But slowly the magnitude of the mistake is beginning to be appreciated.

The World Summit on Sustainable Development held in Johannesburg in September 2002 adopted the clear goals of halving the proportion or people without safe sanitation and water supply by the year 2015.

Just as important, the Summit acknowledged that without progress on 'WASH' issues (water, sanitation, and hygiene), progress towards all of the other development goals will be debilitated. Nutrition will continue to be undermined by the sheer frequency of illness during the vital, vulnerable early years of a child's growth. Health care systems will continue to be overwhelmed by the hygiene-related illness that currently account for half of all visits to health centres in the developing world. Progress towards equality for women and girls will continue to be held back by the huge demands that 'WASH' issues make on their time and energy. Education will continue to yield lower human and economic returns as disease takes its toll on school attendance and performance. Economic growth will continue to be held back by the loss of productivity and the billions of working days lost each year. And groundwater resources and the living environment will continue to be degraded by faecal pollution.

In other words, addressing the 'WASH' issues is now recognised as central to the struggle for sustainable development. 

Underachievement

Lack of priority is not the only reason for the widespread failure to build the foundations of public health.

Even when serious attempts have been made to improve hygiene, sanitation and water supply, they have often been met with limited success. Pilot and demonstration projects have brought small scale breakthroughs. But rare are the examples of 'WASH' programmes that have brought sustained benefits to more than a few thousand people.

And the bad news does not stop there. Even 'successful' water and                                  sanitation programmes have frequently failed to bring the expected gains in human health.

There is therefore also a strategic problem to be addressed. The old models have underachieved. And new models will need to be evolved if more political priority is to translate into more practical progress.

The Water Supply and Sanitation Collaborative Council (WSSCC) has been charged by the United Nations with the task of advocating the 'WASH' cause and working with its many partner organisations to help debate and define

the new approaches that are needed.

This mutual learning process must be rapid. And it is a process that must acknowledge and learn from past mistakes. 

Mistakes

There is now a widespread consensus that past mistakes have included:

The belief that water and sanitation for all can be achieved by governments pursuing top-down policies including the planning and installation of free or heavily subsidised services. All over the developing world, these supply-driven approaches have failed to achieve their goals.

A tendency for politicians to promise and for communities to expect 'water for free'. If water is treated as a free good to be delivered by politicians then good water management - including cost recovery, water conservation, and techniques such as rain water harvesting - is likely to be weakened to the point where services cannot even be maintained let alone expanded. In practice, 'free service' has almost always come to mean 'no service'.

The propensity to give priority to water supply over sanitation and sanitation over hygiene. It is improved hygiene - keeping faecal matter away from hands and food and from water itself when it is stored in the home - that transforms health. And the neglect of hygiene goes a long way towards explaining why even 'successful' water and sanitation programmes have often not brought the expected benefits.  

A new agenda

Experience has identified such mistakes as common features of failure. But in recent years new-style water and sanitation programmes - from the low-income communities of Orangi in Karachi, Pakistan, and the Brazilian capital of Brasilia, to the poor peri-urban areas of Kumasi,  Ghana, and the rural villages of Midnapur, India - have also begun to identify some of the features common to success.

And from them a new approach is beginning to evolve.

The first and perhaps most important lesson is that government water and sanitation policies are most effective when they seek not to do the job themselves but to stimulate and support community-based initiatives.

It follows from this that wherever possible the plans and facilities should be of a kind that communities can see and understand, build and repair, manage and sustain. Water and sanitation services that people feel they are responsible for, and benefit from, are more likely to be well-used and well-managed. They are also more likely to be capable of being expanded onto a larger scale.

It is in this context that modern versions of old strategies such as household rain water harvesting have an enormous potential. People-centred and household-centred technologies offer greater security to the poor; they reduce dependence on remote technologies and plans, and on the decisions made or not made by distant and unaccountable officials. And it is in this context, too, that the private sector can become productively involved. Local artisans, masons, and small scale manufacturers have little role in centralised and large scale operations. But in community-based initiatives they can often help to develop and market low-cost water and sanitation technologies. 

Paying the price

The dangers of 'free' water supply have already been mentioned. And recovering costs through user charges can make the difference between services that are sustained and expanded and services that fall into disrepair and disuse.

In most countries and communities, the poor are prepared to pay a significant share of the costs themselves. In fact many millions of people in low-income communities are already paying more for water bought from vendors than the better-off are paying for government subsidised water piped into their homes. But 'cost recovery' is not a panacea.

First, it flies in the face of equity to charge the poor the full cost of communal water and sanitation systems whilst subsidising domestic piped water and sewerage systems for the better-off. Second, there will always be some who are simply too poor to pay. In such cases targeted direct or indirect subsidies will be needed.

Pricing policy is often the key. Set the price too high and the poor will ignore the improvement and resort to the methods of sanitation and water collection that they have always used. Set the price too low and maintenance and expansion will not be possible, so that the poor are not adequately served and only the better-off benefit from lower prices.  

Conclusions

The WSSCC does not underestimate the difficulties that lie ahead. But the magnitude of the prize should also be kept in mind. For what is at stake here is not just of 'one issue among many' (see back cover) but a renewed attempt to achieve the greatest of all public health breakthroughs. Better water, sanitation, and hygiene were and are the basis of better health in the industrialised nations; and without them no amount of drugs, doctors, or hospitals will lift public health onto an equivalent level in the developing world.  

Text of WSSCC publication "Kyoto: the agenda has changed" produced for participants at the Third World Water Forum, March 16th-23rd, Kyoto, Japan