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for instance the suggestion that 87% of Angola's urban population have improved sanitation placed against the reports on the inadequacies in provision for ...
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................................................................................................................................ 12 Provision for water in urban areas ................................................................................................... 12 Provision for water in rural areas ..................................................................................................... 14 Provision for sanitation ......................................................................................................................... 16 Basic or improved sanitation in urban areas .................................................................................... 16 Basic sanitation in rural areas ........................................................................................................... 19 Reducing slum populations .................................................................................................................. 22 What is provision for water and sanitation trying to achieve?............................................................. 24 ‘Improved’ provision ..................................................................................................................... 24 Innovations ........................................................................................................................................... 26 UN-Water Global Analyses.................................................................................................................... 30 Conclusions ........................................................................................................................................... 31 MDG lessons for post 2015 ................................................................................................................... 33

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 ............................................................................ 10 Box 4: Container based sanitation in an informal settlement in Cap Haitien, Haiti .......................... 28 Figure 1: Provision for household drinking water in rural and urban areas in Nigeria, 2013................. 8 Figure 2: Provision for sanitation in rural and urban areas in Nigeria, 2013 .......................................... 8 Figure 3: Provision for water and sanitation in Nairobi and in Nairobi's informal settlements ........... 11 Figure 4: Changes in provision for water and sanitation in Nairobi's informal settlements, 2000 and 2012 ...................................................................................................................................................... 11 Figure 5: Countries and territories with the lowest percent of their urban population with piped water on premises in 2012 ................................................................................................................... 12 Figure 6: The proportion of the urban population with water piped on premises for 1990 and 2012 14

2 Figure 7: Countries and territories with the lowest percent of their rural population with improved provision in 2012................................................................................................................................... 14 Figure 8: The proportion of the rural population with improved water for 1990 and 2012 ................ 15 Figure 9: Countries and territories with among the lowest percent of their urban population with improved sanitation .............................................................................................................................. 16 Figure 10: The proportion of the urban population with improved sanitation for 1990 and 2012 ..... 17 Figure 11: Countries and territories with among the lowest percent of their rural population with improved sanitation in 2012 ................................................................................................................. 19 Figure 12: The proportion of the rural population with improved sanitation for 1990 and 2012 ....... 20 Figure 13: The countries and territories that had a lower % of their rural population with basic sanitation in 2012 than in 1990 ............................................................................................................ 21 Figure 14: Diarrhoeal disease risk reductions associated with transitions in sanitation and drinkingwater...................................................................................................................................................... 24 Figure 15: Different standards of provision in urban areas mean different risk levels ........................ 25 Table 1: Proportion of urban population living in slums 1990-2012 .................................................... 22 Table 2: The percent of the population with faecally contaminated water ........................................ 26 Table 3: The countries and territories that were furthest from the MDG goal for water piped on premises in urban areas in 2012 ........................................................................................................... 38 Table 4: The countries and territories that have already met the MDG goal for water piped on premises in urban areas in 2012 ........................................................................................................... 39 Table 5: The countries and territories that were furthest from the MDG target for improved water in rural areas in 2012 ................................................................................................................................ 41 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 ............................................................................................... 42 Table 7: The countries and territories that had a lower % of their population with basic sanitation in 2012 than in 1990 ................................................................................................................................. 45 Table 8: The countries and territories that have already met the MDG target for basic sanitation in urban areas ........................................................................................................................................... 46 Table 9: The countries and territories that have rural populations where the MDG sanitation target is met ........................................................................................................................................................ 47 Table 10: The countries and territories with rural populations furthest from meeting the MDG target for sanitation in 2012 ............................................................................................................................ 47

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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 1976. 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 1990. 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 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 2010.

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 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 2010.” 10 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 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 1990. 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 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 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)

Rural

Urban

Total: Non-improved sources 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 0

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Figure 2: Provision for sanitation in rural and urban areas in Nigeria, 2013

100

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Total for non-improved Other non-improved facility No facility/bush/field Total for shared Shared: other Shared: Pit latrine with slab

Rural

Shared: Ventilated improved pit latrine

Urban

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 0

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90 100

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 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 2012. 16 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. 78.2 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 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 100 90 80 70 60 50 40 30 20 10 0 Buying Water Public tap Other drinking piped into source for water residence drinking water Nairobi (average)

Flush toilet

Traditional Ventilated No pit latrine pit latrine sanitation facility

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 2012 100 90 80 70 60 50 40 30 20 10 0 Buying Water Public tap Other drinking piped into source for water residence drinking water 2000

Flush toilet

Traditional Ventilated No pit latrine pit latrine sanitation facility

2012

Figure 4 shows the changes in provision for water and sanitation in Nairobi’s informal settlements, comparing 2012 to 2000. Between these two surveys, there was a dramatic increase in the

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 2012. In developing regions, it was 26%. For the least developed countries, it was 66% in 2012. 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

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

0.0

20.0

40.0

60.0

80.0

100.0

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 1990. Figure 6 shows the changes by region comparing 1990 to 2012. None of these regions got close to halving the percent of their population without water piped on premises between 1990 and 2012. 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 1990. 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 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 2012 100 90 80 70 60 50 40 30 20 10 0

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

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 0.0

20.0

40.0

60.0

80.0

100.0

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 2012. 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

100 90 80 70 60 50 40 30 20 10 0

Improved provision 1990

improved provision 2012

Table 5 shows the countries and territories that were furthest from the MDG target in 2012. 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 2012. 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

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 0.0

20.0

40.0

60.0

80.0

100.0

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

100 90 80 70 60 50 40 30 20 10 0

l990

2012

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 1990. 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 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 2012. For the least developed countries, it was 69% in 2012. 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

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 0.0

20.0

40.0

60.0

80.0

100.0

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, 2012-2015. Figure 12: The proportion of the rural population with improved sanitation for 1990 and 2012

21

100 90 80 70 60 50 40 30 20 10 0

l990

2012

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 2015. 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 1990 0.0 -2.0 -4.0 -6.0 -8.0 -10.0 -12.0 -14.0 -16.0 -18.0 -20.0

Table 7 shows the countries and territories where the MDG target has been met

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 2012. 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 1990-2012 Developing Regions Northern Africa Sub-Saharan Africa Latin America and the Caribbean Eastern Asia Southern Asia South-eastern Asia Western Asia Oceania

1990 46.2 34.4 70.0

1995 42.9 28.3 67.6

2000 39.4 20.3 65.0

2005 35.6 13.4 63.0

2007 34.3 13.4 62.4

2010 32.6 13.3 61.7

2012 32.7 13.3 61.7

33.7 43.7 57.2 49.5 22.5 24.1

31.5 40.6 51.6 44.8 21.6 24.1

29.2 37.4 45.8 39.6 20.6 24.1

25.5 33.0 40.0 34.2 25.8 24.1

24.7 31.1 38.0 31.9 25.2 24.1

23.5 28.2 35.0 31.0 24.6 24.1

23.5 28.2 35.0 31.0 24.6 24.1

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 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 21 and children.” 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 2009. For Bangladesh it dropped from 87.3% in 1990 to 77.8% in 2000 and 61.6% in 2009. For Egypt it dropped from 50.2% in 1990 to 28.1% in 2000 and 17.1% in 2009. 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

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: http://www.who.int/water_sanitation_health/gbd_poor_water/en/

25 Figure 15: Different standards of provision in urban areas mean different risk levels

Risk of contamination with faecal-oral pathogens No improved water supply and open defecation

Protected well Pit latrine Shared standpipe

Improved latrine

VERY HIGH

VERY HIGH HIGH

Good latrine emptying service

MEDIUM

Piped supply to home

Pour flush seal

MEDIUM TO LOW

Drinkable supply available continuously at home

WC with sewer or septic tank properly managed & hand washing facility

Water kiosks and vendors

n

LOW

26 Figure 15 has more ‘rungs’ in the ladder from very high health risks to low health risks within urban contexts but lacks the estimates for diarrhoeal disease risk reduction. Here again, one wonders why so little attention is given to the differences in rural and urban contexts by WHO and by the Joint Monitoring Programme. Figure 15 also implies that there are separate ladders for provision for water and sanitation but of course the two are linked and deficits in sanitation become more critical if reliable safe water is not there. 26 Table 10 is a useful supplement to the two above figures as it shows how a very significant proportion of the population with ‘improved’ provision still do not have safe water or water of drinking quality. This even includes a significant proportion of those with piped water. Table 2: The percent of the population with faecally contaminated water

Innovations There are many innovative initiatives to improve provision for water and sanitation. But the issue here is how many have a scale (which also means a local replicability) that makes them significant? Four examples will be discussed briefly here that have scale. None of them are using innovations in the forms of provision for water and sanitation. One is very conventional – the expansion in water piped to people’s homes and sewers and associated household connections which is evident in many Latin American cities. The other four are innovative in how they are organized and financed: the Baan Mankong programme in Thailand, the community-financed sewers in Pakistan; the community-designed and managed toilets in Mumbai; and co-production in four African cities. For the first of these, there has been a steady increase in the proportion of Latin America’s population with water piped on premises and sewer connections. This is a region where 80 percent of the population live in urban areas. Drawing from JMP figures, 94% of the urban population and 66% of the rural population had water piped on premises in 2012 (up from 87% and 36% in 1990). The list of countries with the best performance in increases in the percent of the urban population with water piped on premises includes most Latin American nations (see Table 4); very few countries from this region are in the worst performers (although Haiti and Dominican Republic are the exceptions). For ‘improved’ provision or increases in ‘improved’ provision in rural areas, generally Latin American nations are among the best performers. The numbers served by a sewer connection doubled between 1990 and 2010 from 168 million to 330 million. 27 Where there are statistics

