Disparity in access to safe water & sanitation

Presented by:

Seema Giri
MPH Ist Year Roll No: 078 SPH & CM

Outlines
Background
Facts

on access to safe water and sanitation

Disparities in access to safe water and sanitation

due to disparity of Narrowing Gap

Impacts

Significance
2

Responsible bodies for eliminating the disparity Intervention to Decrease disparity Role of public health professional

Background
Water :

Used for domestic purposes, drinking, cooking and personal hygiene

Safe drinking water:

Free with microbial, chemical and physical characteristics that meet WHO guidelines or national standards on drinking water quality
An improved drinking-water source:

One that, by nature of its construction or through active

intervention, is protected from outside contamination, in particular from contamination with fecal matter
3

Cont

Access to safe drinking water

The proportion of people using improved drinking water

sources: household connection; public standpipe; borehole; protected dug well; protected spring; rainwater.
Source is less than 1 kilometer away from its place of use

and that it is possible to reliably obtain at least 20 litres per member of a household per day.
(WHO and UNICEF)

Classification between "improved" and "unimproved" drinking-water sources

Improved

Unimproved

Piped water into dwelling, plot Unprotected dug well or yard Unprotected spring Public tap/standpipe Small cart with tank/drum Tube well /borehole Tanker truck Protected dug well Surface water (river, dam, lake, Protected spring pond, stream, channel, irrigation Rainwater channel)
(WHO and UNICEF) JMP 5

cont..

Improved sanitation:
One that hygienically separates human excreta from human

contact. The lowest-cost technology ensuring hygienic excreta and sullage disposal and a clean and healthful living environment both at home and in the neighborhood of users.
Assess to sanitation
Generally refers to the provision of facilities and services for the

safe disposal of human urine and feces. Safety and privacy in the use of these services

Classification between "improved" and "unimproved" types of sanitation facility Improved

Flush or pour-flush to: piped sewer system septic tank pit latrine Ventilated improved pit latrine (VIP) Pit latrine with slab Composting toilet
7

Unimproved
Flush or pour-flush to elsewhere Pit latrine without slab or open pit Bucket Hanging toilet or hanging latrine No facilities or bush or field (open defecation) Public or shared facilities
(WHO and UNICEF) JMP

Facts and figures

Access to water
Global drinking water status

By the end of 2011 89% of the world population used an improved drinkingwater source

2.1 billion people gained access since 1990

> two thirds , 1.3 million live in urban areas

Over 70% of the global progress made in access to improved sources of drinking-water has been achieved through gaining access to piped drinking-water on premises

Cont 185 million relied on surface water to meet their daily drinkingwater needs

768 million people did not use an improved source for drinking-water in 2011

83% of the population lived in rural areas.

In rural areas, 1.7 billion people rely on public taps, hand-pumps, protected wells, protected springs and rainwater
(PROGRESS ON SANITATION AND DRINKING-WATER 2013 UPDATE)

10

Cont.. Drinking water status in Nepal

225 billion metric cube of water available annually An estimated 15 billion metric cube (6.66%) from

medium and small rivers has so far been utilized for economic and social purposes, mainly for drinking water, irrigation and hydropower generation.
The large river systems have been virtually left

untapped.
11

Cont..

In 2012/13

The national average for the proportion of households using safe drinking water sources 85 %
(NPC, 2013)

Nearly 44.5 % of households have access to piped water

12

55.5 %; depend on covered wells (38.5 %), open wells (7 %), and other unreliable sources like river and spring water (10 %)
(CBS,2011)

Access to sanitation
Global sanitation status
In 2011: Almost 2/3rd (64%) of the world

population relied on

improved sanitation facilities,

15% (1Billion) continued to defecate in the open 2.5 billion people lacked access to an improved sanitation

facility
The majority (71%) of those without sanitation live in rural

areas, where 90% of all open defecation takes place.

