The city of Bangalore has more
than 15,000 public fountains connected to the piped network where water is free to users,
though the utility records show only half this number; the rest are assumed to have been provided by elected representatives and local leaders. About 4,500 public fountains are located in
the slums and most of the others in low and middle-income residential areas. The water taken from the unregistered public fountains account for a significant quantity of unaccounted for
water.
Limited financial and institutional resources. This refers not only to very limited financial
resources but also to the incapacity of institutions to work in an integrated manner, leading to
duplication of efforts and wasteful expenditure. Much more could be achieved with existing
resources if government institutions worked with NGOs, communities and elected members.
The high cost of water. The city draws much of its water from a source 94 kilometres away.
Since this water has to be pumped up to the city (due to its elevated location), the incurred
costs are high. Energy costs account for about 60% of the water costs.
The factors constraining households from contracting a water connection with the official government utility were identified in a baseline survey and include:
The fact that tenure is unrecognised in many slums (12%).
The high cost of connection (20%).
The absence of the water network in the area, which is particularly problematic in peripheral
areas and urban villages (30%).
Access to alternative sources such as groundwater, illegal connections and public fountains
(29%).
Original source: Sinclair Knight Merz and Egis Consulting Australia in association with Brisbane
City Enterprises and Feedback HSSI STUP Consultants Taru Leading Edge (2002), Bangalore Water Supply and Environmental Sanitation Masterplan Project; Overview Report on Services to Urban Poor Stage 2, AusAid, Canberra.
6 (New) Approaches
6. (New) approaches: Turning commitment into reality

The richest almost pay nothing for good water services although they are four times more likely to use
improved sanitation than the poorest.
Many water utilities are not free to improve and extend provision (for the poor); politicians often prevent
rises in water prices.
Introduction
What will it take to expand water supply
and sanitation coverage dramatically and
sustainably?
Long-term decision-making in water
by all actors and at every level should
lead to sustainable use of the worlds
water resources, sustainable development of societies and improved, dignified livelihoods for individuals. The water
and sanitation target to reduce by half,
until 2015, the number of people without
sustainable access to safe drinking water
and basic sanitation, will not be reached
unless (UNMP 2005, p. 12):
There is a deliberate commitment by

donors to increase and refocus their
development assistance and to target
sufficient aid to the poorest low-income countries.
There is a deliberate commitment by
governments of middle-income countries that do not depend on aid to reallocate their resources so that they target funding to their unserved poor.
There are deliberate activities to create support and ownership for water supply and sanitation initiatives
among both women and men in poor
communities.
There is a deliberate recognition that
basic sanitation in particular requires
an approach that centres on community mobilisation and actions that support and encourage this mobilisation.
(UNMP 2005)
The Task Force identified ten critical actions for achieving the water
and sanitation target and fostering the sound management of water
resources for all the Goals. They are (UNMP 2005, p. 12):
Action 1
Governments and other stakeholders must move

the sanitation crisis to the top of the agenda.
Action 2
Countries must ensure that policies and institutions for water supply and
sanitation service delivery, as well as for water resources management
and development respond equally to the different roles, needs and
priorities of women and men.
Action 3
Governments and donor agencies must simultaneously

pursue investment and reforms.
Action 4
Efforts to reach the water and sanitation target must focus on

sustainable service delivery, rather than construction of facilities alone.
Action 5
Governments and donor agencies must empower local authorities and

communities with the authority, resources and professional capacity
required to manage water supply and sanitation service delivery.
Action 6
Governments and utilities must ensure that users who can pay do pay to fund
the operation, maintenance and expansion of services but they must also ensure that the needs of poor households are met.
Action 7
Within the context of national poverty reduction strategies based on the

Millennium Development Goals, countries must elaborate coherent
water resources development and management plans that will
support the achievement of the Goals.
Action 8
Governments, their civil societies and private sector partners must support a
wide range of water and sanitation technologies and service levels that are
technically, socially, environmentally, and financially appropriate.
Action 9
Institutional, financial and technological innovation

must be promoted in strategic areas.
Action 10
The United Nations system organisations and their member states must ensure
that the UN system and its international partners provide strong and effective
support for the achievement of the water supply and sanitation target as well
as for water resources management and development.
6 (New) Approaches
6.1 Political approaches

Informational education: Politicians need to know social and economic benefits, they have to sit together
with national and international stakeholders.
Political commitment of water and sanitation solutions needs to be presented before policy and institutional
reforms can be discussed.
Regulations and legislation are needed on different levels (national, local): definition of roles and responsibilities of national and local institutions to implement the law.
Citizens need to be informed about their rights and duties.
Information helps overcome

political resistance
Indeed, information can be one of the
most effective tools to overcome political resistance. Decision-makers often
need education on the social and economic benefits of improving water supply and sanitation to make a case for prioritising the sector in policy and planning
processes. Public education campaigns,
such as the report card and public
meeting approaches employed in parts
of South Asia, can help mobilise broad
support and exert pressure for change
on elected officials. Equally important,
local organisations and the public need
information on the ways existing subsidies are captured by middle and upperincome households and prevent expansion of service to the poorest. (UNMP
2005, p. 26)
Policy and institutional reforms

Broad policy and institutional reform is
also essential to reduce political interference in the day-to-day operation of water
and sanitation agencies in many countries. As long as water supply and sanitation service providers are reliant upon the
state for budgetary transfers, and as long
as agency staff are vulnerable to interference by officials in decisions related to
their careers, priority setting, pricing and
investment will continue to favour those
with political connections which almost
never includes the poor. Ring fencing
of agencies to help make financial and
personnel management processes more
transparent and less vulnerable to corruption, and enactment of civil service
legislation to improve incentives for good
performance, are two examples of the
kinds of reforms that can help reorient
planning and decision-making towards
communities with relatively weak political voice. (UNMP 2005, p. 2627)
How can we make political commitments?

