MDG experience regarding improved drinking water, sanitation and slums and the lessons for implementation of the post 2015 agenda

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1 1 MDG experience regarding improved drinking water, sanitation and slums and the lessons for implementation of the post 2015 agenda David Satterthwaite, International Institute for Environment and Development (IIED) (second draft) 1 Unless otherwise stated, the statistics on provision for water and sanitation are drawn from WHO and UNICEF (2014), Progress on Drinking-Water and Sanitation; 2014 Update, Joint Monitoring Programme, WHO and UNICEF, Geneva, 80 pages. Contents Introduction: Assessing progress towards targets for water, sanitation and slums... 3 Innovation in water and sanitation... 4 A more detailed look at data issues... 5 How bad provision is... 7 Provision for water Provision for water in urban areas Provision for water in rural areas Provision for sanitation Basic or improved sanitation in urban areas Basic sanitation in rural areas Reducing slum populations What is provision for water and sanitation trying to achieve? Improved provision Innovations UN-Water Global Analyses Conclusions MDG lessons for post Box 1: Provision for water and sanitation in Nigeria... 7 Box 2: All we want are toilets inside our homes!... 9 Box 3: Provision for water and sanitation in Nairobi Box 4: Container based sanitation in an informal settlement in Cap Haitien, Haiti Figure 1: Provision for household drinking water in rural and urban areas in Nigeria, Figure 2: Provision for sanitation in rural and urban areas in Nigeria, Figure 3: Provision for water and sanitation in Nairobi and in Nairobi's informal settlements Figure 4: Changes in provision for water and sanitation in Nairobi's informal settlements, 2000 and Figure 5: Countries and territories with the lowest percent of their urban population with piped water on premises in Figure 6: The proportion of the urban population with water piped on premises for 1990 and

2 2 Figure 7: Countries and territories with the lowest percent of their rural population with improved provision in Figure 8: The proportion of the rural population with improved water for 1990 and Figure 9: Countries and territories with among the lowest percent of their urban population with improved sanitation Figure 10: The proportion of the urban population with improved sanitation for 1990 and Figure 11: Countries and territories with among the lowest percent of their rural population with improved sanitation in Figure 12: The proportion of the rural population with improved sanitation for 1990 and Figure 13: The countries and territories that had a lower % of their rural population with basic sanitation in 2012 than in Figure 14: Diarrhoeal disease risk reductions associated with transitions in sanitation and drinkingwater Figure 15: Different standards of provision in urban areas mean different risk levels Table 1: Proportion of urban population living in slums Table 2: The percent of the population with faecally contaminated water Table 3: The countries and territories that were furthest from the MDG goal for water piped on premises in urban areas in Table 4: The countries and territories that have already met the MDG goal for water piped on premises in urban areas in Table 5: The countries and territories that were furthest from the MDG target for improved water in rural areas in Table 6: The countries and territories that have fulfilled the MDG target for improved water in rural areas in 2012 or were close to doing so Table 7: The countries and territories that had a lower % of their population with basic sanitation in 2012 than in Table 8: The countries and territories that have already met the MDG target for basic sanitation in urban areas Table 9: The countries and territories that have rural populations where the MDG sanitation target is met Table 10: The countries and territories with rural populations furthest from meeting the MDG target for sanitation in

3 3 Introduction: Assessing progress towards targets for water, sanitation and slums It is encouraging to see greater attention being paid to water, sanitation and significantly improving the lives of slum dwellers within the Millennium Development Goals (MDGs). The draft Sustainable Development Goals (SDGs) take this further and demand universal provision by 2030, so no-one is left behind. But as this paper discusses in detail, the achievements to date in these three areas are actually much less than what is reported, because of deficiencies in data collected. It is also discouraging to recall that most governments were making commitments to universal provision for water and sanitation and improving slums nearly 40 years ago at Habitat, the first UN Conference on Human Settlements in The commitments to water and sanitation were reaffirmed a year later (at the 1977 UN Conference on Water). The UN even designated the 1980s as the International Drinking Water Supply and Sanitation Decade to help ensure universal provision by This introduction summarizes the key issues in regard to the deficiencies in data available to assess progress on water, sanitation and improving the life of slum dwellers with later sections giving more detail on this, as they report on the most recent UN statistics. Perhaps the issue that needs highlighting most in reviewing MDG progress on water, sanitation and slums is the gap between the (time-bound) goals and targets and the data available to measure whether the targets are being met. At least for the three areas that are the focus of this paper, the data available for measuring success and monitoring progress are very inadequate. Furthermore, reporting on MDG progress is often annually yet at best the surveys and censuses on which reporting relies take place every few years A second issue is that available statistics do not tell us who has sustainable access to safe drinking water or who has sanitation to a standard that means very low health risks. UN Reports on progress towards MDG targets suggest that the MDG drinking water target has already been surpassed. 2 This is confirmed in the latest (2014) report of the WHO/UNICEF Joint Monitoring Programme. 3 But unfortunately, there are no data on the two most important criteria specified in the MDG target: who has sustainable access or who has safe drinking water. Indeed, as described in more detail later, UN reports admit that improved provision for water is often faecally contaminated 4 and that if attention was given to water quality and easy access, the number of people without access to safe drinking water may be two to three times higher than official estimates. 5 The very same documents that report that the drinking water targets have been met also highlight that these are not valid measures of who has safe or sustainable supplies. The only data available to monitor MDG targets on water (for which data are available for most nations and territories) is on who has access to improved water and (as a subset of this) water piped on premises and not who has sustainable access to safe drinking water (what is specified in the MDG target). In addition, reporting on progress for the MDG water target focuses on who has improved water ; if it focused on who has water piped on premises, this would present a very different picture on progress and on coverage For sanitation, official UN Reports suggest less progress globally in reaching the MDG target but here too, there are serious problems with data. In high-income nations, almost all the urban population and most of the rural population have toilets inside the home that are connected to sewers and reliable water supplies (on which flush toilets depend). These are particularly effective from the perspectives of health and convenience and the criteria for who has adequate sanitation could be based on these. But if this was the case, the % of the population with adequate sanitation would be very low in low- and most middle-income nations. This would also over-state the problem, especially in rural areas and low density urban areas since there are other forms of sanitation