13

cont..
Sanitation status of Nepal
Between 2000 and 2011, the national sanitation coverage more

than doubled, from 30 % to 62 %. The average annual increase over this period was 2.9 %, with the increment in the two years between 2009/10 and 2011/12
(NPC & UNDP, 2012).

Remarkable progress in reducing open defecation rates: In 1990=84%, & In 2011= 43%.

41% of the declination in 20 yrs and

Annual rate of decline is 3.2%
((Progress on Sanitation and drinking-water, 2013 update)
14

Faces OF Disparities

15

How disparity ????

Water quality
Contamination by pathogens Chemical pollution Flouride, Arsenols
Health outcomes Pathogenic contamination

Poverty
lack of access to safe water resources

Health outcome Chemical contamination

Water quantity
Insufficient water available for drinking, cooking & personal Hygiene
16

Hygiene related dz

WHO

Sanitation
Poverty
Lack of access to basic sanitation infrastructure Pathogenic contamination of environment & water sources Health outcomes Poor hygiene in a contaminated environment leads to person to person transmission of dz WHO

Education
Lack of information about consequences of poor hygiene
17

Where the disparity lies?

Between countries Rural-urban disparity Intra urban disparity Geographical disparity Disparity by Sex and Age Ethnic disparity

Disparity by wealth

18

Disparities between regions

In world

100% 90% 80% 24 70% 60% 50% 12 33 13

Drinking water coverage by developing regions and the world 2011

1 9 2 9 6 8 1 7 21 2 9 9 2 6 9 2 4 6 3 10 3 8

32

88

34 40

62

59

Surface water Unimproved

40%
30% 20% 10% 0%

48

31 71 53 25 28 30

81

83 55

Other improved
47

Piped on premises

15

19
Source: Progress on sanitation and drinking water 2013

Sanitation coverage by developing regions and the world 2011

120 100
P e r 80 c e 60 n t a 40 g e

26

39
9 11 18 26

14 5 10

10 50

4 0 6

4 8 6

3 5 4

3 5 14

1 13 19

0 1
3

18
12 13

15 10 11
Open defication Unimproved

90

4
71 36

82

88

87 67

96
57 64

Shared Improved

20 0

41

30

20

Source: Progress on sanitation and drinking water progress 2013

In SAARC countries
Figure: Drinking water coverage with sources in SAARC countries 2011
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
2 1

2 5

11

40

58

28

55

64

69

69

67 52

57

41

36

29

19

19

25

Surface water Unimproved Other improved Piped on premises

21

Source: Progress on sanitation and drinking water 2013

Uses of sanitation facilities in SAARC countries 2011

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 55 47 45 98 91

0 2

1 7

4 14 27

3 23 16 26 43 50 45 6 16 6 9 11
35 35 28

24 26 6

Open Defication Unimproved Shared Improved

22

Source: Progress on sanitation and drinking water 2013

Disparities between Rural and Urban

In world:-Global drinking water coverage rural and urban 2011
3500

3000

2888

population in millions

2500

Urban
1732 Rural 967
595

2000

1500

1000

500

465
117

171
15
Surface water

0 Piped on Premise Other improved Unimproved

23

Source: Progress on sanitation and drinking water 2013

Global sanitation coverage and open defecation rural and urban 2011
3500 3000 2500
Population in millions

2887

2000 1500 1568 934

Urban
Rural

1000
500 0
Improved Shared Unimproved

471
290 150

543 107
Open defication

24

Source: Progress on sanitation and drinking water 2013

In SAARC countries
Use of drinking water sources SAARC countries rural and urban

2011
Use of Unimproved water sources 50 40 30 20 28 8
1

47

10
0

11
4 4

11

0 2

13 15

15

Urban Rural

25

Source: Progress on sanitation and drinking water progress 2013

 Uses of sanitation facilities in SAARC countries rural and urban 2011

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
0
98

5
29

5 34 66
55 34

50

21
23

93

Rural Open defication

0
97

1
74 83

4
72

24

13
60

2
55

32

0Rural Improved
46Urban Open

11
50

defication Urban Improved

26

Source: Progress on sanitation and drinking water 2013

In Nepal
Percentage using any improved source of drinking water rural and urban Nepal 2011
94 93 92 91 93.5

