The service level benchmark of targeting safely managed services will require better policy and regulatory frameworks and more resources. Indeed, as environmental consequences intensify and populations demand a higher quality of service, a higher target for service level will be increasingly required. This demand will raise questions about priorities; countries will face a trade-off between 1 dedicating policy space and spending public subsidies to move populations that are already served higher up the water and sanitation ladder and 2 reaching populations that are not served with basic WASH services.
Each country will have its unique set of challenges. The human right to drinking water and sanitation can serve as a reminder that priority should be given to ensuring at least a minimum level of affordable WASH service for all citizens. Populations are growing and moving, economies are developing and becoming richer, and the climate is changing.
Each one has its challenges and opportunities. Population migration to greenfield sites offers a chance of implementing new and appropriate technologies, and selection of cost-effective and affordable technologies in urban planning is essential. Economic growth leads to greater tax revenues for local governments and increased ability to upgrade infrastructure and expand urban renewal.
Climate change challenges the delivery of WASH services by affecting rainfall patterns, freshwater availability, and frequency of heat events, and it exacerbates health risks. However, this new threat, when taken seriously, can be an opportunity to overhaul outdated policies and technologies. Furthermore, as nutrient sources for chemical fertilizer become scarcer, price increases will force suppliers to seek alternatives; the price of composted sludge is expected to increase, thereby attracting investments. New research, data, and technologies are increasingly available to present new possibilities for addressing entrenched problems in the WASH sector.
The annexes to this chapter are as follows. Characterized by villous atrophy, crypt hyperplasia, increased permeability, inflammatory cell infiltrate, and modest malabsorption. The hidden flow of water if food or other commodities that require water to be produced are traded from one place to another. An odds ratio OR is a measure of association between an exposure and an outcome.
The OR represents the odds that an outcome will occur given a particular exposure, compared with the odds of the outcome occurring in the absence of that exposure. The impact evaluation in Senegal was compromised because of contamination of the treatment group with the handwashing with soap intervention group. Basic water: percentage of population using a protected community source or piped water with a total collection time of 30 minutes or less for a round-trip, including queuing same as JMP improved definition except time criteria has been introduced.
Basic sanitation: percentage of population using a basic private sanitation facility same as JMP improved definition. Basic hygiene: percentage of population with handwashing facilities with soap and water at home. Safely managed water: percentage of population using safely managed drinking water services. Corresponds to population using an improved drinking water source located on the premises, available when needed, and free of fecal and priority chemical contamination. Safely managed sanitation: percentage of population using safely managed sanitation services.
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Attribution —Please cite the work as follows: Patel, V. Dua, R. Laxminarayan, and M. Medina-Mora, editors. Mental, Neurological, and Substance Use Disorders. Disease Control Priorities, third edition, volume 4. Washington, DC: World Bank. Translations —If you create a translation of this work, please add the following disclaimer along with the attribution: This translation was not created by The World Bank and should not be considered an official World Bank translation.
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Examples of components can include, but are not limited to, tables, figures, or images. Turn recording back on. National Center for Biotechnology Information , U. Search term. Introduction Safe drinking water, sanitation, and hygiene WASH are fundamental to improving standards of living for people.
Impacts of poor WASH, thereby summarizing the evidence on the continued decline in mortality from diarrheal disease and the emerging evidence on the long-term developmental and cognitive effects of inadequate WASH on children. Effectiveness of interventions, thereby examining the health effects of specific WASH interventions, the approaches to service delivery, and the key role of broader institutional policy in accelerating and sustaining progress. Intervention costs, efficiency, and sustainability, thereby assessing the socioeconomic returns of improved WASH and considering the requirements for populations to have continued access to WASH services.
Targets The MDG targets called for halving the proportion of the population without sustainable access to safe drinking water and basic sanitation between and Definitions To understand the status of drinking water, sanitation, and hygiene, one must make a distinction between different levels of service access and population practices. Self-reported responses of access by household members may be biased Stanton and Clemens Statistics on household access provide no indication of variations in access and practices among different household members.
