TARGET A Mid-Term Assessment of Progress

N D

MEETING THE MDG DRINKING A

WATER SANITATION

 World Health Organization and United Nations Childrens Fund, 2004 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNICEF or the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The final status of Jammu and Kashmir has not yet been agreed upon; the dotted line represents the approximate line of control agreed upon by India and Pakistan. UNICEF and the World Health Organization do not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. UNICEF and the World Health Organization welcome requests for permission to reproduce or translate their publications whether for sale or for non-commercial distribution. Applications and enquiries should be addressed to UNICEF, Division of Communication, 3 United Nations Plaza, New York 10017, USA (Fax: +1 212 303 7985; E-mail: nyhqdoc.permit@unicef.org) or to WHO, Marketing and Dissemination, 20 Avenue Appia, 1211 Geneva 27, Switzerland (Tel: +41 22 791 2476; Fax: +41 22 791 4857; E-mail: permissions@who.int). WHO Library Cataloguing-in-Publication Data WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation; Meeting the MDG drinking water and sanitation target: a mid-term assessment of progress, 2004 1. Water Supply 2. Potable Water - supply and distribution 3. Sanitation 4. Social Justice 5. Development 6. Sustainability 7. Program development I. Title (ISBN 92 4 156278 1) (NLM classification: WA 675)

CONTENTS

Foreword

Target Matters

12

4 8

Definitions of Indicators

The Purpose of this Report

Drinking Water Coverage

Sanitation Coverage

Coverage

22

14 32

10

Why Meeting the

Progress Towards the Drinking Water Target

Progress Towards the Sanitation Target

The Joint Monitoring Programme

24

18

Disparities in

Country, Regional and Global Estimates

on Water and Sanitation

Millennium Development Goals: Regional Groupings

Foreword

he combination of safe drinking water and hygienic sanitation facilities is a precondition for health and for success in the fight against poverty, hunger, child deaths and gender inequality. It is also central to the human rights and personal dignity of every woman, man and child on earth. Yet 2.6 billion people half the developing world lack even a simple improved latrine. One person in six more than 1 billion of our fellow human beings has little choice but to use potentially harmful sources of water. The consequences of our collective failure to tackle this problem are dimmed prospects for the billions of people locked in a cycle of poverty and disease.

In adopting the Millennium Development Goals, the countries of the world pledged to reduce by half the proportion of people without access to safe drinking water and basic sanitation. The results so far are mixed. With the exception of sub-Saharan Africa, the world is well on its way to meeting the drinking water target by 2015, but progress in sanitation is stalled in many developing regions. This report, produced by the WHO/UNICEF Joint Monitoring Programme on Water Supply and Sanitation (JMP), provides the latest estimates and trends on where we stand today. The JMPs estimates are critical for calculating rates of progress towards national goals and for highlighting priorities, especially those that target the underserved. For those countries in which progress has been slow, the reports finding should provide an incentive to accelerate action in the crucial years ahead. For countries on track, they should remind us that our work is not finished until every citizen is served.

LEE Jong-wook Director-General World Health Organization

Carol Bellamy Executive Director UNICEF

Definitions of Indicators

ccess to safe drinking water is estimated by the percentage of the population using improved drinking water sources, as described below. Similarly, access to sanitary means of excreta disposal is estimated by the percentage of the population using improved sanitation facilities. Improved sanitation facilities are those more likely to ensure privacy and hygienic use. Improved drinking water technologies are those more likely to provide safe drinking water than those characterized as unimproved. See page 23 for a discussion of other issues concerning definitions.

Improved drinking water sources

Household connection Public standpipe Borehole Protected dug well Protected spring Rainwater collection

Unimproved drinking water sources

Unprotected well Unprotected spring Rivers or ponds Vendor-provided water Bottled water* Tanker truck water

Improved sanitation facilities

Connection to a public sewer Connection to a septic system Pour-flush latrine Simple pit latrine** Ventilated improved pit latrine

Unimproved sanitation facilities

Public or shared latrine Open pit latrine Bucket latrine
*Bottled water is not considered improved due to limitations in the potential quantity, not quality, of the water. **Only a portion of poorly defined categories of latrines are included in sanitation coverage estimates.

The Purpose of this Report

n September 2000, 189 UN Member States adopted the Millennium Development Goals (MDGs), setting clear, time-bound targets for making real progress on the most pressing development issues we face. Achieving these targets will directly affect the lives and future prospects of billions of people around the globe. It will also set the world on a positive course at the start of the 21st century. Goal 7 is to ensure environmental sustainability. One of its targets is the subject of this report: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. Although the MDGs were formulated in 2000, the baseline for most of the MDG targets, including that on water and sanitation, has been set as 1990. Therefore 2002, the last year for which comprehensive data are available, can be considered the halfway mark towards achieving the 2015 MDG deadline. This report, prepared by the WHO/UNICEF Joint Monitoring Programme (JMP), provides coverage data for 1990 and 2002 at national, regional and global levels and an analysis of trends towards 2015. It also marks a new cycle of more frequent reporting, which can be effectively used for sector capacity-building efforts at the national and subnational levels. The report is intended as a reality check for individual countries and the international community on how far we have come, and where we need to focus next, in order to fulfil our commitment.

Why Meeting the Target Matters

eyond the focus of public attention, an unseen emergency continues to unfold. It doesnt fell dozens all at once, like a bomb, or carry away whole towns in the blink of an eye, like a flood. Rather, it kills its victims mostly infants and small children largely unnoticed, spiriting them away one by one from rural villages and urban slums in every corner of the developing world. Every day, this unremitting but seemingly invisible disaster claims the lives of more than 3,900 children under five, according to WHO. And for every child that dies, countless others, including older children and adults, suffer from poor health, diminished productivity and missed opportunities for education. What is behind this wholesale loss of life and potential? It is the absence of something that nearly every reader of this report takes for granted, something basic, unremarkable, commonplace: toilets and other forms of improved sanitation and safe drinking water. The good news is that, with 83 per cent coverage, the world is on track to meet the MDG target for drinking water. The news is tempered, however, by slow progress in sub-Saharan Africa and stalled action on sanitation in most developing regions. An estimated 2.6 billion people are without improved sanitation facilities. And if the 1990-2002 trend holds, the world will miss the sanitation target by half a billion people. The figures and trends in this report, based on national surveys and censuses, indicate how far we are from achieving the sanitation target. But they also reveal that a number of low-income countries have made tremendous gains in expanding services, even in the face of rapid population growth and economic stagnation. The lesson that can be drawn from these countries is that rapid progress is indeed possible, and that the goals, while ambitious, are within our grasp. Meeting the sanitation target will require that an additional 1 billion urban dwellers and almost 900 million people in often remote rural communities are able to use improved sanitation services. Accomplishing this by 2015 will be no small feat. But it will also be a testament to what the world can achieve with a clear vision and with the focused will and determination of every country on earth.

Getting on track to meet the target in both drinking water and sanitation will mean better health, longer lives and greater dignity for billions of the worlds poorest people. It will also make a significant contribution to the achievement of other Millennium Development Goals.

Advancing the Millennium Development Goals

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 themselves 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 waterrelated 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

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.

Goal 3: Promote Gender Equality and Empower Women

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 and girls at less risk of assault while collecting water or searching for privacy.

Goal 4: Reduce Child Mortality

Improved sanitation and drinking water sources reduce infant and child morbidity and mortality.

Goal 5: Improve Maternal Health

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.

Goal 6: Combat HIV/AIDS, Malaria and Other Diseases

Safe drinking water and basic sanitation help prevent water-related diseases, including diarrhoeal diseases, schistosomiasis, filariasis, trachoma and helminths. The reliability of drinking water supplies and improved water management in human settlement areas reduce transmission risks of malaria and dengue fever.

Goal 7: Ensure Environmental Sustainability

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.

Goal 8: Develop a Global Partnership for Development

Development agendas and partnerships should recognize the fundamental role that safe drinking water and basic sanitation play in economic and social development.

