of squalor, smells, and disease. And it is a failure that holds
back the development of people and of nations.
is a failure that today deprives hundreds of millions not only of health but of productivity. It is a failure that
undermines the normal mental and physical growth of rising generations. It is a
failure that pollutes fresh water resources with faecal matter on a massive
scale. It is a failure that condemns more than a billion people to live with a
daily environmental crisis
But slowly the magnitude of the mistake is beginning to be
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
In other words, addressing the 'WASH' issues is now recognised
as central to the struggle for sustainable development.
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
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.
There is now a widespread consensus that past mistakes have
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
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.
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
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
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
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
Text of WSSCC publication
"Kyoto: the agenda has changed" produced for participants at the Third World
Water Forum, March 16th-23rd, Kyoto, Japan