percentage

90 89 88.6 87.8

88
87 86 85 84
Urban

Rural

National

Source: NDHS 2011

27

Sanitation facilities rural and urban Nepal 2011

Use of toilet
70
58.1 60

50.6
50 percentage 40

36.7
29.5

Rural

30

Urban 20

12.6
10

12.4

0 Improved 28 Shared Non imroved including open defication

Source: NDHS 2011

Geographical Disparity
Nepal water and sanitation coverage of three ecological regions 2011
70

60
50
Percentage

40 30

39.9 24.8

56.91

Without toilet Unimproved water sources

20
10 0
Mountain 29 Hill

22.8

21.42 6.69
Terai
Source: National population and housing census 2011 CBS

Ethnic disparity
Figure : Sanitation coverage of different ethnicity in Western

Nepal 2011
120 100 80 60 40 1 20 1 30 2 32

Percentage

73

69

66

61

59

52

52

50

39
2

Open defication

4 4 35 3 38 44

46

49

59

Unimproved

26
0

Improved

30

Source: National population and housing census 2011 CBS

Disparity by Sex
Responsibility of carrying water in Sub Saharian Africa
Responsibility for carrying water
9% 6%

Girls Boys
23% 62%

Men Women

Source: WHO/UNICEF JMP, 2012

31

Cont
One in five girls of primary-school age are not in school,

compared to one in six boys. One factor accounting for this difference is the lack of sanitation facilities for girls reaching puberty.
( UN & UNICEF 2007)

Girls are also more likely to be responsible for collecting water

for their family, making it difficult for them to attend school during school hours
(UNICEF and IRC )

32

Disparity by Wealth
Figure: Sources of drinking water by consumption quintiles Nepal

2011
120

100 9.9 7 80 percentage 38.5

6.1 4.8

8.1 6.4

10 7.9

12.2 7.7

16.2 9.9

27.6
39.5 45 14.3 44.5

other
Open well

60

40.5

Covered well Piped outside

40 23 20 21.5 0 Nepal 33 Richest Fourth Third 24.5

47.2
21.5

26.2 10.9

Piped to house 27.1 8.5 Second 26.8

6.6
Poorest

Source: CBS 2011

Water coverage
89% World

69%

Sub Saharan Africa

Urban
87%

55%

Sierra Leone 55%

Rural

56 % Poorest
34

10 %
97% Richest JMP 2012 & Sierra Leone DHS Poorest Richest 59 %

Cont..
An American taking a five-minute shower uses more water than

the average person in a developing country slum uses for an entire need (UNDP2006).

35

Reasons behind the disparity

Lack of priority given to the sector, Lack of financial resources, Lack of sustainability of water supply and sanitation services, Poor hygiene behaviours, and

Inadequate sanitation in public places including hospitals,

health centers and schools.

36

37

IMPACTS

Cont

The most affected are the populations in developing countries,

living in extreme conditions of poverty, urban slums, poor, women & children, and marginalized population Lack of access to water, sanitation and hygiene affects the health, security, livelihood and quality of life for children, impacting women and girls first and most.

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Diarrhoae 2 million people die every year from diarrhoeal diseases (including cholera) 2,200everyday

90% are children under 5, mostly in developing countries. Nearly 90 per cent of child deaths due to diarrhoea occur in subSaharan Africa and South Asia

2nd leading cause of <U5 death 88% is attributed to unsafe water supply, inadequate sanitation and hygiene.

39

UNICEF 2012

In Nepal
Prevalence of diarrhoea Source Improved Not improved

Drinking water Toilet Facility

13.9 12.2

13.2 14.6

Percentage of children under age five who had diarrhoea in the two weeks preceding the survey NDHS 2011
40

Malaria 1.2 million people die of malaria each year,

WHO 2012

41

Cont..

