Water and Sanitation in the World's Cities : Local Action for Global Goals 9781849774284, 1849774285, 1844070042, 1844070034

Table of contents :
Content: WATER AND SANITATION IN THE WORLD'S CITIES Local Action For Global Goals
Copyright
Foreword
Acknowledgements
Contents
List of Figures, Tables and Boxes
List of Acronyms and Abbreviations
Introduction
Notes and references
Chapter 1 Provision for Water and Sanitation in Cities
Introduction
Judging who has adequate provision
Setting standards
The lack of data
Provision for water and sanitation in each of the world's regions
The regions where provision needs the greatest improvements
Provision for water and sanitation in urban areas of Asia. Provision for water and sanitation in urban areas of AfricaChanges in provision for water and sanitation in urban areas of East Africa
Provision for water in Africa's larger cities
Provision for sanitation in Africa's larger cities
Provision for water and sanitation in urban areas of Latin America and the Caribbean
The special problems of smaller cities and towns in low-income countries
Provision for water and sanitation
Rural versus urban areas
Notes and references
Chapter 2 The Impacts of Deficient Provision
Introduction. The health impacts of inadequate provision for water and sanitationOverall impacts
Reinforcing inequality, poverty and destitution
Water consumption
Monetary costs of water and sanitation
Time spent getting water
Time and money lost to water-borne and other water-related diseases
Impacts on infauts and children
Health burden for children
Children's vulnerabilities
The impacts for mental and social development
What matters for children with regard to water and sanitation?
Quantity and accessibility versus quality
Storing water
Sanitation
Drainage and waste collection. The quality of care and hygienic practicesVulnerability and susceptibility
Women
Renters
Restricting economic development
Improved provision for water and sanitation and poverty reduction
Notes and references
Chapter 3 Explaining Deficiencies in Urban Water and Sanitation Provision
Introduction
Proximate causes
Illegal status of many settlements
Community capacity to develop autonomous solutions
Household capacity to pay
Contributory causes
The weakness/incapacity of local utilities
Rapid population growth
The expansion of urban and city populations. Patterns of growth and change in the distribution of the world's urban populationWhat role for water within urban change?
War and civil conflict
Weak city and municipal government
The developmental role of local government
The weaknesses in local authorities
Underlying causes
The lack of international funding for investment in water and sanitation in urban areas
The 'lack of development'
The political under-pinning of good provision for water and sanitation
Conclusions
Notes and references
Chapter 4 Increasing Water Stress and How it Relates to Urban Water and Sanitation Provision. Introduction.

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WATER A N D SANITATION IN THE W O R LD 'S CITIES LOCAL ACTION FOR GLOBAL GOALS

WATER AND SANITATION IN THE WORLD’S CITIES

WATER AND SANITATION IN THE WORLD’S CITIES CAL A C T I O N F OR G L O B A L GOA

United N ations H um an S e ttle m e n ts P ro gram m e (UN-HABITAT)

UN-HABITAT

IHSBEIBSHE] Earthscan Publications Ltd London • Sterling, VA

First published in th e UK and USA in 2003 by E a rth s c a n Publications Ltd for and on behalf of the United N ations H uman S e ttle m e n ts P rog ra m m e (UN-HABITAT) Copyright © United N ations H uman S e ttle m e n ts P rog ram m e (UN-HABITAT), 2003 All r i g h ts re s e r v e d United Nations Human S e ttle m e n ts P ro gram m e (UN-HABITAT) PO Box 3 0 0 3 0 , Nairobi, Kenya Tel: + 2 5 4 2 621 234 Fax: + 2 5 4 2 62 4 266 Web: w w w .u n h a b it a t. o r g DISCLAIMER The designations employed and th e p re senta tio n of the m aterial in th is publication do not imply th e expression of a ny opinion w h a t s o ­ ever on th e p a rt of th e S e c re ta ria t of the United N ations concerning the legal s t a tu s of any country, territo ry, city or a re a , or of its au tho rities, or concerning delimitation of its frontiers or boundaries, or regarding its economic system or degree of development. The an alysis, conclusions and recom m endations of th e report do not necessarily reflect th e views of th e United Nations Human S e ttle m e n ts P ro gram m e (UN-HABITAT), the Governing Council of UN-HABITAT or its M em ber S ta t e s H S /6 8 2 /0 3 E ISBN:

1-84407-004-2 pa p e rb a c k 1-84407-003-4 h a rd b a c k

T y pesetting by M ap S et Ltd, G ateshead P age design by S&W Design Ltd Cover design by D anny Gillespie Cover p ho to g rap h s © UN-HABITAT W ate r for African Cities P rog ra m m e (top) and GHK/Kevin Taylor (bottom) P rinted and bound in th e UK by William Clowes, Suffolk For a full list of publications please contact: E a rth s c a n Publications Ltd 120 Pentonville Road, London, N1 9JN, UK Tel: + 4 4 (0)20 7 278 0433 Fax: + 4 4 (0)20 7 27 8 1142 Email: e a rth in f o @ e a rth sc a n .c o .u k Web: w w w .e a r th s c a n . c o . u k 22 8 8 3 Quicksilver Drive, Sterling, VA 20 1 6 6 -2 0 1 2 , USA E a rth s c a n is an editorially in d epen den t subsidiary of Kogan Page Ltd and publishes in association with WWF-UK and the In te rn a tio n a l In s titu te for E nvironm ent and Development A cata log ue record for this book is available from th e British Library Library of Congress Cataloging-in-Publication D ata W ate r and san ita tio n in th e w o rld ’s cities : local action for global goals / United N ations H uman S e ttle m e n ts Program m e (UN-HABITAT), p. cm. Includes bibliographical references and index. ISBN 1-84407-004-2 (pbk.) — ISBN 1-84407-003-4 (h ardback) 1. Municipal w a t e r supply— Developing countries. 2. S a n ita tio n — Developing countries. I. United N ations H uman S e ttlem en ts Program m e. T D 327.W 353 2003 3 6 3 . 6 T 0 9 1 7 2 4 — dc21 2003002259 P rin ted on elemental-chlorine-free p a p e r sourced from s u s tain ab ly m an age d forests

Foreword

The 20 th c e n tu r y will be rem em bered for u n p receden ted technological a dv anc es, th e acceleratio n of globalization an d th e urbanization across th is planet. The closing y e a r s of th e la s t c e n tu ry w itn essed a slow bu t s te a d y decline in th e proportion of people living in ex trem e poverty, and sev eral co un tries are now b ack on t r a c k to achieve universal p rim a ry education. Yet, despite th es e ad van ces, a t th e s t a r t of th e new millennium, over a billion of th e w o rld ’s people remain w ith o u t access to safe drinking w a t e r and over tw ice t h a t n u m b er are denied acce ss to a d e q u a te san itatio n. World lead ers m eeting a t th e Millennium Sum m it and th e following World Sum m it on S u stain ab le Development resolved to halve, by 2 015 , th e proportion of people w ith o u t susta inab le acc ess to safe drinking w a t e r and basic sa n itatio n . Achieving th is goal will not be easy, given the m ounting population pressures, rapid urban izatio n and ubiquitous resource co nstrain ts. Unquestionably, the com m itm ent of policy-makers to t r a n s l a t e th es e global goals into country- and city-level goals and ta r g e t s will be a n e c e ss a ry first step. The goals m ay be global in c h a r a c t e r b u t th e y m ust be im plem ented locally, w here people live and w here sh e lter and services are required. Strong political leadership and sup po rt from nation al g ov ernm ents will be needed to tu rn th ing s around. A stab le policy environm ent will be essen tial to a t t r a c t fresh in vestm ent in w a t e r and san itation . And th e u rb a n poor, mostly living in slums and s q u a t t e r s ettle m en ts, should, unquestionably, receive th e high priority regarding future inv estm en t t h a t th e y deserve. It will be equally im p o rta n t to p u t in place effective monitoring m echa nism s t h a t will allow th e tr a c k in g of progress to w a r d s safe drinking w a t e r an d basic san ita tio n . The global monitoring m echa nism s curren tly available have proved to be in capable of cap turin g th e real a sp iratio n s and needs a t the local level. We need monitoring m echanism s t h a t will allow local voices to be h eard an d th e ir pe rcep tio ns to be relied upon. The timing of th e UN-HABITAT report Water and Sanitation in the World's Cities could not be more opportune. The United N ations Millennium Project h as ju s t e m barked on the identification of th e b e st stra te g ie s for m eeting the Millennium D evelopment Goals and relate d ta r g e ts . By th e t a r g e t y e a r of 2 0 1 5 , n early 60 per cen t of th e w o rld ’s population will m ake cities th e ir home. M eeting th e rapidly growing urb an d em and for safe w a t e r a nd a d e q u a te s a n ita tio n facilities will be a daun ting challenge. The a n a ly tic a l w ork in th is report and its c e n tra l finding - t h a t local solutions are key to achieving global goals - should provide a valuable input to th e w o rk of the Millennium Task Force. A n n a K a jum u lo T ib a i ju k a Under-Secretary-General, United N ations E xecutive Director, U N-H ABITAT

Acknowledgements

Water and Sanitation in the World’s Cities w a s m ade possible by the generous su p p o rt of the S w edish In tern a tio n a l D evelopment Cooperation Agency (Sida) an d th e Jap an W a te r Resources A ssociation (JAWA). Water and Sanitation in the W orld’s Cities w a s prep ared un der th e supervision of K alyan Ray, Chief of Water, S a n itatio n and In f ra s tru c tu r e B ranch. Key s u b s tan tiv e sup p o rt w a s provided by G raham A labaster, Andre Dzikus, Brian Williams and Neeru Singh of th e sa m e branch. An initial outline of th e rep o rt w a s p rep ared by David S a tt e r t h w a i t e of th e In te rn a tio n a l I n s titu te for Environm ent an d D evelopment (IIED) in close con sultation w ith UN-HABITAT. An a n n o ta t e d outline of th e report w a s discussed in a S ta k e h o ld e rs ’ C onsultation organized by UN-HABITAT during th e first World Urban Forum held in Nairobi, Kenya, on 10 May 20 02 . The m eeting w a s chaired by Sir R ichard Jolly, Chairm an of th e W a te r Supply and S an itatio n Collaborative Council, and w a s widely a tte n d e d by e xp ert d e leg a tes to th e World Urban Forum, NGOs and rep re se n ta tiv e s of e x te r n a l su p p o rt agencies. The p re p aratio n of th e rep o rt w a s e n tr u s te d to IIED w ith David S a tt e r t h w a i te and Gordon M cG ran ah an actin g as th e main c o n su lta n ts and principal resource p ersons w ith sup po rt from H a n n a h Reid. They bro ug ht into th is w o rk strong p erso n al com m itm ent, e x tr a o rd i n a ry energy and a rare degree of professionalism to complete th is rep o rt within an alm ost impossible deadline. UN-HABITAT organized an E x p e rt Group M eeting in Nairobi on 1 2 -1 3 S e p tem b er 2 0 0 2 , to discuss the first dra ft of th e report (C hapters 1 -6 ) p rep a re d by IIED. E x p erts atte n d in g th e M eeting included: Jan G Ja n s se n s (the World Bank), B ernh ard Griesinger (Organization of the A m erican S ta te s ), Sekou Toure, H enry Ndede and Gazoulit K a w t a r (UNEP), Mario Vasconez (CIUDAD), Malick Gaye (ENDA-TM), Piers Cross and Ja p h e th Mbuvi (W ater and S anitation P rog ram m e, E a st Africa), P u sh p a P a th a k (W ater and S a n itatio n P ro gram m e, So uth Asia), Diana Lee-Smith (SIUPA-CIP), Professor R A Obudho (Nairobi University), S un ita Kapila and John D Skoda (Consultants), David S a tt e r t h w a i t e an d Gordon M cG ran ah an (IIED); from UN-HABITAT: A n na T ibaijuka, Daniel Biau, Nefise Bazoglu, Farouk Tebbal, Alioune Badiane, Iouri Moisseev, Andre Dzikus, G raham A la baster, Brian Williams, Anne-Maj L ah d e n p e ra, Jam es Ohayo, Pireh Otieno, Junko N ak ai an d K alyan Ray. Extensive com m ents an d inp uts were received from the e x p e rts which led to rew ritin g of several c h a p te rs and some reorganizatio n of the report. A rth u r M cIntosh and K E S e e th a r a m of th e Asian D evelopment Bank, Jam ie B a rtr a m of WHO, San dy Cairncross of the London School of Hygiene and Tropical Medicine, P e rw e e n R a h m a n (Orangi Pilot P roject-R ese arch and Training In stitute ) and David Nilsson of Sida could not personally a tt e n d th e EGM but offered th e ir valuable com m ents an d inp uts to th e report. A num ber of a u th o r s w ere commissioned to w rite b a ck grou nd p ap ers for th e report. They included: S heridan B a rtle tt, W aterA id (Dar es S alaa m ), Pedro Jacobi, Jessica Budds, Micheline Duruz, Khatim K herraz and a tea m in IIED-America L atina in Buenos Aires (Kimberly Vilar, Jorgelina Hardoy, Florencia Almansi). We are also g rateful to th e Indian NGO SPARC for m aking available the p relim in ary findings from th e ir in terv iew s with ‘slu m ’ dw ellers in P une and Mumbai an d to David Johnstone for his help and com m ents on d raft te x ts. Additionally, regional reviews of

W ater

and

S a n it a t io n

in t h e

W

o r l d ’s

C it ie s

• ••

vm th e rep o rt w ere e n tr u s te d to: P e rw e e n R a h m a n for Asia, A lbert W right for Africa and Mario V asconez for Latin America and th e Caribbean. S an dy Caincross and Virginia Roaf (WaterAid) also reviewed th e whole d raft t e x t and gave valuable com m ents and suggestions. The draft rep o rt w a s also widely circulated among professional staff of UN-HABITAT and benefited from th e ir com m ents. Notable am ong them are: Daniel Biau, G raham A la baster, Andre Dzikus, Brian Williams an d Junko N akai. Valuable c ontributions w ere also made by Graham A labaster, Andre Dzikus, Jam es Ohayo and Pireh Otieno. The rep o rt also benefited from th e com m ents received from th e World W a te r A ssessm e nt P ro g ram m e S e c re ta ria t, in p articu lar, Gordon Young and Andy Bullock, and from th e World H ealth O rganization, in p a rtic u la r Jam ie B a rtra m and Robert Bos. H enk Verbeek, Eric Verschuur, Salome G athu, Veronica Njuguna and Emily Njeru of UN­ HABITAT an d Josie Villamin of th e United N ations Office in Nairobi provided valuable ad m in istrativ e support. S pecial th a n k s are due to th e people a t E a rth s c a n Publications Ltd, in p a rtic u la r J o n a th a n Sinclair Wilson, A kan L ean der a nd F ra n c e s M acD erm ott. K a ly a n R a y Chief, Water, Sanitation and Infrastructure Branch U N-H ABITAT

Contents

Foreword

v

A cknow ledgem en ts

vii

L is t o f Figures, Tables and B o xes

xH i

L is t o f A cro n y m s and A b breviations

xvi

Introduction

xvii

N o tes a n d re fe re n c e s

1

xxv

Provision for Water and Sanitation in Cities In tro d u c tio n

1

Judg in g w ho h a s a d e q u a t e provision

2

S e tt in g s t a n d a r d s

4

T h e la c k of d a t a

6

Provision for w a t e r a n d s a n i ta t io n in e a c h of th e w o r l d ’s reg io ns The reg io ns w h e re provision n eed s t h e g r e a t e s t im p ro v e m e n ts

8 12

Pro vision for w a t e r

an d s a n i ta t io n in u rb a n a r e a s of A sia

12

Pro vision for w a t e r

a n d s a n i t a t i o n in u r b a n a r e a s of A frica

21

C h a n g e s in provision for w a t e r a n d s a n i ta t io n in u rb a n a r e a s of E a s t A frica

24

Provision for w a t e r in A fric a ’s la r g e r cities

27

Provision for s a n i ta t io n in A fric a ’s la r g e r cities

30

P rovision for w a t e r

a n d s a n i ta t io n in u rb a n a r e a s of L a tin A m e ric a a n d t h e C a rib b e a n

The sp ecial p rob lem s of s m a lle r cities a n d t o w n s in low-income c o u n tr ie s P rovision for w a t e r a n d s a n i ta t io n

2

1

31 39 39

R u r a l v e rs u s u rb a n a r e a s

48

N otes a n d re fe re n c e s

50

The Impacts of Deficient Provision

57

I n tro d u ctio n

57

The h e a lt h im p a c ts of in a d e q u a te provision for w a t e r a n d s a n i ta t io n

57

O verall im p a c ts R einforcing in eq uality, p o v e rty an d d e s titu tio n

57 61

W a te r c o n su m p tio n

66

M o n e t a r y c o sts of w a t e r an d s a n i ta t io n

66

T im e s p e n t g e tt in g w a t e r

71

Tim e an d m oney lost to w a te r- b o rn e a n d o th e r w a t e r - r e l a t e d d is e a s e s

72

Im p a c ts on in f a n ts a n d children

73

H e a lth b u rd e n for children

74

Children’s v u ln erab ilities

76

T h e im p a c ts for m e n t a l a n d social d e v e lo p m e n t

77

W h a t m a t t e r s for children w ith re g a r d to w a t e r a n d s a n ita t io n ?

78

Q u a n tity an d a ccessib ility v e r s u s q u a lity

78

S to rin g w a t e r

78

S a n it a ti o n

79

D ra in a g e a n d w a s t e collection

80

The q u a lity of c a re a n d hygienic p r a c t i c e s

80

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

X

3

Vulnerability and susceptibility

82

Women

84

R en ters

91

R estricting economic developm ent

91

Improved provision for w a t e r a nd san itatio n a nd poverty reduction

92

Notes and references

93

Explaining Deficiencies in Urban Water and Sanitation Provision

101

P ro xim ate ca u se s

104

Illegal s t a t u s of m an y s e ttle m e n ts

104

Community c a p a c ity to develop a uto no m o us solutions

105

Household c a p a c ity to pay

106

C ontributory ca u se s

107

The w e a k n e s s / in c a p a c i ty of local utilities

107

R apid population g row th

108

The expansion of u rb an a nd city populations

108

P a t t e r n s of g row th and change in th e distribution of th e w o rld ’s u rb an population

110

W h a t role for w a t e r w ithin u rb an change?

112

W ar and civil conflict W eak city an d m unicipal gov ernm ent

113 113

The developm ental role of local gov ernm ent

113

The w e a k n e s s e s in local a u th o ritie s

114

Underlying c a u se s

4

101

Introduction

117

The lack of in tern a tio n a l funding for inv estm ent inw a t e r and sa n ita tio n in u rb an a re a s

118

The ‘lack of d e velo pm en t’

120

The political under-pinning of good provision for w a t e r and s a n ita tio n

123

Conclusions

125

Notes and references

125

Increasing Water Stress and How it Relates to Urban Water and Sanitation Provision Introduction Global tr e n d s and increasing w a t e r s tre ss

129 129 129

P redicting a global crisis

130

Ind icators of regional w a t e r stre ss

131

Local variatio n and b o u n d a ry is sues

132

Temporal v ariatio n and sea s o n a l is sues

132

A daptability a nd com parability issues

132

Accessibility a nd economic c a p a c ity is sues

132

Unaccounted-for w a t e r Regional w a t e r stre ss and its co nsequences for u rb an w a t e r an d sa n ita tio n provision and he alth

132 134

Comparing s t a tis tic s on w a t e r stre ss and w a t e r acc ess

136

W a te r stress, s a n ita tio n and hea lth

137

Urban developm ent an d its contribution to w a t e r stress Urban w a t e r dem and

139 140

W ate r pollution

142

S tr u c tu r a l tra n sfo r m a tio n s

144

D isasters and w a t e r and san itatio n

146

Floods

146

Other kinds of d is a ste r

148

Contents

2d Defining d is a sters

149

Causes of d is a ste r s

150

U nderstan ding d is aste r risks in cities

150

The growing n um b er of w a te r- re la te d d is a ste r s

151

Keeping tr a c k of u rban d is aste rs in Latin America and th e Caribbean Notes and references

Changing Perspectives and Roles in Urban Water and Sanitation Provision: Privatization and Beyond Introduction

152 154

158 158

Evolving in tern a tio n a l persp ectiv es on w a t e r an d sa n ita tio n

159

The increasing role of the private sec tor in w a t e r and san itatio n utilities

162

Defining priv atizatio n , p riv ate se c to r partic ip atio n a nd p u b lic-p riv ate p a rtn e rsh ip

162

C onceptual is sues in th e privatizatio n debates: public goods, economic goods, n a tu r a l monopolies and hum an righ ts

163

Public goods and th e case for public provisioning

164

Economic goods and th e case for p riv ate provisioning

165

N a tu ra l monopolies and th e case for regu latio n

166

Human righ ts and th e case for public accou ntab ility

167

Different forms of private se c to r pa rticipation in w a t e r a nd sa n ita tio n utilities

168

Service c o n tr a c t

169

M an a g e m e n t c o n tr a c t

169

Affermage c o n tr a c t

169

L ease c o n tr a c t

169

Concession c o n tr a c t

169

BOT (build-own-transfer) c o n tr a c ts

170

Full p riv atizatio n (divestiture)

170

Joint v entu res, public w a t e r PLCs an d coo p eratives

170

Multi-utility c o n tr a c ts

170

W h a t drives th e public se c to r to involve p riv a te en terp rises?

171

W h a t drives th e p riv ate se c to r to p a rtic ip a te ?

171

The bidding process and ren ego tiation s for large c o n tr a c ts

172

P riv a te partic ip atio n and finance

173

Regulation of priv ate w a t e r an d s a n ita tio n e n te rp rises

174

Priv atiz atio n and m e a s u re s for pro-poor provision

176

Trends in private secto r partic ipa tion in w a t e r and s a n ita tio n utilities

177

The role of sm all-scale providers

181

The role of CSOs

184

Notes and references

189

Improving Urban Water and Sanitation Provision as part of Integrated Water Resource Management Introduction

193 193

IWRM

194

Urban demand-side w a t e r m a n a g e m e n t as p a r t of IWRM

196

M anag ing dem and to save w a t e r w ith o u t compromising on w a t e r services

198

Raising a w a re n e s s of w a t e r and s a n ita tio n th ro ug h public cam p a ig ns

202

T a rget au dienc es for cam p a ig ns

202

Campaign launch a nd du ration

204

M anag ing dem and to improve public h ealth

206

M anag ing dem and to increase economic efficiency and affordability

209

W ater

•

xn

and

S a n it a t io n

in t h e

W

o r l d ’s

C it ie s

•

M anag ing dem and to em p ow er deprived comm unities

7

214

Combining demand-side s tra te g ie s and serving th e u rban poor

218

Notes and references

222

Governance for Good Water and Sanitation Provision: Getting the Best Out of Public, Private and Community Organizations

224

Introduction

224

The role of city g o vernm ents

224

From improved g ov ern m en t perform ance to good g o vern ance

229

T o w ards more effective a p p ro a c h e s

231

G overnance for sm all u rb an cen tres

240

B e tter g overnance and m echanism s for extending provision to u nserved or in a d eq u a tely se rv ed households

241

Community upg rad ing

243

S u pporting new homes w ith provision

245

B e tter g o vern ance and th e perfo rm ance of w a t e r an d s a n ita tio n utilities

249

B e tter g o vern ance and in te g ra te d w a t e r resource m a n a g e m e n t

250

Developing strong local information system s

251

In te rn a tio n a l su p p o rt for b e tt e r local g ov ern ance for w a t e r and sa n ita tio n

254

W ate r an d s a n ita tio n an d th e Millennium D evelopment Goals

258

Notes and references

261

Index

265

List of Figures, Tables and Boxes

*23 Figures 1.1

How th e risk of tr a n s m i s s i o n of f a e c a l - o r a l p a th o g e n s v a rie s a cc o rd in g to t h e q u a lity of provision for w a te r , s a n i ta t io n a n d hygiene

5

1.2

W a te r in t h e hom e for different size c la s s e s of cities

41

1.3

F lush to i le t for different size c la s s e s of cities

41 62

2.1

R eg io n al d ifferentials in a v e r a g e h e a lt h b u rd e n s from d ia r r h o e a l d is e a s e s

2.2

C o m p arin g provision for w a t e r an d s a n i ta t io n b e tw e e n t h e p o o re s t a n d t h e w e a l t h i e s t 20 p e r c e n t in A cc ra, J a k a r t a a n d S âo Paulo

64

2.3

V ariatio ns in a v e r a g e w a t e r ta riffs for s e le c te d A sian cities

68

2 .4

The v e ry la r g e v a r i a ti o n s in th e cost of w a t e r from dif ferent p ro v id ers indifferent

2.5

P ro p o rtio n of s e le c te d A sian city p o p u la tio n s s e r v e d w ith public t a p s an d n u m b e r of p e rs o n s p e r t a p

3.1

E x a m p le s of th e r a n g e of p ro x im a te , c o n tr ib u t o r y a n d u n d e rly in g c a u s e s for th e p re v a le n c e of d ia r rh o e a l

cities

d is e a s e s in a s q u a t t e r s e t t l e m e n t

70 73

102

3.2

I n f r a s t r u c t u r e ex p e n d itu re p e r p e rs o n in 1 99 0 (selected cities)

115

3.3

A n n u a l in v e s tm e n t in u r b a n w a t e r su p p ly by region, 1 9 9 0 - 2 0 0 0

119

3 .4

A n n u a l in v e s tm e n t in u r b a n s a n i ta t io n by region, 1 9 9 0 - 2 0 0 0

119

3.5

T he p e r c e n t a g e of u r b a n p o p u la tio n s in L a tin A m e ric a n n a ti o n s w ith h o u se t a p s in re la tio n to th e i r n a ti o n a l

3 .6

T h e p e r c e n t a g e of u r b a n p o p u la tio n s in L atin A m e ric a n n a ti o n s w ith s e w e r c o n n e c tio n s in re la tio n to th e i r

3 .7

T h e p e r c e n t a g e of ho u seh o ld s in s e le c te d A sian cities w ith h o u seh old co n n e c tio n s for w a t e r (circa 1 99 5) in

3 .8

T h e p e r c e n t a g e of h o u seh o ld s in s e le c te d A frican cities w ith h o u se ho ld co n n e c tio n s for w a t e r in relation to

4.1

World m a p of p ro je c te d w a t e r s c a r c it y in 2 0 2 5

133

4.2

R e latio n sh ip b e tw e e n u rb a n w a t e r a c c e s s , n a t i o n a l w a t e r s t r e s s a n d n a t i o n a l GDP p e r c a p i t a

136

7.1

M a n a g e m e n t of w a t e r a n d s a n i t a t i o n

23 0

7.2

E le m e n ts of good g o v e rn a n c e for w a t e r a n d s a n i ta t io n

23 0

7.3

S c h e m a tic r e p r e s e n ta t io n of how provision for w a t e r an d s a n i ta t io n often v a rie s in s m a lle r u r b a n c e n tr e s

p e r c a p it a incom es, 2 0 0 0

n a ti o n a l p e r c a p i t a incom es, 2 0 0 0

re la tio n to t h e i r n a t i o n s ’ p e r c a p it a incom e, 2 0 0 0

t h e i r n a t i o n s ’ p e r c a p it a incom e, 2 0 0 0

w ith in c r e a sin g p o p u latio n a n d in c r e a sin g w e a l t h in low- a n d m o s t middle-incom e n a ti o n s 7.4

120

121

122

123

241

T he m a n y f a c t o rs t h a t help s u p p o r t more effective a c tio n by local g o v e rn m e n ts to im prove provision for w a t e r a n d s a n i ta t io n

2 57

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

xiv Tables I

E s t i m a t e s a s to t h e n u m b e r of u r b a n d w e lle r s la c k in g provision for w a t e r an d s a n i ta t io n in 2 0 0 0 b a s e d on w ho h a s ‘im p ro v e d ’ provision an d w h o h a s ‘a d e q u a t e ’ pro vision

xx

1.1

T he p ro p o rtio n of u r b a n p o p u la tio n s w ith a c c e s s to ‘im p ro v e d ’ w a t e r sup ply an d s a n i ta t io n , 2 0 0 0

9

1.2

T he p ro p o rtio n of ho u se h o ld s in m a jo r cities c o n n e c te d to piped w a t e r a n d s e w e r s

9

1.3

P ro p o rtio n of th e u rb a n p o p u latio n in A sian n a ti o n s w ith a c c e s s to im proved w a t e r sup ply a n d s a n i ta t io n

12

1.4

Pro vision for w a t e r su pp lies in A sian cities, m id -1 9 9 0 s

13

1.5

W a te r a v a ila b ility a n d co st in A sian cities, m id -1 9 9 0 s

21

1.6

P ro p o rtio n of th e u r b a n p o p u la tio n in A frican n a ti o n s w ith a c c e s s to im proved w a t e r su p p ly an d s a n i ta t io n ,

1.7

Africa: provision for w a t e r in th e la r g e s t cities w ith in e a c h n a tio n , 2 0 0 0

28

1.8

Africa: provision for s a n i t a t i o n in t h e la r g e s t cities w ith in e a c h n a tio n , 2 0 0 0

29

1.9

P ro p o rtio n of th e u r b a n p o p u la tio n in n a tio n s in L a tin A m e ric a a n d th e C arib b e a n w ith a c c e s s to ‘im p ro v e d ’

2000

w a t e r sup ply a n d s a n i ta t io n , 2 0 0 0

22

32

1.10 Pro vision for w a t e r to h o u seh old s in s e le c te d L a tin A m erica n cities

36

1.11 Pro vision for s a n i ta t io n to ho u seh o ld s in s e le c te d L a tin A m erica n cities

37

1.12 T h e d is trib u tio n of t h e u rb a n p o p u la tio n b e tw e e n different size u r b a n c e n tr e s , 2 0 0 0

40

1.13 C o verag e of basic s e r v ic e s in five ‘s e c o n d a r y c it ie s ’ in N ic a ra g u a , 1 99 5

47

1 .1 4 Pro vision for w a t e r an d s a n i ta t io n in s e le c te d s m a lle r cities in L a tin A m e ric a

48

2.1

E x a m p le s of w a te r - an d s a n i ta t io n - r e la t e d d is e a s e s an d t h e a s p e c t s of in a d e q u a c y t h a t a re linked to th e m

58

2.2

P o te n t ia l r e d u c tio n s in m orb id ity for different d is e a s e s a s a r e s u lt of im p ro v e m e n ts in w a t e r su pp ly an d

2.3

A s p e c ts of in eq u a lity in provision for w a t e r an d s a n i ta t io n

63

2.4

Pro vision for w a t e r a n d s a n i ta t io n a m o n g different socio-econom ic c la s s e s in B a n g a lo re

65

2.5

P re d ic te d p e r c e n t a g e of ho u seh o ld s w ith a c c e s s to w a t e r on t h e p re m ise s a n d flush to ile ts by relative

2.6

T he v e r y la r g e v a r i a ti o n s in t h e co st of w a t e r in cities

69

2.7

E x a m p le s of d ifferen tials in t h e price of w a t e r w ith in cities

71

2.8

T he c o st of w a t e r from ho use c o n n e c tio n s, public t a p s an d w a t e r v e n d o rs in A sia n cities

71

2.9

M o n th ly e x p e n d itu re on w a t e r : s h a c k d w e lle rs in N am ib ia

72

sanitation

p o v e rty s t a t u s

2.1 0 M o r ta lity r a t e s for in f a n ts a n d y o u n g children in th e inform al s e t t l e m e n t s of Nairobi 2.1 1 Loss in th e tim e of cho lera; P e ru , 1991 3.1

T h e r a n g e of c a u s e s c o n tr ib u tin g to i n a d e q u a t e w a t e r a n d s a n i ta t io n in u rb a n a r e a s

62

66

75 92 103

3.2

The d is trib u tio n of th e w o r l d ’s u r b a n p o p u la tio n by region, 1 9 5 0 - 2 0 1 0

110

4.1

W a te r w i t h d r a w a l s by s e c t o r a n d region (com bines v a rio u s re c e n t y e a rs )

140

4.2

Global w a t e r w i t h d r a w a l s a n d co n su m p tio n by s e c t o r

140

4.3

T he im p a c t of flood d i s a s te r s by region a n d by h u m a n d e v e lo p m e n t sco re

147

5.1

A llo cation of k ey respo nsibilities for p ri v a te p a r t ic i p a ti o n optio ns

169

5.2

In v e s tm e n t in w a t e r a n d s a n i ta t io n i n f r a s t r u c t u r e p ro je cts w ith p ri v a te s e c t o r p a r t ic i p a ti o n (US$ billions)

178

5.3

P r i v a te w a t e r a n d s a n i ta t io n p ro je c ts in se le c te d regions, 1 9 9 0 - 1 9 9 7

179

5.4

I n v e s tm e n t in w a t e r an d s e w e r a g e p ro jects in s e le c te d co u n trie s, 1 9 9 0 - 1 9 9 7

179

5.5

C o n tr a c t t y p e s for w a t e r a n d s e w e r a g e p ro je c ts 1 9 9 0 - 1 9 9 7 in low- an d middle-income c o u n tr ie s

180

5.6

D o m in a n t p ri v a te co m p a n ie s in t h e w a t e r an d s e w e r a g e s e c t o r

180

6.1

A typ o lo g y of p a r t ic i p a ti o n in w a t e r an d s a n i ta t io n provision

215

6.2

C o m p arin g d ifferent a p p r o a c h e s to d em and -sid e w a t e r m a n a g e m e n t in th e ho useho ld s e c t o r

21 9

7.1

A d d ressin g th e u n de rly ing , c o n tr ib u t o r y an d p ro x im a te c a u s e s of in a d e q u a te provision for w a t e r an d

7.2

M ain a s p e c t s of different m a n a g e m e n t optio ns for w a t e r su pp lies in sm a ll u rb a n c e n tr e s

s a n i t a t i o n in u r b a n a r e a s

23 4 242

L

is t o f

F

ig u r e s ,

Tables

and

B

oxes

XV 7.3

7.4

C om p ariso n of th e c o st of lan d p u rc h a s e , individual w a t e r a n d s a n i t a t i o n c o n n e c tio n s a n d g ra v e l ro ad s b e tw e e n m u nicip al d e v e lo p m e n t an d c o m m u n ity d e v elo p m en t

247

D ifferent e s t i m a t e s a s to t h e n u m b e r of u r b a n d w e lle rs la c k in g provision for w a t e r an d s a n i t a t i o n in 2 0 0 0

25 8

Si! Boxes 7

1.1

T h e m a n y c o m p lic atio n s in d e te r m in in g w h e t h e r provision for w a t e r a n d s a n i ta t io n is a d e q u a t e

1.2

E x a m p le s of th e in a d e q u a c ie s in c it ie s ’ w a t e r su p p ly an d s a n i ta t io n in Asia

15

1.3

Provision for w a t e r an d s a n i t a t i o n in M u m bai; i n t e rv i e w s w ith in h a b i t a n t s of D h a ra v i in July 2 0 0 2

19

1.4

E x a m p le s of th e in a d e q u a c ie s in c it ie s ’ w a t e r sup ply an d s a n i ta t io n in Africa

23

1.5

Provision for w a t e r a n d s a n i t a t i o n in H u r u m a in Nairobi

27

1.6

E x a m p le s of th e in a d e q u a c ie s in c it ie s ’ w a t e r su p p ly an d s a n i ta t io n in L a tin A m e ric a a n d t h e C a rib b e a n

33

1.7

S t r u g g le s for w a t e r an d s a n i ta t io n in L atin A m erica n cities

35

1.8

T h e a v a ilab ility of w a t e r in th e home an d flush to ile ts in r u r a l a r e a s an d u r b a n a r e a s by size clas s

41

1.9

D ifferences in provision for w a t e r an d s a n i ta t io n by t h e p o p u la tio n size of t h e u r b a n c e n tr e in Brazil

42

1.10 E x a m p le s of provision for w a t e r a n d s a n i t a t i o n in sm a ll A frican u r b a n c e n tr e s

43

1.11 T he d e te r io r a tio n in th e q u a lity of m un icip al w a t e r sup p lies in I g a n g a (U ganda)

44

1.12 E x a m p le s of w a t e r an d s a n i ta t io n provision in s m a lle r u r b a n c e n tr e s in In dia

45

1.13 Provision for w a t e r a n d s a n i ta t io n in t h r e e sm all u rb a n c e n tr e s in China

46

2.1

T h e global b u rd e n of d is e a se from w a te r , s a n i ta t io n an d hygiene

61

2.2

E x a m p le s of d ifferentials in w a t e r volum es used

67

2.3

M a n a g in g child ren ’s fa e c e s in Lima

80

2.4

The inform al s e t t l e m e n t of B a n s h ig h a t in K a th m a n d u

82

2.5

W omen from P u n e t a l k a b o u t th e difficulties t h e y face w ith w a t e r a n d s a n i ta t io n

86

3.1

R e a c h in g th e p oo r in u r b a n a r e a s of B a n g la d e sh

107

3.2

T h e c o n s t r a i n t s on e x te n d in g w a t e r a n d s a n i ta t io n in B a n g a lo re

116

4.1

G u a d a l a j a r a ’s w a t e r crisis

135

4.2

F loods an d la n d s lid es in V a rg a s, V enezuela

149

5.1

The Dublin P rinc ip le s

161

5.2

C o m m u n ity -m a n a g e d w a t e r provision: th e politics an d th e pipes

186

5.3

El M ezq uital: a c o m m u n it y ’s s t r u g g le for d e v e lo p m en t

188

6.1

V alue-based a p p r o a c h to w a t e r ed u c a tio n

201

7.1

T h e use of u n t r e a t e d u r b a n w a s t e w a t e r in a g ri c u lt u re in low -income n a ti o n s

22 6

7.2

C om m u nity to ile ts in P u n e an d o t h e r In d ian cities

232

7.3

Beyond pilot projects: t h e w o r k of O rangi P ilo t P ro je c t

236

7.4

Building w a t e r a n d s a n i ta t io n provision from t h e b o t t o m - u p in L u a n d a

23 8

7.5

U rb a n s a n i t a t i o n m icro -e n terp rises: t h e UN-HABITAT V ac u tu g D ev elo p m e n t P ro je c t

2 40

7.6

W a te r su p p ly in A n a n th a p u r , In dia

243

7.7

The e x p e rie n c e of th e Local D evelo pm ent P ro g r a m m e (PRODEL) in N ic a ra g u a

245

7.8

P e o p le -m a n a g e d r e s e t t l e m e n t p r o g r a m m e s in M um ba i

24 6

7.9

C om m u nity d ev elo p m en t in Namibia

24 7

7.10 C o m m u n ity -m a n a g e d h ou sin g d e v e lo p m e n t by th e S o u th A frican H om eless P e o p le ’s F e d e ra tio n

2 48

7.11 Q u ito’s w a t e r c o n s e r v a ti o n fund: pooling d e m a n d for w a t e r s h e d s e r v ic e s th r o u g h t r u s t funds

252

7.12 E m p o w e rin g c o m m u n ities to g e n e r a t e t h e i r ow n in fo rm a tio n sy s te m : CEMIS

25 4

7.13 R e p lic a tin g th e R ufisque e x p e rie n c e t h r o u g h t h e W a te r for A frican Cities P ro g r a m m e

2 56

7 .1 4 T he M a n a g i n g W a t e r for A frican Cities P ro g r a m m e

25 9

List of Acronyms and Abbreviations

BOT

build-own-transfer

CBO

comm unity-based org anization

CEMIS

comm unity-based environm ental m a n a g e m e n t information system

CEPAL

Comisión Econòmica p a r a América L atin a y el Caribe (UN)

CSO

civil society org anization

DALY

disability ad justed life y e a r

DHS

dem ographic and h ealth survey

DSM

demand-side m a n a g e m e n t

ENDA

E nvironm ent an d D evelopment Association

GDP

gross domestic product

IIED

In te rn a tio n a l In stitu te for Environm ent and Development

IWRM

i n te g ra te d w a t e r resource m a n a g e m e n t

Ksh

Kenyan shillings

N$

Nigerian n aira

Na$

Namibian dollars

NGO

non-governm ental organization

OPP

Orangi Pilot Project (Pakistan)

PAHO

P an A m erican H ealth Organization

PLC

public limited com pany

PPP

p u b lic -p riv ate p a rtn e rsh ip

PRODEL

P ro g r a m a de Desarrollo Local (Local D evelopment Program m e)

Rs

rupee

SEMAPA

Servicio M unicipal de A gua Potable y A lcan ta rillad o (Bolivia)

SEWA

Self-Employed Women’s A ssociation (A hmedabad)

Sida

S w edish I n te rn a tio n a l D evelopment Cooperation Agency

SPARC

Society for the Prom otion of A rea Resource Centres

UN

United Nations

UNCHS (Habitat)

United Nations Centre for Human S e ttle m e n ts (H abitat) (now UN-HABITAT)

UN-HABITAT

United N ations H um an S e ttle m e n ts Pro g ram m e [formerly UNCHS (Habitat))

UNICEF

United N ations Children’s Fund

USAID

United S t a t e s Agency for In te rn a tio n a l Development

WHO

World H ealth Organization

Introduction

W ater and Sanitatio n in the W orld's C ities is th e

4

T he n eed for im proved provision for

first a t t e m p t by th e U nited N atio n s H u m an

w a t e r an d s a n i ta t io n to be w ith in a ‘good

S e t t l e m e n t s P ro g r a m m e (UN-HABITAT) a s th e

g o v e r n a n c e ’ fra m e w o rk ; it is difficult to

‘city a g e n c y ’ of th e U nited N a tio n s to monitor,

see h ow im p ro v e m e n ts ca n be m a d e and

a n a ly s e an d re p o r t on a m ajo r a r e a of th e

good q u ality provision e x te n d e d to low-

H a b ita t A genda, n a m e ly ‘E n v iro n m e n ta lly

incom e ho u seh o ld s w ith o u t more

s u s ta in a b l e , h e a lt h y a n d liveable h u m a n s e t t l e ­

c o m p e t e n t city a n d m u nicip al g o v e r n ­

m e n t s ’. 1 It also re s p o n d s to t h e need for

m e n t s t h a t w o rk w ith an d a re

in t e r n a t io n a l a ctio n to ach ie v e Millennium

a c c o u n t a b le to th e i r citizens.

D ev elop m en t Goal 7, specifically a d d re s sin g tw o t a r g e t s : to red u c e by half th e p rop ortio n

On th e first of t h e s e th e m e s , h u n d re d s of

of people w ith o u t s u s ta in a b l e a c c e s s to safe

millions of u rb a n d w e lle rs h a v e i n a d e q u a te

drin k in g w a t e r by 2 0 1 5 ; an d to achiev e signifi­

provision for w a te r , s a n i ta t io n a n d d ra in a g e ,

c a n t im p ro v e m e n t in th e lives of a t le a s t 100

w h ich c o n tr ib u t e s to v e r y la r g e d ise ase

million slum d w e lle rs by 2 0 2 0 (w ith a specific

b u rd e n s a n d h u n d re d s of th o u s a n d s of p r e m a ­

in d i c a to r on s a n i ta t io n for slum d w e lle r s ).2

tu r e d e a t h s e a c h year. L ess t h a n h alf th e

The re p o r t h a s four c e n t r a l th e m e s :

p o p u la tio n in m o s t u rb a n c e n tr e s in Africa, A sia a n d L a tin A m e ric a h a v e w a t e r piped to

1

The u n d e r- e s tim a tio n by g o v e rn m e n ts

th e i r hom es, a n d less t h a n one-third hav e good

a n d i n t e r n a t io n a l a g e n c ie s of th e n u m b e r

q u a lity s a n i ta t io n . T hose living in larg e cities

of u r b a n d w e lle rs w h o h a v e in a d e q u a te

a r e g e n e ra l ly b e t t e r se rv e d t h a n th o s e in

provision for w a t e r a n d s a n i ta t io n , a nd

s m a ll e r u r b a n c e n tr e s. H ow ever, more t h a n

th e v e r y serio u s h e a lt h c o n s e q u e n c e s

h a lf th e p o p u la tio n in m o s t la r g e cities in sub-

t h a t in a d e q u a te provision brin gs for

S a h a r a n Africa, an d m a n y in A sia, still la c k

h u n d re d s of millions of people. 2

3

T he in a d e q u a c ie s in th e a t t e n t i o n given

w a t e r piped to th e i r h o m es a n d good q u ality to ilets. P e r h a p s a s m a n y a s 100 million u rb a n

by g o v e rn m e n ts a n d in t e r n a t io n a l

d w e lle rs w orld-w ide h ave to d e fe c a te in open

a g e n c ie s to th is, a lth o u g h t h e r e a re m a n y

s p a c e s or in to w a s t e p a p e r or p la s tic b a g s

e x a m p le s of in n o v atio n a n d in g e n u ity

(‘w r a p a n d t h r o w ’) b e c a u s e th e r e a r e no to ile ts

from a ro u n d t h e w o rld w h ic h s u g g e s t

in th e i r h o m e s an d public to ile ts a r e n ot a v a il­

t h a t th e b a r r i e r s to im proved provision

ab le, too d i s t a n t or to o exp ensiv e. Low-income

a re n o t so m u ch t e c h n i c a l or finan cial

u r b a n d w e lle rs a r e often p a y in g high p rices for

b u t in s ti tu t io n a l an d political.

v e ry i n a d e q u a t e w a t e r provision - for

The need for improved provision for w a te r,

in s ta n c e , p u rc h a s in g w a t e r from v e n d o rs a t

s a n ita tio n an d d ra in a g e to be rooted in

2 - 5 0 tim e s th e price p e r litre p aid by higher-

th e specifics of each locality, including th e

incom e gro u p s, w h o receive heav ily su bsidized

n eeds a n d priorities of its citizens and th e

w a t e r piped into t h e i r homes.

local a n d regional ecology.

T his r a i s e s th e issu e of w h y is th is so, a f t e r 50 y e a r s of aid p ro g r a m m e s , d o zens of

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

xviii official aid a g e n c ie s an d d e v e lo p m e n t b a n k s

a c c e s s to w a t e r to be applied to all u rb a n and

a n d h u n d re d s of in t e r n a t i o n a l NGOs w ith

r u r a l a r e a s . For in s ta n c e , som e g o v e rn m e n ts

p r o g r a m m e s for w a t e r a n d s a n ita t io n ? And

classify ev ery o n e w h o h a s a w a t e r source

w h y h a v e n ’t th e p ro m ises m a d e by g o v e r n ­

w ithin 2 00 m e tre s of th e i r home a s having

m e n t s been m et? In 1 9 7 7 , r e p r e s e n t a t i v e s from

a d e q u a t e provision for w a te r , b u t having a

m o s t of th e w o r l d ’s g o v e rn m e n ts c o m m itted

public t a p w ithin 20 0 m e tre s of y o u r home in a

th e m s e l v e s to e n su rin g t h a t e v e ry o n e w o uld

r u r a l s e t tl e m e n t w ith 20 0 p e rs o n s p e r t a p is

h a v e a d e q u a t e w a t e r a n d s a n i ta t io n by 1990.

no t th e sa m e a s hav ing a public t a p w ithin 200

T h e problem is n o t n e c e s s a r il y one of

m e tre s of y o u r hom e in a n u rb a n s q u a t t e r

g o v e r n m e n ts la c k i n g fu nds. In m a n y c ities a n d

s e t tl e m e n t w ith 5 0 0 0 p e rs o n s p e r t a p . U rban

s m a lle r u r b a n c e n tr e s , it is possible to

s e t tl e m e n t s w ith large n u m b e rs of people

im prove provision for w a t e r a n d s a n i t a t i o n in

c o n c e n t r a te d in sm all a r e a s p r e s e n t p a r t ic u l a r

low -incom e s e t t l e m e n t s w h ile c h a rg i n g th e i r

problem s for avoiding faec al c o n ta m in a tio n if

i n h a b i t a n t s less t h a n th e y c u r r e n tl y p a y for

th e r e a re no s e w e r s or o th e r m e a n s to remove

in a d e q u a t e provision. T his b oo k d e s c r ib e s th e

ho usehold a n d h u m a n w a s te . M an y u rb a n

i n n o v a t io n s a n d in g e n u ity of c e r t a in i n t e r n a ­

hou seho ld s h av e so little s p a c e p e r pers o n t h a t

ti o n a l a g e n c ie s , n a t i o n a l g o v e r n m e n ts , local

th e r e is no room to fit to ilets into ea c h p e rs o n ’s

g o v e r n m e n ts , n o n - g o v e r n m e n t a l o rg a n i z a ti o n s

home. B ut u rb a n s e t tl e m e n t s also provide more

a n d c o m m u n ity -b a s e d o r g a n i z a ti o n s in differ­

o p p o rtu n itie s for good q u a lity provision for

e n t cities in t e r m s of im p ro vin g w a t e r an d

w a t e r a n d s a n i ta t io n , b e c a u s e un it c o sts are

s a n i t a t i o n pro vision. T h e s e sh o w t h a t deficien ­

g e n erally lo w er a n d u rb a n d w ellers often have

cies in w a t e r a n d s a n i t a t i o n provision c a n be

more c a p a c i ty to pay.

en o rm o u sly r e d u c e d w i t h o u t a r e a llo c a tio n of

It is difficult to reconcile definitions of

n a t i o n a l i n v e s t m e n t s a n d i n t e r n a t i o n a l aid

‘a d e q u a t e ’ w a t e r a n d s a n i ta t io n provision from

t h a t is po litic ally u nfe asible . T h e y sh o w t h a t

a h e a lt h p e rs p e c tiv e w ith definitions t h a t

th e t a r g e t s r e l a t e d to w a t e r an d s a n i t a t i o n

allow d a t a on provision to be easily collected.

w ith in t h e l a t e s t s e t of i n t e r n a t io n a l ly a g re e d

It w o uld be e a s y to m e e t in t e r n a t i o n a l t a r g e t s

g o a ls - t h e M illennium D e v e lo p m e n t G oals -

for im proving w a t e r a n d s a n i t a t i o n provision if

a r e feasib le. T h e n eed to m e e t t h e s e t a r g e t s is

t h e definition of ‘im proved pro vision’ w e r e to

all t h e m ore p re s sin g , given t h a t so m a n y

be s e t to o low. A nd in one sen se, 100 p e r c e n t

in t e r n a t i o n a l g o a ls h a v e no t been m e t a n d

of u rb a n (an d r u r a l) d w e lle rs a lr e a d y h av e

a n o t h e r failu re will d is c re d it th e m a k i n g of

a c c e s s to w a t e r a n d s a n i ta t io n . No one c an

su c h g o als . B u t to a c h ie v e t h e s e g oals

live w i t h o u t w a te r . No city develops w h e re

re q u ire s a c h a n g e in a t t i t u d e s a n d

t h e r e is no w a te r . V irtua lly all livelihoods (and

a p p r o a c h e s , esp e c ia lly in r e g a r d to u r b a n

th e economic a c tiv itie s t h a t u n d e rp in th em )

a r e a s . M a n y g o v e r n m e n ts a n d i n t e r n a t i o n a l

also d ep end on w a te r , d ire ctly or indirectly.

a g e n c i e s h a v e in a d e q u a t e u r b a n policies,

E v e ry o n e h a s s a n i ta t io n in th e s e n s e t h a t th e y

b a s e d on i n a c c u r a t e s t e r e o t y p e s a b o u t u r b a n

h a v e to d e fe c a te ; a g a in , no one c a n live

a r e a s a n d t h o s e w h o live in th e m . T h ey fail to

w ith o u t doing so. T he is sue is n o t w h e t h e r

re cog niz e t h e s c a le of n e e d in u r b a n a r e a s .

t h e y h av e provision for w a t e r a n d s a n i ta t io n ,

T h e y still th i n k t h a t v ir tu a lly all p o v e r t y is

b u t w h e t h e r th e y hav e a d e q u a t e provision;

lo c a t e d in r u r a l a r e a s . T h e y also fail to s u p p o r t t h e k in d s of local p ro c e s s e s t h a t c a n

•

Do t h e y h ave w a t e r t h a t ca n be safely d r u n k an d used in food p r e p a r a ti o n

b rin g t h e n e e d e d im p ro v e m e n ts .

(especially for in f a n ts an d yo un g

G o v ern m en ts a n d in t e r n a t io n a l ag en cies need to recognize t h a t u rb a n a r e a s h ave p a r t i c ­

children, w h o a r e p a r t ic u l a r ly a t risk

u la r n eed s for w a t e r a n d s a n ita tio n t h a t are

from d ia r r h o e a l d is e a s e s c a u g h t from

distin c t from r u r a l a r e a s , a n d t h e y also have

c o n t a m i n a t e d food or w a te r ) ?

p a r t i c u l a r a d v a n t a g e s over r u r a l s e ttle m e n ts .

•

Do t h e y h av e eno ug h w a t e r for w a s h in g ,

It is still comm on for th e s a m e definition of

food p r e p a r a ti o n , l a u n d r y a n d p e rs o n a l

w h a t c o n s titu te s ‘a d e q u a t e ’ or ‘im p ro v e d ’

hygiene?

•

•

sive? If it is, th is g e n e ra lly m e a n s less

d w e lle r h a s a rig h t to a s t a n d a r d of w a t e r an d

m o ne y for food in low -income h ouseholds.

s a n i ta t io n provision t h a t m a t c h e s th e

Is g e tt in g w a t e r v e r y lab o rio u s a n d tim e

•

con su m ing ? W a te r is v e r y h e a v y to c a r r y o ver a n y d is ta n c e , a n d tr ip s to an d from

h e a lth benefits. It v ir tu a lly e lim in a te s

w a t e r s ta n d p ip e s or k io s k s often t a k e up

d ia r r h o e a l d is e a se s a n d m a n y o th e r w a te r -

Is t h e r e a to ilet in th e home a n d a t a p for

r e l a te d d is e a s e s a s sig nifican t c a u s e s of d e a th . As C h a p te r 2 de scribes, it b rin g s m a n y o th e r

h a n d -w a sh in g ? If n ot, is t h e r e a w ell

b e n e fits to o - including im proved n u tr itio n a n d

m a i n ta i n e d to ilet in e a s y re ach ? If t h is is

often h ig h e r re a l inco m es a n d more e m p lo y ­

a public to ilet a n d th e r e is a c h a r g e for

m e n t o p p o rtu n itie s for m a n y of th e p o o re s t

using it, is it k e p t c lea n, c a n low-income

u r b a n househ olds. B ut it is u n re a listic to se t

h o u seh olds afford to u se it an d is it safe

t h i s s t a n d a r d in m o s t low -income n a tio n s,

for w o m e n an d children, espe cially a f t e r

since, w ith limited r e s o u rc e s a nd limited in s ti­

d a rk ?

tu t i o n a l c a p a c itie s , g e tt in g b e t t e r provision for

Is th e r e provision to rem ove h u m a n w a s t e s an d hou seh old w a s t e w a t e r ?

•

s t a n d a r d s in high-income n a tio n s . C ertainly, t h i s level of pro vision p ro d u c e s th e g r e a t e s t

t w o or more h o u rs a day. •

It c a n be a rg u e d t h a t e v e ry u rb a n

Is g e tt in g sufficient w a t e r v e r y e x p e n ­

Are low -income a r e a s p r o t e c te d a g a in s t floods?

ev e ry o n e is more im p o r t a n t t h a n g e tt in g v e ry good provision for th e m inority. If t h e focus is on g e tt in g v e r y good provision, th e b e n e fic ia r­ ies a re likely to belong to th e ric h e r an d more politically p o w e rfu l groups. If w e t a k e ‘a d e q u a t e ’ w a t e r to m e a n a

Any a s s e s s m e n t of provision for w a t e r and sa n ita tio n h a s to be b ase d on some implicit

r e g u l a r piped su p p ly av a ila b le w ith in th e home

u n d e rs ta n d in g or explicit definition of

or in th e y a r d , a t le a s t h a lf of th e u rb a n

‘a d e q u a t e ’. In u rb an a r e a s in high-income

p o p u la tio n of s u b - S a h a r a n Africa an d

cou n tries, ‘a d e q u a c y ’ for w a t e r is considered a s

S o u t h e a s t A sia h a s in a d e q u a te provision (and

w a t e r t h a t can be safely d ru n k piped into each

p e r h a p s s u b s ta n ti a ll y more t h a n this). If we

home, d istrib uted by in te rn a l plumbing to

to o k ‘a d e q u a t e ’ s a n i ta t io n to m e a n a n easily

toilets, b ath ro o m s an d kitch ens, an d available

m a i n ta i n e d to ile t in e a c h p e rs o n ’s hom e w ith

24 h ou rs a day. ‘A d e q u a c y ’ for s a n ita tio n is a t

provision for h a n d -w a s h in g an d t h e safe

le a s t one w a ter-flu sh ed to ilet in e a c h house or

re m o v a l a n d disp osal of to ile t w a s t e s , a v e ry

a p a r t m e n t , w ith a 24-hour g u a r a n t e e d supply, a

larg e p ro p o rtio n of t h e u r b a n p o p u la tio n of

w a s h basin in th e to ilet or close by w h e re h an d s

s u b - S a h a r a n A frica ( 5 0 - 6 0 p e r cent?) a n d

can be w a s h e d , an d facilities for perso n al

more t h a n h a lf of th e u r b a n p o p u la tio n in m o st

hygiene - h ot w a t e r a n d a b a th or shower. And,

low -income n a ti o n s in A sia an d L a tin A m erica

of course, th e r e m u s t be an income level t h a t

is likely to h a v e in a d e q u a te provision. As

allow s all th is to be paid for, or provisions to

ex a m p le s in different c h a p t e r s will show,

ensu re supplies for th o s e unable to m e e t th e ir

public to ile ts ca n be ‘a d e q u a t e ’ in t e r m s of

bills. If th e s e are used a s th e c rite ria for

c le a n lin e s s, accessib ility a n d cost, b u t th is is

‘a d e q u a t e provision’, a s C h a p te r 1 describes,

ra re .

m o st of A frica’s an d A s ia ’s u rb a n population and much of L atin A m e ric a ’s u rb a n population

A t p r e s e n t, t h e r e a re no global figures for t h e p ro p o rtio n of th e w o r l d ’s p o p u la tio n or of

hav e in a d e q u a te provision. Indeed, m ost have

ea c h regio n’s p o p u la tio n t h a t h av e a d e q u a t e

levels of provision far below th is s t a n d a r d . In

w a t e r an d s a n i ta t io n provision. T h e World

m a n y u rb a n c e n tre s in th e s e regions, no one h a s

H e a lth O rg a n iz a tio n an d UNICEF Joint

this level of provision, b ec a u se even piped w a t e r

M onitoring P ro g r a m m e for W a te r S upply a n d

supplies to th e ric h e st households a re in te rm it­

S a n it a ti o n (on w h o se w o r k th is book d ra w s)

t e n t and of poor quality. M ost u rb a n c e n tr e s in

c an only give fig ures for t h e p ro p o rtio n w ith

Africa an d Asia have no se w e rs, a n d in m ost of

‘im p ro v e d ’ provision, b e c a u s e of th e la c k of

th o s e t h a t do, only a sm all proportion of th e

d a t a on w h o h a s ‘a d e q u a t e ’ or ‘s a f e ’ provision.

population is connected.