DRINKING

n 2002, 83 per cent of the worlds population around 5.2 billion people used improved drinking water sources. These include piped water connections and standpipes, as described on page 4 (coverage estimates for individual countries can be found in the table starting on page 24). The good news gains in all regions since 1990 is counterbalanced by the fact that 1.1 billion people were still using water from unimproved sources in 2002. In sub-Saharan Africa, 42 per cent of the population is still unserved. Of the 1.1 billion people using water from unimproved sources, nearly two thirds live in Asia. The number of people without improved water sources in China alone is equal to the number of unserved in all of Africa. The lowest drinking water coverage levels are found in sub-Saharan Africa and in Oceania.* In contrast, several regions, including Northern Africa, Latin America and the Caribbean, and Western Asia, have achieved coverage levels of close to 90 per cent or more.
*Country distribution by region can be found on the map on page 32.

WATERCOVERAGE

Good water coverage attained in most regions

FIGURE 1

Coverage with improved drinking water sources in 2002

Percentage of population using improved drinking water sources

Less than 50% 50% 75% 76% 90% 91% 100% Insufficient data

More than one billion people, most of them in Asia, are still without improved drinking water sources
FIGURE 2

Population without improved drinking water sources by region in 2002 (in millions)

LATIN AMERICA & CARIBBEAN SUB-SAHARAN AFRICA

60 288

NORTHERN AFRICA DEVELOPED REGIONS EURASIA OCEANIA WESTERN ASIA SOUTH-EASTERN ASIA SOUTH ASIA EASTERN ASIA

15 15 20 3 23 115 234 303

More than 80 per cent of the world population use improved drinking water sources
FIGURE 3

Coverage with improved drinking water sources by region in 2002

-2 98 93 90 79 89 88 84 79 78 +1 +8 +2 +6 +5 +13 +6 +6 +9 +1

% pt. change 1990-2002 +6 % 100

83 80

60

58 52

40

20

WORLD

LATIN AMERICA & CARIBBEAN

SOUTH-EASTERN ASIA

DEVELOPED REGIONS

DEVELOPING REGIONS

SOUTH ASIA

NORTHERN AFRICA

WESTERN ASIA

EASTERN ASIA

SUB-SAHARAN AFRICA

OCEANIA

EURASIA

PROGRESS TOWARDS THE DRINKING

The world is on track to meet the drinking water target, but sub-Saharan Africa lags behind.

WATERTARGET

n 1990, 77 per cent of the worlds population used improved drinking water sources. Considerable progress was made between 1990 and 2002, with about 1.1 billion people gaining access to improved water sources. Global coverage in 2002 reached 83 per cent, putting the world on track to achieve the MDG target. The region that made the greatest progress was South Asia, which increased coverage from 71 to 84 per cent between 1990 and 2002. This jump was fuelled primarily by increased use of improved water sources in India, home to over 1 billion people. Progress in sub-Saharan Africa was also impressive: coverage increased from 49 to 58 per cent between 1990 and 2002, a nine percentage point increase. But this falls far short of the progress needed to achieve the MDG target of 75 per cent coverage by 2015.

Obstacles to accelerating the rate of progress in subSaharan Africa include conflict and political instability, high rates of population growth, and low priority given to water and sanitation. Whats more, breakdown rates of water supply systems in rural Africa can be very high. Among the approaches shown to be effective in speeding up progress, despite these obstacles, are decentralizing responsibility and ownership and providing a choice of service levels to communities, based on their ability and willingness to pay. One recent success in Africa has been steady progress in the eradication of Guinea worm disease. Through improved drinking water and other interventions, the number of people suffering from this disease has been reduced by 99 per cent: from an estimated 3.5 million cases in 1986 to less than 35,000 reported cases in 2003.

If the current trend continues, sub-Saharan Africa will not reach the MDG target
FIGURE 4

Progress in drinking water coverage, 1990 - 2002

Coverage is 95% or higher On track Not on track Insufficient data

10

THE CHALLENGE OF OUTPACING POPULATION GROWTH Population growth is a significant factor in the ability of countries, particularly low-income countries, to increase the coverage of drinking water. For example, just to maintain its 1990 coverage level of 74 per cent, Peru would have had to ensure drinking water services to more than 350,000 people a year, on average, over the period 1990 to 2002. In fact, it provided water to more than 480,000 people a year, raising coverage from 74 per cent to 81 per cent. On a global level, the number of people using improved water sources has increased by more than 90 million people a year since 1990. But because of population growth, the absolute number of people without coverage has only decreased by about 10 million people a year.

African countries making rapid progress in drinking water coverage, 19902002

FIGURE 5

Countries that increased coverage by at least 25% between 1990 and 2002*
Drinking water coverage (%) % increase

Country Tanzania, United Republic of Chad Malawi Angola Central African Republic Ghana Eritrea Mali Kenya Namibia Mauritania Burkina Faso Uganda Cameroon Rwanda

1990 38 20 41 32 48 54 40 34 45 58 41 39 44 50 58

2002 73 34 67 50 75 79 57 48 62 80 56 51 56 63 73

1990-2002 92 70 63 56 56 46 43 41 38 38 37 31 27 26 26

* Table includes countries that increased coverage by at least 25% between 1990 and 2002. Countries with coverage higher than 80% in 1990 were not included, even though they may have increased coverage levels significantly. Nor does it include countries that may have made significant progress but for which data were insufficient to estimate a trend.

11

SANITATIONCOVERAGE
lobal sanitation coverage rose from 49 per cent in 1990 to 58 per cent in 2002. Still, some 2.6 billion people half of the developing world live without improved sanitation. Sanitation coverage in developing countries (49 per cent) is only half that of the developed world (98 per cent).

2.6 billion people without improved sanitation

FIGURE 6

Population without improved sanitation by region in 2002 (in millions)

Though major progress was made in South Asia from 1990 to 2002, little more than a third of its population are currently using improved sanitation. In sub-Saharan Africa as well, coverage is a mere 36 per cent. Over half of those without improved sanitation nearly 1.5 billion people live in China and India.

LATIN AMERICA & CARIBBEAN SUB-SAHARAN AFRICA NORTHERN AFRICA DEVELOPED REGIONS EURASIA OCEANIA

137 437 40 20 50 3

WESTERN ASIA SOUTH-EASTERN ASIA

38 208

photo

SOUTH ASIA EASTERN ASIA

938 749

Half the developing world are still without improved sanitation

FIGURE 7

Sanitation coverage in 2002

Percentage of population using improved sanitation

Less than 50% 50% 75% 76% 90% 91% 100% Insufficient data

12

Sanitation coverage lowest in sub-Saharan Africa and South Asia

FIGURE 8

Coverage with improved sanitation by region in 2002

-2 98 -1 +15 0 +6 +8 +13 -3 +21 +17 +4

% pt. change 1990-2002 +9 % 100

83 80 79 75 73 61 55 49 45 40 37 36

60

58

20

0
DEVELOPED REGIONS LATIN AMERICA & CARIBBEAN SOUTH-EASTERN ASIA DEVELOPING REGIONS NORTHERN AFRICA OCEANIA EURASIA WESTERN ASIA EASTERN ASIA SOUTH ASIA WORLD SUB-SAHARAN AFRICA

Countries with low sanitation coverage

FIGURE 9

Countries where coverage with improved sanitation was one third or less in 2002 Country Sanitation coverage 2002 (%) Central African Republic 27 Mozambique 27 Nepal 27 Micronesia (Federated States of) 28 Congo, Democratic Republic of the 29 Angola 30 India 30 Namibia 30 Yemen 30 Solomon Islands 31 Benin 32 Madagascar 33 Timor-Leste 33

Country Sanitation coverage 2002 (%) Ethiopia 6 Afghanistan 8 Chad 8 Congo 9 Eritrea 9 Burkina Faso 12 Niger 12 Guinea 13 Cambodia 16 Comoros 23 Lao Peoples Democratic Republic 24 Sao Tome and Principe 24 Somalia 25 Liberia 26

13

PROGRESS TOWARDS THE

o halve the proportion of people without improved sanitation, global coverage needs to grow to 75 per cent by 2015, from a starting point of 49 per cent in 1990. However, if the 1990-2002 trend continues, the world will miss the sanitation target by more than half a billion people. In other words, close to 2.4 billion people will be without improved sanitation in 2015, almost as many as there are today. The situation is most serious in South Asia, sub-Saharan Africa, Western Asia, Eurasia and Oceania, none of which are on track for meeting the sanitation target. Despite disappointing progress overall, a number of regions have made tremendous gains. Eastern Asias coverage, for example, has almost doubled since 1990. Similarly, South Asia managed to move from 20 per cent to 37 per cent coverage, although it started with the lowest baseline of any region. The widening gap between progress registered and the target (see Figure 11) signals that the world will meet its sanitation goal only with a dramatic acceleration in the provision of services. The proportion of the worlds population with improved sanitation has increased by just 9 percentage points since 1990, a far slower rate than that required to meet the MDG target.
FIGURE 10

Without a sharp acceleration in the rate of progress, the world will miss the sanitation target by half a billion people.