Schistosomiasis An estimated 160 million people are infected The disease causes tens of thousands of deaths every year,

mainly in sub-Saharan Africa. It is strongly related to unsanitary excreta disposal and absence of nearby sources of safe water.
Trachoma 500 million people are at risk from trachoma.
146 million are threatened by blindness. 6 million people are visually impaired by trachoma.

WHO 2012
42

Intestinal helminths (Ascariasis, Trichuriasis, Hookworm

disease)
133 million people suffer from high intensity intestinal

helminth infections, which often leads to severe consequences such as cognitive impairment, massive dysentery, or anaemia. These diseases cause around 9400 deaths every year.
WHO 2012

Unsafe water, poor hygiene practices and inadequate sanitation

are not only the causes of the continued high incidence of diarrhoeal diseases, they are a significant contributing factor in U5 mortality caused by pneumonia, neonatal disorders & under nutrition
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Cont..
Children and particularly girls are denied their right to

education because their schools lack private and decent sanitation facilities. Women are forced to spend large parts of their day fetching water. Poor farmers and wage earners are less productive due to illness, health systems are overwhelmed and national economies suffer.
Lack of access to safe drinking-water and adequate sanitation

costs countries between 1% and 7% of their annual gross domestic product

(WSP-Africa, 2012).
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Maternal and child health

About 4% of all maternal death can be linked to poor WASH

conditions. Women that live in households with poor sanitation are > 3.0 times more likely to die & with inadequate water are >1.5 times more likely to die.
Drinking water influences the amniotic fluid volume, fetal well

being and removes toxic products.

(Carles, G 2002 )

Lack of access to clean water and living in environment with

dirty stagnant result in largely preventable waterrelated diseases that can lead to severe impact adverse pregnancy outcomes. i.e malaria, typhoid, chronic hookworm infestations
45

Cont..
Typhoid fever can lead to spontaneous abortion, fetal death and

maternal complications with death About 2030% of pregnant women in Sub-Sahara Africa are infected with hookworms by walking or bathing in contaminated water and thus are at risk of preventable hookworm-related anemia .It increases their risk of dying during pregnancy and delivering low birth weight babies who in turn are also at risk of dying (Booker, S et al 2008) A gram of feces can contain 10 million viruses, 1 million bacteria, 1,000 parasite cysts, and 100 worm eggs; one sanitation specialist has estimated that people who live in areas with inadequate sanitation ingest 10 grams of fecal matter every day (George, 2008) Approximately 80%of the worlds illness is caused by fecal matter (George, 2008)
46

Significance of Narrowing Gap

47

To reduce disease & economic burden To achieve MDGs To ensure Human rights

Prevent at least 9.1 per cent of the disease burden, or 6.3 % of all deaths.

Improved drinking water & sanitation

48

Reduces diarrhoea morbidity by 21%. (water supply) Reduces diarrhoea morbidity by 37.5%. ( Sanitation) Reduces transmission of malaria and other vector-borne diseases. Reduces the disease Schistosomiasis by up to 77%. Reduce trachoma morbidity by 27%. Reduce morbidity from ascariasis by 29% and hookworm by 4%.
WHO 2012

Cont..

In a study conducted in households in Uganda containing at least

one member with HIV, use of the safe water system for one year was associated with a 20% reduction in diarrheal episodes among all family members, and a 25%reduction among those with HIV (Lule et al..2005)
Costs and Benefits of Interventions
The estimated global economic benefits of drinking water and

49

sanitation improvements include health-care savings of $7 billion per year for health agencies and $340 million for individuals productivity gains of nearly $10 billion per year; time savings equivalent to $63 billion per year; and values of deaths averted (based on discounted future earnings) of more than $3 billion per year. (Prss-stn et al., 2008)