27 available for particular cities, these often show a very large expansion in the proportion reached with water piped on premises and sewer connections and often close to universal provision. For most countries in this region, 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 provision. 28 This is not to suggest that there are no longer problems in this region. There are still many who are inadequately served, especially in rural areas, small urban centres and informal settlements on city peripheries. The rate of growth in coverage has slowed. And as a regional review of basic services noted, the deficiencies in provision are particularly notable “in the interior and in disadvantaged urban areas and communities” and that “it is particularly difficult to extend coverage to these areas due to their distance from formal water supply and sewerage systems.” 29 But despite the traumatic stories from the region in terms of failed privatizations 30 and the assumption that sewer systems are too expensive, this is a region where sewer systems have been improved and extended in many cities. The example of the Baan Mankong programme in Thailand is one where major improvements in water and sanitation were extended to around 100,000 low-income households living in informal settlements. It is an example too of how upgrading in informal settlements can contribute to increased coverage of high quality provision for water and sanitation. Large scale ‘slum’ and ‘squatter’ upgrading programmes were also one of the reasons for the large expansion in water and sanitation provision in cities in Latin America. The Baan Mankong programme was set up by the Thai government’s Community Organizations Development Institute (CODI) to provide support to community organizations formed by those living in informal settlements. CODI provided a range of loans that allowed these community organizations to design and manage an upgrading programme that also included their members being connected to cities’ piped water and sewer system. The programme has few conditions to allow communities and the networks of which they are part to design what works best for them. In addition, in any city or large city district, the community organizations worked together to bring in local governments and move from individual initiatives to city wide initiatives. By 2012, 91,000 households across 270 towns, cities and city districts had been upgraded and for most of these, tenure for the inhabitants achieved. The costs were kept low, in large part because communities organized and managed most aspects of the upgrading. The quality of the housing was also transformed and further initiatives funded from funds returned through loan repayments. 31 The example of the Orangi Pilot Project in improving provision for water and sanitation is well known. So too is its method of funding sanitation – helping the inhabitants of a street or lane to agree on how to finance sewer construction with the costs of this construction brought done by good management and small design changes. Indeed, the cost per household served is lower than most on-site sanitation systems. What is perhaps less well known is its scale (provision has improved in many more settlements than Orangi) and its continuous expansion (so it certainly is not a pilot project). OPP’s success is also linked to its capacity to bring in municipal government and official water and sanitation agencies as OPP-Research and Training Institute supported the lane residents to implement in their lane (the small pipes) with the local government providing the sewer mains (the big pipes) into which these lane and community sewers connected. OPP-RTI also generated maps for each informal settlement to document existing water and sanitation infrastructure 32 and led a scheme to improve storm and surface drains. This has also been achieved in very difficult political circumstances; the director of the Orangi Pilot Project-Research and Training Institute was assassinated in 2013 and the Institute was forced to move. But by August 2012, 107,090 households

28 in Orangi had connections to sewers through 7,161 collective (lane) initiatives. Outside Orangi, the Orangi Pilot Project Research and Training Institute had supported this in 44 cities and towns and 107 villages covering a population of more than 2 million. 33 What needs repetition is that all of this was achieved without large external funding – because it produced solutions that households wanted and even low-income households could afford. The example of the community-toilet programme in Mumbai is notable for who actually designs, builds and manages community toilets and washing facilities and its scale. 34 This started with the federation of women slum/pavement dwellers constructing community toilets – to show what they could do and to experiment with changes that made the toilets work better. Then there was some support for expanding community provision through the alliance of Mahila Milan (federation of women savings groups), the National Federation of Slum Dwellers and the local NGO SPARC. Then support waned and then increased again in the last few years with the municipal government of Mumbai strongly supporting this whole process and developing a capacity to support the federations in maintenance, repair and response when there were local difficulties (for instance a local politician or landowner blocking toilet construction). This Alliance has built over 600 toilet blocks. The municipal government has been working with the two federations on developing a project management unit within their sewerage and solid waste department to design and execute work, contract local providers and ensure better management. Of course, there are some toilets that are poorly built and this is expensive to remedy. Some toilet contractors do not finish the contract and there are major problems with delays in providing funding. It is also more difficult to make a community toilet work in locations where the federations are not strong. But this is still a remarkable expansion in provision for sanitation and washing in informal settlements all over Mumbai. There are many other examples of slum/shack/homeless people’s federations developing community toilets or household toilets in the homes they build in collaboration with local authorities. 35 These do not have the scale of what is happening in Mumbai but they are producing models of provision that meet needs and are cheap enough to allow large scale replication. The final example in this section is community-led investment in sanitation in Blantyre (Malawi), Chinhoyi (Zimbabwe), Dar es Salaam (Tanzania) and Kitwe (Zambia), where city and national federations of slum/shack dwellers tested what was possible in informal settlements with very low income groups. 36 These aimed for sanitation improvements that were affordable to users, and that required no subsidy so that they could be implemented on a much larger scale with the support of local government. Local constraints in each case included little or no external support, limited piped water supply systems in many settlements and for most, no city sewers to connect to. This meant on-site sanitation that included the safe collection and disposal of toilet wastes, with the additional costs and responsibilities this represents for households. Box 4: Container based sanitation in an informal settlement in Cap Haitien, Haiti One of the most interesting new technologies for urban sanitation is container-based sanitation whose use and costs were recently evaluated in an informal settlement (Shada) in Cap Haitien in Haiti, working with a local NGO SOIL. This system has a toilet or squat plate built over a removable container that can be quickly and easily exchanged for an empty container when full. In the case study, there were separate containers for faeces and urine. Households with this toilet had their faeces container collected and replaced with empty containers twice a week. Among the advantages of this form of toilet: it needs no pit or underground infrastructure, it eliminates odour and insect infestations (a small amount of additive is added after defecation), it is relatively compact and

29 households can chose where to locate it, water needs are limited to those required for anal cleaning and hand-washing and it reduces vulnerability to flooding. It could overcome the difficulties in improving sanitation to tenants (when landlords may object or significantly increase the rent if improvements are made) since the construction of the toilet is relatively cheap and the tenants can pay the service charge. Container based toilets can also be used in households in informal settlements where the municipal authorities either cannot or will not make long-term investments in infrastructure including sewers. The management of the faecal matter is also low risk as excreta filled containers can be sealed and collected and transported safely to designated disposal sites. Thus, it presents many advantages over other on-site sanitation systems for urban contexts. Three aspects of the research findings on this system are highlighted here. The first is on its use by low-income households in an informal settlement and its impact when compared to other households in this settlement and households in a nearby formal settlement who did not get this toilet and service. The second is on its effectiveness in excreta management. The third is on its cost. 118 households received the toilets and the twice weekly collection service. After three months, changes in these households’ satisfaction with their sanitation system were assessed and compared to 117 other households living in this settlement and 131 households living in a nearby formal settlement who did not receive this system. Among the households that received the CBS, before they got this, 32% were “very” or “generally” satisfied when asked “overall, how satisfied are members of your household with your current sanitation situation.” After three months of CBS, 87% were very or generally satisfied compared to the comparison cohorts that reported only 35 and 36%. The households who received the CBS also recorded very large increases in the per cent that were proud of their sanitation conditions and that felt safe – and that did not feel ashamed unlike the two comparison cohorts. Many of the 118 households that got CBS had previously used public toilets or open defecation – and the study also found that bringing toilets into the home did not increase faecal contamination of water. In relation to excreta management, the provision of container based sanitation service to households in Shada virtually eliminated reported open defecation and use of flying toilets, while also yielding a 3.5-fold reduction in the share of unmanaged faeces in the community. The cost of providing a household with the sanitation service in this small pilot was US$22/household/month. This is higher than those of large-scale waterborne sewerage but economies of scale have a significant potential to reduce the unit costs over time – and as noted earlier, it needs no pit or sewer main The observed costs during this start-up period are probably high estimate. First, as a pilot this service did not reflect cost-saving measures that SOIL subsequently identified and continues to implement, including lower cost toilets and streamlined collection procedures. Second, unit costs in the pilot could not exploit potential economies of scale. In particular, the direct labour costs of the household service (transporting waste from households to the compost site), which should scale with service area, constituted 12% of the total labour costs in the pilot. Households were also asked whether his/her household would be willing to pay a monthly price of $5 or $7.50 a month. Among the households that got the CBS and among those in the other cohorts, around three quarters said they would be willing to pay $5 while half would be willing to pay $7, 50. When asked why their households would be interested in subscribing to the CBS, three quarters cited convenience with only 8% citing improved health, 4% citing greater personal safety and 3% lower costs

30

At the conclusion of the study in February 2013, 127 households were using the CBS. As of Nov 2013, 71% continued to use the fee based service and during this period on time payment rates were at least 80 per cent, since then SOIL has expanded the fee based service to more than 300 households. On-time payments have declined and enforcement issues are currently being addressed. SOURCE: Tilmans, Sebastien, Kory Russel, Rachel Sklar, Leah Page, Sasha Kramer and Jennifer Davis (2015), "Container-Based Sanitation: Assessing Costs and Effectiveness of Excreta Management in Cap Haitien, Haiti", Environment and Urbanization Vol 27, No 1, and Russel, Kory, Sebastien Tilmans, Sasha Kramer, Rachel Sklar, Daniel Tillias and Jennifer Davis (2015), "Impacts of a container-based, household toilet and waste collection service in Cap Haitien, Haiti", Environment and Urbanization Vol 27, No 2.