(WHO 2004, Sanitation Challenge, p. 67)
National
governments
Commission a thorough review of policy and institutional arrangements.
Make explicit budget allocations.
Include water and sanitation in poverty reduction

strategies and environmental action plans.
Fund hygiene promotion and sanitation, training and capacity building.
Establish micro-credit policies and facilities for communities to engage in

water and sanitation initiatives.
District/local
governments
Communities
and civil
society
Allocate resources to public and school facilities.
Hire water, hygiene and sanitation specialists.
Review local planning and regulations.
Sponsor hygiene promotion and sanitation marketing.
Raise the profile of sanitation by lobbying local government

for water and sanitation programmes.
Offer expertise and support (social mobilisation and hygiene promotion).
Find out what local people really want

and make sure that government knows.
Show the government what it means to

live without water and sanitation.
Households
Entrepreneurs
Be vocal and active: encouraging local authorities to champion water and

sanitation, and serve as role model for others.
Seek ways of acting collectively with neighbours.
Offer to help with hygiene promotion and marketing in other locations.
Lobby governments to provide water and sanitation services.
Find out what sort of water and sanitation services

people want and start developing products.
International
organisations
Offer financial terms to help people make the needed investments.
Development banks and bilateral aid agencies can

allocate adequate amounts of money.
Specialised agencies for technical cooperation can compile and disseminate examples of successful programmes and good practice.
Develop norms and guidelines.
Continue informing people at all levels.
Generate political support by bringing together international and national

stakeholders in multi-stakeholder decision-making settings.
6 (New) Approaches
Crisis can bring about change
How can we create the right legislation and regulations?
It is also worth noting that in the water and sanitation sector change is often
triggered by a crisis, such as a drought, a
precipitous drop in service levels, an outbreak of disease or a financial failure. Political shifts, such as decentralisation or
elections, can also be an opportunity for
reform, as can external shocks, threats
and opportunities, such as the possibility of privatisation or donor pressure. Indeed, timing is one of the basic challenges of the sector how to make progress
within one political cycle after decades
of neglect or how to interest politicians
in measures that are not likely to yield
visible results during their terms of office.
It is thus important to look for historic opportunities to make large strides,
and also to pursue buy-in around a few
simple first steps that can yield shortterm benefits to the politicians and policy-makers. Such confidence building
measures that build capacity, trust and
social capital can help pave the way
for deeper, subsequent reforms. (UNMP
2005, p. 27)

National
governments
Develop a national sanitation strategy and

create the necessary legislation/regulations.
Define the roles and responsibilities of different

national institutions to implement the law.
Create mechanisms for monitoring and enforcing

implementation of legislation/regulations.
District/local
governments
Develop local sanitation and hygiene regulations

in consultation with stakeholders.
Establish standards and norms.
Inform citizens of their rights and duties.
Set up mechanisms for monitoring and enforcing their implementation.
Communities
and civil
society
Request specific sanitation and hygiene regulations.
Participate in legislation and regulation development as stakeholders.
Report back to authorities when laws are broken.
Households
Learn about their rights and responsibilities

under existing sanitation legislation.
Demand legislation/regulations from local authorities and help to monitor implementation of sanitation and hygiene legislation and regulations at
the local level (e.g. registering complaints with local authorities when legislation/regulations are not adequately implemented).
Entrepreneurs
Lobby governments to have their concerns

addressed in legislation and regulations.
Ensure that their products or services

comply with legislation/regulations.
Further questions
Why is it so hard for politicians to create
the right legislation and regulations? What
is right, for whom?
Which social stratum do politicians usually come from and thus represent?
How can poor people, who do not know

how to write, who live in illegal settlement,... ask (or fight) for more rights and
public services?
Involve stakeholders at all stages of the process.
International
organisations
Let the government know what is happening at the local level.
Compile and disseminate examples of effective sanitation

and hygiene legislation/regulations to interested countries.
Develop and disseminate evidence-based guidance material to help

countries create an effective legal framework.
Facilitate the sharing of information through

conferences, workshops and other forums.
Assist in building regional consensus on the development

and implementation of multilateral agreements.
6 (New) Approaches
6.2 Institutional approaches

Capacity building
Flexible approach: reforms, capacity building and financial investment to proceed in parallel:
New organisational structures and institutional arrangements are needed to support sanitation and hygiene promotion.
Investments in training staff and providing ideas and skills.
Information on sanitation and hygiene available to all: libraries, information centres etc.
Create partnerships on a global, national and local level.
Citizens need to be informed about their rights and duties.
Capacity deficits can be addressed in

part by targeted assistance for training
and institutional investments, for example, information management technology. In addition, relaxing the prerequisite
condition normally prescribed for development assistance (that certain reforms
are first put in place to ensure effective
and accountable use of funds) can also
generate opportunities for capacity building to take place alongside the reform
process in some of the worlds poorest
countries.
Once an accurate determination of
reform and capacity building needs is
made and credible steps are taken to
ensure that they will be carried out during project implementation, investments
in infrastructure should not be further
delayed. A flexible approach should be
adopted allowing reforms, capacity building and financial investments to proceed
in parallel. Regional facilities, such as the
Africa Water Facility, can also help the
poorest countries to embark on such reforms while, at the same time, making
progress towards target 10. The Task
Force strongly advocates such parallel,
learning-by-doing approaches. (UNMP
2005, p. 27)
Further questions
What happens when new infrastructure
is built and ready to use but the people using and maintaining it are not sufficiently
trained?
How can we build capacity to make a difference?