4 4 provision that can be considered adequate. But the difficulty here is devising a set of questions for surveys that can assess who has adequate or basic sanitation and with this set of questions being sensitive to different contexts - for instance where well-designed pit latrines may work well (as in many rural contexts) or very poorly (most high density urban contexts, especially with multistorey dwellings). The United Nations includes so many types of sanitation as representing basic sanitation (and also considered as improved sanitation ) that it includes provision that is very good and provision that is still very inadequate. It also has insufficient detail to assess the adequacy of provision for instance the assumption that if a pit latrine has a slab or a toilet is connected to a septic tank, it provides basic sanitation. For slum populations, UN reports also suggests that the MDG target to significantly improve the lives of at least 100 million slum dwellers by 2020 has already been met. A 2013 report on MDG progress said: Between 2000 and 2010, over 200 million slum dwellers benefitted from improved water sources, sanitation facilities, durable housing or sufficient living space, thereby exceeding the 100 million MDG target. 6 But a more careful look at the data suggests otherwise with the apparent drop in the number of people living in slums perhaps due to changes in how slums are defined. 7 For instance, there are no Government of India statistics or report showing the drop reported by UN statistics in the proportion of the urban population living in slums from 42 to 29 per cent between 2000 and Innovation in water and sanitation There is no shortage of papers documenting innovations in provision for water and sanitation and much of this done by NGOs and community organizations. But the bigger picture in so many nations is of a failure of governments and of international aid agencies and development banks to give the needed priority to water and sanitation and to support the measures that are effective in doing so. As this paper will describe in more detail, in urban areas, this is often linked to the refusal to work in informal settlements (that house around a billion urban dwellers) and the refusal to fund city-scale provision (for instance to invest in a piped water, sewer and storm drainage network for the whole city). This has meant a proliferation of private sector, NGO and community initiatives of varying quality, scale and value to those living in informal settlements which may even contribute to the failure to work at city-scale. The most effective system for collecting and disposing of toilet wastes (that also gets rid of other household liquid wastes) in high density urban contexts is a sewer system with treatment of the waste water. But these require large capital sums up-front and international agencies that could have helped provide this have chosen not to do so. Sewer systems are usually seen as too expensive although as this paper will discuss, this is often not the case. Sewer systems are seen as ecologically suspect yet they need not be. It is a little odd to have the solutions that have worked so well in high-income countries in health and convenience for which there is almost universal provision seen as inappropriate in low- and middle-income countries. And what seems to be ignored is the extent to which city and municipal governments in many Latin American countries have vastly extended provision for water piped to people s homes and household connections to city-wide sewer systems. There seems to be a strong association between more accountable urban governments (including elected mayors and city councils), stronger local government finances (sometimes from decentralization of revenue raising powers) and strong pressure from social movements and community organizations formed by those that lack or used to lack good

5 5 provision. This also includes a much wider acceptance by government of slum upgrading which brings better quality provision for water and sanitation. 8 This paper will also point to other innovations in water and sanitation, especially those that have gone to scale or have some possibility of doing so. This includes water and/or sanitation coproduction - provision undertaken by local government-community organization partnerships. A more detailed look at data issues Before reviewing progress in MDG goals and targets relating to water, sanitation and slums, there is a need for a careful and detailed consideration of the accuracy and relevance of available data. Also, of the large gap between the MDG targets and that data available to monitor progress towards them. This section provides more detail to substantiate the points made in the introduction about this. UN Reports on progress towards MDG targets suggest that the MDG drinking water target has already been surpassed. For instance, a 2013 report on the MDGs stated that significant and substantial progress has been made in meeting many of the targets including halving the proportion of people without sustainable access to improved sources of drinking water. 9 This Report also states that the MDG drinking water target was met five years ahead of the target date, despite significant population growth. This is confirmed in the latest (2014) report of the WHO/UNICEF Joint Monitoring Programme. The MDG drinking water target, to halve the proportion of the population without sustainable access to safe drinking water (an increase in coverage from 76% to 88%) between 1990 and 2015, was met in One of the most pressing limitations of the Millennium Development Goals is the gap between the desired capacity to measure and monitor progress on its goals and targets and the quality and accuracy of the data that are available for this. For instance, the MDG target 7C is Halve, by 2015, the proportion of the population without sustainable access to safe drinking water. But there are no data sources on who has access to safe drinking water or to whether this access is sustainable. The UN Joint Monitoring Programme (JMP) that provides data on progress for water has data on who has improved provision and who has water piped on premises (that is also one category within improved provision ). Improved water sources include piped water on premises (i.e. household water connection located inside the user s dwelling, plot or yard), public taps or standpipes, tube wells or boreholes, protected dug wells, protected springs or rainwater collection. None of these have any measure of whether the water is of drinking quality or of whether access is sustainable. The 2014 WHO/UNICEF report noted above admits that a significant proportion of the population said to have their MDG water needs met are using drinking water sources that are faecally contaminated. The 2013 report on MDG Progress notes the following: Furthermore, concerns about the quality and safety of many improved drinking water sources persist. As a result, the number of people without access to safe drinking water may be two to three times higher than official estimates. 11 It also noted how 2.4 billion people worldwide with improved provision do not enjoy the convenience and associated health and economic benefits of piped drinking water at home. Instead, they spend valuable time and energy queuing up at public water points and carrying heavy loads of water home, often meeting only minimal drinking water needs. The most affected are the poorest and most marginalized people in society many of whom, especially in urban areas, pay high prices for small amounts of often poor quality water. 12 So as noted in the introduction, the very same documents that report that the drinking water targets have been met also highlight that these are not valid measures of who has safe or sustainable water supplies.

