WHO decides what is meant by 'improved'?

In my last post I highlighted some of the concerns regarding the effectiveness of 'improved' water and sanitation services in meeting UN targets of providing safe and affordable drinking water and adequate and equable sanitation and hygiene for all. In this post I want to unpick the term 'improved' even further, by looking at who decides whether a source of water or sanitation is 'improved' and on what criteria this decision is based.

Figure 1

The task of monitoring the provision of water and sanitation services supplied by the Millennium Development Goals and the Sustainable Development Goals is the responsibility of the Joint Monitoring Programme (JMP) which is run jointly by the WHO and UNICEF. It is the JMP that decides how drinking water and sanitation services are classified (Figure 1). In Annex 1 of the UN report "25 Years Progress on Sanitation and Drinking Water" the JMP is described as having "benefitted enormously from the support and advice of experts, policymakers and practitioners working in the field of drinking water, sanitation and hygiene"..."to provide technical advice on specific issues and methodological challenges related to monitoring the MDGs" (p50). Although these experts have undoubtedly provided a wealth of useful information to the JMP, there appears to be no mention of any advice provided by those targeted by the goals themselves.

The concept of participatory development has been prominent within developmental rhetoric since the early 1990s. Guijt and Shah define participatory development as the involvement of "socially and economically marginalised peoples in decision making over their own lives" (1998: p1). It advocates for a bottom-up approach to development practice in which the views of those targeted by the practice are used to ensure that development plans are in-keeping with the needs and wants of the local people.

In a study conducted by Schouten and Mathenge (2010) based on the results of a case study in the Kibera slum attached to Nairobi, concern was raised regarding the lack of inclusion of local people in determining what does, and what does not, constitute an improved sanitation facility. A key issue for prospective sanitation providers in slum areas is determining the most appropriate sanitation facility given the circumstances of the area. For the Kibera slum, a number of potential facilities are identified such as VIP latrines, pour-flush latrines, WC toilets and biogas toilets. Whether or not one of these facilities is more appropriate than another is determined by the prevailing local conditions and environmental, social and economic considerations. However, since this decision is in the hands of the service provider, there is a risk that it will be made without the consultation of the local community, with whom the decision should ultimately lie. Evidence provided in the study indicates that in many cases, the opinions of those who stand to gain/lose the most from these decisions are often not listened to. Instead it appears that providers tend to fall back on the JMP definition of what constitutes an 'improved' sanitation facility when making their decisions, regardless of whether this is the best option for the individual location in question. In the case of Kibera, this involves ignoring the option of communal toilets because they do not officially fall within the classification of an 'improved' sanitation facility. Yet as noted by Schouten and Mathenge and others, communal toilets are often the only viable option for sanitation provision in slums where piped sewage systems are simply not possible to install. Furthermore, the biogas toilets that were found to be widely advocated by government organisations for Kibera, proved to be very unpopular with the local people because they smelt far worse than the other facilities.

Perhaps then the WHO/UNICEF should reconsider their classifications of water and sanitation services. If the existing classification is holding back the progress of service provision, as in the case of Kibera, a more inclusive system should be adopted that uses local knowledge to determine which service options are the most appropriate. Treating locals as 'experts in their own realities' rather than relying on the views of experts in the traditional sense, may prove to be the most effective way of supplying water and sanitation services in a format that benefits the local people to the greatest extent.

SDG number 6: a brief overview and critical analysis.

The Millennium Development Goals (MDGs) set an historic precedent of global cooperation and mobilisation to achieve a common set of humanitarian targets. By packaging the development objectives into eight clearly defined and time-bound goals the MDGs have proved to be very politically effective and have led to substantial (though highly-varied) progress towards sustainable economic, social and environmental development around the world (Sachs 2012).

Following on from 2000-2015, the Sustainable Development Goals are a similar but more demanding and specific set of targets that build on the MDGs and that aim to be completed by 2030 (UN 2016).  The SDGs are made up of 169 clearly defined targets grouped between 17 goals that encompass everything from eradicating poverty to tackling climate change. Within these goals is included sustainable development goal number 6: ‘Ensure availability and sustainable management of water and sanitation for all’. The objectives of this goal can be found here.