SANITATIONTARGET
As shown in Figure 12, Eastern and South-eastern Asia are clearly on track to meet the MDG target in sanitation by 2015. Northern Africa and Latin America and the Caribbean are well on their way. However, the remaining regions will not meet the target without a rapid acceleration in progress.

Progress in sanitation, 1990 - 2002

Coverage is 95% or higher On track Not on track Insufficient data

14

Accelerate progress or miss the sanitation target by half a billion people

FIGURE 11

Projected population without improved sanitation 1990-2015

CURRENT TREND

BILLIONS 3.0

IF ON TRACK TO REACH THE MDG TARGET 2.7 bn 2.4 bn

2.5 1.9 bn 2.0

1.5

1.0

0.5

0
2002 1990 2015

SANITATION SITUATION WORSE THAN PREVIOUSLY THOUGHT An analysis of recent household surveys nearly twice the number available since the last update in 2001 has prompted the Joint Monitoring Programme to revise its global sanitation figures from 2.4 billion people to 2.6 billion people unserved. The revisions are based on this additional information, more detailed definitions of sanitation facilities and a more stringent method used to estimate coverage. In previous estimates, certain categories of latrines that were poorly defined were counted as improved. Now, a breakdown of these categories is sought from which correction factors can be derived and applied to surveys from the same country. Where this breakdown is not available, only half the share of the population using undefined latrines (such as traditional, pit or simple latrines) are counted as having access to an improved sanitation facility. Because traditional latrines are widespread in sub-Saharan Africa, this new method of measuring them has lowered considerably the coverage figures for the region. However, as more surveys are conducted, using more complete definitions and better breakdowns of facilities, sanitation estimates will become even more precise.

15

PROGRESS TOWARDS THE

Meeting the MDG target requires that, between 1990 and 2015, the world reduces by half the proportion of the population not using improved drinking water sources and sanitation. It would seem that countries whose poverty and poor capacity led them to have such low coverage to begin with are charged with the most difficult task. But is achieving a 5 per cent increase when you have high coverage easier than a 20 per cent increase when you have low coverage overall? Not necessarily. Reaching the remaining population without coverage is usually increasingly difficult the higher your overall coverage becomes.

SANITATIONTARGET
Higher per capita investment costs to reach the remaining few follow the law of diminishing returns. Servicing urban slums, remote rural villages and arid areas may require a much greater effort than reaching a population in more accessible or less arid regions. In large urban areas, for example, it is becoming increasingly difficult to provide drinking water services because of rapid urbanization and the fact that new water sources may be further away. In addition, water treatment plants are more complex due to polluted water sources, because transmission mains have to cross long distances, and because there is often the need for costly pumping stations with sophisticated operations and maintenance.

CLOSING MAJOR COVERAGE GAPS AND REACHING THE HARD TO REACH

Five regions are not on track to meet the sanitation target

FIGURE 12

Regional progress towards the MDG sanitation target

Coverage Coverage needed by needed in 2015 to 2002 to be achieve the on track MDG target (%) (%)

Coverage in 1990 (%)

Coverage in 2002 (%)

Regions on track Eastern Asia South-eastern Asia Regions nearly on track Northern Africa Latin America and Caribbean Regions not on track South Asia Sub-Saharan Africa Western Asia Eurasia Oceania World 20 32 79 84 58 49 37 36 79 83 55 58 40 49 84 88 68 62 60 66 90 92 79 75 65 69 73 75 74 77 82 84 24 48 45 61 43 61 62 74

16

Countries making rapid progress in sanitation

FIGURE 13

Countries that increased coverage by at least 25% between 1990 and 2002*
Sanitation coverage (%) % increase

Country 1990 Myanmar 21 Benin 11 Madagascar 12 India 12 Cameroon 21 Haiti 15 Nepal 12 Bangladesh 23 China 23 Viet Nam 22 Congo, Dem. Rep. of the 18 Kiribati 25 Mauritania 28 Senegal 35 Pakistan 38 Nicaragua 47 Honduras 49 Yemen 21 Bolivia 33 Ghana 43 Philippines 54 Paraguay 58 Sri Lanka 70 31 Cte dIvoire Ecuador 56 Malawi 36 Egypt 54 Mali 36 Namibia 24

2002 73 32 33 30 48 34 27 48 44 41 29 39 42 52 54 66 68 30 45 58 73 78 91 40 72 46 68 45 30

1990-2002 248 191 175 150 129 127 125 109 91 86 61 56 50 49 42 40 39 38 36 35 35 34 30 29 29 28 26 25 25

*Countries that increased coverage by at least 25% between 1990 and 2002 and that had at least 25% coverage in 2002. Table includes only countries for which data were sufficient to estimate trends.

REDUCING THE RURAL BACKLOG AND TACKLING URBAN GROWTH Many of the 2.6 billion people without improved sanitation are among those hardest to reach: families living in remote rural areas and urban slums, families displaced by war and famine, and families mired in the poverty-disease trap, for whom improved sanitation and drinking water could offer a way out. Though more than a billion people gained improved sanitation between 1990 and 2002, the population without coverage declined by only 100 million. The challenge will be seven times greater in the crucial years leading up to the MDG deadline. The population without coverage will need to decrease from 2.6 billion people in 2002 to 1.9 billion in 2015, a total decline of 760 million people. Meeting this target, and reducing rural and urban disparities, will mean providing sanitation services to a billion new urban dwellers and almost 900 million people living in rural communities, where progress has been slower.

17

From now until 2015, greater effort must be made to reach the poorand those inruralareas,whose deprivation is hidden behind national averages.
Disparities in drinking water service levels

DISPARITIES IN COVERAGE

lobal coverage figures from 2002 indicate that, of every 10 people, roughly 5 have a connection to a piped water supply at home (in their dwelling, plot or yard); 3 make use of some other sort of improved water supply, such as a protected well or public standpipe; and 2 are unserved, with no choice but to rely on potentially unsafe water from rivers, ponds, unprotected wells or water vendors (see Figure 14). The way that people secure their drinking water has a direct impact on their health and on the economic status of households. In households using only a remote and unprotected source, health can be jeopardized by water

contamination. Moreover, the quantity of water collected is likely to be too small for effective hygiene, even if bathing and laundry are carried out at the source. Using improved water sources, such as a protected spring or well within a reasonable walking distance, provides substantial health benefits. But hygiene may still be compromised and water may be contaminated in transport and storage. Once water is available at home through a yard or house tap, for example then hygienic behaviour and the maintenance of water quality becomes easier. Major improvements in household health usually accompany the use of piped water at home. Similarly, the time saved in not having to collect water may also contribute significantly to improvements in the household economy.

In 2002, more than half the worlds population used water from a piped connection at home
FIGURE 14

Trends in service levels for drinking water

MILLIONS 7,000

6,000

5,000

Population without access

4,000
Population using another improved drinking water source

3,000

2,000 Population with piped water into dwelling, plot or yard 1,000

0
1990 2002

18

Disparities in rural and urban areas

inety-two per cent of the urban population and 70 per cent of the rural population in developing countries use improved drinking water sources. That means that for every person without improved drinking water in urban centres, there are six people unserved in rural areas. The disparities are greatest in sub-Saharan Africa, with a difference of 37 percentage points between rural and urban dwellers. The disparities in urban and rural sanitation are even worse. Only 31 per cent of rural inhabitants in developing regions have access to any type of improved sanitation, as opposed to 73 per cent of urban dwellers. In 2002, the total population in developing regions without improved sanitation was around 560 million in urban areas, compared with a staggering 2 billion in rural areas. Currently, estimates of water and sanitation coverage in urban areas include those living in urban slums. As a consequence, the statistics tend to mask the deprivation found in these communities. Calculating separate estimates for slum and other urban dwellers poses formidable technical challenges. However, efforts are under way to improve the statistical methods used so that a more accurate picture of the water and sanitation situation in slum communities can be presented.