UN-Water Global Analyses The UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) reports on the scale of development assistance to water, sanitation and hygiene. In addition, for a sample of around 90 countries, it reports on progress in national policies, including:

• • •

• •

• •



whether the human right to water and sanitation is recognized in legislation; the status of national policy development and implementation and the coverage targets (for rural and urban areas); whether there are universal access policies for disadvantaged groups that include ‘poor’ populations, populations living in slums and informal settlements and populations in remote or hard to reach areas; whether there is coordination at national level between sanitation, water and hygiene. whether there is drinking water quality surveillance for rural and urban areas (including testing of water quality against national standards) and whether data are available for national decisions making for resource allocation on water and sanitation); tracking progress for sanitation and drinking water for the disadvantaged groups mentioned above; the existence of an overall strategy to develop sanitation, drinking water and hygiene (by rural and urban) and factors that constrain provision for sanitation, drinking water and hygiene at national level; and the existence and level of implementation of a government defined financing plan/budget for sanitation, water and hygiene (by rural and urban) and various measures of financing including sufficiency of finance to meet MDG targets, annual expenditure and funding sources.

In reflecting on the data collected, it suggests that among the 94 countries covered, that governments are showing strong support for universal access to drinking-water and sanitation but these are impeded by insufficient national financing, a lack of human resources, weak capacity at country level and that critical gaps in monitoring. It also notes how efforts are being made to reach the poor but few at scale. Getting greater detail in the areas noted above is a welcome addition to national data. But at least for urban areas, what is needed is a GLAAS report on cities and on local governments too as in most countries, these are critical to water and sanitation planning, finance and provision. For coverage, the GLAAS reports are also reliant on the same data sources that have been shown to be very inadequate. For instance, it must be using the UN Habitat figures to track progress on sanitation and

31 ‘drinking water’ for populations living in slum and informal settlements but we know that the data that UN Habitat uses does not measure whether people have drinking water. It is very difficult to judge whether a well worked national policy means anything actually gets done. And there are absurd figures (presumably sent in by national governments) as in Bangladesh having a coverage target of 100 percent for drinking water and sanitation for urban and rural areas by 2015. Bangladesh also claims it has a universal access policy for disadvantaged groups including those living in slums and informal settlements. The goal by 2015 of 95 percent coverage for drinking water for urban populations in Tanzania will come as a surprise to the very large proportion lacking provision. Zimbabwe’s 2015 goal of 100 percent coverage for urban sanitation and urban water will not be met. “The vast majority of people without access to drinking water and sanitation live in rural areas, yet the bulk of expenditures are currently allocated to improving services in urban areas. 37” But on the first of these, this is likely to be based on the ‘improved provision’ that has been shown to be inappropriate for urban contexts. On the second, this is based on reports form 19 countries - it is not clear that the resources directed to urban areas are prioritizing increasing coverage and reaching low-income groups. Clearly, there are large differences between countries in the criteria used to report on drinking water and sanitation – with some countries using much higher standards that the UN definition of improved provision.

Conclusions This report has described in detail the inadequacies in the statistical base for measuring and monitoring progress on the MDG targets for water, sanitation and slum improvements. It also highlighted how there would be much less progress in meeting MDG targets for water and sanitation if the bar was not set so low in regard to what counts as ‘improved’ provision. This is also supported by Table 2 that shows how much of the population with ‘improved’ provision still have to use faecally contaminated water. If more detailed data were available on water and sanitation that had a more appropriate definition of what can be considered adequate provision (in terms of health risk, access and convenience) and more sustainable provision, there would be far less progress on meeting the MDG water and sanitation targets. This paper also questions the validity of applying the same criteria for improved provision for water and sanitation to urban and rural areas – and wonders why there is no regular reporting of the proportion of households that have levels of provision that mean low risk (and that are the norm in high-income nations) – water piped to the home that is drinkable and available 24 hours a day and connection to a sewer. Why doesn’t the JMP report on the proportion of the urban population with toilets in the home connected to sewers? It is odd that sewer systems that have brought great improvements in health and convenience in urban areas in high-income and many upper-middle income countries and for which there is close to universal provision are not seen as worth including. Also, at least in some contexts, community or public toilets that are well managed are better options than household pit latrines with slabs – yet the former is counted as ‘unimproved’ and the latter as ‘improved’. The paper also points to worrying limitations in the information base for monitoring progress on ‘significantly improving the lives of slum dwellers’. It is difficult to know what to recommend in relation to data. Presumably it would be very expensive to have a monitoring system that recorded progress on the ground year by year. It would be even more expensive to greatly expand sample sizes for national sample surveys so these showed where deficiencies in provision actually were and who was facing the impacts. If a (national, provincial/state or local) government is committed to improving provision for water and sanitation, it needs to know who has inadequate provision and where they live. This is the great limitation of

32 national sample surveys; they do not provide the data needed to act (i.e. where the deficiencies in provision are). It does not help much to know that x% of the urban or rural population lack basic sanitation if there are no details of where these are. A focus on reporting national level statistics also neglects the extent to which in many countries, it is local governments that need to act (and need the data to support this) and this needs a very different data collection process. There are also very large data gaps in many nations in the basic statistics that should underpin policies and priorities for any intervention that contributes to better health – especially vital registration systems that provide accurate data for each locality on the scale of premature death and the main causes. To be effective in risk reduction in concentrated populations, all households need good provision for sanitation. Hazards from poor sanitation have spill-over effects so it is not just those without adequate facilities who are at risk. 38 A household can have a toilet that is clean and safe to use within their home – yet still face risks in their neighbourhood from contact with other people’s excreta – or their toilet wastes are providing risks to others (for instance an overflowing septic tank). Even if a neighbourhood gets to a high proportion of residents with good quality toilets in their home or a high proportion using well-managed community toilets, even a small proportion of the population defecating or disposing of their toilet wastes in the open or having a latrine that flies can access will impose risks for all residents. No city can be defecation free if the needs of low income groups and others who use open defecation are not addressed Sanitation combines our most private behaviours which people tend not to want to talk about in public with most public impacts which people do not have the incentive to do much about individually. No individual household has the incentive to improve toilets and change behaviours if the benefits any individual receives is primarily on action of others. 39 On-site sanitation systems depend on safe and affordable systems for collecting the toilet wastes from each toilet and transporting them to treatment plants. Good quality systems for this can be expensive and difficult for conventional utilities to set up and manage. For most urban contexts, a regular service to collect solid wastes should be added to the water and sanitation targets as this so often proves invaluable in removing faecally contaminated waste as well as serving to help keep drains working. More attention needs to be paid to costs but within each particular local context. It is often said that a sewer system is too expensive for low-income communities but we have the many examples from urban areas in Pakistan of high quality sewers with connections to all households being implemented at costs per household that were affordable in informal settlements – and this done at scale. For most urban contexts, sewers have strong advantages – they need very little day to day servicing, they take up very little room in the home, they allow the safe disposal of other household liquid wastes and it is easier to get 100 percent coverage as all households see the advantage of sewer connections (unless water supplies are constrained). On-site systems are not necessarily cheaper. 40 Technically, significant improvements can be made with lower cost sanitation systems but low cost provision poses institutional challenges that neither utilities nor private enterprises are well equipped to address. Unlike sewers, most low cost systems require users to contribute significantly to their operation and maintenance. Utilities are better suited to operating large scale piped networks. 41 There is also the question of why solutions that worked in what are now high-income nations (and that transformed health) in the late 19th and early 20th centuries are judged today to be too

33 expensive – treated water delivered by pipe 24 hours a day to within each household and (for all urban and most rural areas) connection to sewers. Today, middle and upper income groups know they can avoid risks from epidemics (for instance for cholera) by ensuring they have good provision for safe water and sanitation 42; in the 19th century, these groups did not know how to do this and so, often in response to cholera outbreaks, the very large investments in piped water and sewer systems were made. No doubt, many objected to the disruption caused in cities by the laying of the sewers – but these then provided the base for good sanitation – for some cities for 150 + years. Far more attention needs to be paid to the needs and capacities of low income communities. These may be well-placed to deliver or co-produce sanitation services and they have done so in various cities. 43 But note too the local collective action challenge for sanitation. In most informal settlements, there are many different priorities or interests within residents and so it is difficult to generate agreement. Non-sewered solutions mean that in most urban communities, the local government or utility needs to take on the disposal of (solid and liquid) wastes but they may be reluctant to do so or lack the financial and technical capacity to provide a good quality service. Thus, there are collective action challenges in getting all local residents to work together and coproduction challenges in getting the state to coordinate and where necessary invest and take responsibility for final waste collection and disposal. There is the issue of how best to get more attention to addressing the massive deficits in water and sanitation provision from governments and international agencies. There is an obvious contradiction between recognizing sanitation as a human right and refusing on principle to subsidize its provision for those who cannot afford it. 44 Of course, everyone should have a right to adequate, safe, convenient, sustainable provision – but many of the success stories for getting this to low-income communities involved non-state actors (grassroots organizations and/or local NGOs) working in ways that then brought in support from local authorities. 45 These helped realize the right to good quality sanitation without being rights-based. And do making demands on the state for the right to sanitation work when people face other people’s faeces? Who should be held to account community, utility, regulator, funder? If we start to consider inclusion and equity as part of universal access, space is once again opened up to think more creatively about the role of non-state actors, communities and innovative partnerships. The 2013 United Nations MDG Report, 46 the GLAAS reports 47 and many of the UN JMP reports, like so many UN documents, never miss an opportunity to say things are worse in rural areas. But in large part, this is because no allowance is made in the indicators chosen for differences in context. The definition for ‘improved’ water and sanitation is the same for both rural and urban areas. But can tubewells, boreholes and protected dug wells (all counted as ‘improved’) really work in all urban contexts? Do public taps and standpipes really represent improved provision in urban contexts where these have to be shared among so many households?

