Water Supply, Sanitation and Hygiene (Wash) in the Era of the Sustainable Development Goals - Full Text

The Sustainable Development Goals (SDGs) and the World Bank’s corporate goals of ending extreme poverty and boosting shared prosperity call for specific attention to the poor and vulnerable. The overarching objective of the SDGs is to end poverty in all its forms, but their key difference from the earlier Millennium Development Goals (MDGs) is the integration of social, economic, and environmental goals (UN 2015). This has significant implications for reforms aimed at improving service delivery. With this understanding as its guiding compass, the Water Supply, Sanitation, and Hygiene (WASH) Poverty Diagnostic Initiative focuses on what it would take to reduce existing inequalities in WASH services worldwide. This report, a synthesis of that global initiative, offers new insights on how data can be used to inform allocation decisions to reduce inequalities and prioritize investment in WASH to boost human capital. It also offers a fresh perspective on service delivery that considers how institutional arrangements1 affect the incentives of a range of actors. When it comes to improving services, politics matters as much today as it did in the London of the mid-19th century. Importantly, as will be discussed below, the report does not offer prescriptive global solutions for service delivery challenges. Instead, it seeks to encourage a dialogue on ways to think and work differently, using a problem-driven approach and engaging with the constraints imposed by the broader governance environment. The Time for Action Is Now The importance of water supply, sanitation, and hygiene obviously transcends time and geography—but even where this is explicitly recognized in policy, the needs of hundreds of millions of citizens remain unmet. 2 In particular, renewed efforts are needed to address those populations at greatest risk of death and disease due to inadequate WASH, which threatens human capital and economic development. The SDGs set ambitious new targets for WASH: universal access to safe and affordable services by 2030.3 The SDGs raise the bar by aiming not only to expand access to basic WASH services but also to close gaps in service quality, with an eye toward long-term sustainability. This means not only providing water in people’s homes, but also making sure that the water is safe to drink and continuously available. It means not just constructing more sanitation facilities, but making sure, year after year, that these are used and human waste is properly removed, treated, and disposed of—in all neighborhoods, not just the wealthiest. Beyond their intrinsic value, improved WASH services will ensure the achievement of other development goals. For instance, SDG 3, focused on overall health, includes targets that explicitly relate to improvements in WASH. In their comprehensiveness, the SDGs open the difficult and yet unanswered questions of where to start making improvements, how to prioritize action, and how to overcome existing bottlenecks. Countries that have struggled to reach the MDGs for WASH4 will likely need to improve efficiency and invest even more to reach the SDGs. The fourfold increase in investments that is likely needed to meet the SDGs is beyond what most governments can afford (Hutton and Varughese 2016)5. Hence, private capital for infrastructure investment will become increasingly important for services, such as urban water supply, where cost-recovery, at least for operations and maintenance, is more feasible. And given that resources, whether public or private, will always be finite, increasing the efficiency of investments will be as important as how and where investments are made. In some cases, achieving greater efficiency will mean confronting political obstacles. Often, policy documents say the right things about investing in water supply and sanitation to benefit poor and vulnerable populations, but implementation by governments and donors does not reflect these commitments. Many countries struggle to maintain current infrastructure, let alone respond to growing demand. In densely populated areas, economies of scale can be achieved by providing piped water rather than leaving individual households to rely on their own sources, such as wells. Providing piped water also allows groundwater, a public good, to be better regulated and controlled against pollution and overabstraction. Surprisingly, this report reveals that the public provision of piped water on household premises is declining as countries struggle to keep up with population growth. In Nigeria, it fell from 29 percent in urban areas in 1990 to less than 10 percent by 2015. Similarly, in the Democratic Republic of Congo, piped connections dropped from 48 percent of the urban population in 1990 to only 17 percent in 2015. Haiti, Tanzania, and the West Bank and Gaza also suffered a decline in urban areas during this period. In the face of service delivery failures, households take matters into their own hands, sinking private wells if they can afford to (and thereby straining the local aquifer) or buying from unregulated private providers that charge three to four times what public providers do. In some countries, piped water is hardly any safer than pond water and is a threat to people’s health. The SDGs call for safely managed water, which means that improved water is located on premises, available when needed, and free of biological and chemical contamination. Figure ES.1 presents data on E. coli contamination in four countries—Bangladesh, Ethiopia, Tajikistan, and Ecuador. 6 Contamination levels vary dramatically not only by country, but also by location and household wealth. The figure also reveals a surprising fact about piped water, which is theoretically the safest source: in some locations, it is equally or more contaminated than nonpiped supply. In Bangladesh, 80 percent of piped water is contaminated with E. coli, a level that is just as contaminated as surface water. Reasons for this could be inadequate treatment at the source, and/or the intermittent water supply, whereby porous networks increase the risk of contaminants being drawn in. Giving citizens more information about this problem—making the invisible visible—will be critical for improving accountability of service providers. Improving accountability involves not only giving citizens information, but also creating space to act on that information so that service providers and/or governments have incentives to respond. Thus, it is critical to promote household water treatment in areas where the improvement of infrastructure and service will take time.