Rural communities have less than half the sanitation coverage of urban areas
FIGURE 15

Urban and rural sanitation coverage by region in 2002

URBAN RURAL

% 100

95 89 84 84 73 66 69 57 49 46 49 44

100 92 92 81

80

79

65

60

55

40 30 26 20 24 31

37

LATIN AMERICA & CARIBBEAN

SOUTH-EASTERN ASIA

NORTHERN AFRICA

DEVELOPING REGIONS

SOUTH ASIA

EASTERN ASIA

WESTERN ASIA

DEVELOPED REGIONS

OCEANIA

EURASIA

SUB-SAHARAN AFRICA

WORLD

19

DISPARITIES IN COVERAGE
Disparities by wealth

ot surprisingly, water and sanitation coverage, as well as levels of service, are higher among the rich than the poor. An analysis of 20 Demographic and Health Surveys from the past five years shows that only about 1 in 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.

Richest are twice as likely to use drinking water from an improved source than the poorest
FIGURE 16

Improved drinking water coverage by wealth quintiles

% 100 89 80 65 60 56 76

40

39

INVESTMENTS IN DRINKING WATER AND SANITATION YIELD HIGH DIVIDENDS Increased use of improved water and sanitation has many benefits: a significant reduction in disease, especially diarrhoea; averted health-related costs; and time savings associated with having water and sanitation facilities located closer to home. Time saved may translate into higher productivity and school attendance, more leisure time and other, less tangible benefits, such as convenience and well-being, all of which can have an economic impact. If these benefits are translated into monetary terms, it is possible to compare the total benefits with the costs of a potential intervention. Such an evaluation can often tip the balance in favour of water and sanitation investments. A recent cost-benefit analysis undertaken by WHO found that achieving the MDG target in water and sanitation would bring substantial economic gains: every $1 invested would yield an economic return of between $3 and $34, depending on the region. Globally, meeting the target would require an additional investment of around $11.3 billion per year, over and above current investments. Among the benefits would be an average 10 per cent reduction worldwide in episodes of diarrhoeal diseases.

20

POOREST

3RD

SOURCE: BASED ON DATA FROM SELECTED DHS SURVEYS FOR 20 DEVELOPING COUNTRIES

Richest are four times more likely to use improved sanitation than the poorest
FIGURE 17

Improved sanitation coverage by wealth quintiles

% 100

80

75

60 49 40 32 26 20 17

0
POOREST RICHEST 2ND 3RD 4TH

SOURCE: BASED ON DATA FROM SELECTED DHS SURVEYS FOR 20 DEVELOPING COUNTRIES

20

RICHEST

2ND

4TH

ADVANCING GENDER EQUALITY THROUGH TOILETS AND TAPS Ask anyone what it will take to make womens equality a reality and toilets will probably not be the response. Yet it is difficult to exaggerate the impact that access to private, safe and sanitary toilets would have on the daily lives and long-term prospects of the 1.3 billion women and girls that are currently doing without. The burdens of water-hauling are widely understood: this tedious, time-consuming and physically debilitating chore reduces the time available for productive activities and, for girls, to attend school. Less discussed are the blows to health, productivity and dignity that result from poor sanitation. In some cultural settings where basic sanitation is lacking, women and girls have to rise before dawn, making their way in the darkness to fields, railroad tracks and roadsides to defecate in the open, knowing they may risk rape or other violence in the process. In such circumstances, women and girls often go the whole day without relieving themselves until night affords them the privacy of darkness. Sometimes, they limit their daytime intake of food and water so that they can make it until evening. Without toilets in schools, girls must go in the open that is, if they are even allowed to attend. For many girls, the onset of adolescence means the end of school. All who lack adequate sanitation facilities are exposed to unpleasant and unhealthy daily routines. However, the impact on women and girls is greatest. In their household roles, they may more readily transmit disease-causing pathogens from exposed faeces to other family members. And restricted toilet opportunities cause discomfort and increase the likelihood of health problems such as urinary tract infections and chronic constipation as well as causing unnecessary mental stress. Sick, pregnant and postpartum women particularly suffer from lack of sanitation. How can the future be better if todays girls must drop out of school for want of something as basic as a toilet?

21

THE JOINT

ince 1990, WHO and UNICEF have teamed up to track progress on global water and sanitation goals through the Joint Monitoring Programme for Water Supply and Sanitation. The JMP monitors trends in coverage; helps build national monitoring capacity in developing countries; develops and harmonizes questionnaires, indicators and definitions to ensure comparability of data over time and among countries; and informs policy makers of the status of the water supply and sanitation sector worldwide through publications such as this one. The JMP draws guidance from a technical advisory group of leading experts in water supply, sanitation and hygiene, and from institutions involved in data collection and sector monitoring. Further information about the JMP and its methodology can be found at: www.wssinfo.org.

MONITORING PROGRAMME

nitions, provide a more accurate picture by monitoring the type of services and facilities that people actually use. Household surveys are usually conducted by national institutes of statistics, carried out by trained national staff who collect information on a wide range of health and living conditions through face-to-face interviews. Survey and census data are plotted on a time scale from 1980 to the present. Four graphs for each country show both urban and rural coverage for water and for sanitation. A linear trend line, based on the least-squares method, is drawn through these data points to estimate coverage for 1990 and 2002.

The JMP database

The JMP database is the source for WHO and UNICEFs estimates on the use of drinking water and sanitation facilities. The database currently draws upon more than 350 nationally representative household surveys and censuses, double the amount of data that was available for the 2000 monitoring report. The surveys include the UNICEFsupported Multiple Indicator Cluster Surveys, the USAIDsupported Demographic and Health Surveys, the World Banks Living Standard Measurement Surveys and, most recently, WHOs World Health Surveys. The JMP assembles, reviews and assesses household survey and census data. A rigorous review process, based on a set of objective criteria, ensures that only reliable data are included in the database.

The shift from provider-based to user-based data

Prior to 2000, coverage data were based on information from service providers, such as utilities, ministries and water agencies, rather than on household surveys. The quality of the information varied considerably. Providerbased data, for example, often did not include facilities built by householders themselves, such as private wells or pit latrines, or even systems installed by local communities. Governments had their own definitions of improved water supply and sanitation, which would change over time. Therefore comparisons could not be made among countries or for the same country over time. The shift in 2000 to the use of household surveys, and the clarification of defi-

22

THE JOINT

Challenges and responses

MONITORING PROGRAMME

The MDG target refers to access to safe drinking water and basic sanitation. Though it sounds straightforward, monitoring such a target can be complex. How is drinking water defined, for example, and how is an interviewer to determine whether a households water is safe? In order to standardize data collection, the JMP defines drinking water as the water used for normal domestic purposes, including consumption and hygiene. Extensive research in rural areas found that people satisfy their basic needs for water if the source can be reached in a round trip of 30 minutes or less. When it takes more than 30 minutes to get to the water source and back, people typically haul less water than they need to meet their basic requirements. These requirements are determined locally, depending upon water availability, local customs, and the amount of water required to prepare food staples. Measuring basic sanitation is equally complicated. Ideally, the definition of this term would encompass critical components of what sanitation services should aim for: privacy, dignity, cleanliness and a healthy environment. From a monitoring point of view, however, such characteristics are difficult to measure. To resolve these issues, the JMP classifies sanitation facilities and water supply sources as either improved or unimproved, as defined on page 4 of this report. In doing so, it makes the assumption that those classified as improved are likely to be more sanitary than unimproved ones. Not all people that have access to improved facilities or sources actually use them. Consequently, the JMP has adopted use as the primary indicator for monitoring progress in both water and sanitation. Current coverage estimates from the JMP are expressed as the percentage of the population using improved drinking water sources and improved sanitation facilities.

tions and response categories for drinking water supply and sanitation is being prepared and discussions are under way on incorporating them in major household survey programmes and population censuses. Measuring gender disparities. Data on water and sanitation are collected at the household level. Therefore genderspecific data cannot be calculated. However, who bears the main responsibility for water collection and how long it takes can be ascertained. Questions along these lines are being reflected in the design of new surveys. Safety and water quality. Existing surveys do not provide information on the quality of water, either at the source or in households. Improved sources may still contain harmful substances, and water can be contaminated during transport and storage. Although 'improved drinking water sources' provides a good indicator for progress, it is not a direct measure of it. Dangerous levels of chemicals, such as the arsenic and flouride that are increasingly found in groundwater in South and South-eastern Asia, are of growing concern, along with infectious or other toxic substances. The proportion of the population using safe drinking water is therefore likely to be lower than that using improved drinking water sources. In response, WHO and UNICEF are conducting a pilot study to develop procedures for assessing drinking water quality at the household level. The study is being carried out in China, Ethiopia, Jordan, Nicaragua, Nigeria and Tajikistan with the support of the British Government.