For example, even in communities with high coverage rates for sanitation, children still commonly defecate in the open. Indicators do not adequately reflect accountability and sustainability, which are key elements that cut across all the service levels. Hygiene Although the MDG target 7c does not provide a global indicator for hygiene, the data on the presence of a handwashing facility with soap and water are increasingly collected as part of nationally representative surveys and will form the basis for efforts to monitor target 6.
Distribution of Services The JMP has reported the distribution of water supply and sanitation services by wealth status, breaking the population into five equal wealth quintiles using an asset index. Impacts of Inadequate Wash Understanding the nature and extent of the demonstrated negative effects of inadequate WASH on individuals, the environment, and societies is important for those designing interventions and assessing benefits and efficiency.
Health Consequences Contaminated water and lack of sanitation lead to the transmission of pathogens through feces and, to a lesser extent, urine. The F-diagram explained here but not shown provides a basic understanding of these pathways by which pathogens from feces are ingested through transmission by fingers, flies, fluids, fields soil , and food: Diseases transmitted by the fecal pathway include diarrheal disease, enteric infection, hepatitis A and E, poliomyelitis, helminths, trachoma, and adenoviruses conjunctivitis Strickland Most of these diseases are transmitted through the fecal-oral pathway, but some are transmitted through the fecal-skin pathway for example, schistosomiasis and the fecal-eye pathway for example, trachoma.
These transmissions occur between humans, as well as between animals and humans. Pathogens carried through urine for example, leptospirosis mainly result from animal-to-human transmission. Lack of handwashing is associated with respiratory infections Rabie and Curtis ; inadequate hand hygiene during childbirth is linked to infection Semmelweis and neonatal mortality Blencowe and others ; Rhee and others Helminth Infections Helminth infections are transmitted in water by fecal matter schistosomiasis and in soil by soil-transmitted helminths STH.
Undernutrition and Environmental Enteric Dysfunction Undernutrition causes an estimated 45 percent of all child deaths Black and others and is responsible for 11 percent of global disease burden Black and others Social Welfare Consequences Improved water supply and sanitation provide individuals with increased comfort, safety, dignity, status, and convenience, and also have broader effects on the living environment Hutton and others In or Near Homes Water supply in or adjacent to homes provides greater comfort to household members, notably women and girls tasked with fetching water; water sources closer to home, especially piped water, are associated with increased use Howard and Bartram ; Olajuyigbe Schools and Workplaces Access to improved WASH services in schools and workplaces contributes to school attendance, school performance, and choice of where to work, especially for girls and women.
Environmental Consequences Two major environmental consequences of poor WASH practices are 1 the excessive extraction of water to meet population needs and 2 the pollution caused by poorly managed human excreta. Financial and Economic Consequences Financial and economic studies convert the health, social, and environmental effects of poor WASH to a common money metric, thereby enabling aggregation as well as comparison across locations and over time.
Not all water or sanitation technologies perform the same function, so they can be classified by the service level they provide. Service delivery models cover the components of WASH service implementation.
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Those components include 1 approaches to demand generation and WASH behavior change, 2 approaches to strengthen supply of water and sanitation goods and services, and 3 approaches to improve the effectiveness of WASH service delivery. Strengthening the enabling environment for WASH service delivery includes 1 measures to strengthen capacity, 2 legal framework, 3 policy and planning, 4 resource allocation, 5 monitoring and evaluation, and 6 other interventions to provide a stronger foundation for implementing the technology and service delivery models.
The evidence is provided in annex 9B. Effectiveness of Technologies and Practices Water technologies are designed to source, treat, distribute, and monitor the supply of water. Effectiveness of Service Delivery Models Effectiveness of service delivery models is measured by intervention uptake, change in risky behaviors, sustainability, and, to a lesser extent, health outcomes.
