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The numbers are in: Water is key to poverty reduction and health

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Celebrating World Water Day with the World Bank

Today, on World Water Day, we are humbled by the fact that over 663 million people on the planet still live without access to safe drinking water; 2.4 billion people lack access to basic sanitation services, such as toilets or latrines. With these challenges persisting around the world despite decades of hard work in the water and santiation sectors, are we at a point where we need to take a step back from current solutions and practices and do business differently?
The new Water Supply, Sanitation, and Hygiene Poverty Diagnostic (WASH PD) initiative suggests exactly that.
New findings from the WASH PD initiative (led by the World Bank Water Global Practice in collaboration with Poverty, Governance, and Health, Nutrition, and Population) for the first time advances our understanding in a systematic manner of the relationship between poverty and WASH at the country level. Our deep analysis of 18 countries—across six regions—provides us with new evidence of realities that must be acknowledged, and shows without a doubt that we must work together across sectors if we are to find solutions with sustained impacts on the ground.

Quick facts from around the world: 

  • In Mozambique, 90 percent of the poorest mothers lack access to antenatal care and 90 percent of underweight mothers only have access to unimproved sanitation
  • In Nigeria, 61 percent of the rural population lives more than 30 minutes away - and 34% lives more than 2 hours away - from a functioning water source
  • In Tajikistan, households in the Sugd Region report getting piped water 1 day per week
  • In Pakistan, despite improvements to nutritious food, reductions in open defecation and poverty, childhood stunting has stayed constant at 43 percent.  Construction of unimproved toilets and persistent water quality issues are not helping reduce this burden
  • In Indonesia, it is estimated that only 5 percent of urban wastewater is safely treated and disposed
  • In Tunisia, the richest 20 percent of households receive an estimated 27 percent of water subsidies, while the bottom 20 percent of households receive only 11 percent of the subsidies
  • In Ecuador, 93 percent of people in urban areas and 76 percent in rural areas has improved access to water services but still, 24 percent of the rural population drinks contaminated water 

What we’re learning is telling:  Our initiative reveals critical gaps in policy, or between policy and implementation, which leads to poor service delivery. Working with Governance colleagues at the World Bank is stretching us beyond our water sector lens, and it is becoming abundantly clear that service delivery is many times hindered by inter-governmental fiscal and administrative systems and the interplay with politics. This may not come as a surprise to those who work with these issues on the ground, but now we have the numbers to prove it.
If we shift our focus from purely designing and implementing a project to the ‘service delivery problem’, the need for multi-sectoral thinking becomes apparent. For example, in Nigeria our analysis shows that nearly 30 percent of water points and water schemes fail within the first year. Forty-four percent of borehole construction projects are never started, and only 37 percent of borehole projects that get started are fully completed. The results are that 71 percent of Nigerian households in the lowest wealth quintile lack access to a protected water source. 
So we’re learning how interventions need to be coordinated across sectors to better connect the dots so that we can optimize human development. The issues of inadequate WASH service delivery are too interconnected to think of in silos, and require us to come together as an institution to help our clients tackle what are multi-sectoral issues, like water and health. For example, in Bangladesh, close to 80 percent of samples from piped water are contaminated with E. coli.  Children living in city slums are 5 times less likely to have access to improved sanitation and also 1.5 times more likely to be stunted than other inhabitants in Dhaka. Also in Dhaka, about 88 percent of fecal waste from on-site systems is not properly treated or disposed, with dire consequences especially if it makes its way into sources of drinking water. Today, water-related diseases affect more than 1.5 billion people annually, at an enormous cost. 
The constraints are clearly not only technical in nature – the challenges are many times administrative or political. Many national laws, policies, and strategies for public water provision are not officially approved through appropriate channels. If they do get adopted, formal policies do not automatically result in changes to how systems for water service delivery function in practice.  Challenges include weak public investment management that is centralized in governors’ offices which impacts how resources are spent on water. There is no quick fix to any of these problems, which are entangled in politics, but if we are to help improve services to the poor then alleviating these constraints requires us to think and act differently. 
Our analysis also exposes the significant disparities in WASH services between rural and urban, poor and non-poor, different social groups, and regions within countries, making the explicit case for investments and interventions to be better targeted.  The rural-urban divide is the starkest: Urbanization is a fact, and in Africa we are seeing significant disparities in WASH services between capital cities and other urban areas.   For example, in Niger, with a population of about 18 million, which is largely rural and poor, access to any form of sanitation is virtually non-existent. With stunting rates in children under 5 at 44 percent, the sanitation crisis cannot be ignored. It will handicap these children as they grow up, affecting their education and ultimately, their ability to earn a living.
Lastly, better targeted and more inclusive investments ensure that systems work and service delivery reaches everyone, particularly the poor, voice-less and vulnerable. For the first time, this initiative provides highly disaggregated data giving policy-makers and programmers a laser focus on the geographic areas and populations most in need, providing clear guidance for investments.
The multi-disciplinary World Bank teams came together at both the global and country level to work on this initiative. Combining our thinking and expertise allows us to think through new solutions that are both technically and politically feasible. We hope results from this work will be a game changer and will shine a spotlight on the deficit in services and policies in an inescapable and uncontroversial way, and help us prepare targeted operations that help us scale up our support in the lowest income countries.
With these words, I wish you a thoughtful World Water Day.


Guangzhe Chen

Vice President for Infrastructure, The World Bank

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