As C h a p te r 1 d esc rib e s in more d etail,

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

XX ‘im p ro v e d ’ provision c a n include w a t e r from

•

T a r g e t 11: to ach ie v e, by 2 0 2 0 , a signifi­

public s t a n d p ip e s , b o re ho les a n d p ro t e c te d dug

c a n t im p ro v e m e n t in th e lives of a t le a s t

w ells (w ith no g u a r a n t e e t h a t th is w a t e r is

100 million slum d w ellers.

safe to drin k), provided t h a t a t le a s t 20 litres p e r p e rs o n p e r d a y is a v a ilab le from a so urce

T he World S u m m it on S u s ta in a b le

w ith in 1 kilo m e tre of th e p e rs o n ’s home.

D eve lop m e nt in 2 0 0 2 a d d e d a n o t h e r r e l e v a n t

‘I m p ro v e d ’ provision for s a n i ta t io n c a n include

target:

s h a r e d pit la trin e s , w ith no g u a r a n t e e t h a t t h e s e a r e e a sily a c c e s s e d or clean.

•

Table 1.1 c o n t r a s t s tw o different s e t s of

to h alv e, b y 2 0 1 5 , t h e p ro p o rtio n of people w ho do n o t h av e a c c e s s to basic

e s t i m a t e s for t h e n u m b e r of u r b a n d w elle rs

s a n i ta t io n .

la c k in g w a t e r a n d s a n i ta t io n provision in 2 0 0 0 . The first is b a s e d on t h e definition of

If w e ap ply t h e s e g o als to u r b a n p o p u la tio n s ,

‘im p ro v e d ’ provision u se d by th e above-

th e scale of t h e funding n ee d e d to halve th e

m en tio n e d Join t M on ito ring P ro g r a m m e

p ro p o rtio n of u r b a n d w e lle rs w ho do n ot h av e

( b eca u s e of t h e la c k of d a t a for m e a s u rin g

safe drin k in g w a t e r an d basic s a n i ta t io n m a y

‘a d e q u a t e ’ or ‘s a f e ’ provision for m o s t n atio ns).

be c o n sid era b ly u n d e r - e s ti m a t e d for tw o

T h e seco nd s e t is b a se d on t h e evidence

r e a s o n s. F ir st, e s t i m a t e s for t h e funding

p re s e n te d in th i s book, d ra w in g on all a v a il­

n e e d e d m ay be b a s e d on la rg e u n d e r ­

able c ity s tu d ie s t h a t h a v e more d eta iled

e s t im a ti o n s a s to th e n u m b e r of people la c k in g

d esc r ip tio n s of th e q u a lity a n d e x te n t of w a t e r

a d e q u a t e provision. For in s ta n c e , looking a t

a n d s a n i ta t io n provision.

Table I, if th e r e a re only 98 million u rb a n

M ost of th e w o r l d ’s g o v e r n m e n ts an d

dw ellers in A sia in n eed of b e t t e r w a t e r supply

in t e r n a t i o n a l a g e n c ie s h a v e c o m m itte d

(as all b u t t h e s e h a v e ‘im proved provision’) th e

th e m s e lv e s to th e M illennium D evelo pm ent

problem seem s soluble financially. If t h e r e are

G oals w h ich a ro s e from t h e U nited N atio n s

5 00 million u rb a n d w e lle r s in A sia in n eed of

M illennium D e c la ra tio n a d o p te d in S e p te m b e r

b e t t e r w a t e r supply, b e c a u s e t h e 4 0 2 million

2 0 0 0 . The m o s t re le v a n t of t h e s e for w a t e r

u r b a n d w e lle rs w ho h a v e ‘im proved p rovision’

a n d s a n i ta t io n is M illennium D ev elo p m e n t Goal

still h av e v e ry i n a d e q u a t e provision, th e

7, a d d re s s in g t h e following t a r g e t s :

p ic tu re c h a n g e s d ra m a tic a lly . The second r e a s o n t h a t t h e funding re q u i r e m e n ts for u r b a n

•

T a r g e t 10: to halve, by 2 0 1 5 , th e p ro p o r ­

a r e a s m a y be co n sid e ra b ly u n d e r- e s ti m a t e d is

tion of people w i t h o u t s u s ta in a b l e a c c e s s

th e need for in v e s tm e n t in in f r a s t r u c t u r e , facil­

to safe drin k in g w a te r.

ities a n d in s titu tio n s u p s t r e a m of th e pipes and

E stim ates as to the number of urban dwellers lacking provision for w a te r and sanitation in 20 00 based on who has ‘improved’ provision and who has ‘a d e q u a te ’ provision

Region

Number and proportion o f urban dwellers without ‘improved’ provision for:3

Indicative estimates fo r the number (and proportion) o f urban dwellers without 'adequate' provision for:h

Water

Sanitation

Water

Sanitation

Africa

44 million (15 per cent)

46 million (16 per cent)

100-150 million (circa 35-50 per cent)

150-180 million (circa 50-60 per cent)

Asia

98 million (7 per cent)

297 million (22 per cent)

500-700 million (circa 35-50 per cent)

60 0-800 million (circa 45 -6 0 per cent)

Latin America and th e Caribbean

29 million (7 per cent)

51 million (13 per cent)

80 -1 20 million (circa 20-30 per cent)

100-150 million (circa 25-40 per cent)

Sources: a WHO and UNICEF (2000), Global Water Supply and Sanitation Assessm ent 2 0 0 0 Report, World Health Organization, UNICEF and Wa ter Supply and Sanitation Collaborative Council, Geneva. 80 pages; b based on the evidence presented in Chapter 1.

d o w n s tr e a m of t h e d ra in s to allow b e t t e r

re d ire c tio n of funds a w a y from som e of th e

provision.

p o o re s t n a tio n s b e c a u s e of th e i r g o v e r n m e n t ’s

B ut e s t i m a t e s for t h e scale of e x te r n a l

la c k of i n t e r e s t in im proving w a t e r a n d s a n i t a ­

funding t h a t is n e e d e d c a n also be o v e r- s ta te d

tion provision a n d t h e lo cal g o v e rn a n c e

b e c a u s e too little c o n sid e ra tio n is given to

s t r u c t u r e s t h a t t h i s n eed s. It is also in c o n sis­

lo cal re s o u rc e s, including th e c u r r e n t o r p o t e n ­

t e n t w ith p o v e rt y re d u c tio n g o a ls to pen alize

ti a l roles of in v e s tm e n ts m a d e by h ouseholds,

p oo r g ro u p s in n a tio n s t h a t h av e u n r e p r e s e n t a ­

co m m u n ities an d lo cal g o v e rn m e n ts. The

tive an d anti-p o o r g o v e rn m e n ts. H ere,

e x te n t to w h ic h u n it c o s ts ca n be red u c e d by

i n t e r n a t i o n a l a g e n c ie s need to co n sid er how to

c o m m u n it y - n o n - g o v e r n m e n t a l o rg a n iz a tio n

s u p p o r t lo cal in itia tiv e s directly, including

(N GO )-local a u t h o r i t y ( a n d / o r local utility)

th o s e u n d e r t a k e n by c o m m u n ity o rg a n iz a tio n s ,

p a r t n e r s h i p s c a n also be u n d e r- e s tim a te d ,

r e s i d e n t s ’ g ro u p s an d local NGOs. T h is will

w h ic h in t u r n re d u c e s t h e g a p b e tw e e n good

u su a lly req uire n ew funding c h a n n e ls a n d local

qu a lity provision a n d w h a t low-income h o u s e ­

in s titu tio n s th r o u g h w h ich such funding is

holds can afford. M any c a s e s tu d ie s in th is

ch an n elled . This is n o t in c o m p a tib le w ith

book sh o w th e possibilities of m u ch b e t t e r

b e t t e r lo cal g o v e rn a n c e in t h a t , a s m a n y

provision finan ced by local res o u rc es.

ex a m p le s given in C h a p te r s 5 a n d 7 show,

This h ighlights a n o t h e r c o n s t r a in t - t h a t

su p p o r tin g r e p r e s e n ta t iv e o rg a n iz a tio n s of th e

th e official d eve lop m e nt a s s is t a n c e ag en cies

u rb a n po or to develop b e t t e r w a t e r an d s a n i t a ­

w e re n ot s e t up to s u p p o r t ho useholds, co m m u ­

tion provision helps build good local

nities a n d local g o v e rn m e n ts. Official b ila te r a l

g o v e rn a n c e from th e b o tto m up. T h ere is also th e n e e d for im proved provi­

aid p ro g r a m m e s a n d m u ltila te ra l dev elop m en t b a n k s w e re s e t up to w o r k w ith an d th r o u g h

sion for w a te r , s a n i ta t io n a n d d r a i n a g e to be

n a ti o n a l g o v e rn m e n ts. M ost se e k to s u p p o rt

ro o te d in th e specifics of ea c h locality, in clu d ­

local g o v e rn m e n ts, a n d some s e e k to s u p p o r t

ing th e n e ed s a n d p rio rities of its citizens.

c o m m u n ity in itiativ es or s t e e r th e i r funding

Some of th e m o s t com pelling evid ence for th e

th r o u g h o th e r in stitu tio n s t h a t ca n do th is -

n e e d for c h a n g e d a p p r o a c h e s in th is book

b u t th is r e p r e s e n ts a sm all p a r t of th e i r funding

co m es from in t e r v i e w s w ith low-income h o u s e ­

for w a t e r a n d s a n ita tio n , e x cep t in n a tio n s

holds. T h e se re v e a l ju s t how p oo r w a t e r and

w h e re n a tio n a l g o v e rn m e n ts h ave su p p o rte d

s a n i ta t io n provision is, even w h e n th e i r s e t t l e ­

th is s t a n c e . And all official d ev elop m ent a s s is ­

m e n t is officially classified a s h avin g ‘im proved

t a n c e a g e n c ie s h ave difficulties su p p o rtin g a

provision’ or even w h e n th e local a u th o r it y

larg e an d diverse r a n g e of ‘c h e a p ’ initia tive s by

r e p o r t s t h a t e v e ry o n e h a s h ou se co n n e ctio n s.

local a u th o r it ie s a n d NGOs b e c a u s e of th e high

T h e y ra is e is su e s t h a t a re ra r e ly se e n in

a d m in is tra tiv e cost of doing so.

t e c h n i c a l disc ussion s of w a t e r an d s a n i ta t io n -

If t h e M illennium D eve lop m e nt G oals of

for in s ta n c e , a s sh o w n by in t e rv i e w s w ith

halv ing th e p ro po rtio n of people lac k in g

w o m en in P u n e a n d M u m b ai t h a t a r e re p o r te d

a d e q u a t e w a t e r an d s a n i ta t io n provision by

in C h a p te r s 1 a n d 2:

2 0 1 5 a r e to be m et, alon g w ith th e g oal to h ave a c h ie v e d a sig n ifican t im p ro v e m e n t in th e

•

T he difficulties in g e t t i n g w a t e r from

lives of a t le a s t 100 million slum d w e lle r s by

public t a p s a n d of t h e c on flicts t h a t

2 0 2 0 , in t e r n a t i o n a l a g e n c ie s will n eed to

often o c c u r a t th e t a p , includ ing th e

develop a g r e a t e r c a p a c i t y to s u p p o r t good

p r e s s u r e from th o s e in t h e q u e u e behin d

local g o v e r n a n c e a n d t h e i n v e s tm e n ts and

you n o t to t a k e ‘to o lo n g ’ or t a k e ‘to o

in itia tiv e s u n d e r t a k e n by h o u seho ld s, c o m m u ­ nities an d local g o v e rn m e n ts . T his in evitab ly

m u c h w a t e r ’. •

How h e a v y it is to fetch a n d c a r r y

m e a n s c h a n n ellin g more s u p p o r t to local

en o u g h w a t e r for do m estic use to and

g o v e r n m e n ts t h a t a r e c o m m itte d to im proving

from a s t a n d p ip e , even if th is is less t h a n 100 m e t r e s a w a y from o n e ’s home.

provision a n d less to local g o v e rn m e n ts (or n a ti o n a l g o v e rn m e n ts ) t h a t a r e n o t. T his can be a w k w a r d politically; it m a y m e a n som e

•

T he in dign ity of h av in g to d e fe c a te in th e open an d th e se x u a l h a r a s s m e n t t h a t

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

xxii •

•

w o m e n an d girls suffer w h e n h av in g to

a n d s m a lle r u r b a n c e n tr e s h av e n oth in g to do

do so.

w ith a s h o r ta g e of w a t e r r e s o u rc e s in th e i r

T he op position t h a t people so often face

regions. M o st deficiencies in u r b a n w a t e r an d

collecting w a t e r from a s ta n d p ip e in a

s a n i ta t io n provision a re c a u s e d by o th e r

n e ig hb ou rin g s e t t l e m e n t (w hy a re you

fa c to rs. The a m o u n t of w a t e r re q u ire d to

usin g ‘o ur t a p ’?).

ach ie v e a d e q u a t e w a t e r an d s a n i ta t io n provi­

How d is g u stin g it is to h av e to use public

sion is sm all c o m p a r e d w ith t h e d e m a n d s

to ile ts t h a t a re n o t c le a n e d a n d w ell

a s s o c ia te d w ith o th e r u se s of w a te r . U rban

m a i n ta i n e d , ‘th e in s e c ts t h a t climb up

c e n tr e s in w a t e r - s c a r c e reg io ns c an , a n d often

o u r le g s ,’ th e n e e d to use public to ile ts

do, m a k e a sp e c ia l effort to im prove r e s i d e n t s ’

only once a d a y b e c a u s e low-income

a c c e s s to t h e s e s c a r c e re s o u rc e s. W h a t is

h o u se h o ld s c a n n o t afford to use th e m

p e r h a p s more r e m a r k a b l e t h a n w a t e r - s c a r c e

more often, child ren’s r e l u c ta n c e to use

cities is t h e n u m b e r of c ities t h a t have

public to ile ts (for all th e above r e a s o n s

in c r e a s e d th e i r p o p u la tio n more t h a n fiftyfold

a n d b e c a u s e t h e y h av e difficulty w a iti n g

in t h e la s t c e n t u r y (an d th e i r d r a w on fresh

in q u eues), an d how d a n g e r o u s public

w a t e r re s o u r c e s m uch m ore t h a n fiftyfold) an d

to ile ts can be for w o m e n an d girls to use,

still h a v e n ot ru n o u t of w a te r. Even som e of

e sp e cially a f t e r d a rk .

th e w o r l d ’s l a r g e s t cities still m e e t th e i r w a t e r n e e d s from local so urces.

T h e s e a re also a re m in d e r of how p ro g re ss

One issue t h a t falls u n d e r t h e discussion

t o w a r d s more a d e q u a t e w a t e r an d s a n i ta t io n

of t h e n eed for provision for w a te r , s a n i ta t io n

provision in a n y city for th o s e w ith low

a n d d r a i n a g e to be ro o te d in th e specifics of

in com es is a l w a y s a p olitical s t r u g g le - a s it

ea c h loca lity is t h e n eed for less c e r t a i n t y by

w a s w h en provision im proved so m u ch in w h a t

in t e r n a t io n a l ‘e x p e r t s ’ a n d a g e n c ie s a n d more

a r e t o d a y th e w o r l d ’s high-income c o u n tries.

w illing ness to listen to th o s e w ith i n a d e q u a te

M o st of t h e e x a m p le s of b e t t e r provision in th is

provision an d to s u p p o r t local inn ov atio n. As

b ook a ro s e b e c a u s e of g o v e rn m e n t in s titu tio n s

th e issue of w a t e r s c a r c i t y h a s be com e more

res p o n d in g to d e m o c r a tic p re s s u r e s or th r o u g h

c e n t r a l to d iscu ssio ns b o th of en v ir o n m e n t a nd

p a r t n e r s h i p s b e tw e e n w a t e r a n d s a n i ta t io n

of d ev elo p m e n t, so n ew g e n e r a l iz a t io n s are

utilities a n d c om m un ities, or th r o u g h

m a d e a n d n ew policies a r e p ro p o s ed by

a u to n o m o u s a c ti o n s by co m m u n ity o rg a n i z a ­

n a ti o n a l g o v e r n m e n ts a n d i n t e r n a t io n a l

tio n s w h ich g o v e rn m e n ts p e r m it te d (or a t le a s t

ag e n c ie s. T h ere a re lots of stro n g opinions

did no t p rev en t).

a b o u t w h a t should be done a m o n g politicians,

T h e n e e d for im p ro v e m e n ts to be ro oted

sen io r s t a f f from in t e r n a t i o n a l a g e n c ie s an d

in lo cal re a litie s is also im p o r t a n t from an

n a ti o n a l g o v e r n m e n ts and ‘e x p e r t s ’, esp ecially

e cological p e rs p e c tiv e . This is p a r t ic u l a r ly so

th e e x p e r t s w h o advise in t e r n a t i o n a l ag enc ies.

in a w o rld w h e r e fresh w a t e r is in c re a sin g ly in

A m o n g s t m o s t in t e r n a t i o n a l a g e n c ie s, prio ri­

s h o r t sup ply in m ore a n d m ore place s, an d

tie s a re se t, policies a r e desig n ed or c h a n g e d ,

w h e re finite fresh w a t e r r e s o u rc e s a re often

p r o g r a m m e s a re d eveloped a n d proje cts s e t in

being over-used, d e p le te d a n d polluted. City-

m otion w ith little or no c o n s u lta tio n w ith

b a s e d d e m a n d s for fresh w a t e r by b u s in e s s e s

th o s e w h o suffer th e w o r s t w a t e r a n d s a n i t a ­

a n d affluen t r e s id e n ts should n o t over-ride th e

tio n provision.

n eed s of o t h e r u s e r s (as t h e y often do). But

In re c e n t y e a r s , for ex am p le, in cre asing

h ere, a s in th e o t h e r m ain t h e m e s of th is book,

p riv a te s e c t o r in volvem ent in w a t e r a n d s a n i t a ­

th is discussion is co m p lic a te d by t h e g r e a t

tion utilities h a s b een p u t fo r w a r d a s a widely

d iversity of c ir c u m s t a n c e s a m o n g th e t e n s of

app licab le m e a n s of im proving w a t e r and

t h o u s a n d s of u r b a n c e n tr e s a ro u n d th e w orld.

sa n ita tio n provision. As sh ow n in C h a p te r 5,

A c c u r a te g e n e r a l iz a t io n s a r e no t e asily found.

how ever, m a n y of th e m ost critical o b s ta c le s to

I n a c c u r a t e g e n e r a l iz a t io n s ab o u n d . As

im proved provision p e rs is t w h e n p riv a te se c to r

C h a p te r s 3 a n d 4 discu ss, th e in a d e q u a c ie s in

p a rtic ip a tio n in c re ases, an d in some c irc u m ­

w a t e r a n d s a n i ta t io n provision in m a n y cities

s t a n c e s p riv a tiz a tio n h eig h te n s ( r a t h e r th a n

red uces) th e political conflicts su rro u n d in g

voices, opinions a n d p rio rities of slum a nd

w a t e r a n d s a n i ta t io n provision. R ap id an d

p a v e m e n t d w e lle rs in In d ia n cities, a n d th e

ra d ic a l sh ifts in p riv a te s e c to r involvem ent

in h a b i ta n t s of H u m u ra in Nairobi an d of some

often provide little scope for m e a s u re s p r o m o t­

in fo rm al s e t t l e m e n t s in Cali t h a t a r e re p o r te d

ing th e i n t e re s t s of th o s e w ith o u t a d e q u a t e

in th is book, g e t to in fluence th e policies an d

w a t e r a n d s a n i ta t io n . Also, th e u rb a n c e n tr e s

p r a c t i c e s of th e in t e r n a t i o n a l d ev elo p m en t

a n d n e ig hb ou rh oo ds m o s t in need of im pro ve­

a g e n c ie s (a s w e ll a s influencing th e i r ow n

m e n ts in w a t e r an d s a n i ta t io n provision te n d to

lo cal g o v e rn m e n ts ) . T h ere is a huge p hy sical

be th o s e t h a t a re le a s t a t t r a c t i v e to p riv a te

a n d in s ti tu t io n a l d is ta n c e b e tw e e n decision ­

in v es to rs an d o p e ra to rs . Moreover, w h e re th e

m a k i n g s t r u c t u r e s in m o s t i n t e r n a t io n a l

public s e c t o r la c k s th e will or c a p a c i ty to

a g e n c ie s a n d ‘th e p o o r ’, w h o a re m e a n t to be

provide u rb a n w a t e r a n d sa n ita tio n , it often

th e i r clien ts bu t w h o h av e no fo rm al c h a n n e ls

also la c k s th e will or c a p a c i ty to re g u la te

to in fluence p rio ritie s a n d hold t h e s e a g e n c ie s

p riv a te provision effectively. In som e c irc u m ­

to a c c o u n t. B ut a s C h a p te r 7 describes, th e r e

s ta n c e s , in crea sin g p riv a te s e c t o r in volvem ent

a r e som e hopeful sign s on th i s - i n t e r n a t io n a l

m a y be a n a p p ro p r ia te resp o n se to local w a t e r

a g e n c ie s w ho recog nize th e n e e d for so lution s

a n d s a n i ta t io n problems. M uch d ep e n d s on

to be developed w ith in ea c h lo cal c o n te x t in

lo cal conditions, on th e forms t h a t p riv a te

w a y s t h a t e n su re th e so lutio ns a r e influenced

s e c t o r in vo lvem en t a c tu a lly ta k e s , an d on w h a t

by th o s e la c k in g a d e q u a t e provision.

else is being done to im prove w a t e r an d s a n i t a ­

T h ere is also th e long e s ta b lis h e d t r a d i ­

tion provision. It is n o t a ‘solu tion ’ t h a t should

tion a m o n g c o m m e n ta t o r s on d ev elo p m en t

be p ro m o te d in te rn a tio n a lly in th e n a m e of

is su e s a n d e n v iro n m e n t issu es of ju d g in g u rb a n

th o s e w ho c u rr e n tly la c k a d e q u a t e w a t e r and

a r e a s a s ‘p a r a s i t i c ’ or se ein g th e m a s ‘p la c e s

sa n ita tio n . As C h a p te r 7 em p h as iz es , th e s tre s s

of p riv ileg e’ to w h ic h fe w e r r e s o u rc e s should

should be on g e ttin g th e b e s t ou t of public,

be s te e re d , including th o s e n eed ed to im prove

p riv a te a n d co m m u nity org an iza tio n s.

w a t e r an d s a n i ta t io n provision. T h is helps

Sim ilarly, t h e r e is a g r e a t d e a l of d is c u s ­

explain w h y w a t e r an d s a n i ta t io n provision in

sion in te r n a t io n a l ly of t h e need to t a k e a more

u rb a n a r e a s h a s received in a d e q u a te a tt e n ti o n .

in t e g r a t e d a p p r o a c h to w a t e r r e s o u rc e s

It is com m on for j u d g e m e n ts to be m ade a b o u t

m a n a g e m e n t. W ithin th is i n t e g r a t e d a p p ro a c h ,

cities ‘u n fairly ' d ra w in g w a t e r from r u r a l

t h e r e is a t e n d e n c y to view d em a n d -sid e w a t e r

a r e a s a n d d a m a g i n g t h e r u r a l ecology in doing

m a n a g e m e n t p rincip ally a s a m e a n s of

so. T h ere a r e c e rt a in l y in s t a n c e s w h e re such

p re v e n tin g w a t e r from being w a s t e d . In m a n y

ju d g e m e n ts a re ju stified, b u t m a n y sp e c ia lists

of th e more dep riv ed u r b a n s e t tl e m e n t s ,

a s s u m e t h a t th is is t h e norm . It is not. And

h o w ev er, th e m a jo r c h a llen g e is n o t to find

even w h e re it does h a p p e n , it is ra r e ly th e city

n e w w a y s of sav in g w a te r , b u t to find n ew

p oo r w h o benefit. T h ere is a n u r g e n t n eed for

w a y s of m a k in g more w a t e r a v a ila b le , an d

more p rio rity to be given to im proving w a t e r

e n s u r in g it is p u t to good use. A s d esc rib ed in

a n d s a n i t a t i o n provision in u r b a n a r e a s , bu t

C h a p te r 6, d em an d-sid e m a n a g e m e n t c a n also

th is should no t be a t t h e ex p e n se of r u r a l

p la y a role h ere, b u t only if it is t a k e n to

in v e s tm e n ts . Indeed, th is b o o k ’s claim t h a t th e

include is su e s of s a n i ta t io n , h yg iene b e h a v io u r

in a d e q u a c ie s in w a t e r an d s a n i ta t io n provision

a n d giving dep riv ed g ro u p s m ore in fluence over

in u r b a n a r e a s a r e u n d e r- e s ti m a t e d is likely to

t h e i r ow n w a t e r an d s a n i ta t io n s y s te m s . So for

be valid for m o s t r u r a l a r e a s too. And a s

d em an d-sid e w a t e r m a n a g e m e n t , it is c ritical

C h a p te r 2 de sc rib es, t h e r e is no c le a r line

to a d a p t n e w a p p r o a c h e s to lo cal conditions,

b e tw e e n w h a t is r u r a l a n d w h a t is u rb a n . A

a n d to e n su re t h a t local voices - including

sizeab le p rop ortion of th e people w ith th e

espec ially th e voices of th o s e w ith o u t

w o r l d ’s w o r s t w a t e r a n d s a n i ta t io n provision

a d e q u a t e provision - a re h e a r d a n d h a v e an

live in s e t t l e m e n t s w ith b e t w e e n 10 00 an d

influence. M eetin g th e Millennium D ev elop m e nt Goals for w a t e r an d s a n i ta t io n m e a n s t h a t th e

2 0 ,0 0 0 i n h a b i ta n t s . In som e n a tio n s t h e s e are c on side red r u r a l, in o th e r s u rb a n . This s u g g e s ts th e n eed to c o n sid e r w a t e r an d

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

xxiv s a n i ta t io n provision in r u r a l a n d u rb a n a r e a s

w e re m a d e 26 y e a r s e a r l ie r a t t h e UN

to g e t h e r. H owever, a s n o te d abo ve, for w a te r,

C o nference on H u m a n S e t t l e m e n t s in 1 9 7 6 an d

s a n i ta t io n a n d d ra in a g e , m o s t u r b a n c o n te x t s

a t a s u b s e q u e n t UN W a te r C on ference in 19 77 .

are different from r u r a l c o n te x t s b e c a u s e of

Here to o, t h e r e w a s a v e ry firm a n d b ro ad

t h e size a n d s p a t i a l c o n c e n t r a ti o n of th e

c o n s e n s u s a m o n g g o v e rn m e n t r e p r e s e n t a t i v e s

p o p u latio n a n d th e n u m b e r of n o n -a g r ic u ltu ra l

an d s t a f f from in t e r n a t i o n a l a g e n c ie s a b o u t th e

e n te r p r i s e s - all of w h ic h n e e d w a t e r a n d all

im p o rt a n c e of b e t t e r w a t e r a n d s a n i ta t io n

of w h ich p ro du ce w a s t e w a t e r . In a n atio n

provision. In som e k e y a s p e c t s , b e t t e r w a t e r

w h ich defines u r b a n a r e a s a s s e t t l e m e n t s w ith

an d s a n i ta t io n provision in u rb a n a r e a s is also

2 5 0 0 or m ore in h a b i ta n t s , th e b e s t m e a n s of

ideally su ite d to funding from in t e r n a t io n a l

im proving w a t e r an d s a n i ta t io n provision in

ag e n c ie s, b e c a u s e w ell d esig n e d an d m a n a g e d

‘r u r a l ’ villag es of 1 0 0 0 - 2 4 9 9 in h a b i t a n t s m a y

sy s te m s n e ed c a p it a l u pfron t (which is w h a t

h a v e m uch in com m on w ith im proving p ro v i­

m o s t a g e n c ie s provide) an d th e n deliver th e i r

sion in m a n y m a r k e t t o w n s a n d a g r i c u lt u r a l

be n e fits o ve r m a n y y e a r s or even d e c a d e s.

serv ice c e n tr e s t h a t h av e b e tw e e n 2 5 0 0 an d

Good w a t e r a n d s a n i ta t io n provision in

1 0 ,0 0 0 i n h a b i ta n t s . B u t t h e m e a n s u se d for

cities n eed s c o m p e t e n t city an d m u n icip al

t h e s e v illages a n d sm all u r b a n c e n tr e s will not

a u th o r it ie s t h a t a re a c c o u n t a b le to th e i r

h a v e m u c h in com m on w ith th e m e a n s n eed ed

citiz en s a n d able to m a n a g e im proved provi­

for a city of 1 million plus, or a m e tro p o lita n

sion - w h e t h e r a s p rov id ers th e m s e l v e s o r as

region of 10 million plus in h a b i ta n t s .

t h e in s titu tio n t h a t provides th e leg al an d

T h e fo u r th c e n t r a l th e m e of th is book is

re g u l a t o r y fr a m e w o r k for o th e r p rov ide rs

t h a t deficiencies in w a t e r a n d s a n i ta t io n p ro v i­

(w h e th e r la rg e-scale p riv a te , sm all-scale

sion in cities a re often as m uch th e re s u lt of

p riv a te , non-profit, NGO or c o m m u n ity b ased ).

in a d e q u a c ie s in th e in s ti tu t io n s w ith re s p o n s i­

M ost aid a g e n c ie s an d d e v e lo p m e n t b a n k s

bilities for providing w a t e r a n d s a n i ta t io n , an d

b a c k e d a w a y from la r g e c a p it a l p ro je c ts in

t h e g o v e rn a n c e s t r u c t u r e s w ith in w h ic h th e y

u rb a n a r e a s du rin g th e 1 9 8 0 s b e c a u s e local

o p e r a t e , a s a la c k of funds. This m a k e s th e

g o v e rn a n c e s t r u c t u r e s p ro ved u n ab le to

t a s k of im proving provision more difficult. This

m a n a g e a n d m a i n ta i n th e m . As a re s u lt, m ost

help s exp lain w h y p ro g r e ss h a s b e e n so

such a g e n c ie s now h a v e ‘good g o v e r n a n c e ’

limited. Unlike m o s t su b je c ts r e l a te d to

p r o g r a m m e s - a lth o u g h m a n y still u n d e r ­

en v ir o n m e n t an d dev elo p m en t, t h e r e is v e ry

e s t i m a t e t h e im p o rt a n c e of a p p lyin g t h e s e to

little d i s a g r e e m e n t a b o u t t h e n eed for b e t t e r

lo cal g o v e rn m e n ts . B ut su p p o r tin g im p ro v e­

w a t e r a n d s a n i ta t io n provision in Africa, A sia

m e n t s in city a n d m u n icip al g o v e rn a n c e is

an d L a tin A m erica. T h e re m a y be d is a g r e e ­

n e v e r e a s y for i n t e r n a t i o n a l a g e n c ies. T h ese

m e n ts a b o u t w h e re t h e p riorities should be

ag e n c ie s w e re no t s e t up to do so, a n d it c an

(w ith m a n y b ein g a n ti-u rb a n ), a b o u t w h o th e

be difficult to p ro m o te su c h e n d s w h e n th e i r

b e s t p ro v id ers a re (public, p riv a te , co m m u nity)

official c o u n t e r p a r t s , n a ti o n a l g o v e rn m e n ts ,

an d a b o u t t h e b e s t te c h n o lo g ie s to use. B ut th e

are r e l u c t a n t to let local g o v e rn m e n ts h av e th e

n eed for b e t t e r provision is v e ry ra r e ly

pow er, r e s o u rc e s a n d fund-raising c a p a c i tie s

q u e stio n ed . In 2 0 0 2 , Nelson M a n d e la m a d e th e

t h e y n eed to be effective. B ut in th e end, it is

n eed for im proved provision for w a t e r one of

difficult to see ho w m ost in t e r n a t i o n a l goals

t h e c e n t r a l p o in ts in his sp e e c h to th e World

an d t a r g e t s , in cluding th o s e d irectly or

S u m m it on S u s t a in a b l e D evelo pm e nt. During

in d irectly r e l a te d to w a t e r a n d s a n i ta t io n , c an

t h e s u m m it, The E c o n o m ist e m p h a s iz e d t h a t

be m e t w ith o u t more c o m p e te n t, effective,

t h e n e e d to help th e w o r l d ’s p o o re s t se cu re

a c c o u n t a b le local g o v e rn m e n ts. The q u a lity of

safe drin k in g w a t e r a n d a d e q u a t e s a n i ta t io n

lo cal g o v e r n m e n ts a n d th e i r c a p a c i ty to r e p r e ­

w a s th e le a s t c o n tr o v e rs ia l of all t h e p rio rities

se n t, s u p p o r t an d w o r k w ith t h e i r citizen s h a s

d is cu ssed a t th e s u m m it, a n d even u se d th e

g r e a t re le v a n c e for th e a c h ie v e m e n t of s u s t a i n ­

im ag e of som eon e d rin k in g from a cup a s its

able d ev elo p m en t, w ith in w h ich good q u ality

co ver p h o to .3 B u t m a n y of th e s a m e points

w a t e r a n d s a n i ta t io n provision is so im p o rt a n t.

I n t r o d u c t io n

XXV N otes and referen ces 1

UNCHS (Habitat) (1997), The H abitat Agenda, H S /4 4 1 /9 7 E , UNCHS (H abitat), Nairobi,

2

The Millennium Development Goals arose from th e United N ations Millennium Declaration

C ha pter IV, Section C. Available at:

ad opted by th e United N ations General

w w w . u n h a b ita t.o rg /u n c h s /e n g lis h /h a g e n d a /c h

Assem bly (the Millennium Assembly) in

4c-5.htm.

S ep tem ber 2000. 3The E co n o m ist, 31 A ugust 2 00 2, page 66.

CHAPTER

Provision for Water and Sanitation in Cities

Introduction This c h a p t e r re v ie w s t h e q u a lity an d e x t e n t of

w h a t is defined a s ‘im p ro v e d ’ pro vision an d

provision for w a t e r an d s a n i ta t io n in u rb a n

w h a t is c o nsid ered ‘a d e q u a t e ’ o r ‘s a f e ’ p ro vi­

a r e a s . It h ig hlig h ts how t h e in a d e q u a c ie s in

sion. ‘I m p ro v e d ’ provision for w a t e r is often no

provision in m uc h of L atin A m e ric a a n d A sia

m ore t h a n a public t a p s h a r e d by s e v e r a l

a n d m o s t of Africa a re m u ch w o rs e t h a n m ost

h u n d re d people w ith a n in t e r m i t t e n t su p p ly of

in t e r n a t i o n a l s t a t i s t i c s su g g e s t. As su ch , th e y

w a te r . ‘I m p ro v e d ’ s a n i ta t io n is often no more

a r e k ey c o n tr ib u t o rs to p o v e rt y a n d p r e m a tu r e

t h a n a la trin e , to w hich a c c e s s is difficult,

d e a th . It also h ig hligh ts how to o little a t t e n ­

s h a r e d a m o n g m a n y hou seh olds.

tion is given to s a n i ta t io n . M an y people still

T his c h a p t e r also m a k e s c le a r w h y it is

a s s u m e t h a t c lea n w a t e r is t h e m ain issue, a s

so difficult to r e a c h low-income g ro u p s in

c a n be seen in in t e r n a t i o n a l c o n v e n tio n s and

u r b a n a r e a s w ith good q u a lity provision for

d e c la r a ti o n s t h a t fo r g e t to m e n tio n s a n i ta t io n .

w a t e r an d s a n i ta t io n . M o s t of th e w o r l d ’s

It m u s t be re m e m b e r e d t h a t h u m a n e x c r e t a is

u rb a n p o p u la tio n lives in low- a n d middle-

e x tr e m e ly d a n g e r o u s u n less disposed of safely.

income n a ti o n s in Africa, A sia a n d L atin

W h ere pro visions for w a t e r an d s a n i ta t io n are

A m e ric a a n d th e C a rib b ea n . A sig nificant

i n a d e q u a te , t h e d is e a s e s t h a t a ris e from

p ro p o rtio n of t h e s e people h av e inc om es t h a t

fa e c a lly c o n ta m in a t e d food, w a t e r an d h a n d s

are so low t h a t t h e y ca n afford no more t h a n

a r e a m o n g th e w o r l d ’s lead in g c a u s e s of

U S $ 0 .0 1 - U S $ 0 . 0 5 a d a y on w a t e r an d s a n i t a ­

p r e m a t u r e d e a t h an d se rio u s illness; such

tion. If piped w a t e r is n o t av a ila b le a t th is

d is e a se s also c o n tr ib u te m u c h to u n d e r ­

price, t h e y will u se a n y o t h e r av a ila b le w a t e r

n u tr itio n , a s d ia r rh o e a l d is e a se s an d i n t e s t in a l

so u rc e t h a t is c h e a p e r or free (for in s ta n c e ,

p a r a s i t e s rob p e o p le ’s bodies of n u tritio n . Good

d ra w in g from po lluted an d faec ally c o n ta m i­

provision for s a n i t a t i o n shou ld v ir tu a lly elimi­

n a t e d lak es, riv ers or s h a llo w w ells). Tens of

n a te t h e s e h e a lth b urden s.

millions of u rb a n d w e lle rs d e fe c a te in th e open

This c h a p t e r is also a b o u t definitions.

or into p la s tic b a g s or w a s t e p a p e r ( w h a t is

L ess t h a n h a lf of th e u r b a n p o p u la tio n of

often t e r m e d ‘w r a p a n d t h r o w ’) b e c a u s e th e y

Africa, Asia a n d L atin A m e ric a h a s a d e q u a t e

h a v e no to ile t t h e y c a n use. M a n y su c h people

provision for w a t e r an d s a n i ta t io n . Yet 85 p e r

live in su ch c ra m p e d cond ition s ( 5 - 6 p e rs o n s

c e n t of th e u r b a n p o p u latio n in t h e s e sa m e

in a sm all room) t h a t th e r e is no room in th e i r

region s h a s ‘im p ro v e d ’ w a t e r a n d 8 4 p e r c e n t

h o m e s for toile ts. M a n y a r e t e n a n t s an d th e i r

h a s ‘im p ro v e d ’ s a n i ta t io n . Both of t h e s e s t a t i s ­

la n d lo rd s m a k e no provision for s a n i ta t io n in

tic s a re c o rre c t; t h e s t a t i s t i c a l evidence for

th e room s t h e y ren t. This is th e ch alleng e

bo th is ro b u st. H ere, w e explain how t h i s is

facing g o v e r n m e n ts an d in t e r n a t i o n a l a g e n c ie s

possible a n d t h e im p o r t a n t differences b e tw e e n

in te n t on im proving provision.

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

2 Judging who has adequate provision

H

Official s t a t i s t i c s on provision for w a t e r an d s a n i ta t io n s u g g e s t t h a t it is only a m in o rity of u r b a n d w e lle rs w h o a r e u n s e r v e d , ev en in lowincom e n a tio n s in Africa, A sia a n d L atin A m erica. For in s ta n c e , even in Africa, by th e y e a r 2 0 0 0 , 85 p e r c e n t of th e u r b a n p o p u latio n h a d ‘im p ro v e d ’ provision for w a t e r an d 84 p e r c e n t h a d ‘im p ro v e d ’ provision for s a n i ta t io n . T h e t o t a l n u m b e r of u rb a n d w e lle r s w o rld w id e la c k in g im proved provision by t h e y e a r 2 0 0 0 (173 million for w a te r , 4 03 million for s a n i t a ­ tion) is obviously a serio u s pro blem , b u t g r e a t ly re duc ing th is should be rela tiv e ly easy, given t h a t u rb a n c e n tr e s c o n c e n t r a t e people in w a y s t h a t u su a lly re d u c e u n it c o sts for im p rov ­ ing provision. Much of th e u rb a n p o p u latio n is w illing an d able to p a y for im proved provision. P ro b le m s seem m u ch more se rio u s in r u r a l a r e a s , w h e r e m o s t of th o s e la c k in g im proved provision live. Ind ee d , if in t e r n a t i o n a l c o m m it­ m e n t s to halve t h e p ro p o rtio n of people la c k in g w a t e r a n d s a n i ta t io n by 2 0 1 5 a re to be m e t, th is w ou ld imply giving p rio rity to ru ral areas. B ut w h a t if th e h u n d re d s of millions of u r b a n d w e lle rs w h o a r e sa id by g o v e rn m e n t s t a t i s t i c s or hou seho ld s u r v e y s to h av e im proved provision for w a t e r an d s a n i ta t io n still h a v e v e ry in a d e q u a te provision, w hich also m e a n s v e ry larg e h e a lt h b u rd e n s from w a t e r - r e l a t e d d is ea ses? This c h a p t e r s e e k s to d e m o n s t r a t e t h a t th is is th e c a s e a n d to p r e s e n t t h e e vid ence for this. It is n ot claim ing t h a t th e official s t a ti s ti c s a re w ro n g , b u t it is su g g e s tin g t h a t m o s t g o v e r n m e n ts a n d i n t e r ­ n a ti o n a l a g e n c ie s m i s i n te rp r e t t h e s e s t a t i s t i c s an d , in so doing, give a false im pressio n of th e e x t e n t of provision for w a t e r an d s a n i ta t io n in u r b a n a r e a s . It also s u g g e s ts t h a t n e w b e n c h ­ m a r k s n e ed to be s e t to m o n ito r global tr e n d s on provision for w a t e r a n d s a n i ta t io n in u rb a n areas. E v e ry o n e h a s a c c e s s to w a t e r in some form since no one c a n live w ith o u t w a te r . The issue is no t w h e t h e r th e y h av e a c c e s s to w a t e r b u t w h e t h e r th e w a t e r supp lies a re safe, suffi­ cie n t for th e i r n ee d s, r e g u l a r (for in s ta n c e av a ilab le 24 h o u rs a d a y a n d th r o u g h o u t th e

y e a r) , c o n v e n ie n t (for in s ta n c e piped to th e i r hom e or close by) an d a v a ila b le a t a p rice t h e y ca n afford. Similarly, for s a n i ta t io n , every o n e h a s to m a k e som e provision for d efec atio n, even if th is is d e fe c a tin g on open la n d or into a n open d ra in (as is th e c a s e for t e n s of millions of u r b a n dw elle rs). The issu e is no t w h e t h e r t h e y h av e provision for s a n i ta t io n b u t w h e t h e r t h e y h a v e a q u a lity of provision t h a t is c o n v e n ie n t for all ho useho ld m e m b e rs (including w o m e n an d children), a ffo rd able and e lim in a te s th e i r (and o t h e r s ’) c o n t a c t w ith h u m a n e x c r e t a a n d o th e r w a s t e w a t e r (which m a y also be c o n ta m in a t e d w ith e x c re ta ) w ith in th e home a n d th e w id e r neig hb ou rh oo d. If h o u seh o ld s do n o t h a v e to ile ts in th e home, do th e y h ave a c c e s s to to ile ts close by t h a t are w ell m a in ta in e d , affo rdab le a n d acc essible w i t h o u t q u eu es? Are t h e r e to i le t s t h a t children are h a p p y to use? As C h a p te r 2 will describe, children a re fr ig h te n e d to use m a n y to ile ts. If th e to ile ts a re no t c o n n e c te d to s e w e r s , th e r e is also th e issue of w h a t h a p p e n s to th e e x c r e t a (for in s ta n c e , is it po llutin g g r o u n d ­ w a t e r or going into open drains?) a n d also th e provision for th e d isp o sal of h o u s e h o l d s ’ w a s t e ­ w a te r . If t h e y a re c o n n e c te d to s e w e r sy s te m s , t h e r e is th e issue of w h e t h e r th e o u tp u t s from t h e s e s y s te m s a re po llu ting o th e r p e o p le ’s w aters. T h us, an y a s s e s s m e n t of provision for w a t e r a n d s a n i ta t io n (in cities, s m a lle r u rb a n c e n tr e s or r u r a l a r e a s ) h a s to begin w ith a definition of ‘a d e q u a t e prov isio n’ a g a i n s t w hich to c o m p a r e a c t u a l provision. In high-income n a tio n s, t h e n e e d for all u rb a n h o useh old s to h a v e w a t e r piped to t h e i r hom e t h a t is safe (ie d rin k ab le) a n d r e g u l a r (available 24 h o u rs a d ay), i n t e r n a l p lum bing (so piped w a t e r is av a ilab le in b a th r o o m s , k it c h e n s a n d to ilets) an d t h e i r o w n s a n i t a r y to ile t w ith in th e house or a p a r t m e n t (usu ally c o n n e c te d to se w e rs ) is u n q u e stio n e d . T h ese e x p e c t a tio n s ca n be used a s th e s t a n d a r d s . V irtu a lly all u rb a n d w ellers in high-incom e n a ti o n s live in h ou se s, a p a r t ­ m e n t s or b o a rd in g h o u se s t h a t m e e t th e s e s t a n d a r d s . T h ese s t a n d a r d s m a y also be se t a n d ach ie v a b le in w ell-g ov ern ed cities in middle-income n a tio n s, a s d e m o n s t r a t e d by cities such a s P orto A le g re 1 a n d S e o u l.2 T h ese a r e good s t a n d a r d s too from a public h e a lth

P r o v is io n f o r w a t e r a n d s a n it a t io n in c i t ie s

3 v iew p oin t, a s will be e l a b o r a te d l a t e r in th is

r i c h e s t 20 p e r c e n t of ho u seh o ld s w ith w a t e r

c h a p t e r an d in C h a p te r 2. T h e y a re also th e

piped to th e i r homes.

s t a n d a r d s p re f e rre d by h o u seho ld s so long as

B ut c a re n e e d s to be t a k e n in s e ttin g

t h e y a re n o t too ex pensiv e, b e c a u s e t h e y elimi­

lo w e r s t a n d a r d s . S e t th e s t a n d a r d s to o low

n a te a lot of h a rd w o r k a n d d r u d g e r y fetchin g

a n d th e problem a p p e a r s to d is ap p ea r. A

a n d c a r r y i n g w a t e r a n d g e tt in g rid of h u m a n

s u r v e y t h a t a s k s ho u seh o ld s w h e t h e r th e y

w a s t e s a n d w a s t e w a t e r . B ut by t h e s e

h a v e a c c e s s to piped w a t e r ca n find t h a t m o s t

s t a n d a r d s , m o s t of th e u rb a n p o p u la tio n in

s a y yes, w h e r e a s a more d e taile d s e t of

A frica an d A sia an d m uc h of th e u rb a n p o p u la ­

q u e stio n s a b o u t w h e t h e r t h e y h a v e safe, suffi­

tion in L a tin A m e ric a a n d t h e C a rib b e a n h av e

cient, c o n v e n ie n t, affo rdab le w a t e r supplies

in a d e q u a te provision b o th for w a t e r an d for

p ro d u c e s v e r y different re s u lts . Obviously,

s a n i ta t io n . In d e ed , la r g e s e c tio n s of th e u rb a n

t h e r e is little po int in a s c e r ta i n in g t h e p r o p o r ­

p o p u la tio n in t h e s e regio ns h av e levels of

tion of people w h o se h o m e s a re c o n n e c te d to a

provision t h a t a re n o w h e re n e a r th is s t a n d a r d .

piped w a t e r sy s te m if th e r e is no w a t e r in th e

H u n d re d s of millions of people only have

pipes (which is th e c a s e for m a n y u r b a n h o u s e ­

u n sa fe a n d in c o n v e n ie n t w a t e r so urce s,

holds). T he v alu e of piped w a t e r su p p lies is

c o m p e te w ith h u n d re d s of o th e r s to g e t w a t e r

also dim inished if w a t e r is only a v a ilab le ir r e g ­

from d i s t a n t s ta n d p ip e s , h a v e to s h a r e dirty,

u la r ly an d th e q u a lity of th e w a t e r in t h e pipe

poorly m a i n ta i n e d to ile ts w ith do zen s of o th e r

is v e r y poor. O ne-third of th e u rb a n w a t e r

people, or h a v e no to ile ts a t all w ith in th e

su p plies in Africa an d in L a tin A m e ric a an d

hom e. T his fa c t will su r p ris e no one w ho

th e C arib b e a n an d more t h a n half of th o s e in

w o r k s in cities an d s m a lle r u rb a n c e n tr e s in

A sia o p e r a t e in te rm itte n tly , a n d m a n y do not

t h e s e region s b u t it does seem to c o n tr a d ic t

disinfect th e i r w a t e r . 3 T he pro b lem s of i n t e r ­

th e official in t e r n a t i o n a l s t a ti s ti c s on provision

m i t t e n t sup plies a re p a r t ic u l a r ly serio u s in

for w a t e r a n d s a n i ta t io n , w h ic h s u g g e s t t h a t it

m a n y cities in N orth Africa a n d th e Middle

is only a m ino rity of u rb a n d w e lle rs t h a t la c k

E ast.4

provision. B ut t h e r e is a d a n g e r in s e t ti n g th e

A s s e s s m e n t s of provision for w a t e r an d s a n i ta t io n a re c o m p lic a te d w h e n w a t e r piped

s t a n d a r d s for a d e q u a t e provision too high. In

to th e hom e a n d i n t e r n a l plu m bing an d

a n y city or s m a lle r u rb a n c e n tr e w h e re larg e

s a n i t a r y to ile ts in ea c h housin g unit a re not

s e c tio n s of th e p o p u la tio n h a v e v e ry i n a d e ­

th e norm . If a lo w e r s t a n d a r d t h a n ‘w a t e r

q u a te provision (and low incom es), a n d w h e re

piped to th e h o m e ’ is s e t, th e n ‘a d e q u a t e p rov i­

t h e r e a re lim ited re s o u r c e s av a ila b le for

sion’ h a s to c o n sid e r n o t only w h e t h e r a

im proving provision, s e t ti n g too high a

hou seho ld h a s a w a t e r so u rc e close by b u t th e

s t a n d a r d could w o r k to th e d i s a d v a n ta g e of

re g u l a r i ty of th e w a t e r su p p ly an d issu es of

th o s e w ith th e w o r s t provision. It could m e a n

w a t e r q u a lity a n d price. For u rb a n s e ttin g s ,

t h a t all av a ila b le r e s o u rc e s go to providing a

co n sid e ra tio n m u s t be given to e a s e of a c c e s s

sm a ll p ro po rtio n of th e p o p u la tio n w ith high

a s w ell a s d is ta n c e , since being w ith in 100

s t a n d a r d s - a n d of co urse, it will g e n e ra lly be

m e t r e s of a single public t a p m a y be a d e q u a t e

th e hig her-inc om e g ro u p s a n d th o s e w ith

in a sm all s e t t l e m e n t b u t v e ry in a d e q u a te in a

g r e a t e r p o litical m u scle w ho benefit from this.

high -d ensity s e t tl e m e n t , a s h u n d re d s of people

In su c h c ir c u m s t a n c e s , it c a n be a r g u e d t h a t

co m p e te for a c c e s s to it. I n t e r v ie w s w ith low-

th e p rio rity should be to e n su re t h a t e v e ry o n e

income d w e lle rs often re v e a l difficulties t h a t

h a s im proved provision, w ith h ig h e r s t a n d a r d s

e x t e r n a l a g e n c ie s do n ot a n ti c ip a t e : th e need

provided to a r e a s of th e c ity w h e r e th e in h a b i­

to q u eue for tw o h o u rs o r more to g e t eno ug h

t a n t s a re willing a n d able to p a y th e full co st

w a t e r ; t h e difficulty in g e tt in g en o u g h w a t e r

of th is. From a public h e a lt h p e rs p e c tiv e or a

from a s ta n d p ip e for h o useh old n eed s, b e c a u s e

p o v e rty re d u ctio n p ers p e c tiv e , it is b e t t e r to

of p re s s u re from o th e r s in th e q u e u e n ot to

provide a w h ole c i t y ’s p o p u la tio n w ith safe

ta k e too much; th e u nrelia b ility of sup plies to

w a t e r su pp lies by m e a n s of t a p s w ith in 50

th e s t a n d p ip e s ( w a t e r is often av a ila b le for

m e t r e s of t h e i r hom e t h a n to provide only th e

only a few h o u rs a day) a n d low w a t e r

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

4 p re s s u re , b o th of w h ich a c t to in c r e a se w a iti n g

provision for w a t e r an d s a n i ta t io n a c k n o w le d g e

tim es; an d th e p h y sica l effort n e ed ed to fetch

th e high proportion of people w h o d e fec ate in

a n d c a r r y w a t e r from d i s t a n t s t a n d p ip e s or

th e open in m a n y u rb an c e n tr e s in Africa and

o th e r sou rc es.