Achieving Millennium Development Goal

Safe drinking water and adequate sanitation are crucial for poverty reduction, crucial for sustainable development and crucial for achieving any and every one of the Millennium Development Goals

(Ban Ki-moon, UN Secretary General)

50

 To achieve MDG by 2015 its essential to address. Goal 7: Ensure environmental sustainability Target 7C: Halve the proportion of people without sustainable

access to safe drinking water and basic sanitation by 2015

Indicator Proportion of population using an improved drinking-water source 1990 46 2000 2010 73 80.4 2012/13 2015 85 73

Proportion of population using an improved sanitation facility

30

43

62

80

51

Relationship with other Goals

Water & Sanitation

52

To ensure human rights

In November 2002, the UN Committee on Economic, Social and Cultural Rights adopted its general comment No. 15 on the right to water stating that: The human right to water entitles everyone to sufficient, safe, acceptable, physically accessible & affordable water for personal and domestic uses.

Universal access to sanitation is, not only fundamental for human dignity and privacy, but is one of the principal mechanisms for protecting the quality of water resources. Furthermore, in April 2011, the Human Rights Council adopted, through Resolution 16/2, access to safe drinking water and sanitation as a human right: a right to life and to human dignity.
53

The human right to water & Sanitation

Sufficient

The water supply and sanitation facility for each person must be

continuous and sufficient for personal and domestic uses

According WHO, between 50 and 100 litres of water per person

per day are needed to ensure that most basic needs are met and few health concerns arise.

54

Safe
Free from micro-organisms, chemical substances and radiological

hazards that constitute a threat to health. Facilities must be situated where physical security can be safeguarded. Substantial hygiene education and promotion. Toilets must be available for use at all times of the day or night and must be hygienic; wastewater and excreta safely disposed and toilets constructed to prevent collapse. Services must ensure privacy and water points should be positioned to enable use for personal hygiene, including menstrual hygiene.
55

Acceptable
Water should be of an acceptable colour, odour and taste for

personal or domestic use. All water and sanitation facilities and services must be culturally appropriate and sensitive to gender, lifecycle and privacy requirements.
Sanitation should be culturally acceptable ensured in a non-

discriminatory manner and include vulnerable and marginalised groups. Includes addressing public toilet construction issues such as separate female and male toilets to ensure privacy and dignity.
56

Physically accessible
Everyone has the right to water and sanitation services that are

physically accessible within, or in the immediate vicinity of their household, workplace and educational or health institutions.
Within safe reach for all sections of the population, taking into

account the needs of particular groups, including persons with disabilities, women, children and the elderly
According to WHO, the water source has to be within 1,000

metres of the home and collection time should not exceed 30 minutes.
57

Affordable
No individual or group should be denied access to safe drinking

water because they cannot afford to pay

Water and sanitation facilities and services must be available and

affordable for everyone, even the poorest.

The costs for water and sanitation services should not exceed 5%

of a households income, meaning services must not affect peoples capacity to acquire other essential goods and services, including food, housing, health services and education. UN & WHO

58

Who is responsible for eliminating the disparity???

International agencies National Government

Ministries
Different stakeholders: health workers, local leaders, school

management community, NGOs, clubs, CBOs. Community Family Individual

59

What can be done to reduce disparity ????

International level: The UN system organizations and their Member States must

ensure that the UN system and its international partners provide strong and effective support for the achievement of the water supply and sanitation target and for water resources management and development Priorities funding strategies for those who do not currently have basic access, rather than giving priority to those who already have basic access. UNICEF support governments and NGOs to accelerate the provision of water supply and sanitation facilities and hygiene education for schools
60

Cont..

Partnerships and networks to increase support for related

initiatives. The Joint Monitoring Programme (WHO & UNICEF) include key indicators of the use of water supply and sanitation facilities and the effectiveness of hygiene National level (Government) Should put the sanitation crisis to the top of the agenda. Ensure that policies and institutions for water supply and sanitation service delivery, as well as for water resources management and development, respond equally to the different roles, needs and priorities of different groups Must simultaneously pursue investment and reforms for improved water supply, sanitation and water management
61

Cont..

