Valuing water supply, sanitation and hygiene (WASH) services in human settlements.

 

In 2017, 5.3 billion people (71% of the global population) used a safely managed drinking water service – one located on premises, available when needed and free from contamination. 3.4 billion people (or 45% of the global population) used safely managed sanitation services – an improved toilet or latrine that is not shared, from which excreta are safely disposed of in situ or treated off-site. Each year, it is estimated that approximately 829,000 people die from diarrhoea as a result of unsafe drinking water, sanitation and hand hygiene. These causes represent 60% of all deaths due to diarrhoea globally, including nearly 300,000 children under the age of five, 5.3% of all deaths in this age group. Poor sanitation and hygiene, as well as unsafe drinking water, cause diarrhoeal disease and environmental enteropathy, which inhibit nutrient absorption, resulting in undernutrition. Roughly 50% of all malnutrition is associated with repeated diarrhoea or intestinal worm infections as a direct result of inadequate water, sanitation and hygiene. An estimated 45% of all deaths of children under the age of five is from undernutrition. The economic cost of undernutrition is estimated to be up to US$2.1 trillion. A recent assessment of the impact of unsafe WASH on childhood diarrhoeal disease suggests that household connections to water supplies and higher levels of sanitation coverage in communities lower risks of diarrhoeal morbidity. The assessment found that piped water of higher quality and continuous availability to premises reduced diarrhoea risk by 75%, compared to a baseline of unimproved drinking water. Sanitation interventions reduced diarrhoeal risk by 25%, with evidence for greater reductions when high sanitation coverage is reached, while interventions promoting handwashing with soap reduced these risks by 30%, compared with no intervention. Hand hygiene is extremely important to prevent the spread of COVID-19. Globally, over three billion people and two out of five health care facilities lack adequate access to hand hygiene facilities. At the global level, 11% of maternal deaths, mostly in low- and middle-income countries, are caused by infections linked to unhygienic conditions during labour and birth at home or in facilities, and to poor hygiene practices in the six weeks after birth. Infections associated with unclean births may account for more than one million deaths each year. Basic hygiene practices during antenatal care, labour and birth can reduce the risk of infections, sepsis and death of infants and mothers by up to 25%. WHO/UNICEF showed that 69% of schoolchildren had access to drinking water (based on data from 92 countries), 66% to sanitation (in 101 countries) and 53% to hygiene (in 81 countries). This equates to 570 million children lacking drinking water in schools, 620 million lacking sanitation and 900 million lacking hygiene. UNDP reported that over 443 million school days are lost due to water-related illnesses. Around 230 million people, mostly women and girls, spent more than 30 minutes per trip collecting water from sources away from their home. This puts them at additional risk of attack or rape. Across 61 countries, women and girls were responsible for carrying water in eight out of ten households. The United Nations Children’s Fund has calculated how much time women and girls spend carrying water everyday, which equals 200 million hours, or 8.3 million days, or 22,800 years. It is estimated that at least US$6.5 billion is lost per year in working days due to a lack of access to sanitation. In addition, almost 400,000 work-related deaths occur each year from communicable diseases, which have the main contributing factors being poor-quality drinking water, and poor sanitation and hygiene. Access to WASH in the workplace is also an issue that impacts gender equality and women’s workplace productivity. It was shown that in the Philippines and Viet Nam, in workplaces where WASH facilities were inadequate and assuming women would be absent for at least one day during their menstrual period for lack of such facilities, this would equate to 13.8 million and 1.5 million workday absences, respectively, and US$13 million and 1.28 million in economic losses. The World Health Organization (WHO) estimated that the total economic losses associated with inadequate WASH services amount to US$260 billion annually in 136 low- and middleincome countries, which is roughly equivalent to an average annual loss of 1.5% of the aggregate GDP of those countries. It has been estimated that achieving universal access to safe drinking water, sanitation and hygiene (SDG Targets 6.1 and 6.2) in 140 low- and middle-income countries would cost approximately US$1.7 trillion from 2016 to 2030, or US$114 billion per year. According to research done across ten low- and middle-income countries, on average, 56% of subsidies end up in the pockets of the richest 20%, while only 6% of subsidies find their way to the poorest 20%. The 2019 World Water Development Report observed that people living in informal settlements often pay 10–20 times more for their water, which comesfrom suppliers such as water tankers. While it has previously been reported that returns on investment in sanitation, based on the global averages, deliver over twice the return on investment compared to drinking water, new analysis by Hutton, based on disaggregated data between rural and urban areas, suggest that current benefit–cost ratios (BCRs) favour drinking water supply (with BCRs of 3.4 and 6.8 for urban and rural areas respectively) over sanitation (with 2.5 and 5.2. for urban and rural areas respectively). These differences in BCRs between the two services and the differences in BCRs for each service between urban and rural settings are possibly due to basic sanitation being generally more expensive to provide than basic water supply, while both are more costly in urban areas.