Other issues
The use of household surveys has significantly increased the quality and comparability of information on improved drinking water sources and sanitation. Making this data even more useful to policy makers means tackling additional challenges: Harmonizing indicators and survey questions. Surveys use different indicators and methodologies, making it difficult to compare information. A guide harmonizing ques23

COUNTRY, REGIONAL AND GLOBAL ESTIMATES ON WATER & SANITATION

Improved Drinking Water Coverage Population Countries, areas and territories
Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh* Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia

Total
Total %
13 97 97 95 87 100 100 32 50 60 91 94 92 100 100 100 100 100 100 66 77 97 71 75 100 100 100 100 91 60 68 62 72 85

Urban
Household Connection %
8 96 96 83 87 100 100 1 13 45 90 76 97 97 100 100 100 100 63 76 69 100 100 28 26 98 100 78 100 100 92 99 17 26 81 76 92

Rural
Total Household Connection % %
11 95 95 92 80 100 100 40 40 60 89 73 80 100 100 100 100 100 100 49 59 86 68 72 100 100 100 100 82 54 60 60 48 68 0 0 46 39 60 0 1 45 79 23 64 100 100 100 100 16 19 80 0 0 22 90 63 1 1 23 47

Improved Sanitation Coverage

Total %
8 89 88 92 100 100 30 30 99 99 95 82 84 100 100 100 100 55 100 100 23 48 100 99 47 11 32 70 33 45

Total Urban Rural (thousands) % %

Year
1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 13,799 22,930 3,289 3,141 25,017 31,266 47 60 53 69 9,340 13,184 9 12 63 73 32,527 37,981 3,545 3,072 66 98 16,888 19,544 7,729 8,111 7,192 8,297 255 310 490 709 109,402 143,809 257 269 10,266 9,940 9,967 10,296 186 251 4,650 6,558 74 81 1,696 2,190 6,669 8,645 18 23 36 43 51 58 81 90 94 92 26 35 100 100 35 37 87 90 67 65 50 46 85 92 66 66 54 50 84 89 88 90 20 24 45 51 66 71 96 97 48 48 34 44 100 100 5 8 56 63 82 77 64 57 49 42 19 10 6 8 74 65 0 0 65 63 13 10 33 35 50 54 15 8 34 34 46 50 16 11 12 10 80 76 55 49 34 29 4 3 52 52 66 56 0 0 95 92 44 37

Household Total Connection % %

2 68 62 76 1 5 45 83 69 85 100 100 100 100 41 47 70 6 6 61 100 80 6 12 53 75 19 99 99 99 92 100 100 11 70 60 95 95 97 97 99 99 100 100 100 100 100 100 80 95 98 98 100 100 83 82 100 100 100 100 100 100 100 100 71 79 86 91 95

Urban %
16 99 99 99 99 100 100 62 56 99 99 98 98 87 96 96 100 100 100 100 73 100 100 100 100 71 75 99 99 71 31 58 65 49 58

Rural %
5 5 81 76 82 100 100 19 16 99 99 94 47 61 100 100 100 100 36 100 100 11 39 100 100 25 1 12 70 13 23

*The figures for Bangladesh have been adjusted for arsenic contamination levels on the basis of national surveys conducted and approved by the Government.

24

Improved Drinking Water Coverage Population Countries, areas and territories

Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China China, Hong Kong (SAR) China, Macao (SAR) Colombia Comoros Congo Congo, Democratic Republic of the Cook Islands Costa Rica Cte d'Ivoire Croatia Cuba Cyprus

Total
Total %
98 98 93 95 83 89 98 98 100 100 39 51 69 79 34 50 63 100 100 80 48 75 20 34 90 95 70 77 92 92 89 94 46 43 46 94 95 97 69 84 91 100 100

Urban
Household Connection %
98 98 40 62 90 91 97 97 100 100 25 23 31 41 31 25 28 100 100 41 2 9 6 19 98 99 80 91 94 96 32 47 58 89 32 99 99 52 65 77 82 100 100

Rural
Total Household Connection % %
96 96 88 90 55 58 98 98 100 100 35 44 67 78 29 32 41 99 99 73 35 61 13 32 49 59 59 68 78 71 85 96 17 24 29 87 88 92 66 74 78 100 100 69 13 28 28 17 97 97 94 1 0 1 1 1 1 2 2 38 4 4 0 0 0 0 25 40 37 40 41 51 12 14 5 5 0 1 81 5 9 31 49 100 100

Improved Sanitation Coverage

Total %
93 38 41 70 75 100 100 100 100 13 12 44 36 16 21 48 100 100 42 23 27 6 8 85 92 23 44 82 86 23 23 9 18 29 95 100 92 31 40 98 98 100 100

Total Urban Rural (thousands) % %

Year
1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 4,308 4,126 1,354 1,770 148,809 176,257 17 21 257 350 8,718 7,965 8,921 12,624 5,609 6,602 9,744 13,810 11,661 15,729 27,701 31,271 349 454 26 39 2,943 3,819 5,822 8,348 142 145 13,100 15,613 1,155,305 1,294,867 5,704 6,981 372 460 34,970 43,526 527 747 2,494 3,633 37,370 51,201 18 18 3,076 4,094 12,505 16,365 4,842 4,439 10,628 11,271 681 796 39 44 42 51 75 82 50 63 66 75 66 69 14 17 6 10 13 18 40 51 77 80 44 55 100 100 37 42 21 25 31 30 83 87 27 38 100 100 99 99 69 76 28 34 48 53 28 31 58 69 54 60 40 44 54 59 74 75 65 69 61 56 58 49 25 18 50 37 34 25 34 31 86 83 94 90 87 82 60 49 23 20 56 45 0 0 63 58 79 75 69 70 17 13 73 62 0 0 1 1 31 24 72 66 52 47 72 69 42 31 46 40 60 56 46 41 26 25 35 31

Household Total Connection % %

82 25 46 74 78 97 97 98 4 4 3 4 6 11 15 88 24 1 4 1 5 86 92 49 59 78 85 18 25 33 25 10 92 24 33 65 74 100 100 100 100 100 100 93 96 98 98 100 100 63 82 96 90 58 77 84 100 100 86 70 93 45 40 98 100 100 92 98 99 99 90 72 92 83 99 98 100 100 74 98 95 95 100 100

Urban %
99 99 61 57 82 83 100 100 100 100 47 45 42 47 53 43 63 100 100 61 32 47 27 30 91 96 64 69 95 96 41 38 14 56 43 100 100 89 52 61 99 99 100 100

Rural %
88 21 25 37 35 100 100 100 100 8 5 44 35 8 7 33 99 99 19 18 12 1 0 52 64 7 29 52 54 16 15 2 2 3 23 88 100 97 97 16 23 95 95 100 100

25

Improved Drinking Water Coverage Population Countries, areas and territories

Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Falkland Islands (Malvinas) Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Greece Grenada Guadeloupe Guam Guatemala Guinea

Total
Total %
100 100 78 80 97 86 93 69 86 94 98 67 82 44 40 57 25 22 100 100 84 100 100 87 82 76 100 100 54 79 95 98 100 100 77 95 42 51

Urban
Household Connection %
100 100 40 40 98 98 70 37 74 77 89 98 74 78 12 17 40 42 96 96 4 23 96 100 100 100 83 99 99 52 39 83 100 100 35 50 91 93 98 98 67 58 37 23

Rural
Total Household Connection % %
100 100 67 67 90 72 85 54 77 92 97 47 68 42 36 54 16 11 100 100 71 100 100 47 77 61 100 100 36 68 93 93 100 100 69 92 32 38 100 100 11 11 58 35 31 32 32 40 67 16 34 0 0 0 0 67 0 0 85 93 95 95 65 96 96 8 3 3 30 97 97 2 3 73 75 75 34 53 2 1

Improved Sanitation Coverage

Total %
48 50 83 48 57 56 72 54 68 51 63 53 8 9 4 6 98 98 100 100 78 98 98 36 53 83 43 58 97 97 64 99 99 50 61 17 13