Approaches to Demand Generation and WASH Behavior Change Demand-based approaches start from the premise that lasting change is brought about when individual and community behaviors are affected. Approaches to Strengthening Supply of Water and Sanitation Goods and Services Supply-side approaches to water and sanitation service delivery cover the full value chain from production and assembly of inputs, importation, sales, distribution, installation, and maintenance of water infrastructure and latrines.
Examples include the following: Sanitation subsidies and financing can be targeted to conditional-cash transfer CCT participants, many of whom lack adequate sanitation. These programs also provide outreach and counseling to reach target households with sanitation promotion messages that build awareness and help change behavior.
Community-driven development CDD programs can be used as a platform to deliver CLTS and to follow up with participatory planning and budgeting to ensure that communities become free of open defecation. Safety-net programs that build skills and strengthen sources of livelihood can include sanitation businesses and services such as masonry, plumbing, and electrical skills among the list of profitable investments for beneficiaries. Many nutrition interventions already promote handwashing with soap, safe water, and sanitation. Handwashing demonstrations are often included in promotions for breastfeeding and interventions for feeding infants and young children, which also stress the use of safe water in food preparation.
Intervention Costs, Efficiency, and Sustainability Any intervention in the WASH sector requires an economic rationale, thus satisfying conditions of efficiency, affordability, and relevance. Costs The cost of interventions is one key piece of evidence for decision making, because it is relatively easy to obtain and is often cited as a constraint for an investment decision, whether by governments, private sectors, households, or individuals.
Benefits WASH services have a large array of welfare and development benefits. Intervention Efficiency: Cost-Benefit Analysis The discussion of efficiency should distinguish between cost-benefit analysis, which uses a common money metric for all costs and benefits, and cost-effectiveness analysis, which compares interventions for one type of outcome. Efficiency studies can be conducted in two ways Whittington and others : By generating estimates of cost and benefit in specific sites or field studies for the purposes of either evaluating intervention performance or selecting a site for a future project Kremer and others By using model costs and benefits for specific sites or larger jurisdictions, such as country or global level, and best-available evidence from multiple sources Hutton ; Whittington and others Intervention Efficiency: Cost-Effectiveness Analysis The main outcomes used in cost-effectiveness studies are health and environmental outcomes.
Conclusions Although global deaths from diarrhea have declined significantly over the past 20 years, poor water supply, sanitation, and hygiene are still responsible for a significant disease burden. The following research priorities are recommended for immediate attention: To adequately address equity considerations in the SDG era, there is a need to understand where poor people live and what their levels of access are. Disaggregated data on the underserved—including slum populations, ethnic groups, women, elderly, and persons with disabilities—can support prioritization.
Greater focus is needed on how to increase access in the lagging regions of South Asia and Africa, where a large proportion of the unserved live. At the country level, policy and financial incentives need to be aligned and the economic arguments made for allocating resources to WASH services. More evidence is needed to support the emerging understanding of the wider health effects of water, sanitation, and hygiene.
Multisectoral approaches will become more important as the complementarities among WASH, health, and nutrition are better understood. Further, rigorously designed and controlled studies are needed to quantify these benefits, including the measurement of cost-effectiveness to guide policy and program design. The social welfare consequences of poor WASH are not well documented but are potentially very large. In particular, a greater understanding is needed of the gender effects of inadequate WASH and of how improved WASH services contribute to gender equality.
A large part of the remaining challenge of improving access to sanitation and hygiene is behavioral rather than technical. However, little evidence exists on the effectiveness of behavior change using conventional methods at scale or on the transferability of behavior change interventions that are successful in a particular context. A better understanding of habit formation and what leads to sustainable behavior change is needed. Innovative delivery platforms that leverage national poverty reduction programs, such as CCT and CDD programs, have the potential to achieve wide coverage at little marginal cost.
