Drive against childhood illness is jeopardised by failure to invest in sanitation, warns charity

BMJ 2011; 343 doi: (Published 18 November 2011) Cite this as: BMJ 2011;343:d7498
  1. Peter Moszynski
  1. 1London

Ending the worldwide water, sanitation, and hygiene crisis is one of the biggest development challenges of the 21st century, says the latest report by the charity WaterAid, which says that there are more people in the world today lacking adequate sanitation services than in 1990.

The charity estimates that the shortfall in water and sanitation services costs sub-Saharan African countries around 5% of their gross domestic product each year ($47.7bn (£30bn; €35bn) in 2009), which it says is “more than is provided in development aid to the entire continent” ($47.6bn in 2009).

It says that almost 900 million people worldwide are without access to clean water and that more than two and a half billion lack adequate sanitation, which is the primary cause of diarrhoea­­—“the biggest killer of children in Africa and the second biggest killer of children in South Asia”­—and responsible for more than two million deaths worldwide each year.

In sub-Saharan Africa “access to sanitation is now the most off-track 2015 millennium development goal (MDG) target,” it says. In developing countries, “spending on water, sanitation and hygiene services is minimal compared to health and education,” and the “share of aid flows going to water and sanitation has fallen over the last 15 years.”

This “continued neglect leaves stark inequalities unchecked”: five times more people in rural areas live without clean water than in urban areas; poor people in South Asia are more than 13 times less likely to have access to sanitation than the rich; and poor people in sub-Saharan Africa are more than 15 times as likely to practise open defecation.

The report points out that Africa and Asia’s urban population is forecast to double by 2030, with much of this growth in unplanned settlements, “where high density living conditions without adequate sanitation substantially raise the incidence of disease.”

Barbara Frost, WaterAid’s chief executive, said, “Governments in both donor and developing countries have it in their power to save hundreds of thousands of children’s lives every year by increasing what they spend on water and sanitation. Investments in these basic services are engines of economic growth and prosperity in developing countries, but unless we grasp this opportunity we will be failing the millions of poor people whose health, livelihoods, and opportunities suffer because they lack these essential services.”

WaterAid estimates that to get the millennium development goal targets on sanitation and water back on track, countries in sub-Saharan Africa need to spend at least 3.5% of gross domestic product on these services. The report also calls on donor countries to double their aid flows on water, sanitation, and hygiene by prioritising an additional $10bn a year.

Without “a serious shift in approach,” the report concludes that the “unacceptable and avoidable tragedy of children dying before they reach the age of 5” is not going to end any time soon.


Cite this as: BMJ 2011;343:d7498


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