A sia, an d th e p a r t ic u l a r problem s t h a t w om en

In addition, hou seho lds t h a t la c k co n v en ­ ien t a c c e s s to good q u ality a n d re a s o n a b ly

an d girls face in t e r m s of h a r a s s m e n t an d sex u al a b u se a s a resu lt of doing so.

p riced w a t e r supplies often rely on multiple so u rc e s - for in s ta n c e , g e ttin g (expensive) w a t e r from ven d o rs for drinking an d cooking,

Setting standards

an d using (ch eaper) riv er or w ell w a t e r for

P e rh a p s th e m o st re le v a n t b asis for settin g

l a u n d r y an d w a sh in g . It is difficult to develop

s t a n d a r d s for w a t e r and s a n ita tio n provision is

com m on s t a n d a r d s for su ch v a rie d sources.

th e e x te n t to w hich provision redu ces th e v e ry

O th er issues such a s s e a s o n a l v a ria tio n s in

larg e h ea lth bu rd en t h a t a rise s from in a d e q u a te

qu ality or reliability also h av e to be considered.

provision. C h a p te r 2 d ocu m en ts ju s t how large

Sim ilarly, for s a n i ta t io n , if e n su rin g

th is h e a lth b urden is a n d how it is difficult for

provision for all h o u se h o ld s of a s a n i ta r y ,

th o s e w h o do n ot experience it to recognize its

easily c le a n e d an d m a i n ta i n e d to ile t inside

significance and its con tribu tion to poverty.

t h e i r ho use, a p a r t m e n t or s h a c k is u n re a listic ,

Non-health c rite ria for provision a re also im p or­

c o n s id e ra tio n n e e d s to be given to how to

t a n t - for in s tan c e, price an d convenie nce - b ut

e n su re a c c e s s to s h a r e d , co m m u n ity or public

th e s e a re p a rtially covered by a focus on r e d u c ­

facilities t h a t a re close, easily a c c e s s e d , c h eap

ing hea lth burdens, in t h a t high prices and

a n d cle a n . A s s e s s m e n t s of ‘a d e q u a c y ’ should

inconvenient supplies lead to low er levels of

p a y a t t e n t i o n to w h e t h e r t h e r e is a d e q u a t e

w a t e r use t h a t a re th e n reflected in higher

provision for d isposing of e x c r e t a , w a s t e w a t e r

h ealth burdens. Of th e m a n y d iseases ass o c iate d

an d sto rm a n d s u r fa c e run-off. Sim ilarly,

w ith in a d e q u a te w a t e r and s a n ita tio n , the

a s s e s s m e n t s should include som e co n sid e ra tio n

f a e c a l - o r a l d isea se s are am o ng th e m o st signifi­

of h e a lt h beh aviou r, since re d u cin g th e

c a n t in t e r m s of h e a lth im p a c t (although th e r e

in ciden ce of d is e a s e s c a u s e d by h u m a n e x c r e t a

are m a n y o th e r im p o rta n t d iseases re la te d to

(the so-called ' f a e c a l - o r a l ' d is e a se s, of w h ic h

in a d e q u a te provision: see C h a p te r 2 for more

d ia r r h o e a l d is e a s e s a re th e m o s t comm on)

details). Figure 1.1 illu s tra te s how th e risk s of

d e p e n d s n o t only on th e a v a ilab ility of w a t e r

h u m an c o n tam in atio n from f a e c a l - o r a l d iseases

a n d s a n i ta t io n b u t on h a n d -w a s h in g an d

v a r y w ith different levels of provision for w a te r,

p e r s o n a l hygiene.

sa n ita tio n an d hygiene. This illu s tra te s th e diffi­

It is c le a r from m a n y c a se s tu d ie s t h a t

culty of s e ttin g ap p ro p r ia te b e n c h m a rk s for

public, c o m m u n a l or sh a re d to ile ts are im p o r­

ass essin g th e provision for w a t e r and s a n i t a ­

t a n t for larg e sectio n s of th e u rb a n poor in

tion, since - even if w e ignore th e v a riatio n a t

m a n y n a tion s. Yet th e r e is surprisin gly little

each level - it is u n clea r w h e re w ith in Figure

dis cussion of th e s e in th e g e n e ra l lite r a tu r e on

1.1 to d r a w th e line b e tw e e n ‘a d e q u a t e ’ a nd

w a t e r an d sa n ita tio n . P a r t ic u l a r c a re is n eeded

‘i n a d e q u a t e ’ provision.

in ass e ssin g w h e t h e r public, c o m m u n a l or

The dividing line b e tw e e n th o s e w ho have

sh a r e d provision of to ilets is a d e q u a t e . U rban

a d e q u a t e provision an d th o se w ho do n ot could

p o p u la tio n s w ith c o m m u n a l or public to ilets

be s e t close to th e top of th is figure, so t h a t

close by m a y be a s s u m e d to be a d e q u a t e ly

th o s e w ho h ave a c c e ss to s h a r e d s ta n d p ip e s

serv ed w h en larg e sectio n s of th e u rb a n

an d pit la trin e s a r e classified a s a d e q u a t e ly

p o p u la tio n do n o t use th e m - for in s ta n c e ,

se rv e d - b u t a s th e figure su g g e s ts, th e risk of

b e c a u s e p a r e n t s do not h ave tim e to a c c o m ­

h u m a n c o n ta m in a tio n from f a e c a l - o r a l

p a n y th e i r children an d young girls to th e s e

p a th o g e n s w ith th is level of provision rem ain s

to ile ts (and of course y ou ng children hav e g r e a t

v e ry high. This dividing line does not m e a s u re

difficulty in w a itin g an d queuing), or b ec au se

w h o h a s safe w a te r , or w ho h a s sufficient

w o m en a n d children a re afra id to visit th em ,

provision for w a te r , or w h o h a s safe sa n ita tio n .

especially a f t e r d a r k . Few official s tu d ie s of

The dividing line ca n be s e t rig ht a t th e bottom

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

5 F igu re

How th e r i s k of t r a n s m i s s i o n of f a e c a l - o r a l p a t h o g e n s v a r i e s a c c o rd in g to th e q u a lity of p rovision for w a te r,

s a n i t a t i o n a n d h y gie ne

R i s k of h u m a n c o n t a m i n a t i o n N o improved water supply

wi th f a e c a l - o r a l p a t h o g e n s

( eg r e l i a n c e o n w a t e r f r o m r ivers o r unp rot ect ed wells)

V E R Y HIGH

and no basic sanitation (open defecation c o m m o n )

I m p r o v e d w a t e r s u p p l y ( eg

B a s i c s a n i t a t i o n (eg pit

shared standpipe drawing

l a t r i n e in t he h o u s e ) b u t n o

fr om piped s up p l y ) a n d no

V E R Y HIGH

improved water supply

basic sanitation

Imp ro ve d wa t er s up p ly (including public stan dpi pes , boreholes, protect ed d u g w e l l s a nd r ai nw at er ) a n d b as i c s anit at ion ( a c c e s s HIGH

to a t oi l et c o n n e c t e d to a s e w e r o r s e p t i c t a n k , a p o u r - f l u s h l a t r i n e o r a pit l a t r i n e )

I m p r o v e d a c c e s s to d r i n k i n g w a t e r (piped w a t e r s u p p l y to a t ap in e a c h h o u s e h o l d ' s yard) a s w e l l a s i m p r o v e d

Improved p e r s o n a l hygiene

I m p r o v e d w a t e r q u a l i t y (eg

( eg r e g u l a r h a n d - w a s h i n g

d r i n k i n g w a t e r d is inf ected

af t e r d e f e c a t i o n ) a s w e l l a s

at p o i n t of u s e ) a s w e l l a s

imp rove d w ate r s up p ly and

impro ved w at er s up p ly and

basic sanitation

basic sanitation

wa t er s u p p ly a n d basic

M EDIUM

sanitation

C o n t i n u o u s , g o o d q u a l i t y p i p e d w a t e r s u p p l y i nt o t h e h o u s e p l u s h y g i e n i c , w e l l m a i n t a i n e d toi l et in e a c h d w e l l i n g u n i t t h a t is u s e d b y a l l f a m i l y m e m b e r s a n d s a f e a n d c o n v e n i e n t d i s p o s a l of

M E D I U M TO L O W

wastewater

In a d d i t i o n to t h e c o n t i n u o u s g o o d q u a l i t y p i p e d w a t e r s u p p l y into t he h o u s e , i n t e r n a l p l u m b i n g wi th hot a n d col d r u n n i n g w a t e r p i p e d to b a t h r o o m s , k i t c h e n s a n d t o i l e t s a n d p r o v i s i o n for

VERY LOW

w a s t e w a t e r r e m o v a l f rom e a c h of t h e s e

Source: Based on Table 2 and Figure 2 in Priiss, Annette, David Kay, Lorna Fewtrell and Jamie Bartram (2002), ‘Estimating the burden of disease from w ater, sanitation and hygiene at a global level’. Environmental Health Perspectives, Vol 110, No 5, May, pages 539 and 540, modified to reflect urban situations. The original figure in this paper is p art of a calculation of the contribution of deficiencies in provision for w ater, sanitation and hygiene to global disease burdens: see Chapter 2 for more details.

of t h e fig u re w h e r e t h e r i s k of h u m a n c o n t a m i ­

t i o n o n ly a s s e s s w h o h a s i m p r o v e d p r o v i s io n .

n a t i o n fro m f a e c a l - o r a l p a t h o g e n s is v e r y low,

F o r w a t e r s u p p l y , im p r o v e d p r o v i s io n m e a n s

b u t t h i s im p li e s a q u a l i t y o f p r o v i s io n w i t h u n i t

‘r e a s o n a b l e a c c e s s ’ t o a w a t e r s u p p l y fro m a

c o s t s t h a t a r e u n r e a l i s t i c in m o s t u r b a n c e n t r e s

h o u s e h o l d c o n n e c t i o n , a p u b lic s t a n d p i p e , a

in lo w - i n c o m e n a t i o n s a n d m a n y m i d d le - in c o m e

bo rehole, a p r o te c te d d u g w ell, or a p ro te c te d

natio n s.

sp rin g a n d ra in w a t e r c o n n ectio n . A t le a s t 20

T h i s s u g g e s t s t h e n e e d for a s s e s s m e n t s

li t r e s p e r p e r s o n p e r d a y m u s t b e a v a i l a b l e

t h a t u s e m o r e t h a n o n e b e n c h m a r k - for

fr om a s o u r c e w i t h i n 1 k i l o m e t r e o f t h e u s e r ’s

i n s t a n c e , a s s e s s i n g w h o h a s im p r o v e d ,

d w e l l i n g . F o r s a n i t a t i o n , ‘i m p r o v e d ’ p r o v i s io n

a d e q u a t e a n d g o o d p r o v i s io n . T h i s w o u l d a ll o w

m e a n s a c c e s s to a p riv a te or sh a r e d to ilet

a f o c u s on e n s u r i n g i m p r o v e d p r o v i s io n fo r

c o n n e c t e d t o a p u b li c s e w e r o r a s e p t i c t a n k ,

e v e r y o n e a n d s u p p o r t i n g b e t t e r t h a n im p r o v e d

o r a c c e s s t o a p r i v a t e o r s h a r e d p o u r - f lu s h

p r o v i s io n w h e r e v e r p o s s ib le . A t p r e s e n t , g lo b a l

la trin e , sim ple p it la trin e o r v e n tila te d

a s s e s s m e n t s of p r o v i s io n fo r w a t e r a n d s a n i t a ­

im p r o v e d p i t l a t r i n e . 5

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

6 The lack of data

hou seho ld s sp end a c c ess in g sh a re d , co m m u nal

D etaile d a s s e s s m e n t s of w h o h a s im proved an d

th e s e facilities are c le a n e d .8

or public facilities or th e frequ ency w ith w hich b e t t e r t h a n im proved provision dep en d on good

In ad d itio n , t h e c r i t e r i a u se d in m ost

d a t a . T he m o s t u rg e n t n eed for b e t t e r d a t a on

c e n s u s e s or h o u se h o ld s u r v e y s for d r a w in g th e

t h e q u ality an d e x t e n t of provision for w a t e r

line b e tw e e n w h o h a s an d do es n o t h a v e

a n d s a n i ta t io n is obviously a t t h e level w h e re

a d e q u a t e pro vision for w a t e r a n d s a n i ta t io n

t h e deficiencies in provision a re to be t a c k l e d -

do n o t rec og niz e i m p o r t a n t d ifferences

t h a t is, d a t a for e a c h hou seh o ld in e a c h u rb a n

b e t w e e n r u r a l a n d u r b a n c o n te x t s . For

a r e a , or for d is tric ts or m u n icip alities w ith in

i n s ta n c e , m a n y c e n s u s e s or h o u seh old s u r v e y s

u r b a n a re a s .

c o n sid e r t h a t t h e a v a ila b ility of w a t e r w ith in

N a tio n a l a n d global a s s e s s m e n t s a re also n ee d e d to help guide n a ti o n a l g o v e rn m e n ts a nd

100 m e t r e s of t h e hom e in d i c a te s a d e q u a t e a c c e s s to w a te r , y e t w a t e r t a p s e v e r y 100

i n t e r n a t i o n a l ag e n c ie s, b u t t h e s e should be

m e t r e s in a village of 100 p e rs o n s is n o t th e

b uilt up from d e ta ile d local a s s e s s m e n ts .

s a m e a s w a t e r t a p s e v e r y 100 m e t r e s in a

U n fo rtu n ately , t h e r e is little d e ta ile d d a t a

hig h -d en sity s q u a t t e r s e t t l e m e n t w ith 1 0 0 ,0 0 0

av a ilab le on th e q u a lity of provision for w a t e r

in h a b i ta n t s .

a n d s a n i ta t io n for m uc h of th e w o r l d ’s u rb a n

T h u s, w e end up w ith a p a ra d o x : th e

p o pu la tio n. T h e re a re tw o problem s: t h e level

w o rs e th e q u a lity of provision for w a t e r an d

of d e ta il a n d t h e e x t e n t of th e c o v e ra g e .

s a n i ta t io n , th e more s o p h i s ti c a te d th e d a t a

In re g a r d to d etail, m o s t of th e d a t a on

n e e d to be to a s c e r t a i n w h a t should be done.

w h ic h n a tio n a l or global s u r v e y s of provision

F or in s ta n c e , if a hou seh old h a s a r e g u l a r

for w a t e r an d s a n i ta t io n rely a re d r a w n from

sup ply piped to th e hom e t h a t is n o t too e x p e n ­

c e n su s e s or household s u r v e y s t h a t do n ot a sk

sive, no q u e s tio n s a r e n eed ed r e g a r d in g all th e

m ost of th e c ritical q u e stio n s r e g a r d in g th e

o th e r w a t e r s o u r c e s th e m e m b e rs use, th e i r

a d e q u a c y of provision - so th e y c a n n o t provide

q u ality or th e i r e a s e of ac c e ss . If a ho usehold

inform ation on w ho h a s ‘safe a n d sufficien t’

h a s a w a te r- flu s h e d to i le t in t h e hom e t h a t

w a t e r an d a d e q u a t e sa n ita tio n . For in s ta n c e ,

only th e h o u se ho ld m e m b e rs use, an d w h ich is

q u e stio n s a re u su ally a s k e d a b o u t w h e t h e r

co n n e c te d to s e w e rs , th is elim in a te s t h e need

t h e r e is a piped sup ply to th e house or w a t e r

for m a n y q u e stio n s a b o u t how th e e x c r e t a is

a vaila ble on th e prem ises, b u t n ot a b o u t th e

disposed of a n d th e e x t e n t of provision for

re g u la rity of th e supply, th e re s p o n d e n t’s

to ile t cle a n ing . A sc e rta in in g th e q u a lity of

p e rcep tio n of its quality, th e co st a n d w h e th e r

s a n i ta t io n provision is also p a r t ic u l a r ly com pli­

th e household u s e s o th e r w a t e r so u r c e s .6 The

c a te d w h e n t h e r e a re no facilities w ith in a

ca se stu d ie s given in la t e r sectio n s of th is

hom e, an d people rely on s h a r e d , c o m m u n a l or

c h a p t e r sh ow h ow m a n y cities an d sm a ller

public facilities. Box 1.1 h igh lig hts th e com pli­

u rb a n c e n tr e s h ave piped w a t e r s y s te m s in

c a tio n s of a s c e r ta i n in g w h e t h e r w a t e r and

w h ich w a t e r is in th e pipes for only a few

s a n i ta t io n provision is a d e q u a t e . To a s c e r t a i n

h o u rs a d a y (or less), an d th e piped w a t e r itself

w h e t h e r ho u seh o ld s h a v e a d e q u a t e w a t e r a n d

is unfit for drinking. Similarly, a s s e s s m e n ts of

s a n i ta t io n provision w o uld req u ire fa r more

provision for s a n i ta t io n a re often b a s e d on th e

q u e stio n s t h a n th o s e c u rr e n tl y included in

ty p e of to ilet t h a t people use, b ut th e h ealth

c e n su s e s or h o u se ho ld su rv e y s.

risk s from using to ile ts in m a n y u rb a n se ttin g s

T h e re is also th e is sue of c o v era g e . T h ere

m a y be more linked to th e n u m b e r of people

a r e no d a t a on w a t e r a n d s a n i ta t io n provision

s h a r in g ea c h to ile t t h a n to th e kind of toilet

for m o s t (u rb a n an d r u r a l) h o u seho ld s in m a n y

u s e d .7 It is r a r e for d a t a to be collected on th e

low-income n a tio n s. The only re c e n t d a t a on

e x te n t of to ile t sh aring . For in s ta n c e , in

w a t e r an d s a n i ta t io n provision come from

d em o g rap h ic an d h e a lth s u r v e y s (which a re th e

h o u se ho ld s u r v e y s t h a t a re b a s e d on re p r e s e n ­

m ain so u rc e s of d a t a on provision for w a t e r

ta t i v e s a m p le s of th e p o p u latio n . T h ese m a y be

a n d s a n ita tio n in m a n y low-income natio ns), no

able to provide a c c u r a t e s t a t i s t i c s on th e

inform ation is g a th e r e d a b o u t th e tim e t h a t

prop o rtio n of th e p o p u la tio n t h a t h a s (for

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

7 Box 1.1 T h e m a n y c o m p lic a tio n s in d e te r m i n in g w h e t h e r prov ision for w a t e r a n d s a n i t a t i o n is a d e q u a t e

Complications in determining the adequacy of water supplies

have most responsibility for obtaining

sion for a n a l cleaning, hand-w ashing

th e w a t e r or for th e t a s k s t h a t require

and m ain ten ance.

People often use more th a n one w a t e r

w ater.

mem bers, especially by those who

Good sa n itatio n needs good provi­

th e quality, accessibility, reg ularity

charge for w a t e r sold by w a t e r kiosks

and cost of each, and w h e th e r its use

or vendors w hen viewed as the cost

is a problem (ie, it is not so much of a

charged per pot can still be very

Additional issues for the hundreds of millions of people who have only shared, communal or public toilets

problem if people are using a cheaper,

expensive for poor households,

E ase of a ccess for each m em ber of a

more accessible w a t e r supply t h a t is

especially if th is is th e only w a te r

household (close enough for children

not of drinking w a t e r quality if this is

source t h a t people have a ccess to.

to use; accessible a t night and with

W h a t seems like a ‘re a s o n a b le ’

source, an d it is difficult to a scertain

T he le gal b asis for h ou seholds to

used only for lau n d ry or washing).

public lighting in the ro a d s /p a s s a g e s

qualify for official provision is often

to it and inside it; not dangerous for

th e w a t e r sources t h a t households use

unclear, an d is often complex or

w om en /girls to get to it and use it a t

over time - for instan ce, th e availabil­

am big u ou s if people live in inform al

night).

ity of some sources varies seasonally,

or illegal s e t tl e m e n t s a n d /o r are

and people might sw itch to more

ren te rs.

There m ay be large v a ria tio n s in

Quality of provision to keep it clean and quality of m ainten ance (especially difficult if toilet facilities

co n tam in ated sources during w a te r

Complications in ascertaining the adequacy of provision for sanitation

toilets t h a t do not g e n e ra te revenues

th e w a t e r sources t h a t households use

Good sa n itatio n needs good quality

to ensure good m a n a g e m e n t and

in different a re a s of a settle m en t,

provision in th e home (eg, th e toilet),

cleaning).

sh o r ta g e s when vendors p u t up their prices. There may be large v a ria tio n s in

are sh ared among several households, or if th e y are com m unal or public

Cost of use (w h a t seem s like a

reflecting differences in available

th e im mediate surrou nd s (eg, co nn ec­

w a t e r resources (eg, b etw een those

tion to a se w e r or to a pit or septic

cheap price per use may be very

who live close to com m unal facilities

t a n k t h a t does not c o n tam in ate the

expensive for low-income households,

and those who do not).

g ro u n d w a te r or o th er p eople’s w ater)

even if each family m em ber uses it

and th e neighbourhood (provision to

ju s t once a day).

There m ay be la rge v a ria tio n s in th e ad e q u ac y of provision w ithin a

ensure no hum an co n ta c t w ith ex creta

se ttle m e n t depending on household

and to make sure t h a t w a s t e w a t e r is

income (ie, high-quality provision for

removed safely). To be effective, everyone m ust

households able to spend more th a n a certain a m o u n t on w ater). W h a t seems like an ad e q u a te supply (eg, a w a t e r ta p inside the

use it (so issues of easy access and

Additional issues in many cities W h a t hap pen s to w a t e r and san itatio n provision during periods of high

children’s use of it are im portant: do

rainfall (ie, flooding of pit latrin es and

t e n a n t s g et a ccess to toilet facilities?)

septic ta n k s , conta m in ation of some

The ‘a d e q u a c y ’ of provision may

home) often is not (eg, th ere is no

w a t e r sources)? Are there problems with block­

w a t e r in th e pipes, w a t e r is available

be perceived very differently by differ­

only very irregularly or is of poor

e n t household m em bers, especially by

ag es in drains (very common w here

quality).

those who have most responsibility

the re is in ad eq u a te or no provision for

for cleaning and m ain tain ing the

reg u lar house-to-house solid w a s te

toilets.

collection)?

The ‘problem’ may be perceived very differently by different household

in s ta n c e ) w a t e r on t h e p r e m ise s a n d a c c e s s to

m u c h to k n o w t h a t 3 8 p e r c e n t of th e h o u s e ­

a la tr in e (but not for m o st of t h e issu es r a ise d

holds w ith in th e i r b o u n d a r ie s la c k w a t e r on

in Box 1.1), b u t th e y do no t sh o w w h e r e th e

t h e i r p r e m ise s b u t not to k n o w w h ich h o u s e ­

people la c k in g su c h provision live. T h ese

holds, w h ich n e ig h b o u rh o o d s a n d w h ich

s u r v e y s u s u a lly h av e a s a m p le size la rg e

d is t r ic ts t h e s e people live in.

en o u g h to allow t h e s t a t i s t i c s on provision to

T he re c o rd s of th e utilities or ag e n c ie s

be d i s a g g r e g a t e d to ‘r u r a l ’ a n d ‘u r b a n ’ p o p u la ­

responsible for providing w a t e r an d s a n ita tio n

tio n s a n d s o m e tim e s to a few specific citie s (or

should be a good info rm atio n so u rce a b o u t th e

ju s t th e l a r g e s t city in th e n a tio n ). B u t it does

q u a lity of provision for e a c h household - b u t

n o t help a city u tility or a local a u t h o r i t y

obviously, t h e s e g e n e r a lly only hav e d e ta ils for

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

8 th o s e hou seho lds to w hich t h e s e a g e n c ie s

ab ility to identify w h e r e th o s e w ith i n a d e q u a te

provide serv ic es. As th e ca se stu d ie s in th is

provision a re. T h ey c a n only provide e s t im a te s

c h a p t e r will show, it is com m on for half or

of th e p ro p o rtio n w ith in e a c h n atio n (or larg e

more of t h e hou seh olds in a city to la c k c o n n e c ­

city) w ith im proved provision. Global a s s e s s ­

tion to th e w a t e r supply s y s te m , an d for

m e n t s c a n only be a s d e ta ile d a s th e c e n su s e s

t h r e e - q u a r t e r s o r more to lack c o n n ectio n s to

an d ho useho ld s u r v e y s on w h ich th e y d r a w . 10

se w e r s or drains. In m ost sm all u r b a n c e n tr e s

Ironically, th e n a ti o n s w h e re t h e n e ed for

in low- an d middle-income n a tio n s (and m a n y

b e t t e r provision is g r e a t e s t a re g e n e ra l ly th e

la r g e r u rb a n centres) th e r e a re no s e w e r s a t

n a ti o n s w ith th e m o s t in a d e q u a te info rm ation

all, so local utilities have no in form ation on

b ases.

provision for sa n ita tio n . H owever, th e qu ality an d e x te n t of w a t e r an d s a n i ta t io n provision m a y be u n d e r- e s tim a te d if only th e reco rd s of w a t e r an d s a n i ta t io n co m p an ies a re d r a w n on. T h e se ra r e ly record th e hou seh olds t h a t have

Provision for water and sanitation in each of the world’s regions

in vested in provision for sa n ita tio n . T h ey m a y

Table 1.1 s h o w s t h e p ro p o rtio n of th e u rb a n

no t record th e piped w a t e r a n d s a n ita tio n

p o p u la tio n in ea c h of th e w o r l d ’s reg ion s t h a t

sy s te m s installed by com m unities. For in s ta n c e ,

h a d a c c e s s to im proved w a t e r su p p ly and

in K a rach i, in a high p ro po rtion of th e katchi

s a n i ta t io n in 2 0 0 0 . T he W H O/UNICEF Global

abadis (informal se ttle m e n ts] in w h ich aro u n d

W ater S u p p ly and S a n ita tio n A sse s sm e n t 2 0 0 0

half th e p o p ulation live, th e r e a re piped w a t e r

R ep o rt (A sse s sm e n t 2 0 0 0 ) from w h ich th e s e

s y s te m s an d s e w e r s t h a t w e re installed by self-

figures come d e sc r ib e s th e difficulties

help, no t by g o v e rn m e n t a g e n c ie s.9

m en tio n e d ab ov e in a s s e s s in g w h e t h e r p ro v i­

C e n su se s a re g e n e ra lly th e only in f o rm a ­

sion for w a t e r is a d e q u a t e , a n d e x p lain s t h a t

tio n s o u r c e s t h a t provide d eta ils of provision

its figures do no t m e a s u r e th e p ro p o rtio n of

for e a c h h ou sehold; th e q u a lity a n d level of

people w ith a d e q u a t e p rov ision .11 A d e q u a te

d e ta il of th e i r d a t a on w a t e r an d s a n i ta t io n

provision w o uld m e a n th e su pp ly of ‘s a f e ’

m a y be limited for th e re a s o n s outlined above,

w a t e r (ie, w a t e r t h a t c a n be safely d r u n k an d

b u t a t le a s t t h i s is in fo rm atio n on e a c h h o u s e ­

used for cooking) of a sufficient volum e to

hold. B ut in m a n y n a tio n s, th e r e h a s been no

allow for all do m estic n e e d s including food

ce n s u s for m a n y y e a r s an d in t e r n a t io n a l

p r e p a r a ti o n a n d cooking, w a s h in g , la u n d r y

ag e n c ie s a r e r e l u c t a n t to fund th e m . In m a n y

a n d o th e r a s p e c t s of p e r s o n a l hygiene. The

n a ti o n s w h e re c e n s u s e s h a v e b een held, the

a s s e s s m e n t does n o t e s t im a te t h e p ro p o rtio n of

d a t a on w a t e r a n d s a n i ta t io n provision by

people w ith safe or a d e q u a t e supplies, b u t

ho usehold o r by n eig h b o u rh o o d a re n o t a v a il­

th o s e w ith a c c e s s to im proved w a t e r sup ply -

able to city a u th o r it ie s or to w a t e r an d

w h ic h is t a k e n to include hou seho ld c o n n e c ­

s a n i ta t io n utilities. As C h a p te r 7 will d escribe,

tio n s, public s t a n d p ip e s , bo reh oles, p ro te c te d

t h e r e a re cities w h e r e d e ta iled , house-by-house

dug w ells, p r o t e c te d s p rin g s an d ra in w a t e r

a n d sh a c k - b y -s h a c k a s s e s s m e n t s of w a t e r an d

collection. It w a s n o t possible for th e a s s e s s ­

s a n i ta t io n provision h a v e b een built from th e

m e n t to g e t d a t a on w h e t h e r th e w a t e r w a s

b o tto m up by city a u th o r it ie s , local NGOs an d

safe, a n d m a n y c a s e s tu d ie s h a v e sh o w n t h a t ,

ev en f e d e r a tio n s of th e u r b a n poor, b u t t h e s e

in u r b a n s e t ti n g s , it is co m m o n for w a t e r from

a r e th e exce ptio n, n o t t h e rule.

all t h e s e different s o u r c e s to be c o n ta m in a t e d .

This e x p la in s w h y g lo b al an d reg io n al

Table 1.1 s u g g e s ts t h a t in 2 0 0 0 , th e r e

a s s e s s m e n t s of w a t e r an d s a n i ta t io n provision

w e re 173 million u rb a n d w e lle rs u n s e r v e d w ith

for th e w o r l d ’s u r b a n (and r u r a l) p o p u la tio n s

im proved provision for w a t e r - 98 million in

(w hich h a v e to d r a w p rim a rily on ex istin g

A sia, 44 million in Africa, 29 million in L atin

ce n s u s e s an d hou seh o ld su r v e y s) a re n ot able

A m erica a n d th e C arib b ea n a n d 3 million in

to m e a s u re th e p rop ortion of people w ith

E urope. T h is a p p e a r s a s a s e rio u s problem b ut

a c c e s s to safe an d sufficient w a t e r an d good

could be ju d g e d a s n o t req u irin g a high p ri o r­

q u a lity s a n i ta t io n , an d h a v e a v e ry limited

ity. A fter all, if 93 p e r c e n t of th e u rb a n

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

9 p o p u la tio n of A sia a n d L a tin A m e r ic a a n d 85 p e r c e n t of t h e u r b a n p o p u la tio n of A frica h ave im proved provision, th e n th is sim ply r e q u ir e s a

T h e p ro p o r tio n of u r b a n p o p u la tio n s w ith a c c e s s to ‘i m p r o v e d ’ w a t e r supply a n d s a n i t a t i o n , 2 0 0 0 Urban

Proportion with

Number

population

‘im proved’

o f people

(millions)

provision

unserved

(%)

(millions)

94

173

86

403

85

44

84

46

Region

p r o g ra m m e focusing on p a r t i c u l a r u r b a n a r e a s , in p a r t i c u l a r c o u n trie s w h e r e provision is p a r ti c u la r l y poor, a n d m in o r im p r o v e m e n ts in provision e ls e w h e re . B ut in d ivid ual city s tu d ie s a n d th e d a t a collec te d by t h e A s s e s s m e n t 2 0 0 0 for la rg e c i tie s 12 s u g g e s t t h a t , if it w e r e possible to w id en t h e a s s e s s m e n t to m e a s u r e t h e p r o p o rtio n w ith a c c e s s to safe, sufficient sup p lies, t h e n u m b e r of u r b a n d w e lle r s i n a d e ­ q u a t e ly se rv e d w o uld be m u c h h ig h e r -

Global Urban w a t e r supply Urban sanitatio n A frica Urban w a t e r supply

A sia Urban w a t e r supply

no lo n g e r a problem of r e a c h in g a sm all

Urban san ita tion

Urban w a t e r supply

a d e q u a t e l y se rv in g 3 0 - 6 0 p e r c e n t of th e

Urban sanitatio n

Table 1.1 s u g g e s ts t h a t provision for s a n ita tio n in u r b a n a r e a s is m ore of a problem t h a n for w a t e r - b u t ag a in , t h a t it is a m inority

Urban san ita tion

297

93

29

87

51

21

98

0

99

0

545

100

3

99

8

100

0

100

0

N o rth e r n A m e ric a

Africa, only 16 p e r cent; in A sia, 22 p e r cent.

Urban w a t e r supply

T he a s s e s s m e n t rec ognize s th e difficulties in

Urban sanitatio n

tion of people w ith a d e q u a t e s a n ita tio n , bu t

98

78

E u ro p e Urban w a t e r supply

a d e q u a t e a n d it does not e s tim a te t h e p ro p o r ­

391

Urban sanitatio n

C a rib b ea n , only 13 p e r c e n t of th e u rb a n

a s se ss in g w h e t h e r provision for s a n ita tio n is

93

O cean ia Urban w a t e r supply

w ho suffer. In L atin A m eric a a n d th e

p o p u la tio n do n o t have im proved provision; in

1352

L a tin A m e ric a an d t h e C a rib b e a n

t h a t e x istin g s y s t e m s of provision a r e no t

u r b a n p o p u la tio n in m o st n a tio n s.

297

Urban sanitatio n

p e r h a p s a s m u c h a s four tim e s higher. So it is

p ro p o rtio n of th e u r b a n p o p u la tio n , b u t im plies

2845

239

Source: WHO an d UNICEF ( 2 0 0 0 ) , G lobal W ater S u p p ly and S a n ita tio n A s s e s sm e n t 2 0 0 0 R ep o rt, World H e a l th O rg a n iz a ti o n , UNICEF an d W a t e r S u p pl y a n d S a n it a ti o n Co ll ab or at iv e Council. Ge ne va , 8 0 pa ge s.

th o se w ith im proved s a n ita tio n (which includes an y toilet co nne ction to a s e w e r or septic t a n k , a pour-flush la tr in e or a pit la trin e). S h a r e d la tr in e s a r e included in ‘im p ro v e d ’ w hile public la tr in e s a n d serv ice or b u c k e t la tr in e s a r e not.

T able 1.2 T h e p ro p o r tio n of h o u s e h o ld s in m a jo r c ities c o n n e c t e d to

No a s s e s s m e n t w a s possible re g a rd in g th e

p iped w a t e r a n d s e w e rs

availa b ility of w a t e r for h a n d - w a s h in g or p e r s o n a l hygiene. This m e a n s t h a t t h e b e n c h ­

Region

m a r k for a s s e s s in g im proved provision for

House or yard

Connected to

connection fo r

sewer (%)

w ater (%)

s a n ita tio n is up a t t h e top of F igure 1.1. A frica

43

18

Asia

77

45

L atin America and th e Caribbean

77

35

Oceania

73

15

f a e c a l - o r a l dise a se s, th e n t h e n u m b e r of u r b a n

Europe

96

92

dw ellers w ith in a d e q u a te provision for s a n i t a ­

North America

100

96

If a choice w a s m a d e to use w a te r-flu sh e d to ile ts c o n n e c te d to s e w e rs a s th e s t a n d a r d b e c a u s e t h e y perform b e s t in t e r m s of red ucing

tion w ould pro b ab ly be th r e e tim e s a s m a n y as in d ic a te d in Table 1.1 - n o t 4 0 0 million bu t 120 0 million. Of th e pop u la tio n of a sa m p le of 43 la rg e African cities, th e a s s e s s m e n t sh o w ed t h a t 82 p e r c e n t la ck e d to ile ts c o n n e c te d to s e w e rs . For th e la rg e cities in A sia, it w a s 55

So u rc e: WHO a n d UNICEF (2 0 0 0 ) , Global W ater S u p p ly and S a n ita tio n A s s e s sm e n t 2 0 0 0 R ep o rt, World H e a l th O r g a ni za tio n , UNICEF an d W a t e r S up p ly a n d S a n it a ti o n Col la bo ra ti v e Council, Ge n ev a, 8 0 p ag e s. T h e se figure s a r e b a s e d on in fo rm at io n pro vid ed for 116 ci ties. In no region w a s th e r e a r e p r e s e n t a t i v e s a m p l e of larg e ci ties, a l t h o u g h th e figu res for e a c h region a r e likely to be indi cat ive of a v e r a g e levels of provision for m a jo r cit ie s in t h a t region.

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

10 p e r cent; for th o s e in L atin A m erica an d the

d e m o n s t r a t e d t h a t th e unit c o s ts of s e w e r s c a n

C aribb ea n , it w a s 65 p e r c e n t (see Table 1.2).

be red u ced to th e poin t w h e re even low-income

In g e n era l, larg e cities h ave h ig h er p ro po rtio ns

h o useh old s in K a ra c h i can afford t h e m . 14

of people co n n e c te d to se w e rs , so if d a t a w ere

B ut to a s s u m e t h a t only u r b a n h o u s e ­

a vaila ble for th e proportion of all u rb an

holds w ith w a te r- flu s h e d to ile ts c o n n e c te d to

dw ellers w ith to ile ts in th e i r ho m es c on ne cted

s e w e r s in th e home h ave a d e q u a t e provision

to s e w e rs , c o v e ra g e w o uld be less t h a n t h a t

for s a n i ta t io n w o uld o v e r- s ta te t h e c a s e , since

sh ow n in Table 1.2. A decision to use ‘w a te r- flu s h e d to ile ts

m a n y u r b a n r e s id e n ts a re a d e q u a t e l y se rv e d w ith on-site s a n i ta t io n su c h a s to ile ts

av a ilab le in ea c h dw elling u n it c o n n e c te d to

c o n n e c te d to se p tic t a n k s or pour-flush

s e w e r s ’ a s th e b e n c h m a r k for a d e q u a t e s a n i t a ­

la trin e s , or good q uality , easily cle a n e d pit

tion is in c re a sin g ly criticized by

la t r i n e s . 15 In m a n y u r b a n s e t ti n g s , n e it h e r th e

e n v ir o n m e n ta lis ts b e c a u s e of th e ecological

funding n o r th e in s ti tu t io n a l s t r u c t u r e e x is ts to

d is a d v a n t a g e s t h a t s e w e r s y s te m s ca n bring.

allow th e c o n s t ru c ti o n of s e w e r s to se r v e m ost

B ut if decisions a b o u t provision for s a n i ta t io n

of th e p o p u latio n . W ate r-flu sh ed to i le t s a re

w e r e m a d e only on public h e a lt h g ro un ds, t h e n

also n o t m uch u se if w a t e r su p p lies a r e too

in m o s t city c o n te x t s - w ith high d ensities,

irreg u la r, exp ensiv e or difficult to o b ta in to

v e r y sm all lot sizes an d m a n y m ultiple-storey

allow r e g u l a r flushing. H ow ever, it does

b uildings - w a te r- flu s h e d to i le t s c o n n e c te d to

h ig hligh t how th e scale of th e ‘s a n i ta t io n g a p '

s e w e r s w o u ld be th e s a n i ta t io n sy s te m of

is v e ry d e p e n d e n t on w h a t is said to be

choice. S e w e r-b a s e d s y s te m s h ave t h e g r e a t

‘a d e q u a t e ’. On-site s a n i t a t i o n also m e a n s t h a t

a d v a n t a g e of re m oving w a s t e w a t e r s too , an d

h u m a n e x c r e t a is still in th e s e t tl e m e n t ; in

often provide a d d itio n a l d r a i n a g e c a p a c i ty

o ve r-crow d ed city s e t ti n g s w h e r e s p a c e is a t a

du rin g sto rm s . T h ey should also p ro t e c t

p rem iu m , it is difficult to en su re good m a i n t e ­

g r o u n d w a t e r from c o n ta m in a t io n by h u m a n

n a n c e an d r e g u l a r a n d safe sludge rem o v a l

e x c r e t a . S e w e r s a r e th e only te c h n o lo g y

from la t r i n e s o r se p tic t a n k s . In cities or city

re g a r d e d a s a d e q u a t e in cities in high-income

d is tric ts w h e re flooding is com m on, pit la t r i n e s

n a tio n s, an d th e e x ten s io n of s e w e r s to entire

a n d se p tic t a n k s re g u la rly over-flow, s p r e a d in g

city p o p u la tio n s d u rin g t h e sec o n d h a lf of th e

h u m a n e x c r e t a e v e r y w h e r e w ith v e r y serio us

1 9 th c e n t u r y a n d t h e e a rl y p a r t of th e 2 0 th

public h e a lth im plications.

c e n t u r y b ro u g h t v e ry la r g e h e a lt h g a in s in E u ro pe an d N orth A m erica. It is w o r t h r e c a ll­

One of th e c e n t r a l t h e m e s of th is book is t h a t th e deficiencies in w a t e r a n d s a n i ta t io n

ing t h a t in f a n t m o r ta l it y r a t e s of 1 0 0 - 2 0 0 p e r

provision in u r b a n a r e a s a re m u ch w o rs e t h a n

1 00 0 live b ir th s w e re com m on in cities in

th e figures in Table 1.1 su g g e s t. L a t e r se c tio n s

E u ro pe an d N o rth A m e ric a only 1 00 y e a r s

in th is c h a p t e r will p r e s e n t m ore evidenc e for

a g o . 13 W a te r-b a s e d s e w e r a g e c a n h a v e

th is. For in s ta n c e , th e y will sh o w t h e v e ry

ecological d is a d v a n ta g e s , e sp e cia lly w h e re

la r g e deficiencies in w a t e r a n d s a n i ta t io n

t h e r e are s h o r t a g e s of fresh w a t e r a n d in larg e

provision in u r b a n a r e a s in m a n y A frican and

cities w h e re th e v e ry larg e volum e of s e w a g e

A sian n a tio n s w h e r e officially more t h a n 90

o v e rw h e lm s a n y c a p a c i ty for t r e a t m e n t .

p e r c e n t of th e u rb a n p o p u la tio n have

H ow ever, t h e s e d is a d v a n t a g e s a re n o t in h e r e n t

im proved w a t e r an d s a n i ta t io n . This inclu des

to s e w e r s y s te m s b u t to t h e w a y t h e y a r e used

n a ti o n s w h ich claim t h a t 99 p e r c e n t of th e i r

an d th e w a y s in w h ich w a t e r use an d re-use

u r b a n p o p u la tio n h av e im proved w a t e r

a r e m a n a g e d (see C h a p te r 6 for m ore d etails).

sup plies w h e n d e tailed s tu d ie s of th e i r m ajo r

It w o u ld also be in a p p r o p r ia te to s e t a s t a n d a r d for s a n i t a t i o n t h a t h a d a cost far

cities sh o w t h a t 3 0 - 5 0 p e r c e n t of th e i r p o p u latio n h a v e v e r y in a d e q u a te provision.

b eyo nd th e m e a n s of low -income househ olds.

Sim ilarly, th is includes n a ti o n s w hich claim

S e w e r s a re g e n e ra lly more exp ensiv e p e r

t h a t more t h a n 95 p e r c e n t of th e i r u rb a n

h ousehold s e r v e d t h a n on-site s y s te m s su ch a s

p o p u latio n h ave im proved s a n i ta t io n w h en

pit la trin e s. H ow ever, a s d esc rib ed in C h a p te r

d e ta ile d city s tu d ie s sh o w t h a t 3 0 - 5 0 p e r c e n t

7, th e O rangi P ilo t P ro je c t in P a k i s t a n h a s

of th e p o pu latio n h av e v e ry poor q u ality

P r o v is io n f o r w a t e r a n d s a n it a t io n in c i t ie s

11 l a t r i n e s (w hich a r e often difficult to ac c e ss ) or

D evelopm ent R e p o rt 2 0 0 1 ,19 UNDP d r a w s on

d e fe c a te in th e open or into b a g s or w a s t e

th e a s s e s s m e n t figures for provision for w a t e r

paper.

an d p r e s e n t s figures for th e p ro p o rtio n of

The a s s e s s m e n t on w hich th e figures in

people n o t using im proved s o u rces, b u t it does

Table 1.1 d r a w is n o t a t fault. It is v e ry c lea r

n o t include a definition of ‘im p ro v e d ’. This

t h a t its figures do no t show th e p rop ortio n of

re p o r t lists figures for th e ‘p o p u latio n using

people w ith safe w a t e r supplies a n d a d e q u a t e

a d e q u a t e s a n i ta t io n facilitie s’ w h ic h a re in c o r­

provision for sa n ita tio n . It recog nizes t h a t ‘th e

rect; it gives th e p ro p o rtio n w ith im proved

definition of safe or im proved w a t e r su pp ly and

provision, no t a d e q u a t e provision. The World

s a n i ta t io n facilities so m e tim e s differed no t only

B a n k in its World D evelopm ent R ep o rt

from one c o u n tr y t o a n o th er, b u t also for a

2 0 0 0 /2 0 0 1 gives fig ures for ‘a c c e s s to s a n i t a ­

given c o u n tr y over t i m e ’.16 It n o te s t h a t some

tio n ’ a n d 'a c c e s s to im proved w a t e r s o u r c e s ’ in

of th e d a t a from individual c o u n trie s ‘often

u rb a n a r e a s w ith no q ua lificatio n s given in th e

sh o w e d rapid an d im plausible c h a n g e s in level

t a b l e 20 an d little recog nition in th e te c h n i c a l

of c o v e ra g e from one a s s e s s m e n t to th e n e x t ’.17

n o te s t h a t give definitions of w h a t t h e s e m e a n

In addition, th e q u a lity an d level of d e ta il in

in re g a r d to th e i r in a d e q u a c y . For in s ta n c e , th e

th e A ss e s s m e n t 2 0 0 0 is a co nsid erable a d v a n c e

t e x t of th e te c h n i c a l n o te s s t a t e s t h a t ‘A cc ess

on e a rlie r a s s e s s m e n ts . The a d v a n c e in this

to s a n i ta t io n is t h e p e r c e n t a g e of th e p o p u la ­

a s s e s s m e n t w a s ach ie v ed by d ra w in g prim arily

tion w ith disp o sa l facilities t h a t c a n effectively

on h ousehold s u r v e y s (ie, d a t a from co nsum ers)

p re v e n t h u m a n , a n im a l a n d in s e c t c o n t a c t w ith

a n d n a tio n a l re p o r ts an d c e n su s e s r a t h e r th a n ,

e x c r e t a ’21 b u t it is c le a r from t h e e x a m p le s

a s previously w a s th e case, exclusively on

given l a t e r in th is c h a p t e r t h a t th is is no t so.

in form ation from service providers. B ut details

One of th e c h a r a c t e r i s t i c s of m a n y ‘s t a t e of the

of c o v e ra g e w ere inev itab ly limited by th e

w o r l d ’ r e p o r ts on e n v iro n m e n t a n d d ev elo p ­

(limited) r a n g e of q u estio n s a sk e d a b o u t w a t e r

m e n t ov er th e la s t 15 y e a r s is th e inclusion of

a n d s a n i ta t io n w ith in th e s e su rv ey s. As noted

ta b l e s w ith a g r e a t a r r a y of s t a t i s t i c s t h a t

earlier, n e it h e r c e n su s e s n or household s u r v e y s

p u r p o r t to s u m m a riz e cond itio ns in e a c h of t h e

give sufficient a t t e n ti o n to a ss e ssin g th e

w o r l d ’s n a tio n s. Som e of th e s e , including th o s e

q u a lity of w a t e r a nd s a n i ta t io n provision. In

for w a t e r an d s a n i t a t i o n provision, a re also

addition, th e a s s e s s m e n t q u e stio n n a ire s t h a t

b rok en do w n into r u r a l a n d u r b a n a r e a s . The

w e re co m p le ted for all n a tio n s did n ot include

s e c tio n s t h a t follow th is one d e m o n s tr a t e th e

a n y m eth od olo gy for discou ntin g co verag e

false im p ressio ns t h a t th e use of t h e s e s t a t i s ­

figures to allow for in te rm itte n c e or poor

tic s on w a t e r an d s a n i ta t io n in u r b a n a r e a s

q u a lity of th e w a t e r su p p lie s.18

ca n give. One h op es t h a t t h e s t a t i s t i c s for

W h a t is a g r e a t e r problem is t h e w a y

a s p e c t s of en v ir o n m e n t and d e v e lo p m e n t o th e r

t h a t n a ti o n a l g o v e rn m e n ts a n d in t e r n a t io n a l

t h a n w a t e r a n d s a n i ta t io n provision a re more

a g e n c ie s use t h e s e official figu res - an d th e

accurate.

confusions in h e r e n t in t h e t a r g e t s s e t by m a n y

T h e re s t of th is c h a p t e r is d ev o ted to

in t e r n a t i o n a l ag e n c ie s. For in s ta n c e , for m a n y

ex a m in in g th e q u a lity of w a t e r a n d s a n i ta t io n

y e a r s , official s t a t i s t i c s on w a t e r a n d s a n i t a ­

provision in u rb a n a r e a s of Africa, A sia a n d

tion provision p r e s e n te d by i n t e r n a t io n a l

L atin A m e ric a a n d th e C arib b ea n a n d to

a g e n c ie s g a v e fig ures for th e p ro p o r tio n s of

high ligh ting th e v e ry la r g e n u m b e r of u rb a n

r u r a l an d u rb a n p o p u la tio n s in e a c h n a tio n

d w e lle rs w ith in a d e q u a te provision, an d how

t h a t h a v e ‘a c c e s s to safe w a t e r ’ w h e n th e

th is is m uc h la r g e r t h a n th e n u m b e r la c k in g

c r ite r ia used in m ost n a ti o n s for collecting th e

im proved provision. This is n o t to s a y t h e r e is

s t a t i s t i c s w e re c le a rly n ot m e a s u rin g a d e q u a c y

no n eed for im proved provision e ls e w h e r e . For

or a d e q u a t e a c c e s s for ‘s a f e t y ’. R e c e n t re p o r ts

in s ta n c e , more t h a n 10 p e r c e n t of th e u rb a n

h a v e te n d e d to p r e s e n t figures for th e p ro p o r ­

p o p u la tio n in m a n y u r b a n c e n tr e s in E a s t e r n

tion of r u r a l a n d u rb a n d w e lle rs w ith im proved

E u ro pe do no t h ave w a t e r piped into th e i r

provision for w a te r , d ra w in g on th e

hom e, a n d a sign ific ant p ro p o rtio n of u rb a n

A s s e s s m e n t 2 0 0 0 . For in s ta n c e , in th e H um an

ho u seh o ld s suffer from deficiencies in provision

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

12 for s a n i t a t i o n . 22 T h e re a r e also issu es r e g a r d ­

m e n t a r e w e a k e s t , b e c a u s e of w e a k in s t i t u ­

ing t h e q u a lity of disinfection for u rb a n w a t e r

tio n s an d la c k of funding.

su pp lies a n d th e q u ality of pollution con tro l (including s e w a g e t r e a t m e n t ) , no t only in E a s te r n E u rop e b u t also in W e ste rn E urope a n d N o rth A m erica. B u t th is book h a s chosen to focus on w h e r e th e q u a lity a n d e x t e n t of w a t e r an d s a n i ta t io n provision is w o r s t a n d , gen era lly, w h e r e t h e possibilities for improve-

Table 1.3 Proportion of the urban population in Asian nations with access to improved w a te r supply and sanitation

The regions where provision needs the greatest improvements Provision for w ater and sanitation in urban areas of Asia Table 1.3 s h o w s t h e prop o rtio n of th e u rb a n p o p u la tio n in A sian n a ti o n s w ith a c c e s s to

Country

Percentage o f urban population with improved coverage fo r Water supply

Sanitation

Afghanistan

19

25

Bangladesh

99

82

Bhutan

86

65

Cambodia

53

58

100

100

Cyprus Democratic People’s Republic of Korea (North Korea) India

in s e le c te d cities d ra w in g from a n A sian D eve lop m e nt B an k s u r v e y in t h e m id -1990s. Table 1.4 gives m ore d etail t h a n Table 1.3 in t h a t it s h o w s th e prop o rtio n of h o u seho ld s w ith h o u se t a p s , a c c e s s to public ta p s , an d h ow th o s e w h o la c k piped w a t e r su pp lies o b ta in w a te r . Box 1.2 gives s h o r t s u m m a r i e s of th e e x te n t of w a t e r a n d s a n i ta t io n provision in s e le c te d A sian cities; m o s t of t h e s e s u m m a rie s

100

100

92

73

sho w t h a t la r g e s e c tio n s of t h e s e c it ie s ’ p o p u la tio n s la c k a d e q u a t e provision.