Such approaches can also provide the methodology and data sources to support targeting areas of poverty in WASH services. A better understanding is needed on which WASH interventions work in slum areas and low-income neighborhoods and under what conditions the interventions work. A greater understanding is needed of how output-based incentives can be used to improve WASH service delivery and to lead to greater sustainability of services.
Innovations in subsidies and microfinance are needed to ensure that the poor gain access to improved sanitation. Despite greater availability and lower cost of sanitation goods and services, some people remain too poor to afford adequate water supply and sanitation. Such populations should be identified to receive hardware and financial subsidies. Annexes The annexes to this chapter are as follows. Annex 9A. References Adukia A. Atia A, Buchman A. Baker J L. A Case Study in Burkina Faso. Burr P, Fonseca C. Cairncross S.
Chase C, Do Q T. The Cochrane Library Curtis V, Cairncross S. Esrey S A. Fisher J. Geneva: WHO.
Child Health Indicator
Hammer J, Spears D. Howard G, Bartram J. Humphrey J. Hutton G. Economic Impacts of Sanitation in Southeast Asia. Water and Sanitation Program. Hutton G, Varughese M. Ilahi N, Grimard F. Jenkins M, Curtis V. Jenkins M, Scott B. Koolwal G, Walle D Van de. Lokshin M, Yemtsov R. Murcott S. London: IWA Publishing. Olajuyigbe A. Oster E, Thornton R.
Evaluation of Water and Sanitation Programmes in India. Pickering A J, Davis J. Berlin-Heidelberg: Springer.
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Geneva: World Health Organization. Rabalais N N, Turner R. Coastal and Estuarine Studies Rabie T, Curtis V. Ram P. Oxford, U. Schmidt W P, Cairncross S. Scott C, Shah T. Semmelweis I. Shah N B. International Development Enterprises, Phnom Penh. Smets H. Cambridge, U. Spears D. Spears D, Lamba S. Stanton B, Clemens J. Strickland G. B Company. Sumpter C, Torondel B. Turner R, Rabalais N. Van den Berg C, Danilenko A. Progress on Drinking Water and Sanitation: Update. World Bank. The Philippines: Country Environmental Analysis.
The accessibility of children and youth to safe drinking water and hygienic sanitation is vital for their survival and development. Despite a burgeoning global population, these deaths have come down significantly over the last decade, from 1. Access to clean water and sanitation are prerequisites for the achievement of other Sustainable Development Goals including SDG 3 good health and well-being , 5 gender equality , 9 industry, innovation, infrastructure , 12 responsible consumption , 13 climate action , 14 life below water , and 15, life on land.
The film was shot in approximately 20 countries and mixes spectacular shots of freshwater seen from above in countries like South Sudan or the north of Congo with the harsh reality on the ground: how to get water, and good quality water. The film brings forward the challenges but also some of the solutions — and aims to raise awareness on the scarcity of water, by throwing some surprising facts, like:. A number of major reports were released in the first half of to expand the information base and provide governments with policy guidance in critical areas. These reports include:. The OECD work on water will continue in and expand into a number of key areas of current and emerging policy priority.
These areas include:. Women for Water Partnership. It creates opportunities for converting the benefits from investments in water management into revenue streams, potentially improving the financial case for investment. A range of policy instruments are available to recover the costs of investment from those who benefit and provide a revenue stream for investors e. Improving willingness to pay for water management and water services requires clear explanation about how revenues collected will be used for stated goals that benefit users.
Robust allocation arrangements can help to shift water towards higher value uses and provide flexibility to adjust to changing conditions. Seizing opportunities from water-related innovation. Improved recognition of the value of water and use of related policy instruments can help to stimulate innovation. This in turn can lower the costs of minimising water risks and enhancing water-related services and can generate investment opportunities.
Water-related innovation, as measured by patenting activity, has more than doubled since Figure 1 OECD, a forthcoming. The top ten countries which account for the largest share of global water-related technologies patents are indicated in Figure 2. The figure also illustrates the relative specialisation of each of these countries in patents related to water security demand-side, supply-side and pollution abatement technologies.