Two key targets of SDG 6 are to provide safe and affordable drinking water for all, as well as, adequate and equable sanitation and hygiene for all. It is important to interrogate the definitions of these targets in order to understand how they will be measured. The UN uses the term ‘improved’ to describe safe drinking water within water policy rhetoric. Having access to an improved source of water, as defined by the UN, is to be within 200m of a source of water that has had human intervention to reduce its contamination from pollutants such as faecal matter. However, this definition has attracted concern from many water experts for hiding inconvenient realities. For one, having an ‘improved’ source of water nearby does not necessarily guarantee good access. In their paper, Tucker et al. (2014) investigated the socio-economic constraints on improved water source access in Ethiopia. They found that access to improved water sources was driven by interactions of poverty and rainfall variability, rather than the presence of improved water sources. For example, poorer households with less labour and capital to devote to water collection used less water even when improved water sources were available. Furthermore, poorer households were found to sometimes resort to using nearby, unimproved water sources over improved sources located further away. Similar results were found in Johannesburg following the installment of many communal taps in rural communities. Although access (distance) improved significantly from 750m to 120m, water-use remained very low at around 18l per person per day (Jagais 2006)

Further criticisms have been raised regarding the monitoring of improved water resources. After an improved water source is installed it is not uncommon for it to fall into disrepair due to a lack of maintenance. This may lead it to become contaminated and no longer safe to drink. However, if the well is not regularly monitored (which many are not), as far as the UN is concerned it will remain an improved source of water. In their paper, Heitinger et al. (2015) highlight this problem in Peru. They found that 47% of ‘improved water sources’ in the study area were contaminated with E.coli.

Furthermore, water collected from improved water sources may also be contaminated between collection and the point of use. Following the assessment of improved water sources in rural Zimbabwe and South Africa, Gundry et al. (2006) found that 12% of water samples collected at source were contaminated with E.coli. Yet more than 40% of water samples collected from household storage were contaminated, suggesting significant contamination between collection and the point of use.

‘Improved sanitation’ is a similarly ambiguous term. Many socio-economic factors affect a person’s access to sanitation even when ‘improved sanitation’ is ‘available’. One particularly pressing concern is the access inequality between men and women. Women are more threatened than men when using sanitation facilities due to the risk of sexual attack (see Moszynski 2010). It is therefore not uncommon for women to avoid using toilets at night or indeed communal facilities during the day and instead resort to alternative methods such as going to the loo in the home before throwing it outside. In Lagos for example, 67% of women interviewed by WaterAid stated they felt unsafe using a shared toilet (WaterAid 2012). 

This blog has provided a brief overview of the 2015 Sustainable Development Goals before looking in more detail at SDG number 6. A critical stance was taken in order to highlight the complexity of achieving improved water and sanitation access for all. If the UN is to achieve SDG number 6 by 2030 it must carefully consider how it defines and measures access to improved water/sanitation to ensure that statistics are not misrepresentative of reality.

Is urbanisation a blessing or a curse for sub-Saharan Africa?

The high rates of urbanisation in sub-Saharan Africa are being fuelled by rapid population growth and mass rural-to-urban migration. Although urbanisation is generally considered to be a universal driver of economic development, it is also recognised that most theories of economic development are based upon the historical development paths of ‘western’ societies and therefore do not necessarily apply to developing nations. There is little doubt however that urbanisation provides the means for increased economic and social development. Cities offer many opportunities for both rich and poor to increase their incomes, political influence and access to services such as education, health, and transport that are lacking in rural environments (WHO 2010). The agglomeration of people in urban centres is linked to structural adjustments in a nation’s economy from a low-income agrarian society to a higher income, industrial and service-based economy. As incomes rise and money becomes available for investment in urban infrastructure, the capacity for further economic and social development increases.

Urbanisation in sub-Saharan Africa has contributed to high levels of economic growth in recent decades (>5% between 2000 and 2010)(Barton and Leke 2016). Although Africa remains the most rural region on the planet, cities are playing an increasingly important role within the continent’s growing economy. Large cities such as Dar es Salaam, Tanzania, now account for significant proportions of their country’s GDP (17.5%) (NBS & RCO 2014), while the city of Lagos alone is the 7^th largest economy in all of Africa – higher than that of countries such as Kenya and Angola (Kazeem 2016). The economic benefits of urbanisation are also being translated into social developments as service provision is substantially higher in cities than it is in rural areas. In 2015, approximately 87% of those living in urban areas in sub-Saharan Africa had access to “safe water” compared to 56% in rural areas (WHO/UNICEF 2015). 