6 6 If progress towards the MDG target for drinking water was assessed on the basis of who has piped water on premises rather than improved provision, it would show much less progress (and for many nations no progress). To give but one example, 79% of Nigeria s urban population and 49% of its rural population had improved provision for water in 2012 but only 6% of the urban population and 1% of the rural population had water piped on premises. Reviewing change from 1990 to 2012, the proportion of urban dwellers with improved provision went from 78% to 79% yet the proportion of urban dwellers with water piped on premises fell from 33% to 6%. The proportion of rural dwellers with water piped on premises fell from 3% to 1% during this same period. For urban areas, water piped on premises is a far more valid indicator for assessing MDG progress on sustainable access to safe drinking water than access to an improved source and if this is agreed, it completely changes the extent of provision and the extent of progress in regard to MDG targets. Another important data issue is the number of countries and territories for which there are no data either for 1990 or for 2012 so it is not possible to assess progress towards the MDG target. As will be discussed in more detail later, for some indicators, there can be over 60 countries and territories with no data and this means that reporting is incomplete. For sanitation, there is the issue of what is basic or improved ; at present, progress on sanitation is measured by who has what the UN term improved provision yet the definition for what constitutes improved provision includes forms of provision that are not adequate for good health. Improved sanitation facilities are those that are likely to ensure hygienic separation of human excreta from human contact. 13 But improved provision includes flush or pour flush toilets that are linked to a piped sewer system, a septic tank or a pit latrine, a ventilated improved pit latrine, a pit latrine with a slab or a composting toilet. There is also the fact that the quality of provision for sanitation cannot be assessed only by household facilities; it has to be assessed at a neighbourhood or village level to ascertain whether faecal matter is being managed adequately and this is not being measured. Even if a settlement has a majority of households with good quality toilets, these households are still at risk from faecal contamination if the minority are defecating in the open or disposing of their toilet wastes in open drains. Two further issues needs highlighting. The first is the lack of a data gathering system that reports accurately on progress towards MDG targets each year. No low- or middle-income nation has a data gathering system that collects data each year on provision for water and sanitation or on the number of people living in slums. Most of the data for these come from national sample surveys (for low-income countries mostly from the Demographic and Health Surveys) that are generally held every five years and from censuses that are generally held every ten years. Many low-income nations have had no recent census. So even for nations with the most complete data regular censuses and national sample surveys data on provision for water and sanitation and on slums are only available every few years. For many nations, data are much less complete for instance perhaps only available for two or three years since Yet the UN reports often have statistics for each nation presented for each year as if there was a national sample survey or census every year and so with statistics presented for many years for which there was no data from a census or a national sample survey. Many of the annual statistics are estimates or projections, yet are reported and commented on, as if they are based on actual measurements. The second issue is the failure to recognize differences in rural and urban contexts. Progress in provision for water and for sanitation are reported separately for rural and for urban areas yet the same definitions of what constitutes improved provision are applied to rural and urban areas. One