MDG lessons for post 2015

The draft SDGs 48 make a strong commitment to leaving no-one behind and to universal provision for many services, including water and sanitation. They propose the following wording for Goal 6: “Ensure availability and sustainable management of water and sanitation for all.” It includes a range of sub-goals relevant to water and sanitation including by 2030, achieve universal and equitable access to safe and affordable drinking water for all (6.1); by 2030, achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation, paying special

34 attention to the needs of women and girls and those in vulnerable situations (6.2). 6.3 is on protecting water quality 6.4-6.6 on more efficient and ecologically sustainable freshwater management and 6.b support and strengthen the participation of local communities for improving water and sanitation management. So the indicators for water and sanitation are going to have to change a lot if they are to track progress in these. The current definitions for ‘improved’ provision are not measuring equitable access as they contain so many different options (a household with a pit latrine and a slab is treated as equal to a household with their own WC with a sewer connection; a household with water piped on premises is treated as equal to access to a standpipe). Adequate provision just in terms of risk levels is very different from ‘improved’ provision. New questions will need to be included in surveys on water quality (safety), reliability and cost (to gauge whether it is affordable). There will need to be an indicator related to ‘sustainable’. Definitions for adequate provision need separate rural and urban categories. And JMP reports should make more use of the Demographic and Health Survey data – for instance reporting separately on the proportion of urban households with flush/pour flush toilets connected to sewers. There is also the issue of how to generate the data on inadequacies in provision for water, sanitation and housing for each locality so these actually guide policy and investment. And there is a need for more transparency – and honesty about the limitations in the statistics. Perhaps in tables showing improvements by year, the numbers given could be colour coded to highlight which figures are based on data and which are projections or estimates. A need for national governments to agree to “support and strengthen the participation of local communities for improving water and sanitation management” would constitute a major shift in policy for many nations. But this needs to cover more than management; this needs financial and political support for grassroots innovation – in the form of technologies and partnerships/governance arrangements that can support inclusive access to sustainable water and sanitation. 49 Goal 3, “Ensure healthy lives and promote well-being for all at all ages” includes 3.3: by 2030 end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne diseases, and other communicable diseases. Obviously, good provision for water and sanitation will help greatly in addressing the water-borne diseases and good water and waste water management can help cut malaria. Goal 11 is “Making cities and human settlements inclusive, save, resilient and sustainable.” This includes a sub goal by 2030 to ensure access for all to adequate, safe and affordable housing and basic services, and upgrade slums. This too implies a need for new data. There is a need to rethink how to monitor progress on what are currently referred to as slums. If this is to include an index made up of different indicators (as is currently the case), more appropriate indicators are needed that might include water piped on premises, more specific forms of sanitation that are appropriate to urban contexts and regular solid waste collection, as well indicators on overcrowding and the quality of building. It may even be worth considering water piped on premises as not only essential for better water access but also essential for good sanitation (as it supports hand washing after defecation). If these remain in the final agreed set of SDGs after the discussions on this within the UN General Assembly, then clearly water and sanitation need a lot more attention. They need major improvements in data – both in its detail for assessing whether it is safe, regular and easily accessed

35 and in coverage to highlight where improvements are most needed. Perhaps more fundamentally it needs a rethink within many governments and international agencies on water and sanitation provision and slum avoidance in an urbanizing world. We cannot address the water and sanitation needs of the billion or so people living in informal settlements with a multiplicity of (usually illcoordinated) small NGO projects. It is very unfashionable to suggest a need for city wide piped water, sewer and storm drainage systems; indeed, my colleague Gordon McGranahan was accused of raping Mother Earth when he suggested this during a debate. Of course there will be many settings where these citywide systems are inappropriate or not possible. They will be expensive – unless they can use the co-production model developed by the Orangi Pilot Project Research and Training Institute and by other community organization-local government partnerships. But in many locations they can provide the underpinnings for the kinds of universal access to good quality solutions that the SDGs promote. But there are also so many contexts where safe water piped to homes is still far beyond the capacity of governments and international agencies so intermediate solutions are needed – that prioritize easy and quick access and protection of water quality. There is also a need for more effective onsite sanitation in most rural and many urban contexts that will rely on household investment – and wherever there are dense population concentrations, provision for faecal sludge removal and treatment. 50 Much of the innovation in urban sanitation over the last decade is not about innovations in toilet technology but in the roles and tasks of low-income households and community organizations, in funding to support them and in support from local authorities (that often involve coproduction). 51 In many urban contexts, provision for sanitation, including the removal of faecal sludge, can to be viewed more as a service people pay for than as the provision of hardware (as in the scheme in Cap Haitien reported in Box 4). It has become more common to consider sanitation costs in terms of daily, weekly or monthly costs to individuals or households. One of the challenges is finding better sanitation solutions for what low-income households can afford – say US$3 or 4 per household per month. Even relatively low charges for pay-to-use toilets add up over a month and can still be unaffordable. 52 In regard to external funding, UN Reports suggest that funding to water and sanitation from development assistance agencies is substantial and increasing 53 yet for most nations, there is little evidence of this addressing the needs of low-income dwellers. It may be that a large part of this is large and expensive water treatment and sewage treatment plants in middle-income nations – and these benefit those with piped water and sewer connections. Although much needed, these do not necessarily increase coverage and they are concentrated in countries with higher levels of coverage. If it is accepted that in many contexts, solutions must be locally devised with the full engagement of those who are inadequately served, this also means a complete rethink of external funding systems. This has to include a capacity among donors to listen to, work with and support local governments and civil society organizations to develop locally appropriate solutions including coproduction. This also has to go beyond supporting a few innovative ‘community’ initiatives to developing the financial and institutional means to support this at scale. This may include support needed for forms of provision that many funders don’t fund at the moment (shared toilets, community toilets) and organizations they do not fund (especially representative organizations of slum/shack dwellers). It is often assumed that water and sanitation improvements in low- and middle-income nations need external financing. But the OPP model shows one example that this is not so – indeed, it sought to avoid external funding because such funding always comes with (often inappropriate) conditions and

36 is often far most costly than locally-developed solutions. 54 It is likely that most of the funding for the extension of piped water and improved sanitation in Latin American nations was funded by national and local governments. Of course there is also the funding needed to put city-wide systems in place even if most new provision for sanitation is on-site – for piped water (and water treatment), for solid waste collection and management, for faecal sludge, for storm and surface drainage. Such city-wide systems can bring enormous advantages to low-income groups. If done properly they also provide benefits over many decades. Look at how much cities in Europe and North America still benefits from sewers constructed 100-150 years ago.

37

38 ANNEX Table 3: The countries and territories that were furthest from the MDG goal for water piped on premises in urban areas in 2012

Country Nigeria DR Congo Haiti Central African Republic Marshall Islands Sierra Leone Madagascar Liberia Rwanda GuineaBissau Togo United Republic of Tanzania Sudan Myanmar Mongolia Vanuatu Zambia Ghana Malawi Mozambique Cameroon Kenya Indonesia Uganda Bangladesh Burkina Faso Chad Benin Papua New Guinea Angola Nepal Guinea Dominican

% with water piped on premises 1990 32.6 49.0 25.5

% with water piped on premises 2012 5.9 20.1 12.4

% without water piped on MDG premises in Target (half 1990 of 1990) 67.4 33.7 51.0 25.5 74.5 37.2

Change in % 19902012 -26.7 -28.9 -13.1

Gap between MDG target and actual 60.4 54.4 50.4

8.3

4.0

91.7

45.8

-4.3

50.2

3.9 16.4 23.0 4.8 27.6

4.0 11.5 14.9 6.2 17.8

96.1 83.6 77.0 95.2 72.4

48.0 41.8 38.5 47.6 36.2

0.0 -4.9 -8.0 1.3 -9.8

48.0 46.7 46.5 46.2 46.0

13.8 14.1

11.2 12.2

86.2 85.9

43.1 43.0

-2.6 -1.8

45.7 44.8

33.5 77.7 17.0 44.3 78.5 48.2 40.5 37.3 19.7 24.5 55.6 25.0 6.4 23.1 10.9 7.2 15.7