National
governments
Why are politicians not always supporting capacity building and information flow?
Recognise that a radical overhaul of organisational structures and institutional arrangements may be needed to ensure that the right people are in
the right places to support sanitation and hygiene promotion, allocate money for this overhaul and for training (and retraining) of public sector staff.
Financial incentives for small-scale private sector development and for

registration of civil society organisations into sanitation and hygiene
promotion service delivery.
District/local
governments
Review the effectiveness of current sanitation programmes and design

better and more cost-effective programmes.
Invest in training staff and finding ways of attracting

new skills into the programmes.
Ensure that entrenched interests are not preventing effective coordination between front-line staff (often from health and education) and
technical staff (often in infrastructure ministries or utilities).
Communities
and civil
society
Provide ideas and skills that could change the way sanitation and hygiene promotion services are delivered.
Contribute to a review of current sanitation and hygiene practices.
Start to participate actively in national or local sanitation and hygiene

promotion programmes.
Households
Participate in training programmes.
Teach other members of the community the necessary skills for

building, operating and maintaining sanitation facilities and
practising good hygiene.
Entrepreneurs
Invest in learning more about innovative ways of delivering sanitation.
Provide ideas about what people want.
Speak up about the type of support that would help them

deliver better products or services to households.
International
organisations
Provide both financial support and information for sanitation and hygiene
training programmes.
Develop and disseminate tools for good practice and guidance.
Take a critical look at the way sanitation is handled within integrated

water resources management, environmental planning and
poverty reduction strategies.
Is there a time within a project (concept, realisation, maintenance) when international organisations, which were forcing the project, are no longer needed? At
what time and what requirements have to
be fulfilled?
Promote information sharing, southsouth

cooperation and mutual support.
How can we ensure information flow and strengthen partnership?

National
governments
Emphasise the importance of sanitation and hygiene programmes for

their national development through poverty reduction strategy papers and
by otherwise reaching out to external aid agencies to create
partnerships.
Work to increase the interagency flow of information by creating

information exchange forums among different national entities (for
example, ministries of environment and ministries of health).
Make sanitation and hygiene information available to all.
6 (New) Approaches
Pirvate Sector Partnership (PSP)

Private participation in water and
sanitation utilities generally results

in efficiency gains, improved service
and faster investments in expanding
coverage.
However, it is still a challenge to
serve the poor who are unable to
afford household connections and
live on untenured land without public rights etc.
Strengthening and training smallscale providers in all regions of the
city is of key importance.
How can we ensure information flow and strengthen partnership?

District/local
governments
Work with national agencies, NGOs and entrepreneurs

to develop partnerships at the local level.
Make information on sanitation and hygiene

(including local regulations) available to all.
Communities
and civil society
Help to select villages for pilot projects.
Participate with various partners to implement

sanitation and hygiene projects.
Disseminate sanitation and hygiene information

to communities and households.
Create libraries or information resource centres with sanitation and

hygiene information (for example, a library with an Internet connection or
computer with CD-Rom).
Households
Participate in local sanitation and hygiene programmes.
The private sector improves efficiency and lowers costs by introducing commercial principles, such as limited and
well-focused performance objectives, financial and managerial autonomy, a hard
budget constraint, and a clear accountability to both customers and providers
of capital.
Private participation in water and
wastewater utilities has generally resulted in sharp efficiency gains, improved
service and faster investments in expanding coverage. However, designing
and implementing sustainable solutions
to respond to the needs of the urban
poor remains a challenge. The poor may
be unable to afford the cost of household
connections. They may be located far
from main water distribution lines, live
on untenured land or in neighbourhoods
where terrain or the absence of public
rights of way prevent the construction
of traditional piped water or sewerage
networks. Traditional utility billing systems may not be compatible with the
way poor households handle their budgets, and not all may be aware of the benefits and use of safe water and sanitation
services. (UNMP 2005)
Request information on sanitation and hygiene

from various agencies and partnerships.
Entrepreneurs
Work together as partners to develop appropriate sanitation and

hygiene technologies and services.
International
organisations
Provide information on available products and services.
Learn to recognise each others strengths and weaknesses. Find ways

of working together to maximise use of shared skills and interests.
Develop and disseminate information and focus efforts on achieving a

common vision and goal and hold this goal at the forefront of efforts to
make sanitation and hygiene a reality for people all over the world.
How can we support small-scale entrepreneurs?

National
governments
Review and modify laws, rules and regulations that constrain

small-scale entrepreneurs from working in sanitation.
Invest in strengthening regulators in order for them to how

to support, regulate and control small-scale providers.
District/local
governments
Invest in training and capacity building for small-scale providers.
Contract or partner with small-scale providers as part of sanitation and

hygiene promotion programmes.
Provide support and local oversight to maintain the quality and

effectiveness of small-scale providers.
Focus on monitoring small-scale providers to generate

a more realistic assessment of access.
Communities
and civil
society
Provide information to the government about the

role and importance of small-scale providers.
Establish local accountability and transparency

mechanisms to maintain quality and keep prices low.
Lobby local political actors to remove constraints

to small-scale providers.
Further questions
There is a difference between large-scale
and small-scale private sector partnership
(PSP):
Households
Entrepreneurs
Large-scale PSP cannot subsidise the

water for the poor and ask for more from
the rich as the rich are not willing to pay
more for the same service. But, how else
can PSP benefit the poor?
Turn their ideas into business opportunities and develop

products or supply services to their communities.
Support local entrepreneurs by buying their products or services.
Find ways of working with governments, understanding some of their

constraints and seeking constructive dialogue to improving
effective working relationships.
Invest in research to improve products.
Form coalitions to self-regulate quality and price, and

facilitate negotiations with the government.
On the other hand, small-scale PSP does

not provide services to entire cities. They
are specialised and operate locally. Where
does the money come from if they operate
in poor neighbourhoods?
International
organisations
Help design policies and regulatory frameworks that

support the work of small-scale entrepreneurs.
Publicise their role and participate in programmes that support them.
6 (New) Approaches
6.3 Financial and economic approaches