7 7 of the reasons that urban provision for water and sanitation appears to be so much better than rural provision is that what might be appropriate criteria for rural water and sanitation areas (for instance a pit latrine with a slab) are applied to urban areas where this is often not appropriate Any sanitation intervention that is not connecting people to sewers needs to think of what happens to the faecal matter. If toilet wastes are going to a septic tank, is this actually working (most simply push their untreated liquid wastes into local and often open drains). For all forms of pit latrine can it be emptied easily and is there a cheap local treatment plant to treat this (usually not). Getting a cheap yet effective system for this is so difficult as the journey time and distance between latrines or septic tanks emptied and the treatment plant has to be short and it often is not. Getting access to household latrines to empty them is often impossible along narrow and muddy lanes. Toilet wastes in pit latrines may well be contaminating groundwater sources. How bad provision is Before assessing progress between 1990 and 2012 on MDG targets for water, sanitation and slums, some examples are given of where provision is very poor. The scale of the problem in rural areas is evident. In 2012, 57% of the rural population in developing regions and 69% of the rural population in the least developed countries lacked improved sanitation. On this year, only 60% of the rural population had improved provision for water. What is less well understood is how bad provision for water and sanitation is in urban areas. For instance, in India, nearly 30% of urban households do not have water on their premises and 66% of urban households are not connected to piped sewer system. 37% are connected to septic tank, 6% use public latrines and 13% rely on open defecation. 14 Only 300 cities in India have a sewerage network in place among over 5,000 urban centres. Most are badly maintained with frequent blockages and hardly any preventive maintenance. The percent of the urban population with sewers is probably overstated because households have been shown to be connected to sewers in cities that do not have a sewerage network. 15 Box 1 highlights the inadequacies in provision for water and sanitation in urban and rural areas in Nigeria while Box 2 highlights how bad provision for toilets are in Bengaluru for adolescent girls with Box 3 looking at the inadequacies in provision in informal settlements in Nairobi. Box 1 included bottled water as within improved water sources although the UN JMP include it as unimproved except when the household uses an improved source for cooking and personal hygiene (see note 16 on page 40 of JMP 2014). Box 1: Provision for water and sanitation in Nigeria The 2013 Nigeria Demographic and Health Survey presents some detailed statistics on types of provision for water and sanitation although not disaggregated spatially beyond rural and urban. These are summarized in the figures below. It is possible to draw on the figures below to highlight how provision is better in urban areas than rural areas. But what is perhaps more relevant is how inadequate provision is for both rural and urban areas. For urban areas, for what can be considered as the closest to the MDG goal on safe and sustained supplies (water piped into the dwelling/yard/plot), only 5.5% of households. If the UN definition for improved provision is used, a higher proportion of urban and rural households have

8 8 such provision. But for urban areas, we know that public taps/standpipes (that very often have long queues), tubewells, boreholes and protective wells rarely provide safe and sustained supplies. Figure 1: Provision for household drinking water in rural and urban areas in Nigeria, 2013 % using appropriate water treatment 30+ minutes to collect water (round trip) Total: Non-improved sources Rural Urban Total: all "improved" sources Improved: Bottled water Improved: Protected well Improved:Tubewell or borehole Improved: Public tap/standpipe Improved: Piped into dwelling, yard or plot Figure 2: Provision for sanitation in rural and urban areas in Nigeria, 2013

9 9 Total for non-improved Other non-improved facility No facility/bush/field Total for shared Shared: other Shared: Pit latrine with slab Shared: Ventilated improved pit latrine Shared: Household: Flush/pour flush to pit Shared: Flush/pour flush to septic tank Shared: Flush/pour flush to sewer Total for 'improved' Household: composting toilet Household: Pit latrine with slab Household: Ventilated improved pit latrine Household: Flush/pour flush to pit latrine Household: Flush/pour flush to septic tank Household: Flush/pour flush to sewer Rural Urban For sanitation, the data are presented in three categories. The first is households with their own toilets/latrines classified as improved and this covers 36.6% of urban households and 25.1% of rural households. If we consider only households that have their own flush/pour flush toilets connected to a piped sewer system as having adequate provision in most urban contexts, only 6.1% of the urban population have this. The proportion with flush/pour toilets connected to septic tanks is slightly higher but again, in many urban contexts, septic tanks overflow. The second category is households with shared toilets/latrines classified as improved; in urban areas there are more households in this category than in the first category mentioned above. The third category is households with non-improved toilets/latrines or with no facility/bush/field; close to a quarter of urban households and more than three fifths of rural households fall into this category and most such households have no toilet facility. SOURCE: National Population Commission and ICF International (2014), Nigeria; Demographic and Health Survey 2013, PEC and ICF, Abuja, Nigeria and Rockville, USA, 538 pages. Box 2: All we want are toilets inside our homes! A study from Bengaluru (formerly Bangalore) shows the range of hardships and risks faced by adolescent girls without easy access to safe, well maintained toilets. These include sexual harassment, assault, health problems, and difficulty with school attendance and lack of free time and privacy. The advent of menstruation added to their difficulties, constraining mobility and opening them to even more humiliation. (What should also be noted is that Bengaluru is one of India s wealthiest and most successful cities). This study included some important but perhaps unexpected findings: Adolescent girls without adequate provision for toilets at home often wait till they are at school to