Indonesia

91

87

Islamic Republic of Iran

99

86

Jordan

im proved w a t e r su pp ly an d s a n i ta t io n in 2 0 0 0 , w hile Table 1.4 s h o w s th e provision for w a t e r

It is c le a r from t h e s e ta b l e s an d Box 1.2

100

100

t h a t t h e r e a re v e ry la r g e v a r i a ti o n s in th e

Kazakhstan

98

100

q u a lity an d e x t e n t of w a t e r an d s a n i ta t io n

Krygyzstan

98

100

provision. For in s ta n c e , all or v irtu a lly all of

People’s Democratic Republic of Laos

59

84

th e p o p u la tio n s of cities su ch a s S in g a p o re,

Lebanon

100

100

H ong Kong, Seoul a n d K u a la L u m p u r hav e

Maldives

100

100

w a t e r piped into th e i r h om e s for 24 h o u rs a

Mongolia

77

46

Myanmar

88

65

Nepal

85

75

Oman

41

98

Pakistan

96

94

Philippines

92

92

Republic of Korea (South Korea)

97

76

Saudi Arabia

100

100

Singapore

100

100

Sri Lanka

91

91

Syrian Arab Republic

94

98

Thailand

89

97

Turkey

82

98

Uzbekistan

96

100

Vietnam

81

86

from t h a t u se d to m e a s u re th e p ro p o rtio n of

Yemen

85

87

th e u r b a n p o p u la tio n w ith a c c e s s to im proved

Source: WHO and UNICEF (2000), Global Water Supply and Sanitation Assessm ent 2 0 0 0 Report, World Health Organization, UNICEF and Water Supply and Sanitation Collaborative Council, Geneva, 80 pages.

day. B ut t h e r e a re also m a n y e x a m p le s of cities in w h ic h less t h a n one-third of th e p o p u la tio n h a v e w a t e r piped into th e i r hom es, a n d in m a n y cities w a t e r su pp lies a re u n reli­ able a n d in t e r m it te n t. This in fo rm atio n on A sia n u r b a n a r e a s m a k e s ev id e n t th e difficulties discu ssed e a rlie r in th is c h a p t e r r e g a r d in g th e b e s t b e n c h m a r k to use in a s s e s s in g t h e q u a lity of provision. In t h e cities m en tio n e d above t h a t h ave highq u a lity provision for v irtu a lly all th e i r i n h a b i ta n t s , th e g o v e r n m e n ta l s t a n d a r d of a d e q u a t e provision for w a t e r is v e r y different

w a t e r su pp lies in B a n g la d e sh , India, In do nesia , P a k i s t a n , th e Philippines, Sri L a n k a and V ietn am - th e s t a n d a r d u sed to p ro d u ce th e figures sh o w n in Table 1.3. Or, to p u t it

PROVISION FOR WATER AND SANITATION IN CITIES

13 1

P ro v isio n for w a t e r su p p lie s in A sia n cities, m id -1 9 9 0 s

City

Percentage o f

Percentage

Persons

population

o f population

per

with house

served by

public

taps

public taps

tap

A lmaty (K azak hstan )

39.8

27.8

150

Bandung (Indonesia)

31.4

10.4

100

Other

No d a ta ; utility e stim a te s 99% coverage 58% w ith ou t piped w a te r; relying mostly on tub ew ells and dug wells

B angkok (Thailand)

62.8

0.0

Utility claims 82% coverage; those not served draw on wells, ponds and rain w a te r

Beijing (China)

99.9

0.1

115

99.9% coverage w ith house t a p s but most such ta p s serve several families

Bishkek (Kyrgyzstan)

64.5

12.2

42

C alcu tta (India)

24.1

20.3

75

Utility e stim a te s 98% coverage 34% w ith o u t piped w a te r; use mostly tubew ells and dug wells

Cebu (Philippines)

20.9

1.6

128

77% w ith o u t piped w a te r; 47% g etting w a t e r from wells and re s t from vendors

Chennai (India)

68.0

26.4

150

97% coverage claimed by utility but other figures dispute this - see Box 1.2

Chiangmai (Thailand)

64.8

0.0

35% w ith o u t piped w a te r; rely on wells and rain w a te r

Chittagong (Bangladesh)

43.3

17.0

250

40% w ith o u t piped w a te r; rely on tu bew ells and ponds

Chonburi (Thailand)

79.8

0.0

Colombo (Sri Lanka)

31.2

29.2

Davao (Philippines)

52.0

0.0

Delhi (India)

65.8

Utility claims 89% coverage; those not served rely on tu bew ells and rain w a te r 150

42% w ith o u t piped w a te r; rely on tu bew ells and dug wells 48% w ith o u t piped w a te r; rely on tubew ells and rain collectors Circa 11,000 public t a p s t h a t are not m etered and circa 7 500 know n u n auth orized connections

D h a k a (Bangladesh)

35.6

6.7

500

58% w itho ut piped w a te r; rely on tu bew ells and o th e r sources

F aisalab ad (Pakistan)

31.1

5.6

100

Hanoi (Vietnam)

70.8

4.9

116

Ho Chi Minh City (Vietnam)

50.0

0.1

1270

Hong Kong (China)

99.6

0.3

89

J a k a r t a (Indonesia)

20.5

6.7

300

40% w ith o u t piped w a te r; rely mostly on tubew ells 24% w ith o u t piped w a te r; rely on wells, ponds and rain w a t e r 48% w ith o u t piped w a te r; most rely on tu bew ells

73% w ith o u t piped w a te r; most use tubew ells, dug wells and rain collectors

Johor B ah ru (Malaysia)

99.9

0.0

K a rach i (P akistan)

50.5

8.7

100

30% w ith o u t piped w a te r; rely on tu bew ells and dug wells

K ath m an d u (Nepal)

69.3

6.0

42

Utility claims 81% coverage; those unserv ed use tubew ells, dug wells and ponds

K uala Lumpur (M alaysia) L ahore (P akistan)

45.9 81.5

0.0 2.3

Utility claims 100% coverage 100

16% w itho ut piped w a te r; using tubew ells with handpum ps

M and alay (M yanmar)

36.6

0.4

50

Utility claims 80% coverage; those w ith ou t piped w a te r use tub ew ells or rivers

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

14 continued

Manila (Philippines)

38.0

5.7

357

Medan (Indonesia)

57.1

5.7

60

Mumbai (India)

99.9

0.0

100.0

0.1

Phnom Penh (Cambodia)

83.1

0.0

Rarotonga (Cook Islands)

100.0

0.0

Seoul (South Korea)

99.9

0.0

Shanghai (China)

68.4

0.5

Penang (Malaysia)

Singapore

100.0

0.0

Suva (Fiji)

98.6

0.0

Taipei (China)

37% without piped water; most use tubewells and shallow wells Many people registered as having house connection clearly do not

50 17% without piped water; rely on wells and ponds

80

100.0

0.0

Tashkent (Uzbekistan)

37.3

24.1

Thimphu (Bhutan)

93.8

0.0

Tianjin (China)

94.6

2.2

150

6.6

59.3

10,846

Ulsan (South Korea)

83.7

0.0

Vientiane (Laos)

54.2

0.1

16.25

Yangon (Myanmar)

56.4

11.8

180

U laanbaatar (Mongolia)

33% without piped water; most depend on wells

100

100% coverage claimed by utility

Others connections are bulk supply to residential areas 7% without piped water; rely on w ater from streams

Includes bulk supply to housing and apartments and to w ater service centres where tankers draw w ater for delivery to w ater kiosks 16% without piped water; using ponds, streams and tubewells Utility claims 92% coverage; those not covered use wells, rivers and rainfall 40% without piped supplies, relying on tubewells, ponds and rain collectors

Source: McIntosh, Arth ur C and Cesar E Yniguez (1997), Second Water Utilities Data Book, Asian Development Bank. Manila. 210 pages.

a n o t h e r w ay, th e line d r a w n on to F igu re 1.1 to

c e n t m a y h av e h a d a c c e s s to im proved s a n i t a ­

divide t h e u r b a n p o p u latio n into t h o s e w ith

tion, b u t a m uch lo w er p ro p o rtio n h a d a c c e s s

im proved provision a n d th o s e w ith o u t w ou ld be

to a d e q u a t e provision.

p u t in v e r y different p la c e s, w h ic h also m e a n s

T a kin g w a t e r su p p ly first, Table 1.4 an d

v e r y dif ferent im p lication s in t e r m s of th e

th e ca se s tu d ie s in Box 1.2 s u g g e s t t h a t t e n s

e x t e n t to w h ic h th e ‘im p ro v e d ’ provision

of millions of A sian h o u se h o ld s w ith a c c e s s to

re d u c e s th e risk of f a e c a l - o r a l d is e ases. C om p a rin g th e figu res in Table 1.3 w ith

im proved provision for w a t e r h a v e a c c e s s only to public t a p s - to w h ich it is difficult to g e t

th o s e in Table 1.4 an d Box 1.2, it is c le a r t h a t

a c c e s s (th ere a re often 2 0 0 or more p e rs o n s

t h e p ro p o r tio n s of th e u rb a n p o p u la tio n s in

p e r ta p ) - or w a t e r from tu b e w e ll s or sha llow

B a n g la d e s h , Ind ia, In d o n es ia, M y a n m a r,

w ells. For in s ta n c e , Table 1.3 s h o w s t h a t 99

P a k i s t a n , th e P hilippines, S ri L a n k a an d

p e r c e n t of B a n g l a d e s h ’s u rb a n p o p u latio n h ad

V ietn am w ith ‘a d e q u a t e ’ or ‘safe an d suffi­

a c c e s s to im proved w a t e r sup plies in 2 0 0 0 .

c i e n t ’ w a t e r a n d s a n i ta t io n provision a r e v e ry

S tu d ie s d r a w n from in dividual cities w ith in

m u ch lo w e r t h a n t h e p ro p o rtio n s w ith

B a n g la d e s h sho w t h a t th e p ro p o rtio n w ith safe

‘im p ro v e d ’ provision. This m a y also be t h e case

an d sufficient provision is m uc h smaller. For

for m a n y o th e r n a tio n s. T h u s, by 2 0 0 0 , 93 pe r

in s ta n c e , in D h a k a , t h e c a p i t a l an d m u ch th e

c e n t of A s i a ’s u r b a n p o p u la tio n m a y h a v e h a d

la r g e s t city, th e h e a d of th e w a t e r sup ply and

a c c e s s to im proved w a t e r sup plies, a n d 78 p e r

s e w e r a g e a u th o r it y e s t i m a t e d t h a t th e r e w ere

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

15 2.5 million people in D h a k a ’s slu m s in 2 0 0 2 , a n d m o st h a d v e r y in a d e q u a t e w a t e r an d s a n i t a t i o n provision. T ens of t h o u s a n d s of ch ild ren die e a c h y e a r in D h a k a b e c a u s e of w a te r - b o r n e d is e a s e s a n d po llu ted w a t e r . 23 Table 1.4 s h o w s t h a t in th e m id -1 9 9 0 s, 58 p e r c e n t of D h a k a ’s p o p u la tio n w e r e no t c o n n e c te d to piped w a t e r supplies, w hile 6 .7 p e r c e n t h a d a c c e s s only to public t a p s w ith , on a v e r a g e , 5 0 0 p e r s o n s p e r t a p . M a n y o t h e r s tu d ie s h av e sh o w n th e i n a d e q u a c ie s in provision for w a t e r in D h a k a . 24 Sim ilarly, T able 1.3 s h o w s t h a t 92 p e r c e n t of t h e u r b a n p o p u la tio n in India h ad im p ro v e d w a t e r s u p p lie s in 2 0 0 0 , b u t d e s c r ip ­ tio n s of w a t e r p rov ision in m a n y city c a s e s tu d i e s s u g g e s t t h a t a m u c h s m a lle r p r o p o r ­ tio n h a v e a c c e s s to sa fe , su fficie n t provision; som e of t h e s e c a s e s tu d i e s a r e s u m m a r iz e d in Box 1.2. I n d e e d , t h e s e s u g g e s t t h a t t h e r e m a y be no In d ia n city w h e r e 92 p e r c e n t of t h e p o p u la tio n h a v e safe a n d su fficie n t w a t e r sup p lies. M u m b a i a p p e a r s to be an e x c ep tio n : in th e m id - 1 9 9 0 s , 100 p e r c e n t of its p o p u l a ­ tio n w e r e sa id to h a v e w a t e r piped into th e i r ho m e s, b u t t h e w a t e r u tility th e r e r e p o r te d t h a t th e r e w e r e 4 3 .5 p e r s o n s p e r hou se

E x a m p le s of th e i n a d e q u a c ie s in c i t i e s ’ w a t e r su pp ly an d s a n i t a t i o n in A sia

Ahmedabad (India) In this city, with 2.9 million inhabitants within municipal boundaries in 1991, in the slums (which contained a quarter of all households) only 23 per cent of house­ holds had individual piped w ater connections and only 26 per cent had individual sanitation. Most slum households only had access to shared piped w ater or sanitation - for instance, through standpipes, with an average of 50 shelters per standpipe. Water is only available intermittently; in 1998, supplies were available for two hours in the morning and half an hour in the evening. 16 per cent had no access to piped w ater and 28 per cent had no sanitation facility. Water provision was better in the non-slum area, where 87 per cent had individual w ater connec­ tions and 73 per cent had individual toilets. Regarding sewers, only the old city and 60 per cent of the new incorporated area in East Ahmedabad is connected to an underground sewerage network. Around three-fifths of the population have sewer connections to their home. Official figures show th a t 550,000 people use public toilets but there is widespread dissatisfaction with their cleanliness and quality. A sample survey of members of the Self-Employed Women’s Association (SEWA) found th at 63 per cent of 1200 respondents used community public toilets, and of these, 75 per cent were dissatisfied because of a lack of cleanliness and unusable conditions because of no w ater connection. Many households also face very inadequate provision in terms of shared toilets. An estimated half a million people defecate in the open. A 1998 survey of 7512 slum households on the river banks found tha t 80 per cent had no w ater connection and 93 per cent had no toilet facility of their own. However, an upgrading initiative called the Slum Networking Project is underway, which aims to greatly improve w ater and sanitation provision.29

Bandung (Indonesia) In 1995, only 31 per cent of the population of 2.25 million had house connec­ tions, with 10 per cent reliant on public taps (an average of 100 persons per tap) and 58 per cent not connected (mostly relying on tubewells and dug wells). Average w ater availability was only six hours per day. However, the number of connections had increased significantly between 1991 and 1995, and the hope was to reach 80 per cent coverage by 2000.30

c o n n e c tio n , w h ic h im plies a r a t h e r d ifferent c o n c e p t of h o u se h o ld c o n n e c tio n t h a n t h a t w h ic h o p e r a t e s in m o s t o t h e r c i tie s .25 It is also c l e a r from m a n y s tu d i e s of inform al s e t t l e m e n t s in M u m b a i t h a t v e r y la rg e s e c ti o n s of th e p o p u la tio n do n o t h a v e in divid­ u a l h o u se c o n n e c t io n s (see Box 1.3). T h e re a r e also so m e s u r p r i s in g e x a m p le s in Box 1.2 - for i n s t a n c e , s h o w in g how m u c h of th e p o p u la tio n in B a n g a lo re suffer from v e r y i n a d e q u a t e provision, d e s p ite th is c i t y ’s r e m a r k a b l e ec on om ic su c c e s s . In P a k i s t a n , 96 p e r c e n t of t h e u rb a n p o p u la tio n m a y h av e h ad im prov ed w a t e r su p p lies by 2 0 0 0 , b u t d e s c r ip tio n s of co ndi­ tio n s in K a r a c h i a n d F a is a la b a d , as s u m m a r iz e d in Box 1.2 a n d Table 1.4, s u g g e s t t h a t a m u c h s m a lle r p ro p o rtio n h a v e safe, su fficient provision. V ery la rg e g a p s b e t w e e n th e p r o p o rtio n s of u r b a n p o p u la tio n s w ith im proved su p p lies a n d th o s e w ith sa fe an d sufficient su p p lies a r e also ev id e n t in th e P h ilippines (see, for in s t a n c e , t h e d e s c rip tio n s of provision in M a n ila , Cebu a n d D avao , th e

Bangalore In this city of close to 6 million inhabitants, a baseline survey covering 2923 households in 2000 found th a t 73 per cent of households in the municipal corporation area have access to w ate r from the official network within the house or compound. But only 36 per cent have individual connections; 36 per cent share a connection with others, such as a landlord, other tenan ts or other users in an apartm ent and commercial complex. 27 per cent of the population do not have access to the piped w a te r network. 29 per cent of all households (and a large proportion of low-income households) draw w ater from some 18,000 w a te r fountains (although a much smaller proportion rely only on these); it is common for women to spend two hours collecting w a te r from these fountains. A study of public fountains found t h a t many were located in unhygienic surroundings: 45 per cent had w a stew a ter stagnation in the surrounding area, 31 per cent had solid waste dumps in the immediate vicinity, and 24 per cent had evidence of defecation in the surrounding areas. W astewater drainage w as only found in 48 per cent of standpipes. In two-thirds of the standpipes, w ater is available on alternate days and when it is supplied, it is available on average for six hours a day. The household survey found tha t two-thirds of households in the city of Bangalore reported the presence of a toilet within the premises, but less than half of these have a tap in the toilet and only 4 per cent have a flush tank. 28 per cent share a toilet with other households and one-fifth of households who share a toilet report problems with the arrangement - such as too many people per toilet, problems of blockages, poor maintenance and lack of cleaning. 4 per cent use public toilets and many users complain th a t they are dirty, not cleaned regularly and lack lights. 1 per cent reported th a t they defecate in the open. Only one-third of poor households in the city have access to satisfactory sanitation facilities.31 In a study of five slums, two had no w a ter supply, one was supplied by borewells and two had to depend on public fountains, where between one and two borewells and one tap served a population of between 800 and 900. Residents of the four slums had to walk distances of between 20 metres and 1 kilometre to fetch water. In

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

16 regard to sanitation, 113,000 households are reported to have no latrine at all. In a study of 22 slums, nine (with a total population of 35,400) had no latrine facilities. In another ten, there were 19 public latrines serving 102,000 people. Defecation in the open is common.32

n a t io n ’s th r e e l a r g e s t cities, in Table 1.4, an d th e d e s c r ip tio n of provision in Cebu in Box 1.2). S im ila r g a p s a r e ev id e n t in M y a n m a r, In d o n esia , Sri L a n k a a n d V ietn am .

Baroda (India) A survey in 1991 found th a t only 70 per cent of households had access to adequate drinking water, with 53 per cent having individual bathrooms and 60 per cent having individual toilets. One-third of households were not connected to sew ers.33 A 1992 survey of 400 households drawn from different slums found th a t almost all had w ater available to them but only 12 per cent had an independent source. In all but one slum, most households depended on taps and handpumps provided by the municipality. Only 9 per cent had their own latrines. In many localities, community toilets had been provided by the munic­ ipality but people did not use them because they were not regularly cleaned or there was no w ater supply. Drainage facilities were equally poor: 87 per cent of the households in 12 slums reported th a t there w as no provision.34

Calcutta (India) In the Calcutta Municipal Corporation, only around 25 per cent of the popula­ tion are served by single tap connections in their homes. About half the population of the slums or sq uatter colonies collect w ater from standposts. The rest of the population do not have access to the municipal w ater supply and have to make their own arrangements - for instance, relying on handpumps drawing from tube wells. 70 per cent of the population (and 50 per cent of the area) have sewerage and drainage facilities. Of the larger Calcutta Metropolitan Area population, only half have sewer connections and drainage facilities.35

H ow ever, m o s t of th e c itie s in T ab le 1.4 a n d Box 1.2 a r e la rg e citie s, so p e r h a p s t h e y a r e u n r e p r e s e n t a t i v e of c o n d itio n s in all u r b a n c e n tr e s . M ig h t it be t h a t p rovision is b e t t e r in sm a lle r u r b a n c e n tr e s ? B ut a n a l y s e s of p ro v i­ sion for w a t e r d r a w n from d e m o g r a p h ic an d h e a l t h s u r v e y s w ith sa m p le siz es la r g e en o u g h to e n a b le u s to c o m p a r e c o v e r a g e in u r b a n c e n t r e s of d iffe ren t siz es s u g g e s t t h a t p ro v i­ sion for w a t e r is w o r s e in s m a lle r u r b a n c e n t r e s t h a n in th e la r g e r c i tie s , 26 a n d t h i s is also confirm ed by t h e ( re la tiv e ly few) s tu d ie s of provision for w a t e r in s m a lle r u r b a n c e n tr e s . T he d a t a in Table 1.4 a r e d r a w n from a su r v e y in 1 9 9 5 , w hile som e of t h e figures in Box 1.2 a r e d r a w n from c e n s u s d a t a from t h e la te 1 9 8 0 s or e a r ly 1 9 9 0 s. W h en ce n su s d a t a

Cebu (Philippines)

from th e c e n s u s e s held in 2 0 0 0 a n d 20 0 1

In 1990, only 15 per cent of households had their own individual household connection to a piped w ater supply, with another 24 per cent relying on a shared tap. Most others rely on wells (often shared) or buy w a te r from vendors. Only 45 per cent of households had access to water-sealed toilets (and many of these shared such toilets), with 18 per cent relying on pit latrines and 36 per cent having no toilets. There is a lot of open defecation (wrap and throw).36 In Metro Cebu in 1995, only 23 per cent of the population were served; 47 per cent got w ater from wells and 30 per cent from w a ter vendors.37

bec om e a v a ila b le th e y m a y sh o w t h a t p ro v i­ sion h a s im proved in m a n y n a tio n s , b u t it is unlikely t h a t th e v e r y la rg e g a p s b e t w e e n th o s e w ith im proved provision a n d th o s e w ith safe a n d sufficient provision will h a v e dim in­ ished m uch. A c o m p a r a b le g a p (b e tw e e n t h e p r o p o r ­

Chittagong (Bangladesh)

tion of u r b a n d w e lle r s w hom i n te r n a tio n a l

In the mid-1990s, around one-quarter of the population of 1.6 million were served by individual house connections, 200,000 were served by 588 street hydrants and the rest collected w ater from other sources, such as natural springs, canals, ponds and rain w ater catchments.38 In terms of sanitation, a 1993 survey found th a t nearly three-quarters of the metropolitan slum popula­ tion relied on buckets or pit latrines.39 A survey undertaken in the mid-1990s found th a t 62 per cent of those interviewed had experienced w a ter service interruption in the month preceding the interview.40

s t a t i s t i c s show to h a v e im proved provision an d th o s e w ith a d e q u a t e provision) is ev id e n t for s a n ita tio n . D etailed city s tu d ie s show t h a t a la rg e p ro p o rtio n of t h e p o p u la tio n w ith im proved s a n i t a t i o n do n o t h a v e safe, c o n v e n ­ ie n t s a n ita tio n . Table 1.3 s h o w s t h a t 82 p er c e n t of B a n g l a d e s h ’s u r b a n p o p u la tio n h ad

Colombo (Sri Lanka)

im proved s a n i t a t i o n by 2 0 0 0 , b u t a m uch

In Colombo City, virtually all perm anent residents have access to piped w ater but some 30 per cent rely on public taps, with 4 0 -5 0 persons per tap on average. There is low pressure, and supplies in some areas are irregular. Two different figures are given for the proportion of residents served by the city sewerage system: 60 per cent and 78 per cent. A 1994 demographic survey showed th a t 46 per cent of the housing units in Colombo either share toilets or have no access to toilets. Open defecation is common. A high proportion of the population live in places with 50 or more persons per toilet. There are serious problems with flooding, linked to inadequate drainage in many parts of the city, in part because many w aterw ay s are not maintained adequately and so debris builds up, blocking the free flow of water. Poor drainage is also a major cause of filariasis, of which there are 7 0 0-2 00 0 cases annually.41 In Greater Colombo in 1995, only 58 per cent of the 2.8 million inhabitants had connec­ tions to piped w a ter supplies (including several hundred thousand who shared public taps, with an average of 150 persons per tap). The rest were reliant on tubewells and dug wells.42

s m a lle r p ro p o rtio n h a d a d e q u a t e s a n ita tio n : 7 0 - 8 0 p e r c e n t of D h a k a ’s p o p u la tio n h av e no c o n n e c tio n to a s e w e r . 27 A s u r v e y in 1995 found t h a t 42 p e r c e n t of th e u r b a n poor used a p it or op en la tr in e , 2 p e r c e n t h a d no fixed a r r a n g e m e n t , a n d 2.7 p e r c e n t d e f e c a te d in th e open (see Box 1.2). P rovision for s a n ita tio n a p p e a r s to be no b e t t e r in C h itta g o n g , th e s e c o n d - la r g e s t city. In India, 73 p e r c e n t of th e u r b a n p o p u la tio n m a y h av e h a d im proved s a n ita tio n by 2 0 0 0 , bu t th e d a t a on Ind ian citie s in Box 1.2 an d Table 1.4 s u g g e s t t h a t

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

17 t h e p ro p o rtio n w ith sa fe , c o n v e n ie n t provision

Davao (Philippines)

is m uch sm aller.

In 1995, only 52 per cent of the population of close to 1 million were served by the piped w ater system; most of those not served relied on tubewells and rain collectors.43

It is also c l e a r from v a rio u s c a s e s tu d ie s t h a t a la rg e sectio n of t h e p o p u la tio n in m a n y la rg e In d ian citie s d e f e c a te in th e open, e i th e r

Dhaka (Bangladesh)

b e c a u s e th e r e is no provision for s a n i ta tio n , or

According to a 1995 study of urban poverty in Bangladesh, 99 per cent of poor households in urban Bangladesh had access to safe drinking water. However, if ‘access’ is defined as the availability of w ater within 100 metres, the propor­ tion counted as having access is much lower.44 In 2002, the head of D hak a’s w ater supply and sewerage authority estimated th a t there were 2.5 million people in D haka’s slums, and most have very inadequate w ater and sanitation provision. 70 per cent of the population have no sewers. Tens of thousands of children die each year in Dhaka because of water-borne diseases and polluted w ater.45 A survey found th a t for half the population in slum areas, it takes more than 30 minutes to collect w ater.46 In regard to sanitation, 13 per cent of the poor had a connection to a sewerage system, 13 per cent used a septic tank, 19 per cent had a sanitary/latrine, and 42 per cent a pit or open latrine. 2 per cent of the urban poor had no fixed arrangement, and 2.7 per cent used an open field.47 Another source suggested th a t over 90 per cent of the slum population in Metro Dhaka rely on pit latrines or bucket/'hanging’ latrines, which also served 35 per cent of the non-slum population.48

b e c a u s e th e only provision a v a ila b le to th e m is ‘p a y ’ to il e ts t h a t t h e y c a n n o t afford or public to il e ts t h a t a r e so d ir ty t h a t open d e fe c a tio n is p referre d . M a n y public to il e ts in In d ia c h a r g e one r u p e e (R) p e r use, w h ic h w o u ld m e a n an e x p e n d itu r e of a r o u n d R 1 8 0 a m o n th for a family of six if e a c h family m e m b e r u se d th e to ile t j u s t once a day. T h is w o u ld r e p r e s e n t a sig n ific a n t p r o p o rtio n of th e incom e of a n y low -incom e h ou seh old. In m a n y In d ian cities, la rg e s e c tio n s of t h e p o p u la tio n live in s e t t l e ­ m e n ts w h e r e t h e only provision for s a n ita tio n c o n s is ts of g o v e rn m e n t-p ro v id e d public to ilets , w h ic h a r e of su c h poor q u a lity a n d so poorly m a in ta in e d a n d ir re g u la rly c le a n e d t h a t m o st people t r y to avoid using th e m .

Faisalabad (Pakistan) Some two-thirds of the city’s 2 million inhabitants live in largely unserviced areas. Over half have no piped w ater supply and less th an one-third have sewers.49 Service coverage for w ater supply w as said to be 60 per cent in 1995, with w ater available for, on average, seven hours a day, but this included those served by public taps with an average of 100 persons per ta p .50

In a few In d ian cities r e m a r k a b le p r o g re s s h a s been m a d e , in cluding in n o v a tiv e

Jakarta (Indonesia)

p r o g r a m m e s in P u n e a n d M u m b a i to g r e a tly

In 1995, most of the city’s population w as still getting its w ater from tubewells, dug wells and rain collectors; the corporation in charge of w ater supply and sewerage suggested th a t 38 per cent of the population were connected to the w a te r system, with other estim ates suggesting a lower cover­ age. This coverage includes several hundred thousand people served only by public taps.51 Residents face a great variety of problems in regard to water, sanitation and drainage. Microbial contamination of household w a te r supplies is pervasive; almost nobody drinks unboiled tap or well w a te r voluntarily. A household survey drawing on five households from each of 211 census areas found th a t the government’s piped drinking w a ter supply system reached only 18 per cent of households. Private wells were the primary source of drinking w ater for 48 per cent of households, with 22 per cent using w ater vendors (who charged about ten times the price of the piped w ater tariff). Many of those using wells faced problems; the salination of groundwater, possibly fuelled by excessive abstraction, has rendered w a te r from wells in the northern pa rt of the city undrinkable even after boiling. Many residents face supply interruptions - for instance, 9 per cent of respondents had suffered from periods of a t least a week in the past year when there were regular interrup­ tions to their drinking w ate r supply. Regarding sanitation, the city has no sewer system. 73 per cent of households had private lavatories in their homes th a t they did not have to share, while 16 per cent had shared private toilets and 12 per cent used public toilets. There were high levels of dissatisfaction among those who used public toilets: the most common complaint w as the long waiting times, although many households complained of dirt, damage or problems with flushing. Of the 851 household toilets observed, more than half had no hand-washing basin in the vicinity. One-third of respondents reported th a t some people in their neighbourhood sometimes defecated outside the toilet; this w as mostly done by children, and the most common sites were drains and gutters. Problems of flooding are common in many parts of the city, and accumulations of w ater provide breeding grounds for insect vectors, includ­ ing the dengue-bearing mosquito.52

im prove provision for s a n i t a t i o n in low -incom e a r e a s th r o u g h c o m m u n ity - c o n s tr u c te d and -m a n a g e d public to ile ts , w h ich a r e d es c rib e d in C h a p te r 7. T h e se s e rv e a s a re m in d e r of how fa r provision ca n be im proved, given th e p o liti­ ca l will a n d g o v e r n m e n ta l c a p a c i t y to w o rk w ith c o m m u n ity - b a s e d o r g a n iz a ti o n s (CBOs). Box 1.3 p r e s e n t s som e s u m m a r ie s of w a t e r an d s a n i t a t i o n provision by people living in D h arav i, a la rg e a n d d en sely p o p u la te d inform al s e t t l e m e n t in M u m b a i w ith a ro u n d 1 million i n h a b ita n ts . T h e s e a r e d r a w n from a la r g e r p r o g ra m m e of i n te r v ie w s w ith lowincom e in h a b i t a n t s of In d ian cities, w h ic h g av e th e i n te r v ie w e e s th e c h a n c e to t a l k a b o u t th e ir n e e d s a n d p r io ritie s a n d how c o n d itio n s have c h a n g e d . 28 C h a p te r 2 in c lu d es e x t r a c t s from o th e r i n te r v ie w s - from th e In d ian city of P u n e - to h ighlig ht w o m e n ’s c o n c e r n s a b o u t w a t e r a n d s a n ita tio n . T h e y give som e in sig h ts into th e daily difficulties fac ed by low -incom e group s. It is w o r t h r e m e m b e rin g , a s one r e a d s th e a c c o u n t s of th e v e r y po o r q u a lity provision in Box 1.3, t h a t all th e people in D h a r a v i are p r o b a b ly officially co n s id e re d to h av e im proved

Kabul (Afghanistan) The most common type of toilet used in both planned and unplanned housing is the raised drop latrine. It consists of a raised squatting slab, often of wood and mud, built over a box structure (usually built of stone or concrete) with a base

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

18 approximately at street level. This box has a small outlet th a t leads directly to the street. In two- or three-storey buildings, sewage from higher floors reaches the outlet box by means of a drop chute. Some sections of the community separate the urine and the faeces, with the faeces passing through to the recep­ tacle and the urine down a tube to the outside of the house. This causes a pile of fresh faeces to build up under the slab until somebody removes it. In many areas there is no way to mechanically collect the faeces due to the steep terrain and narrow streets. When the latrine is not manually emptied, fresh faeces pass out into the street. Defecation in the open is also common practice. Kabul has an extensive network of surface drains for carrying rain water, but the munici­ pality cannot afford to maintain them. Refuse and night soil are often dumped into the drains, forming blockages th a t restrict the w ater flow. This results in the formation of hundreds of large pools of standing water, forming breeding sites for disease vectors. In the rainy season, this inadequate drainage leads to flooding and the formation of large pools of sewage in the flatter areas, where the w ater collects and mixes with the excreta from the latrines.53

w a t e r a n d s a n i t a t i o n provision. T able 1.4 sh o w s th e official s t a t i s t i c s for M um bai, w h ich s t a t e t h a t 9 9 .9 p e r c e n t of t h e p o p u la tio n h av e hou se t a p s . A m ong th e p o in ts w o r t h h ig h lig h tin g in t h e s e i n te r v ie w s are:

•

use to ile ts (in D h a ra v i, a s in m a n y lowincom e a r e a s in I n d ia n cities, m o st ho u se s do n o t h a v e to ilets ), t h e high c o s ts of doing so, a n d th e c o m p la in ts a b o u t th e d ir tin e s s of th e public toilets;

Karachi (Pakistan) More than half of the city’s 12 million inhabitants live in katchi abadis [infor­ mal settlements]. A survey covering 334 of the 539 katchi abadis in the city found th a t 71 per cent have w ater supply lines. Half of these were laid by people through self-help, and half were laid by government agencies. But only one-third of households get piped water, with the rest purchasing w ate r from vendors or resorting to their own wells. The survey found th a t 84 per cent of households in the katchi abadis have sewer systems, of which 62 per cent were laid by self-help and 38 per cent by government agencies. In the remaining 16 per cent of households, people have invested in soakpits or open drains.54

t h e n u m b e r of people w h o h a v e to p a y to

•

t h e q u e u e s a t t h e public to ile ts , t h e diffi­ cu ltie s of h av in g to q u eu e a n d th e p r e s s u r e from o t h e r s in th e q u eu e to h u r r y up;

•

t h e difficulties in g e t tin g w a te r , a n d how com m on it is for th e m o s t ac c e ssib le w a t e r s o u r c e s to be of po o r q u ality;

Madras/Chennai (India) With a metropolitan population of about 5 million, Madras has the lowest per capita supply of any metropolitan centre in India - an average of 70 litres per day. A household survey in 1996 found th a t 42 per cent of households in the city and 70 per cent of households in the rest of the metropolitan area were not connected to the piped w a ter supplies. For the whole metropolitan popula­ tion, 18 per cent of households had no w a ter source on the premises, while 29 per cent relied on shallow wells. Statistics for 1991 suggested th a t the sewerage system serves 31 per cent of the metropolitan population, and raw sewage flows freely into the metropolitan a r e a ’s natural w atercourses a t many points.55 In 1995, w ater w as available for four hours a day.56

•

t h e w id e s p r e a d p r a c tic e of d e fe c a tin g in t h e open, b u t only doing so a t n ight; an d

•

t h e f a c t t h a t m o st h o u se h o ld s h av e p ro b lem s w ith m o sq u ito e s a n d w ith d r a in a g e .

T he s a m e g a p b e t w e e n th e p ro p o rtio n of u r b a n p o p u la tio n s w ith im proved s a n i t a t i o n a n d th e

Manila (Philippines) In Metro Manila in 1995, 67 per cent of the population had piped water, although this included several hundred thousand who had access only to public taps, with an average of 357 persons per tap. The other third relied mostly on wells.37

Visakhapatnam (India) The Water Supply Department claims th a t 90 per cent of the city’s population have access to clean drinking water, although other sources suggest it is between 60 and 70 per cent. Official figures suggest th a t 48 per cent of residents have piped w ater supplies to their home, while 42 per cent rely on public fountains with an average of 150 residents to each fountain.58 A 1996 case study on 170 slums in Visakhapatnam reported th a t few slum households in the city have private tap water, and only half of the slums have public tap water.59 The w ater is supplied twice a day, for one and a half hours in the morning and one hour in the evening. In terms of sanitation, the underground sewerage system covers only one block. Close to two-thirds of slum dwellers have private toilets linked to septic tanks. A large section of the slum popula­ tion have to rely on public toilets.60 As a result, large sections of the population defecate in the open.61

p r o p o rtio n w ith safe, c o n v e n ie n t s a n ita tio n is also ev id e n t in P a k i s t a n a n d th e P h ilippin es a n d p r o b a b ly in m a n y o th e r A sian n a tio n s . B ut here to o , th e r e are local e x a m p le s t h a t show how f a r provision c a n be im proved. In th e c a se of P a k i s t a n , th e r e is th e w o r l d ’s l a r g e s t c o m m u n ity - m a n a g e d s e w e r c o n s tr u c tio n p r o g ra m m e , w h ic h w a s s t i m u l a t e d an d s u p p o r te d by th e local NG0, th e O rangi Pilot Pro je ct. T h is h a s g r e a tly im p rov ed provision for s a n ita tio n for h u n d r e d s of th o u s a n d s of u r b a n h o u se h o ld s in P a k i s t a n (see C h a p te r 7 for more details). T h e A sia n D ev e lo p m e n t B a n k s u r v e y of provision for w a t e r su p p ly on w h ic h T ables 1.4 a n d 1.5 d r a w w a s u n u s u a l in t h a t it also

Yangon (Myanmar) In 1995, 60 per cent of the population of 3.3 million were connected to the piped w ater supply, and several hundred thousand of these had access to a public tap only (with on average 180 persons per tap). The rest of the popula­ tion were reliant on tubewells, ponds and rain collectors.62

collec te d in fo rm atio n on th e volum e of w a t e r u se d p e r p e rso n , th e q u a lity of t h e w a te r , th e re g u la r i ty of th e su p p ly a n d th e price. M a n y citie s h av e v e r y low levels of w a t e r c o n s u m p tio n p e r p e r s o n - for in s t a n c e

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

19 Box 1.3 P ro v isio n for w a t e r an d s a n i t a t i o n in M um bai; i n t e r v i e w s w ith i n h a b i t a n t s of D h a ra v i in July 2 0 0 2

Chandrakala Macchinder Nausuke

th e re used to be fights. We have w a t e r in th e evenings

com pany compound. The municipal toilet w a s v ery dirty. If w e w e n t th ere we w a n te d to vomit. The toilet

There is a problem w ith w a t e r and

for 2 - 3 hours, and a little in the

toilets. During th e rains th ere are a

morning. Before t h a t , a m an would

in th e com pany compound w a s not

lot of mosquitoes an d w a t e r comes

sh o ut ‘w a t e r is h e r e ’ and everybody

far, ju s t tw o m inutes aw ay. W ater

into th e house. We have to s t a y up

would run to fill [containers). This

w a s a big problem. The ta p w a s in a

all night. We have to get w a t e r from

w a s 25 y e a r s ago. Then g radually

trench. We had to fill w a t e r [contain­

a place 1 5 - 2 0 m inutes aw ay. We

ta p s came. We had m eetings and

ers] by the num ber system -

w e n t to a ta p in th e chawl [tenement)

everybody signed forms and w e n t to

w h a te v e r we could g et - tw o , four or

outside and we would p ay R s50 per

th e office, th e n each gulli (lane) w a s

six handaa [containers), depending on

month for the w ater. People living

given a tap. [There was] one ta p

th e am ou n t of w a t e r in th e trench.

close by som etim es do not give w a te r

(shared] b etw een 10 or 15 houses. It

We had to ta k e w a t e r from outside

to people from th e slums. T h a t is

w a s a problem. [The w a t e r cam e out

also. We did not pay for w a ter. We

w hy we had to go elsewhere.

in] a very thin stream an d [was only

would a sk somebody for w ater, and if

Sometim es from the highway, from

available] from time to time [in the]

they had w a t e r th ey would give it.

th e chawl. Even now we ta k e w a te r

mornings and evenings. We had to

from here and there, maybe from a

s t a n d in a queue and fight. Now

Asmaa Bano

broken municipal pipe. There is no

th ere is a ta p in each house. [The

I have been here for ten years.

tap. We did not t r y for w a te r

w a t e r is] m etered. We had to pay

[Before th a t] I lived in a village and

becau se we felt t h a t since we would

R s 3 0 0 0 - 5 0 0 0 ; before t h a t it w a s

came here occasionally. The village

be shifting to a building soon [it

R s 2 0 0 0 - 3 0 0 0 , but I w a s one of the

w a s much better. [Before the recent

would not be w orth it,) so we kept

last ones to ta k e a ta p four y ears

improvements] even the children did

quiet. We have to go far for the

ago, an d I had to pay R s5 00 0.

not like it here. It w a s so dirty here

E very day we spend a t least R s 2 - 3

Safikunnissa

village is P r a t a p g a r h , and the re each

on the toilet. There is w a t e r in the

I have been here for 40 years. For

house has a ta p . We had to go into

toilet but it is not clean. It is v ery

w a t e r we used to come to the munic­

the fields in th e night to defecate.

dirty. The w a t e r co n ta in ers are

ipal ta p in K alyanw adi. There were

Here we had to go to the toilet like

broken and dirty. It t a k e s us ten

fights a t th e tap . We used to sta n d in

everybody else. R ains w ere a

m inutes to reach th e toilet, and once

line and get maybe one or tw o

problem w h en w alk in g along because

the re it is very crowded. Children

handaa [an urn t h a t can hold 1 0 -1 2

of w aterlogging. The children would

also go to th e toilet a fte r paying for

litres of w ater), and t h a t a fter fights.

fall sick b eca u se of the mosquitoes.

it. There is only one toilet n e a r the

Then we got ta p s for ourselves.

The room would ge t w a terlo g g ed and

and th e re w ere mosquitoes. My

toilets. We have to pay R s l per day.

1 0 -1 2 people took th e ta p s , so the

every y e a r we would raise th e floor

to ta l cost cam e to a b o u t R s3 5,0 00 .

level. We never had enough drinking

S Punnamal and Valiamma

Each house paid about R s 2 0 0 0 -2 5 0 0 .

w a t e r becau se it w a s such a big

The toilet w a s very dirty earlier, so

Then the bills came: R s2000, R s l5 0 0 ,

chawl. Then th e children would

th e children used to s q u a t in the

RslOOO. Then we would collect th e

scrounge around an d [find] w ater. We

drains. Now th e y have built b e tte r

money to pay th e bills. Our pay w a s

did not have to pay for w a t e r since

toilets but th e kids still s q u a t in the

R s 2 0 0 0 - 2 5 0 0 a month; w h a t to eat

th e people around us would allow us

drains. We have to ask for the drains

and w h a t to spend! There w a s a lot

to ta k e some. Two y e a rs ba ck we

to be covered. Even schoolchildren

of w aterlo gg in g during rains, sea

got ta p s in th e house, and th en we

defecate in th e drain opposite my

w a t e r also used to come in. We had

moved to th e colony. There w a s no

house. They don’t listen. Four or five

to raise th e floor of our h u t every

problem with th e to ilets and w a t e r in

y e a rs ba ck th e y built to ilets for us,

year. In this m a n n e r we p assed 30

th e colony, but th e people w ere not

1 0 - 1 2 for th e ladies and s e p a r a te

ye ars. Now we have some relief

good. We w ere not together. We were

ones for th e gents. Before t h a t we

becau se this building w a s built. We

given houses w h en th e y were av ail­

used to go to th e chawl and squat.

came here four m onths ago. Before

able. Now we are in th e building, we

Everybody w e n t the re and dirtied the

t h a t th e y moved us to th e colony.

road crossing.

are OK, although th e r e are still some problems w ith light and w ater.

place. There is no problem about w ater. There is a ta p in each house.

Sahin Bano

Before t h a t th ere w a s a ta p in front

I have been here for seven or eight

of th e Bank. We had to go th ere for

ye ars. In the beginning it w a s very

I have been here for th e p a s t 18

w ater. It took a very long time,

dirty, th ere w a s no place to walk.

y ears. 18 y e a rs ago we had to go to

[there were) so m any people and

We had to go to th e toilet in the

th e Ganesh temple for w ater. We

Bhagwati

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

20 w e n t a t 4am and stood in line until

toilets, one for men and one for

[while they] c o n stru c t a building. At

6am, and got tw o handaa of w ate r. We

women. Once we w e n t in [the other

night we have to go across th e road

had to leave the children a t home. My

people in th e queue] would shout and

w ith men on one side and w omen on

child once fell into the drain and I

we had to come out in tw o minutes.

th e other! It is em b arrassin g. During

th o u g h t he had died, b u t th e neigh­

At night we would go across the road.

th e day we c a n ’t go there and we

bo urs picked him up and b a th e d him

When th ey dug th e road all the mud

have to spend money. The toilet is five

and he w a s OK. Five y e a rs bac k we

came into our huts. We have a ta p but

minutes a w a y a t least. We have to

p u t in a ta p , but w hen th ey p u t in the

th e w a t e r is dirty. We have to get

w a lk th ere, and if w e are d esp erate

borewell they broke the pipe. Now the

drinking w a t e r [from elsewhere). We

we have to ru n, b u t w hen we g et

w a t e r is dirty and we can only w ash

have to ta k e w a t e r stealth ily from the

th ere we have to w a it. Our tu rn

clothes in it. We have to go here and

building. They would not give it to us

comes, but if a n o th e r w om an is in a

the re for drinking w ater. The building

openly. If somebody gives w a t e r [to

hu rry she tells us to hu rry up. Others

walas [inhabitants) don’t give us

us], somebody else will sh ou t a t them

say ‘W here have you all sprun g up

w ater. We c an ’t complain because the

and tell them not to give w a t e r away.

from?’ We have to listen to some

boring is for our own building. For a

The toilet is also far off. It is a

[unpleasant] th ing s [just so t h a t we

toilet, we use th e roadside. We have

problem.

can go to the] toilet! There are a lot of problems.

to pay R s30 every month. E very time you go you have to p ay R s l . It is a

Lakshmi

problem. In th e morning you have to

I have lived here since childhood. We

Paliniamma

send th e children to school and your

used to get w a t e r from P o o n aw a n a

I have been here for 1 5 - 2 0 years. We

h usband to th e office. I have to cook,

Chawl or from the temple. We have to

have a lot of problems. There is no

and if you have to go to the toilet at

queue up th e re also. I had seven or

outlet for th e drains. We dig holes

the sam e time, th ere is a queue. Even

eight bro thers an d sisters, an d we

n e a r our houses and collect our mori

if w e go a t 5 .3 0am th e n your tu r n

used to c a rr y w a t e r along w ith my

w a t e r [washing w a ter] in it. The

comes a fter four people. Once you

mother. [After th a t] it becam e better,

building people sa y t h a t no w a te r

m ana ge to go in then people sh out a t

b u t people broke the pipe w h en

should come out on the p a th , so we

you to h u rr y up. If it rains, the w a te r

boring. Now th e w a t e r is very slow.

collect th e dirty w a t e r in d ru m s and

from th e drain does not so a k aw ay.

Sometim es it is OK, som etim es it

then we ta k e th e dru m s and throw the

stin ks so t h a t you c a n ’t even touch it,

w a t e r in the drain along th e road.

Kalyani

as if it has been mixed w ith drain

Children ask us w h en we will g e t the

I have been here for the p a s t 39

w ater. Now som etim es I have to go to

house. The oth er day I filled some

yea rs, since I got married. I cam e here

my m o th e r’s house for w ater. W hen it

con tain e rs w ith w a t e r and it w as

before the highw ay w a s built. There

rains w a t e r comes into th e house.

stinking. I couldn’t drink any w a te r a t

w a s no toilet, no drains. There w a s no

There is no exit for th e drain w ater.

night a fter my food.

w ater. We had to go and beg for

There is a drain ju s t outside my house

w ater. There w a s no p ath . There were

[and] even mosquitoes. You ca n ’t sit

stones here and we had to jump over

outside, even in th e morning. We use

them . We could get ju s t four or six

mosquito coils all th e time. We pay

handaa of w a ter. We would not b ath e

R s l to go to th e toilet. E arlier there

because there w a s no w ate r. If we had

w a s a municipal toilet an d we w en t

to go to th e toilet the re w ere just tw o

th ere, but t h a t has been demolished

Source: Thi s is d r a w n from a ser ie s of i n t e r v ie w s u n d e r t a k e n by t h e NGO SPARC (S ociety for th e P r om o ti o n of A r ea R es o u r ce C en tr es ) in va ri ous Indian citi es in 2 0 0 2 t h a t a r e to be pub li she d in th e Oc to be r 2 0 0 3 iss ue of E n viro n m en t and U rbanization. F u r t h e r e x t r a c t s from t h e s e i n t e r ­ vie w s a r e incl ud ed in Box 2.5 in C h a p t e r 2.

P hnom P en h (32 litre s p e r p e r s o n p e r day),

t h a n 20 litre s p e r p e rso n p e r day. It is difficult

H an o i [45), Y angon (67), a n d s e v e r a l o th e r s

to p u t a specific figure on a n ‘a d e q u a t e ’

w h e r e th e daily p e r-p e rso n u s a g e is less t h a n

volum e of w a t e r , b u t in m o st c i r c u m s ta n c e s , a t

100 litre s ( N u k u ’alofa, K a th m a n d u , T h im p h u ,

le a s t 20 litre s p e r p e rso n p e r d a y is e s s e n tia l,

D h a k a a n d Beijing). Given t h a t t h e s e are

a n d 60 litre s p e r p e rso n p e r d a y is n e e d e d to

a v e r a g e s for w hole city p o p u la tio n s , a n d t h a t

allow sufficient w a t e r for su c h d o m e stic n ee d s

t h e g ro u p s t h a t h a v e w a t e r piped to t h e i r

a s w a s h in g , food p r e p a r a tio n , cooking , c l e a n ­

hom e will h a v e m u c h h ig h e r c o n s u m p tio n

ing, la u n d r y a n d p e r s o n a l h ygiene. (More

levels t h a n th o s e w h o d r a w on public t a p s or

w o u ld be n e e d e d if flush to il e ts w e r e being

o th e r s o u rc e s, t h e s e a v e r a g e figures hide la rg e

used.) T his s u g g e s ts t h a t a la rg e s e c tio n of

d isp a ritie s, a n d it is possible t h a t sign ific ant

A s i a ’s u r b a n p o p u la tio n does n o t g e t sufficient

p r o p o rtio n s of e a c h c i t y ’s p o p u la tio n use less

supplies.

P R O V IS IO N FOR WATER AND SANITATION IN C ITIES

21 Table 1.5 also s h o w s th e ir re g u la rity of sup plies for m a n y cities. Only 26 o u t of 50 u tilities re p o r t t h a t t h e y provide a 2 4-h ou r

Table 1.5 Water availability and cost in Asian cities, mid-1990s

City

w a t e r supply, a n d som e provide w a t e r for only a few h o u rs a day. A c o n s u m e r su r v e y in each of th e cities listed in Table 1.4 d r a w n from 100 ra n d o m ly s e le c te d c o n s u m e rs s u g g e s te d t h a t sup plies w e re m ore ir r e g u la r t h a n w a s s t a t e d by t h e utilities. In only fou r cities did c o n s u m e rs confirm a 100 p e r c e n t 2 4-h o u r supply.

Provision for w ater and sanitation in urban areas of Africa

Almaty

Water availability

Average tariff

(number o f hours per day)

(US$ per cubic metre)

Per cent of unaccountedfo r water

24

0.056

13

Bandung

6

0.369

43

Bangkok

24

0.313

38

Beijing

24

0.061

8

Bishkek

24

0.027

42

Calcutta

10

0.011

50

Cebu

18

0.663

38

Chennai

4

0.247

20

Chiangmai

20

0.299

35

Chittagong

15

0.119

35

S u b - S a h a r a n A fric a ’s u rb a n p o p u latio n p r o b a ­

Chonburi

16

0.461

37

bly h a s th e w o r l d ’s w o r s t provision for u rb a n

Colombo

22

0.144

35

w a t e r an d s a n i ta t io n . T h e re a re a few cities

Davao

24

0.271

31

Delhi

3.5

0.034

26

Dhaka

17

0.093

51

7

0.034

30

Hanoi

18

0.113

63

Ho Chi Minh City

24

0.131

34 36

t h a t h a v e re la tiv e ly good provision. In m ost sm all u rb a n c e n tr e s , th e r e is little or no public provision. S o u th A frica is a n e x cep tio n in t h a t a rela tiv ely high p ro p o rtio n of its u rb a n p o p u la tio n h av e a d e q u a t e w a t e r an d s a n i t a ­ tion provision. M o s t n a ti o n s in N orth Africa also h a v e rela tiv ely good levels of provision. Table 1.6 s h o w s th e p ro p o rtio n of th e

Faisalabad

Hong Kong

24

0.555

Jakarta

18

0.611

53

Johor Bahru

24

0.186

21

1-4

0.091

30

6

0.141

40

Karachi

u r b a n p o p u la tio n in A frican n a tio n s w ith

Kathmandu

a c c e s s to im proved w a t e r sup ply a n d s a n i t a ­

Kuala Lumpur

24

0.131

36

tion in 2 0 0 0 , w hile T ables 1.7 a n d 1.8 show

Lahore

17

0.197

40

th e w a t e r a n d s a n i ta t io n provision in th e

Mandalay

24

1.201

60

l a r g e s t cities of m o s t A frican n a tio n s. Box 1.4

Manila

17

0.232

44

gives s h o r t s u m m a r i e s of th e e x t e n t of w a t e r

Medan

24

0.266

27

a n d s a n i ta t io n provision in different cities.

Mumbai

5

0.058

18

24

0.208

20

Phnom Penh

12

0.150

61

Rarotonga

24

Seoul

24

0.281

34

Shanghai

24

0.068

14

Singapore

24

0.553

6

Suva

24

0.223

43

in Box 1.4 s u g g e s t t h a t a v e r y la r g e p ro p o r ­

Taipei

24

0.388

26

tion of s u b - S a h a r a n A fric a ’s u r b a n p o p u la tio n

Tashkent

24

0.022

14

h a v e v e ry in a d e q u a te w a t e r an d s a n i ta t io n

Thimphu

12

0.052

37

provision. Yet t h e d a t a in t h e s e ta b l e s a n d box

Tianjin

24

0.059

11

a r e m ostly from th e l a r g e s t a n d m o s t im p o r­

Ulaanbaatar

21

0.102

49

t a n t cities, w h e r e th e p ro p o rtio n of people

Ulsan

24

0.396

33

w ith a d e q u a t e provision is likely to be h ig h e r

Vientiane

24

0.081

33

t h a n in s m a lle r cities a n d u r b a n c e n tr e s .

Yangon

12

0.456

60

This gap b e t w e e n t h e p ro p o rtio n of u rb a n dw e lle rs w ith im proved provision a n d th e p ro p o rtio n w ith safe, sufficient provision is a s ev id e n t in m o s t A frican n a ti o n s a s it is in m ost A sian n a ti o n s - p e r h a p s even more so. T ables 1.7 an d 1.8 a n d th e c a s e s t u d ie s su m m a riz e d

Penang

The d a t a in Table 1.6 could be u sed to t e s t th e

Source: McIntosh. Arth ur C and Cesar E Yñiguez (1997). Second Water Utilities Data

a ss o c ia tio n b e tw e e n p e r c a p it a incom es an d

Book, Asian Development Bank, Manila. 210 pages.

th e e x te n t of im proved provision for u rb an

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

22 P rop ortion of th e u rb an population in A frican natio ns w ith acce ss to im proved w a t e r supply and s a n ita tio n , 2 0 0 0 Country

Percentage o f urban population with improved coverage fo r

p o p u la t io n s . C e rta in ly , so m e of t h o s e n a t i o n s in w h ic h v e r y low p ro p o r tio n s of t h e u r b a n p o p u la t io n h a v e im p ro v e d w a t e r a re a m o n g t h e p o o r e s t - G u in e a B issau , C h ad, M a u r i t a n i a . For o t h e r n a t i o n s w ith low p ro p o r tio n s s u c h a s

Water supply

Sanitation

Algeria

98

90

t h e r e s u l t of t h e civil con flic ts t h a t so d is r u p te d

Angola

34

70

all a s p e c t s of life for m u c h of t h e i r p o p u la t io n

74

46

in r e c e n t y e a r s . B u t w h a t is s u r p r is in g in Table

Benin Botswana

100

A n g o la a n d S i e r r a L e on e, th i s m u s t p a r t l y be

1.6 is t h e v e r y high p ro p o r tio n of t h e u r b a n

Burkina Faso

84

88

Burundi

96

79

Cameroon

82

99

p o p u la t io n w i t h im p ro v e d w a t e r a n d s a n i t a t i o n in m a n y lo w -in com e n a ti o n s (in cluding som e

Central African Republic

80

43

t h a t h a v e h a d little or no eco n o m ic g r o w t h in

Chad

31

81

r e c e n t y e a r s , s u c h a s B u ru n d i, R w a n d a a n d

Congo

71

14

Z am b ia). M ig h t th i s s u g g e s t t h a t go od w a t e r

Cote d ’Ivoire

90

Democratic Republic of Congo

89

53

Egypt

96

98

Eritrea

63

66

Ethiopia

77

58

A fric a n n a t i o n s c o n s i d e ra b l e s u c c e s s s t o r ie s for

a n d s a n i t a t i o n pro visio n for u r b a n p o p u la t io n s is a c h ie v a b le w ith low p e r c a p i t a in c o m e s an d little eco n o m ic g r o w th ? A re so m e s u b - S a h a r a n

Gabon

73

25

w a t e r a n d s a n i t a t i o n provision? W ith d a t a s e t s

Gambia

80

41

su c h a s t h e s e , it is te m p t i n g to e x a m i n e th e

Ghana

87

62

Guinea

72

94

Guinea Bissau

29

88

Kenya

87

96

Lesotho

98

93

t h e i r ec o n o m ic p e r f o r m a n c e o v e r t h e l a s t

Libyan Arab Jam ahiriya

72

97

1 0 - 2 0 y e a r s . B u t c o m p a r in g t h e fig u re s in

M adagascar

85

70

T able 1.6 w ith findings from c ity c a s e s t u d ie s

Malawi

95

96

Mali

74

93

Mauritania

e x t e n t of t h e a s s o c ia ti o n b e t w e e n t h e i r p e r f o r m a n c e in w a t e r a n d s a n i t a t i o n pro vision in u r b a n a r e a s a n d t h e i r p e r c a p i t a in co m e or

in Box 1.4 a n d t h e m ore d e ta i le d s t a t i s t i c s for p a r t i c u l a r c ities in T a b le s 1 .7 a n d 1.8 s u g g e s t s

34

44

Mauritius

100

100

Morocco

100

100

e x p la in e d by d ifferen t g o v e r n m e n t i n t e r p r e t a ­

t h a t t h e v a r i a t i o n s in Table 1.6 a re b e t t e r

86

69

t io n s of w h a t c o n s t i t u t e s ‘im p r o v e d ’ w a t e r a n d

100

96

s a n i t a t i o n . F or in s t a n c e , a l t h o u g h t h e r e a re

Niger

70

still g r o u n d s for im p r o v e m e n t in prov ision for

Nigeria

81

79 85

Rwanda

60

12

Senegal

92

94

Sierra Leone

23

23

s e r v e d w i t h w a t e r t h a n u r b a n c itiz e n s in

South Africa

92

99

B u ru n d i, M a l a w i a n d Z im b a b w e - ev en if t h e

Sudan

86

87

figu re s in Table 1.6 could be u s e d to s u g g e s t

Togo

82

71

o t h e r w i s e . 63

Tunisia*

94

97

Uganda

80

96

United Republic of Tanzania

80

98

Zambia

88

99

u r b a n p o p u l a t i o n h a s im p ro v e d s a n i t a t i o n t h a n

100

99

im p ro v e d w a t e r . In g e n e r a l , p ro v isio n for

Mozambique Namibia

Zimbabwe

Note: The ta ble only includes nati ons w ith 1 million plus in h a b it a n ts in 20 00 for which d a t a w ere available. Sources: WHO and UNICEF (2 000). Global Water Supply and Sanitation A ssessm en t 2 0 0 0 Report, World H ealth Organization, IJNICEF an d W a te r Supp ly a n d Sani ta ti on Collaborative Council, Geneva, 8 0 pages. * D a ta on Tunisia from Saghir, J am a l Ma nu el Schifflcr and M at h c w o s Woldu (2 000), Urban Water and Sanitation in the Middle E ast

w a t e r in m a n y u r b a n a r e a s in S o u th A frica, its u r b a n p o p u la t io n s a re g e n e r a l l y m u c h b e t t e r

One p u z z le in T ab le 1.6 is t h e n u m b e r of n a t i o n s in w h ic h a h i g h e r p r o p o r tio n of t h e

s a n i t a t i o n la g s b e h in d p ro v isio n for w a t e r . T h is is a l m o s t c e r t a i n l y e x p la i n e d by t h e f a c t t h a t p it l a t r i n e s a re c o u n t e d a s im p ro v e d p ro v isio n , and households can c o n s tru c t th ese a t th e ir

and North A frica Region: The Way Forward, Middle E a s t an d North Africa Region

o w n in iti a ti v e w i t h o u t re ly in g on a n y g o v e r n ­

I n f r as tr u ct u re Development Group, The World Bank, Washington, DC.

m e n t p r o g r a m m e . In m o s t u r b a n a r e a s , in d iv id u a l h o u s e h o l d s o l u ti o n s for w a t e r a re

P r o v is i o n f o r w a t e r a n d s a n i t a t io n in c i t i e s

23 more difficult, or th e re is no local w a t e r source t h a t each individual household can ta p , or all local w a t e r sou rces are c o n tam in ate d . The case stu d ies in Box 1.4 highlight how w a t e r an d sa n ita tio n provision is very in a d e q u a te for large sections of th e African

E xam ples of th e inad equ acies in c itie s’ w a t e r supply and san ita tio n in Africa

Abidjan (Côte d’Ivoire) In 1997, the official distribution network supplied 180,000 customers, less than half of all households (the city has some 3 million inhabitants). Most other households obtain w ater from standpipes or w ater re-sellers. In 1998, around one-fifth of households were connected to sewers.74

u rb a n p o p ula tio ns t h a t are classified as having ‘improved provision’ in Table 1.6. For

Accra (Ghana)

in sta n c e , 87 p er cent of K e n y a ’s u rb a n

Interviews with 1000 households undertaken in 1991 found that only 35 per cent had water piped into their houses. Most of the rest relied on private or community standpipes or vendors, although a small percentage have to rely on open waterways, rain w ater collection and wells. Over 80 per cent of the lowest income quintile had to fetch their water, compared to 10 per cent of the wealthiest group.75 The w ater distribution system to low-income areas is more vulnerable to contamination, and the w ater quality in low-income areas is generally worse than in those areas with indoor plumbing.76 A survey of 558 households in 1997 found th a t only 45 per cent had drinking w ater from an inside tap.77 For sanitation, 36 per cent of the 1000 households interviewed in 1991 had flush toilets, with 41 per cent using pit latrines, 20 per cent using pan or bucket latrines and about 4 per cent having no access to toilet facili­ ties. Nearly three-quarters of the lowest income quintile shared toilet facilities with more than ten people.78 Users of public toilets generally find them unsat­ isfactory in regard to cleanliness, convenience and privacy. Those using public toilets pay the equivalent of around US$1 per head per month. Those with pit latrines in the house paid about US$4 monthly to a private individual for emptying. There is a sewer system in Accra’s central business district, but only 1 per cent of the city’s population are connected.79 Open defecation is a common practice, with people using various means including wrapping human excreta in polythene bags (commonly referred to as ‘precious packages’) for disposal. With no usable toilets in the home or conveniently located nearby, many Accra residents have no choice but to defecate along beaches, w ater­ courses and drains.80

pop ulation m a y have had improved w a t e r supplies by th e y e a r 2 0 0 0 , b u t detailed stu d ies in K e n y a ’s tw o la rg e s t cities, Nairobi an d M o m b a sa (su m m arized in Box 1.4) show t h a t a much sm a lle r propo rtion have safe, sufficient provision. The fact t h a t 96 p er ce nt of K e n y a ’s u r b a n population had improved s a n ita tio n is only possible b e c a u s e sh a re d la tr in e s w e r e coun ted as ‘im p ro v e d ’. The in h a b ita n ts of inform al s e ttle m e n t s such as Kibera in Nairobi, who com pete w ith h undreds of o th e r people for a c c e ss to la trin e s, are co u n ted as having ‘improved provision’. Box 1.5 d escribes w a t e r an d sa n ita tio n provision in H u ru m a , a s e ttle m e n t in Nairobi w ith aro u n d 6 5 0 0 in h a b ita n ts . On a v e r a g e , th e re a re 500 p erso n s to each toilet. A stu d y b ased on a re p r e s e n ta tiv e sam p le of households in N airobi’s inform al s e ttle m e n t s (which house aro u n d half t h e c i ty ’s population) su g g e ste d

Addis Ababa (Ethiopia) Around 30 per cent of residential dwellings in Addis Ababa use open fields for defecation. In peri-urban and urban centres outside Addis Ababa, about 46 per cent of families have no sanitary facilities.81

t h a t ‘th e high propo rtion of slum resid e n ts who rep o rt a c c e ss to pit la tr in e s conceals the fact t h a t m o st to ilets in th e slum s are filthy an d un u sa b le b e c au s e t h e y are sh a re d by a large n u m b e r of h o u se h o ld s.’64 This stu d y

Benin City (Nigeria) Families in the informal housing sector in Benin City normally use pit latrines. A 1995 survey found that 74 per cent of households relied on these, and most were of questionable quality. Household w ater is mainly piped from outside the housing premises (from another compound, the street or other neighbourhoods) or obtained from a w ater vendor or from a rain-harvester underground tank.82

found t h a t more t h a n 8 p er ce n t of th e p o p u la ­ tion of th e s e inform al s e ttle m e n ts d efe cate

Conakry (Guinea)

outside. It also found t h a t 31 per ce nt of

Around 45 per cent of the population are connected to w ater mains. Residents of unplanned and planned settlements tha t are not connected to the water network get water from those who have connections (32 per cent of house­ holds), from standpipes (7 per cent) and from handcarts (2 per cent). Conakry’s sanitation network, built in 1954, is not operational due to the lack of maintenance and renovation of the facilities. A minute, antiquated sewer system services the city centre. Independent mini-systems are also in service in some areas.83

children un d er th r e e y e a r s of age in N airobi’s inform al s e ttle m e n t s h ad d ia rr h o e a in th e tw o w e e k s prior to th e survey, w ith 11 p e r ce nt of children having d ia rr h o e a w ith blood w hich signifies serio us sy stem ic infection.65 A stu d y in M u k u ru K w a Reuben, a n o t h e r low-income in form al s e ttle m e n t in Nairobi, found t h a t th e 10 ,0 0 0 in h a b ita n ts had only 215 toilets, w hich w ere on th e s e t t l e m e n t ’s periphery. Even th e se could not be used a t night b ec au s e it w a s unsafe to w a lk aro u n d th e s e t t l e ­ m e n t.66 And th is is in a c o u n t r y w hich rep o rts t h a t 96 p e r c e n t of its u r b a n popu lation has im proved sa n ita tio n .