Financial
Prepayments or pay-per-use (metered services) for poor households.
Redistribute existing resources: wealthy/poor.
Everywhere: adequate resources for extensions, rehabilitation and operation of water and sanitation infrastructure, hygiene
promotion and education programmes: financing strategies must be adopted by each community.
Economic
Investments in sustainable water and sanitation infrastructure, services and behaviour will be paid back by greater GDP:
Increasing working days to cover business investments.
334% benefit for every dollar invested in water and sanitation.
Strengthening and training small-scale providers in all regions of the city is of key importance.
Often, the only way the poor are able

to pay so much for their water supply
and sanitation is by making small but frequent payments. Hence, when improved
services become available (for instance,
through a utility) and the poor are required to pay their tariffs at less frequent
intervals (for instance, monthly), experience shows that they are often unable to
cover the costs, given the numerous demands on their limited incomes and the
resulting inability to save. This suggests
that mechanisms allowing prepayment
or pay-per-use (metered services) could
be a factor to improve access.
Thus, while institutional reform is often necessary for the expansion of access to water supply and sanitation, it is
often not sufficient. Financial investment
is also required, whether from national or
sub-national government tax revenues,
user charges, cross-subsidies from users who can afford to pay, private-sector
investment or official development assistance. (UNMP 2005, p. 28; Original:
OECD-DAC 2004)
In discussing financial constraints,
a distinction should be made between
the absolute lack of resources for expanding water and sanitation coverage
and the need to redistribute potentially sufficient existing resources, in order
to meet target 10. Among the poorest
low-income countries, pervasive poverty creates binding financial constraints
to the expansion of coverage (cf. Figure
30 Political under-pinning). There, no
progress can be made in achieving the
Millennium targets for water and sanitation unless external aid is increased
and refocused. In some countries with
higher levels of income, sufficient financial resources exist to provide universal
coverage, however, their concentration
among wealthier households leaves a
How can we mobilise financial resources?

National
governments
Allocate funds to sanitation and hygiene education and ensure their

inclusion in poverty alleviation strategies and budgetary allocations.
Assess the effectiveness of different public spending

programmes on increasing access.
Lobby external support agencies for discretionary terms to finance

hygiene promotion and sanitation.
Provide financial incentives to local and district governments,

which can deliver efficient and effective sanitation and hygiene
promotion programmes.
Develop and finance micro-credit schemes managed by

local NGOs or the private sector to target households.
Work with private sector lenders and product manufacturers to

create programmes for extending credit to members of the most
vulnerable communities.
District/local
governments
Review the effectiveness of sanitation and hygiene promotion

programmes and ensure that funds are not used to finance
high-cost, low-impact investments.
Make subsidy programmes clear and transparent, create incentives to

develop new technologies to reduce costs and increase penetration.
Actively seek to stamp out corruption and waste, create micro-credit

and credit guarantee programmes to target households.
Provide incentives for local manufacturers to extend credit to the

poorest households.
Communities
and civil
society
Scrutinise public accounts and check on reported spending on sanitation and hygiene promotion to help increase accountability and reduce
wastage.
Propose alternative institutional and technical approaches that could

reduce costs and ensure that these are well-known and well-publicised.
Develop micro-credit schemes to fund household sanitation

improvements.
Create synergies between sanitation and hygiene promotion and other

developmental activities so that outreach workers can support
households efficiently and at low cost.
Create mechanisms for generating user fees for funding

continuing operation and maintenance of facilities.
Households
Find out how subsidised latrine programmes are supposed to work.
Get together in neighbourhood groups to lobby for subsidised

services and then scrutinise progress and spending.
Complain when subsidies or sanitation programmes in

general do not appear to be working as they should.
Participate in community schemes and/or micro-credit schemes.
Pay back loans to loan providers and contribute

maintenance fees to user groups.
6 (New) Approaches
substantial proportion of the population

unserved. For these countries, emphasis must be placed on enacting the policy and institutional reforms necessary
to redirect internal resources to benefit
the poor.
Across all countries, meeting the Millennium Development Goals for water
and sanitation requires adequate resources for extension, rehabilitation, operation
of water supply, sanitation, wastewater
treatment infrastructure, hygiene promotion, and public education programmes
(cf. Chapter 5.3 Lack of international
funding). The financing strategy to be
adopted by each country to meet the
costs of achieving an often dramatic expansion of water supply and sanitation
coverage including who will foot the bill
and how depends principally on a countrys income level and whether the majority of the unserved is above or below
the poverty line. (UNMP 2005, p. 29)
How can we mobilise financial resources?

Entrepreneurs
Offer poor households low-interest credit to purchase their products.
Work with local governments, NGOs and/or

banks to develop micro-credit schemes.
Develop cost-effective products and services for

poor communities and households.
International
organisations
External funding agencies can allocate sufficient resources

to the sector and mobilise other donors to contribute funds.
Specialised agencies can compile and disseminate information

on a variety of cost-effective sanitation alternatives and effective
behaviour change strategies.
Compile and disseminate information on effective programmes for

mobilising financial resources, including micro-credit schemes,
targeted subsidies and others.
Driving development by investing in water and sanitation

