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sanitation

Reaching the last mile in Latin America and the Caribbean: How to provide sustainable water supply and sanitation to Indigenous Peoples

Clementine Marie Stip's picture
Young Wayúu girls go fetch water in La Guajira, Colombia

Extending the human right of access to water supply and sanitation (WSS) services to Indigenous Peoples represents the final step for many countries to reach universal coverage in Latin America and the Caribbean (LAC). As the 7th Rural Water Supply Network Forum is underway in Abidjan, Côte d'Ivoire, we must remind ourselves what “inclusion” means in the WSS sector. Poverty levels among Indigenous Peoples are more than twice those found among other Latin Americans, and they are 10 to 25 percent less likely to have access to piped water and 26 percent less likely to have access to improved sanitation.

With dire consequences on health, productivity, and well-being, these access gaps also exemplify two shortcomings of past engagement with Indigenous Peoples in the WSS sector: Indigenous territories have often been overlooked, and, even where investments specifically target Indigenous Peoples, WSS service sustainability remains a large issue. Several barriers explain this: investors’ and service providers’ lack of understanding of Indigenous Peoples' unique social and cultural characteristics, limited engagement with Indigenous authorities and attention to their priorities and aspirations, and the remoteness and difficult access to many Indigenous communities, to name a few. More generally, we need a tailored approach that responds to these challenges through institutional development, partnership with Indigenous authorities, and local capacity building for WSS services management in order to overcome the existing system that incentivizes physical interventions in easily accessible areas with limited social accompaniment. 

Helping children survive and thrive: How toilets play a part

Claire Chase's picture



While child mortality rates have plummeted worldwide, nearly one-third of all children under 5 in developing countries are stunted. Children who are stunted (having low height-for-age) suffer from a long-term failure to grow, reflecting the cumulative effects of chronic deficits in food intake, poor care practices, and illness. The early years of life, especially the first 1,000 days, are critical; if a child’s growth is stunted during this period, the effects are irreversible and have lifelong and intergenerational consequences on their future human capital and potential to succeed.  
 
For the water and sanitation community the year 2009 marked a turning point in our understanding of the role that Water, Sanitation and Hygiene (WASH) has on child stunting. A provocative Lancet article (Humphrey 2009) put forth the hypothesis that a key cause of child stunting is asymptomatic gut infection caused by ingestion of fecal bacteria. Small children living in poor sanitary environments are especially at risk, through frequent mouthing of fingers and objects during exploratory play, playing in areas contaminated with human and animal feces and ingesting contaminated food and water (Ngure et al. 2013). Researchers now estimate that up to 43 percent of stunting may be due to these gut infections, known as environmental enteric dysfunction (EED) (Guerrant et al. 2013).
 
Just last week estimates were released suggesting that poor sanitation is the second leading cause of child stunting worldwide (Danaei et al. 2016). In a key departure from previous work, the researchers defined risk as the sanitation level of a community, rather than an individual. This is consistent with mounting evidence showing that a community’s coverage of sanitation is more important than any one household’s (Andres et al. 2013). Across different studies, data sets and outcomes the evidence consistently shows that a threshold of around 60–70 percent household usage within a community is needed before the health and nutrition benefits of sanitation begin to accrue. Studies that have focused on an individual’s toilet use as a predictor, rather than a community’s use, may have vastly underestimated the impacts (Hunter and Prüss-Ustün 2016).  
 
As we advance our understanding of the ways in which a poor sanitary environment impacts growth in small children, we can better design water and sanitation interventions to target these pathways. While there is a role for multi-sectoral interventions, which can simultaneously target the underlying determinants of child undernutrition, such as food security, access to health services, and childcare practices — there are ways that the water sector can adapt its own approaches so that they are more nutrition-sensitive, and more impactful on nutrition. Here are four key actions:

Addressing the urban sanitation crisis: Time for a radical shift

Martin Gambrill's picture

Co-authors:

The Bill & Melinda Gates Foundation – Jan Willem Rosenboom
The University of Leeds – Barbara Evans
Emory University – Christine Moe & Eduardo Perez
The World Bank – Sophie Trémolet, Valérie Sturm, Clémentine Stip
WaterAid – Andrés Hueso
Plan International – Darren Saywell

Children in Maputo, Mozambique 
Photo credit: 
Isabel Blackett/The World Bank

A successful city is economically and culturally vibrant, healthy, safe, clean and attractive to business and tourism, and provides quality of life to its citizens. This vision is appealing but remains hard to realize as developing cities have to cope with changing demographics and climate with limited financial and human resources. The sustainable development goals have given a new impetus for cities to be inclusive, safe, resilient and sustainable (SDG11), ensure citizens’ health and wellbeing (SDG3) and secure access to sustainable water and sanitation services (SDG6).

World Toilet Day on November 19th is the opportunity to remind ourselves of a few facts and propose a set of guiding principles for a renewed and revitalized urban sanitation agenda.