All technologies total patents Water pollution abatement All technologies total patents Demand-side technologies water conservation Water pollution abatement Supply-side All technologies total patents technologies water availability Demand-side technologies water conservation Water pollution abatement Supply-side technologies water availability Note: The annual number of patented inventions filed for technologies each category has beenconservation normalised to 1 in Demand-side water. Investments in water security comprise a very heterogeneous range of activities. For example, investing in a wastewater treatment plant is very different from financing a floodplain to protect a city from flood risks.
Similarly, financing the construction and start-up of a new desalination plant raises different challenges and opportunities than financing the refurbishment of one in operation. At the same time, the range of financiers is also very diverse: with different mandates, investment objectives, risk appetites and liquidity needs.
As part of the on-going work of the Roundtable on Financing Water, a typology of water security investments and a typology of financiers will be developed to help match. Potential classifiers for water investments include scale from watershed to household ; function water supply, wastewater management, flood protection, etc.
A taxonomy of instruments and vehicles for infrastructure financing developed by the OECD illustrates the wide range of financing channels for infrastructure investment both direct and market-based. Each instrument has its own characteristics and implications for lending or investment portfolios Table 1.
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Analytical work on financing water is impeded by a lack of data and patchy information. Projections of financing needs are diverse and can vary by several orders of magnitude. Mapping the flow of finance to water security investments can identify the ultimate sources of capital; the level of investment and who are the different players at different stages as well as the different channels and vehicles to access investment in water security e. To advance work on mapping financing flows, the OECD is working with the European Commission to project financing needs for water supply and sanitation and flood protection in 28 EU member states by The study will also identify the sources of available finance in each country, to develop an assessment of financing capacity.
This work could be extended to a broader range of countries. Lack of data pertaining to infrastructure investment is not only an issue in the domain of water. It is a well-recognised barrier to scaling up private sector investment across infrastructure sectors. Water infrastructure is typically very long-lived and capital-intensive.
For instance, dams and conveyance infrastructure can last for years or longer. It is especially challenging to ensure that investments can cope with considerable uncertainty due to climate change, economic and demographic trends as well as technological advances. Further, investments outside of the water sector - such as urban design or the construction of physical assets in flood plains - influence the exposure and vulnerability of people and assets to water risks. Addressing this requires long-term strategic planning of investment pathways that reduce water risks at least cost and that can be adapted over time in response to developments.
This requires investments not only in infrastructure, but also in institutions and information, such as data collection and analysis. Well-designed infrastructures only deliver expected benefits when they are backed by appropriate institutions for project design, financing, management, accountability , and when they build on the best available knowledge and information. It also requires undertaking cost-benefit analysis on sequences or portfolios of projects and carefully.
Further work is required to develop the appropriate methodologies and analytical tools to assess the economic, social and environmental costs and benefits of such pathways and their combination at different scales from local level, to basin, national, transboundary and global. This methodology should also explore the potential benefits from synergies emerging from interrelated projects and their impact on water resources. It would inform project preparation and selection by governments, development finance institutions and other partners.
This depends on two factors: i a stable revenue stream; and ii how the range of risks related to water security investments are shared between public and private actors. Mobilising commercial finance, in particular domestic sources, need to be based on policy reforms of the water sector to promote efficiency gains, cost reduction and cost recovery, as well as improving the balance of tariffs and taxes as sources of finance.
Blended finance — defined as the strategic use of development finance for the mobilisation of additional finance towards sustainable development in developing countries — is a promising approach to scale-up financing flows for water Figure 3 OECD, b. It can dramatically enhance the leverage effect of development finance - which is significant and rising but not at scale Figure 4 - by mobilising other types of funds.
Further, blended finance can significantly improve the risk-return profile of water-related investments for commercial financiers.