10 10 use a toilet, and place especially high value on good provision there. Living in a modern multi-storey building with indoor toilets did not mean piped water was available and it often fell to adolescent girls to haul enough water from standpipes for flushing. This was especially hard for those in upper stories, and many girls had chronic back problems as a result. Some families living in upper floors preferred to use nearby public toilets when there was no piped water supply. For those without their own toilets, it was common to urinate in the open to save money on paytoilets. Women and girls would wait for darkness and squat near open drains or along boundary walls. Squatting outside felt more private after monsoon when there was thick vegetation to hide behind but also more dangerous because of snakes. Men, boys and children can bathe in open spaces but women cannot, except under cover of darkness. Some families drilled holes in their walls, so that water could drain out and girls could wash in private at home. But the grey water that ended up in lanes outside could cause problems with neighbours. Queues at public toilets often made students late for school; many girls had to wake up very early when it was less dangerous to defecate in the open or when there were smaller queues at public toilets Radha lived in an unrecognized slum where more than half the population used adjoining plots of empty land for their daily toileting. She didn t mind waiting for hours at the water tap, carrying home heavy pots of water, doing household chores or minding her younger siblings; what brought tears to her eyes was the lack of a toilet. Two years previously, her family invested in a pit latrine but had to close it in a year, when they could not pay to empty the pit. Radha and other girls talked about using nearby open space and their fear of harassment and snake bites and the challenge of disposing of sanitary napkins or rags. A common toilet block had been built in their settlement but it had no piped water and the funding to make it functional was more than residents could afford. SOURCE: Nallari, Anupama (2015), All we want are toilets inside our homes! The critical role of sanitation in the lives of urban poor adolescent girls, Environment and Urbanization, Vol. 27, No. 1. Box 3: Provision for water and sanitation in Nairobi Nairobi is unusual in having detailed data on provision for water and sanitation in the informal settlements in which over half its population live and for having two surveys on this, one in 2000, the other in This allows an analysis of changes in provision between these two dates and, by drawing on the Kenya Demographic and Health Survey data for Nairobi, a comparison of provision between Nairobi and its informal settlements. The most dramatic difference between the average for Nairobi and for its informal settlements was the proportion of households with water piped into residence per cent of Nairobi s households had water piped into residence compared to 27.6% for Nairobi s informal settlements which must also mean that almost all households outside informal settlements had water piped into residence. The differences in the proportion of households getting drinking water through a public tap are also dramatic 13.4% for Nairobi on average, 59.3% for the city s informal settlements. Again, this implies that almost all Nairobi s households that live outside informal settlements do not rely on public taps. For sanitation, the figures imply that almost all Nairobi households living outside

11 11 informal settlements have flush toilets whereas less than half the households in informal settlements have this. Figure 3: Provision for water and sanitation in Nairobi and in Nairobi's informal settlements Buying drinking water Water Public tap piped into residence Other source for drinking water Flush toilet Traditional Ventilated No pit latrine pit latrine sanitation facility Nairobi (average) Nairobi informal settlements By 2012, water from a public tap had become much the most common source of drinking water in Nairobi s informal settlements. A 2006 study of provision for water, sanitation and solid waste collection in Kenya s three largest cities had highlighted the hours spent fetching water from outside the home (the mean daily time on this in Nairobi was 54 minutes) and how this more than doubled in Nairobi in times of scarcity. This study also highlighted the problems faced by those fetching water that included long queues (highlighted by 34% of respondents in Nairobi), heckling and quarrelling (17%) and queue jumping (20%). Figure 4: Changes in provision for water and sanitation in Nairobi's informal settlements, 2000 and Buying drinking water Water Public tap piped into residence Other source for drinking water Flush toilet Traditional Ventilated No pit latrine pit latrine sanitation facility Figure 4 shows the changes in provision for water and sanitation in Nairobi s informal settlements, comparing 2012 to Between these two surveys, there was a dramatic increase in the

12 12 proportion of households drawing drinking water from a public tap and equally dramatic fall in the proportion buying drinking water, there was some increase in the proportion of households with water piped into residence but in 2012, close to three quarters of households still lacked this. For sanitation, there was a substantial increase in the proportion of households with flush toilets and a drop in the proportion using traditional pit latrines and having no sanitation facility If we apply the MDG targets to Nairobi s informal settlements, if we take water piped into residence as the indicator for safe and sustained water provision, then the increase between 2000 and 2012 is far smaller than it should be if the MDG target was to be met in Nairobi informal settlements. For sanitation, the increase in the proportion of households with flush toilets+ventilated pit latrines suggests that the MDG target for basic sanitation has been met. But if there were realistic criteria on what could be considered basic sanitation at the neighbourhood level i.e. the safe collection of all toilet wastes), then it is likely that the MDG target would not be met. Flush toilets in a home may deliver good sanitation for their occupants but their toilet wastes need to be collected and/or treated and there is little evidence of this in Nairobi s informal settlements. Provision for water Provision for water in urban areas The United Nations claims that in 2010, the world had met the Millennium Development Goals target on access to safe drinking-water, as measured by the proxy indicator of access to improved drinking-water sources. Thus, this claims that the proportion of the population without sustainable access to safe drinking water had been halved. But in most urban contexts, much of what is termed improved provision is not safe (there is no measurement of water quality in improved provision) or sustained (supplies are not regular) or easily accessed. Those with access to a standpipe are included as having improved provision even as the time taken to get water (and usually with long queues) and to fetch and carry heavy loads between the standpipe and the home make this very inadequate provision. Add to this the fact that water supplies in standpipes are often irregular and also often not of drinking quality and we can see that improved provision is a very inadequate proxy for safe or for sustainable water. The United Nations also collects data on who has water on premises. This too is an inadequate indictor in that no data are collected on whether the supply of water is regular or whether the water is safe. But in urban contexts, this is a better proxy for sustainable access to safe drinking water than improved Piped water on premises The first issue is how many countries and territories have much of their urban population lacking water piped on premises. 20 percent of the world s urban population lacked this in In developing regions, it was 26%. For the least developed countries, it was 66% in Figure 5 gives examples of the many countries and territories with very low coverage. Figure 5: Countries and territories with the lowest percent of their urban population with piped water on premises in 2012