Total Urban Rural (thousands) % %

Year
1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 10,306 10,246 5,140 5,351 528 693 72 78 7,058 8,616 10,264 12,810 55,768 70,507 5,110 6,415 354 481 3,103 3,991 1,584 1,338 48,856 68,961 48 47 2 3 724 831 4,986 5,197 56,735 59,850 116 174 195 241 953 1,306 936 1,388 5,460 5,177 79,433 82,414 15,277 20,471 10,160 10,970 85 80 391 436 134 160 8,749 12,036 6,122 8,359 75 74 85 85 75 83 68 72 55 59 55 61 43 42 49 59 35 47 16 20 71 69 13 15 33 38 68 81 42 51 61 61 74 76 75 75 56 52 68 83 25 26 55 52 85 88 36 45 59 61 32 40 98 100 91 94 41 46 25 34 25 26 15 15 25 17 32 28 45 41 45 39 57 58 51 41 65 53 84 80 29 31 87 85 67 62 32 19 58 49 39 39 26 24 25 25 44 48 32 17 75 74 45 48 15 12 64 55 41 39 68 60 2 0 9 6 59 54 75 66

Household Total Connection % %

100 100 32 35 87 54 35 55 59 61 80 45 60 4 8 6 8 87 1 4 92 97 99 99 79 98 98 45 12 58 100 100 14 24 84 82 98 48 55 10 8 100 100 82 82 100 100 97 98 81 92 97 100 88 91 45 60 72 80 81 100 100 100 100 88 100 100 95 95 95 95 90 100 100 85 93 97 97 98 98 100 100 88 99 70 78

Urban %
55 55 86 60 67 73 80 70 84 70 78 60 46 34 93 14 19 99 99 100 100 85 99 99 37 72 96 96 54 74 96 96 64 99 99 71 72 27 25

Rural %
27 27 75 33 43 36 59 42 56 33 40 46 0 3 2 4 98 98 100 100 57 97 97 30 46 69 37 46 97 97 61 98 98 35 52 13 6

26

Improved Drinking Water Coverage Population Countries, areas and territories

Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia

Total
Total %
59 83 53 71 83 90 99 99 100 100 68 86 71 78 91 93 83 81 100 100 92 93 100 100 98 91 86 86 45 62 48 64 100 100 92 76 43 100 100 76 56 62 71 72

Urban
Household Connection %
15 66 27 24 82 92 92 93 100 100 51 51 26 31 96 96 94 94 99 99 100 100 100 100 87 93 98 98 99 89 88 88 58 56 46 49 81 96 96 87 25 93 100 100 31 31 21 1 54 54

Rural
Total Household Connection % %
49 83 43 59 78 82 98 98 100 100 61 82 62 69 83 83 50 50 100 100 86 87 100 100 91 91 72 72 30 46 33 53 100 100 71 66 38 100 100 74 34 52 68 68 0 0 45 2 3 43 55 74 67 100 100 5 13 3 5 69 69 33 33 81 98 98 96 96 32 45 91 91 87 81 27 27 11 12 13 22 71 39 28 4 4 85 2 2 3 0 55 55

Improved Sanitation Coverage

Total %
34 70 15 34 49 68 95 12 30 46 52 83 84 81 80 75 80 100 100 93 72 72 42 48 25 39 59 60 24 98 37 37 38 26 97 97

Total Urban Rural (thousands) % %

Year
1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1,016 1,449 731 764 6,914 8,218 4,868 6,781 10,365 9,923 255 287 846,418 1,049,549 182,117 217,131 56,703 68,070 17,341 24,510 3,515 3,911 69 74 4,514 6,304 56,719 57,482 2,369 2,627 123,537 127,478 3,254 5,329 16,809 15,469 23,585 31,540 72 87 19,956 22,541 42,869 47,430 2,143 2,443 4,395 5,067 4,132 5,529 2,713 2,329 2,712 3,596 1,570 1,800 2,135 3,239 4,306 5,445 24 33 33 37 29 37 40 45 62 65 91 93 26 28 31 44 56 66 70 67 57 60 52 52 90 92 67 67 51 52 63 65 72 79 57 56 25 38 35 46 58 61 74 80 95 96 38 34 15 20 70 66 83 87 17 18 42 46 80 86 76 67 67 63 71 63 60 55 38 35 9 7 74 72 69 56 44 34 30 33 43 40 48 48 10 8 33 33 49 48 37 35 28 21 43 44 75 62 65 54 42 39 26 20 5 4 62 66 85 80 30 34 17 13 83 82 58 54 20 14

Household Total Connection % %

5 53 10 11 59 72 85 84 100 100 17 24 10 17 84 87 76 74 91 100 100 99 99 60 70 95 96 95 87 62 61 22 29 24 34 77 84 48 8 98 7 7 11 1 54 54 79 83 77 91 89 99 100 100 100 100 88 96 92 89 98 98 97 97 100 100 100 100 100 100 97 98 100 100 100 91 96 96 91 89 76 77 100 100 97 97 98 98 66 100 100 88 85 72 72 72

Urban %
57 86 27 52 77 89 100 100 43 58 66 71 86 86 95 95 100 100 85 90 100 100 97 94 87 87 49 56 33 59 58 75 61 100 100 61 61 59 49 97 97

Rural %
23 60 11 23 31 52 85 1 18 38 38 78 78 48 48 64 68 100 100 85 52 52 40 43 21 22 60 51 14 87 32 32 24 7 96 96

Iran (Islamic Republic of) 1990 2002 Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002

27

Improved Drinking Water Coverage Population Countries, areas and territories

Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand

Total
Total %
100 100 40 45 41 67 95 99 84 34 48 100 100 96 85 41 56 100 100 80 91 87 94 92 62 62 100 100 75 80 42 48 80 58 80 69 84 100 100 97 -

Urban
Household Connection %
100 100 30 14 33 45 78 76 8 27 100 100 18 29 98 74 89 96 78 100 100 49 49 98 98 75 92 28 11 23 83 76 42 48 100 100 100 100

Rural
Total Household Connection % %
100 100 27 34 34 62 94 99 78 29 35 100 100 97 95 57 45 100 100 54 72 85 94 88 30 30 100 100 58 56 24 40 74 43 72 67 82 99 99 82 98 98 1 1 2 2 64 0 0 0 1 96 96 3 11 82 50 71 9 1 1 9 12 2 2 1 2 12 21 3 8 95 95 -

Improved Sanitation Coverage

Total %
12 33 36 46 96 58 36 45 75 82 28 42 99 99 66 77 30 28 68 59 96 96 57 61 27 21 73 24 30 12 27 100 100 -

Total Urban Rural (thousands) % %

Year
1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 29 33 3,739 3,465 378 447 11,956 16,916 9,456 11,871 17,845 23,965 216 309 9,046 12,623 360 393 44 52 360 390 2,030 2,807 1,057 1,210 0 0 83,225 101,965 96 108 4,364 4,270 30 34 2,216 2,559 11 3 24,564 30,072 13,465 18,537 40,506 48,852 1,409 1,961 9 13 18,625 24,609 14,952 16,067 188 219 171 224 3,360 3,846 21 22 68 67 86 92 24 26 12 16 50 63 26 28 24 32 88 91 65 66 90 96 44 60 40 43 72 75 26 29 47 46 100 100 57 57 12 13 48 57 21 34 25 29 27 32 100 100 9 15 60 65 68 70 60 61 85 86 79 78 32 33 14 8 76 74 88 84 50 37 74 72 76 68 12 9 35 34 10 4 56 40 60 57 28 25 74 71 53 54 0 0 43 43 88 87 52 43 79 66 75 71 73 68 0 0 91 85 40 35 32 30 40 39 15 14

Household Total Connection % %

100 100 8 5 6 9 20 22 2 10 100 100 9 22 78 78 89 41 28 28 41 57 11 3 8 31 39 6 14 98 98 100 100 82 75 90 96 96 96 100 99 50 76 100 100 95 80 19 63 100 100 90 97 93 95 97 97 100 100 87 87 100 100 94 99 76 73 95 99 98 94 93 100 100 100 100

Urban %
25 49 52 66 94 100 100 50 59 100 100 88 93 31 64 100 100 84 90 53 61 86 100 100 75 96 96 87 83 51 39 96 68 66 62 68 100 100 -