Cotonou (Benin) This city of around 1 million inhabitants has no sewer system. For water, more than half the population depend on w ater re-sellers or handcart vendors. Many low-income areas are prone to flooding.84

Dar es Salaam (Tanzania) According to a survey of 660 households drawn from all income levels in 1986-1987, 47 per cent had no piped w ater supply either inside or immedi­ ately outside their houses, while 32 per cent had a shared piped w ater supply. Of the households without piped water, 67 per cent bought w ater from neigh­ bours while 26 per cent drew w ater from public kiosks or standpipes. The

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

24 average w ater consumption w as only 23.6 litres a day. Of the 660 households, 89 per cent had simple pit latrines (and most of Dar es Salaam continues to rely on pit latrines). Only 4.5 per cent had toilets connected to septic tank s or sewers. Most households have to share sanitary facilities. Over-flowing latrines are a serious problem, especially in the rainy season, and provision for empty­ ing septic tan k s and latrines is very inadequate.85 A study conducted during 1 9 9 7 -19 98 in six low-income w ards found th a t in most sites, w a ter supplies were sporadic and often unsafe and expensive, and the sole w ater source was vendors. Where people had access to w a te r from government wells, the wells were generally poorly managed. In some instances, pumps were stolen within weeks of being installed. In all the areas visited, pit latrines were the only form of sanitation.86

Gaborone (Botswana) There is generally only one standpipe per 20 plots in self-help housing areas. Over 95 per cent of tena nts renting a room in Gaborone have to share a communal toilet (usually a pit latrine) with their landlords and other ten ant households on the plot. Cleaning the toilet is often a point of dispute, while in some cases there are so many households on one plot th a t one communal toilet is insufficient for their needs.87

Ibadan (Nigeria)

Table 1.6 s u g g e s t s t h a t four o u t of five u r b a n d w e lle r s in N igeria h a v e im proved w a t e r a n d s a n ita tio n . B ut, a s i ll u s tr a te d in th e c a se stu d ie s of O w erri, Benin City, Z a r ia a n d Ib a d a n in Box 1.4, w a t e r in piped s y s t e m s is often c o n t a m i n a te d , ir r e g u la r a n d difficult to g et b e c a u s e so m a n y p e r s o n s c o m p e te for a c c e s s to e a c h t a p . M o st of N ig e r ia ’s u r b a n p o p u la ­ tio n h a v e no a c c e s s to to il e ts c o n n e c te d to s e w e r s or s e p tic t a n k s . Table 1.6 s u g g e s t s t h a t four ou t of five u r b a n d w e lle r s in T a n z a n ia h a v e im proved w a t e r a n d v ir tu a lly all h av e im proved s a n i t a ­ tion. T his is difficult to reconcile w ith d e ta ile d stu d ie s in in fo rm al s e t t l e m e n t s in D ar es S a la a m (see Box 1.4) a n d d a t a from o th e r

Only 22 per cent of the population are served by the municipal w ater supply system. The city has no sewer system. City inhabitants rely on pit latrines and latrines connected to septic tan k s .88

T a n z a n ia n cities. M ore t h a n 60 p e r c e n t of D ar

Johannesburg (South Africa)

s a n ita tio n a n d d r a i n a g e . 67 Only a s m a ll p r o p o r ­

By 1995, 80 per cent of households had a w a te r supply piped to their house or flat; 18 per cent had a tap on the plot and 2 per cent relied on public taps, kiosks or boreholes. The legacy of apartheid can be seen in the fact th a t nearly all households th a t had a tap on the plot or relied on public taps, kiosks or boreholes were Black. Most of those reliant on public taps, kiosks or boreholes lived in informal dwellings. Sewers cover almost 80 per cent of the metropoli­ tan area. 70 per cent of households have a flush toilet within the dwelling, with another 23 per cent having one on site. But only half the Black population have a flush toilet within the dwelling (with another 38 per cent having a flush toilet on site). Virtually all households with toilets not connected to sewers (including pit, chemical and bucket toilets) are within Black households. Also, one cannot assume th a t a flush toilet on site means adequate provision, since landlords may not let ten ants use it, and in hostels many households have to share a toilet. Provision for sanitation remains very inadequate in many settlements. For instance, a survey of informal settlements found th a t 39 per cent of households used pit latrines, 13 per cent buckets, 38 per cent portable latrines and 7 per cent flush toilets, while 2 per cent had no toilet.89

tion of t h e p o p u la tio n of T a n z a n i a ’s la r g e s t

es S a l a a m ’s p o p u la tio n live in a r e a s w ith m inim al or no i n f r a s t r u c t u r e for w a t e r supply,

cities su c h a s D a r es S a la a m , A ru s h a , T a n g a a n d T a b o r a have s e w e r a g e c o n n e c t io n s .68 83 p e r c e n t of h o u se h o ld s in D a r es S a la a m use pit la tr in e s ; 10 p e r c e n t h av e s e p tic t a n k s an d 6 - 7 per cent have sew ers. The sew erag e n e t w o r k co v e rs only t h e c e n t r a l p a r t of D a r es S a la a m a n d a sm a ll se c tio n ou tsid e th e city c e n tr e . T he sy s te m is old a n d unreliab le , ow ing to d efe rre d m a i n t e n a n c e . 69 M a n y citie s in T a n z a n ia h av e w a t e r for only a few h o u rs a d a y on a v e r a g e - including D odom a (seven ho u rs), S h in y a n g a (six h o u rs), S u m b a w a n g a (five h o u rs), M t w a r a a n d Lindi (four hours)

Kampala (Uganda) Only inhabitants of affluent and middle-income districts in central and residen­ tial areas have private connections serviced by the National Water and Sewerage Corporation. Water truckers supplement the corporation by supply­ ing the non-serviced areas. The low-income population are supplied by private operators, standpipe vendors and connected customers who re-sell the w a ter in densely populated and poor areas th a t are serviced by w ate r mains or its extensions, and by bicycle w a ter vendors outside the serviced areas. Only afflu­ ent families are connected to sewers (which serve 9 per cent of households) or septic tan k s (10 per cent).90

Khartoum (The Sudan) A report in 1989 described how the systems of w ate r supply and sewage disposal were inadequate both in coverage and in maintenance of the service. For w ater supply, coverage w as poor, with low-income groups in squatter settlements paying the most for water, often bought from vendors. Breakdowns and cuts in the supply system were common. The municipal sewerage system served only about 5 per cent of the Khartoum urban area. Even th a t system w a s susceptible to breakdowns during which waste w as discharged either directly into the river or onto open land. For most people in the low-income areas, there w as no system of sewage disposal.91

an d S ingida (tw o h o u r s ) .70 Official s t a t i s t i c s m a y s u g g e s t t h a t only 2 p e r c e n t of t h e u r b a n p o p u la tio n in T a n z a n ia la c k im proved provision for s a n i t a t i o n a n d only 20 p er c e n t la ck im proved provision for w a te r , b u t a far la r g e r p r o p o rtio n la c k a d e q u a t e provision.

C hanges in provision for w a t e r and sa n itation in urban are a s of E ast Africa For a r a n g e of u r b a n s ite s in K en y a , U g a n d a a n d T a n z a n ia , th e r e a r e c o m p a r a b le d a t a on w a t e r use for t h e la te 1 9 6 0 s a n d t h e la te 1 9 9 0 s w h ich allow som e insig h t into t r e n d s over t i m e . 71 T h e se sh o w e d t h e following tre n d s .

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

25 Declining w ate r use f o r those with p ip e d supplies For h o u se h o ld s w ith piped w a te r , a v e r a g e p er c a p i t a use declined from 124 litre s a d a y in 1 9 6 7 to 64 litre s a d a y in 1 9 9 7 . In th e 14 s ite s w ith piped w a t e r su p p lie s co v e red by th e

Kinshasa (Congo) A report in 1989 noted th a t there is no sewerage system in Kinshasa. Around half the urban population (some 1.5 million people) were not served by a piped w ater network. High-income areas were often 100 per cent connected while many other areas had 2 0 -30 per cent of houses connected - essentially those along the main roads. The sale of w a te r flourished in areas far from the network - in these areas w ater w as usually obtained from wells, the river or deep wells.92

r e s e a r c h , all b u t th r e e h a d m u c h lo w e r c o n s u m p tio n levels in 1 9 9 7 c o m p a r e d to 19 6 7 . In som e t h e decline w a s d r a m a tic , a s in I g a n g a (U g anda) - from 79 to 3 4 litre s p e r d ay - a n d in M oshi (T anzania) - from 95 to 41 litre s p e r day. A lth o u g h th e m ore afflu ent s tu d y site s - su c h a s P a r k l a n d s in N airobi an d O y ste r B ay a n d U p a n g a in D a r es S a la a m e x p e r ie n c e d d e c r e a s e s in w a te r - u s e levels, th e m e a n daily w a t e r u se in 1 9 9 7 still r e m a in e d w ell ab o v e t h e a v e r a g e , w hile for th o s e w ith re la tiv e ly low ho u se h o ld incom es, w a t e r use w a s w ell below it. M a n y low -incom e h o u s e ­ holds h a d su c h u n re lia b le piped w a t e r su pplies t h a t t h e i r w a t e r use h a d fallen to levels

Kumasi (Ghana) Three-quarters of the population are served with piped water, but large numbers only have access through shared tap s or standpipes and long waits and queues are common. Only 10 per cent of households have indoor plumbing. Even when an area has a piped network, w ater pressure is often inadequate and the service is not continuous. Those who depend on vendors have to pay high prices. Water provision is particularly poor on the urban periphery where there is rapid urban growth. For sanitation, only 30 per cent of households have satisfactory arrangements in their homes. 15 per cent of the population rely on bucket latrines, 7 per cent on pit latrines, 8 per cent on open defeca­ tion, 25 per cent on toilets and septic ta n k s and 7 per cent on sewers. Nearly 40 per cent rely on 400 public latrines scattered around city: long waits are common and most such latrines are poorly maintained. In Atoinsu, for example, there are only tw o public toilets with 14 squat holes each to serve 10,000 inhabitants. Many people relieve themselves in plastic bags, which are put into the community refuse skips or disposed of indiscriminately. There is no compre­ hensive storm drainage system, and flooding - with related building damage and loss of property - is a common occurrence during the rainy season. Usually the poor are affected most because they have settled the least desirable locations in low-lying areas adjacent to drains and w atercourses.93

sim ila r to m a n y h o u se h o ld s t h a t did n o t have piped supplies.

R ed u ced reliance on *im p ro v e d 9 w a ter sources used by households w ith o u t p ip e d supplies In 1 9 9 7 , a s m a lle r p ro p o rtio n of h o u se h o ld s t h a t did n o t h a v e piped su p p lies d rew on p r o te c te d or im proved s o u r c e s (wells, s t a n d ­ pipes a n d h y d r a n ts ) t h a n h a d b ee n t h e c a s e in 19 6 7 . In 1 9 6 7 , m ore t h a n t h r e e - q u a r t e r s of unp ip e d sa m p le h o u se h o ld s o b ta in e d w a t e r from p r o te c te d or im proved s o u r c e s - w ith a l m o s t 100 p e r c e n t of h o u se h o ld s d r a w in g from th e s e in M a t h a r e Valley (one of th e l a r g e s t in fo rm a l s e t t l e m e n t s in Nairobi) a n d in t h e to w n s of M oshi a n d D odom a in T a n z a n ia . T h ir ty y e a r s la ter, only 56 p e r c e n t of u npiped h o u se h o ld s u se d p r o te c te d or im proved s o u rc e s. In p a r t t h i s is b e c a u s e m ore are s e rv ic e d by p r iv a te v e n d o r s a n d k io sk s , a n d th e s e are p a r t i c u l a r l y i m p o r t a n t in M a t h a r e Valley a n d in M oshi a n d D odom a w h e r e over

Luanda (Angola) Of a population estimated at over 3.2 million, only 17 per cent of households report a domestic w a ter connection and only 10 per cent have an internal w ater supply. Most of the population rely on w ater purchased from those with tank s who get their w a te r from tan ker lorries.94 More than three-quarters of the city population have no access to sewers and, until 1989, on-site sanitation w as discouraged, even though this w as the only possible w ay to provide sanita­ tion for much of the city population. A 1996 study in one of the municipalities in Luanda (Sambizanga) found th a t only half of all families had on-site san ita­ tion.95 A more recent review suggested th a t the proportion of families with on-site sanitation is dropping, as newly arrived migrants are less likely to be able to afford to construct a latrine.96

Mombasa (Kenya) Although the majority of households are said to have access to piped water, a 1993 estimate suggested t h a t only 29 per cent had their own connection. Very few pa rts of the city receive a continuous supply and some have had no w ater in their pipes for several years. On average, w a te r is available for only 2.9 hours a day. In a sample-survey of 182 poor households in 1986, 92 per cent experienced w ater shortages - about half all the time, and half occasionally. Regarding sanitation, the 1989 census showed th a t only 10 per cent of Mom basa’s households were served by a conventional sew erage system. The great majority of households (68 per cent in the mid-1990s and 81 per cent of poor households) use pit latrines. Shortages of w ater and capital funds have delayed extensions to the sewerage system and repairs to the non-functioning treatm ent works, with the result t h a t untreated sewage runs into the sea. Those lacking sewers face particular problems disposing of their domestic w a ste w ater (grey w ater).97

h a lf th e sa m p le d unp ip e d h o u se h o ld s view

Nairobi (Kenya)

th e s e a s t h e i r p r i m a r y so u rc e of w a t e r . M a n y

More than half the population depend on standpipe vendors for access to water; around 30 per cent of the population have a connection to the official network, with the rest relying on tru ck s or private operators. 10 per cent of the population are served by sewers, 20 per cent with septic tan k s and 70 per cent with manually cleaned latrines. There are 260 latrines in Pumwani, with an average of 450 persons per latrine.98 A report in 1994 described how 55 per cent of Nairobi’s population lived in informal settlements, which are squeezed onto less than 6 per cent of the city’s land area. Only 12 per cent of plots in these settlements have piped supplies. Most people have to obtain

h o u se h o ld s also use m ore t h a n one w a t e r so u rc e - a n d by 1 9 9 7 , som e 60 p e r c e n t of u n p ip e d h o u se h o ld s re g u la rly use a s e c o n d a r y so u rc e t h a t is som e d is t a n c e from t h e i r home for w a te r .

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

26 w ater from kiosks. Water shortages are common, with pipes often running dry; a survey found th a t 80 per cent of households complained of w ater shortages and pipes often running dry. In regard to sanitation, this same survey suggested th a t 94 per cent of the inhabitants of informal settlements do not have access to adequate sanitation. Only a minority of dwellings have toilets. Significant proportions of the total population have no access to showers and baths, and in most areas drainage is in a d e q u a te ." Kibera is the largest lowincome urban area in Nairobi, covering an area of 225 hectares and with an estim ated population of 470,000. Traditional pit latrines are the only excreta disposal system available, and a high proportion of households have no toilet within or close to their home. There are often up to 200 persons per pit latrine. Pits fill up quickly and emptying is a problem due to difficult access. Space to dig new pits is often not available.100

w h o h a d piped su p p lies received 24-h o u r service; by 1 9 9 7 , only 56 p e r c e n t did so, w ith a r o u n d one-fifth receiving only one to five h o u rs of se rv ic e a day. A gain, t h e m ore afflu ­ e n t s ite s w e r e g e n e r a lly t h e o n es w h ich h ad th e m o st reliable w a t e r supplies. T h e re h ad b ee n a huge in c re a s e in t h e p ro p o rtio n of h o u se h o ld s sto r in g w a t e r a t ho m e - from 3 p er c e n t in 1 9 6 7 to 90 p e r c e n t in 1 9 9 7 . In som e site s, all th o s e in te r v ie w e d in 1 9 9 7 co llected

Ouagadougou (Burkina Faso)

w a t e r from v a rio u s s o u r c e s a n d s to r e d it a t

23 per cent of households have w a te r connections from the official w ate r and sanitation agency; most others depend on getting w a te r from standpipe vendors or handcarts. 8 per cent of the population are served by sewers, with 2 per cent served by septic ta n k s and 90 per cent served by traditional latrines. The sewer system is still in the embryonic stag e.101 A 1991 study covering 600 households found th a t 38 per cent were connected to the munici­ pal w ater supply, although only one-third of these had indoor plumbing (the rest had yard taps). Most other households obtained w ater at higher costs from public standpoints, vendors or neighbours.102 Around 75 per cent of the sample households were dissatisfied with existing arrangements for w ater supply. The average monthly household expenditure (exclusive of rent for ten ant house­ holds) w as FCFA45,000 (about US$200). Among the 600 households, 70 per cent used traditional pit latrines, 18 per cent used vault latrines and 5 per cent used septic tanks. About 7 per cent of the population were without any facility and defecated in the open. A public latrine existed in the Central Market but no respondent reported using a public latrine on a regular basis. About 57 per cent of the households were dissatisfied with current sanitation arrangements, including the odour and inconvenience.103

hom e to e n s u re a d e q u a t e su p p lies b e c a u s e th e piped sy s te m is so u n reliab le . T he single m o st im p o r ta n t c h a n g e in th e n a t u r e of s e c o n d a r y w a t e r su p p lies is th e in tr o d u c tio n of p r iv a te so u r c e s su c h a s k io s k s a n d v e n d o rs. By 1 9 9 7 , th e s e w e r e u se d by a lm o s t 40 p e r c e n t of piped sa m p le h ouseh olds. P r iv a te s o u r c e s a r e p a r t i c ­ ula rly i m p o r ta n t in m a n y low -incom e a r e a s such a s C h a n g o m b e a n d T e m e k e 72 in D ar es S a la a m (T a n za n ia ) a n d in I g a n g a (U gan da), w h e r e over 60 p e r c e n t of piped h ouse hold s use v e n d o r s a s th e i r p r i m a r y so u rce . By 19 9 7 , p r iv a te w a t e r ven d in g th r o u g h k io s k s or v e n d o r s h a d bec om e a boom ing b u sin e ss in

Owerri (Nigeria) A 1995 study found th a t 83 per cent of the sampled residents had access to a piped w a ter supply; the rest relied on other sources, which were often contami­ nated. More than half of those with access to piped w ate r did not have private connections in their homes; they either shared with neighbours or used public tap s near their houses. In regard to regularity, 45 per cent of respondents only received free flowing w ater for a few hours a day while 15 per cent had w ater flowing every alternate day, 2.5 per cent had w ater once a week, and 8.5 per cent rarely had water. When ta p w a te r w as not available, most households used w a ter from streams. 27 per cent of respondents had a bathroom in the home, 67 per cent had one in the compound and 6.5 per cent had no bathroom a t all. For sanitation, w ater closets were the most common means (69 per cent) followed by pit latrines (15 per cent). 16 per cent of respondents had no toilet at all.104

m a n y of t h e low- a n d m iddle-incom e s tu d y sites, d e s p ite t h e f a c t t h a t th e w a t e r t h e y sell fre q u e n tly c o s ts c o n s id e r a b ly m ore p e r litre t h a n th e public supplies. R e s e a r c h e r s e n c o u n ­ t e r e d s e v e r a l in s t a n c e s of public sup plies being s a b o ta g e d .

The increase in the tim e taken to obtain w a te r T he a v e r a g e d ista n c e t h a t unpiped household m e m b e rs w a lk e d to o b ta in t h e i r w a t e r did not

Zaria (Nigeria) A 1995 household survey found th a t most buildings in the core area did not have individual w ater connections, and relied on public connections. 83 per cent of the sample had access to piped water. Water supplies were irregular for much of the population, including 11 per cent who received w ate r one day in two, 4 per cent who received it once a w eek or once a fortnight and 12 per cent who rarely or never received water. The most common type of toilet was the earth or pit latrine, used by 73 per cent of respondents. The remaining 27 per cent reported using a modern water-closet system.105

ch a n g e m u ch b e t w e e n 1 9 6 7 (222 m e tre s) an d 1 9 9 7 (204 m e tre s), b u t d is t a n c e s to u n p r o ­ te c t e d w a t e r s o u r c e s h a d in c re ase d . The n u m b e r of tr ip s to collect w a t e r h a d in c re a se d from an a v e r a g e of 2.6 a d a y in 1 9 6 7 to 4 in 19 9 7 . On a v e r a g e , u npiped u r b a n househo ld m e m b e rs w e r e w a lk in g 1 k ilo m etre e a c h d a y to an d from w a t e r so u r c e s (up from 0.6 k ilo m e tre s a d a y in 1967). But th e t o t a l tim e sp e n t

R ed u ced reliability o f p i p e d supplies

collecting w a t e r e a c h d ay in c re a se d m ore t h a n

D ifferent f a c to r s c o n t r i b u te to th is re d u c e d

threefold, from a n a v e r a g e of 28 m in u te s in th e

reliability, including a la c k of sy s te m m a i n t e ­

la te 1 9 6 0 s to an a v e r a g e of 92 m in u te s in

n a n c e a n d th e s tr e s s on ex istin g n e t w o r k

19 9 7 . H ouseho lds using p r iv a te so u rc e s such as

c a p a c i t y from in c re a s in g u r b a n p o p u la tio n s. In

kio sk s re p o r t th e l a r g e s t a m o u n t of tim e sp e n t

1 9 6 7 , v ir tu a lly all t h e h o u se h o ld s in te r v ie w e d

collecting w a te r . By 1 9 9 7 , on a v e r a g e , th o se

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

27 Box 1.5 P ro v isio n for w a t e r a n d s a n i t a t i o n in H u ru m a in N airobi

In Kambi Moto, no households

Toilet facilities in all the s e ttle m en ts

situ a te d in th e S tareh e division of

have toilets of th e ir own. There is

w ere perceived to be in ad eq u a te , w ith

Nairobi city and consist of six villages.

one pit latrine and th e Nairobi

an a v e ra g e toilet-to-person ratio of

The settle m e n ts have been in

City Council toilets, w hich have

1:500 or more.

existence for as long as 28 y ears. The

th re e units for men and three for

The H urum a inform al settle m e n ts are

•

3 .8-hectare site occupied by these settle m e n ts is public land under the tr u ste e s h ip of th e Nairobi City

All th e settle m e n ts d ra w th eir

w omen. The cost is Ksh2 per

w a t e r from privately o p e rate d w a te r

visit.

points a t Ksh2 per 20 litres of w a ter;

In M ahira, th ere is one self-help

45 w a t e r points were m apped within

Council, which h a s agreed to delineate

toilet w ith ten units - te n toilets

th e five se ttle m en ts. The only o th e r

this land and set it aside for the

•

and tw o b a throo m s for a s e t tl e ­

w a t e r source is a river t h a t passes

purpose of upgrading th e a re a for the

ment w ith 332 houses and 1500

G itath u ru , but this is extrem ely

benefit of th e residents.

inh ab ita n ts. However, th e toilets

polluted as it is a major w aste-

An en um era tion and mapping

are not connected to th e sew e r

dumping site.

exercise in five of th e settlem e n ts,

line. The cost per visit is Ksh2.

The residents of H u ru m a are

u n d e rta k e n by the residen ts w ith the

The resp on den ts said t h a t 80 per

unanim ous in seeing security of th eir

sup po rt of Pamoja T ru s t and th e City

ce n t of ex c re ta is disposed of in

homes and land as th e ir biggest need.

flying toilets.

This comes a g a in s t a backdrop of

Council in 2 00 1, found t h a t th ese

In Redeemed, th e re is a com m er­

num erous evictions in o th e r informal

a to t a l population of 6 5 69 people.

cial toilet w ith six units. It is

s e ttle m e n ts or irreg ula r allocations

There are 1105 te n a n t s and 1002

connected to th e se w e r line and

t h a t benefit non-residents. Although

‘s tru c tu r e o w n e r s ’ in these s e t tl e ­

costs Ksh2 per visit. The flying

upgrading the housing, san itatio n and

ments. The a v era g e household income

toilets are also prevalent in th e

he alth facilities is considered vital,

settle m e n ts have 2309 households and

•

se ttle m en t.

th ere is a ratio n al fear t h a t w ith ou t

In G hetto, th ere is a self-help

ten u re reg ularization the benefits of

food, tr a n s p o rt, w a t e r and th e use of

comm ercial toilet t h a t is not

th ese o th er developm ents m ay not

toilet facilities.

connected to the se w e r lines and

a c c ru e to th e residents, especially the

costs Ksh2 p er visit.

te n a n ts.

is K sh 50 00 (Kenyan shillings) and the main a r e a s of daily expenditure are

•

In all instances, toilet facilities w ere perceived to be most insufficient.

•

In G itath uru, th e respondents

Source: P am o ja T r u s t (2 0 0 1 ) , H urum a In fo rm a l

All th e residents used th e few public

indicate t h a t the re is no public

S ettle m en ts - P lanning S u rvey R ep o rt. Pam oj a

or comm unity toilets or th e so-called

toilet facility. The riverside w as

T r u s t , Nairobi. This w a s b a s e d on a n e n u m e r a ­

‘flying to ile ts ’ (which refers to the

identified as the main place

practice of w rap p in g ex c reta in plastic

w here residents go to th e toilet.

tion an d m a p p in g e xe rc is e u n d e r t a k e n b e t w e e n M a y an d Oc to b e r 2 0 0 1 by th e Nairobi City Council in co nj unc ti on w it h th e P a m o j a T r u s t a nd

bags or w a s te p ap er and th row in g it

t h e re s id e n ts of five of t h e vi ll age s (K amb i Moto,

a w ay).

M ah ii r a, R e d e e m e d , G he tt o an d G it a th u r u ) , w h ic h w a s c a rr i e d out a s a first s te p t o w a r d s th e r eg ul a r iz a ti o n of t h e s e s e t t l e m e n t s . The d a t a col lection in all i n s t a n c e s w a s c a r r i e d ou t by th e r e s id e n ts of H u r u m a .

using k io sk s w e r e spe n d in g a lm o s t tw o h o u rs a

Provision for w a t e r in A frica’s larger

d a y collecting w a te r.

cities T ables 1.7 a n d 1.8 provide m o re d e t a il r e g a r d ­

The higher c o s t o f w ater

ing t h e q u a lity of w a t e r a n d s a n ita tio n

In 1 9 9 7 , piped su p p lies w e r e le ss t h a n one-

provision in t h e l a r g e s t city w ith in ea ch

q u a r t e r of t h e c o s t p e r litre of su p p lies from

A frican n a tio n . D ra w in g from Table 1.7, th e

v e n d o r s (the only o th e r w a t e r s o u rc e t h a t

following p o in ts c a n be noted:

delivers to th e h o use h old). W a t e r from k io sk s w a s n e a r ly tw ic e t h e c o s t of piped supp lies,

•

T he n u m b e r of citie s w h e r e on e-th ird or

b u t a s n o te d abov e, g e t tin g t h i s w a t e r w a s

m ore of th e e n tir e p o p u la tio n w a s

also tim e co nsum ing. G e ttin g w a t e r from a

u n s e r v e d by public w a t e r su p p ly s y s t e m s

n e ig h b o u r or from a p r o t e c t e d or im proved

in 2 0 0 0 a n d relied on w ells, v e n d o r s or

so u rc e w a s less co stly t h a n k io sk s b u t m ore

o th e r w a t e r so u rc e s; L u a n d a , B an gui,

co stly t h a n piped supplies.

N ’D ja m e n a , B raz za ville, A c c ra , C onakry,

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

28 Africa: provision for w a te r in the la rg est cities within each nation, 2000

City

Abidjan (Cote d'Ivoire) Accra (Ghana) Addis Ababa (Ethiopia) Algiers (Algeria) Antananarivo (Madagascar) Asmara (Eritrea) Bamako (Mali) Bangui (Central African Republic) Bissau (Guinea Bissau) Blantyre (Malawi) Brazzaville (Congo) Bujumbura (Burundi) Conakry (Guinea) Dakar (Senegal) Dar es Salaam (Tanzania) Freetown (Sierra Leone) Gaborone (Botswana) Harare (Zimbabwe) Kampala (Uganda) Kigali (Rwanda) Kinshasa (Democratic Republic of Congo) Libreville (Gabon) Lome (Togo) Luanda (Angola) Lusaka (Zambia) Malabo (Equatorial Guinea) Maputo (Mozambique) Maseru (Lesotho) Mbane (Swaziland) N’Djamena (Chad) Nairobi (Kenya) Niamey (Niger) Nouakchott (Mauritania) Ouagadougou (Burkina Faso) Port Louis (Mauritius) Windhoek (Namibia)

House connections

Yard taps

Public standpipes

(%)

(%)

(%)

43 25 4 84

20 48

45

50 (vendors)

5 2

(%)

0.7

20 41

43 40 (tanker trucks)

36 11

12

0.6

75 71

12 25 14 (vendors)

63 55 33 63 7 2 43

35 0.8 15 13

17 0.4 56

8 42 16

8 13

13 23

70 31

23

39 12 28 55

55 18

4 26

38 22

3 28

27 9

26 37 13

48 39

8 0.4

3

8 2

48 84

Unserved (%)

35

20

78 33 30 27

Other (%)

19 22 12

47

37 7

Boreholes with handpumps

8 15 28 70 5 0.7 17

15 0.2

44 14

34 23 2 63 22

8 24 (wells)

39

15 (wells) 7 (wells, surface water)

13

9 9

33 50 19 6 1 64 24

1 1 2

71 (wells) 7 (wells) 36 (vendors) 20 2 (wells)

Source: WHO (2001), Water Supply and Sanitation Sector A ssessm ent 2000; Africa Region Part 2; Country Profiles. World Health Organization Regional Office for Africa, Harare, 287 pages

B issau , M a s e ru , A n ta n a n a r i v o , B lan ty re ,

T h e low p ro p o rtio n of h o u seho ld s w ith

Niamey, D a r es S a la a m a n d Lome. The

house c o n n e c tio n s in m o s t cities; v e ry

list w o uld be lo n g e r if t h e r e w a s

few cities h a v e a s m a n y a s h a lf of all

c o m p le te in form ation a b o u t all n a t i o n s ’

h o u seh old s w ith house co nn ection s.

la r g e s t cities. It is also likely t h a t m o st

T h e d e p e n d e n c e of so m a n y h o u seho ld s

u r b a n c e n tr e s in ea c h of t h e s e n a tio n s

on public s t a n d p ip e s - for in s ta n c e , more

h a d h ig h e r p ro p o r tio n s of t h e i r p o p u la ­

t h a n o n e - q u a r te r of th e city p o p u la tio n in

tion u n s e r v e d by public w a t e r supply

L u a n d a , G aborone, B uju m bu ra, Addis

s y s te m s t h a n in t h e s e cities.

A b a b a , Libreville, A n ta n a n a r i v o ,

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

29 Table 1.8 Africa: provision for sa n itation in the la r g e st cities w ithin each n ation, 2 0 0 0

C ity

Abidjan** A d d is A b a b a A lg ie rs A n tan an ariv o

Sew er

S e p tic ta n k

W et la trin e

V IP latrine a n d

O ther

U nserved

(% )

(% )

(% )

sim p le la trin e (% )

(% )

(% )

0

67

0 .0 1

2

82

10

0

0

Bamako

1.5

32

B is s a u

0 .8

2

12

13

39

11

0

A sm ara

64

6

B r a z z a v i lle

0

7

B ujum bura

7

20

12

23

69

12

5 0 (s e p tic t a n k a n d all k in d s of p it la t r i n e ) 0.3

44

71

1

58

21 15

70

C onakry

7

C o to n o u

0.3

14

D akar

26

47

5

30

Freetow n

0

18

12

G a b o ro n e

32

1

3

D ar es S alaam

45

66

2

B lantyre

C a s a b la n c a *

23

6 3 (s e p tic t a n k s a n d all fo r m s of l a t r i n e )

28

62

6

18 22

5 63

2 12 60

3

1

H arare

6

K am p ala

11

6

K igali

0

10

10

90

K inshasa

1

6

1

44

Libreville

0

27

67

6

Lom e

1

24

56

20

20

38

71

4

79

11

50

2

Luanda

17

Lusaka

41

M aputo

25

25

M aseru

6

M bane

47

M o ro n i

0

69

N ’D ja m e n a

0

6

N airob i

30

16

N ia m e y

0

5

N o u ak ch o tt

5

9 5*

O uagadougou

0

13

P o r t L ouis

15

3

S a o T om e

5

T u n is*

70

W in d h o e k

83

83

5

20

15

11 60

11

0 .7

33

43

1

85

10

81

6

3

59 (pail)

17 (c o m m u n a l)

N o te : V I P l a t r i n e s t a n d s f o r ‘v e n t i l a t e d i m p r o v e d p i t l a t r i n e ’. S o u r c e s : W H O ( 2 0 0 1 ) , W a te r S u p p ly a n d S a n ita tio n S e c to r A s s e s s m e n t 2 0 0 0 ; A fr ic a R e g io n P a r t 2 ; C o u n tr y P r o file s , W o r l d H e a l t h O r g a n i z a t i o n R e g i o n a l Office for A f r i c a , H a r a r e , 2 8 7 p a g e s , e x c e p t f o r t h o s e c i t i e s m a r k e d * w h e r e t h e d a t a a r e f r o m S a g h i r , J a m a l M a n u e l S c h i f f l e r a n d M a t h e w o s W o l d u ( 2 0 0 0 ) , U rban W a ter a n d S a n ita tio n in th e M id d le E a s t a n d N o r th A fr ic a R e g io n : T h e W a y F o rw a rd , M i d d l e E a s t a n d N o r t h A f r i c a R e g i o n I n f r a s t r u c t u r e D e v e l o p m e n t G r o u p , T h e W o r l d B a n k , W a s h i n g t o n , DC. ** A n o t h e r s o u r c e s u g g e s t s t h a t a s i g n i f i c a n t p r o p o r t i o n of h o u s e h o l d s t h a t a r c c o n n e c t e d t o t h e w a t e r s y s t e m a r c a l s o c o n n e c t e d t o sew ers or the w a s te w a te r system .

B a m a k o , N o u a k c h o t t , N ia m e y , M a p u t o

q u a l i t y . I t is a l s o r a r e fo r t h e r e t o be

a n d L u s a k a . W h i le w e l l m a i n t a i n e d a n d

en o u g h pu blic s ta n d p ip e s re la tiv e to th e

s u f f i c i e n t p u b lic s t a n d p i p e s c a n p r o v id e

p o p u latio n .

a d e q u a t e w a t e r f o r g o o d h e a l t h , in m o s t A f r i c a n u r b a n a r e a s it is r a r e fo r t h e m to

In t h e 4 3 A f r i c a n c i t i e s f o r w h i c h i n f o r m a t i o n

b e w e l l m a i n t a i n e d , f o r w a t e r s u p p l i e s to

on w a t e r a n d s a n i t a t i o n p r o v is io n w a s

be r e g u l a r a n d f o r w a t e r t o b e of g o o d

c o l l e c t e d , 3 1 p e r c e n t of t h e p o p u l a t i o n w a s

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

30 unserved, w ith only 43 per cent having a house

Provision for sa n ita tio n is so poor in m any

connection or yard ta p and 21 per cent relying

African cities t h a t significant proportions of

on public ta ps. Thus, if th e definition of

th e ir po pulations reso rt to open defecation or

'a d e q u a te provision for w a t e r ’ is a house

to defecation in w a s te m a te ria l (such a s w a s te

connection or y ard ta p , then more th a n half the

p a p e r or plastic bags) - th is is te r m e d ‘flying

population in th ese cities have inad equ ate

to ile ts ’ in Nairobi.106 S tu d ies of m any individ­

provision. But this is not a represen tativ e

u al cities, including A ccra, Addis Ababa,

sample of u rb an a re a s in the region. The

Kumasi, L uan da, Nairobi and O uagadougou,

larg est city within each nation is generally the

have found open defecation to be com m on.107

n atio nal capita l and generally h as higher levels

A re s e a rc h project on on-site san itatio n

of w a t e r and sanitatio n provision th a n other

included in terv iew s w ith 1843 households in

cities. Reviews of the findings from

V ijay aw ad a (India), M aputo (M ozambique) and

demographic and health surveys, which are

A ccra, Cape Coast an d Tamale (Ghana). The

b ased on represen tativ e sam ples of national

d istricts w here th e in terv iew s w ere held

populations w ith a sufficient sample size to

included th o s e w h ere collaborating agencies

allow comparisons be tw een cities of different

had a history of comm unity-based work;

sizes, show t h a t in general, the sm aller the

d istricts w ith mixed physical site conditions,

city, th e la rg e r the proportion of th e population

mixed density housing and v ary in g household

with inad equ ate provision.73 So p e rh a p s as few

plot sizes; a nd districts w ith a mix of formally

a s one-quarter of su b-S aharan Africa’s urban

and informally developed a re a s a nd a re a s

population have house connections for w ater.

w here pit emptying pra c tic e s could be found an d observed. 29 p e r cent of households had

Provision for sanitation in A frica’s larger cities

plots; the m ajority of ca se s w e re from Ghana

The following points can be highlighted,

(84 per c e n t).108

d raw in g on Table 1.8:

no domestic s a n ita tio n facilities within th eir

The WHO/UNICEF A ssessm ent 2 0 0 0 ’s s ta tis tic s for s a n ita tio n for 43 cities t h a t are

•

•

•

The only provision for san itatio n for m ost

th e la rg e st in th e ir c o u n try show t h a t 19 per

of th e population in th e cities listed is

cent of th e population are unserved. Of th e

latrine s t h a t households dig th em selves,

people in th es e 43 cities, only 18 per cent

or public latrine s which are often dirty

have toilets co nnected to sew ers. This very

an d difficult to access.

low proportion is confirmed by an analy sis of

More th a n 90 pe r cent of th e population

demographic and h ealth surveys, which

in th e following cities live in homes with

su g g es ts t h a t 25 per c en t of A frica’s urban

no connection to a sewer: Addis A baba,

population have acce ss to toilets connected to

A n tan an ariv o , A sm a ra , B amako, Bissau,

s e w e r s .109 As l a t e r c h a p te rs will discuss, on­

B lantyre, Brazzaville, Bujumbura,

site s a n ita tio n (ie, sa n ita tio n t h a t does not

Conakry, Cotonou, D ar es S alaam ,

require sew ers) c an provide good quality provi­

F ree tow n , H ara re, Kigali, K inshasa,

sion, an d in m any urb an settin g s in

Libreville, Lome, M aseru , Moroni,

s u b -S a h a ra n Africa it is more ap p ro p riate th a n

N’Djamena, Niamey, N ou akch ott,

sew er-based sy stem s, especially w h ere per

Ouagadougou and Sao Tome. Good

ca p ita incomes are v e ry low, m ost housing is

quality pit latrin es or toilets connected to

one-storey and w a t e r supplies are very in a d e ­

septic t a n k s can provide a d e q u a te

q u a te (so flush toilets c a n n o t w o rk well). But

quality a lte rn a tiv e s - bu t th e case

m ost go vernm ents do not s u p p o rt on-site

studies sum m arized in Box 1.4 su g gest

san itatio n. Governm ents t h a t have not ensured

t h a t th e y do not do so for th e majority of

th e installatio n of s e w e rs have generally not

su b -S a h a ra n A frica’s u rb an population.

su pp orted household in vestm ent in good

Betw een 10 and 45 per cent of the

quality on-site san itatio n an d the su pp ort

population in m any of the cities listed are

serv ices it needs (for instan ce, reg u lar pit-

classified as ‘u n s e r v e d ’.

emptying services). Thus, it is unlikely t h a t

P r o v is io n f o r w a t e r a n d s a n it a t io n in c i t ie s

31 m ore t h a n one-third of s u b - S a h a r a n A fric a ’s

pipes w ith in 4 0 0 m e t r e s 113). One w o n d e r s a t

u r b a n p o p u la tio n h a v e a c c e s s to s a n i ta t io n

th e v alidity of d e sc rib ing a s ‘e a s y a c c e s s ’

t h a t is a d e q u a t e in t e r m s of co nv en ie n ce and

w a t e r in a public s ta n d p ip e 4 0 0 m e t r e s from

th e safe d isp o sal of h u m a n e x c re ta .

th e home (at w h ich , in a n y den se u r b a n s e t t l e ­

T h e a b s e n c e of provision for d ra in a g e a n d th e collection of ho u seh old w a s t e s w ith in m o s t low -income s e t t l e m e n t s also c o n tr ib u te s

m e n t, t h e r e is likely to be a long queue). If co m p a r iso n s a re to be m a d e w ith p rov i­ sion for n a ti o n a l u r b a n p o p u la tio n s in Africa

to t h e likelihood of f a e c a l c o n ta m in a t io n of th e

an d A sia, t h e p ro p o rtio n of u rb a n i n h a b i ta n t s

e n v iro n m e n t a n d t h e la r g e d is e a se b u rd e n th is

w ith h o u se co n n e c tio n s plus th o s e w ith e a s y

brings. M o s t inform al s e t t l e m e n t s in u rb a n

a c c e s s in Table 1.9 w ould be e q u iv a le n t to

a r e a s of A frica h av e no serv ic e to collect solid

th o s e w ith im proved provision in e a r l ie r ta b le s .

w a s t e . In m a n y A frican cities, only 1 0 - 3 0 p e r

T h e d a t a on s a n i t a t i o n in Table 1.10 d is tin ­

c e n t of all u r b a n h o u s e h o ld s ’ solid w a s t e s are

gu ish b e tw e e n th o s e w ith c o n n e c tio n s to

co llected, a n d s e r v ic e s a r e in ev itab ly m ost

s e w e r s an d ‘in s i t u ’ s a n i ta t io n . Table 1.10

deficient in inform al s e t t l e m e n t s . 110

sh o w s t h e provision of w a t e r a n d s a n i ta t io n

U n co llected g a r b a g e , alon g w ith h u m a n faeces,

for 41 c it ie s 114 w hile Box 1.6 gives s h o r t

is often disposed of in d r a i n a g e ditc hes, w h ich

s u m m a r i e s of th e e x te n t of w a t e r a n d s a n i t a ­

c a n qu ick ly bec om e clogged. W h e n w a s t e ­

tio n provision in s e le c te d c ities o r n a ti o n a l

w a t e r an d sto rm w a t e r c a n n o t be easily

u rb a n p op ula tion s.

d rain ed , flooding s p r e a d s w a s t e (including

For th e region a s a w hole, only 7 per

f a e c a l m a t t e r ) th r o u g h th e su r ro u n d in g a re a .

c e n t of th e u rb a n p o p u la tio n la c k im proved

S ta n d i n g w a t e r ca n also be c o n ta m in a t e d by

provision for w a t e r a n d only 13 p e r c e n t la ck

b locked s e w e r s a n d over-flowing sep tic t a n k s ,

im proved provision for s a n i t a t i o n . 115 As in Asia

a n d p a t h o g e n s a re th e n s p r e a d qu ickly to

an d Africa, it is c le a r t h a t th e r e a r e v e ry larg e

ev e ry th in g else. D ra in a g e is a n esp ecially

v a r i a ti o n s in th e q u a lity a n d e x t e n t of w a t e r

se rio u s c o n c e rn for th e m a n y u rb a n c o m m u n i­

an d s a n i ta t io n provision b e tw e e n n a tio n s a nd

tie s on s t e e p or s w a m p y l a n d . 111 O rgan ically

b e tw e e n cities. A t one e x tr e m e t h e r e is H aiti,

po lluted w a t e r also b e c o m e s a pro du ctive

w ith a sm all m ino rity of its u rb a n p o p u latio n

breedin g p lace for c e r t a in d is e a se v e c to r s, ie,

w ith w a t e r piped to th e hom e a n d none w ith

C ulex quinquefascia tu s m o sq u ito es, w h ich in

s e w e r co nn ection s; a t th e o th e r is Chile, w ith

E a s t A frica t r a n s m i t ly m p h a tic filariasis. But

nine o u t of te n u rb a n re s id e n ts w ith w a t e r

even w h e r e t h e s e m o s q u ito e s do no t t r a n s m i t

piped to t h e i r ho m es a n d s e w e r co n n ec tio n s. In

d is e a se s, t h e i r biting is a c o n s t a n t and

som e n a tio n s , less t h a n 2 p e r c e n t of th e u rb a n

u n p l e a s a n t n u is a n c e t h a t also c a u s e s loss of

p o p u latio n is w ith o u t im proved provision for

sleep - a n d m a n y low -income ho u seh o ld s end

w a t e r (household c o n n e c tio n s or e a s y ac c e ss ),

up s p en d in g up to 5 p e r c e n t of t h e i r incom es

w hile in s e v e r a l 1 0 - 1 5 p e r c e n t a re w ith o u t

on m osq uito coils o r o th e r m e a s u r e s to p ro t e c t

im proved provision (including A rg e n tin a ,

th e m s e l v e s a g a i n s t th is problem.

P a n a m a , P a r a g u a y an d V enezuela). In E c u a d o r th is figure is 19 p e r c en t, in P a r a g u a y 30 p e r

Provision for w ater and sanitation in urban areas of Latin America and the Caribbean112

c e n t a n d in H aiti 51 p e r cen t. For s a n i ta t io n , in close to h a lf the n a ti o n s listed in Table 1.9 more t h a n 10 p e r c e n t of th e u r b a n p o p u la tio n h av e no s a n i t a ­ tion service. In E c u a d o r an d V enezuela more

Table 1.9 s h o w s th e p rop o rtio n of t h e u rb a n

t h a n a q u a r t e r of th e u r b a n p o p u latio n h a v e no

p o p u la tio n in L atin A m e ric a n a n d C aribb ea n

s a n i ta t io n se rvice , a n d in H a iti it is more t h a n

n a tio n s w ith im proved w a t e r supply and

a half.

s a n i ta t io n in 2 0 0 0 . For w a t e r supply, th is is

A lth o u g h g lob al a s s e s s m e n t s of w a t e r

divided into th o s e w ith ho use c o n n e c tio n s a n d

an d s a n i ta t io n provision m a y n eed to use th e

th o s e w ith w h a t is t e r m e d ‘e a s y a c c e s s ’

s a m e a s s e s s m e n t c r ite r ia for all n a tio n s,

(u sually a c c e s s to w a t e r th r o u g h public s t a n d ­

clearly, s t a n d a r d s of provision (and th e c rite r ia

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

32 I

Table 1.9 P ro p o r tio n of th e u r b a n p o p u la tio n in n a ti o n s in L a tin A m e ric a an d t h e C a rib b e a n w ith a c c e s s to ‘i m p r o v e d ’ w a t e r su pp ly a n d s a n i ta t io n , 2 0 0 0 Country

Water supply; percentage o f

Sanitation; percentage o f urban

urban households w ith:

households with:

H ousehold

No household

connection

connection but

No service

Connection to

No sewage

sewers

connection but

with ‘e a sy ’ access

Unserved

‘in s itu ’ sanitation

Argentina

72

13

15

55

34

11

Bolivia

87

6

7

45

37

18

Brazil

91

5

4

59

35

6

Chile

95

4

1

90

4

7

Colombia

89

9

2

79

18

3

Costa Rica

100

47

41

11

Cuba

84

15

2

48

49

3

Dominican Republic

62

35

4

31

64

4

Ecuador

77

5

19

61

9

30

El Salvador

86

6

8

64

22

14

G ua tem a la

87

11

1

93

2

5

Haiti

15

34

51

0

46

54

H onduras

89

5

6

55

39

6

Jam aica

59

39

2

30

60

10

Mexico

93

1

6

75

12

13 7

N icaragua

88

7

5

32

61

Panama

87

14

12

64

35

1

P a ra g u a y

69

1

30

13

72

15

Peru

76

11

13

67

23

10

Puerto Rico

100

60

40

0

Trinidad and Tobago

66

20

14

19

80

0

Uruguay

94

5

2

51

45

5

Venezuela

84

1

15

62

9

29

Note: Th e t a b le only in c lu de s n a t io n s w it h 1 million plus i n h a b i t a n t s in 2 0 0 0 for w h ic h d a t a w er e av ai lab le . Source: P AH0 a n d WHO (2 0 0 1 ) , W ater S u p p ly and Sanitation: Current S ta tu s and Prospects. Regional R ep o rt on the E va luation 2 0 0 0 in the Region o f the A m erica s, Pan A m e r i c a n H ea lt h O rg a n iz a ti o n an d World H ea lt h O rg a n iz a ti o n , W a sh i n g to n , DC, 81 pa g es .

u se d to a s s e s s th e m ) should be b e t t e r in u r b a n

u r b a n p o p u la tio n h av e im proved provision b u t

a r e a s in L a tin A m e r ic a n n a t io n s w ith

la c k h o u se c o n n e ctio n s.

re la tiv e ly high p e r c a p i t a in c o m es t h a n in low-

Similarly, in m o st n a tio n s , a la rg e p a r t of

incom e n a t io n s (or in t h e v e r y low-incom e

th e u r b a n p o p u la tio n w h o h a v e im proved

A sia n a n d A frican n a tio n s). If h ig h e r s t a n d a r d s

s a n ita tio n do n o t h a v e c o n n e c tio n s to s e w e rs .

a r e s e t t h a n th o s e used to define ‘im proved

Only in Chile an d G u a te m a la do official s t a t i s ­

p rovision’, t h e p ro p o rtio n of t h e p o p u la tio n

tic s s u g g e s t t h a t m ore t h a n 90 p e r c e n t of th e

in a d e q u a t e l y se rv e d in L a tin A m e r ic a a n d th e

u r b a n p o p u la tio n h a v e c o n n e c tio n s to s e w e rs .

C a rib b e a n in c re a s e s s u b s t a n tia lly . For

In m o st n a t io n s in th e region w ith m ore t h a n 1

i n s t a n c e , in J a m a i c a , H aiti, t h e D om inican

million in h a b i t a n t s , m ore t h a n o ne-th ird of th e

Republic a n d T rin id a d a n d T obago, b e t w e e n 20

u r b a n p o p u la tio n h av e in situ s a n ita tio n .

a n d 3 9 p e r c e n t of th e u r b a n p o p u la tio n have

In Belize, only 3 9 p e r c e n t of th e u r b a n

im proved provision b u t n o t hou se co n n e c tio n s.

p o p u la tio n h a d a c o n n e ctio n to a public s e w e r

Sim ilarly, only 72 p e r c e n t of A r g e n t i n a ’s

in 2 0 0 0 ; in C o s ta R ica th is figure w a s 47 p e r

u r b a n p o p u la tio n a r e se rv e d w ith house

c e n t, in Cuba 48 p e r c e n t, in N ic a r a g u a 32 p er

c o n n e c tio n s c o m p a r e d to 85 p e r c e n t w ith

c e n t, in th e D om inican R epublic 31 p e r c e n t, in

im proved provision; in C uba, G u a te m a la ,

P a r a g u a y 13 p e r c e n t a n d in H aiti 0 p e r cent.