13 13 India Vanuatu United States Virgin Islands Nepal Burundi Timor-Leste Sudan Kenya Micronesia (Fed. States of) Niger Sao Tome and Principe Congo Mali Zambia Mauritania Guinea Ghana Angola Mongolia Malawi Indonesia Bangladesh Benin Afghanistan Cameroon Burkina Faso Mozambique Chad Uganda United Republic of Tanzania Democratic Republic of the Congo Myanmar Rwanda Madagascar Haiti Togo Sierra Leone Guinea-Bissau Liberia Nigeria Central African Republic Marshall Islands A second related issue is how little provision for water piped on premises has improved. For the world, there was actually a slight decline in the per cent of the urban population with water piped in premises between 1990 and 2012; for developing regions, there was a small increase and for the least developed nations a decrease as it was 66% in 2012, compared to 71% in Figure 6 shows the changes by region comparing 1990 to None of these regions got close to halving the percent of their population without water piped on premises between 1990 and Indeed, what Figure 6 shows is how little progress has been made although the problem is less serious in some regions that had achieved relatively high percentages in If water piped on premises is the indicator chosen to monitor MDG progress on halving by 2015 the proportion of the population without sustainable access to safe drinking water in urban areas, then we are not on-track to meet the MDGs for water. This is evident in Figure 6 where in none of the regions was the percent of the population lacking piped water on premises halved. Table 3 shows

14 14 the countries and territories that were furthest from the goal in 2012 with table 4 showing the countries and territories that have already met the goal. Most of the countries and territories that have more than halved the urban population without water piped on premises are middle- and highincome nations. Figure 6: The proportion of the urban population with water piped on premises for 1990 and Piped on premises 1990 Piped on premises 2012 For the 160 nations and territories for which there are data on 1990 and 2012, 44 had met the goal in 2012, 22 were at or close to 100 percent by 1990, 27 may meet goals in the remaining three year and 67 are not likely to do so. No data were available for 1990 or 2012 for over 50 countries or territories. Provision for water in rural areas A high proportion of the rural population in many nations still does not have access to improved water sources. Figure 7 gives examples of countries and territories that have among the largest percentage of their rural population lacking improved provision. Figure 7: Countries and territories with the lowest percent of their rural population with improved provision in 2012

15 15 Afghanistan Guinea-Bissau Kenya Central African Republic Mali Cameroon Kiribati Sudan Zambia Nigeria Mauritania Haiti Yemen Chad United Republic of Tanzania Sierra Leone Niger Ethiopia Togo Madagascar Mozambique Angola Papua New Guinea Democratic Republic of the Congo Within the five areas of concern for this paper whether MDG targets have been met for water in urban and rural areas, for sanitation in urban and rural areas and for significantly improving lives for slum dwellers, this is the only one where it seems MDG targets are being exceeded if the JMP definition of improved provision are applied. They would not be met if water piped on premises was used. Figure 8 shows changes in the percent of the rural population with improved water 1990 to The MDG target had been met in aggregate for developing regions but sub-saharan Africa, Oceania and least developed nations were a long way from doing so. Within Asia, Eastern Asia, Southern Asia and South-eastern Asia had met the goal by 2012 but not Western Asia Figure 8: The proportion of the rural population with improved water for 1990 and 2012

16 Improved provision 1990 improved provision 2012 Table 5 shows the countries and territories that were furthest from the MDG target in Of the 219 countries and territories for which data are available for 1990 and for 2012, 64 had met the MDG target by 2012, 79 already had 100 or close to 100% by 1990, 30 were close to meeting the MDG target and 46 were not. Most of the worst performing countries are in sub-saharan Africa. Provision for sanitation Basic or improved sanitation in urban areas The first issue is how many countries and territories have much of their urban population lacking what the MDGs term basic sanitation and what the UN Joint Monitoring Programme term improved sanitation. 20 percent of the world s urban population and 27% of those living in urban areas in developing regions lacked basic/improved sanitation in For the least developed countries, it was 52%. Figure 9 highlights this by showing the many countries and territories with very low levels of provision. Figure 9: Countries and territories with among the lowest percent of their urban population with improved sanitation

17 17 Niger Uganda Côte d'ivoire Guinea Chad Kenya Haiti Nigeria Democratic Republic of the Congo Liberia Ethiopia Togo Benin United Republic of Tanzania Sierra Leone Malawi Ghana Congo Madagascar South Sudan A second related issue is how provision for improved sanitation in urban areas has changed. Globally, the per cent of the urban population with improved sanitation increased from 76 to 80 percent between 1990 and 2012; for developing regions, it went from 64 to 73 percent and for the least developed countries, from 38 to 48 percent. Thus, in these aggregate figures, the target of halving the population lacking improved sanitation between 1990 and 2015 is not likely to be met. Figure 10 highlights in particular how there was almost no increase in the proportion of the urban population with improved sanitation in sub-saharan Africa and not much increase in Southern Asia and Oceania. Progress on this in the least developed nations was also very inadequate. Figure 10: The proportion of the urban population with improved sanitation for 1990 and 2012