Targeting urban sanitation: Looking behind aggregated city-level data

Peter Hawkins's picture
Also available in: Español

In our previous blogs: Fecal Sludge Management: the invisible elephant in urban sanitation,  5 lessons to manage fecal sludge better, and A tale of two cities: how cities can improve fecal sludge management, we outlined the neglect of Fecal Sludge Management (FSM) and presented new tools for diagnosing urban sanitation challenges and how they can be used. Today, on World Cities Day, we are looking more deeply into a city — Lima, Peru, to shed light on how cities around the world can meet opportunities and address challenges of urbanization including providing improved sanitation for a rapidly growing number of urban residents.

Korea: A model for development of the water and sanitation sector

Alexander Danilenko's picture
Cheonggyecheon Stream, Seoul, Korea 
Photo: Mark Pegrum

Can a sustainable water sector be developed simultaneously with a country’s growth? Can the water sector continue to expand and achieve comprehensive coverage and financial sustainability goals to become a recognized global model for water sector management and performance? Can a country without a single sewer line in 1958 have 90 percent of its wastewater treated by 2012?

The answer is yes! The example is Korea.

How we help countries track and report on the Sustainable Development Goals on water, sanitation and hygiene

Ana María Oviedo's picture
Enumerators in Ecuador collecting water sample
for water quality test.
Credit: World Bank team in Ecuador

Over the last few years, the international community has been busy establishing new indicators for the Sustainable Development Goals (SDGs), which officially replaced the Millennium Development Goals (MDGs) for the period 2015-2030. SDG #6: Ensure access to water and sanitation for all, seeks to reduce the incidence of malnutrition, communicable diseases, and inequities that are directly related to lack of access to improved sources of drinking water (affecting 663 million people worldwide) and sanitation (which 2.4 billion people still lack). This new goal implies a commitment by countries to monitor and report on their progress, similarly to what was done for the MDGs, but with much more detail.
 
From MDGs to SDGs: What’s New for Water and Sanitation?
 
Under the Millennium Development Goals (MDGs), countries were requested to report the coverage of water and sanitation, distinguishing between “improved” and “unimproved” coverage. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), established specific indicators for each, using definitions that could be captured with information from standard household surveys, which typically rely on self-reported questions on access to services collected from a nationally representative sample of households.

Delivering water and sanitation services in Niger: challenges and results

Taibou Adamou Maiga's picture

Niger is one of the world’s poorest countries (44.5% of poverty incidence in 2014). The country faces a number of challenges in meeting the national (PROSEHA, the National Program for sustainable development) and global targets to increase access to sanitation and potable water, particularly in rural areas where the access to water is 44.2% and 7% for sanitation (2015 Ministry of Water and Sanitation data).

Overcoming these challenges while satisfying increasing demands for better or expanded service, the government began investigating options that bring in the know-how of the private sector. This has led to a growing domestic private sector provision of services in Niger.

Water markets can support an improved water future

Brian Richter's picture


Fresh water touches every part of daily life—from drinking water and sanitation, to agriculture and energy production. Unfortunately, for nearly half of the world’s population, water scarcity is a growing issue with devastating impacts to our communities, economies and nature. In the past, countries have primarily turned to more supply-side infrastructure, including reservoirs and canals, as solutions to increasing water demands. But we can no longer build our way out of scarcity. We must find ways to do more with less, and impact investment can provide a catalyst for revolutionary changes in water management.  

Water markets can be a powerful mechanism for alleviating water scarcity, restoring ecosystems and driving sustainable water management. Water markets are based upon water rights which can be bought and sold, enabling water to be transferred from one user to another. A well-managed water market provides economic flexibility, encourages water saving measures and brings a variety of stakeholders to the table to find balance between the water needs of people and nature.

The Nature Conservancy’s new report, “Water Share: Using water markets and impact investment to drive sustainability,” explores the potential for water markets and impact investment to serve as part of the solution to global water scarcity. Water markets, when paired with creative investment solutions including The Nature Conservancy’s concept of Water Sharing Investment Partnerships, can help provide a more water-secure future for cities, agriculture, industries and nature.

A tale of two cities: how cities can improve fecal sludge management

Isabel Blackett's picture
Photo credit: World Bank

In previous blogs on Fecal Sludge Management (FSM), we outlined the lack of appropriate attention given to FSM as a formal urban sanitation solution and we presented new tools for diagnosing fecal sludge challenges. In this blog, we provide illustrations from Indonesia and Mozambique of the challenges and opportunities of using FSM.

5 lessons to manage fecal sludge better

Peter Hawkins's picture
Desludging in Tanzania
A motorized tricycle fitted with a small tank provides
desludging services in Dar Es Salaam, Tanzania.
Photo credit: Kathy Eales / World Bank

Our last blog outlined the neglect of Fecal Sludge Management (FSM) and presented new tools for diagnosing FSM challenges and pointing the way to solutions.  
In this blog, we’ll share some lessons learned from the city-specific case studies and analysis to highlight key areas which need to be addressed if the non-networked sanitation services on which so many citizens rely are to be effectively managed.

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