P a n a m a a n d P e r u m ore t h a n 10 p e r c e n t of th e

T he po int t h a t w e m a d e e a r lie r - t h a t ‘in s i t u ’

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

33 s a n i t a t i o n c a n be good q u a lity b u t also v e r y poor q u a lity - n e e d s to be r e p e a te d . A v e r y la rg e p r o p o rtio n of in situ s a n i t a t i o n in u r b a n a r e a s in th e region is n o t of good q u a lity - in p a r t b e c a u s e official a g e n c i e s do little or n o th in g to s u p p o r t good q u a lity in situ s a n i t a ­ tion. In A rg e n tin a , only 55 p e r c e n t of th e u r b a n p o p u la tio n h a d c o n n e c tio n s to s e w e r s in 2 0 0 0 , c o m p a r e d to 8 9 p e r c e n t w ith im proved s a n ita tio n . W ith in B r a z il’s u r b a n p o p u la tio n , 94 p e r c e n t m a y h av e h a d im proved s a n ita tio n by 2 0 0 0 b u t only 56 p e r c e n t h a d c o n n e c tio n s to s e w e r s y s t e m s a n d n e a r ly h a lf of all m u n ic i­ p a litie s in t h e n a tio n h av e no s e w e r s . 116 More

E x a m p l e s of th e i n a d e q u a c ie s in c i t i e s ’ w a t e r su pply and s a n i t a t i o n in L a tin A m e ric a an d th e C a rib b ea n

Cochabamba (Bolivia) Only 60 per cent of the urban area and 53 per cent of the population are connected to w ate r systems either inside or outside the home, and only 23 per cent of those connected receive a 24-hour supply of water. The w a ter network provided by SEMAPA (Servicio Municipal de Agua Potable y Alcantarillado) has not been able to keep up with the growth of the city, and it is estimated t h a t 100,000 people are not connected to the system. Industrial, commercial and wealthier residential areas have the highest rates of connection, reaching 99 per cent in Casco Viejo. Yet half the homes in Cochabamba are located in the northern and southern suburbs, and in some districts in these areas, 1992 data indicate th a t less than 4 per cent of homes had potable w ater connec­ tions; 18 per cent had access to w ater outside the house; and 8 0 -9 0 per cent obtained w ater supplies from cistern trucks. Only 46 per cent of the population have a connection to a sewerage network. There is insufficient w ater provision to meet existing levels of demand.123

t h a n h a lf t h e u r b a n p o p u la tio n s in th e

Guayaquil (Ecuador)

D om inican R epublic, N i c a r a g u a , J a m a i c a ,

35 per cent of the population of 1.6 million dwellers do not have access to adequate and reliable w ate r supplies and the whole city suffers from chronic and absolute w a te r shortages. The sewerage system is on the verge of collapse. Approximately 400 tankers service 35 per cent of the total urban population; these w ater merchants buy the w ater at a highly subsidized price and can charge up to 400 times the price per litre paid by consumers who receive w ater from the public w a te r utility. There is sufficient supply available to be able to reach each inhabitant with an average daily consumption of 220 litres. In 1990, average daily consumption ranged from 307 litres per inhabi­ t a n t in the well-to-do p arts of the city to less than 25 litres per inhabitant for those supplied by the private w ater sellers. Compared with the internationally accepted standard of 150 litres per person per day, Guayaquil is in the position to provide every citizen with a sufficient supply of potable water. The problem is thus clearly one of distribution.124

P a r a g u a y an d T rin id a d an d T obago h a v e in situ s a n ita tio n . In all L a tin A m e r ic a n and C a rib b e a n cities, less t h a n h a lf th e u r b a n p o p u la tio n h a v e c o n v e n tio n a l s e w e r c o n n e c ­ tio n s , so a v e ry la rg e p a r t of t h e u r b a n h o u se h o ld s classified a s h a v in g im proved s a n i t a t i o n h av e only pit la tr in e s or (less com m only) to il e ts c o n n e c t e d to se p tic ta n k s . A rou nd 10 p e r c e n t of u r b a n h o u se h o ld s have no provision for s a n ita tio n . T he c a s e s tu d ie s of specific cities in Box 1.6 give f u r t h e r ev id ence t h a t a la rg e n u m b e r of th o s e w ith im proved provision still have v e r y in a d e q u a t e provision. A la rg e p a r t of th e u r b a n p o p u la tio n in J a m a i c a w o u ld be s u r p r i s e d to le a r n t h a t t h e y a r e officially classified a s h a v in g im proved provision for w a t e r a n d s a n ita tio n : it does n o t ta lly w ith local r e p o r ts of t h e i n a d e q u a c ie s in provision in th e tw o l a r g e s t cities, K in g sto n and M o n te g o B ay (see Box 1.6). In E cu a d o r, 81 p er c e n t of th e u r b a n p o p u la tio n m a y h av e im proved w a t e r a n d 70 p e r c e n t m a y have im proved s a n ita tio n , b u t in G u ay a q u il, the n a t i o n ’s l a r g e s t a n d r ic h e s t city, only 60 p e r c e n t of th e p o p u la tio n a r e c o n n e c te d to piped w a t e r n e t w o r k s a n d only 50 p er c e n t are c o n n e c te d to s e w e r s (see also Box 1.6). In H o n d u ra s , 9 7 p e r c e n t of th e u r b a n p o p u la tio n m a y h av e im proved w a t e r provision b u t - as th e d e s c rip tio n of provision for w a t e r in

Kingston (Jamaica) Official estim ates suggest t h a t 3 5 -4 0 per cent of the population in Kingston Metropolitan Area are served by sewers. Other estim ates suggest th a t only 18 per cent are served by sewers with 27 per cent having soakaw ay pits, 47 per cent using pit latrines and 8 per cent with no facilities a t all. The sewers in the inner city are very old and often blocked. A significant percentage of the Kingston Metropolitan Area population, especially in low-income communities, defecate in open lots, in abandoned buildings or in plastic shopping bags which are then thrown into gully courses to be washed down into the city.’125

La Paz (Bolivia) The La Paz-El Alto metropolitan area has a population of over 1.3 million. As in many Latin American cities, public services in the poorer, often newer, neighbourhoods on the outskirts of the metropolitan area lag behind services in the wealthier and older central area. In-house w a te r and sewer connections are much more common in central and southern La Paz t h a n in El Alto. Between 83 and 93 per cent of El Alto and La Paz residents have access to some form of piped w ater service: either an in-house w ater connection or a public tap near their homes. Households without in-house w ater connections or access to public standposts get w ater from a combination of w ater vendors, municipal w a te r delivery services, neighbours with w a te r service, rain w ater collection, private household wells and nearby streams. An estimated 66 per cent of La Paz homes and between 30 and 45 per cent of El Alto homes have sewer connections. For households without sewers, septic tank s offer an alter­ native, but in 1992, only a small number of households had septic tanks: 4 per cent of households in El Alto and 21 per cent in La Paz. Households without septic ta n k s or sewer connections use stream beds, latrines, public toilets and toilets in other private homes.126

T e g u c ig a lp a (its c a p i t a l a n d l a r g e s t city) in

Lima (Peru)

Box 1.6 s h o w s - a v e r y la rg e p r o p o rtio n of its

According to a 1996 article, almost 2 million of Lima’s inhabitants have no w ater supply, and 30 per cent of those who do receive w a te r of dubious quality. The aquifer th a t provides a third of Lima’s w ater is due to run out by 2005 because of over-abstraction.127

p o p u la tio n h av e v e r y in a d e q u a t e provision. Table 1.9 s u g g e s ts t h a t only a m in o rity of

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

34 Montego Bay (Jamaica)

h o u s in g w i t h o u t a c c e s s to s a n i t a t i o n in

Over 90 per cent of households have access to good quality piped w ater for drinking, but in informal settlements a much smaller percentage have connec­ tions to their house. Two-thirds of the population (many in informal settlements) rely on pit latrines or septic tank systems or have no sanitation. The densest settlements often have only a few pit latrines to serve residents. Pit latrines are often little more than holes in the ground about 1-1.5 metres deep. Possibly 5 or even 10 per cent of those living in informal settlements put their faeces in plastic bags and throw these into nearby gullies or bushes.128

1 9 9 6 117 - c o m p a r e d to a figu re of 15 p e r c e n t in t h e A s s e s s m e n t 2 0 0 0 . T h e w a t e r c o v e r a g e s t a t i s t i c s in T a b le s 1.9 a n d 1 .10 s a y n o th i n g a b o u t t h e r e g u l a r i t y of s u p p ly o r t h e q u a l i t y of t h e w a t e r w ith i n t h e p ip ed s y s t e m s . A v ailab le s t a t i s t i c s from t h e P a n A m e r i c a n H e a l t h O r g a n iz a t io n

Port-au-Prince (Haiti) Although local groundwater around Port-au-Prince is more than sufficient to supply all 2 million of the city residents with water, only 10 per cent of families have w ater connections in the home. The public w ater service, CAMEP, is heavily in debt and has stopped maintaining many of the city’s standpoints (public w ater taps). A vast clandestine system of w ater distribu­ tion has sprung up to meet the needs of 90 per cent of the city’s population. The operators of this system rely on private wells and distribution trucks that provide w ater to private tank owners. The tank owners then sell small amounts of w ater to individuals and families at prices that range from USS3-5 per cubic metre, compared to the 50 cents per cubic metre th at CAMEP charges its customers. Residents in slums not only paid the highest prices for water, they also carried it for long distances in areas with no paved roads.129

(PAHOJ/W HO a s s e s s m e n t s u g g e s t t h a t in m a n y citie s , t h e t y p i c a l n u m b e r of h o u r s p e r d a y in w h ic h w a t e r is a v a il a b le is 2 2 - 2 4 , a l t h o u g h for L im a it w a s 13 h o u r s a n d for P o r t - a u - P r in c e it w a s only 4 h o u rs . For n a t i o n a l u r b a n p o p u l a t i o n s , t h e n u m b e r of h o u r s p e r d a y d u ri n g w h ic h d r i n k in g w a t e r w a s a v a il a b le w a s 14 in P e r u , 6 in H a iti a n d H o n d u r a s a n d 6 - 1 2 in G u a t e m a l a . 118 T h e r e w e r e no d a t a for m a n y of t h e n a t i o n s w i t h th e

Santo Domingo de los Colorados (Ecuador) 70 per cent of the w ater entering the supply system is tapped illegally (compared with 30-40 per cent for most South American cities). Approximately 60-80 per cent of households receive running water, but only for a few hours a day.130

l a r g e s t u r b a n p o p u l a t i o n s in t h e re g io n , in c l u d ­ ing B ra z il a n d M exico. In a d d it io n , official s t a t i s t i c s often o v e r - s t a t e t h e r e g u l a r i t y of su p ply . One e s t i m a t e s u g g e s t e d t h a t 6 0 p e r

Tegucigalpa (Honduras)

c e n t of t h e p o p u la t io n s e r v e d t h r o u g h h o u s e ­

The w ater shortage in the city is particularly acute as there is not even enough water to supply consumers who are already connected to the municipal system, much less those who are outside the distribution network. Of the total urban population, it is estimated th at 32 per cent receive their w ater from sources other than house connections and public taps. This includes 200,000 people in the barrios marginales. Many inhabitants of the barrios marginales receive their water from unregulated water vendors who sell 55-gallon barrels of water to the barrios for US$1.75. While water use differs between households (depending on factors such as family size and income), it is estimated tha t in the early 1990s the total cost to all households in the barrios marginales who buy water from vendors is collectively US$11-13 million a year. The price people pay in the barrios is estimated to be 34 times higher than the official government rate charged to the better-off families who are connected to the town system. If even a fraction of the total annual cost of water paid by people in the peripheral areas could be allocated to an urban system, the same level of service could be provided at a fraction of the cost.131 (There is a programme underway to install water systems in all the city’s legalized peri-urban communities.)

hold c o n n e c t io n s in t h e re g io n a r e s e r v e d by o p e r a t i o n a l l y i n t e r m i t t e n t w a t e r s u p p ly s y s t e m s . In t h e c a p i t a l of H o n d u r a s , T e g u c ig a l p a , t h e r e a r e s e r io u s w a t e r s h o r t ­ a g e s , w h ic h m e a n s t h a t t h e r e is n o t e n o u g h w a t e r to s u p p l y c o n s u m e r s w h o a r e a l r e a d y c o n n e c t e d to t h e m u n i c ip a l s y s t e m , m u c h less t h o s e w h o a r e o u ts id e t h e d is tr i b u ti o n n e t w o r k . M o s t u r b a n n e t w o r k s pro v id e only i n t e r m i t t e n t s e r v ic e (six h o u r s a d a y on a v e r a g e ) . 119 In re v i e w i n g t h e re g io n , o ne c o m m e n t a ­ to r su g g ested th a t:

Urban services [and esp ecia lly w a ter and u r b a n d w e lle r s in B olivia la c k im p ro v e d w a t e r

sa n ita tio n p ro v isio n ] in L a tin A m erica

a n d s a n i t a t i o n , b u t t h e d e s c r ip ti o n s of w a t e r

show a com m on s e t o f cen tra l p ro b le m s:

a n d s a n i t a t i o n p ro v isio n in L a P a z (inclu din g

in s u ffic ie n t coverage th a t exclu d es an

El A lto) a n d C o c h a b a m b a in Box 1.6 m a k e

im p o rta n t p ro p o rtio n o f the p o p u la tio n ;

c l e a r t h a t a high p ro p o r tio n of t h e i r p o p u l a ­

d e fic ie n t q u a lity th a t has a direct im p a ct on

tions have very in a d e q u a te w a te r and

q u a lity o f life ... [and] serio u s en viro n m en ­

s a n i t a t i o n provision.

ta l im p a c ts d erived fr o m the f a c t th a t the

D iffe ren t s o u r c e s als o give v e r y d if fe re n t s t a t i s t i c s fo r t h e e x t e n t of w a t e r a n d s a n i t a ­

gro w th o f needs has increased p e rs iste n tly q u icke r than the a ssig n e d fin a n c ia l

ti o n p ro v isio n , p r o b a b l y b e c a u s e t h e y a re

resources a n d th e ca p a city f o r p ro visio n ,

b a s e d on d if fe re n t d e fin itio n s of ‘a d e q u a t e ’. In

p la n n in g a n d re g u la tio n } 20

P a r a g u a y , a s t u d y by CEPA L s u g g e s t s t h a t 76 p e r c e n t of t h e u r b a n p o p u l a t i o n lived in

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

35 Box 1.7 S t r u g g l e s f o r w a t e r a n d s a n i t a t i o n i n L a t i n A m e r i c a n c i t i e s

Huaycan (Peru)

provide h ealth care. Illegal connec-

settlers. Some resid ents installed a

In July 1984, th e se ttle m e n t of

tions w ere made to w a t e r mains and

com m unity ta p . Many tap p e d into

H u ayc an w a s create d by th e invasion

to electricity pylons; the electricity

n earb y w a t e r pipes and ran hoses to

of a v a c a n t plot of land by a group of

com pany agreed to supply them but

th eir plots. During th e first w in ter

low-income households organized in

the police kep t them out. In th e r u n ­

th ere w ere serious floods due to the

an association. Having successfully

up to dem ocratic elections in 1984,

lack of sew e rs and drains, and w a te r

occupied the land, a plan t h a t had

each political p a rty made promises to

and mud poured into the houses. A

already been prepared before the

the in h ab ita n ts, and th e democratic

sew er h as been built but it does not

invasion w a s put into effect: the

gov ern m en t elected in 1984 w a s more

w o rk very well, and in 1998 th ere

householders set up housing groups

sy m p a th e tic to th eir needs, but by the

w a s an o th e r serious flood which

m easuring 1 h e c ta re each on av erag e,

late 1 980s no in fra stru c tu re had been

dam ag ed several houses. N egotiations

with 60 housing plots an d space for

provided.137

and lobbying have produced some in fra stru c tu re - a telephone in 1995,

streets , p a rk s an d comm unal prote ct th e se ttle m e n t from eviction

Barrio San Jorge (Buenos Aires)

tr a n s p o r t services) and g a rb ag e

and from the guerrilla groups t h a t

This s e ttlem en t w a s originally

collection services. But th e problem of

sought to ta k e power. They also

founded in 1961 w hen th e governm ent

se w e rs rem ain s unresolved, and

sought to get recognition from th e ir

re settled 60 families here. Despite the

solving this is costly becau se it would

own governm ent. Prom ises from the

la ck of in fra stru c tu re and services,

mean rebuilding and repaving all the

go vernm en t of electricity and w a te r

o th e r families moved in, a t t r a c t e d by

ro a d s .139

w ere not fulfilled, so in 1987, the

the v a c a n t land and th e low risk of

in h a b ita n ts m arched d ow ntow n to

eviction. After 1979, the se ttle m e n t

El Vergel (Cali, Colombia)

demand this. The electricity grid w as

expanded into a new section w hen the

The se ttle m e n t of El Vergel had some

then extended to H uay can but no

municipal a u th o rities evicted some

7400 in h a b ita n ts in 1999. It w as

action w a s ta k e n to provide w ater. A

200 families from a nearby site. After

formed initially by an invasion in

premises. The first t a s k w a s to

paved ro ads (which also m ean t public

second m arch w a s organized in 1988

30 y e a rs of settle m en t, in 1990 th ere

1980: the invaders cleared th e land

and this led to some im provem ent in

w a s no se w e r system and most ho use­

and m arked off th eir house sites with

provision for w ater. Titles to th e land

holds relied on public sta n d p ip es for

rope. They h ad to defend th e ir plots

w ere also n eg otiated by m any house­

w ater. There were no paved ro ads or

from th e arm y an d a militia hired by

holds. M any comm unity le ad e rs in

drains an d most in h ab ita n ts had no

th e landowner. S h a c k s w ere hastily

H u ayc an w ere th r e a te n e d by guerril­

g a rb ag e collection service. Conditions

assembled using bamboo, plastic,

las and sev eral w ere killed, so the

have improved since th e n throu gh self-

m etal sh eets and cardb oard. There

in h ab itan ts so ug ht to establish a

help projects and some externally

w a s no provision for w ater, sanitatio n,

police statio n . In th e early 1990s,

funded w o rk (providing w a t e r supplies

electricity, roads, he alth care or

o ther projects w ere n ego tiated includ­

and small-bore se w e rs ) .138

schools. Initially, w a t e r w a s obtained from small stre a m s t h a t ran th rough

ing a d rain age system and a m other and child c e n tr e .136

Puertas del Sol IV (Cali, Colombia)

the plot, but th ese w ere insufficient

Quilmes (Buenos Aires)

This settle m e n t had 7152 in h a b ita n ts

s e ttle rs began to p urcha se buck ets of

In late 1981, some 2 0 ,00 0 people

in 20 0 1. It w a s formed in 1994 by

w a t e r from a neighbouring se ttlem en t

invaded 211 h e c ta re s of abandoned

families living in a s q u a t te r s e ttlem en t

as well as more d is ta n t settlem en ts,

private land in tw o o u te r d istricts of

in a n o th e r p a r t of Cali who w ere

b u t th is w a s expensive and inconven­

Buenos Aires. At first, th e only official

provided w ith plots on w hich they

ient. El Vergel, like m an y illegal

response w a s to t r y to bulldoze them

could build. The s e ttle rs u n d e r w e n t a

se ttle m e n ts, developed next to a legal

or to set a cordon aro un d them to stop

lengthy negotiation to g et th e land:

neighbourhood becau se of th e proxim­

supplies and people going in. The

th eir former settle m e n t had been built

ity to existing w a t e r and se w e r mains

in h a b ita n ts developed six settlem e nts,

on hill sides t h a t w ere a t high risk of

and electricity supplies. The settle rs

organized so t h a t th ere w a s room for

landslides. W hen they moved to the

m an ag e d to neg otiate th e right to

acc ess roads and in fra stru c tu re . A

new site, th e re w a s no provision for

stay, piped w a te r supplies w ere

rep re se n tativ e comm unity o r g a n iz a ­

w a ter, san itatio n or d rain age. They

extended and now most dwellings

tion n eg otiated with e x te rn a l

had to ask th e in h a b ita n ts of neigh­

have piped w ater. However, th e r e are

agencies, albeit with little success.

bouring se ttle m e n ts for w ater, but this

serious flooding problems and rivers of

The local gov ernm ent refused to pave

w a s made difficult becau se th e neigh­

sew ag e run throu gh the comm unity

streets , install se w ers an d d rains or

bours did not welcome th e new

during periods of heavy rain fall.140

and became co nta m in ated. The

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

36 Table 1.1

Nation

P r o v i s i o n f o r w a t e r t o h o u s e h o l d s in s e l e c t e d L a t i n A m e r i c a n c i t i e s

City

Water supply Connected to network Total

%

population

N o t connected to network Total

%

population

Public

Well

Well

tap

with pum p

without

water

(%)

pum p

sources

(%>)

(%)

(%)

Other

Argentina

Buenos Aires

7 ,4 83 ,00 0

78.1

Bolivia

La Paz

7 7 5 ,00 0

95.9

3 3,00 0

4.1

S a n ta Cruz de la Sierra

7 6 1 ,00 0

72.5

2 2 8 ,00 0

21.7

El Alto

5 7 8,0 00

74.8

59,000

7.6

Belem

7 9 2 ,00 0

50.2

148,000

9.4

Belo Horizonte

3 ,7 1 5 ,0 0 0

95.2

148,000

3.8

3.8

Curitiba

2 ,2 3 7 ,0 0 0

90.9

2 2 0 ,00 0

8.9

8.9

Fortaleza

2 ,0 0 4 ,0 0 0

75.3

3 0 9 ,00 0

11.6

11.6

Porto Alegre

2 ,9 8 3 ,0 0 0

90.9

2 8 5,000

8.7

8.7

Recife

2 ,7 9 1 ,0 0 0

90.8

176,000

5.7

5.7

Rio de Janeiro

9 ,2 4 7 ,0 0 0

89.8

9 9 2,0 00

9.6

9.6

Salvador

2 ,5 6 0 ,0 0 0

92.6

106,000

3.8

3.8

Säo Paulo

1 6 ,53 2,0 00

99.1

2 8 9,0 00

1.7

1.7

4 ,5 5 4 ,7 0 0

99.4

Brazil

Chile

Gran S a ntiago

Colombia

B arran qu illa

Costa Rica

9 7 4 ,9 7 0

81.2

Bogotá

5 ,5 6 6 ,3 2 0

91.1

Cali

1,88 4,44 0

91.5

0.24

3.8

21.7 2.1

5.6 9.4

Medellin

1,8 13,79

93.7

Región M etropolitana

4 3 0,8 70

30.1

1,582 ,00 0

62.2

9 6 0,300

27.8

13.8

24.0

5 2 2,0 00

89.2

6 3,0 00

10.8

2.2

9.9

60.6

2 0 0,000

9.4 6.7

Dominican

S anto Domingo

Republic

S antiago

E cuador

Guayaquil

1,2 84 ,5 00

G ua tem a la

Area M etropolitana

1,6 80 ,00 0

93.3

120,000

Haiti

P ort-au-Prince141

700,00 0

41.2

2 5 0 ,00 0

H onduras

San Pedro Sula

3 13 ,6 0 0

60.2

179,500

34.4

Mexico

Distrito Federal 8 ,18 5,0 00

96.4

3 0 4,0 00

3.6

0.8

2.8

2 ,91 9,0 00

92.1

249,0 00

7.9

1.4

6.5

1,001,000

86.4

157,000

13.6

1.5

12.1

8 63 ,0 0 0

91.6

79,000

8.4

1.4

7.0 3.8

(Mexico City) G u ad alaja ra

9.4 6.7 8.2

5.9

34.4

Heroica Puebla de Z aragoza León G uan ajuato

2 ,7 52 ,00 0

94.8

151,000

5.2

1.5

N icaragua

M onterrey M an ag u a

83 6,0 0 0

92.0

72,700

8.0

1.0

Panama

Panamá

96 9,0 4 0

96.1

3 9,1 10

3.8

P a ra g u a y

Asunción

525,18 5

92.2

4 4,6 68

7.8

Peru

Lima M etrop olitana

5 ,3 67 ,00 0

74.3

549 ,00 0

P u erto Rico

San Juan

Dominican

S anto Domingo

Republic

Santiago

Venezuela

C arac as

7.0 3.9

3.8

3.1

0.9

7.6

138,000

30.3

3 1 8,0 00

69.7

1,582,000

62.2

9 6 0 ,30 0

37.8

13.8

522,0 00

89.2

6 3,000

10.8

2.2

2 ,8 5 5 1 ,0 0 0

90.3

3 0 5,0 00

9.7

4.9

M aracaibo

1,068,000

56.0

8 4 0 ,00 0

44.0

Valencia

1,149,000

88.3

153,000

11.8

M a ra c a y

92 8,0 0 0

88.3

123,000

11.7

24.0 9.9 1.8

0.7

* O th er w a t e r s o u r c e s includ e r a i n w a t e r , riv er w a t e r , w a t e r fo u n ta in s a n d p u r c h a s e d w a t e r jugs. Source: Cent ro P a n a m e r i c a n o de In g en i er ía S a n i t a r i a y Cien cia s del A m b ie nt e. Evaluación de los Servicio s de A g u a P otable y Sa n ea m ien to 2 0 0 0 en las A m erica , www .cepis.opsom s.org.

P R O V IS IO N FO R W A T E R A N D S A N IT A T IO N IN C IT IE S

37 T able 1 .11 P r o v i s i o n f o r s a n i t a t i o n t o h o u s e h o l d s in s e l e c t e d L a t i n A m e r i c a n c i t i e s

C ountry

City

Sanitation coverage Connected to city

N o t connected to city

sewer system

sewer system

Total

%

population

Total

%

population

Sm all­

Dry

Sim ple

Other

bore

septic

Well/ Latrine with

latrine

p it

(%)

sewer

tank

water

(%)

latrine

connec­ connec-drainage tion

tion

(%)

(%)

(%)

(%)

A rgentina

Buenos Aires

9 8 0 ,00 0

10.2

4600

Bolivia

La Paz

6 1 1 ,00 0

75.6

3 0,000

3.7

1.7

S a n ta Cruz de la Sierra 2 9 4 ,00 0

28.0

139,000

13.2

13.2

El Alto

3 0 8 ,0 0 0

39.8

136,000

17.6

3.0

14.6

Belem

3 3 9,0 00

21.5

581,0 00

36.8

30.6

6.1

Belo Horizonte

2 ,9 80 ,0 00

76.4

8 7 4,0 00

22.4

15.7

6.7

Curitiba

1,4 09 ,00 0

57.3

9 9 9,0 00

40.6

36.1

4.5

6 4 3,0 00

24.2

1,82 2,00 0

68.5

66.8

1.7

2 ,4 97 ,00 0

76.1

727 ,0 00

22.1

20.9

2.2

Brazil

Fortaleza Porto Alegre

0.05 2.0

Recife

1,1 23 ,00 0

36.5

1,7 94 ,0 00

58.3

51.7

6.6

Rio de Janeiro

8 ,6 3 7 ,0 0 0

83.9

1,599,000

15.5

Salvador

1,589,000

57.5

1,033,000

37.4

8.3 24.7

7.3 12.7

14 ,8 37 ,00 0

88.9

2 ,0 05 ,0 00

12.0

7.7

4.4

4 ,5 1 8 ,4 0 0

98.6

36,300

0.8

0.8

9 9 5,8 10

82.9

Bogotá

4 ,9 9 9 ,3 2 0

81.8

Cali

1,82 3,6 50

88.5

Medellin

1,837,680

95.0 31.1

Sáo Paulo Chile

Gran S antiago

Colombia

B arranquilla

Costa Rica

Región M etropolitana

720 ,00 0

50.3

4 4 5,0 00

31.1

Dominican

S an to Domingo

6 8 6,4 00

27.0

1,855,900

73.0

Republic

S antiago

Ecuador

Guayaquil

G u atem ala

G ua tem a la City

Haiti

Port-au-Prince

H onduras

San Pedro Sula

Mexico

Mexico City (Distrito

4 3 7,0 00

74.7

148,000

25.3

1,05 5,0 00

49.8

250,00 0

11.8

9.4

1.7

0.7

Metropolitan Area

Federal) G u ada lajara

8.6

11.6

5.1

71.9 48.2

8 8 2 ,00 0

51.8

16.9

5.0

10.0

20.0

71.7

140,020

26.9

8.4

5.5

11.7

1.4

7 ,6 51 ,00 0

90.1

8 3 8,0 00

9.87

284,0 00

89.7

3 2 8 ,00 0

10.4

1,0 26 ,00 0

88.6

132,000

11.4

3.5

7.9

8 7 7,0 00

93.1

6 5,00 0

7.0

4.1

2.8

2 ,6 7 4,0 00

92.1

3 7 3,8 00

5.2

5.7

5.7

4.6

Heroica P uebla de Zaragoza León G uanajuato M onterrey

229,00 0

7.8

N icaragua

M anagua

4 9 2,9 00

54.2

4 1 6 ,10 0

45.8

Panamá

Panamá

707 ,39 0

70.2

3 0 0 ,76 0

29.8

13.4

16.4

P a ra g u a y

Asunción

2 9 1,48 0

51.2

278 ,37 8

48.9

40.9

1.4

Peru

Lima 16.5

P u erto Rico

San Juan

Dominican

S an to Domingo

Republic

S antiago

U ruguay

Montevideo

Venezuela

C araca s

M etropolitana

71.5

1,1 9 1 ,0 00

16.49

26.8

3 3 4,0 00

73.3

6 8 6 ,4 0 0

27.0

1,85 5,90 0

73.0

4 3 7,0 00

74.7

148,000

25.3

8.6

9 4 8,4 90

70.5

3 9 6,3 50

29.5

24.4

2 .9 1 9.0 00

92.5

2 3 7 .00 0

7.5

6 9 4 ,8 5 0

36.4

1,213,150

63.6

Valencia

1.099.000

84.4

203.00 0

15.5

M a ra c a y

730 ,00 0

69.5

3 2 1 .00 0

30.5

M aracaibo

5 ,1 63 ,0 00

38.8

122,00’

11.6

7.0

4.9

5.1 5.1

Source: Ce n tr o P a n a m e r i c a n o de In g en i er ía S a n i t a r i a y Cien cia s del A m b ie n te , Evaluación de los Servicios de A g u a P otable y S aneam iento 2 0 0 0 en las A m erica, w w w . c e p is .o p s - o m s . o r g .

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

38 T h e p olitical conflicts in v a rio u s L atin

s p u r re d by th e a t t e n t i o n given to improving

A m e ric a n cities over w a t e r an d s a n i ta t io n also

w a t e r q u a lity a n d s a n i ta t io n du ring th e 1 9 9 0 s

su g g e s t t h a t t h e r e a re m ore p ro blem s t h a n

in re s p o n se to t h e c h o le ra epidem ic t h a t b egan

th o s e im plied by th e s t a t i s t i c s on w h o h a s

in 1 9 9 1 . 132 H ow ever, th e 1 9 9 0 s also b ro u g h t a

im proved provision. For in s ta n c e , Table 1.9

s m a lle r drop in th e p ro p o rtio n of th e u rb a n

s u g g e s ts t h a t m o s t of th e p o p u la tio n s of

p o p u latio n w ith im proved provision t h a n in

Bolivian a n d M ex ican cities a re s e r v e d w ith

prev io us d e c a d e s, w h ic h m a y be th e re s u lt of a

w a te r , b u t t h e r e h a v e b een s e rio u s conflicts in

re - o rie n ta tio n in p rio rities t o w a r d s im p ro v e­

v a rio u s cities aro u n d is su es of a c c e s s , quality,

m e n t s in w a t e r quality, disinfection an d

d is trib u tio n an d price. T h e c a s e of

s a n i ta t io n a t t h e e x p e n se of in c re a sin g c o v e r­

C o c h a b a m b a is one of th e b e s t k n o w n a n d b e st

a g e . 133 One re p o r t s u g g e s ts t h a t t h e p rop ortion

d o c u m e n te d . In Mexico, t h e r e h a v e been

of u r b a n ho u sing w i t h o u t s a n i t a t i o n in c r e a s e d

v a rio u s w id e s p r e a d p o p u la r p r o t e s t s - for

co n sid e rab ly in P a r a g u a y b e tw e e n 1 99 0 an d

i n s ta n c e b e tw e e n th e city of M o n te rre y an d

1 9 9 6 (from 64 to 76 p e r cen t) w hile it did not

t h e Bajo Rio S a n J u a n T a m a u l ip a s s e t tl e r s ,

dim inish in V en ez u e la b e tw e e n 19 90 a n d 1 99 7

a n d a m o n g s t people in A g u a s c a li e n te s and

(stickin g a t 25 p e r c e n t ) . 134

Mexico City. In t h e Valley of Mexico, th e social

It is also difficult to g a u g e th e overall

s tru g g le to o k different forms: people w ith h e ld

im p a c t of p r iv a tiz a tio n on th e q u a lity of p rov i­

p a y m e n t of w a t e r bills, c om p la ined t h a t th e

sion a n d c o v e ra g e , a lt h o u g h - a s in o th e r

a m o u n t s c h a r g e d w e re ex cessive, d e stro y e d

re gion s of th e w o rld - t h e p ro p o rtio n of th e

t h e w a t e r m e t e rs , k id n a p p e d w a t e r sellers or

u r b a n p o p u la tio n s e r v e d by la rg e -sc a le , form al

m a d e violent a t t a c k s on t h e w a t e r u tilitie s .121

p riv a te e n te r p r i s e s is low (see C h a p te r 5 for more d etails).

The m odernization p olicies which in m any

No a n a ly s is of a v a ila b le s t a t i s t i c s can

respects involve the expropriation o f rights

brin g o u t th e y e a r s (or de c a d e s) of s t r u g g le by

and fu r th e r exclusion fo r large sectors o f

u r b a n d w e lle rs to g e t official w a t e r an d s a n i t a ­

the population have been answ ered back not

tio n provision. Box 1.7 gives som e ex am p les.

only with d efensive actions fro m those

Of co u rse, t h e problem is, in p a r t , r e l a te d to

being excluded, but also with in itiatives

th e f a c t t h a t la r g e s e c tio n s of t h e p o p u latio n

directed a t expanding the scope and depth

in m ost cities live in inform al or illegal s e t t l e ­

o f the rights o f the p eo p le. 122

m en ts. Obviously, m u nicip al or s t a t e w a t e r an d s a n i ta t io n a g e n c ie s (or p ri v a te co m p a n ie s t h a t

D espite t h e in a d e q u a c ie s in provision for both

ow n or m a n a g e w a t e r a n d s a n i ta t io n p rov i­

w a t e r a n d s a n i ta t io n t h a t affect la r g e sectio n s

sion) m a y be r e l u c t a n t to e x te n d official w a t e r

of t h e u rb a n p o p u la tio n s in m o s t n a tio n s , it is

an d s a n i t a t i o n provision to illegal s e t tl e m e n t s ,

also c le a r t h a t t h e p ro p o rtio n of people

b e c a u s e it im plies official e n d o r s e m e n t of th e i r

r e a c h e d by im proved provision (and w ith good

la n d o c c u p a tio n , or it is illegal for th e m to do

q u a lity provision) h a s in c r e a s e d v e r y c o n sid e r­

so. H owever, a s will be d is c u ssed in more

ab ly o ve r th e la s t few d e c a d e s. The

d e ta il in C h a p te r 2, in m ost cities th e r e is a

PAHO/WHO 2 0 0 0 a s s e s s m e n t only h a s figures

more c om plex s t o r y t h a n this: som e illegal

for how c o v e ra g e c h a n g e d for t o t a l p o p u la ­

s e t t l e m e n t s a re w ell se rv e d , som e a re p a r t ly

tion s: in 19 60 j u s t 33 p e r c e n t of th e reg io n’s

s e r v e d a n d som e a re n o t s e r v e d by official

p o p u la tio n h a d w a t e r piped to th e i r h o m es or

providers. In m a n y cities, th e e x t e n t of official

e a s y a c c e ss ; by 2 0 0 0 it w a s 85 p e r c e n t. In

w a t e r and s a n i ta t io n provision in illegal s e t t l e ­

1 9 6 0 , j u s t 14 p e r c e n t of th e p o p u la tio n h ad

m e n t s r e l a t e s m ore to p olitical s t r u c t u r e s an d

c o n n ectio n to se w e rs ; by 2 0 0 0 , 49 p e r c e n t

decisions an d th e c o m p e te n c e , c a p a c i ty and

h a d c o n n e c tio n s (an d obviously m o s t of th o s e

a t t i t u d e of t h e utilities t h a n to s e t t l e m e n t s ’

w ith s e w a g e co n n e c tio n s w e re in u r b a n a re a s ).

leg al s t a t u s . In add ition , provision for in f r a ­

It is also likely t h a t , in g e n e ra l, m o s t u rb a n

s t r u c t u r e to illegal s e t t l e m e n t s is a lm o st

d w e lle rs h a v e m ore reliable an d s a f e r w a t e r

a lw a y s a d hoc a n d bit by bit - so a f t e r n e g o ti­

sup plies t h a n w a s th e c a s e in 1 9 6 0 - in p a r t

a tio n a n d lobbying, t h e y g e t r o a d s p av ed one

P r o v is io n f o r w a t e r a n d s a n it a t io n in c i t ie s

39 y e a r (often j u s t before elections!), p e r h a p s a

w o r l d ’s u rb a n po p u latio n ). Table 1.12 gives

piped w a t e r sup ply som e y e a r s l a t e r an d (more

th e p ro p o rtio n of people living in cities in

u n u su a lly ) s e w e r co n n e c tio n s som e y e a r s later.

different size c a te g o r ie s in e a c h region of th e

This also m e a n s t h a t t h e w hole p ro c e s s is

w orld.

more costly, a s th e different a g e n c ie s re s p o n s i­

In A frica (and E urope) in 2 0 0 0 , more

ble for different forms of i n f r a s t r u c t u r e do not

t h a n th re e-fifth s of t h e u r b a n p o p u la tio n lived

w o r k to g e th e r. In th e c a s e of P u e r t a s del Sol

in u rb a n c e n tr e s w ith less t h a n ha lf a million

IV in Box 1.7, th e i n h a b i t a n t s finally g o t th e i r

in h a b i t a n t s a n d th is included a la r g e p ro p o r­

r o a d s p a v e d b u t no provision for s e w e r s an d

tion in u rb a n c e n tr e s w ith less t h a n 2 0 ,0 0 0

dra in s, a n d now t h e c o st of p u tt in g in s e w e r s

i n h a b i ta n t s . In L a tin A m e ric a a n d th e

a n d d ra in s is m u c h h ig h e r b e c a u s e it w ou ld

C arib b e a n a n d A sia, close to h a lf th e u rb a n

m e a n rep av in g all th e r o a d s . 135

p o p u la tio n lived in u r b a n c e n tr e s w ith less

In conclusion, it is c le a r t h a t m uch of th e

th a n half a million p o p u la tio n . Even in Latin

u rb a n p o p u latio n in th is region a re b e t t e r

A m eric a, w h e re a high p ro p o rtio n of u rb a n

se r v e d w ith w a t e r an d s a n i ta t io n t h a n a re th e

d w e lle rs live in m eg a-cities, t h e r e w e re still

u r b a n p o p u la tio n s in A frica a n d Asia; it is also

m ore t h a n t h r e e ti m e s a s m a n y people in u rb a n

c le a r t h a t c o n sid era b le p ro g r e ss h a s been

c e n tr e s w ith less t h a n h a lf a million in h a b i­

m a d e in e x p a n d in g an d e x te n d in g provision

t a n t s , t h a n in m ega-cities. All u r b a n c e n t r e s ( w h e th e r la r g e o r sm all

ov er th e l a s t few d e c a d e s (a lth o u g h th e m o m e n tu m for im proving provision slow ed

cities or u r b a n c e n tr e s to o sm all to be called

during t h e 1 9 9 0 s). H ow ever, it is also c le a r

cities) need:

t h a t a sig n ifica n t p ro p o rtio n of th e regio n’s u r b a n p o p u la tio n s still la c k a d e q u a t e w a t e r

•

w a t e r su p p ly s y s te m s d ra w in g from p r o t e c te d w a t e r s o u r c e s, e n su r in g t h a t

a n d s a n i ta t io n provision - m uch more t h a n th e 7 p e r c e n t w h o la c k im proved provision for

u n c o n ta m in a t e d w a t e r is easily ava ilab le

w a t e r an d th e 13 p e r c e n t w h o la c k im proved

to all ho u seh o ld s (preferab ly th r o u g h

provision for s a n i ta t io n hig hligh ted in t h e 2 0 0 0

c o n n e c tio n s to h o m es or y a r d s , a n d if no t

a s s e s s m e n t. M ost of th o s e w ith in a d e q u a te

to n e a r b y s ta n d p ip e s ) ; and

provision a re in t h e p o o rer n a tio n s, or in th e

•

provision for t h e disp o sal of househ old

s m a ll e r cities a n d u r b a n c e n tr e s in t h e middle-

a n d h u m a n w a s t e s (including e x c r e t a ,

incom e n a tio n s.

h o u seh old w a s t e w a t e r , sto rm a n d su rfa c e run-off a n d solid w a s te s ) .

The special problems of smaller cities and towns in low-income countries

Provision for w ater and sanitation

T h ere is fa r m ore d o c u m e n t a ti o n of w a t e r an d

The lim ited r a n g e of a v a ilab le s t a t i s t i c s

s a n i ta t io n provision in larg e c ities t h a n in

s u g g e s t t h a t in g e n e ra l, w ith in low- an d

s m a ll e r cities or in t h e u r b a n c e n tr e s t h a t are

middle-incom e n a tio n s, th e la r g e r t h e city, th e

too sm a ll to be c o n sid e red c itie s .142 B ut m ost

h ig h er th e p ro p o rtio n of th e p o p u la tio n w ith

of th e w o r l d ’s u rb a n d w e lle r s do n o t live in

w a t e r piped to th e i r home or y a r d a n d c o n n e c ­

la r g e cities. For in s ta n c e , by 2 0 0 0 , less t h a n 4

tio n to s e w e r s - a lth o u g h , a s n o te d earlier,

p e r c e n t of t h e w o r l d ’s p o p u latio n an d less

m a n y cities in Africa a n d A sia h a v e no se w e rs .

t h a n 8 p e r c e n t of its u rb a n p o p u la tio n lived in

This w a s sh o w n by an a n a ly s is of service

t h e 16 m ega -c ities of 10 million or more i n h a b ­

provision in u rb a n a r e a s of 43 low- a n d middle-

i t a n t s . B ut t h e r e is a m uch la r g e r li te r a t u r e on

incom e n a ti o n s d r a w n from d em o g r a p h ic an d

t h e w a t e r a n d s a n i ta t io n p ro b lem s of m e g a ­

h e a lt h s u r v e y s (see Box 1.8). T h e v a r i a ti o n s in

cities t h a n on th o s e of th e t e n s of t h o u s a n d s of

provision b e tw e e n u rb a n c e n tr e s of different

u rb a n c e n tr e s w ith u n d e r h alf a million in h a b i­

size c la s s e s is less d r a m a ti c for w a t e r in th e

t a n t s , w hic h h ave m ore t h a n six tim e s a s

home (F igure 1.2) t h a n for flush to ile ts (Figure

m a n y people in t o t a l (and m ore t h a n h a lf th e

1.3), an d in s u b - S a h a r a n Africa an d A sia, in

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

40 Table 1.12 The distribution of th e urban population betw een different size urban centres, 2000

Region

Urban population (millions)

World

2862 295 1376 534 391 243

Africa Asia Europe Latin America and the Caribbean Northern America Oceania

Percentage o f the urban population in urban centres with 10 million + 5 0 0 ,0 0 0 -9 .9 9 Under 500,000 million inhabitants inhabitants inhabitants

23

7.9 0 9.9 0.0 15.0 12.3 0.0

39.6 38.6 40.3 35.7 36.9 48.6 54.2

52.5 61.4 49.8 64.3 48.1 39.1 45.8

Source: sta tistics dr aw n or derived from United Nations (2002), World Urbanization Prospects; The 2001 Revision; Data Tables and Highlights, Population Division, Department of Economic and Social Affairs. United Nations Secret ari at , E S A /P /W P /1 7 3, New York, 181 pages.

u rb a n c e n tr e s w ith fe w er t h a n 1 0 0 ,0 0 0 in h a b i­

provision in different u r b a n c e n t r e s in Africa,

t a n t s a g r e a t e r p ro p o rtio n of t h e p o p ula tion

an d also il lu s t r a t e s th e la c k of a n y c a p a c i ty

a p p a r e n t l y h a v e w a t e r in th e hom e t h a n in th e

am o n g local a u th o r it ie s to en su re a d e q u a t e

la r g e s t cities. For flush to ilets, in all regions,

w a t e r an d s a n i ta t io n provision. A review of

u r b a n c e n tr e s w ith less t h a n 1 0 0 ,0 0 0 in h a b i­

provision for w a t e r in sm all to w n s in Africa

t a n t s s e r v e th e lo w e s t p ro p o rtio n of th e

h igh ligh ted t h a t t h e s e g e n e ra lly h av e s e v e r a l

p op ula tion . D ra w in g from all th e stu d ie s , less

different co ex isting w a t e r supply sy s te m s ,

t h a n tw o -fifth s of th e i n h a b i t a n t s of u rb a n

w hic h s o m e tim e s co m p e te w ith ea c h o th e r -

c e n tr e s w ith less t h a n 1 0 0 ,0 0 0 in h a b i ta n t s

for in s ta n c e m ech a n iz e d su pp lies (gen erally

h a v e flush toile ts, c o m p a r e d to 70 p e r c e n t for

bo reh oles w ith m o to riz ed p u m p s sup plying

cities w ith 1 - 5 million in h a b i t a n t s a n d more

w a t e r to e le v a te d s t o r a g e t a n k s a t t a c h e d to a

t h a n 80 p e r c e n t for cities w ith 5 million plus

limited d is trib u tio n sy s te m of public t a p s t a n d s ,

i n h a b i ta n t s . F ig u re 1.3 is also a re m in d e r of

so m e tim e s coupled w ith c a t t l e tr o u g h s an d

how sm all a p ro p o rtio n of th e u r b a n p o p ulatio n

individual ho u se co n n ectio n s) a n d w a t e r d r a w n

in A frica h a s a c c e s s to flush to ilets.

from t a p p e d a n d p ro t e c te d s p rin g s or o th e r

In m a n y n a tio n s , esp ecia lly th o s e w h e re t h e r e h av e b een im p ro v e m e n ts in w a t e r a n d

(often d is ta n t) s o u r c e s . 143 Note how few of th e people (or in som e

s a n i ta t io n provision in re c e n t y e a r s , s m a lle r

in s ta n c e s none of them ) h a d a c c e s s to a piped

u r b a n c e n tr e s in w e a l t h i e r reg io ns m a y h ave

w a t e r sy s tem in M bandjock, Aliade, Igugh,

b e t t e r provision t h a n la r g e r u r b a n c e n tr e s in

Ugba, th e sm a lle r to w n s in M w a n z a P rovince

p o o re r regions. Box 1.9 s h o w s how w a t e r and

an d tw o of th e th r e e to w n s in Benin. In Kumi

s a n i ta t io n provision v a rie s by th e size of u rb a n

an d Wobulenzi in U g a n d a , m ost of th e p o p u la ­

c e n tr e in Brazil. This s h o w s how w ith in ea c h

tion have a c c e s s to a piped supply b u t only

region in Brazil, provision g e n e ra lly im proves

th r o u g h w a t e r kio sks, w h e re th e w a t e r is

a s t h e size of th e city in c r e a s e s , b u t t h e r e a re

expensive. In 4 7 sm all to w n s in th e M a ta m

s m a lle r differences b e tw e e n provision in larg e

d e p a r t m e n t in S en eg al, w ith b e tw e e n 2 0 0 0 a n d

a n d sm all u r b a n c e n tr e s in th e w e a l t h i e r

1 5 ,0 0 0 in h a b i ta n t s , t h a t a re p a r t of a w a t e r

regions.

m a n a g e m e n t s u p p o r t p ro g r a m m e , th e ty p ica l

D etailed c a s e s tu d ie s of w a t e r a n d

w a t e r supply sy s tem is a borehole w ith m o to r­

s a n i ta t io n in sm a ll u r b a n c e n tr e s confirm t h a t

ized p um p an d a piped n e tw o r k w ith b e tw e e n 5

provision is g e n e ra l ly v e r y i n a d e q u a t e -

a n d 20 s t a n d p o s t s a n d one or tw o c a ttle

a lth o u g h t h e r e a re re lativ ely few such case

tr o u g h s .144 A review of 25 sm all u rb a n c e n tr e s

s tu d ie s, e sp e cially in re latio n to t h e n u m b e r of

in tw o d is tric ts of n o rt h e rn D a rfu r in th e S u d an

sm all u rb a n c e n tr e s in low- a n d middle-income

pointed to co m p a ra b le sy stem s: boreholes

n a tio n s. Box 1.10 provides som e e x a m p le s of

eq uipped w ith diesel-pow ered p u m p s supplying

P r o v is i o n f o r w a t e r a n d s a n i t a t io n in c i t i e s

41 The availability of w a t e r in th e home an d flush to ilets in r u r a l a r e a s and urban a r e a s by size class

The demographic and health surveys

are as and four categories of urban

w a te r piped to people’s homes, and

have limited data on geographic

a reas (under 100,000 inhabitants,

Figure 1.3 shows the variation in the

identifiers, but it w as possible to

1 0 0 ,0 00 -4 99 ,99 9, 5 00 ,0 0 0 -1 million,

availability of a flush toilet.

analyse their d a ta on service provision

1-5 million and above 5 million).

grouped within five categories: rural

Figure 1.2 shows the variation in

1.2 W a te r in th e home for different size classes of cities

Flush to ile t for different size classes of cities

% h o u s e h o l d s with piped o r w e ll w a t e r on p r e m i s e s

% h o u s e h o l d s w i t h f l u s h toilet

1 00

90

80

70

60

50

40 30

20

10

North A frica

Su b -S a h a ra n Southeast Africa

South and

A siaW est A sia

Latin

A m erica

Rural

100.000-500,000

U rb a n u n d e r 100,000

500.000-1

North A frica

Su b -Sa h a ra n Southeast Africa

South and

A siaW est A sia

A m erica

1 - 5 m illion m illion

I O ver 5 m illion

Source: H e w et t, Paul C and Mar k R M on tgo me ry (2002) , Poverty and Public Services in Developing-Country Cities, Population Council, New York, 62 pages.

w a t e r to e le v a te d s t o r a g e t a n k s w ith a lim ited

la c k of a n y i n v e s t m e n t c a p a c i t y for in s ta llin g

d is trib u tio n s y s te m of s t a n d p i p e s . 145

or e x p a n d i n g b a s i c i n f r a s t r u c t u r e , a n d t h e

M o s t s m a ll c itie s a n d u r b a n c e n t r e s in

i n a d e q u a c y of t h e b a s i c i n f r a s t r u c t u r e a n d

A frica h a v e no p ub lic p ro v isio n for s a n i t a t i o n .

e q u i p m e n t . E v e n w h e n so m e c a p i t a l i n v e s t ­

T h is d oe s n o t j u s t m e a n t h a t t h e r e is no s e w e r

m e n t h a s t a k e n p la c e , t h e c a p a c i t y to m a n a g e

s y s t e m , b u t also t h a t t h e r e is no p u b lic s y s te m

or m a i n t a i n it is o fte n v e r y lim ited. For

to s e r v e a p o p u la t io n r e l i a n t on p it l a t r i n e s -

i n s t a n c e , e v e n t h o u g h t w o of t h e s m a ll e r

fo r in s t a n c e , no s e r v ic e to a d v is e on p it - l a tr i n e

t o w n s in t h e M w a n z a r e g io n in T a n z a n i a h a d a

c o n s t r u c t i o n (so t h e y f u n c tio n eff e c tiv e ly a n d

n e t w o r k of p ip e s in p la c e a n d fu n c tio n in g

do n o t p o llu te g r o u n d w a t e r ) a n d no e q u i p m e n t

p u m p i n g s t a t i o n s , w a t e r w a s r a r e l y d e liv e re d

to e m p t y t h e m . It is als o c l e a r from t h e c a s e

t o t h e n e t w o r k b e c a u s e t h e fuel a llo c a ti o n

s t u d i e s s u m m a r i z e d in Box 1 .1 0 t h a t it is

c o u ld only m e e t t h e r e q u i r e m e n t s of a few

co m m o n for a s ig n if i c a n t p r o p o r tio n of h o u s e ­

w e e k s ’ o p e r a t i o n p e r y e a r . 146

h o ld s to h a v e no l a t r i n e . W h a t t h e c a s e s t u d i e s of s u c h c e n t r e s m a k e c l e a r is lo c a l a u t h o r i t i e s ’

Given t h a t so m e of t h e s t u d i e s r e p o r t e d in Box 1 .1 0 w e r e u n d e r t a k e n t e n or m o re

Latin

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

42 Box 1.9 D i f f e r e n c e s in p r o v i s i o n f o r w a t e r a n d s a n i t a t i o n b y t h e p o p u l a t i o n s i z e o f t h e u r b a n c e n t r e in B r a z i l

In general, the larger the city popula­ tion, the higher the proportion of households with piped w ater and the greater the likelihood th a t the water is treated. Only 46 per cent of house­ holds in municipalities with under 20.000 inhabitants have access to the general w ater network system, and smaller municipalities are also less likely to have w ater treatm ent plants. 14 per cent of Brazil’s population live in municipalities with fewer than 20.000 inhabitants. The larger a city’s population, the larger the proportion of house­

holds with connections to sewers, although in the wealthier regions, the disparities between large and small cities is much smaller. 48 per cent of municipalities in Brazil have no sewers, and there is a clear pattern of disadvantage in the poorer regions and the smaller urban centres. On average, in municipalities with more than 300,000 inhabitants, the propor­ tion of households connected to sewers is three times greater than in municipalities with fewer than 20,000 inhabitants. In the southeast, 59 per cent of households in municipalities of

300,000 or more inhabitants have sewer connections, compared to 42 per cent of households in municipali­ ties with fewer than 20,000 inhabitants. In the northeast, in municipalities with 300,000 or more inhabitants, the proportion of house­ holds with sewer connections is 3.4 times greater than in municipalities with fewer than 20,000 inhabitants; in the centre west there is a tw enty­ fold difference. Source: Jacobi. Pedro (2002), Management o f Urban Water and Sanitation in Brazil, Background Paper prepared for UN-HABITAT, Nairobi.

y e a r s ag o, c o nd ition s m a y h ave im proved since

tio n s b u t a ro u n d 4 3 ,0 0 0 i n h a b i ta n t s ; in

t h e n . B ut one c a n n o t a s s u m e th is is t h e c a se.