18 l In relation to the target of halving those without basic provision, looking at each region, Northern Africa, Eastern Asia and Western Asia are close to meeting this MDG target; Latin America and Caribbean and the Caucasus and Central Asia are also close. Sub Saharan Africa is far from meeting it (and actually there was no increase in the percent of the urban population with basic sanitation during this 22 year period) and Southern Asia and Oceania are also way off. Table 7 lists counties and territories that actually had a lower proportion of their urban population with improved sanitation in 2012 than in Table 8 gives examples of countries and territories that have already met the MDG target of halving those without basic sanitation between 1990 and 2012 and with some countries and territories greatly exceeding the target (including Cambodia, Paraguay and Vietnam). But here, some consideration must be given to the very large range in the kinds of sanitation provision so that a household with a flush toilet in their home connected to a sewer that gets regular water supplies (so the flush toilet works effectively) and with good provision for hand washing is in the same improved category as a pit latrine with a slab. Some of the JMP figures seem at odds with reality for instance the suggestion that 87% of Angola s urban population have improved sanitation placed against the reports on the inadequacies in provision for sanitation in Luanda. 17 Many of the forms of sanitation judged to be improved are very inadequate for urban contexts where there are large population concentrations (and thus high concentrations of faecal matter) at high densities with so little space including spaces for septic tanks, for roads and paths through which pit latrine emptying equipment can reach the pits that have to be emptied and for toilet waste treatment systems. Toilets connected to septic tanks are considered as basic sanitation but it is common for septic tanks to overflow. Pit latrines with slabs are considered improved sanitation but with no consideration of whether all household members use them (or have access to it). The JMP does not report on the proportion of households with sewer connections although this would be a more useful indicator of good quality sanitation in urban areas (even if we accept that there are other forms of provision that can keep down health risks in most urban contexts). An even

19 19 better indicator of good quality sanitation would be households that have toilets in their home connected to sewers with water piped on premises that are regular. If this was used to assess who had basic sanitation in urban areas, the figures would be much lower. The lack of detail in the JMP assessments also masks the achievements in many middle-income nations of extending much better than basic sanitation to a large section of their urban population. 18 Basic sanitation in rural areas The first issue that needs highlighted is how many countries and territories have much of their rural population lacking what the MDGs termed basic sanitation. The earlier section on sanitation in urban areas noted how the indicator for basic sanitation was what the Joint Monitoring Programme term improved sanitation which does not mean safe and convenient provision. Yet even with the bar for the definition of improved sanitation set so low, in 2012, more than half the world s rural population lacked improved sanitation. 57% of the rural population in developing regions lacked improved sanitation in For the least developed countries, it was 69% in Figure 11 highlights this by showing the many countries and territories with very low provision; here 22 countries having less than 20% of their rural population with basic sanitation and 20 of them are in sub-saharan Africa. Most of the nations that have halved the proportion of their rural population lacking improved provision are from middle-income nations (see Table 9). The list of nations and territories that will not meet the MDG target is much longer than those that will (see also Table 10). Figure 11: Countries and territories with among the lowest percent of their rural population with improved sanitation in 2012

20 20 India Nigeria Bolivia (Plurinational State of) Ethiopia Djibouti Angola Namibia Haiti Mali Sudan Papua New Guinea Madagascar Guinea Mozambique Côte d'ivoire Mauritania Guinea-Bissau Ghana Malawi United Republic of Tanzania Central African Republic Sierra Leone Burkina Faso Chad Liberia Benin Niger Eritrea Togo A second related issue is how provision for basic sanitation in rural areas has changed. Globally, the per cent of the rural population with basic/improved sanitation increased from 28 to 47 percent between 1990 and 2012; for developing regions, it went from 21 to 43 percent and for the least developed countries, from 14 to 31 percent. Thus, in aggregate, the target of halving the population lacking improved sanitation between 1990 and 2015 is not likely to be met. For instance, for developing countries, meeting the MDG target would need an increase in the proportion with basic sanitation from 43 to 60 percent, Figure 12: The proportion of the rural population with improved sanitation for 1990 and 2012

21 l Looking at each region, the Caucasus and Central Asia has met the MDG target for 2015, Eastern Asia is likely to meet the target and Northern Africa, South-eastern Asia and Latin America and the Caribbean have all made substantial progress and may meet the target by Sub Saharan Africa is far from meeting the target; so too are Southern Asia and Oceania. So too, in aggregate, are the least developed countries. Figure 13 shows the countries and territories that actually had a lower proportion of their rural population with improved sanitation in 2012 than in 1990 Figure 13: The countries and territories that had a lower % of their rural population with basic sanitation in 2012 than in Table 7 shows the countries and territories where the MDG target has been met

22 22 Reducing slum populations A 2013 UN report on MDG progress said: Between 2000 and 2010, over 200 million slum dwellers benefitted from improved water sources, sanitation facilities, durable housing or sufficient living space, thereby exceeding the 100 million MDG target. 19 This report also stated: The proportion of urban slum dwellers declined significantly. 20 But a more careful look at the data suggests otherwise. The information needed to allow monitoring of progress annually on the numbers of slum households by nation, region and globally does not exist. Here, MDG reporting requirements are far beyond the data available. Table 1 seems to contradict this as it has statistics on the proportion of the urban population living in slums for various years between 1990 and But there are good grounds for doubting the accuracy of UN Habitat s statistics and its claim that there has been a very substantial drop in the proportion of urban households living in slums between 1990 and 2012 (or between 2000 and 2012). The data problems here mirror those related to many of the MDG goals including those relating to water and sanitation; the ambition to monitor closely trends in relation to MDG goals and associated targets and indictors exceeds the data that are actually being collected often by a very large margin. Table 1: Proportion of urban population living in slums Developing Regions Northern Africa Sub-Saharan Africa Latin America and the Caribbean Eastern Asia Southern Asia South-eastern Asia Western Asia Oceania SOURCE: UN-Habitat The desire to report on MDG progress annually confronts a data system that at best only provides data every five years. This means that most annual figures are estimated, drawing on statistics that are at best available every five years and for many countries and territories far less often or even not at all. The figures in Table 9 have statistics for 1990, 1995, 2000, 2005, 2007, 2010 and 2012 but these must be based on a lot of estimates and projections and for many nations guesses in the absence of any reliable data. This is an issue with importance far beyond a discussion of definitions in that it calls into question much of the apparent progress in meeting the MDGs. When the Millennium Development Goals included a goal on slums, so the need arose to measure and monitor progress towards the goal. The goal was By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers. The wording is important; it is not to reduce or eliminate slums (which can worsen conditions for low-income groups) but significantly improve the lives of slum dwellers. The numbers are a bit of a mystery why 2020 instead of 2015 (used in other MDGs) and why only 100 million which would represent a small proportion of slum dwellers in need of significant improvements in their lives? It fell to UN Habitat to devise a way to measure slum populations and also to use this in monitoring progress. But UN Habitat does not have the capacity or funding to set up a global data collection system on this. So for national data, it is limited to using or re-using data collected by other