23.0 46.3 18.5 33.0 51.0 36.0 34.1 32.9 24.9 27.6 44.2 32.4 23.3 31.9 26.6 24.8 31.6

66.5 22.3 83.0 55.7 21.5 51.8 59.5 62.7 80.3 75.5 44.4 75.0 93.6 76.9 89.1 92.8 84.3

33.3 11.2 41.5 27.8 10.7 25.9 29.8 31.3 40.1 37.7 22.2 37.5 46.8 38.4 44.6 46.4 42.2

-10.5 -31.3 1.5 -11.3 -27.5 -12.2 -6.4 -4.4 5.2 3.0 -11.4 7.4 16.9 8.8 15.8 17.6 15.9

43.8 42.5 40.0 39.1 38.2 38.1 36.1 35.7 34.9 34.7 33.6 30.1 29.9 29.6 28.8 28.8 26.3

61.3 16.1 45.9 19.0 95.0

55.1 33.7 48.8 35.4 73.5

38.7 83.9 54.1 81.0 5.0

19.3 41.9 27.1 40.5 2.5

-6.3 17.6 2.9 16.4 -21.5

25.6 24.4 24.2 24.1 24.0

39 Republic Afghanistan India Mauritania Mali Niger Yemen United States Virgin Islands Namibia Pakistan Zimbabwe Burundi Iraq Guyana Algeria Gambia Viet Nam Côte d'Ivoire

3.1 47.8 15.4 16.9 22.1 84.5

28.0 51.1 35.4 36.3 39.0 70.8

96.9 52.2 84.6 83.1 77.9 15.5

48.5 26.1 42.3 41.5 38.9 7.8

24.9 3.4 20.1 19.4 16.8 -13.7

23.6 22.7 22.2 22.1 22.1 21.5

40.2 81.7 55.5 96.7 31.5 95.3 79.2 87.4 27.2 43.2 49.9

48.9 70.7 57.7 78.6 48.0 83.7 75.8 80.2 52.4 60.5 64.5

59.8 18.3 44.5 3.3 68.5 4.7 20.8 12.6 72.8 56.8 50.1

29.9 9.2 22.2 1.7 34.2 2.4 10.4 6.3 36.4 28.4 25.1

8.8 -11.0 2.2 -18.1 16.4 -11.6 -3.4 -7.2 25.1 17.3 14.6

21.1 20.1 20.0 19.7 17.8 13.9 13.8 13.5 11.3 11.1 10.4

Table 4: The countries and territories that have already met the MDG goal for water piped on premises in urban areas in 2012

Country Bahrain Maldives Botswana Oman Guatemala Argentina Cambodia American Samoa Paraguay Georgia Malaysia Bolivia (Plurinational State of) Egypt Honduras Lithuania Senegal Turkey

% with water piped on premises 1990 38.9 49.8 39.3 29.6 68.3 74.1 14.5

% with water piped on premises 2012 100.0 98.5 89.7 84.5 98.4 99.0 67.4

% without water piped on MDG premises in Target (half 1990 of 1990) 61.1 30.6 50.2 25.1 60.7 30.4 70.4 35.2 31.7 15.8 25.9 12.9 85.5 42.7

64.6 60.8 80.1 86.2

92.3 90.1 96.9 99.3

35.4 39.2 19.9 13.8

78.6 89.8 84.2 88.5 46.3 91.1

95.5 100.0 96.6 98.5 77.0 99.0

21.4 10.2 15.8 11.5 53.7 8.9

Change in % 19902012 61.1 48.8 50.4 55.0 30.0 24.8 52.9

Gap between target and actual -30.6 -23.7 -20.0 -19.7 -14.2 -11.9 -10.1

17.7 19.6 10.0 6.9

27.7 29.4 16.9 13.1

-10.0 -9.8 -6.9 -6.2

10.7 5.1 7.9 5.7 26.9 4.5

16.9 10.2 12.4 10.0 30.7 7.9

-6.2 -5.1 -4.5 -4.3 -3.9 -3.5

40 Costa Rica Ecuador Estonia Uruguay Morocco Lesotho Belize Portugal Finland Mexico Republic of Korea Armenia El Salvador Tuvalu Peru Chile Montserrat Poland Bulgaria Brazil Greece South Africa Barbados Japan Mauritius Samoa Fiji

92.6 75.8 92.7 94.5 75.1 26.3 73.0 95.7 96.2 86.0

99.6 91.0 99.4 99.9 90.1 65.6 88.7 99.8 100.0 94.9

7.4 24.2 7.3 5.5 24.9 73.7 27.0 4.3 3.8 14.0

3.7 12.1 3.7 2.8 12.4 36.8 13.5 2.1 1.9 7.0

7.0 15.2 6.7 5.4 15.0 39.3 15.6 4.1 3.8 8.9

-3.3 -3.1 -3.1 -2.6 -2.6 -2.5 -2.1 -1.9 -1.9 -1.9

95.7 94.8 69.2 91.6 73.1 97.6 90.6 97.5 95.9 92.4 98.9 84.5 93.6 96.8 99.5 82.5 92.4

99.2 98.6 85.7 96.9 87.4 99.6 96.1 99.3 98.5 96.7 99.9 92.7 97.1 98.7 99.9 91.3 96.2

4.3 5.2 30.8 8.4 26.9 2.4 9.4 2.5 4.1 7.6 1.1 15.5 6.4 3.2 0.5 17.5 7.6

2.2 2.6 15.4 4.2 13.5 1.2 4.7 1.3 2.0 3.8 0.5 7.7 3.2 1.6 0.3 8.8 3.8

3.5 3.9 16.5 5.3 14.4 2.0 5.5 1.8 2.6 4.3 1.0 8.2 3.5 1.8 0.4 8.8 3.9

-1.3 -1.2 -1.1 -1.1 -0.9 -0.8 -0.8 -0.5 -0.5 -0.5 -0.5 -0.4 -0.3 -0.3 -0.2 -0.1 -0.1

41 Table 5: The countries and territories that were furthest from the MDG target for improved water in rural areas in 2012 Country

% with % with provision provision in 1990 in 2012

% without provision in 1990

MDG Target (half of 1990 deficit)

Change in % 19902012

Gap between MDG target and actual

Angola

41.8

34.3

58.2

29.1

-7.5

36.6

Democratic Republic of the Congo Yemen Sudan Papua New Guinea

25.8 58.5 61.3

29.0 46.5 50.2

74.2 41.5 38.7

37.1 20.7 19.4

3.3 -12.0 -11.1

33.8 32.7 30.5

24.3

32.8

75.7

37.8

8.5

29.4

46.0 36.2 50.4 23.3 37.2 29.5 15.0

44.0 40.3 47.5 35.0 44.8 42.1 35.4

54.0 63.8 49.6 76.7 62.8 70.5 85.0

27.0 31.9 24.8 38.3 31.4 35.2 42.5

-2.0 4.2 -2.9 11.7 7.5 12.6 20.3

29.0 27.8 27.7 26.7 23.9 22.7 22.2

46.4 22.4 36.1 70.8 66.7 26.2 28.0 33.5 60.3 87.6 53.3 23.1 85.3 32.9

54.4 42.4 50.6 68.7 67.8 47.7 49.1 51.9 65.5 79.5 63.6 49.2 80.9 55.1

53.6 77.6 63.9 29.2 33.3 73.8 72.0 66.5 39.7 12.4 46.7 76.9 14.7 67.1

26.8 38.8 31.9 14.6 16.7 36.9 36.0 33.2 19.8 6.2 23.4 38.4 7.4 33.6

8.0 20.0 14.5 -2.1 1.1 21.5 21.1 18.3 5.1 -8.1 10.3 26.1 -4.3 22.2

18.8 18.8 17.5 16.7 15.5 15.4 14.9 14.9 14.7 14.3 13.0 12.3 11.7 11.4

77.2 58.6 74.9 68.8 32.2

77.2 68.3 76.7 73.6 55.5

22.8 41.4 25.1 31.2 67.8

11.4 20.7 12.5 15.6 33.9

0.0 9.7 1.7 4.8 23.3

11.4 11.0 10.8 10.8 10.6

United Republic of Tanzania Togo Haiti Mozambique Chad Niger Madagascar Central African Republic Sierra Leone Kiribati Zimbabwe Côte d'Ivoire Mauritania Nigeria Cameroon Djibouti Algeria Morocco Zambia Uzbekistan Kenya Dominican Republic Rwanda Lesotho Colombia Guinea-

42 Bissau Senegal Burundi Ethiopia Nicaragua Kazakhstan Mali Jamaica Ecuador Benin Jordan Guinea Indonesia Azerbaijan Saint Lucia

41.7 67.0 3.5 53.9 89.9 20.5 88.8 61.4 49.1 91.1 39.1 61.0 49.2 92.4

60.3 73.2 42.1 67.8 86.0 54.2 88.8 75.2 69.1 90.5 65.0 76.4 70.7 92.8

58.3 33.0 96.5 46.1 10.1 79.5 11.2 38.6 50.9 8.9 60.9 39.0 50.8 7.6

29.1 16.5 48.3 23.0 5.0 39.8 5.6 19.3 25.4 4.5 30.4 19.5 25.4 3.8

18.6 6.2 38.6 13.9 -3.9 33.7 0.0 13.8 20.0 -0.6 25.9 15.4 21.4 0.5

10.6 10.3 9.7 9.2 9.0 6.1 5.6 5.5 5.5 5.1 4.5 4.1 3.9 3.3

Democratic People's Republic of Korea

100.0

96.9

0.0

0.0

-3.1

3.1

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 NB This table excludes countries and territories that already had 99-100% coverage in 1990 Country