What can we gain from investments
in the water and sanitation sector?
Benefit from the environment
applied) would be gained in the health,

individual, household, agricultural, and
industrial sectors if the water and sanitation MDG targets were achieved.
Proper water supply, sanitation and
3. Since national economies are more

resilient to rainfall variability, economic
growth is boosted when water storage
capacity is improved.
Improved resilience to the effects of
floods and droughts could make Kenyas GDP grow annually at a rate of at
least 5 6% the amount needed in order to start reducing effectively poverty rather than the current 2.4% annual
growth rate.
5. The overall public and private investment needs for improved water supply
and sanitation and water resources management are considerable. However, at
the country level, meeting such investment challenges is highly feasible and
within the reach of most nations.
Broken down nationally, meeting such
investment challenges by 2015 is clearly doable. The annual per capita costs
to meet the water supply and sanitation
MDG in Bangladesh, Cambodia, Ghana,
Tanzania, and Uganda ranges from USD
4 to USD 7. The annual benefits accrued
could range from USD 3 to USD 34 for
every dollar invested.
(WHO/SIWI, Driving development)
water resources management is increasingly becoming a competitive advantage

for attracting business investment.
Reduce hunger
From poverty to productivity
Better lives for women
Invest in future generations
Health is wealth
Improve education
1. Improved water supply, sanitation and

water resources management boosts
the economic growth of countries and
contributes significantly to poverty eradication.
Poor countries with access to improved water and sanitation services enjoyed annual average growth of 3.7%
GDP; those without grew at just 0.1%.
2. The economic benefits of improved
water supply and in particular sanitation far out-weigh the investment costs,
surprisingly good news for Northern and
Southern decision-makers who often
view such investments as mere costs.
Economic benefits ranging from USD
3 to USD 34 per USD 1 invested (depending on the region and technologies
4. Investing in water is good business

improved water resources management,
water supply and sanitation contributes
significantly to increasing production and
productivity within economic sectors.
It is estimated that 322 million working days per year and an annual global value of USD 750 million from working days gained as a result of improved
health could come from achieving the
water supply and sanitation targets of
the MDG.
Further questions
How can households understand the
economic benefits of household connections they have to pay for?
Who benefits from the 3.7% increase

in GDP? The private sector? The government? The people?
6 (New) Approaches
6.4 Social approaches

Water and sanitation services and facilities should address both the practical and strategic needs of men,
women and children: cultural differences.
Capacity building for all groups of society (rich, poor, male, female, minorities etc.
Hygiene and environmental sanitation should be promoted at school and at home: teachers and parents need
to be taught about water and sanitation.
How can we pay attention to gender and equity?

National
governments
Frame national policies in a way that enshrines the idea of gender

and equity at the centre of sanitation and hygiene promotion.
Invest in training or retraining front-line staff to work effectively with

women, men and children, earmark funds for school sanitation.
Commission research to identify where social or economic groups are

persistently excluded from access to sanitation.
National governments can ensure that the overall

sanitation framework is gender sensitive by enabling
the participation of women in the development of sanitation policy.
Gender provisions should address both the practical and strategic needs
of men and women, which differ in culture, traditions, location, and other
factors, and adopt an appropriate strategic approach that takes these differences into consideration.
Keeping girls in school ultimately impacts the adoption of healthy sanitation and hygiene practices and significantly reduces infant mortality.
District/
local
governments
Hire front-line staff with skills to work with women, men

and children, reorganise public sector institutions to
remove internal gender biases and discrimination.
Invest in school sanitation, design and implement formative research and

capacity building to ensure that the needs and aspiration of all groups are
considered in the design of sanitation and hygiene promotion programmes.
Communities
and civil
society
Lobby for better services targeted towards women, men

and children, support public sector efforts to improve
gender and social development skills.
Provide information about what all groups in society want.
Encourage and build capacity of community-based organisations

to engage effectively with public sector programmes.
Households
Keep their daughters in school.
Select user-friendly sanitation facilities for all members of the

household (for example, by including women and children).
Give responsibility for sanitation and hygiene

practices to all household members.
Entrepreneurs
International organisations
Employ and train female workers to construct products

and provide sanitation and hygiene services.
Design user-friendly products for all household members.
Support and advocate for more gender-sensitive approaches.
Compile and disseminate information on how to

improve gender and equity issues.
6 (New) Approaches
How can we focus on youth and use education?

National governments
Invest in sanitation in schools, pay for training of

teachers to deliver effective hygiene education.
Create incentives for schools to do more in-house.
Fund national education and awareness campaigns

aimed at children and young people.
Create legislation to require schools to provide

separate toilet facilities for boys and girls.
District/local
governments
Invest in sanitation in schools.
Find ways to use the expertise of health and infrastructure

professionals in the education department.
Create incentives for schools and teachers who

improve sanitation access or deliver effective hygiene promotion.
Communities
and civil society
Actively support schools in their efforts to improve sanitation and hygiene.
Campaign for more public funds for sanitation and hygiene promotion.
Create connections between social organisations

focusing on youth and those centering on health.
Households
Entrepreneurs
Endorse and further reinforce hygiene messages delivered in schools.
Lobby schools for better sanitation facilities and hygiene education.
Keep their children in school (both boys and girls).
Use good sanitation and hygiene practices in the home.
Find ways of raising resources to support schools in this effort.
Provide free or subsidised services in own community schools (this will

not only have a direct positive impact on childrens health, it
will also increase demand for sanitation in the homes).
International organisations
Endorse and reinforce hygiene messages delivered in schools.
Improve the coordination and common understanding

between education and public health professionals and
programmes within international organisations.
Compile and disseminate sanitation and teaching materials.
Further questions
How do male and female differ in
their sanitation facility needs?
How does water and sanitation provision affect the daily life of women
and men? Are there differences?
Where to start with education: at

school with children (future decisionmakers: effect in 20 years) or at home
for parents (present decision-makers:
effect now)?
6.5 Planning approaches (Module 7)