23 23 institutions for instance the Demographic and Health Surveys or censuses. This also means that the UN Habitat statistics have to make do with whatever data are collected by censuses or surveys. When considering how to measure progress on this goal, initially UN Habitat set five criteria for defining slum populations. Slum household were defined as a group of individuals living under the same roof in an urban area who lack one or more of the following: 1. Durable housing of a permanent nature that protects against extreme climate conditions. 2. Sufficient living space which means not more than three people sharing the same room. 3. Easy access to safe water in sufficient amounts at an affordable price. 4. Access to adequate sanitation in the form of a private or public toilet shared by a reasonable number of people. 5. Security of tenure that prevents forced evictions. It seems as if the fifth criterion has been dropped presumably because of inadequate data. But there are also many problems with data for the other criteria. This is especially the case for water and sanitation. What is puzzling is that UN Habitat seems to be using the UN JMP data for water and sanitation but giving other definitions for what improved or basic provision is. So the UN Habitat Guide to Monitoring MDG Target 11 contains definitions for improved provision that are very different from those of the JMP. The UN Habitat definition: A household is considered to have access to improved water supply if it has sufficient amount of water for family use, at an affordable price, available to household members without being subject to extreme effort, especially to women and children. 21 But the JMP data does not assess whether the water is sufficient or affordable or available without extreme effort For sanitation, there are comparable differences between what UN Habitat describes as improved provision for sanitation and what are available from JMP data. UN Habitat defines access to improved sanitation as access to an excreta disposal system, either in the form of a private toilet or a public toilet shared with a reasonable number of people. 22 One wonders where UN Habitat gets data on whether or not a public toilet is shared by a reasonable number of people and whether this is an appropriate measure (public toilets need to be assessed for their access (including distance from users, queue time and opening hours), safety, cleanliness and affordability.. When UN definitions on slum households were applied as in the global report in 2005, it produced some very questionable statistics as more than 99 percent of urban households were said to live in slums in some nations. 23 Many countries are reported to have had very large falls in the proportion of their urban population living in slums. For instance, drawing on data provided by UN Habitat, the proportion of the urban population living in slums in India dropped from 54.9% in 1990 to 41.5% in 2000 to 29.4% in For Bangladesh it dropped from 87.3% in 1990 to 77.8% in 2000 and 61.6% in For Egypt it dropped from 50.2% in 1990 to 28.1% in 2000 and 17.1% in Among other nations reported to have had large falls in the proportion of their urban population living in slums are Mali, Indonesia, Ghana and Nigeria. But this does not fit with the many papers that have highlighted the growth of informal settlements in these and many other nations and the lack of success in increasing provision for water and sanitation (and in some nations as in Nigeria where there has been a decline in the proportion of the urban population with provision).

24 24 What is provision for water and sanitation trying to achieve? Improved provision Figures 14 and 15 are both recognizing that there are many intermediate steps between no improved provision (with all its health risks) and provision that has very low health risks and is the standard solution in high-income nations (water piped into the home that is drinking water quality and available 24 hours a day and a flush toilet in the home connected to sewers or septic tanks that work). In effect, there is a ladder of different options for water and for sanitation that lower health risks and increase convenience and reduce time (for instance from walking to and from and/or having to queue for community standpipes or toilets). It is likely that almost all households would prefer the solution with the lowest risks and greatest convenience unless these come with a cost burden that households find unaffordable or where indoor space is so constrained (several people living in a single small room) that there is no room for a toilet. Of course, flush toilets will not be a preferred solution unless there is a regular and affordable water supply to flush them. Figure 14 comes from WHO and draws on a range of studies. 24 It makes evident the very large reduction in diarrhoeal disease between unimproved source of drinking water and piped water systematically managed. Also between unimproved sanitation facilities and community sanitation or sewer connections. It is also reminder of the importance of good practice in water treatment and storage in the home (although those with regular piped water supplies can dispense with storage in the home). But this figure includes the following note: Estimates of risk reductions associated with transitions to higher levels of service are based on limited evidence and should therefore be considered as preliminary. They are not used in estimating deaths attributable to poor water and sanitation, but suggest that additional health gains could be achieved by transitions to higher levels of service. 25 Figure 14: Diarrhoeal disease risk reductions associated with transitions in sanitation and drinking-water SOURCE: