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VOICE out loud
Access to water and sanitation is one of the major challenges for the 21st century. According to the WHO, across the world, 1.5 billion people do not have access to safe water and 2.6 billion people do not have access to basic sanitation facilities. Despite the global efforts linked to the achievement of Millennium Development Goal (MDG) N°7 (Ensuring environmental sustainability), those figures are going to increase. As a consequence, every day around 15,000 people, the majority of whom are children, die from water and sanitation related preventable diseases. Two thirds of these deaths being due to diarrhoea, a disease which represents 28% of mortality in developing countries (WHO 2003) as well as one third of under five child mortality. Acute malnutrition, killing one person every four seconds, is strongly linked to water and sanitation related diseases, especially when the vicious circle between infections and hunger is accelerated by HIV. The risk of mortality is 80% higher when children are malnourished or immunodeficient (WHO, 2002), and the relative part played by the factor ‘weight lower than average’ in diarrhoeal diagnostics is 61%.
Water, Sanitation and Environment
This disastrous access to water and sanitation is due partly to a lack of infrastructure, but also to poor management, creating discrepancies in the service and poor management of waste, which can lead to contamination and degradation of the environment. Water shortages lead to tensions between individuals, communities or countries, which can evolve into conflicts or fuel them. At the same time, the demand for water is increasing due to population growth, urbanisation (rural exodus), climate change and industrialisation.
Water, Sanitation, Hygiene and Public Health
Urbanisation has also created extremely poor sanitary conditions, and the peri-urban context becomes a key problem in term of public health and risks related to water related epidemics. Water, sanitation and hygiene need therefore to be considered in a broad public health sense, to include general sanitary conditions, hygiene practices –mainly responsible for water contamination (faecal contamination)- and pathogen development control (e.g. malaria).
Water, Sanitation and Livelihoods
However, water is not only important for public health, but also for general livelihoods: crop production (70 to 80% of all water used is for crop production), livestock production, industry, commerce and daily life depend on access to water. Water-supply and sanitary environment therefore affect health, hunger, poverty and community development.
Lack of access to water has a strong impact on the household economy, as the cost of water is an important part of many families’ budgets (particularly in urban and peri-urban areas). In Haiti, after the floods of December 2003 that destroyed the water-supply network of Port de Paix, and the lack of capacity of the government, that had just fallen, to carry out its rehabilitation, the price of water multiplied by five and reached an important part of the daily family budget. The economic impact of lack of access to water can be also directly linked to the water- related chores that consume time and energy (mainly for women and children), instead of productive or educational activities.
The problem is particularly acute in the remote areas of arid and semi-arid land (ASAL) regions where Action Contre la Faim often observes several hours dedicated daily to water collection during the dry season, or in urban areas where queuing can consume a lot of time and energy.
Lack of water access may severely impact the community economy too. Firstly water-related diseases indeed affect economic development too: sick people represent a loss of working capacity, and the cost in terms of drugs and treatment (even traditional) has an impact on the family and society budget. Secondly, the economical dependence on water is particularly true for many rural communities who rely on agriculture and livestock production. In ASAL regions, where livelihoods are chronically affected by droughts that cause disruption of the economic system, the construction of appropriate water systems and the training of communities in water-resource management can significantly decrease the vulnerability of rural populations to water shortages.
Approaches to WASH Problems
Most of the humanitarian crises of the late 20th and early 21st centuries have had a political component resulting from a failure within the political system, just as they may have stemmed from a lack of concern by key actors, or by a blatant disregard for human rights. This complexity and overlap of factors means that WASH problems should be solved through a large variety of approaches, linking technical interventions to the use of advocacy and lobbying.
The first principle is comprehensive management of water resources and demand: integrated management of the resource, linking it systematically with the social as well as the environmental approach is essential for a sustainable project.
Secondly, a proper prioritisation of fund allocation both from governments and the international community is necessary: water, sanitation and hygiene programmes are, paradoxically, ‘not so’ expensive projects (in average 22 Euros per beneficiary of ACF WASH projects in 2007) compared to the economic advantages they may generate. The achievement of MDG 7 is estimated to cost between US $ 9 billion (Evans, 2001) and US $ 15 billion (SE I, 2005), but the payback would be an injection of an extra US $ 65 billion to US$ 84 billion per year into the economy of developing countries (money saved by averted deaths, lower health care costs and productivity gains).
Finally, a rights based approach to the sector is the best way to make access to water and sanitation a concrete and opposable human right, that can be developed at three levels: internationally to define rules to protect water resources and people and to avoid international conflicts; nationally to apply defined rules and to define water-access policies; and locally to develop initiatives to ensure communities’ water access. Access to such basic resources should not be a commodity depending on the goodwill of local authorities or international stakeholders.
Examples of activities carried out include the collection of information (identification underlying political and economical causes), awareness campaigns, victim-protection programmes, institutional lobbying, and defence of human rights, including the human right to water.
ACF and WASH
Conflicts, natural disasters, discrimination and marginalisation, break down of social structures and extreme poverty exacerbate WASH problems and may lead to humanitarian crises. The first objective of humanitarian assistance programmes, and as such Action contre la Faim’s approach, is to protect and improve the lives of the people in these critical situations. In principle, the first interventions of WASH programs focus on coverage of the most basic and immediate needs, while at the same time seeking to reinforce and stabilise the foundations for development in the community, in a way that will reduce or eliminate the risks linked to these vulnerable situations.
In addition, WASH programmes also contribute to establish peace and equity: community mobilisation through water supply and sanitation projects can be a means of creating social cohesion and removing tension. The mechanisms of response are various and the strategy of any intervention includes several different kinds of response. Nevertheless, these responses of ACF in the WAS H sector can be classified from emergency response (Darfur, Chad), postcrisis interventions (isolated regions of central Afghanistan), to development contexts where the part of the population targeted is the one excluded from the development mechanisms (water access in the peri-urban areas of Ulan Bator in Mongolia). Specific responses like capacity building of institutions, or disaster preparedness complete the variety of approaches and make intervention more sustainable.
Action contre la Faim principles of intervention are based on developing a measurable impact; essentially verifiable either through the reduction of water related diseases morbidity figures, either through improvement of proxy-indicators like household water quantity and quality. This impact is due to the achievement of an appropriate project, including both a technical, cultural and economical feasibility and a sustainable approach oriented to strategically disengagement that can be done through an identified and partner with proper or reinforced capacity. The projects aim to be integrated (several sectors like nutrition and food security, linked to the WASH approach in a defined area, will enhance the global impact), and coherent with strategies and policies of other stakeholders, especially the institutional ones when receivable. Also, the projects, with an effective and efficient approach, aim at a valuable coverage (this is specifically tricky for sanitation where up-scaling activities is often at stake). Finally, Action contre la Faim projects consider systematically transversal issues (gender and HIV pandemics for example) and promote accountability through the regular exercise of external evaluations of their impact.
Dr Jean Lapegue
Manager Water and Hygiene Programmes
Action contre la Faim
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