Supply-driven planning approaches, where planners and engineers define the needs of the poor, are seldom
appropriate in the developing country context.
Based on the market model, driven by market mechanisms and private sector competition, low-income households are rarely reached.
The bottom-up approach, initiated by community groups or individuals can improve the individual and
neighbourhood environment but does not work for the well-being of society as a whole.
The HCES approach responds directly to the needs and demands of the user, however, coordination remains
with the local authority
Conventional approaches
The typical conventional approach, addressing the problems related to urban
environmental sanitation, has been one
in which planners and engineers defined
the needs of the poor and then decided
what type of infrastructure and service
to provide. Sector professionals subsequently translated hypothetical demand
into project design based on sewerage
and treatment technologies commonly
used in industrialised cities of Europe
and the United States. Such supply-driven approaches have seldom been ap-
propriate in the developing country context. McGranahan et al. describes three

organisational approaches for environmental improvements (cf. Table 7). The
supply-driven approach described above
corresponds closely to the planning
model.
The market model involves an increasing role of market mechanisms,
emphasising financing of public utilities,
promoting competition where the private
sector operates and, if necessary, privatising public systems. The shortcom-
ings of the market model are low expected revenues for the private sector when
pro-poor service is required. Even at the
height of interest of large-scale private
sector participation in water supply and
sanitation, few projects sought to deliver services for low-income areas. Few
dealt with sanitation services where the
backlog of investment was considered
too high and the revenue stream to hard
to secure. (Evans et al. 2004)
Now, as private sector is losing interest in the emerging market, it seems
even less likely that the large-scale priSandec Training Tool: Module 1 46
6 (New) Approaches
vate sector can provide the levels of investment needed. However, there is still
potential for medium and small-scale private sector participation in some aspects
of sanitation and hygiene promotion. Research from Africa and Asia has shown
that there is a small but flourishing private sector market in areas such as pit
and septic tank emptying, and in the operation of small localised sanitation systems. (Heierli et al. 2004)
Bottom-up approaches or the collective action model (cf. Table 7) can
be described as self-help initiatives of
community groups or individuals. Motivation for action is given by the threatening environmental health situation and
little hope that the responsible authorities will provide alleviation. Although often successful in improving the individual or neighbourhood environment, many
individual or collective actions are initiated and operated without any coordination with the local authorities and
with little thought towards the well-being of society as a whole. Individual
or collective options, which do not follow citywide strategic plans, may transfer the environmental health problem to
a neighbouring community or even to
the city as a whole. For example in Manila (Philippines) and Jakarta (Indonesia),
faced by an inadequate supply of sanitation options, middle-income households
have been constructing their own septic tanks. Since regulations for soil adsorption systems are not enforced and
sludge treatment strategies and facilities
are not available, the septic tank effluent
and untreated faecal sludge pollute water bodies and result in a faecal film
in other parts of the city. While self-provision may have addressed private sanitation needs, it has also created costly
environmental pollution. Bottom-up approaches, once perceived to be the best
alternative to the planning model, can
often not solely solve complex environmental problems, especially in urban areas. Such initiatives need to be integrated
and harmonised with the public sector.
Table 7: The organisational basis of three approaches for local environmental improvement.
New Approaches
In a meeting at Bellagio, Italy, in February 2000, an expert group brought together by the Environmental Sanitation
Working Group of the Water Supply and
Sanitation Collaborative Council (WSSCC) agreed that current waste management policies are abusive to human wellbeing, economically unaffordable and
environmentally unsustainable. They formulated the following principles as underpinning basis for a new approach in
environmental sanitation: (Morel 2003)
(cf. also Chapter 1)
1. Human dignity, quality of life and environmental security at household level should be at the centre of the new
approach, which should be responsive and accountable to the needs
and demands at the local and national level.
2. In line with good governance principles, decision-making should involve
participation of all stakeholders, especially the consumers and service
providers.
3. Waste should be considered a resource, and its management should
be holistic and form part of integrated
water resources, nutrient flows and
waste management processes.
4. The domain in which environmental sanitation problems are resolved
should be kept to the minimum prac-
ticable size (household, community,

town, district, catchment, city) and
the waste diluted as little as possible.
Based on these Bellagio Principles
the Environmental Sanitation Working
Group developed the Household-Centred Environmental Sanitation (HCES)
model (Schertenleib 2001). It places the
stakeholder at the core of the planning
process. The HCES approach responds
directly to the needs and demands of
the user, however, with coordination remaining with the local authority. With
reference to Table ..., it could be best described as a hybrid of the three models.
Its main components comprise improved
practices in the field of planning and recovery of waste as a resource.
(Zurbrgg 2004, p. 25)
Further questions
The Bellagio principles and new approaches sound very promising. However, who will be really willing and interested
in establishing a link between households
and authorities? Who will be managing
such projects? Who will be deciding?
If the market-model is not working for

poor areas, how can long-term solutions
(without external help) be implemented
and financed?
6 (New) Approaches
6.6. Technical approaches

The provision of safe and reliable services is often more technically challenging in poor communities than in
rich ones.
Fortunately, a wide range of technologies is currently available to provide safe and reliable water supply and
sanitation services to households around the world. However, selection of the right technology is a critical
issue.
One of the important lessons of the past

several decades of international collaboration for expanding water supply and
sanitation services has been that non
technical issues, such as financing and
institutions, are equally important than
technical challenges and often more
important explanations for the persistent lack of access to sanitation facilities
in developing countries. At the same
time, the pendulum should not swing so
far as to neglect entirely the role of technical considerations in expanding services.
Indeed, the provision of safe and reliable
services is often more technically challenging in poor communities than in rich
ones. Extending services to a dispersed
rural settlement or dense urban community on marginal land, for example, is one
of the tougher design problems a water
and sanitation engineer can face.
Though the amounts of water required

to increase access to safe drinking water
supply and sanitation are relatively low in
comparison with the amounts required
for agricultural uses, there are often situations in which the physical availability
of water resources on a sustainable basis (and access to technologies suited
to that environment) limits efforts to increase sustainable access to water and
sanitation. Similarly, climatic factors can
certainly shape a countrys ability to provide and maintain water supply and sanitation services for its citizens. Whereas inexpensive solutions are available in
some cases (for example, rainwater harvesting), in others, costly infrastructure
is required to control droughts and store
water for the dry periods. Such physical constraints may hinder economic development in general and thus impede
progress toward all the Millennium Development Goals.
Fortunately, a wide range of technologies is currently available to provide safe

and reliable water supply and sanitation services to households around the
world. However, selection of the right
technology one capable of delivering services reliably and sustainably in
a particular local context, is a critical issue. A mismatch between supply and
demand has too often led to the installation of infrastructure too expensive or
complex for communities to maintain or
ill-suited to community preferences or
customs. Planners and decision-makers
must heartily collaborate with unserved
communities to identify and implement
water supply and sanitation improvements, which are technically, financially, environmentally, socially sustainable,
and respond to households felt needs
and preferences.
(UNMP 2005, p. 3132)
Household water treatment and safe storage (Module 3)