% with % with provision provision in 1990 in 2012

% without provision in 1990

MDG Target (half of 1990 deficit)

Change in % 19902012

Gap between MDG target and actual

Paraguay Belize Chile Viet Nam Malawi

24.4 59.8 48.2 54.4 35.7

83.4 100.0 91.3 93.6 83.2

75.6 40.2 51.8 45.6 64.3

37.8 20.1 25.9 22.8 32.2

59.0 40.2 43.1 39.1 47.5

-21.2 -20.1 -17.2 -16.3 -15.4

Guyana Ghana Turkey Sri Lanka Mexico Georgia Vanuatu

70.4 37.6 73.3 62.6 58.8 72.1 54.6

97.9 81.3 98.8 92.9 90.8 97.3 88.3

29.6 62.4 26.7 37.4 41.2 27.9 45.4

14.8 31.2 13.4 18.7 20.6 13.9 22.7

27.6 43.6 25.5 30.3 31.9 25.1 33.7

-12.8 -12.4 -12.1 -11.6 -11.4 -11.2 -11.0

Argentina Namibia Tunisia India Uruguay

69.3 55.2 63.3 64.0 74.7

95.3 87.4 90.5 90.7 94.9

30.7 44.8 36.7 36.0 25.3

15.4 22.4 18.3 18.0 12.7

26.1 32.2 27.2 26.7 20.2

-10.7 -9.8 -8.8 -8.7 -7.5

43 Malaysia Myanmar China South Africa Burkina Faso Swaziland Nepal Cambodia Samoa

82.1 47.6 56.0 63.3 38.6 24.9 63.4 19.5 86.9

98.5 81.1 84.9 88.3 75.8 68.9 87.6 65.6 98.8

17.9 52.4 44.0 36.7 61.4 75.1 36.6 80.5 13.1

9.0 26.2 22.0 18.3 30.7 37.5 18.3 40.2 6.6

16.4 33.5 28.9 24.9 37.3 43.9 24.2 46.1 11.9

-7.5 -7.3 -6.9 -6.6 -6.6 -6.4 -5.9 -5.9 -5.4

Comoros Afghanistan Hungary Thailand Egypt Greece Philippines American Samoa Panama Kyrgyzstan Tuvalu Lithuania Fiji Portugal Bahrain Maldives Tokelau Uganda Barbados

82.8 2.8 90.9 82.3 90.2 91.5 75.4

96.7 56.1 100.0 95.3 98.8 99.4 91.2

17.2 97.2 9.1 17.7 9.8 8.5 24.6

8.6 48.6 4.5 8.9 4.9 4.2 12.3

13.9 53.4 9.1 13.1 8.5 7.9 15.8

-5.3 -4.7 -4.5 -4.2 -3.7 -3.7 -3.5

93.6 67.1 59.2 88.6 72.3 79.3 94.7 94.9 90.8 90.1 37.2 95.4

100.0 86.6 82.3 97.0 88.9 92.2 99.9 100.0 97.9 97.4 71.0 99.8

6.4 32.9 40.8 11.4 27.7 20.7 5.3 5.1 9.2 9.9 62.8 4.6

3.2 16.4 20.4 5.7 13.8 10.4 2.7 2.6 4.6 5.0 31.4 2.3

6.4 19.5 23.2 8.5 16.5 12.9 5.3 5.1 7.1 7.4 33.8 4.4

-3.2 -3.0 -2.8 -2.7 -2.7 -2.6 -2.6 -2.6 -2.5 -2.4 -2.4 -2.1

Bangladesh Russian Federation Honduras Bosnia and Herzegovina

64.8

84.4

35.2

17.6

19.6

-2.0

80.4 59.6

92.2 81.5

19.6 40.4

9.8 20.2

11.8 21.9

-2.0 -1.7

95.7

99.5

4.3

2.1

3.8

-1.6

El Salvador Brazil Bolivia (Plurinational State of) Guatemala Oman Saudi Arabia Saint Vincent and the Grenadines

58.9 67.8

81.0 85.3

41.1 32.2

20.6 16.1

22.1 17.5

-1.5 -1.4

41.0 74.5 70.0 92.0

71.9 88.6 86.1 97.0

59.0 25.5 30.0 8.0

29.5 12.8 15.0 4.0

30.9 14.1 16.2 5.0

-1.4 -1.3 -1.2 -1.0

88.2

95.1

11.8

5.9

6.9

-1.0

44 United States of America Malta Total Northern Mariana Islands Montserrat Mauritius Marshall Islands Slovakia Peru Iran (Islamic Republic of)

94.0 98.3 62.1

98.0 100.0 81.6

6.0 1.7 37.9

3.0 0.8 19.0

4.0 1.7 19.5

-1.0 -0.8 -0.5

94.0 97.2 98.7

97.5 99.0 99.7

6.0 2.8 1.3

3.0 1.4 0.6

3.6 1.8 1.0

-0.5 -0.4 -0.4

94.4 99.6 43.6

97.5 100.0 71.6

5.6 0.4 56.4

2.8 0.2 28.2

3.1 0.4 28.0

-0.3 -0.2 0.2

83.9

91.7

16.1

8.1

7.8

0.2

Botswana Guam

86.2 99.7

92.8 99.5

13.8 0.3

6.9 0.2

6.6 -0.1

0.3 0.3

Slovenia Syrian Arab Republic TFYR Macedonia Gambia

99.4

99.4

0.6

0.3

0.0

0.3

75.0

87.2

25.0

12.5

12.2

0.3

98.5 69.6

98.8 84.4

1.5 30.4

0.7 15.2

0.3 14.8

0.4 0.4

Canada Kuwait Belarus Serbia Saint Kitts and Nevis Antigua and Barbuda Bulgaria Niue Iraq Réunion

99.0 99.0 99.2 99.3

99.0 99.0 99.0 98.9

1.0 1.0 0.8 0.7

0.5 0.5 0.4 0.4

0.0 0.0 -0.2 -0.4

0.5 0.5 0.6 0.8

98.3

98.3

1.7

0.9

0.0

0.8

97.4 99.8 99.1 39.1 97.8

97.9 99.0 98.6 68.5 97.8

2.6 0.2 0.9 60.9 2.2

1.3 0.1 0.4 30.4 1.1

0.4 -0.8 -0.5 29.4 0.0

0.9 0.9 1.0 1.1 1.1

Estonia Pakistan Croatia Mongolia Seychelles Latvia Montenegro Costa Rica

97.7 80.8 96.8 26.0 96.3 95.8 95.3 86.9

97.6 89.0 96.8 61.2 96.3 95.8 95.3 90.9

2.3 19.2 3.2 74.0 3.7 4.2 4.7 13.1

1.1 9.6 1.6 37.0 1.9 2.1 2.3 6.5

-0.1 8.1 0.0 35.3 0.0 0.0 0.0 4.0

1.3 1.4 1.6 1.8 1.9 2.1 2.3 2.6

45 Table 7: The countries and territories that had a lower % of their population with basic sanitation in 2012 than in 1990

Suriname Sudan Papua New Guinea Russian Federation Nigeria Malawi Namibia Zambia Haiti Rwanda Democratic Republic of the Congo Zimbabwe Algeria French Polynesia Georgia Samoa Ukraine Aruba Togo Trinidad and Tobago Pakistan Sierra Leone Maldives Greece Estonia Nauru Kyrgyzstan

% with improved provision 1990 99.2 52.0 61.6 79.6 36.0 27.3 60.6 60.8 34.5 63.9

% with improved provision 2012 88.4 43.9 56.4 74.4 30.8 22.3 56.1 56.4 31.0 61.0

% without provision in 1990 0.8 48.0 38.4 20.4 64.0 72.7 39.4 39.2 65.5 36.1

MDG Target (half of 1990) 0.4 24.0 19.2 10.2 32.0 36.3 19.7 19.6 32.8 18.1

Change in % 19902012 -10.8 -8.0 -5.2 -5.2 -5.1 -5.0 -4.5 -4.4 -3.5 -2.9

31.6 53.7 99.4 98.6 96.8 94.3 97.4 98.6 26.3 92.7 72.2 22.7 97.7 99.5 95.9 65.7 92.0

29.1 51.6 97.6 97.1 95.5 93.3 96.5 97.7 25.5 92.1 71.8 22.5 97.5 99.4 95.8 65.6 91.9

68.4 46.3 0.6 1.4 3.2 5.7 2.6 1.4 73.7 7.3 27.8 77.3 2.3 0.5 4.1 34.3 8.0

34.2 23.2 0.3 0.7 1.6 2.8 1.3 0.7 36.8 3.7 13.9 38.6 1.2 0.2 2.1 17.2 4.0

-2.5 -2.1 -1.8 -1.5 -1.3 -1.0 -1.0 -1.0 -0.8 -0.6 -0.3 -0.2 -0.2 -0.2 -0.1 -0.1 -0.1