However, economic growth in sub-Saharan Africa is slowing (~3% in 2016) and is currently lower than population growth (World Bank 2016). Sub-Saharan Africa is the only region in the world where rates of urbanisation are much higher than rates of economic growth (Molen 2014). Although there have been reductions in the incidence of extreme poverty in recent decades, it still remains high (43% in 2012) and overall economic growth has been much less able to reduce poverty in Africa than elsewhere in the world (World Bank 2016). The implications of this can be seen clearly in many of sub-Saharan Africa’s major cities. The proportion of the urban population living in slums is higher in sub-Saharan Africa than anywhere else in the world (>60%) while some countries such as Sierra Leone have more than 95% of their urban population living in slums (UN-HABITAT 2010). Those who most need it are not feeling the benefits of economic growth and the result is that many of Africa’s cities are being dubbed ‘oceans of poverty with small islands of wealth’ (UN-Habitat 2010 p12). 

As for water and sanitation provision in urban areas, there is evidence to suggest that this too is suffering to a greater extent compared to previous decades. Thompson et al. (2000) investigated changes in domestic water use between the 1960s and 1990s in rural and urban areas across East Africa. Their findings showed that while rural water supplies improved during the time period, urban water supplies showed signs of fatigue under the stresses of rapid population growth. Urban per capita water use fell by almost half between 1967 and 1997 due to the deterioration of piped water supplies, leading to an increased reliance upon expensive private water vendors. The increased unreliability of urban water supplies is suggested to have had a negative effect on hygiene, as less water is available for activities such as washing. 

There is little doubt that urbanisation is a necessary prerequisite for economic and social development in sub-Saharan Africa. The growth of cities has allowed many millions of people to have access to better economic opportunities and social services compared to those offered by traditional rural societies. However, the challenge exists where rates of urban population growth are so high that urban governance structures are unable to keep pace. Slums are an unfortunate product of this, however it is important that slum dwellers are not viewed as part of the problem. Acknowledging that these people represent resources rather than problems is critical if people-centred, sustainable urban development is to be achieved (UN-Habitat 2010).

Introduction

"The biggest change of our time?

- Africa's increase from 1 to 4 billion people!"

- Hans Rosling 2015

The image above illustrates the fact that almost half of the world’s present population is concentrated in Asia. With a population of over 4.4 billion people, Asia supports approximately four times as many people as the continent of Africa (1.2 billion). However,  according to UN projections, this will not be the case for long, for this century we will witness a population explosion that will see the number of people living in Africa shoot up to over 4 billion by 2100.  By this time Africa and Asia will together be home to over 80% of the world’s population. The implications of this for Africa are huge and it will be a great challenge to try and realise the socio-economic potential of such growth without suffering from severe growing pains.

 

One consequence of this population growth will be the swelling of urban areas to absorb the increasing number of people (Fox 2013). By 2050, Africa will be the most rapidly urbanising region in the world with urban dwellers numbering 1.3 billion people, up from 500 million this year (UN 2016). Although this urbanisation will in theory give Africa the means to achieve substantial economic development, it may also lead to increased rates of urban poverty and the continued cancer-like growth of urban slums.

In their paper, Ravallion et al. discuss the implications of urbanisation on economic growth in many developing countries around the world. They address concerns regarding the increase of urban poverty due to rapid rates of urbanisation and identify sub-Saharan Africa as one region where this is particularly prevalent. According to UN-Habitat 2008, over 60% of urban dwellers in sub-Saharan Africa live in slums, more than any other region in the world, and this value is increasing as cities such as Dar Es Salem in Tanzania, and Lagos, Nigeria, continue to grow at record speeds.

The growth of slums represents one of the greatest challenges facing the 2015 Sustainable Development Goals (SDGs), as more people than ever will be forced to live in inadequate housing with little or no access to freshwater and improved sanitation. This blog will present an overview of the current slum situation in sub-Saharan Africa and attempt to understand whether SDG number 6 can be achieved by 2030.