Quality and quantity of drinking water are
important to prevent water and excreta
related diseases. Unsafe water can contain bacteria, viruses and parasites, but
it can also be chemically polluted. Contamination can occur at the source, during delivery or through inaccurate handling and storage at the household level.
Water treatment at the point-of-use the
household is a very important instrument in reducing the global disease burden. The most important and promising household water treatment and safe
storage (HWTS) technologies are presented in this module. Which of the
technologies is the most appropriate depends on local criteria, such as water
quality at the source or cultural preferences. If the water is highly turbid, often
a pretreatment is indicated to make the
HWTS system effective. Once the water
is safe for drinking, it has to be prevented from recontamination. Safe storage of
drinking water includes the appropriate
Situation in
developing
countries:
No access to safe water supply: 1/3 of rural population (900 m)
1/10 of the urban population (200 m).
Goals:
>20 l/p/d
<1 km distance to house
good quality.
Water resources and

consumption:
Resources: rainwater, groundwater, surface water.
Industrialised
countries:
Multiple taps, 150 l/cap/d:
Consumption: agriculture (~60%), industry (~20%), household consumption (~15%, communal tap, 20 l/cap/d): drinking (23 l/cap/d), cooking (35 l/
cap/d), cleaning/showering (510 l/cap/d), toilet flushing (25 l/cap/d).
toilet flushing (~40%)
shower and cleaning (~40%)
cooking and washing (~20%)
drinking (~2%).
Table 8: Water-facts (goals, re/sources),

comparison developing and industrialised
countries.
vessels as well as the correct handling of

the stored water.
Additional info
The focus of Module 3 is the treatment
of water at the household level: the possible systems and technologies, their functioning, as well as their advantages and
limitations.
6 (New) Approaches
Sanitation systems and technologies (Module 4)

Rapid urbanisation in the developing
world has increased the demand for
housing, infrastructure and services. In
the past, efforts to improve sanitation
have tended to focus on ambitious master plans requiring large investments in
trunk sewerage and stormwater drainage systems. These master plans have
not paid enough attention to financial and
institutional constraints and have tended
to ignore what sanitation users actually want and are willing and able to pay
(GHK 2002, pp. 28). The limited infrastructure provided is often inadequate,
thus leading to a poor, deteriorating environment (Parkinson and Taylor 2003).
This is especially true in informal areas
built outside a formal regulatory boundary where most poor communities live
and work. Official facilities and services often extend only to the rich, leaving
the underprivileged to provide for their
own sanitation needs in a piecemeal and
generally unsatisfactory manner (GHK
2002, pp. 28).
Furthermore, access to a latrine or
connection to a septic tank does not
necessarily indicate adequate sanitation
if faecal sludge management is not en-
Situation in
developing
countries:
Goals:
22.5 billion dwellers use on-site sanitation.
Integrate systems for resource recovery
Optimise sequence of the relevant wastewater management processes: collection, transport, treatment, reuse, and disposal.
Waste and
resources:
amounts and
nutrients:
Industrialised
countries:
Blackwater (toilet wastewater): 25,000100,000 l/cap/a.
Greywater: domestic wastewater from kitchen, bath, shower (excluding faeces and urine).
Brownwater: blackwater without urine (50 l/cap/a; 107109/100 ml).
Yellowwater: urine (5485% N/P/K, 12% COD, 0% faecal coliforms).
Faecal sludge: sludge accumulation in on-site sanitation systems.
Conventional sewerage: abundance of water, skilled labour, labour is

more expensive than capital, energy is cheap (costs up to 4 times more
than treatment and disposal), very strict design criteria.
Table 9: Sanitation-facts (goals, re/sources), comparison developing and industrialised countries.
sured or if the liquid effluent flows untreated into open drains, adjacent surface water or groundwater. A system
approach to environmental sanitation,
which extends from the point of generation to the point of disposal/discharge or
reuse from cradle to grave is urgently needed, both at the planning and implementation level. (Sandec News No. 8,
2007, pp. 2)
Additional info
Module 4 aims to define the main issues
related to the lack of adequate sanitation
in developing countries, to compare different technological approaches of sanitation
management and to identify new strategies for reaching unserved communities.
The main focus is placed on wastewater
and excreta management, i.e. from their
source to their final disposal or reuse. The
module is centred mainly on urban sanitation management.
Faecal sludge management (Module 5)

Compared to wastewater management,
the development of strategies and treatment options adapted to conditions prevailing in developing countries have long
been neglected as regards faecal sludges (FS) the by-products of on-site
sanitation installations. In recent years,
an encouraging number of initiatives towards improved FS management, including appropriate FS treatment schemes,
have been developed, particularly so in
several West African countries (Senegal,
Mali, Ivory Coast, Burkina Faso, Ghana),
in South East Asia (Nepal, Thailand, Vietnam) and in Latin America. These initiatives assist urban dwellers and authorities to overcome the challenges of
indiscriminate and uncontrolled disposal
of faecal sludge into drains, canals and
onto open spaces, thus creating a faecal film in urban areas that impair public health and cause pollution. (Strauss
et al., 2002)
Situation in developing
countries:
70100% of cities and towns served by on-site sanitation

(latrines and septic tanks)
most installations produce faecal sludge to be collected
lack of regulations, illegal dumping and use of untreated faecal sludge.