46 Table 8: The countries and territories that have already met the MDG target for basic sanitation in urban areas

Country Cambodia Palau Paraguay Viet Nam Micronesia (Fed. States of) Yemen Belize Chile Saudi Arabia Iran (Islamic Republic of) Angola Argentina Lithuania Uzbekistan Egypt Malaysia Portugal Cuba TFYR Macedonia Singapore Turkmenistan Tonga Tunisia Honduras Serbia China

MDG Target (half of 1990)

Change in % 19902012

Gap between target and actual

% with improved provision 1990

% with improved provision 2012

% without provision in 1990

17.7 63.4 62.0 64.1

81.6 100.0 96.1 93.1

82.3 36.6 38.0 35.9

41.1 18.3 19.0 17.9

63.9 36.6 34.1 29.0

-22.8 -18.3 -15.1 -11.0

49.4 69.8 77.2 91.3 91.5

85.1 92.5 94.2 100.0 100.0

50.6 30.2 22.8 8.7 8.5

25.3 15.1 11.4 4.3 4.2

35.7 22.7 17.0 8.7 8.5

-10.4 -7.6 -5.6 -4.3 -4.2

78.4 67.4 89.2 92.5

92.8 86.8 97.1 98.7

21.6 32.6 10.8 7.5

10.8 16.3 5.4 3.7

14.4 19.4 7.9 6.2

-3.6 -3.1 -2.5 -2.5

95.4 91.4 88.4 97.7 86.2

100.0 97.8 96.1 100.0 94.0

4.6 8.6 11.6 2.3 13.8

2.3 4.3 5.8 1.1 6.9

4.6 6.4 7.7 2.3 7.8

-2.3 -2.1 -1.9 -1.1 -0.9

93.3 99.2 99.1 98.0 94.1 69.9 96.9 47.8

97.2 100.0 100.0 99.4 97.4 85.3 98.6 74.1

6.7 0.8 0.9 2.0 5.9 30.1 3.1 52.2

3.3 0.4 0.4 1.0 2.9 15.0 1.6 26.1

3.9 0.8 0.8 1.4 3.3 15.4 1.7 26.3

-0.5 -0.4 -0.4 -0.4 -0.4 -0.4 -0.2 -0.2

47 Table 9: The countries and territories that have rural populations where the MDG sanitation target is met

Country Palau Tokelau Maldives Oman Egypt Argentina Fiji Chile Uzbekistan Mexico Sri Lanka Syrian Arab Republic Ecuador Honduras Thailand Tunisia Portugal Uruguay Malaysia Saudi Arabia Cuba Lithuania Viet Nam Greece Albania United States of America Bulgaria Jordan Iran (Islamic Republic of) Costa Rica Rwanda Belize Morocco

% with provision for improved sanitation in 1990 7.8 41.4 57.6 55.3 56.6 68.5 37.2 52.6 75.8 35.0 65.4

% with provision for improved sanitation in 2012 100.0 92.9 99.6 94.7 94.4 99.4 81.7 89.3 100.0 79.0 93.9

% without improved sanitation in 1990 92.2 58.6 42.4 44.7 43.4 31.5 62.8 47.4 24.2 65.0 34.6

74.7

95.1

25.3

12.7

20.4

-7.8

36.8 33.4 79.5 42.9 89.9 81.4 80.5 91.5 68.5 67.0 30.6 92.5 70.7

75.9 74.0 95.9 76.6 100.0 95.8 94.6 100.0 88.2 85.4 66.6 97.5 86.3

63.2 66.6 20.5 57.1 10.1 18.6 19.5 8.5 31.5 33.0 69.4 7.5 29.3

31.6 33.3 10.3 28.6 5.1 9.3 9.7 4.2 15.8 16.5 34.7 3.7 14.6

39.1 40.6 16.4 33.7 10.1 14.3 14.1 8.5 19.7 18.4 36.0 5.0 15.6

-7.5 -7.3 -6.2 -5.1 -5.1 -5.0 -4.3 -4.2 -3.9 -1.9 -1.3 -1.2 -1.0

98.6 98.7 94.9

100.0 100.0 98.0

1.4 1.3 5.1

0.7

1.4

-0.7

0.7 2.6

1.3 3.1

-0.7 -0.6

62.4 83.4 28.3 74.8 25.9

81.6 92.0 64.4 87.6 63.1

37.6 16.6 71.7 25.2 74.1

18.8

19.3

-0.5

8.3 35.8 12.6 37.1

8.6 36.1 12.9 37.2

-0.3 -0.3 -0.2 -0.2

MDG Target Change in (half of % 19901990) 2012 46.1 92.2 29.3 51.5 21.2 42.0 22.4 39.4 21.7 37.8 15.8 30.9 31.4 44.5 23.7 36.7 12.1 24.2 32.5 44.0 17.3 28.5

Gap between MDG target and actual -46.1 -22.2 -20.8 -17.0 -16.1 -15.2 -13.1 -13.0 -12.1 -11.5 -11.2

Table 10: The countries and territories with rural populations furthest from meeting the MDG target for sanitation in 2012

48

Country Togo Central African Republic Djibouti Niger Eritrea Sudan Liberia Sierra Leone Chad Malawi United Republic of Tanzania Benin Mauritania Burkina Faso Nigeria Ghana Côte d'Ivoire Guinea-Bissau Papua New Guinea Madagascar Guinea Mali Mozambique Haiti Namibia Cameroon Zimbabwe Angola Kenya Bolivia (Plurinational State of) Zambia Kiribati Uganda India Ethiopia Nicaragua Cambodia Burundi Democratic Republic of

% with provision for improved sanitation in 1990 7.9 11.6 39.2 1.6 0.0 18.3 3.3 5.1 4.4 7.3

% with provision for improved sanitation in 2012 2.5 7.2 21.6 3.8 3.5 13.4 5.9 6.8 6.5 8.0

% without improved sanitation in 1990 92.1 88.4 60.8 98.4 100.0 81.7 96.7 94.9 95.6 92.7

MDG Target (half of 1990) 46.1 44.2 30.4 49.2 50.0 40.8 48.4 47.5 47.8 46.3

Change in % 19902012 -5.4 -4.4 -17.5 2.2 3.5 -4.9 2.6 1.7 2.1 0.7

Gap between MDG target and actual 51.5 48.6 47.9 47.0 46.5 45.8 45.8 45.7 45.7 45.6

6.2 0.3 8.4 1.9 37.4 3.8 6.5 3.3 12.9 5.9 4.7 10.0 1.7 12.6 9.5 26.7 35.3 6.6 24.2

7.5 5.1 9.2 6.7 24.7 8.4 10.0 8.5 13.3 11.3 11.2 14.5 10.7 16.3 16.9 26.8 32.4 20.1 29.1

93.8 99.7 91.6 98.1 62.6 96.2 93.5 96.7 87.1 94.1 95.3 90.0 98.3 87.4 90.5 73.3 64.7 93.4 75.8

46.9 49.8 45.8 49.1 31.3 48.1 46.7 48.4 43.6 47.1 47.7 45.0 49.2 43.7 45.2 36.7 32.4 46.7 37.9

1.3 4.8 0.8 4.8 -12.8 4.6 3.5 5.2 0.5 5.4 6.6 4.6 9.0 3.7 7.4 0.1 -2.9 13.6 4.8

45.6 45.0 45.0 44.2 44.0 43.5 43.2 43.1 43.1 41.6 41.1 40.4 40.2 40.0 37.9 36.6 35.3 33.1 33.1

12.0 28.6 19.7 25.5 6.6 0.0 25.7 0.0 42.4 11.5

23.7 33.9 30.6 34.1 24.7 22.8 37.0 25.5 48.1 32.6

88.0 71.4 80.3 74.5 93.4 100.0 74.3 100.0 57.6 88.5

44.0 35.7 40.1 37.3 46.7 50.0 37.1 50.0 28.8 44.3

11.7 5.3 10.9 8.6 18.1 22.8 11.3 25.5 5.6 21.1

32.3 30.4 29.2 28.7 28.6 27.2 25.9 24.5 23.1 23.1

49 the Congo Yemen Senegal Pakistan Russian Federation Botswana Panama American Samoa Nepal Total Brazil Indonesia Swaziland Marshall Islands Peru El Salvador Tonga Jamaica Turkey South Africa Georgia Dominican Republic Micronesia (Fed. States of) Tuvalu Samoa Colombia Northern Mariana Islands Guam Paraguay Trinidad and Tobago Guyana Kyrgyzstan Mauritius Philippines

11.5 20.7 6.9 57.9 22.2 41.2 61.0 3.5 28.2 31.4 23.7 44.3 41.0 15.5 30.4 94.7 81.1 66.1 39.7 96.0 61.7

34.1 40.5 33.6 59.3 41.8 52.5 62.5 33.7 47.2 49.2 45.5 56.0 55.5 44.8 53.4 88.9 82.2 75.5 62.4 90.7 73.8

88.5 79.3 93.1 42.1 77.8 58.8 39.0 96.5 71.8 68.6 76.3 55.7 59.0 84.5 69.6 5.3 18.9 33.9 60.3 4.0 38.3

44.2 39.7 46.6 21.0 38.9 29.4 19.5 48.3 35.9 34.3 38.1 27.8 29.5 42.2 34.8 2.7 9.4 17.0 30.2 2.0 19.1