Intersectoral collaboration in planning,intervention and

evaluation of water and sanitation facilities

At the school Governments and NGOs should ensure that children and young people participate in decisions and actions pertaining to water, sanitation and hygiene education for schools, and will enable them to be agents of change in their homes and communities. Governments and schoolteachers should provide hygiene education based on life skills.

62

Cont..

Governments should enable schools to obtain safe drinking

water and adequate water for hygiene; adequate numbers of toilets, urinals and washing facilities should be provided with separate units for girls and female teachers, and boys and male teachers Toilets should be comfortable for children to use and environmentally sustainable
Schoolteachers and students should consistently use, operate

and maintain the school water and sanitation facilities

63

Cont

At rural Governments and their civil society and private sector partners must support a wide range of water and sanitation technologies and service levels that are technically, socially, environmentally and financially appropriate Community participation in the planning and design of water and sanitation programmes Foster higher participation by women and disadvantaged groups in water projects and water user groups, particularly women heads of households Awareness to the people regarding the use of toilet, hand washing and safe drinking water
64

Cont

Individuals

and communities should have access to information and participate in decision-making

Overall Educational approach Service approach: Access Legal approach: Rule, regulation intervention

65

Role of a public health professional

Public awareness regarding utilization of safe water & sanitation Surveillance of health status and trends, including outbreak

investigations Represent health concerns in wider policy development highlighting the impact of disparity in water & sanitation to health & economy. Provide guidance in surveillance of drinking water supplies either directly or through regional/local environmental health authorities Epidemiological studies to determine the role of water & sanitation as a risk factor in disease in a risk group. Formulation and implementation of policy to ensure access to reliable, safe drinking water & sanitation facilities
66

References
Annette Prss-stn, R. B. (2008). Safer water, better health Costs, benefits

67

and sustainability of interventions to protect and promote health . Booker, S. e. (2008). Hookworms related Anemia among pregnant women: A systematic review. PLOS Negl Trop Dis . Carles, G. (2002). Fever typhoid et Grossesse,. Journal de gynecologie obstetrique et Biologie de la reproduction, . CHRISTOPHER. (2011, August 24). WASH For Mothers: Importance of clean water and sanitation during pregnancy. (2006). Human Development Report Beyond Scarcity: Power, poverty and the global water crisis. UNICEF & IRC Water Sanitation and Hygiene Education for Schools: Roundtable Proceedings and Framework for Action. http://www.who.int/water_sanitation_health/publications/factsfigures04/en/htt p://www.who.int/ceh/risks/cehwater2/en/index1.html

 (2011). Nepal Demographic Health Survey. New era. Report, N. M. (2013). Report, Nepal Millennium Development Goals

Progress. Rheingans, C. L. (2006). Global challenges in water, sanitation and health. Journal of water and health .. Richard Rheingans, O. C. (2012). Estimating inequities in sanitation-related disease burden and estimating the potential impacts of propoor targeting . UNICEF. (2012). Pneumonia and diarrhoea Tackling the deadliest diseases. UNICEF &WHO. (2013). Progress on sanitation & drinking water update. WHO. (2010). The Right to Water, Fact Sheet .Institute of Medicine (US) Forum on Microbial Threats, National Academies Press (US); 2009. Global Issues in Water, Sanitation, and Health: Workshop Summary. Washington (DC):

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Water is a fixed commodity. At any time in history, the planet contains about 332 million cubic miles of it Most is salty. Only 2 percent is freshwater and twothirds of that is unavailable for human use, locked in snow, ice, and permafrost. We are using the same water that the dinosaurs drank, and this same water has to make ice creams in Pasadena and the morning frost in Paris. It is limited, and it is being wasted. . . . But usage is only part of the problem. We are wasting our water mostly by putting waste into it. Rose George (2008)

69