Rural %
8 27 34 42 98 98 42 32 38 51 59 26 9 99 99 20 39 21 14 52 37 96 96 28 31 14 14 15 63 8 14 7 20 100 100 88 -

28

Improved Drinking Water Coverage Population Countries, areas and territories

Nicaragua Niger Nigeria Niue Northern Mariana Islands Norway Occupied Palestinian Territory Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Runion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia

Total
Total %
69 81 40 46 49 60 100 100 98 98 100 100 94 77 79 83 90 80 84 91 39 39 62 83 74 81 87 85 100 100 57 94 96 58 73 99 99 98 98 91 88 79 90 -

Urban
Household Connection %
89 86 19 35 31 20 100 100 93 100 100 91 30 30 61 50 96 96 61 61 59 82 74 84 37 60 93 99 97 97 100 100 79 87 92 24 34 72 75 74 34 97 97

Rural
Total Household Connection % %
42 65 35 36 33 49 100 100 100 97 100 100 86 72 72 78 87 99 94 79 32 32 46 62 42 66 82 77 100 100 16 86 88 57 69 99 99 98 98 93 89 88 73 63 15 31 0 0 3 3 80 35 100 100 63 7 7 13 9 10 72 4 4 2 18 16 40 6 22 56 89 50 13 49 52 0 1 72 75 73 52 19 60 -

Improved Sanitation Coverage

Total % Urban % Rural %

Total Urban Rural (thousands) % %

Year
1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 3,824 5,335 7,650 11,544 86,018 120,911 2 2 44 76 4,241 4,514 2,154 3,433 1,845 2,768 110,901 149,911 15 20 2,411 3,064 4,114 5,586 4,219 5,740 21,753 26,767 61,104 78,580 38,111 38,622 9,899 10,049 3,528 3,859 467 601 604 745 23,207 22,387 148,292 144,082 6,775 8,272 41 42 131 148 110 119 160 176 23 27 116 157 16,554 23,520 53 57 16 22 35 46 31 35 89 94 72 78 66 71 62 77 31 34 70 69 54 57 13 13 49 57 69 74 49 60 61 62 47 54 72 96 89 92 81 91 53 55 73 73 5 16 35 32 27 30 41 57 21 22 90 89 37 38 78 87 47 43 84 78 65 54 69 65 11 6 28 22 34 29 38 23 69 66 30 31 46 43 87 87 51 43 31 26 51 40 39 38 53 46 28 4 11 8 19 9 47 45 27 27 95 84 65 68 73 70 59 43 79 78 10 11 63 62 22 13

Household Total Connection % %

54 62 3 8 13 11 87 100 100 83 21 25 28 23 85 11 11 30 54 56 72 21 44 78 95 72 49 77 81 1 6 72 75 57 25 89 92 93 62 80 78 72 100 100 98 98 100 100 97 97 81 81 95 95 71 79 99 99 88 88 80 100 88 87 93 90 100 100 100 100 91 97 99 88 92 99 99 98 98 99 91 89 97 97

47 66 7 12 39 38 100 100 84 94 76 83 89 38 54 66 83 72 45 45 58 78 52 62 54 73 100 100 51 87 87 37 41 96 96 89 98 100 24 -

64 78 35 43 50 48 100 100 85 94 78 97 97 81 92 72 96 89 67 67 71 94 68 72 63 81 100 100 86 93 93 49 56 96 96 89 100 100 32 100 100

27 51 2 4 33 30 100 100 78 96 70 61 61 19 35 54 52 51 41 41 46 58 15 33 46 61 100 100 10 70 70 36 38 96 96 89 96 96 98 100 20 -

29

Improved Drinking Water Coverage Population Countries, areas and territories

Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Tanzania, United Republic of Thailand The former Yugoslav Republic of Macedonia Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan

Total
Total %
66 72 93 93 87 57 100 100 70 29 83 87 68 78 64 69 92 52 100 100 100 100 79 79 58 38 73 81 85 52 49 51 100 100 92 91 77 82 81 93 71

Urban
Household Connection %
50 71 98 98 100 100 30 100 100 80 76 76 3 3 94 82 90 37 35 75 46 91 67 100 100 100 100 82 30 44 69 80 26 14 12 72 81 80 91 93 64 64 81

Rural
Total Household Connection % %
50 54 86 86 75 46 100 100 65 27 67 73 62 72 57 64 73 42 100 100 100 100 64 64 47 27 62 78 80 51 37 36 96 89 100 100 89 88 57 60 65 87 54 4 11 64 64 75 1 1 1 1 0 0 23 31 50 4 4 19 13 48 13 100 100 99 99 26 4 2 11 12 8 0 0 0 0 76 68 67 28 30 30 30 29

Improved Sanitation Coverage

Total %
35 52 87 87 39 100 100 31 25 63 67 70 91 33 34 93 52 100 100 100 100 76 77 53 47 46 80 99 33 37 34 97 97 100 100 75 80 84 83 62

Total Urban Rural (thousands) % %

Year
1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 7,345 9,855 10,156 10,535 71 80 4,054 4,764 3,016 4,183 5,256 5,398 1,918 1,986 319 463 7,163 9,480 36,848 44,759 39,303 40,977 16,830 18,910 24,927 32,878 402 432 847 1,069 8,559 8,867 6,834 7,171 12,717 17,381 5,303 6,195 26,068 36,276 54,389 62,193 1,909 2,046 740 739 3,455 4,801 2 2 99 103 1,215 1,298 8,207 9,728 57,593 70,318 3,668 4,794 40 49 51 52 50 50 30 38 100 100 56 57 51 51 14 16 29 34 49 56 75 76 21 21 27 38 65 75 23 23 83 83 68 68 49 50 32 25 22 34 29 32 58 59 8 8 29 35 0 0 31 33 69 75 58 63 59 66 45 45 60 51 49 48 50 50 70 62 0 0 44 43 49 49 86 84 71 66 51 44 25 24 79 79 73 62 35 25 77 77 17 17 32 32 51 50 68 75 78 66 71 68 42 41 92 92 71 65 100 100 69 67 31 25 42 37 41 34 55 55

Household Total Connection % %

22 40 82 82 87 12 11 13 1 1 58 60 80 11 10 34 26 80 26 100 100 100 100 40 10 16 28 34 9 4 4 75 77 77 64 70 50 52 52 90 90 99 99 100 100 75 100 100 100 100 94 32 99 98 91 99 85 78 98 98 87 100 100 100 100 94 94 93 79 92 87 95 73 81 80 100 100 93 92 93 94 92 96 93

Urban %
52 70 97 97 53 100 100 100 100 98 98 47 85 86 89 98 53 50 99 99 78 100 100 100 100 97 97 71 51 54 95 97 65 71 71 98 98 100 100 95 90 96 94 77

Rural %
23 34 77 77 100 100 30 100 100 18 14 42 44 64 89 26 24 76 44 100 100 100 100 56 56 47 45 41 74 100 30 24 15 30 74 96 96 100 100 47 62 67 62 50

30

Improved Drinking Water Coverage Population Countries, areas and territories

Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom

Total
Total % Household Total Connection % %
68 3 1 78 99 100 100 91 54 53 38 38 81 11 14 31 33 22 18 33 35 100 100 92 94 79 87 100 100 100 100 100 100 98 98 97 97 93 85 85 93 93 74 74 86 90 99 100

Urban
Household Connection %
78 24 8 93 100 100 100 100 95 94 85 85 80 73 79 84 51 51 64 64 51 47 95 91

Rural
Total Household Connection % %
100 100 89 92 40 52 94 100 100 93 84 84 53 52 70 67 67 68 68 27 36 69 74 60 0 0 49 92 100 100 56 33 33 28 28 61 1 1 22 22 2 2 8 5

Improved Sanitation Coverage

Total % Urban % Rural %

Total Urban Rural (thousands) % %

Year
1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 12 20 9 10 17,359 25,004 51,891 48,902 2,035 2,937 56,761 59,068 255,712 291,038 101 110 3,106 3,391 20,515 25,705 149 207 19,502 25,226 66,074 80,278 207 301 11,944 19,315 8,200 10,698 10,467 12,835 43 46 41 54 11 12 67 67 83 85 89 89 75 80 88 93 89 92 40 37 19 22 84 87 20 25 88 93 21 25 39 35 29 34 57 54 59 46 89 88 33 33 17 15 11 11 25 20 12 7 11 8 60 63 81 78 16 13 80 75 12 7 79 75 61 65 71 66