22.6 19.8 26.7 1.4 19.6 11.3 1.5 30.2 19.0 17.8 21.8 11.7 14.5 29.3 23.1 -5.8 1.1 9.4 22.7 -5.3 12.1

21.6 19.9 19.8 19.6 19.3 18.1 18.0 18.0 16.9 16.5 16.4 16.2 15.0 12.9 11.8 8.5 8.4 7.5 7.4 7.3 7.0

9.0 71.4 92.3 40.9 68.7 88.6 13.6 92.7 72.0 90.9 87.2 45.2

49.0 80.2 91.1 65.7 79.7 89.8 52.5 92.1 82.0 91.7 90.1 69.4

91.0 28.6 7.7 59.1 31.3 11.4 86.4 7.3 28.0 9.1 12.8 54.8

45.5 14.3 3.8 29.5 15.7 5.7 43.2 3.6 14.0 4.6 6.4 27.4

39.9 8.8 -1.2 24.8 11.1 1.2 38.9 -0.6 10.0 0.8 2.9 24.3

5.5 5.5 5.0 4.8 4.6 4.5 4.3 4.2 4.0 3.7 3.5 3.1

50

1

The author is grateful to Nazrul Islam and his colleagues and to Anna Walnycki (IIED) for valuable comments and suggestions on the previous draft. 2 United Nations (2013), The Millennium Development Goals Report 2013, United Nations, New York, page 3 3 WHO and UNICEF (2014), Progress on Drinking-Water and Sanitation; 2014 Update, Joint Monitoring Programme, WHO and UNICEF, Geneva, page 2. 4 WHO and UNICEF 2014, op. cit. 5 United Nations 2013 op. cit., page 47 6 United Nations 2013, op. cit., page 4 7 IFRC (2010), World Disasters Report 2010: Focus on Urban Risk, International Federation of Red Cross and Red Crescent Societies, Geneva, 211 pages. 8 Galilea Ocón, Sergio (2014), Chapter 6: Latin America, in United Cities and Local Governments (UCLG), Basic Services for All in an Urbanizing World; the Third Global Report on Local Democracy and Decentralization, Routledge, London, pages 133-158 9 United Nations 2013, op. cit., page 3 10 WHO and UNICEF 2014, op. cit., page 2. 11 United Nations 2013 op. cit., page 47 12 United Nations 2013 op. cit., page 47 13 WHO and UNICEF 2014, op. cit., page 40. 14 Wankhade, Kavita (2015),”Urban sanitation in India: key shifts in the national policy frame”, Environment and Urbanization, Vol, 27, No, 2, forthcoming. 15 Ibid. 16 APHRC (2002), Population and Health Dynamics in Nairobi’s Informal Settlements, African Population and Health Research Center, Nairobi, 256 pages and APHRC (2014), Population and Health Dynamics in Nairobi’s Informal Settlements: Report of the Nairobi Cross-sectional Slums Survey (NCSS) 2012, APHRC, Nairobi, 187 pages. 17 Cain, Allan, Mary Daly and Paul Robson (2002), Basic Service Provision for the Urban Poor; The Experience of Development Workshop in Angola, IIED Working Paper 8 on Poverty Reduction in Urban Areas, 40 pages and Cain, Allan (2010), "Research and practice as advocacy tools to influence Angola’s land policies", Environment and Urbanization, Vol. 22, No. 2, pages 505-522. 18 United Cities and Local Governments (2014), Basic Services for All in an Urbanizing World; the Third Global Report on Local Democracy and Decentralization, Routledge, London. 19 United Nations 2013, op. cit., page 4 20 United Nations 2013, op. cit. 21 UN Habitat(2003), Guide to Monitoring Target 11: Improving the lives of 100 million slum dwellers, Progress towards the Millennium Development Goals, UN Habitat, Global Urban Observatory, Nairobi, page 7 22 http://ww2.unhabitat.org/mdg/ 23 See Table B1 in UN Habitat (2005), Financing Urban Shelter; Global Report on Human Settlements 2005, Earthscan Publications, London, 245 pages. 24 See http://www.who.int/water_sanitation_health/gbd_poor_water/en/ and also the papers in Tropical Medicine & International Health Vol 19, Issue 8, August 2014 25 http://www.who.int/water_sanitation_health/gbd_poor_water/en/ 26 Wankhade 2015, op. cit. 27 Galilea Ocón, 2014, op. cit. 28 Ibid. 29 Ibid; also Ducci, Jorge and Martin Soulier Faure (2010), Drinking Water, Sanitation and the Millennium Development Goals in Latin America and the Caribbean`, Inter-American Development Bank, Washington DC.

51

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Loftus, Alexander J and David A McDonald (2001), "Of Liquid Dreams: A Political Ecology of Water Privatization in Buenos Aires", Environment and Urbanization, Vol 13 No 2, pages 179-199; Budds, Jessica and Gordon McGranahan (2003), "Are the debates on water privatization missing the point? Experiences from Africa, Asia and Latin America", Environment and Urbanization, Vol. 15, No. 2, pages 87-114; McGranahan, Gordon and Jessica Budds (2003), Privatization and the Provision of Urban Water and Sanitation in Africa, Asia and Latin America, Human Settlements Discussion Paper, IIED, London, 58 pages. 31 Boonyabancha, Somsook (2005), "Baan Mankong; going to scale with 'slum' and squatter upgrading in Thailand", Environment and Urbanization, Vol. 17, No. 1, pages 21-46; Boonyabancha, Somsook (2009), "Land for housing the poor by the poor: experiences from the Baan Mankong nationwide slum upgrading programme in Thailand", Environment and Urbanization, Vol. 21, No. 2, pages 309-330; and Satterthwaite, David and Diana Mitlin (2014), Reducing Urban Poverty in the Global South, Routledge, London. 32 Orangi Pilot Project - Research and Training Institute (2002), Katchi Abadis of Karachi: Documentation of Sewerage, Water Supply Lines, Clinics, Schools and Thallas - Volume One: The First Hundred Katchi Abadis Surveyed, Orangi Pilot Project, Karachi, 507 pages. 33 Hasan, Arif (2006), "Orangi Pilot Project; the expansion of work beyond Orangi and the mapping of informal settlements and infrastructure", Environment and Urbanization, Vol. 18, No. 2, pages 451480; Hasan, Arif (2008), "Financing the sanitation programme of the Orangi Pilot Project: Research and Training Institute in Pakistan", Environment and Urbanization, Vol. 20, No. 1, pages 109-120; Hasan, Arif (2010), Participatory Development: The Story of the Orangi Pilot Project-Research and Training Institute and the Urban Resource Centre, Karachi, Oxford University Press, Oxford, 325 pages. 34 This draws on Patel, Sheela (2015), “The 20 year sanitation partnership of Mumbai and the Indian Alliance”, Environment and Urbanization Vol 27, No 1. 35 See for instance Banana, Evans, Beth Chitekwe-Bitiki and Anna Walnycki (2015), “Co-producing inclusive city-wide sanitation strategies; lessons from Chinhoyi, Zimbabwe”, Environment and Urbanization Vol 27, No 1. 36 Banana, Evans, Patrick Chikoti, Chisomo Harawa, Gordon McGranahan, Diana Mitlin, Stella Ntalishwa, Noah Schermbrucker, Farirai Shumba and Anna Walnycki (2015), "Sharing reflections on inclusive sanitation", Environment and Urbanization, Vol. 27, No. 1. 37 GLAAS: UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (2014), Investing In Water and Sanitation: Increasing Access, Reducing Inequalities, World Health Organization, page 23 38 This draws on Wankhade 2015, op. cit. and McGranahan, Gordon (2015), “Realizing the Right to Sanitation in Deprived Urban Communities: Meeting the Challenges of Collective Action, Coproduction, Affordability and Housing Tenure”, World Development, Vol. 68, pages 242–253. 39 McGranahan 2015, op. cit. 40 See discussion in Wankhade 2015 op. cit. 41 See McGranahan 2015 and Wankhade 2015, op. cit. 42 Chaplin, Susan E. (1999), "Cities, sewers and poverty: India's politics of sanitation", Environment and Urbanization, Vol.11, No.1, April, pages 145-158; Chaplin, Susan E. (2011), "Indian cities, sanitation and the state: the politics of the failure to provide", Environment and Urbanization, Vol. 23, No. 1, pages 57-70. 43 See Banana and eight co-authors 2015, op. cit. 44 McGranahan 2015, op. cit. 45 Patel 2015 and Banana and eight co-authors 2015, op. cit. 46 United Nations 2013, op. cit. 47 GLASS 2014, op. cit. 48 Open Working Group (2014), Sustainable Development Goals draft 19th July.

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Banana and eight co-authors 2015, op. cit. Satterthwaite, David, Diana Mitlin and Sheridan Bartlett (2015), "Is it possible to reach low-income urban dwellers with good quality sanitation?" Environment and Urbanization, Vol. 27, No. 1. 51 Satterthwaite, Mitlin and Bartlett 2015, op. cit.; Banana and eight co-authors 2015, op. cit. 52 Satterthwaite, Mitlin and Bartlett 2015, op. cit. 53 GLAAS 2014, op. cit. 54 Hasan 2006 op. cit. 50