P on ani, 8 4 5 hou seh old co n n e c tio n s a n d 5 1 ,7 7 0

T h e sec tio n on Africa included d e ta ils of how

in h a b i ta n t s .

pro vision for w a t e r h a d go t w o rs e in m a n y

The 1 9 9 9 S ta te o f In d ia ’s E n viro n m ent

u rb a n sites in E a s t A frica ov er th e l a s t 30

re p o r t pro d u ced by t h e C entre for S cien ce and

y e a r s . Box 1.11 p r e s e n t s a n ex a m p le of th is

E n v ir o n m e n t137 r e p o r ts on e n v ir o n m e n ta l

from a sm all u rb a n c e n tr e in U gan d a.

prob lem s in s m a lle r cities an d u rb a n c e n tr e s . It

In A sia, t h e r e is far more d o c u m e n ta tio n

re p o r te d s tu d ie s in four in d u s tria l to w n s

of th e pro blem s w ith w a t e r a n d s a n i ta t io n in

(L u d h ian a , Jetp u r, T ir u p p u r a n d R ou rk e la) an d

la rg e cities t h a n in sm a ll u r b a n c e n tr e s. In

four no n -in d u strial u rb a n c e n tr e s (A ligarh,

p a r t , th is is b e c a u s e c e n s u s d a t a a b o u t th e

B h aga lpu r, K o tta y a m a n d Ja is a lm e t) , w hich

e x t e n t of provision for w a te r , s a n i ta t io n an d

h igh lig hte d th e v e r y p o o r s t a t e of t h e s e u rb a n

d r a i n a g e a re n e v e r p ublished (or m a d e a v a il­

c e n t r e s ’ e n v ir o n m e n ts ra n g in g from t h e i n a d e ­

able) for individual u r b a n c e n tr e s. It is usu ally

q u a c ie s in provision for w a te r , s a n i ta t io n ,

i n d e p e n d e n t r e s e a r c h s tu d ie s t h a t provide

d r a i n a g e an d g a r b a g e collection to failu re s to

evidence of t h e in a d e q u a c ie s in provision, a s in

con tro l in d u s tria l pollution. T hey also

Box 1.1 2, w h ic h gives e x a m p le s from s m a lle r

h ig h lig h ted t h e a b s e n c e of a n y o rg a n iz e d civic

cities in In dia. T h e se e x a m p le s also il lu s tr a t e a

effort to a d d r e s s this.

problem w hich a p p e a r s to be p a r t ic u l a r ly com m on in s m a lle r u rb a n c e n tr e s in A frica a nd

Box 1.1 3 r e p o r t s on th e findings of s t u d ie s in t h r e e s m a ll u r b a n c e n t r e s in

A sia - th e high p ro p o rtio n of low-income

C h in a .158 T h e s t u d y from w h ic h t h e s e d e s c r ip ­

h o u seh o ld s t h a t h av e no provision for s a n i t a ­

ti o n s a re d r a w n cho se sm a ll t o w n s from

tion a n d so d e fe c a te in open sp a c e s .

d ifferent a r e a s : one is in t h e p oo r n o r t h w e s t ­

For t h r e e u r b a n c e n tr e s in Box 1.12 th e

ern pro vince, one is in a t r a d i t i o n a l (far from

s t u d y focused on t h e slum s, a n d in tw o of

afflu ent) province a n d one is in a more

th e m , B h ilw a ra a n d S a m b a lp u r, m o s t slum

p r o s p e ro u s c o a s t a l province. In e a c h u r b a n

h o u seh o ld s h a d no w a t e r so u rce w ith in th e

c e n tr e , 133 h o u se h o ld i n t e r v i e w s to o k p lace.

home a n d no toile t. In th e s t u d y of C h e rta la ,

The a b s e n c e of a n y public pro vision for s a n i t a ­

w hic h covered th e w ho le p o p u la tio n , 25 p e r

tio n o th e r t h a n a few public la t r i n e s , a n d th e

c e n t of h o u seh old s w e re w i t h o u t toilets. The

a b s e n c e of h o u s e h o ld s w ith piped w a t e r

s t u d y of C h e r ta l a an d P o n a n i also s h o w e d how

su p p lie s to th e h om e, is p a r t i c u l a r l y n o ta b le in

m o s t h o u se ho lds la ck e d h o u se ho ld c o nn ec tion s;

N e ig u an a n d Y a n ta n . Of co u rs e , g e n e r a l

in C h e r ta l a t h e r e w e re 2 3 8 h ousehold c o n n e c ­

c on clusio ns c a n n o t be d r a w n from t h e s e

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

43 Box 1 .10 E x a m p l e s o f p r o v i s i o n f o r w a t e r a n d s a n i t a t i o n i n s m a l l A f r i c a n u r b a n c e n t r e s

Kumi (Uganda)

There are also th re e public latrin es,

Kumi Town is the c a p ital of Kumi

b u t th e num ber of u sers is low

deep boreholes equipped with diesel-

d istrict and h a s a population

becau se of a high c harge (100

pow ered pumps, supplying w a t e r to

e stim a ted a t 17,000 in h ab ita n ts in

Ugandan shillings p e r use). A piped

elevated sto ra g e ta n k s , w ere used. A

2000. Kumi to w n council is responsi­

w a t e r n e tw o rk covers most of the

limited distribution system of s t a n d ­

ble for w a t e r and sa n itatio n services.

to w n an d feeds 31 kiosks, 64 private

pipes, tro u g h s for w ate rin g livestock

The to w n ’s w a t e r supply comes from

co nnections and 6 in stitu tio n s.148

new w a t e r suppliers. In all cases,

and a tank-filling outlet w a s provided in each to w n . 151

boreholes and pumps plus overhead t a n k s feeding a piped distribution

Kabale (Uganda)

n etw o rk, w ith public kiosks (at the

With 27 ,905 in h ab ita n ts in 1991, this

Mbandjock (Cameroon)

time of th e study the re w ere 15 kiosks

is a m a r k e t to w n in an extremely

Only ab ou t 20 per cent of the p op ula ­

but tw o w ere closed from lack of

fertile and high-density ru r a l a rea.

tion (estim ated a t 2 0,0 00 in 1996)

operation) and a few household

There w ere ju s t 21 7 connections to

have access to piped w a te r; the rest

connections. In F eb ru ary 2 0 0 0 , w a te r

th e piped w a t e r system and, on

rely on wells and springs for th eir

w a s available for tw o hours a day.

av erag e, w a t e r w a s supplied for four

w a t e r supply, but te s ts found t h a t all

L akes t h a t are 10 and 16 kilometres

hours in the morning and tw o hours in

spring and well w a te r s presented

a w a y could be tap p ed , but th is would

the evening. E stim a te s sug gest t h a t

evidence of faecal con tam in atio n of

require e x te r n a l funding. In Kumi,

less th a n 16 per cent of th e population

hum an a n d /o r anim al origin. D ata

virtually all households are reliant on

had access to w a t e r from th is system.

from th e city hospital show th a t

w a t e r kiosks or w a t e r vendors. A

Provision for san itatio n w a s also very

ga stro -intestin al and d iarrh oeal

family w ith an income e quivalent to

deficient. Refuse collection relied on

diseases are am o n g s t th e m ost p re v a ­

the a v erag e daily w ag e and co nsum ­

one w orking t r a c t o r and trailer, w hich

lent in the comm unity (after m alaria

ing 24 litres p e r person per day would

collected w a s te s from 20 a re a s

and onchocerciasis). The city h as no

be spending 15 p er c en t of its income

m arked with signposts w here refuse

se w e r system and th e only m ethods of

on w a te r; if it relied on vendors, it

w a s deposited by th e public. It is

sew ag e disposal are pit latrin es and

would be 45 per cent of its income.

estim a te d t h a t aro un d 1 0 - 2 0 per cent

septic t a n k s . 152

Around 60 per cent of households

of th e daily refuse w a s co llected .149

Mwanza province (Tanzania)

have pit latrin es and th ere are tw o

According to the 1988 census, over 90

n ear th e bus p a rk , th e other n e a r the

Matam department, northeast Senegal

Town used a piped w a t e r supply for

public pit latrin es in th e tow n - one

per cent of households in M w a nza

m a rk e t - and the se are free. They

Among 47 small to w n s with b etw een

should be available during daylight

2000 an d 15,000 in h ab ita n ts t h a t are

drinking, but th e situation in sm aller

hours but th e latrine n ea r th e m a rk e t

p a rt of a w a t e r m a n a g e m e n t support

to w n s n earb y w a s much w orse. Only

w a s locked w hen visited by

p rogram m e, the typical w a t e r supply

2 0 - 3 0 per cent of households in the

re s e arc h e rs in 2000. According to the

system is a borehole w ith a motorized

o th e r tw o to w n s on th e lakeshore had

m a rk e t tr a d e rs , th e keyholder is often

pump, and a piped n e tw o rk w ith

piped drinking w ater, and in the

absent. A th ird public toilet w ith a

b etw een 5 and 20 sta n d p o sts and one

inland to w n s this fell to ju s t 1 -5 per

septic t a n k w a s built beside th e new

or tw o c attle tr ou gh s. For la rg er

cent. The main problems in providing

m a r k e t but w a s n ever completed, and

se ttle m e n ts, the nu m ber of private

piped supplies in u rb an a r e a s w ere the

the w a t e r had not been connected.

connections becomes significant (eg

m ain ten an ce and installation of infra­

Men who collect w a t e r are mostly

up to 200 connections in to w n s of

s tru c tu r e , and obtaining fuel for

vendors, and th e y bully w om en and

10,0 00 inh abitants). In to w n s of 5000

pumping (the over-riding problem for

children so t h a t th ey can ge t priority,

or more, the uncontrolled expansion of

sm aller to w ns). Even th ou gh tw o of

even w hen w omen have been queuing

the original n e tw o rk cau se s w a te r

th e sm aller tow n s in the M w an za

for as long as tw o hours. Children

pressure im balances and l e a k s .130

region had n e tw o rk s of pipes in place

the w o m e n .147

Northern Darfur (Sudan)

w a t e r w a s rarely delivered to the

25 u rb an cen tres in tw o d istricts of

n e tw o rk s becau se th e fuel allocation

Wobulenzi (Uganda)

northern D arfur w ere included in a

could only m eet th e requirem ents of a

The to w n ’s population w a s estim ated

w ater, san itatio n and hygiene e d u c a ­

few w e e k s ’ operation per year. In the

a t 12,000 in 2000. The to w n council

tion project from 1 9 8 7 - 1 9 9 0 . They

sm aller to w ns, virtually all households

is responsible for w a t e r and sanitation

ranged in size from 3 00 0 to 10,000

t h a t report using piped w a t e r supplies

but has deleg ated responsibility to a

in hab itants. 15 had m echanized w a te r

are de pendent on public standpipes. In

w a te r - u s e r s ’ association. Around 70

system s (th at th e project sou gh t to

M w an za Town, aro un d 20 per cent of

per cent of households have latrines.

rehabilitate) while ten w ere to have

households have w a t e r piped into th e

and functioning pumping station s,

have lower priority in the queues th a n

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

44 home or th eir yard, and 10 per cent

of w a t e r are strea m s, ponds and

Benin City (Nigeria)

have full plumbing facilities including

rivers. The s t a te w a te r boards in

Families in th e informal housing sector

flush toilets. In urban M w an za, on

Nigeria are responsible for providing

in Benin City norm ally use pit latrines.

av erag e, m ig rant people had to w alk

w a t e r supplies to urban centres, but

A 1995 survey found t h a t 74 per cent

750 m etres, and resident people 600

piped w a t e r schem es are rarely av a il­

of households relied on these, and

m etres, to obtain w a t e r .153

able to small u rb an centres. There is

most w ere of questionable quality.

no public provision for sa nitation;

Household w a t e r is mainly piped from

Aliade, Igugh and Ugba (Nigeria)

most households use pit latrines,

outside th e housing premises (from

although some households have no

a n o th e r compound, th e stre e t or other

E ach of th ese u rban centres had a

a ccess to a latrine. About half of the

neighbourhoods) or obtained from a

population e stim ated a t b etw een 6000

households using such latrin es share

w a t e r vendor or from a rain h a rv e s te r

and 8 0 00 in 1980. Two of them have

them . Refuse collection and disposal is

underground t a n k . 130

no piped w a t e r system , and in the

in th e o ry a local go vern m en t responsi­

third, only a sm all num ber of h ou se ­

bility, but 67 per cent of households

Small cities in Benin

holds have a ccess to tr e a te d w a te r

dump refuse in th eir b a c k y a rd s while

A stud y of three s ec o n d ary cities in

(from th e s t a te ru r a l w a t e r supply

most of th e rest burn or bu ry it. Only

Benin found t h a t in tw o of them , the

scheme). Most households obtain

in one of th e th ree urban cen tre s w as

v a s t majority of th e population lacked

w a t e r from compound wells, which

th ere neighbourhood collection and

running w a t e r and latrines, so most

are th e responsibility of the compound

disposal, and this w a s organized on a

people defecated in th e b u s h .156

owner; th e next most common sources

small s c a le .154

s t a t i s t i c s ; t h e r e a r e 2 0 , 0 0 0 su c h zhen [small

C hina is m u c h in flu e n c e d by th e q u a l ity an d

u r b a n c e n tr e s ) in China. B ut t h e s tu d y from

e x t e n t of p rovision in t h e s e s m a ll u r b a n

w h ic h t h e s e e x a m p le s a r e d r a w n does

c e n tr e s . V aclav Smil s u g g e s ts t h a t t h e problem s

hig h lig h t how a sig n ific a n t p r o p o rtio n of C h i n a ’s u r b a n p o p u la tio n live in s m a ll u r b a n

w ith w a t e r q u a lity found in m o st u r b a n a r e a s

c e n tr e s , so t h e q u a l ity a n d e x t e n t of w a t e r

of China a r e esp ec ially se rio u s in r u r a l t o w n s

a n d s a n i t a t i o n p rovision in u r b a n a r e a s of

a n d m edium -size c i tie s .159

Box 1.11 T h e d e t e r i o r a t i o n in t h e q u a lity of m u n ic ip al w a t e r s u p p lie s in I g a n g a (U g and a)

A study of domestic w a t e r supplies in

situation worsened in the

By th e late 1980s, in an a t t e m p t to

Igan ga in 1967 found t h a t all sample

1 9 8 0 s when water pu m p s and

com pen sate for th ese problems, a l t e r ­

households received a d e q u a te supplies

m ost o f the distribution lines

native sources w ere developed.

of w a t e r 24 hours a day. A study in

broke down. O f the fo u r p u m p s

P riv ate individuals began to drill

1997 which retu rn ed to th e sam e sites

operating in the 1 9 6 0 s, only

boreholes and establish th e ir own

found t h a t for th e households in te r­

one was still working by 1 9 8 0 .

w a t e r kiosks. In 1998, th e s e private

viewed, th e municipal w a t e r system

sources w ere supplem ented w ith

had d ete rio rated to th e point t h a t only

The w a t e r storag e t a n k s and the

kio sks built by th e Igan ga tow n

13 p er cent of th em received piped

distribution lines w ere also r u s ty and

council.

w ater, and even in these case s w a te r

leaking. One u rb an w a t e r officer

only trickled out of pipes for a few

reported th at:

hours each day. Some households

Per c a p ita w a t e r use had increased for unpiped households, although not by v ery much - from an

re ported being w ith o u t piped w a te r

m ost o f the revenue collected

av erag e of 15 litres p er person per

for up to three years. One respondent

from water bills is spent on

day in 1967 to 24 in 1997.

explained:

repairing the pipes and pum ps.

Source: Th o m p so n , J ohn, Ina T P o r r a s , El isa b et h

Moreover, since the water

Wood, J a m e s K Tu m w i n e, M a r k R M u jw ah u zi ,

During the 1 9 6 0 s and early

pu m p s run o ff electricity that

M u n g u ti K a tu i - K a t u a an d Nick J o h n s t o n e (2 0 00 ),

1 9 7 0 s the situation was good,

is subject to freq u en t pow er

in E a s t Africa ov er t h r e e d e c a d e s ', E n viro n m en t

but from the late 1 9 7 0 s

cuts, the water supply is

and U rbanization, Vol 12, No 2, Oc tobe r; an d

Ionwards/, the supply o f water

unreliable. I t is really beyond

W h it e. Gilbert F, David J B ra dl ey an d Ann e U

began to deteriorate. The

our control.

'W ait in g a t t h e ta p : c h a n g e s in u r b a n w a t e r use

W h i te (1 9 7 2 ) , D raw ers o f W ater, Un ive rs it y of Ch ic ago P re s s, Ch icago an d London.

P r o v is io n f o r w a t e r a n d s a n it a t io n in c it ie s

45 Box 1.12 E x a m p l e s o f w a t e r a n d s a n i t a t i o n p r o v i s i o n i n s m a l l e r u r b a n c e n t r e s i n I n d i a

Chertala

piped w a t e r supplies. The rest rely on

th e slums had grown up around a ta n k

With around 4 3,0 00 in h a b ita n ts in

s ta n d p o s ts or o ther w a t e r sources.

or a pond which had initially been a

2000, there is an abu nd an ce of w a t e r

W a te r supplies in the piped system are

major source of w ater, b u t these

and a high incidence of mosquito-

in te rm itte n t and a t risk of c o n ta m in a ­

becam e unusable becau se th ey were

re lated disease, especially m alaria and

tion. There are no sew ers; 52 per cent

not kept clean and m any of them had

filariasis. The w a t e r supply is

of th e population rely on toilets

dried up completely. The municipality

op era ted by the s t a te w a t e r authority.

connected to septic ta n k s , 15 per cent

does not ta k e responsibility for clea n ­

The main w a t e r supply comes from

use tw in-pit pour-flush la trin e s an d 33

ing th e se ponds. More th a n

tu b ew ells and is distributed u n tr e a te d

p er cent have no latrin e or use a

th re e -q u a rte rs of th e 4 00 households

to 4 37 sta n d p o sts (around 1 per 100

‘service la t r i n e ’ (a simple dry latrine

re ported t h a t th e y had no provision

people) and 238 house connections.

in which faeces a re deposited on the

for any type of toilet facility and no

The piped supply is in ad eq u a te and

ground b e n e ath a s q u attin g hole and

dra ina ge facility around th e house. Of

commonly reg ard ed as unfit to drink.

removed each day by a ‘s w e e p e r ’).

th e 24 per cent of households re p o r t­

There is strong dissatisfaction am ong

There are also problems with flooding,

ing an y type of d rain age, 43 per cent

th e tow n dwellers w ith th e s ta te

especially for poorer groups who live

said t h a t th ese w ere not cleaned

agency, and th ere are plans to develop

in the most flood-prone areas.

regularly.

A survey of 400 households

municipal w a t e r supplies in each w ard . E stim ate s su g g est t h a t 7 0 - 8 0

d raw n from different slums in each of

per cent of households have latrines.

three cities found the following.

Siliguri Half th e households surveyed had independent w a t e r sources while the

There are th re e pay-and-use to ilets a t th e hospital, bus statio n and

Bhilwara

m a rk e t place. Two fu rth er toilet

Most households surveyed had access

houses had w a t e r supplies nearby, 87

complexes are planned. Officials

to w a t e r th rough ta p s and

p er cen t th o u g h t t h a t th e w a t e r w a s

reg ard the se as facilities for busy

handpum ps, b u t m any mentioned their

fit for drinking and n early all of them

public places, not for residential

distance from a w a t e r source as a

w ere satisfied w ith th e supply. Three-

major problem. Only 25 per cen t had

q u a r t e r s of th e houses had

areas.

rest used common sources. Most

w a t e r sources inside th e ir houses, and

in depende nt toilets (mostly built by

Ponani (Kerala)

the proportion of households with

th e municipalities a g a in s t a deposit of

With a population of 5 1,7 70 in 2000,

w a t e r inside th e ir houses rose with

R 150 by the beneficiary) and 18 per

this is one of the poorest to w n s in the

income - from 10 per cent for th o se

cent used comm unal toilets. Two-fifths

s ta te . Most of th e poor live in ten

with monthly incomes of less th a n

of th e households had no provision for

c o a s ta l w a rd s an d rely on fishing for

R 500 to 48 per cent for th o se with

drainage, and th e rest had open drains

th eir livelihoods; th e c o astal w a rd s

incomes above R 2 0 0 0 . T h ree-q u a rte rs

t h a t w ere rarely cleaned.

have saline g ro u n d w a te r for six

of surveyed households had no toilets,

Source: For th e first t w o s tu d ie s , Colin, J ere m y

m onths of th e y e a r an d poor drainage.

and most defecated in open s p aces or

a n d Joy M o r g a n (2 0 0 0 ) . Provision o f W ater and

The piped w a te r system has 845

n earb y fields. There w ere no public or

house connections (serving roughly 12

comm unity toilets.

San ita tio n S ervices to S m a ll T o w n s; P art B: Case S tu d ies in Uganda and In d ia , Well S tu d ie s in W a te r . S a n i t a t i o n an d E n v i r o n m e n t a l H e a l th Ta sk 3 2 3 , WE LL, L o u gh b or o u gh an d London, 53

per cent of all households), 75 non­

p a g e s . For t h e s t u d y on B h a r a t p u r , W S P ( 2 00 0 ),

household connections and 488

Sambalpur

standpipes. Most ta p s deliver w a te r

95 p e r cent of th e households

fro m Bharatpur, R ajasthan, In d ia , Field Note,

for 8 - 1 2 hours a day. Officials

surveyed depended on a community

W a t e r a n d S a n i t a t i o n P r o g r a m , S o u th Asia

estim a te t h a t all houses will have

w a t e r source, and in m ost slums the

Region. New Delhi, 8 p ag e s. Thi s r e p o r t also

latrin es by 2001.

num ber of such sources w a s in ad e­ q uate. Only 56 per cent had ac cess to

Urban E n viro n m en ta l San ita tio n Planning: L esso n s

d c s c r i b c s a p r o g r a m m e to provide impro ved w a t e r a n d s a n i t a t i o n provision. For t h e s tud ie s on s lu m s , Ghosh, A, S S A h m a d an d S hi pr a M a it r a ( 1 9 9 4 ) , B a sic S ervices fo r Urban Poor: A

Bharatpur (Rajasthan)

a municipal piped w a t e r supply, and

With around 2 0 0 ,0 0 0 in h a b ita n ts in

the supply w a s irregular. In four of

2000, 61 p er cent of households have

the 12 sam ple slums the re w ere no

Sc ie nc es an d C on ce pt Pu bl ish in g Co m pa ny , New

legal household connections to the

so urces of piped w a t e r a t all. Most of

Delhi, 3 0 5 pa ge s.

S tu d y o f Baroda, B hilw ara, S a m b a lp u r and Siliguri, Urb an S tu d ie s S er ie s No 3, I n s t i t u t e of Social

In L a tin A m e ric a , th e r e a r e also so m e c a s e

only 4 6 p e r c e n t of h o u se h o ld s in m u n ic ip a li­

s tu d ie s of s m a lle r cities. M ost h ig h lig h t t h e

tie s w ith u n d e r 2 0 ,0 0 0 i n h a b i t a n t s h a d a c c e s s

i n a d e q u a c ie s in w a t e r a n d s a n i t a t i o n p ro v i­

to th e g e n e r a l w a t e r n e t w o r k s y s t e m , a n d

sion. Box 1.9 on B razil sh o w e d t h a t by 2 0 0 0 ,

close to half of all m u n ic ip a litie s h a d no s e w e r

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

46 Box 1.13 P r o v i s i o n f o r w a t e r a n d s a n i t a t i o n in t h r e e s m a l l u r b a n c e n t r e s i n C h i n a

Neiguan

plumbing. Over 90 per cent of

The town had 10,500 inhabitants in

surveyed households possessed their

Only one household in the survey had

1993. A piped w a te r supply became

own latrines; members of other house­

piped water.

of the rest used pond or stream water.

available in 1992 for the first time;

holds used public toilets. ‘The public

prior to this, residents relied on wells

toilets in factories and government

Shengze

and river water. The town faces a

offices were poorly maintained and

By the mid-1990s, there were 32,000

serious w a te r shortage, in part due to

usually extremely dirty due to the

urban residents - but if unregistered

progressive reductions in river flow

shortage of w a te r for flushing’ (page

and temporarily permitted migrants

and over-exploitation of groundwater,

53).

were included it would be much higher. Over 60 per cent of households

and in p a rt because of a series of low rainfall years. In a survey, only 20 per

Yantan

in a survey had connections to sewers

cent of households had access to tap

This had 31,000 inhabitants in 1992,

and 94 per cent had tap w ater,

w a te r - in p art because installation

and around 50,000 by the mid-1990s

although many complained about the

costs were very high. Half of the

if the floating population is included.

quality (and there were worries about

households relied on wells for their

90 per cent of surveyed households

increasing numbers of typhoid cases).

water. The town government has set

used earth closet latrines, while the

Source: Kirky. Ric har d, Ian Br ad bu ry and

up a dozen or so w a te r stations, and it

rest used public toilets; none were

G uan bao Shen (200 0), S m all Town China;

is estim ated th a t around 2000 people

connected to sewers. Close to 75 per

Governance. Econom y, Environm ent and L ifestyle

use these. Among surveyed house­

cent of the households surveyed

holds, there w a s no w a s te w a te r

obtained w a te r from wells while most

in Three Zhen, A sh g a te , Basingstoke.

s y s t e m s (th e s m a l l e r m u n i c ip a l it ie s a n d t h o s e

p ip ed w a t e r a n d c o n n e c tio n to s e w e r s - a s w ell

in p o o r e r r e g i o n s w e r e t h e l e a s t likely to h a v e

a s t h e la c k of a r e g u l a r g a r b a g e collection

s e w e r s ) . 160

s y s te m in m o s t r e s id e n ti a l a r e a s a n d t h e m a n y

T ab le 1 .1 3 s h o w s p o ta b l e w a t e r a n d

in fo rm al s e t t l e m e n t s a t h ig h ri s k from flo ods.161 V ir t u a ll y all t h e e x a m p l e s of w a t e r a n d

s e w e r c o v e r a g e in five ‘s e c o n d a r y c i t i e s ’ in N i c a r a g u a ; t h e fo u r s m a l l e r u r b a n c e n t r e s h a d

s a n i t a t i o n p ro v isio n so f a r in t h i s s e c t io n co m e

b e l o w - a v e r a g e fig u re s in r e g a r d to t h e p r o p o r ­

from w e ll- e s ta b lis h e d u r b a n c e n t r e s . A s t u d y of

ti o n of t h e u r b a n p o p u la t io n w i t h p o ta b l e

t h e n e w u r b a n c e n t r e s t h a t h a v e g r o w n up in

w a t e r , a n d s e w a g e s e r v ic e s .

t h e a g r i c u l t u r a l / f o r e s t f r o n tie r in B r a z i l 162

T h e 2 0 0 0 a s s e s s m e n t of w a t e r a n d s a n i t a t i o n pro v isio n in L a ti n A m e r i c a in c lu d e d

h ig h l ig h t e d t h e la c k of w a t e r a n d s a n i t a t i o n p ro v isio n in t h e s e to o:

so m e d a t a on s m a ll e r c itie s - se e T able 1.14 . T h is s h o w s t h a t t h e q u a l i t y a n d e x t e n t of

•

A s u r v e y of 4 1 9 h o u s e h o l d s in Rolim de

w a t e r a n d s a n i t a t i o n p ro v isio n c a n be high , a s

M o u r a (w ith a p o p u la t io n of a r o u n d

in t h e t h r e e c it ie s in Chile. T h e p r o p o r tio n of

3 0 , 0 0 0 in 1 9 9 0 ) found t h a t 4 4 p e r c e n t

t h e p o p u l a t i o n s e r v e d w i t h p ip ed c o n n e c t io n s

h a d in f o r m a l w a t e r s u p p l ie s ( e i t h e r a

is also v e r y high in S a n t a C la r a (C uba) a n d in

p r i v a t e w e ll w i t h o u t a p u m p o r w a t e r

t h e o t h e r C u b a n a n d V e n e z u e la n c it ie s -

c a r r i e d from t h e lo ca l riv er) a n d 6 7 p e r

in d e e d , h i g h e r t h a n s o m e of t h e l a r g e L a ti n

c e n t h a d in f o r m a l s a n i t a t i o n ( la c k in g a

A m e r i c a n c itie s (see T able 1 .1 0 ). H o w ev er, in

s e p t ic t a n k o r c o n n e c t io n to a s e w e r a n d

g e n e r a l , a p a r t from t h e c it ie s in Chile, p r o v i­

re ly in g on o u t h o u s e s or d e f e c a t io n

sion for s a n i t a t i o n is m u c h le s s e x te n s iv e .

o u ts id e ).

O th e r c a s e s t u d ie s of s m a ll e r cities

•

A s u r v e y of 2 0 8 h o u s e h o l d s in S a n t a

m e n tio n t h e s e r io u s i n a d e q u a c i e s in provision.

L u iz a d ’O e ste (w it h a p o p u la t io n

For i n s t a n c e , a c a s e s t u d y of C h im b o te in P e ru ,

e s t i m a t e d a t 6 0 0 0 in 1 9 9 0 ) fou nd t h a t

w h ile d e sc r ib in g t h e in n o v a tiv e L o cal A g e n d a

52 p e r c e n t re lied on in f o r m a l w a t e r

21 d e v e lo p e d by a c o alitio n of g ro u p s , also

s u p p l ie s a n d 8 0 p e r c e n t relied on in fo r­

n o te d t h a t tw o -fifth s of t h e p o p u la t io n la c k e d

m al sa n itatio n .

P r o v is io n f o r w a t e r a n d s a n it a t io n in c i t ie s

47 Table 1.13 Coverage of basic services in five ‘secondary cities’ in Nicaragua, 1995

City Urban population León 123,865 Chinandega 97,387 Esteli 71,550 Somoto 14,218 Ocotal 25,264 Average coverage in all urban areas

% average coverage o f basic services per city Potable Sewage Streets Electricity water 90 74 78 72 80 90

60 38 35 43 10 44

70 75 15 60 45 37

85 75 75 85 78 93

Garbage collection 75 51 55 30 65 78

Source: PRODEL (1997), Proyecto de la Segunda Fase, PRODEL, Manag ua, and reports from the municipalities served by PRODEL; the Social Action Ministry (1995), Medicion de la Pobreza en Nicaragua [Measurement of Poverty in Nicaragua!, MAS/UNDP. Man agu a, reproduced in Stein, Alfredo (2001), Participation and Sustainability in Social Projects: The Experience o f the Local Development Programme (PRODEL) in Nicaragua, IIED Working Paper 3 on Poverty Reduction in Urban Areas, IIED, London.

•

•

•

A s u r v e y of 4 1 0 ho u seh o ld s in X in g u a ra

In conclusion, w e a re fa c e d w ith r e m a r k ­

found t h a t 72 p e r c e n t relied on inform al

ab ly little d e ta ile d in fo rm atio n on w a t e r an d

w a t e r su p p lies a n d 8 6 p e r c e n t on infor­

s a n i ta t io n provision in u r b a n c e n tr e s o th e r

m al s a n i ta t io n .

t h a n th e la r g e r a n d more politically i m p o r t a n t

A s u r v e y of 3 2 0 h o u seh o ld s in T u c u m a

cities. Yet t h e r e a re t e n s of t h o u s a n d s of th e s e

found t h a t 69 p e r c e n t relied on inform al

u r b a n c e n tr e s , a n d t h e y include a la r g e p ro p o r ­

w a t e r sup plies an d 8 6 p e r c e n t on infor­

tion of t h e w o r ld 's u r b a n (and to ta l)

m a l sa n ita tio n .

p op ula tio n. This sectio n h a s d r a w n in fo rm atio n

A s u r v e y of 173 h o useh old s in O urilandia

from c a s e s tu d ie s of a ro u n d 50 u rb a n c e n tr e s,

do N o rte, w h ich h a d 1 0 ,8 9 3 i n h a b i ta n t s

w h ic h v a r y from sm all m a r k e t to w n s to cities

in 1 9 9 1 , found t h a t 95 p e r c e n t relied on

w ith s e v e r a l h u n d re d t h o u s a n d in h a b i ta n t s .

inform al w a t e r su p p lie s a n d in form al

M o st of t h e s e sh o w th e larg e in a d e q u a c ie s in

s a n i ta t io n (typically o u th o u s e s or

w a t e r a n d s a n i ta t io n provision, e sp ecially

d e fe c a tin g outdo ors).

th o s e from low -income n a ti o n s in Africa and A sia. T h e re is no re a s o n to s u s p e c t t h a t th e

T h u s, it is no t only in th e s m a ll e r u rb a n

c a s e s tu d ie s of s m a lle r A frican u r b a n c e n tr e s

c e n tr e s in th e low er-incom e n a tio n s of L atin

in Box 1 .1 0 or of s m a lle r u r b a n c e n tr e s in

A m e ric a a n d th e C a rib b ea n t h a t t h e r e a re

In dia in Box 1.12 a re u n ty p ic a l, or t h a t th e

se rio u s p roblem s, a s e x a m p le s from A r g e n ti n a

s t u d ie s of t h e s e u rb a n c e n tr e s d e lib e ra te ly

a n d B razil show. In deed , a s u b s t a n t i a l p ro p o r ­

chose u rb a n c e n tr e s w h e re w a t e r an d s a n i t a ­

tion of th e p o p u la tio n in som e of th e

tion provision w a s p a r t ic u l a r ly in a d e q u a te .

w e a l t h i e s t s m a ll e r u r b a n c e n tr e s m a y still

T h e re is also one final e x a m p le w o rth

h a v e serio u s prob lem s, a s illu s tr a t e d by th e

m e ntioning: th e city of Ilo in P e ru . T his is no t

c a s e of S a n C arlos de B ariloche. This is a v e ry

a w e a l t h y or la r g e city; it h a d a ro u n d 6 0 ,0 0 0

s u ccessfu l to u r i s t city w ith 8 1 ,0 0 0 i n h a b i ta n t s

i n h a b i ta n t s by 2 0 0 0 an d h a d g ro w n rapidly.

in 1 9 9 1 , lo c a te d w ith in a n a r e a of e x c e p tio n a l

Yet it h a d m a n a g e d to in c r e a s e t h e pro po rtio n

n a t u r a l b ea u ty . B u t in 1 9 9 1 , 19 p e r c e n t of

of its p o p u la tio n w ith d rin k in g w a t e r c o n n e c ­

h o u seh olds still la c k e d w a t e r piped into th e i r

tio n s from 40 to 85 p e r c e n t b e tw e e n 1981

home an d 11 p e r c e n t la c k e d a c c e s s to public

a n d 19 9 8 , a s w ell a s in c r e a sin g t h e re g u la rity

w a t e r n e tw o r k s . A c o n sid e rab le p ro po rtion

of t h e su p p ly (along w ith m a n y o th e r im p ro v e­

lac k e d a d e q u a t e provision for s a n i ta t io n ;

m e n t s in living conditions). M uch of th e

how ever, t h e r e h a d b een c o n sid e ra b le p ro g r e ss

im p ro v e m e n t w a s due to a c o n s i s te n t policy

in re d u cin g th e p ro po rtio n of t h e p o p u latio n

followed by th e local g o v e r n m e n t of su p p o r tin g

w ith u n m e t b asic n e e d s b e tw e e n 1 98 0 and

p ro jec ts u n d e r t a k e n by com m unity-level

1 9 9 1 163

m a n a g e m e n t c o m m itte e s d u rin g th is period. It

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

48 Table 1.14 P r o v i s i o n f o r w a t e r a n d s a n i t a t i o n in s e l e c t e d s m a l l e r c i t i e s in L a t i n A m e r i c a

Nation

City

Chile

Arica Osorno Antofagasta Camaguey Pinar del Rio Santa Clara Saint Laurent du Maroni Guanare San Cristobal

Cuba

French Guyana Venezuela

Nation

Chile

Cuba

French Guyana Venezuela

Population

City

178,600 130,200 247,700 318,100 138,100 201,080 19,200 132,000 436,000 Population

Arica Osorno Antofagasta Camaguey Pinar del Rio Santa Clara Saint Laurent du Maroni Guanare San Cristobal

% with piped connections 99.8 98.6 99.2 75.3 79.3 97.3 46.8 89.4 81.2 % with sewer connections

178,600 130,200 247,700 318,100 138,100 201,080 19,200 132,000 436,000

98.6 93.3 96.8 48.5 60.0 44.1 26.0 79.6 64.0

% with public sources

Other (%)

15.7 (well with pump) 5.3 1.6 (well with pump) 26.0 (public sources)

4.8 7.2 1.2 26.0 10.6 18.8

% with % with connection to simple latrine septic tank/soakaway 1.2 5.3 2.4 11.3 18.1 36.7 15.6

31.4 21.9 3.2

Other (%)

1.5 16.3 5.1

18.9 1.5 36.0 (without connection)

Source: Centro Panamericano de Ingeniería Sa nitaria y Ciencias del Ambiente, Evaluación de los Servicios de Agua Potable y Saneamiento 2 0 0 0 en las America, www.cepis.ops-oms.org.

also o w ed m uch to th e succ ession of elec te d

only 47 p e r c e n t of A fric a ’s r u r a l p o p u la tio n

m a y o r s from 1982 o n w a r d s . 164 It is a re m in d e r

h a d im proved w a t e r supplies; in A sia it w a s 75

t h a t th e r e is often scope for im proving w a t e r

p e r c e n t, in L a tin A m e ric a a n d th e C a rib b ea n

an d s a n i ta t io n provision in s m a lle r u rb a n

it w a s 62 p e r c en t. In all t h r e e of t h e s e

c e n tr e s , if solu tion s a re b a s e d on m a k i n g th e

re gions, less t h a n h a lf t h e r u r a l p o p u la tio n h ad

b e s t use of local re s o u r c e s - including th e

im proved s a n i t a t i o n . 165

w illing ness an d c a p a c i ty of t h e i n h a b i t a n t s to

The figures from th is a s s e s s m e n t might

w o r k w ith lo cal a u th o r it ie s . T his is a p o in t to

be t a k e n to justify less a t t e n t i o n to w a t e r an d

w h ich th is book will r e t u r n in C h a p te r 7.

s a n i ta t io n in u rb a n a r e a s b e c a u s e fa r more people in r u r a l a r e a s la c k im proved provision.

Rural versus urban areas

For in s ta n c e , in 2 0 0 0 , t h e n u m b e r of r u r a l d w ellers la c k in g im proved provision for w a t e r

This book u n d erlin e s th e need for g o v e rn m e n ts

an d for s a n i ta t io n w a s aro u n d five ti m e s t h a t

an d in t e r n a t i o n a l a g e n c ie s to give more a t t e n ­

in u rb a n a r e a s . B ut if th e n u m b e r of u rb a n

tion to im proving w a t e r a n d s a n i ta t io n

d w ellers la c k in g a d e q u a t e provision is t h r e e to

provision in u r b a n a r e a s . This c h a p t e r h a s

fo ur ti m e s m ore t h a n th o s e m e a s u re d a s

p re s e n te d t h e evidence to ju stify th is. This

h av in g im proved provision, t h e n th e difference

m ig ht be t a k e n a s a d e m a n d for r e s o u rc e s to

in th e p ro p o rtio n of th e p o p u la tio n la c k in g

be d iv e rte d from r u r a l a r e a s for th is p urpo se.

a d e q u a t e provision b e tw e e n r u r a l an d u rb a n

T h a t is n o t o ur in ten tio n . The W IIO/UNIC EF

a r e a s dim inishes a lot. H ow ever, t h e r e a r e also

A s s e s s m e n t 2 0 0 0 m a k e s c le a r t h e v e r y la rg e

g ro u n d s for q u e stio n in g w h e t h e r th e figures for

n u m b e r of r u r a l d w e lle rs w h o la c k im proved

th e u n s e r v e d r u r a l p o pu latio n fully reflect th e

provision for w a t e r an d s a n i ta t io n ; in 2 0 0 0 ,

sca le of need: th e c e n s u s e s or household

P R O V IS IO N FOR WATER AND SANITATION IN C ITIES

49 s u r v e y s from w h ic h th e y d r a w also fail to m e a s u r e w h e t h e r provision is a d e q u a t e . The d e b a te a b o u t th e re la tiv e prio rity

h a z a r d o u s in m o s t r u r a l a r e a s b e c a u s e t h e r e is m ore open s p a c e an d c a re c a n be t a k e n t h a t t h e a r e a s w h e r e open d e fe c a tio n h a p p e n s a re

t h a t sho uld be a c c o rd e d to r u r a l p o p u la tio n s

n o t close to w a t e r s o u r c e s or h o m es (a lth o u g h

v e rs u s u r b a n p o p u la tio n s h a s been one of th e

p ro b le m s w i t h h a n d - w a s h i n g a n d h a r a s s m e n t

c e n t r a l d e b a t e s in d e v e lo p m e n t policy for th e

for w o m e n m a y be c o m p a r a b le ) . The

l a s t 30 y e a r s . C ertainly, one of t h e m o st im p o r­

A s s e s s m e n t 2 0 0 0 s u g g e s t s t h a t ‘r e a s o n a b le

t a n t c h a n g e s in d e v e lo p m e n t policy t h a t aro se

a c c e s s ’ for w a t e r sh ou ld be b ro a d ly defined as

in th e la t e 1 9 6 0 s a n d e a rly 1 9 7 0 s w a s th e

‘t h e a v a ila b ility of a t l e a s t 20 litr e s p e r

reco g n itio n t h a t m o s t p oo r r u r a l d w e lle rs w e re

p e rs o n p e r d a y from a so u rc e w ith in 1 k ilo m e ­

being b y p a s s e d by m o s t d e v e lo p m en t

t r e of t h e u s e r ’s d w e llin g .’167 For m o s t u rb a n

p r o g r a m m e s - a lth o u g h th e r e is n ot m uch

s e t ti n g s , t h i s is an i n a p p r o p r ia te s t a n d a r d . In

ev iden ce t h a t po or u r b a n d w e lle r s w e r e doing

la rg e , d en se u r b a n s e t t l e m e n t s , t h e a v a il a b il­

m uch b e tte r, e sp e cially th o s e w h o lived outsid e

ity of a w a t e r s o u r c e w ith in 1 k ilo m e tre will

c a p it a l cities (which is t h e m a jo rity of u rb a n

m e a n lo ng q u e u e s; t h e p e r s o n s resp o n sib le for

dw ellers). M o st i n t e r n a t i o n a l a g e n c ie s g av e a

fe tc h in g a n d c a r r y i n g w a t e r m a y be s p en d in g

h ig h e r p rio rity to re a c h in g r u r a l p o p u la tio n s

h o u rs a d a y doing th is . T he a p p r o p r i a t e n e s s of

an d su p p o r tin g sm a llh o ld e r fa r m e r s and

th e s t a n d a r d m a y also be q u e s tio n e d for b o th

p a s t o r a li s t s . H ow ever, since th e m id -1 9 7 0 s

r u r a l a n d u r b a n c o n te x t s , since h a v in g to

m a n y i n t e r n a t i o n a l a g e n c ie s h a v e been r e lu c ­

c a r r y w a t e r for 1 k ilo m e tre (or even only 100

t a n t to s u p p o r t u r b a n in v e s tm e n ts . Since th is

m e tre s ) is an a r d u o u s t a s k - a n d u su a lly

re cog nition t h a t m o s t of th e r u r a l po or w e re

h o u se h o ld s w ith d i s t a n t w a t e r s o u r c e s will

being b y p a s s e d by d e v e lo p m e n t a s s is t a n c e ,

n o t co llect en o u g h to e n s u r e plen tiful w a t e r

m a n y a g e n c ie s h ave c o n tin u a lly e m p h a s iz e d

su p p lies for w a s h i n g (including w a s h in g

t h a t r u r a l n eed s a re m uch la r g e r t h a n u rb a n

child ren a f t e r d e fe c a tio n ), la u n d r y , food p r e p a ­

needs. For in s ta n c e , in th e 1 9 9 6 H u m an

ra t io n a n d k e ep in g th e h o u se a n d h o u se ho ld

D ev elo p m e n t R e p o rt, th e figures for th e provi­

u te n s ils c lea n . H av in g a w a t e r t a p w ith in 1

sion of safe w a t e r an d s a n i ta t io n for r u r a l and

k ilo m e tre do es n o t m e a n t h a t th e r e is a

u r b a n a r e a s w e r e p re s e n te d in a w a y w hich

re g u l a r su p p ly in t h e t a p , a n d pro b lem s of

e m p h a s iz e d t h a t r u r a l p ro b lem s w e re much

a c c e s s a n d tim e s p e n t q u e u in g a re often m uc h

more se rio u s t h a n u rb a n p ro b le m s .166

in c r e a s e d a s w a t e r is only a v a ila b le for a few

B ut t h i s a n d m o s t o t h e r a s s e s s m e n t s of

h o u r s a d a y (as sh o w n by m a n y of th e

w a t e r a n d s a n i t a t i o n p rovision fail to r e c o g ­

e x a m p l e s giv en e a rlie r ). T h e w a t e r in t h e t a p

nize diffe ren ces b e t w e e n r u r a l a n d u rb a n

m a y n o t be sa fe , e sp e cially if t h e su p p ly is

c o n te x t s . One lim ita tio n of all n a t i o n a l s t a t i s ­

i n t e r m i t t e n t . H a v in g a t a p w ith in 1 k ilo m e tre

t i c s (an d t h u s of t h e g lo b al s t a t i s t i c s on w h ic h

do es n o t m e a n t h a t t h e su p p ly is free or

t h e s e a r e b a se d ) is t h e i r failu re to recognize

r e a s o n a b ly priced . It m a y be t h a t t h i s w a t e r

d ifferen ces in c o n t e x t b e t w e e n (m ost) r u r a l

su p p ly is m a n a g e d or c o n tro lled by a c o m p a n y

a n d (m ost) u r b a n a r e a s . T h e s a m e c r i te r ia for

or in div idu als w ho c h a r g e high p ric e s for it.

im p ro ved pro vision c a n n o t be u se d in all

T w o o th e r points have relev an ce to th e

s e t ti n g s . A w a t e r s o u r c e w ith in 100 m e t r e s of

r u r a l v e rs u s u rb a n issue. F irst, th e relative

all h o u se h o ld s is n o t t h e s a m e in a villag e of

sizes of th e r u r a l an d u rb a n p o p u la tio n s w ith in

2 0 0 p e rs o n s w ith 50 p e r s o n s p e r t a p a s it is

low- an d middle-income n a tio n s h ave c h a n g e d

in a s q u a t t e r s e t t l e m e n t w ith 1 0 0 , 0 0 0 p e rs o n s

significantly since th e d e b a te s a b o u t u rb a n bias

(a n d 5 0 0 p e r s o n s p e r ta p ) . P r o t e c ti n g a w ell

b e g a n (p e r h a p s r a t h e r more t h a n th e d e b a te

from h u m a n e x c r e t a a n d w a s t e w a t e r is n o t

itself). Since 1 9 7 5 , th e u rb a n pop ulation in

th e s a m e in a v illage of 2 0 0 p e r s o n s a s it is in

low- an d middle-income c o u n trie s h a s n e a rly

a s q u a t t e r s e t t l e m e n t of 1 0 0 , 0 0 0 p e rs o n s

tripled; th e r u r a l p o p ulation h a s in c r e a se d by a

(w h e re th e r e is 5 0 0 ti m e s more h u m a n

t h i r d . 168 A m ong th e n a tio n s classified by th e

e x c r e t a an d h o u se h o ld w a s t e w a t e r to dispose

United N atio n s a s th e le a s t developed, th e

of). D efecatio n in t h e open is obviously less

u rb a n p o p ulation h a s more t h a n q u a d ru p le d

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

50 since 1 9 7 5 w hile th e r u r a l p o p u la tio n in c re a se d

p o p u la tio n m a y still be in r u r a l a r e a s , b u t th e

by aro u n d 75 p e r ce n t. This is no t to claim t h a t

tw o-fifths in u r b a n a r e a s m e a n t h a t it h a s more

u r b a n n ee d is g r e a t e r t h a n r u r a l need, n or to

u r b a n citizens an d tw ic e a s m a n y urb an

p r e te n d t h a t u r b a n p o p u la tio n s o u tn u m b e r

children a s N orth A m erica. This is a pop u la tio n

r u r a l p o p u la tio n s am o n g low -incom e n a tio n s

t h a t d e s e r v e s more a t te n t io n to its n ee d s for

(alth o u g h th e y do in m a n y middle-income

w a t e r a n d s a n ita tio n . T h e se co n d po in t is t h a t a la rg e p a r t of

n atio n s). But th is book does s e e k to highlight t h a t th e r e are v e ry se rio u s deficiencies in

t h e in v e s tm e n t in im proving provision in u r b a n

w a t e r a n d s a n ita tio n provision for la rg e

a r e a s c a n com e from t h e b e t t e r m a n a g e m e n t

se c tio n s of t h e u r b a n p opu la tio n in Africa, A sia

of w a t e r a n d s a n i t a t i o n utilitie s a n d b e t t e r

a n d L atin A m eric a a n d th e C a rib b ea n , a n d t h a t

g o v e r n a n c e , so t h a t it n e e d n o t d r a w on s c a r c e

th e n ee d s of poor u r b a n d w e lle rs also need to

n a t io n a l or in t e r n a t i o n a l d e v e lo p m e n t funds.

be ta k e n into a c c o u n t by g o v e r n m e n ts a n d

This is th e m ain th e m e of th is b o o k ’s final

in te r n a tio n a l ag e n c ie s. Three-fifths of A fric a ’s

c h a p te r.

N otes and referen ces 1.

See for instance levels of provision in Porto

Orangi Pilot Project - R esearch and Training

Alegre in Brazil described in M eneg at, Rualdo

Institute. See also Orangi Pilot Project -

(2002), ‘P a rtic ip a to ry dem ocracy an d s u s ta in ­

R esearch and Training Institute (2002), Katchi

able development: in te g ra te d urban

Abadis o f Karachi: Documentation o f Sewerage,

environm ental m a n a g e m e n t in Porto Alegre,

Water Supply Lines, Clinics, Schools and

Brazil’, E nvironm ent and U rbanization, Vol 14,

Thallas Volume 1: The F irst 1 0 0 Katchi Abadis S urveyed, OPP-RTI, K arachi, 507 pages.

No 2 , p ages 1 8 1 -2 0 6 . 2.

3.

4.

See McIntosh, A rth u r C an d Cesar E Yniguez

10.

The WHO/UNICEF Joint Monitoring

(1997), Second Water Utilities Data B o o k ,

P ro gram m e for W a te r Supply and S anitatio n

Asian D evelopment Bank, M anila, 210 pages.

intends to support and draw on new p rim ary

WHO and UNICEF (2000), Global Water

d a ta sources - see w w w .w h o .in t/w a te r_

S u pply and Sanitation A ssessm e n t 2 0 0 0

san itation_health/G lobassessm ent/G lobalT O C .

R ep o rt, World H ealth Organization, UNICEF

htm.

and W a te r Supply and S an itation

11.

WHO and UNICEF 20 00 , op cit.

Collaborative Council, Geneva, 80 pages.

12.

WHO and UNICEF 20 00 , op cit, page 23.

Saghir, Jam al, M anuel Schiffler and

13.

Bairoch, Paul (1988), Cities and Economic Development: From the Dawn o f H istory to the

M ath ew o s Woldu (2000), Urban Water and

P resent, Mansell, London, 574 pages.

Sanitation in the Middle E a st and North Africa Region: The Way Forward, Middle E a s t and

14.

H asan, Arif (2001), Working with

15.

Cotton, Andrew and Darren Sayw ell (2001),

Communities, City Press, K arachi, 200 pages.

North Africa Region In f ra stru c tu r e Development Group, The World Bank, W ashington, DC; Khatim, K herraz (2002),

On-plot Sanitation in Low-income Urban

Water S u pply and Sewage in Cities o f Algeria,

Communities; Guidelines fo r Selection, Water,

B ackground Paper, UN-H abitat, Nairobi.

Engineering and Development Centre

5.

WHO an d UNICEF 2000, op cit.

(WEDC), Loughborough University,

6.

See H ew e tt, Paul C and M ark R M ontgom ery

Loughborough.

7.

(2002), Poverty and Public Services in

16.

WHO an d UNICEF 2 00 0, op cit, page 77.

Developing-Country C ities, Population Council,

17.

WHO an d UNICEF 2 00 0, op cit, page 77.

New York, 62 pages.

18.

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World B ank 20 01 , op cit, see page 321.

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117

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118. Table 10 of PAHO/WHO 2 0 01 , op cit.

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119. CEPIS 2000, op cit.

133. PAHO/WHO 2 00 1, op cit.

120. Duhau, 1991, page 87 quoted in Pirez, P

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136.

in S c h te in g a rt, M and L d ’A ndrea (eds)

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A m b ien te, El Colegio de Mexico, CERFE, Mexico, quoted in Pirez 2 00 0, op cit.

137.

Cuenya, B eatriz, H ector Alm ada, Diego Arm us, Julia Castells, M aria di Loreto and

123. M arvin, Simon and Nina Laurie (1999), ‘A n

124.

Arévalo, Pedro, T (1997), ‘May hope be

emerging logic of u rb a n w a t e r m a n a g e m e n t,

S u sa n a P enalva (1990), ‘Housing and h ealth

C ochabam ba, Bolivia’, Urban S tu d ie s, Vol 36,

problems in Buenos Aires: th e case of Barrio

No 2, p a g e s 3 4 1 - 2 5 7 .

S an M artin’, in Cairncross, Sandy, Jorge E

Swyngedouw, Erik A (1995), ‘The c o n tra d ic ­

H ardoy and David S a tt e r t h w a i te (eds), The

tions of u rb an w a t e r provision a stu dy of

Poor Die Young: H ousing and Health in Third

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World Cities, E a rth s c a n Publications, London.

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138.

S c h u sterm an , Ricardo and Ana Hardoy (1997), ‘R e con stru ctin g social c a p ital in a

125. Robotham , Don (1994), ‘Redefining urban

poor u rb an settlem ent: the In te g ra te d

h ealth policy in a developing country: the Jam a ic a c a s e ’, in S Atkinson, J Songsore and

Im provem ent P ro g ram m e, Barrio San Jo r g e ’,

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Developing Countries: Im plications fo r Policy, CAB In te rn atio n al, Wallingford, p ag es 3 1 - 4 2 .

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The quote is from page 39.

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126. Kristin Komives (1999), Designing Pro-Poor Water and Sew er Concessions: E arly Lessons

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from B olivia, World B ank Policy R esearch

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Working P a p e r 2 2 43 , World Bank,

(AMM), Fundación Grupo E x p e rim en tal de

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A lte rn ativas C ulturales (GEAC) and Asociación Mujeres Activas por un Futuro

127. Clapham, David (1996), ‘W ater and sanitation

Mejor 20 02 , op cit.

problems in Lima, P e ru ’, Water & H ealth, No 1 9/96 , North West W ater Ltd, Warrington, UK. 128. Ferguson, Bruce (1996), ‘The environm ental

140. 141.

The figures draw n from th e CEPIS-OMS d a ta b a s e do not necessarily add up to 100 per

im p acts and public costs of unguided informal

cent.

settle m en t: th e case of Montego B a y ’, E nvironm ent and U rbanization, Vol 8, No 2,

Ibid.

142.

The proportion of people living in cities is also considerably less th a n the proportion living in

October, p ag es 1 7 1 -1 9 3 . 129. C onstance, Paul (1999), ‘W h a t price for

u rb an centres, as a significant proportion of

w a te r? Why people in some of the poorest

the u rb an population lives in urban centres

comm unities would r a t h e r p ay m o re’,

too small to be called cities (because th ey

ID B A M É R IC A , Ju ly -A u g u st, p ag es 3 - 5 . Also

lack the size and the economic, a d m in is tra ­

gives details of scheme to reach poorest

tive or political s t a tu s t h a t being a city

groups w ith improved provision by the French

implies). There is no a g reem en t as to w h a t

NGO GRET.

c h a ra c te ris tic s an urban centre should have to be classified as a city.

130. Ferguson, Bruce an d Crescencia M au rer (1996), ‘Urban m a n a g e m e n t for environm en­

143.

Moriarty, P B, G P atricot, T Bastem eijer, J

t a l quality in South A m erica’, Third World

Sm et and C Van der Voorden (2002), Between

Planning R eview , Vol 18, No 2, pages

R ural and Urban: Towards Sustainable

117-154.

M anagem ent o f Water Sup p ly S yste m s in Sm all

131. Choguill, C L (1994), ‘Im plem enting urban developm ent projects: a sea rc h for crite ria for

Towns in A frica, In te rn a tio n a l W a te r and S an itatio n Centre, Delft.

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

56 144.

145.

Information sh e et in W a te r and S anitatio n

156

Secondary Cities in West Africa: The Challenge

Sanitation Providers in Africa: B eyond Facts

o f E nvironm ental Health and Prevention,

and Figures, W SP Africa Regional Office,

Occasional P ap er Series: Comparative Urban

World B ank, Nairobi.

Studies, No 21, Woodrow Wilson

Livingstone, A J (1994), ‘Community m a n a g e ­

I n te rn a tio n a l Center for Scholars,

ment of small urban w a t e r supplies in Sudan and G h a n a ’, in WHO and WSSCC Working

W ashington, DC, 27 pages. 157

Operations and M aintenance o f Water Supply

The C itizens' F ifth Report, Centre for Science

and Sanitation System s: Case S tu d ie s, World

and Environm ent, New Delhi, 44 0 pages.

Health Organization, Geneva, pages 4 4 - 5 6 .

158

Shen (2000), S m all Town China: Governance,

drop to drink; population an d w a t e r

Economy, E nvironm ent and L ifestyle in Three

resources; illustrations from Northern

Zhen, A sh gate Publishing Ltd, A ldershot, 168

T a n z a n ia ’, in de Sherbinin, Alex and Victoria

pages. 159

in China: E stim a tes o f Economic Costs,

Association for the A d van cem ent of Science

E a s t- W e s t C enter Special Report No 5, E a s t- W e s t Center, Honolulu.

Colin, Jeremy and Joy Morgan (2000),

160

Jacobi 20 02 , op cit.

Provision o f Water and Sanitation Services to

161

Foronda, F M aria Elena (1998), ‘C him bote’s Local Agenda 21: initiatives to su p p o rt its

Sm all Towns; Part B: Case Studies in Uganda and India, Well Studies in Water, S a nita tion

developm ent and im p lem entation ’,

and E nvironm ental H ealth Task 323 , WELL,

E nvironm ent and Urbanization, Vol 10, No 2, October, p a g e s 1 2 9 -1 4 7 .

Loughborough and London, 53 pages. Ibid.

162

Uganda: S urvival Under Stress, The

and Globalization o f the Brazilian A m azon,

Institu tio nal F ra m e w o r k of Urban

Columbia University Press, New York and Chichester, 429 pages.

Government: Case S tudy No 5, Development A dministration Group, INLOGOV, University of

163

E stienne, C (2000), The PAGE Water Supply

case of S an Carlos de Bariloche, A rg e n tin a ’,

M anagem ent Support Programme, case study

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subm itted to th e Small Towns W a te r and S an itatio n: Third Electronic Conference.

164

Lopez Follegatti, Jose Luis (1999), ‘Ilo: a city in tr a n sfo r m a tio n ’, E nvironm ent and

Livingstone 1994, op cit.

Urbanization, Vol 11, No 2, October, pages

152. T chounwou, P B, D M L an tum , A Monkiedje, I

1 8 1 -2 0 2 .

Takougang and P H B arb a zan (1997), ‘The u rgen t need for e nvironm ental san ita tio n and

165

WHO and UNICEF 20 00 , op cit.

safe drinking w a t e r in Mbandjock, Cameroon’,

166

UNDP (1996), Human Developm ent Report 1 9 9 6 , Oxford University P re ss, Oxford, 228

Archives o f E nvironm ental Contamination and

pages.

Toxicology, Vol 33, No 1, p a g e s 1 7 -2 2 . 153.

Zaba and Madulu 1998, op cit.

167

154.

M ee ky aa, Ude Jam es and Carole R akodi

168

155.

A baleron, Carlos Alberto (1995), ‘M arginal urban space and unsatisfied basic needs: the

Birmingham , Birmingham , 110 pages.

151.

Browder, John D and Brian J Godfrey (1997), R ainforest Cities: Urbanization, Development

149. Amis, Philip (1992), Urban M anagem ent in

150.

Srnil, Vaclav (1995), E nvironm ental Problems

Case Studies and Policy Im plications, A merican (AAAS), W ashington, DC, p ag es 4 9 - 8 6 .

148.

Kirkby, R ichard, Ian B radbury and Guanbao

Zaba, Basia and N d alah w a Madulu (1998), ‘A

Dompka (eds), Water and Population Dynamics:

147.

A g a rw a l, Anil, S un ita Narain and S rab an i Sen (eds) (1999), State o f In d ia ’s Environm ent:

Group on Operation and M ain tain an ce,

146.

Yacoob, May and Margo Kelly (1999),

Program (2 0 0 0 ), Independent W ater and

WHO and UNICEF 2 00 0, op cit, p ag es 7 7 -7 8 . United N ations ( 2 0 0 2 ^ World Urbanization

(1990), ‘The neglected small to w ns of

Prospects; The 2 001 Revision; Data Tables and

N igeria’, Third World Planning R eview , Vol 12,

Highlights, Population Division, D e p a rtm e n t of

No 1, F ebruary, p ages 2 1 - 4 0 .

Economic and Social Affairs, United Nations

Ogu, Vincent I (1998), ‘The dynamics of infor­

S e c re ta ria t, E S A / P /W P / 1 7 3 , New York, 181

mal housing in a tr a d itio n a l W est African

pages.

City: the Benin City ex a m p le ’, Third World Planning Review , Vol 20, No 4, p ag es 419-439.

CHAPTER

The Impacts of Deficient Provision

Introduction C ha p te r 1 described th e inad eq ua cies in w a t e r an d s a n ita tio n provision for hu ndreds of millions of u rb an dwellers; how w a t e r sources a re often dista nt, difficult to access, c o n ta m i­ n a te d and in te rm itte n t; and how provision for s a n ita tio n does not fulfil its p rim a ry t a s k ensuring th e safe disposal of hu m an ex creta an d w a s te w a te r . This c h a p te r focuses on th e im pact of th es e inadequacies. This includes th e h ealth bu rden s a nd th e o th e r costs to people, such a s high m o n e ta ry costs and th e time and effort needed to g et w ater. It also discusses who is m ost affected: overw helm ingly this is low-income households, b ut within these households th e burden s of in a d e q u a te provision often fall especially heavily on w o m en and girls (who typically end up doing m ost of the w a t e r collection an d m an agin g th e disposal of w astes ) and children (who typically suffer m ost from th e diseases a ss o c iate d w ith in ad e­ q u a te w a t e r supplies and sanitatio n). To add insult to injury, while low-income dwellers often pay high prices for w a te r, w ea lth ie r households n earb y often have piped co nn ec­ tions providing w a t e r t h a t is heavily subsidized, b ecau se the price is well below the unit cost of providing it. This c h a p te r also dis cusses th e large economic costs of inad e­ q u a te provision, for households, cities and nations. This c h a p te r focuses on u rb an a re a s in low- and middle-income nation s b ecause, as C ha p te r 1 made clear, th is is w h ere th e deficiencies in w a t e r and sa n ita tio n provision a re heavily con cen trated .

