Chemical Technology July 2016

Water, sanitation and hygiene by Robert Bain, Richard Johnston, Cecilia Scharp, Rifat Hossain, Bruce Gordon and Sanjay Wijesekera, all of either UNICEF or WHO

This article reflects on the role of water, sanitation and hygiene (WASH) in achieving sustainable development, and outlines key challenges that need to be addressed in order to achieve and sustain universal coverage.

W ASH is fundamentally important to lives and liveli- hoods, and underpins poverty alleviation and sus- tainable development. At a basic level, everyone needs access to safe water in adequate quantities for drink- ing, cooking and personal hygiene, and sanitation facilities that do not compromise health or dignity. lack of WASH takes a huge toll on health and well-being and comes at a large financial cost, including a sizeable loss of economic ac- tivity in many countries, not just least developed countries. While the impacts are most pronounced in lower income countries, challenges remain in wealthier nations where concerns regarding water safety and environmental sustain- ability persist alongside inequalities. Many of the broader implications of inadequate WASH – for education, cognitive development and nutrition – are not fully documented, and inadequate WASH is one of many deprivations suffered by the world’s poorest and most marginalised populations. Access to water and sanitation is recognized as a hu- man right and has long been a central aim of international development policies and targets [1]. The MDG’s (Millen- nium Development Goals) sought to “halve the proportion of the population without access to safe drinking water and basic sanitation” between 1990 and 201 5 [2]. The WHO and UNICEF Joint Monitoring Programme for Water supply and sanitation (JMP) reports impressive gains made over the last two decades with 2,3 billion people gaining access to an improved drinking water source and 1,9 billion to an improved sanitation facility [3]. Of those gaining access to drinking water, 1,6 billion now use a higher level of service: a piped water supply on premises. However, much still needs to be done – 748 million do not use an improved source of drinking water and 2,5 billion do not use an im- proved sanitation facility. Moreover, not all of those using improved facilities have fulfilled their rights; for example, an estimated 1,8 billion people drink water contaminated with Escherichia coli , an indicator of faecal contamination [4].

Hand washing with soap is one of the important elements of hygiene in WASH, although it did not form part of MDG monitoring. Globally, the prevalence of hand washing with soap is very low with some estimates suggesting four out of five people do not wash their hands after contact with excreta [5]. Moreover, many challenges remain in address- ing concerns about the adequacy of WASH services and ensuring their sustainability. Return on WASH investments Investments in water and sanitation services result in substantial economic gains. in developing region;, the return on investment has been estimated at USD$5 to USD$28 per dollar invested [6]. Overall, USD$53 billion per year over a five-year period would be needed to achieve universal coverage [7] – a small sum given this represented less than 0,1% of global world product in 2010 and since the return on investment is many times higher. Despite the potential for sizeable returns on investment, sustainable financing has not yet been attained in many settings, raising questions about who should pay and what the barriers to investment are. In many cases, capital invest- ments are made without adequate financial planning or investment in maintenance, operations and monitoring [8] which leads to poor levels of service (eg, quality, reliability, acceptability), lower usage and, in some cases, permanent failure. Such unsustainable financing not only reduces the benefits but also wastes available capital, resulting in lower coverage per dollar spent. From the user’s perspective, the affordability of WASH services is of utmost importance and may influence access, especially for the poor. The financing of water and sanita- tion, including the proportion contributed by households, varies greatly [9] as does willingness to pay for water and sanitation services. Data on household contributions are few and generally available at the national level,

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Chemical Technology • July 2016