Goals:
Waste with lots of

nutrients:
Industrialised countries:
Prevent indiscriminate dumping,
Pit emptying
Treatment
Soil conditioning/fertilisation.
Faecal sludge: 4.5 kg N/cap/a, 0.6 kg P/cap/a; 1.2 kg K/cap/a

1 l of faecal sludge is mixed with 100 l of greywater, 100 l are
expensive to treat in the central treatment plant, in some countries sewage sludge is used as fertiliser.
Table 10: FS-facts (goals, re/sources), comparison developing and industrialised countries.
Additional info
Module 5 pays special attention to the haulage, treatment and reuse or disposal of faecal
sludge. It covers both technical and non-technical (socio-cultural, economic, political etc.) aspects and provides practical information on design, financing and planning of faecal sludge
treatment plants.
6 (New) Approaches
Solid waste management (Module 6)

With progressing urbanisation, solid
waste management is becoming a major public health and environmental problem in urban areas of many developing
countries. The overall goal of urban solid waste management is to collect, treat
and dispose of solid waste generated by
all urban population groups in an environmentally and socially satisfactory manner using the most economical means
available.
However, a typical solid waste management system in a developing country displays an array of problems, including low
collection coverage, irregular collection
services, indiscriminate open dumping
and burning without air and water pollution control, breeding of flies and vermin,
as well as handling and lack of control of
informal waste picking or scavenging.
These public health, as well as environmental and management problems are
caused by various factors constraining
the development of effective solid waste
management systems. (The World Bank,
2008)
Situation in developing
countries:
Slum population in cities 2570% (approx. 5% in industrialised countries)
Inadequate municipal SWM: health risk for the population,

health risk of workers, water and soil pollution, greenhouse gas,
climate change.
Goals:
Solid waste generated in
developing countries:
Solid waste generated in

industrialised countries:
Avoidance, minimisation, reuse, recycling, recovery, treatment,

disposal.
0.40.6 kg/cap/d:
Organic (4085%)
Paper and cardboard (110%)
Glass and ceramics (110%), metal (15%)
Plastics (15%)
Dust and ash (140%)
0.71.8 kg/cap/d: only 2050% organic waste
Table 11: SWM-facts (goals, re/sources), comparison developing and industrialised countries.
Further questions
Can the goals of the different systems
be summarised as one goal for all?
Are the technical approaches and peoples habits in industrialised countries sustainable? Should households in developing
countries start using 150 l/cap/d and produce more solid waste etc.? What would
happen if nearly 7 billion people adopt the
industrialised lifestyle?
Additional info
Module 6 provides an overview of the
present state-of-the-art of solid waste production and management. It contains the
characteristics of municipal solid waste
and describes current waste treatment
systems and technologies, as well as nontechnical aspects like private sector involvement and financial arrangements.
How can billions of people be served by

other options than centralised, conventional technologies well-known in industrialised
countries?
How does the climate influence technical approaches?
Additional info for Chapter 6

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7 References and Links
Bold: The key readings (additional info)

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Training Tool. They are open source
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source and copyright holder.
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Sandec: Department of Water and Sanitation in Developing Countries

Sandec Training Tool 1.0 Module 1

Water and Sanitation in Developing

transmitted helminth infections (WHO

Figure 1: The Sandec Training Tool focuses on

Sandec Training Tool: Module 1

1 Definitions and Objectives

What is environmental health?

3 Millennium Development Goals

3.1 What are the Millennium Development Goals?

Sandec Training Tool: Module 1

1 Definitions and Objectives

1.1 What is environmental health?

Ensure a built environment free from

At what spatial level should the required

Sandec Training Tool: Module 1

1 Definitions and Objectives

1.2 What is water supply and environmental sanitation?

velopment. It has been defined by the

Sandec Training Tool: Module 1

1 Definitions and Objectives

1.3 What resource and waste systems are we tackling?

Water supply and household water

Sanitation planning and infrastructure (Modules 4 and 7)

gen or biosolids, are given little attention. Failures or unsustainable solutions

Excreta and faecal sludge management (Module 5)

er cities, haulage distances or the time

Solid waste management (Module 6)

Sandec Training Tool: Module 1

1 Definitions and Objectives

and decision-making are considered key

Where (cf. Figure 3) would you expect

How does the industrialised country

What water and sanitation facilities and

Modules 3, 4, 5 and 6 provide further information on the aforementioned waste

DFID Guidance Manual on Water Supply

(New) principles of water and

How does this affect water supply

The principles governing the new approach are the following:

Water supply and sanitation systems

How can stakeholders be included in the

How is environmental pollution interr

Module 7 describes in detail new planning approaches based on the Bellagio

WSSCC/EAWAG (2000); Summary Report of Bellagio Expert Consultation

Sandec Training Tool: Module 1

haviour. The Water and Sanitation for

What facilities, services and behaviours

Sandec Training Tool: Module 1

2.2 What is the global burden of disease?

Diarrhoea causes two million deaths

Expected reduction (median %)

Figure 7: Reduction in diarrhoeal disease morbidity resulting from improvements in drinking

severe consequences. This disease is

Dracuncu- Hookworm Schistoliasis

Disease (number of studies)

Sandec Training Tool: Module 1

2.3 What are the main transmission routes

Most diseases associated with water

Sandec Training Tool: Module 1 10

2.4 How can we disrupt the transmission routes of pathogens?

How can flies be kept away from water and food?

Water treatment and safe storage: Module 3

Sanitation systems and technologies: Module 4

Sandec Training Tool: Module 1