100 100 91 93 44 56 98 100 100 98 89 89 60 60 83 72 73 69 69 50 55 77 83

96 78 88 43 41 99 99 100 100 100 100 94 58 57 50 68 22 41 21 30 41 45 49 57

98 98 83 92 54 53 100 100 100 100 100 100 95 95 73 73 78 71 46 84 59 76 64 68 69 69

94 74 83 41 39 97 97 100 100 100 100 85 48 48 42 48 16 26 11 14 26 32 40 51

United States of America 1990 2002 United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Western Sahara Yemen Zambia Zimbabwe 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002 1990 2002

WORLD DEVELOPED regions EURASIA

1990 5,263,484 2002 6,224,874 1990 2002 1990 2002 934,014 993,055 281,700 280,970

43 48 72 75 65 64 35 42 49 52 28 35 71 76 30 40 27 30 32 41 62 66 23 24

57 52 28 25 35 36 65 58 51 48 72 65 29 24 70 60 73 70 68 59 38 34 77 76

77 83 100 98 92 93 71 79 88 90 49 58 83 89 72 78 71 84 73 79 83 88 51 52

48 52 96 96 71 72 36 42 57 73 16 16 70 78 50 61 20 24 14 23 62 63 21 22

95 95 100 100 97 99 93 92 95 96 82 82 93 95 99 93 90 94 91 91 94 95 92 91

79 79 99 99 86 90 69 71 83 91 47 39 86 89 82 91 55 53 37 45 79 79 69 67

63 72 99 94 83 82 59 70 82 84 36 45 58 69 60 68 64 80 65 70 65 74 39 40

25 27 89 88 42 41 18 21 33 54 4 4 32 42 37 40 7 12 3 8 33 31 6 8

49 58 100 98 84 83 34 49 65 73 32 36 69 75 24 45 20 37 48 61 79 79 58 55

79 81 100 100 93 92 68 73 84 89 54 55 82 84 64 69 54 66 67 79 96 95 83 84

25 37 99 92 68 65 16 31 47 57 24 26 35 44 7 30 7 24 39 49 52 49 50 46

DEVELOPING regions 1990 4,047,770 2002 4,950,850 Northern Africa Sub-Saharan Africa Latin America & the Caribbean Eastern Asia South Asia South-eastern Asia Western Asia Oceania 1990 2002 1990 2002 1990 2002 118,068 147,319 504,369 684,768 441,525 535,626

1990 1,226,424 2002 1,374,838 1990 1,174,590 2002 1,480,287 1990 2002 1990 2002 1990 2002 439,926 535,611 136,444 183,961 6,425 8,440

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Millennium Development Goals: Regional Groupings

In charting progress towards the Millennium Development Goals, the United Nations has classified the worlds countries into three regions: developed regions, developing regions and Eurasia (countries in the Commonwealth of Independent States). The developing regions are further divided into the subregions shown on the map below. A complete listing of countries included in these subregions can be found at: www.wssinfo.org

FIGURE 18

Millennium Development Goals: Regional Groupings

Developed countries Eastern Asia Eurasia Latin America & Caribbean Northern Africa Oceania South Asia South-eastern Asia Sub-Saharan Africa Western Asia

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WHO/UNICEF JOINT MONITORING PROGRAMME FOR WATER SUPPLY AND SANITATION Established: In 1990, at the end of the International Drinking Water Supply and Sanitation Decade Executing Agencies: WHO and UNICEF Technical Advisory Group: Individual experts from academic institutions and civil society, plus representatives of organizations involved in water and sanitation and data collection, including UN-Habitat, ORC Macro, United Nations Environment Programme, the Environmental Health Project of the United States Agency for International Development, the World Bank, the Water Supply and Sanitation Collaborative Council and the Millennium Project Funding Support: United Kingdoms Department for International Development and the Swiss Agency for Development and Cooperation

Photo credits: Cover UNICEF/HQ97-0537/Maggie Murray-Lee; Inside Front Cover UNICEF/HQ03-0156/Shehzad Noorani; Page 1 UNICEF/ HQ95-0079/Jonathan Shadid; Pages 2 and 3 UNICEF/HQ99-0460/ Giacomo Pirozzi; Page 4 (from top): UNICEF/98-0699/Alejandro Balaguer, UNICEF/HQ93-0816/Cindy Andrew; Page 5 (from top): UNICEF/HQ961167/Giacomo Pirozzi, UNICEF/HQ95-0066/Jonathan Shadid, UNICEF/ HQ99-0812/Roger LeMoyne; Page 6 (from top): UNICEF/HQ00-0630/ Roger LeMoyne, UNICEF/HQ02-0580/Jim Holmes; Page 7 UNICEF/ HQ00-0048/Jim Holmes; Page 8 (from top): Victor Mello, UNICEF/ HQ00-0566/Roger LeMoyne; Page 9 (from top): Victor Mello, UNICEF/ HQ00-0615/Roger LeMoyne; Page 10 UNICEF/HQ00-0631/Roger LeMoyne; Page 11 (from top): UNICEF/HQ00-0631/Roger LeMoyne, UNICEF/HQ94-1334/Giacomo Pirozzi; Page 12 (from top): UNICEF/ HQ04-0276/Christine Nesbitt, UNICEF/HQ98-0928/Giacomo Pirozzi; Page 13 UNICEF/HQ04-0276/Christine Nesbitt;

Page 14 (from top): UNICEF/HQ04-0112/Christine Nesbitt, UNICEF/ HQ04-0114/Christine Nesbitt; Page 15 (from top): UNICEF/HQ04-0112/ Christine Nesbitt, UNICEF/HQ93-0781/Cindy Andrew; Page 16 (from top): UNICEF/HQ92-1309/Roger LeMoyne, UNICEF/HQ99-0135/ Giacomo Pirozzi; Page 17 (from top): UNICEF/HQ92-1309/Roger LeMoyne, UNICEF/HQ96-0382/Franck Charton; Page 18 (from top): UNICEF/HQ04-0115/Christine Nesbitt, UNICEF/HQ03-0501/Shehzad Noorani; Page 19 (from top): UNICEF/HQ04-0115/Christine Nesbitt, UNICEF/HQ02-0502/Giacomo Pirozzi; Page 20 Basil E. Sam; Page 21 (from top): Basil E. Sam, UNICEF/HQ99-0643/Giacomo Pirozzi; Page 22 UNICEF/HQ02-0352/Giacomo Pirozzi; Page 23 UNICEF/HQ96-0312/Franck Charton; Page 32 UNICEF/HQ00-0483/ Radhika Chalasani; Back Cover UNICEF/HQ95-0055/Jonathan Shahid Design: Emerson, Wajdowicz Studios / NYC / www.designews.com

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HIGHLIGHTS
The world is on track to meet the drinking water target, but sub-Saharan Africa lags behind.
Eighty-three per cent of the worlds population are using improved drinking water sources, but 1.1 billion people are still without coverage. Progress in sub-Saharan Africa was impressive, moving from 49 per cent coverage in 1990 to 58 per cent in 2002. But at this rate it will not meet the MDG target by 2015. More than half the worlds population use water piped to their homes, which frees them from the drudgery of water collection and protects their health.

Without a sharp acceleration in the rate of progress, the world will miss the sanitation targetbyhalf a billion people.
An estimated 2.6 billion people half of the developing world lack improved sanitation. Despite major progress in South Asia, little more than a third of its population use improved sanitation; coverage in sub-Saharan Africa is only 36 per cent. Global population growth is cancelling many of the gains already made. Though more than a billion people gained improved sanitation between 1990 and 2002, the population without coverage declined by only 100 million.

From now until 2015, greater effort must be made to reach the poor and those in rural areas, whose deprivation is hidden behind national averages.
For every person in urban areas, there are six people in rural areas without improved drinking water sources. An estimated 560 million people lack improved sanitation in urban areas of the developing world, compared with a staggering 2 billion in rural communities.

United Nations Childrens Fund 3 UN Plaza, NY, NY 10017 USA World Health Organization Avenue Appia 20, 1211 Geneva 27, Switzerland $10.00 5.50 8.30 ISBN: 92-415-6278-1 Sales no.: E.04.XX.8 August 2004