The health impacts of inadequate provision for water and sanitation Overall impacts There are tw o reaso n s w h y u rb an a re a s should have b e tt e r health th a n ru r a l a re a s , and should also be b e tt e r served with w a t e r and sa n ita tio n provision, w ith o u t a bias favouring provision th ere. The first is t h a t u rb an a re a s provide significant economies of scale and proximity for th e delivery of piped w a t e r and provision for good quality s a n ita tio n and d rain age, so unit costs should be lower. Unit costs are also lo w er for m any oth er services t h a t improve h ea lth or reduce disease burdens - including good quality h ealth care (with special provision for infants, children and p re g n a n t mothers), em erg ency services (including th ose t h a t rapidly t r e a t healthth r e a te n in g w a te r- re la te d diseases) and schools (and th e ir links to improving k n o w l­ edge of hea lth-enhancing behaviours, including tho se related to hygiene). The second is t h a t m any cities have a more prosperous economic base th a n ru r a l a re a s , providing higher av e ra g e incomes for large sections of the population (and th u s g r e a t e r c a p a c ity to pay for good quality provision) and g r e a t e r possi­ bilities for g ov ern m en ts (or p riv ate utilities) to raise rev enu es to fund such provision an d to ge t costs b ack from u ser c h a rg e s (from businesses as well a s households). But making use of p o ten tial u rb an a d v a n ta g e s depends on co m petent, effective local g ov ern m ents a n d /o r w a t e r and s a n ita tio n utilities. In th e absence of such in stitu tio ns - an d w ith th e resulting la ck of inv estm ent in in f ra s tru c tu re , services

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

58 T a b le 2.1 E x a m p le s of w a t e r - a n d s a n i t a t i o n - r e l a t e d d i s e a s e s a n d t h e a s p e c t s o f i n a d e q u a c y t h a t a r e l i n k e d t o t h e m

Strength o f the link

Disease Water quality

Water quantity

Personal and

W astewater

Excreta

Food

or convenience

domestic

disposal or

disposal

sa n itation/

hygiene

drainage

hygiene

D iarrh o e a V iral d ia r r h o e a

M edium

H igh

H igh

-

M edium

M edium

B a cterial diarrh o ea

M edium

H igh

H ig h

-

M edium

M edium

P ro to z o al d iarrh o ea

Low

H igh

H ig h

-

M edium

M edium

P o lio m y elitis a n d h e p a t i t i s A

Low

H igh

H igh

-

M edium

M edium

A scaris, tric h u ris

Low

Low

Low

Low

H igh

M edium

H ookw orm

Low

Low

Low

-

High

-

P inw orm , d w a rf ta p e w o rm

-

High

H igh

-

M edium

Low

O ther ta p e w o rm s

-

Low

Low

-

High

High

S chistosom iasis

Low

Low

-

Low

High

-

G uinea-w orm

High

H igh

-

-

M edium

-

a q u a tic hosts

High

-

-

M edium

M edium

H igh

Skin infectio n s

-

H igh

H igh

-

-

-

E ye infections

Low

H igh

H igh

Low

M edium *

-

M a laria

-

-

-

Low

-

-

U rb a n yellow fever, d e n g u e

-

-

L ow *

M edium

-

-

B a n c ro ftia n fila riasis

-

-

-

H igh

H igh

-

O nchocerciasis

-

-

-

-

-

-

W orm in fectio n s

O th er w o rm s w ith

In sect-tran sm itted

Note: Th e de gr ee of i m p o r t a n c e of e a c h in t e r v e n t io n for e a c h p a r t i c u l a r dis ea se is r a n k e d a s high, medium or low; a d a s h m e a n s t h a t it h a s negligible im p o r ta n c e . • V ect or s br ee d in w a t e r - s t o r a g e co n t ai n er s . + Flies w hic h t r a n s m i t infection br ee d in s c a t t e r e d h u m a n faeces. Source: T h is ta b le d r a w s on WHO (1 9 8 3 ) , M a xim izin g B e n e fits to H ealth: A n A p p ra isa l M ethodology fo r W ater S u p p ly and S a n ita tio n Projects, u n p ub li sh e d WHO R ep o r t E T S / 8 3 . 7 , WHO. G en ev a, qu o te d in WHO ( 1 9 8 6 ) , Intersecto ra l A c tio n fo r H ealth - T he Role o f In tersecto ra l Cooperation in N a tio n a l S tra teg ies fo r H ealth fo r A ll, B a c k g r o u n d D oc u m e n t for T ec h ni ca l Discu ssi ons , 3 9 t h World H e a l th Ass embly, May, Ge n ev a, u p d a t e d an d modified by S a n d y C ai rn cr o s s from t h e London S cho ol of Hy gie ne an d Tr op ic al Medicine.

a n d w a s t e m a n a g e m e n t - an u r b a n c o n c e n t r a ­

pro v isio n .2 Som e a r e a s s o c ia te d p rim a rily w ith

tio n b e c o m e s a se rio u s h e a lth d i s a d v a n t a g e .

poor w a t e r q u a lity w hile o th e r s a r e m ore

U rb a n a r e a s a r e n o t only c o n c e n t r a tio n s of

a s s o c ia te d w ith th e i n a d e q u a t e q u a n t i t y of

people a n d e n t e r p r i s e s b u t also c o n c e n t r a tio n s

w a t e r av a ila b le to hou se h o ld s, or w ith in a d e ­

of t h e i r w a s t e s - of w h ich h u m a n e x c r e ta is a

q u a t e hygiene or un h y g ie n ic food p r e p a r a tio n

p a r ti c u la r l y d a n g e r o u s ex a m p le . As th e WHO

p r a c tic e s ; o th e r s are a s s o c ia te d w ith i n a d e ­

h a s recogn ized , w h e n i n f r a s t r u c t u r e a n d

q u a t e provision for e x c r e t a d isp o s a l or

se rv ic e s a r e la c k in g , u r b a n a r e a s a r e a m o n g

w a s t e w a t e r d isp o s a l or d r a in a g e - including a

th e w o r l d ’s m o s t lif e -th r e a te n in g h u m a n

grou p of d is e a s e s for w h ic h w a t e r or w a s t e ­

e n v i r o n m e n ts . 1

w a t e r p ro vides a h a b i t a t for d is e a s e v e c to r s or

M a n y d is e a s e s a r e a s s o c ia te d w ith in a d e ­

h o s ts (see Table 2.1).

q u a t e w a te r , s a n i t a t i o n a n d h ygiene. A t an y

W a te r - r e la te d d is e a s e s c a n be classified into

one tim e, close to h a lf th e u r b a n p o p u la tio n in

four c a te g o rie s , a c c o rd in g to th e e n v iro n m e n ­

Africa, A sia a n d L a tin A m e r ic a a r e suffering

t a l p a t h w a y s by w h ich infection t a k e s place:

from one or m ore of t h e m ain d is e a s e s a s s o c i­

faecal-o ral, w ater-w ash ed , w ater-b ased and

a t e d w ith in a d e q u a t e w a t e r a n d s a n ita tio n

w a t e r - r e l a t e d in s e c t v e c to r .3

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

59 F a e c a l - o r a l d is e a se s, m o stly d ia r rh o e a l

g uin ea-w o rm . M ost of th e 2 0 0 million people

d is e a se s, a re th e m o s t com m on a n d a c c o u n t

w orld-wide in fected w ith b ilh arzia live in r u r a l

for a high p ro po rtio n of in fa n t, child an d a d u lt

a r e a s , since infection g e n erally t a k e s p lace as

illnesses - a n d for m ost w a t e r - r e l a t e d in fan t

people w o rk in ir rig a te d fields or w a lk in

a n d child d e a t h s . 4 D ia rr h o e a l d is e a s e s c a u s e

s t r e a m s a n d ponds. B ut it m a y be a serious

6 0 0 0 d e a t h s a day, m o stly a m o n g children

h e a lth problem in u rb a n a r e a s to o, a s m a n y

u n d e r five.5 T h e m icro -o rg an ism s w h ich c au se

people in fected in r u r a l a r e a s h ave moved to

t h e s e d is e a se s can be w a te r - b o r n e , or t r a n s ­

u rb a n a r e a s , an d th e r e m a y be w a t e r bodies in

m itte d by o th e r f a e c a l - o r a l ro u t e s by w h ich

u rb a n a r e a s t h a t h av e th e a q u a ti c sn ails w hich

f a e c a l m a t t e r can e n t e r th e m o u th . W h ere

ho u se th e v e c to r s th r o u g h w h ich th is d isea se is

w a t e r su p p lie s an d provision for s a n i t a t i o n a re

tr a n s m i tt e d . G uinea-w orm is also prim arily

i n a d e q u a t e for m uc h of a c i t y ’s po p u latio n ,

ru r a l an d its incidence h a s been much red uced

f a e c a l - o r a l d isea se c a n be a m o n g th e m o st

re c e n tly by th e era d ic a tio n initiative, b u t it h a s

se rio u s h e a lth p rob lem s for th e w h ole city.6

occ u rred in epidem ic form in sm all u rb a n

O ver-crow ding an d in a d e q u a te food hygiene

c e n tr e s w h e n piped w a t e r s y s te m s b r e a k down.

e x a c e r b a t e t h e ris k s from c o n ta m in a t e d w a t e r a n d p oo r s a n i t a t i o n ; 7 it is com m on for t h e r e to

D ise a s e s s p r e a d by w a t e r - r e l a t e d in s e c t v e c to r s a r e a m o n g th e m o s t p res sin g e n v iro n ­

be t h r e e p e rs o n s p e r room in te n e m e n t s , c h ea p

m e n t a l p rob lem s in m a n y cities. M a la ria , often

b o a rd in g h o u se s a n d inform al s e t t l e m e n t s

c o n sid ered a r u r a l d is ease , is now a m o n g th e

w h e re m o s t low -income u rb a n d w elle rs live in

m ain c a u s e s of illness a n d d e a th a m o n g

Africa, A sia an d L a tin A m erica . T h e re a re also

children an d a d u lt s in m a n y u r b a n a r e a s . In

i n t e s t in a l w o rm s w h o se egg s a re found in

S o u th A sia it is r e l a te d to d rin k in g w a t e r

e x c r e t a . T h e s e can c a u s e severe p ain an d

s t o r a g e on rooftops (so-called o v e rh e a d ta n k s ) ,

u n d e rm in e th e n u tr itio n a l s t a t u s of h u n d re d s of

to w h ich th e m a l a r i a l m osqu ito A nopheles

millions of u rb a n d w e lle rs (especially children),

step h en si h a s a d a p t e d its b re ed in g h ab its; in

b u t only a sm all p ro p ortion of th o s e infected

A frica an d L a tin A m e ric a it is more often

will die of t h e m . 8 M a n y c a s e s tu d ie s in low-

a s s o c ia te d w ith poorly d ra in e d lo c a tio n s w h e re

incom e s e t t l e m e n t s sh o w t h a t a high

t h e A n o p h eles m o s q u ito e s b reed in c le a r s t a n d ­

pro p o rtio n of th e p o p u latio n h a v e d eb ilita tin g

ing w a t e r . 11 Some i n f r a s t r u c t u r e w o r k s also

in te s t in a l w o rm b u r d e n s . 9

co n tr ib u te s u b s ta n ti a ll y to u r b a n a no ph elin e

W a te r - w a s h e d d is e a s e s a r e a s s o c ia te d

breedin g, a n d in som e S o u th A sian cities, th e

w ith a la c k of w a t e r su p p lies for w a s h in g , and

ce lla rs of buildings w h o se c o n s tru c tio n

include v a rio u s skin an d eye in fection s su c h a s

re m a in s unfinished for re a s o n s of in v e s tm e n t

s c a b ie s an d t r a c h o m a (from w h ich millions

an d sp e c u la tio n bec om e e x ten s iv e b reed ing

b eco m e blind). T he n u m b e r of people w h o can

p la c e s during t h e r a i n y s e a s o n . In some cities,

be affec te d a n d t h e e x t e n t to w h ich lower-

a g r a d i e n t h a s b een o b se rv e d w h e r e m a l a r i a

incom e g ro u p s face g r e a t e r prob lem s (largely

tr a n s m i s s i o n d eclines t o w a r d s th e city ce n tre ,

b e c a u s e of p o o rer q u a lity provision for w a t e r )

w ith pollution of open w a t e r b eing t h e k ey

is il lu s tra t e d by a s t u d y of 11 03 p r i m a r y

d e te r m i n a n t. A ed es m o sq u ito e s, w h ic h t r a n s ­

school s t u d e n t s in th e u rb a n d is tric t of

mit a n u m b e r of v iral d is e a s e s including

B am ak o (M ali’s c a p it a l a n d l a r g e s t city). This

d en g u e fever, den g u e h a e m o r r h a g i c fever and

found t h e o v era ll p re v a le n c e of s c a b i e s a m o n g

yellow fever, b re ed in sm all w a t e r collections

t h e pupils to be 4 p e r c en t, r a n g in g from 1.8

an d c o n ta in e rs . T h ese a re r e l a te d to poor

p e r c e n t a t t h e school w ith th e h ig h e s t so cio­

d r a i n a g e or to solid w a s t e (c a r ty r e d u m p s are

economic level to 5 p e r c e n t a t p r i m a r y

notoriou s) a n d also sm all d om estic w a t e r

schools s e rv in g po o rer a r e a s . 10 M o st w a t e r ­

co llecto rs. The l a t t e r m a y be th e re s u lt of

b o rn e d is e a s e s a re also w a te r - w a s h e d , a s th e i r

in a d e q u a te or in t e r m i t t e n t w a t e r supplies,

in ciden ce is a s s o c ia te d w ith i n a d e q u a te w a t e r

w hic h force people to keep d rin k in g w a t e r

su p p lies a s w ell a s w ith c o n ta m in a t e d w a te r.

c o n ta i n e r s in t h e i r h o m e s .12

T h e tw o m o s t significant w a te r - b a s e d d is e a se s a re b ilh arzia (or sch istoso m iasis) a nd

L y m p h a tic filariasis, a p a r a s iti c w orm infection t h a t in its m o s t d r a m a ti c forms

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

60 b e c o m e s e le p h a n tia s is , m o stly affe cts u rb a n

ingly, heav ily c o n c e n t r a t e d in low- an d middle-

p o p u la tio n s in E a s t Africa, c o a s t a l B razil an d

incom e n a tio n s; Fig ure 2.1 sh o w s t h e v e ry

S o u th a n d S o u t h e a s t A s i a .13 T he v e c to r s of

la r g e differen tials b e tw e e n regio ns in th e scale

ly m p h a tic filariasis (Culex spp) b re ed in o r g a n i­

of th e h e a lth b u rd en from d ia r r h o e a l disea se s.

cally po llu ted w a t e r s , including open s e w a g e

In fec tio u s d i a r r h o e a is p ro b a b ly th e

c a n a l s . M an y o t h e r d is e a se v e c to r s th riv e

la r g e s t c o n tr ib u t o r to th e d is e a se b u rd e n from

w h e r e t h e r e is po or d r a i n a g e an d i n a d e q u a te

w a te r , s a n i ta t io n a n d hy g iene - a lth o u g h it is

provision for ru b b is h collection, s a n i ta t io n a nd

also t r a n s m i t t e d t h r o u g h food a n d air. D isease

piped w a t e r - including ho use flies, fleas, lice

b u rd e n s from d ia r r h o e a l d is e a se s in children

a n d c o c k r o a c h e s . 14

y o u n g e r t h a n five c a n be up to 2 4 0 tim e s

Box 2.1 r e p o r ts on w o r k by th e WHO

h ig h e r in low-income n a tio n s t h a n high-income

t h a t e s t i m a t e s th e b u rd e n of d is e a se from

n a tio n s. And if d a t a w e re a v a ilab le for how

w a te r , s a n i ta t io n a n d hy gien e globally. This

d ia r r h o e a l d is e a se b u rd e n s v a rie d b e tw e e n

d is e a se b u rd e n is m e a s u re d in disability

different incom e g ro u p s (or b e tw e e n th o s e

a d ju s te d life y e a r s (DALYs), w h ich m e a n s t h a t

living in in fo rm al s e t t l e m e n t s an d th o s e in

a c c o u n t is t a k e n n ot only of life y e a r s lost

good q u a li ty h ousing), th e d ifferen tials could

from p re m a tu r e d e a th b u t also th e loss of

be even larger. For in s ta n c e , t h e p re v a le n c e of

h e a lt h y life y e a r s from n o n -fatal illness or

d ia r r h o e a a m o n g children u n d e r t h r e e in m a n y

inju ry .15 It s u g g e s ts t h a t th e b u rd e n of i n a d e ­

of N airo b i’s in fo rm al s e t t l e m e n t s w a s found to

q u a t e w a te r , s a n i ta t io n an d h yg ien e is a t le a s t

be tw ic e t h e n a ti o n a l a v e r a g e (and t h e r u r a l

2.2 million d e a th s a n d 82 .2 million DALYs

a v e ra g e ) w hile th e p re v a le n c e of d ia r r h o e a

e a c h y e a r; th is is 4 p e r c e n t of all d e a t h s an d

w ith blood (w hich signifies serio u s sy stem ic

5.7 p e r c e n t of all DALYs. B ut a s th e a u th o r s

infection) w a s often t h r e e to four ti m e s th e

of th is w o r k s t re s s , th is in clu des no c o n s i d e r a ­

n a ti o n a l a v e r a g e (an d r u r a l a v e r a g e ) . 18

tion of th e role of in a d e q u a te w a t e r in

M o r ta lity due to d i a r r h o e a re c o r d e d in

c o n s tra in in g food p ro d u ctio n an d its c o n tr ib u ­

S a m b i z a n g a m unicipio in L u a n d a (Angola)

tion to m a ln u tr itio n (which c a u s e s s e v e r a l

before a pro jec t to im prove w a t e r su p p ly w a s

million d e a t h s e a c h y e a r a n d more t h a n tw ic e

te n ti m e s g r e a t e r t h a n t h a t in u rb a n L u a n d a ;

a s m a n y DALYs a s d is e a s e s from w a te r ,

in C a z e n g a it w a s 24 ti m e s g r e a t e r . 19 A lth o u g h

s a n i ta t io n a n d hygiene). D iseas e s w h e re w a t e r

d ia r r h o e a l d is e a se s a re still com m on in high-

h a s som e role in th e i r tr a n s m is s io n , su c h a s

incom e n a tio n s a n d in high-incom e a r e a s of

m a l a r i a , a c c o u n t for a n o t h e r 1.6 million

cities in low- a n d middle-income n a tio n s, th e i r

d e a t h s a y e a r a n d an a d d itio n a l 6 7 .5 million

h e a lt h im p a c t is m u ch s m a lle r an d v e r y ra r e ly

DALYs - a n d a sig n ifica n t p a r t of t h e s e should

do t h e y c a u s e d e a th or seriou sly im p air

be ad d ed to th e h e a lt h b u rd e n r e l a te d to i n a d e ­

ch ildren's p h y sic a l d evelo pm ent.

q u a t e w a te r , s a n i ta t io n an d hygiene.

M o s t of th e s tu d ie s t h a t sho w t h e h e a lth

D ia rr h o e a an d m a n y w a t e r - r e l a t e d d is e a se s

im p a c t of w a t e r - r e l a t e d d is e a s e s focus on th e i r

often combine w ith u n d e r-n u tritio n an d,

c o n trib u tio n to in fa n t a n d child d e a t h or

to g e t h e r, so w e a k e n th e d efences of in f a n ts or

d isease a n d a re s u m m a riz e d in a l a t e r section .

y o u n g children t h a t d is e a s e s su c h a s m e a s le s

H owever, som e s t u d ie s sho w th e s c a le of the

a n d p n e u m o n ia becom e m a jo r c a u s e s of d e a th ;

im p a c t on u rb a n p o p u la tio n s . A s t u d y in P e r u ’s

t h e s e tw o d is e a s e s a re a m o n g th e leading

c a p it a l n o te d t h a t

c a u s e s of in f a n t a n d child d e a th w o rld - w id e .16 WHO e s t i m a t e s t h a t th e provision of a piped,

...w a ter-b o rn e and w ater-related diseases

w ell re g u l a te d w a t e r sup ply a n d full s a n i ta t io n

are a m ajor cause o f m orbidity and m ortal­

w ou ld le a d to a 70 p e r c e n t re d u ctio n in c a s e s

ity especially in the poorer neighbourhoods

of d ia r r h o e a a s w ell a s r e d u c tio n s in o th e r

o f L im a. The m edical co sts and lost wages

w a te r - , s a n i ta t io n - a n d h y g ie n e -re la te d

fro m such diseases were a high p a rt o f

d i s e a s e s .17

household incom e fo r the poor, 2 7 p e r cent

T h e h e a lth b u rd e n linked to in a d e q u a te w a te r , s a n i ta t io n a n d hy gien e is, n o t s u r p r i s ­

by one e stim a te. 20

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

61 Box 2.1 T h e g lo b a l b u rd e n of d is e a s e from w a te r, s a n i t a t i o n a n d h y g ien e

The Global Burden of Disease study

hygiene to include the following t r a n s ­

covered 107 major diseases an d ten

mission path w ay s:

risk factors, and produced e stim a te s

This analy sis su gg ested t h a t th ere are 2.2 million d e a th s and 82.2 million DALYs lost; a b o u t 4 p er cent

•

as to th e contribution of different

transm ission th ro ug h ingestion of

of all d e a th s and 5.7 p er cent of

diseases or disease clu sters to

w a t e r such a s drinking w a t e r and

DALYs. This exceeds th e disease

people’s health, using DALYs, which

to some ex te n t bath in g (includes

burden of m any major diseases

combined m ortality and morbidity.

diseases from fa e c a l-o ra l

(including m alaria and tuberculosis).

The inform ation on disease burdens

path o g en s and diseases from

They dis proportionately affect poorer

toxic chemicals);

mem bers of society. The e stim a te is

transm ission c aused by lack of

likely to be co nserv ativ e b ecause

relevant to policy becau se it may

w a t e r linked to ina deq u a te

exposure d a t a do not a c co u n t for all

allow action to be directly t a r g e te d to

personal hygiene (including

routes, and becau se numerous

modify exposure. WHO is now a s s e s s ­

tr a c h o m a and scabies);

diseases are not cu rren tly q uantifi­

w a s rela ted to risk factors r a t h e r th a n •

to diseases; this is likely to be more

•

transm issio n c aused by poor

able, pa rticu larly those relating to

risk factors; six focus on environm en­

personal, domestic or ag ricu ltu ra l

w a t e r resource m a n a g e m e n t and

ta l and o ccupational hea lth concerns.

hygiene (includes person-to-

ag ric u ltu ral m ethods involving disease

ing the disease burden of a b o u t 20

person transm issio n of

vectors. In addition, we based the

su gg ested t h a t world-wide, risk

f a e c a l -o ra l pa tho ge ns, food-borne

e stim a te p redom inantly on risk infor­

fac tors for w ater, sa n itatio n and

transm issio n of fa e c a l-o ra l

mation from in tervention studies in

hygiene in te r m s of d iarrh oe al and

p a th o g en s as a result of poor

w a ter, san itatio n and hygiene, and

selected p a ra sitic diseases accounted

hygiene, or use of con tam in ate d

intervention studies tend to u n d e r­

for 5.3 per c en t of all d e a th s and 6.8

w a t e r for irrigation or cleaning);

estim ate a ttrib u ta b le risk b ecause an

tran sm ission throu gh c o n ta c t

interven tion needs to be im plemented

cable diseases and non-communicable

with w a t e r (through b ath in g or

a t the com m unity level in ord er to

diseases associa te d w ith w a t e r were

w ading) containing organisms

eliminate related disease burdens.

The original e stim ate for 1990

•

per cent of all DALYs. Other comm uni­

such a s schistosoma;

not considered (including typhoid, hep atitis A, schistosomiasis and

Diseases with as-yet unknow n

to a certain ex tent, transm ission

fractions due to w a t e r including

through v ecto rs proliferating in

m alaria add up to 1.609 million

w a t e r reservoirs or other

d e a th s and 67.5 million DALYs; a

factors are a num ber of in terre lated

s t a g n a n t w a te r s or certain

significant fraction of this burden

transmission p a th w a y s composed of

a g ricu ltu ral pra ctice s (eg

should probably be added to the

competing or complementing events

m alaria, lym phatic filariasis); and

fraction presented here. An additional

•

arsenicosis). Water, sanitation and hygiene risk

for causing disease. F a e ca l-o ral

transm ission th ro ug h c o n ta m i­

fa ctor is m alnutrition re lated to w a t e r

diseases a ccount for an im p ortant part

n ated aerosols from poorly

scarcity, w hich alone ac co u n ts for a

of this disease burden. T heir tr a n s m is ­

m an ag e d w a t e r resources (eg

burden more t h a n double t h a t

sion ro utes are complex; hu m an and

legionellosis).

re ported here.

•

anim al excreta can affect hum an

Source: Pr iiss, A n n e t t e . David Kay. Lo rn a

health directly through drinking w ater,

There are also w a te r- re la te d injuries

F ew tre ll an d J am ie B a r t r a m (2 0 0 2 ) , ‘E s ti m a t in g

sew ag e, indirect c o n ta c t and food,

t h a t could be prevented by ap p ro p ri­

th e b u r d e n of d is ea se from w a t e r , s a n i t a t i o n and

through various p a th w ay s. We assume

a te w a t e r m an ag e m en t, but these

risk factors for w ater, sanitation and

w e re not considered in this analysis.

16 p e r c e n t of all d e a t h s in one K a th m a n d u h o s p ita l b e t w e e n 1 9 9 2 a n d 1 9 9 8 w e r e due to

h ygi en e a t a glo ba l le vel ’. E n viro n m en ta l H ealth P erspectives, Vol 110 . No 5, Ma y, p a g e s 5 3 7 - 5 4 2 .

R einforcing inequality, p overty and d estitu tion

w a t e r - r e l a t e d d i s e a s e s . 21 D ia r r h o e a l d is e a s e s a n d m a l a r i a a r e th e tw o m ain k illers in

T h e se c tio n ab ove c o n c e n t r a t e d on th e direc t

L u a n d a . 22 For t h e u r b a n p o p u la tio n a s a

h e a lth im p a c t s of i n a d e q u a t e provision for

w h ole, th e r e a r e la rg e p o te n tia l r e d u c tio n s in

w a t e r , s a n i t a t i o n a n d h ygien e. B ut th e r e are

m o rb id ity from m a n y d is e a s e s a s a r e su lt of

m a n y o th e r im p a c t s t h a t need to be c o n s id ­

im p r o v e m e n ts in w a t e r su p p ly a n d s a n ita tio n

ere d , including:

(see Table 2.2).

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

62 F igure 2.1 R eg ion al differentials in a v e ra g e h e a lth b urden s from

p ro v isio n , in c lu d in g t h e co n flic ts t h a t

d ia r rh o e a l d iseases

o fte n a r i s e in q u e u e s , t h e in d ig n itie s of h a v in g to d e f e c a t e in t h e o p en , th e

W e althie st m a rk e t e conom ies

s e x u a l h a r a s s m e n t su f fe re d by w o m e n

F o r m e r U S S R and Eastern Europe

t h e r e l u c t a n c e of c h ild re n a n d w o m e n to

a n d g irls a s a r e s u l t of h a v in g to do so,

v is it pu blic t o i l e t s a f t e r d a r k b e c a u s e s t r e e t s a r e n o t safe; a n d

C h in a

• Latin A m e r i c a and the C a r i b b e a n

t h e l a c k of slee p a n d l a r g e p h y s i c a l d is c o m fo r t du e to t h e c o n s t a n t m o s q u ito n u i s a n c e a t n ig h t.

W o r ld

T h e s e i m p a c t s a re u s u a l ly m o s t e v id e n t a m o n g

O ther A s i a and islan d s

p a r t i c u l a r s e c t i o n s of t h e p o p u la t io n in c itie s in low- a n d m id d le-in co m e n a t i o n s . T h e s e

M id dle East

s e c t io n s of t h e p o p u l a t i o n c a n be c h a r a c t e r i z e d India

by t h e i r low in c o m e s o r b y t h e p a r t i c u l a r S u b - S a h a r a n Africa

s e t t l e m e n t s in w h ic h t h e y live (for i n s t a n c e , t e n e m e n t s a n d illeg al s e t t l e m e n t s ) . C h a p t e r 1 0

5

10

15

20

25

D isa bility adju sted life y e a r s lost per p e r s o n

h ig h l ig h t e d t h e l a r g e d if fe re n c e s b e t w e e n c ities in t h e p r o p o r tio n s of t h e p o p u la t io n t h a t fac e p a rtic u la rly serious problem s w ith w a te r and

Source: World Bank (1 993), World D evelopment Report 1993: Investing in H ealth, Oxford

san itatio n .

University Pre ss, Oxford.

T ab le 2.3 lists d if fe re n t a s p e c t s of i n a d e ­ q u a c i e s in w a t e r a n d s a n i t a t i o n p rov ision a n d t h e h ig h c o s t s of w a t e r to m a n y low-

t h e i n d i c a t o r s c o m m o n ly u s e d t o m e a s u r e

in co m e g r o u p s a n d h ow t h i s a f f e c ts

t h e m . In w e ll g o v e r n e d citie s , t h e r e a r e no

h o u s e h o l d in c o m e s;

in e q u a l it ie s b e t w e e n low- a n d h ig h -in co m e

t h e high e c o n o m ic c o s t s for t h o s e w h o

g r o u p s in m o s t of t h e s e a s p e c t s , a s all (or

fall ill from d i s e a s e s r e l a t e d to i n a d e ­

v ir tu a l ly all) lo w -in c o m e h o u s e h o l d s h a v e th e

q u a t e w a t e r a n d s a n i t a t i o n , in c lu d in g t h e

s a m e q u a l i t y w a t e r from t h e s a m e p ip ed

c o s t of t r e a t m e n t a n d of in c o m e forgo ne;

s y s te m (d e liv ered 2 4 h o u r s a d ay ) a s high-

t h e h u g e p h y s i c a l eff o rts n e e d e d to fe t c h

in co m e g r o u p s ; t h e i r to i l e t s a r e als o c o n n e c t e d

a n d c a r r y w a t e r - a n d o fte n t h e h o u r s

t o t h e s a m e s e w e r s a n d t h e y a r e (g e n e r a lly ) a s

n e e d e d to q u e u e fo r it a n d t h e i n c o n v e n ­

w e ll d e fe n d e d a g a i n s t floods. For m o s t of t h e s e v a r i a b le s , t h e differen ­

ien ce of h a v in g to g e t up v e r y e a r l y to g e t to w a t e r p o in t s b efo re q u e u e s b e c o m e

t i a l s b e t w e e n high- a n d low -in com e g ro u p s

to o long;

b e c o m e a p p a r e n t a s t h e d a t a from high-incom e

t h e s t r e s s a n d o t h e r diffic ulties f a c e d by

a r e a s of a c ity a r e c o m p a r e d to t h e d a t a from

t h o s e h a v in g to c o p e w i t h i n a d e q u a t e

low -inco m e a r e a s . B u t th i s is less pre c ise t h a n

Table 2.2 P o te n tia l re du ctio ns in morbidity for different disea se s as a re s u lt of im pro ve m en ts in w a t e r supply and s a n itatio n Diseases Cholera, typhoid, leptospirosis, scabies, guinea-worm infection Trachoma, conjunctivitis, yaws, schistosomiasis

Projected reduction in morbidity (%) 8 0 -1 0 0 6 0 -7 0

Tularaemia, paratyphoid, bacillary dysentery, amoebic dysentery, gastro-enteritis, lice-borne diseases, diarrhoeal diseases, ascariasis, skin infections Source: WHO (1 986), Intersectoral A ction fo r Health. World H ealth Or ganization. Geneva.

4 0 -5 0

T h e I m p a c t s o f D e f ic ie n t P r o v is io n

63 Table 2.3 A sp e cts of inequality in provision for w a te r and sanitation

N a tu re o f in eq u a lity

T y p ic a l m easure

D iffe re n tia ls

L it r e s p e r p e r s o n p e r d a y

W ith in m o s t low - a n d m id d le-in c o m e n a t i o n s , t h e r e a re

W a te r supply V olume of w a t e r a v a il a b le

v e r y la r g e d if f e r e n t ia l s w i t h i n c it ie s w h e r e s e c t i o n s of t h e p o p u l a t i o n l a c k a c c e s s to p ip e d s u p p lie s Q u a lity of w a t e r

Coliform c o u n t a n d m a n y o ther m easures

A c c e s s ib ility

T im e s p e n t e a c h d a y

F ro m h o u s e h o l d s w i t h i n t e r n a l p ip ed c o n n e c t i o n s w h o

c o lle c tin g w a t e r

s p e n d no ti m e g e t t i n g w a t e r to h o u s e h o l d s w h e r e one or

D i s t a n c e from t a p

m o re p e o p le h a v e to s p e n d o n e to t h r e e h o u r s a d a y

N u m b e r of p e r s o n s p e r

q u e u in g , f e t c h in g a n d c a r r y i n g

s tan d p ip e R e lia b ility

H ours a d a y or w e e k th a t

V aries from 2 4 h o u r s a d a y to on e o r t w o h o u r s a day,

w a t e r is a v a i l a b l e

or in so m e i n s t a n c e s a few h o u r s e v e r y few d a y s ; lowin co m e a r e a s o fte n g e t m o r e w a t e r c u t s t h a n higher* in co m e a r e a s

C ost p e r u n it v o lu m e

P r i c e p e r cub ic m e t r e o r

O ften h ig h r a t i o s ( 1 0 - 1 5 : 1 ) b e t w e e n t h e c o s t of w a t e r

p e r litre

from v e n d o r s o r k i o s k s a n d t h e c o s t of w a t e r from pip ed s u p p l ie s to t h e h o m e

C ost of c o n n e c t io n to pip ed

P r i c e p e r c o n n e c t io n

C o n n e c tio n c h a r g e s a r e o fte n to o e x p e n s i v e for lo w -in c o m e h o u s e h o l d s

w a t e r s u p p l ie s

S an itatio n I n f r a s t r u c t u r e to re m o v e to ile t

S e w e r c o n n e c t io n

w a s t e s (s e w e r s )

M a n y c it ie s a n d m o s t s m a l l e r u r b a n c e n t r e s in A frica a n d A sia h a v e no s e w e r s ; in m o s t c it ie s in low- a n d m id d le-in co m e n a t i o n s t h a t h a v e s e w e r s , la r g e s e c t io n s of t h e p o p u la t io n a r e u n c o n n e c t e d

R is k of f a e c a l c o n t a m i n a t i o n of

Coliform c o u n t

w a t e r s u p p lie s

V e ry l a r g e d if f e r e n t ia l s b e t w e e n h o u s e h o l d s in m o s t u r b a n c e n t r e s ; t h e r i s k s a r e p a r t i c u l a r l y high for h o u s e h o l d s w h o h a v e to s t o r e w a t e r o r u s e u n p r o t e c t e d s o u r c e s . P ip e d s y s t e m s w i t h i n t e r m i t t e n t s u p p l ie s o fte n becom e c o n ta m in a te d

T im e t a k e n to a c c e s s t o i le t s

D i s t a n c e t o t o i le t

H o u s e h o ld s w i t h t h e i r o w n t o i l e t s s p e n d v e r y li ttle ti m e

T im e s p e n t q u e u in g

w a i t i n g to u s e th e m ; h o u s e h o l d s t h a t re ly on pu blic t o i l e t s o fte n s p e n d a s i g n if i c a n t a m o u n t of ti m e e a c h d a y q u e u in g

I n f r a s t r u c t u r e to s u p p o r t d r a i n a g e

H o u se c o n n e c t e d to a

M a n y u r b a n d i s t r i c t s w i t h li ttle o r no p ro v isio n for

d r a i n a g e n e t w o r k w ith in

d r a i n s ; m a n y h a v e d r a i n s t h a t a r e in effe ctiv e b e c a u s e of

s e t t l e m e n t c o n n e c t e d to

p o o r m a i n t e n a n c e a n d b l o c k a g e s from solid w a s t e s

w ider d ra in a g e system S e w e r a g e c o n n e c t io n c h a r g e s

P r i c e p e r c o n n e c t io n

High c h a r g e s for n e w c o n n e c t i o n s

Solid w a s t e co lle c tio n

E x t e n t to w h ic h s e t t l e m e n t

W ith in m a n y u r b a n c e n t r e s , la r g e s e c t i o n s of t h e

o r n e ig h b o u r h o o d h a s

p o p u l a t i o n (ty p ic a lly t h o s e living in in f o rm a l

r e g u l a r s e r v ic e to co lle c t

s e t t l e m e n t s ) h a v e no p ub lic s e r v ic e to re m o v e h o u s e h o ld

household w a s te s

w a s t e s , o r t h e q u a l i t y of t h e s e r v ic e is v e r y i n a d e q u a t e . W h e r e p ro v isio n fo r s a n i t a t i o n is i n a d e q u a t e , h o u s e h o ld w a s t e s o fte n c o n t a i n e x c r e t a so a r e g u l a r w a s t e co lle c tio n s e r v i c e h e lp s d is p o se of t h e s e sa f e ly

C itizen r i g h t s

A c c o u n t a b i l i t y to c it iz e n s

Middle- a n d u p p e r- in c o m e g r o u p s lik ely to h a v e m o re

of w a t e r a nd sa n ita tio n

p o s s ib ilitie s of h o lding w a t e r a n d s a n i t a t i o n p ro v i d e r s to

provider

a c c o u n t t h a n lo w -in c o m e g r o u p s

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

64 Comparing provision for w a te r and sanitation betw een the poorest and the w ealth iest 20 per cent in Accra, J a k a r ta and Sâo Paulo

% h o u s e h o l d s w h o s h a r e toilets with 10 o r m o r e h o u s e h o l d s % h o u s e h o l d s with no w a t e r s o u r c e at their r e s i d e n c e

32

31

19 12

10

1 Accra poo re s t

20%

A ccr a w e a lt h ie st 20%

J a k a r ta poo re s t 20%

Jakarta w e a lt h ie st

S â o P a u lo poorest

S â o P a u lo w e a lt h ie st

20 %

20 %

20 %

Source: Stockholm Environment Institute Household Environment Data Rase 19 9 1- 9 2 , quoted in McGranahan. Gordon, Pedro Jacobi, Jacob Songsore, Charles Surjadi and Marianne Kjellen (2001), The Citizens at Risk: From Urban Sanitation to Sustainable Cities, Ear ths can Publications, London, 200 pages. Figures for shared toilets in J a k a r t a and Sao Paulo are ‘less than'.

co m p ariso n s b e tw e e n income groups, since

T h re e s tu d ie s a re d r a w n on h ere to show

v irtu ally all d is tric ts h ave som e mix of income

th e k in d s of d ifferen tials in w a t e r a n d s a n i t a ­

groups. The size of th e differential b e tw e e n

tio n provision t h a t o ccu r b e tw e e n income

high- an d low-income g ro u p s is also m ask ed

gro up s. The first involved househo ld s u r v e y s

w h e n d a t a a re only av a ilab le to co m p a re provi­

covering 1 0 0 0 h o u seh o ld s in A c c ra , J a k a r t a

sion b e tw e e n p o p u latio n s of relatively larg e

an d Sâo P au lo , a n d th e findings a r e s u m m a ­

a r e a s - for in s ta n c e , for th e m u n icipalities

rized in F ig u re 2.2.

w h ich m a k e up a m ajor city. M ost d a t a on th e

This s t u d y s h o w s t h e d r a m a t i c differ­

qu ality an d e x te n t of serv ice provision or on

e n c es in provision for w a t e r an d re lian ce on

h e a lth o u tco m es for p a r t ic u l a r low-income

s h a r e d to ile ts b e tw e e n th e p o o re s t an d th e

d is tricts a re also only a vailable a s a v e r a g e s for

ric h e st 20 p e r c e n t of hou seh olds, esp ecia lly in

th e w hole d i s tr i c t’s p op ulation , w hich can

A c c ra (w hich h a s t h e lo w e s t p e r c a p it a income

obscure th e more serio u s h e a lth problem s

of th e t h r e e cities). In A c c ra , t w o -t h ird s of th e

suffered by th e po o rer g ro u p s w ith in t h a t

p o o re s t h o u se h o ld s h a d no w a t e r so u rce in

d istrict. This w a s d e m o n s tr a t e d by a s t u d y in a

t h e i r re s id en ce, co m p a r e d to 10 p e r c e n t for

low-income s e t tl e m e n t in K h u ln a (B angladesh),

th e w e a l t h i e s t h ou seho ld s. Sim ilarly, tw o -

w h ich sh o w ed th e s h a r p differentials in w o rk

th i r d s of th e p o o re s t h o u seh olds h a d to sh a r e

d a y s lost to illness or inju ry a m o n g th e in h a b i­

to ile ts w ith t e n or more h o useh old s, co m p ared

t a n t s w h en c o m p arin g th e (within th e c o n te x t

to 12 p e r c e n t for th e w e a l t h i e s t hou seh olds.

of th e s e ttle m e n t) w e a lth i e r ho useh old s to

The d ifferentials a r e also la r g e for th e o th e r

p o o rer households. It also sh o w ed how in th e

t w o cities, a lth o u g h a lo w e r p ro p o rtio n of th e

p o o rer ho useholds, such illness or in jury often

p o o re s t a n d r i c h e s t ho u seh o ld s h a v e no w a t e r

m e a n t g row in g in d e b te d n e ss and u n d e r­

so u rc e in th e i r re siden ce an d h a v e to s h a r e

n u tritio n for all family m e m b e rs.23

to ile ts w ith t e n or m ore h ouseholds.

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

65 T able 2.4 P r o v i s i o n f o r w a t e r a n d s a n i t a t i o n a m o n g d i f f e r e n t s o c i o - e c o n o m i c c l a s s e s i n B a n g a l o r e

Characteristics

Percentage o f the population with access by socio-economic category: Total

SEC-A

SE C -B

SEC-C

SEC-D

SE C -E

Slum s*

100

16

20

27

20

17

17

36

60

45

35

23

19

25

W ith in B a n g a lo r e M un icip al C o rp o ratio n Proportion of all households Individual connection to official w a te r netw o rk S ha red connection to official w a te r netw o rk

36

32

40

40

36

30

29

Any public fountain

29

5

14

27

45

55

61

Toilet a t home

66

96

85

69

50

32

34

S h are d toilet outside home

28

4

14

28

43

52

44

3

6

12

19

1

5

5

Public toilet

4

Defecate in open

1

Tap in to ile t-*“

47

73

58

39

23

14

9

C arry w a t e r to toilet**

45

14

32

56

71

81

86

D rainage connection to municipal sewers***

81

91

89

83

73

70

75

Household collection of solid w a s te s

34

45

45

35

25

20

12

66

56

39

26

C o n u rb a tio n Toilet a t home

47

Sh ared toilet outside home

19

11

27

20

14

Open are a

35

23

18

40

62

Note: B as ed on a s u r v e y of 3 9 3 7 ho us eho lds : 2 9 2 3 in th e m un ic ipa l c o r p o r a t io n , 3 1 0 in t h e c o n u r b a t io n a n d 7 04 in th e gr ee n b el t a r e a s . Using th e c h a r a c t e r i s ­ tic s of e d u c a ti o n a n d oc c u p a ti o n of th e chief w a g e ea rn e r , ho u s eh o ld s w e r e divided into u p p e r inco me (SEC-A), mi ddle-income (SEC-B an d C) a n d low-income (SEC-D an d E). * NB: m a n y p o or ho u s eh o ld s a r e found in o t h e r s e t t l e m e n t s of t h e city; t h e s e a r e t h e s e t t l e m e n t s t h a t a r e officially d e s ig n a te d a s slum s ** For th e 1 8 7 7 h o us eh o ld s hav in g a n In di an toilet. *** For th e 2 8 1 8 h o us eh o ld s t h a t ha v e d r a i n a g e o u tl e ts in t h e ir home. Source: S inc la ir K nig ht M erz an d Egis Cons ulting A u s t r a l i a in a s s o c ia ti o n w i t h Br is b an e City E n t e r p r i s e s an d F ee d b a ck II SSI - S T U P C o n s u lt a n ts - Ta ru Le ad in g Ed g e (2 0 0 2 ) , Bangalore W ater S u p p ly and E nviron m en ta l Sa n ita tio n M asterplan Project; Overview R e p o rt on Services to Urban Poor S ta g e 2 , AusAid, C a n b e r ra .

T he second s tu d y w a s of th e qu ality of w a t e r

T he th ir d s tu d y to high lig h t d iffe rentia ls

an d s a n ita tio n provision in t h e city of B an galore

b e t w e e n incom e g ro u p s is a n a n a ly s i s of

an d its su rroun ds. D ra w in g on household in te r ­

d e m o g ra p h ic a n d h e a l t h s u r v e y s from 43 low-

views, th is ex am ined not only th e differentials

a n d m iddle-incom e n a tio n s , w h ich c o m p a r e d

b e t w e e n geo g ra p h ic a r e a s b u t also differentials

w a t e r a n d s a n i t a t i o n provision for u r b a n poor

ac cording to socio-economic c a te g o r y (which

a n d u r b a n non-poor hou se h o ld s. H ouseholds

w ere defined b ased on th e edu c atio n a n d th e

w e r e a l lo c a te d to ‘p o o r ’ a n d ‘n o n -p o o r’ b a s e d

occ u p atio n of th e chief income ea rn e r) (see

on d a t a on c o n s u m e r d u r a b le s a n d ho u sin g

Table 2.4). In g en e ral, all in d ic a to rs re la tin g to

q u a lity ; th is s tu d y p o in te d o u t t h a t m o st

th e qu ality of w a t e r an d sa n ita tio n provision

d a t a s e t s on public s e rv ic e s a n d d e m o g ra p h ic

decline a s one moves from th e h ig h e st to th e

b e h a v io u r h a v e no d a t a on h ou se ho ld incom es

lo w e s t socio-economic ca te g o ry . For in stan c e,

a n d c o n s u m p tio n . T he a n a ly s i s a llo w e d a

60 p er c e n t of households in th e hig h e st socio­

pred ic tio n of t h e p ro p o rtio n of h o u se h o ld s w ith

economic c a te g o r y have individual con nectio ns

w a t e r on th e p re m ise s (piped or well) a n d a

to th e official w a t e r n e tw o r k , co m p ared to 19

flush to ile t (see Table 2.5). T his high lig h ts

p er ce n t of households in th e low est. V irtually

w h a t m ig h t be e x p e c te d : t h e p ro p o rtio n of poor

all househ olds in th e h ig h e st socio-economic

h o u se h o ld s w ith w a t e r on th e i r p r e m ise s a n d

c a te g o r y (96 p er cent) h av e to ile ts in th e ir

flush to il e ts is m u ch lo w e r t h a n th e p r o p o rtio n

home, co m p a re d to 32 p er ce n t of households in

of non-poor hou se h o ld s. (It shou ld also be

th e low est.

re c a lle d t h a t su c h a n e x e r c is e in u r b a n a r e a s

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

66 | |

P re d ic te d p e rc e n ta g e of households w ith access to w a t e r on th e prem ises and flush to ilets by rela tiv e po verty s t a tu s Water on premises

Countries in region

Flush toilet

Electricity

Lack all three services

North Africa Urban poor

0.75

0.88

0.86

0.08

Urban non-poor

0.92

0.97

0.97

0.02

S u b -S ah aran Africa Urban poor

0.31

0.20

0.26

0.57

Urban non-poor

0.46

0.32

0.52

0.34

S o u th e a s t Asia Urban poor

0.36

0.67

0.77

0.12

Urban non-poor

0.50

0.88

0.97

0.01

S outh, Central, West Asia Urban poor

0.59

0.48

0.71

0.22

Urban non-poor

0.74

0.60

0.92

0.06

0.59 0.74

0.44

0.84

0.12

0.67

0.98

0.02

L atin A merica Urban poor Urban non-poor

Source: H ew ett . Paul C and M ar k R M on tgo me ry (2002) . Poverty and Public Services in Developing-Country C ities, Population Council. New York. 62 pages.

of h ig h -in co m e n a t i o n s w o u ld find little o r no

a l e n t of U S $ 0 . 0 0 0 0 1 p e r litre (for i n s t a n c e ,

differe n c e b e t w e e n p o o r a n d n o n -p o o r

t h e c o s t of w a t e r in C a l c u t t a ’s p ip e d s u p p l y

h o u s e h o ld s .) T h e fig u re s a ls o s h o w t h e v e r y

from a 1 9 9 5 s u r v e y ) w h ile a t t h e o t h e r

l a r g e n u m b e r of n o n -p o o r h o u s e h o l d s la c k i n g

extrem e, th e r e are u rb a n households w ho pay

a d e q u a t e p ro v isio n - ie, h a lf of t h e u r b a n n o n ­

w a t e r v e n d o r s t h e e q u i v a l e n t of $ 0 .1 o r m o re

p o o r in S o u t h e a s t A sia a n d m o r e t h a n h a l f t h e

p e r l i t r e 24 ( a l t h o u g h a s T a b le s 2 .6 a n d 2.7

u r b a n n o n -p o o r in s u b - S a h a r a n A frica do n o t

sho w , m o s t w a t e r from v e n d o r s is a lo t less

h a v e w a t e r on t h e i r p re m is e s .

t h a n th is ). T ab le 2 .6 a n d F ig u r e 2 .4 h ig h lig h t th is . Of c o u r s e , b o t t l e d w a t e r c a n c o s t f a r

Water consumption

m o re t h a n th is. H o w e v e r, in so m e w a y s t h e d a t a in t h e

W h e r e t h e r e a r e s t a t i s t i c s for w a t e r c o n s u m p ­

a b o v e fig u re s a n d t a b l e s a r e m i s l e a d in g , in

ti o n p e r p e r s o n , t h e y o fte n r e v e a l la r g e

t h a t t h e d if fe re n tia ls in p ric e for w a t e r a r e

d if fe re n tia ls b e t w e e n r i c h e r a n d p o o r e r a r e a s

e v id e n t w i t h i n c itie s a s m u c h a s b e t w e e n

of a c it y w h ic h a r e lin k ed to t h e q u a l i t y of

citie s. M o s t u r b a n p o o r g r o u p s n o t only p a y a

p ro v isio n for t h e w a t e r (see Box 2.2).

h i g h e r p ro p o r tio n of t h e i r t o t a l i n c o m e s for w a t e r a n d s a n i t a t i o n t h a n h ig h e r-in c o m e

Monetary costs of water and sanitation T h e m o n e t a r y c o s t s of w a t e r v a r y g r e a t l y from

g ro u p s , b u t t h e y o fte n p a y m u c h h i g h e r p ri c e s p e r litre for w a t e r a n d for a c c e s s to s a n i t a t i o n - a n d t h i s is so e v e n w h e n pro v isio n is m u c h w o r s e t h a n for r i c h e r g ro u p s . T a b le s 2 .7 a n d

c it y to city. T h is c a n be s e e n in t h e d a t a on

2 .8 s h o w d if fe re n tia ls w i t h i n c itie s in t h e c o st

t h e a v e r a g e w a t e r t a r i f f in d if fe re n t A s ia n

of w a t e r . W a t e r c o s t s w e r e p a r t i c u l a r l y h igh

c it ie s in t h e m i d - 1 9 9 0 s (see F ig u r e 2 .3 ). F or w a t e r , t h e c o s t p e r litre t o u r b a n

for m o s t of t h o s e t h a t u se d w a t e r v e n d o r s , w i t h t h e p rice fo r w a t e r from v e n d o r s go ing

c o n s u m e r s a r o u n d t h e w o rld v a r i e s by a f a c t o r

from 10 to 1 0 0 t i m e s t h e u n it p ri c e for h o u s e

of a t l e a s t 1 0 ,0 0 0 ! A t on e e x t r e m e , t h e r e a r e

c o n n e c t io n s . A s t h e A s ia n D e v e lo p m e n t B a n k

i n s t a n c e s w h e r e t h e c o s t of w a t e r is t h e e q u iv ­

s u r v e y h ig h lig h ts , t h e u n it c o s t of w a t e r from

|

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

67 Box 2.2 Examples of differentials in w a te r volumes used

Accra (Ghana)

Dar es Salaam

In the high-class residential areas with w ater piped to the home and w ater closets for sanitation, w ater consumption per capita is likely to be well in excess of the recommended figure of 200 litres per person per day. In slum neighbourhoods such as NimaMaamobi and Ashiaman, where buying w ater from vendors is common, the w ater consumption is about 60

A 1997 study of domestic w ater use in four sites, all with piped supplies, found large differentials in w ater use and reliability. The average per capita w ater use for households interviewed in Oyster Bay (a high-income area) was 164 litres a day. It was much less among households in two lowerincome areas: in Changombe it w as 44 litres a day and in Temeke, 64 litres a day. 70 per cent of the households interviewed in Oyster Bay received a 24-hour supply, compared to 10 per cent of households in Temeke and 11 per cent in Changombe. The unreliabil­ ity of the piped w ater supplies in Changombe and Temeke meant th at

litres per capita per day.25 A survey of 1000 households in 1991-1992 found th a t the average w ater consumption among the wealthiest 20 per cent was 90 litres per capita per day, while it was 33 litres per capita per day for the poorest 20 per cent.26

more than 60 per cent of the inter­ viewed households with piped supplies use vendors as their primary source, despite the higher costs.27

Guayaquil (Ecuador) In 1990, average daily consumption ranged from 307 litres per inhabitant in the well-to-do parts of the city to less than 25 litres per inhabitant for those supplied by the private w ater sellers.28

Nairobi (Kenya) Average daily w ater consumption varies between 20 and over 200 litres per person per day, depending on the quality of provision for water.29

public t a p s m a y also be m uch h ig h e r t h a n from

70 0 million in t h e la s t 15 y e a r s ) . 31 And in

house co n n e ctio n s; in its survey , th is w a s th e

p a r t i c u l a r c a se s , t h e p ro p o rtio n of u rb a n

c a s e in s e v e r a l cities, including Hanoi,

d w e lle rs t h a t rely on v e n d o rs h a s gone up, as

C hennai, K a th m a n d u a n d K a ra ch i.

d e scrib e d in C h a p te r 1 for m a n y u rb a n c e n tr e s

It is also difficult to s e p a r a t e t h e d is c u s ­

in E a s t Africa. M o st h o u seh o ld s will p u r c h a s e

sion of t h e c o sts of provision (or th e prices

w a t e r from v en d o rs for use only in cooking an d

c h a rg e d ) from th e in a d e q u a c ie s of provision,

d rin k in g a n d rely on p o o re r q u a lity bu t

b e c a u s e t h e y a re re la te d . One ke y re a s o n w hy

c h e a p e r w a t e r s o u r c e s for, for in s ta n c e ,

so m a n y u rb a n d w e lle r s d e fe c a te in th e open is

w a s h in g a n d lau nd ry. H ow ever, w a t e r from

b e c a u s e th e y h a v e no to ile ts in th e i r h om e s

v e n d o rs often c o sts U S $ l - 5 p e r cubic m e tre

a n d r e g u l a r use of p a y to i le t s is too expensive.

a n d s o m e tim e s fa r m ore t h a n th is (see Tables

Low-income g ro u p s often use po or q u a lity

2.6, 2.7 an d 2.8).

w a t e r b e c a u s e it is m ore e asily a c c e s s e d and

S om e s tu d ie s h a v e ex a m in e d w h a t

m u c h c h e a p e r t h a n good q u a lity w a te r . So

p ro p o rtio n of househo ld incom e go es on w a t e r

d a t a on how m uch low -income h o u se h o ld s pay

a n d s a n i ta t io n . It sho u ld be n o te d t h a t in m o st

for w a t e r or for to ile ts m a y be m isleading,

low- a n d middle-incom e n a tio n s , th e r e is a n

b e c a u s e t h e y a re in c u r rin g high c o sts in o th e r

a s s u m p ti o n t h a t w a t e r a n d s a n i ta t io n p ro vi­

form s to sa v e m oney (eg, long q u e u e s, fetching

sion does n o t c o s t m uch , since th e income a t

a n d c a r r y i n g w a t e r from long d is ta n c e s , living

w h ic h p o v e rty lines a r e s e t m a k e s no explicit

w ith th e econom ic a n d h e a lt h c o sts t h a t a rise

provision for th e c o st of w a t e r an d s a n i ta t io n .

from in a d e q u a te provision).

In fact, low-income h o u seh olds t h a t h av e to

F ifteen y e a r s ago, John Briscoe e s tim a te d

rely on w a t e r v e n d o rs in m a jo r cities often

t h a t w a t e r v e n d o rs p ro b ab ly s e r v e b e tw e e n 20

s p e n d 5 - 1 0 p e r c e n t of th e i r t o t a l incom e on

a n d 30 p e r c e n t of th e u rb a n p o p u la tio n in

w a te r. T h ere a re e x a m p le s of low-income

low- a n d middle-income n a ti o n s ;30 th e p ro p o r ­

h o u seh o ld s p a y in g a m u ch h ig h er p ro po rtio n

tion h a s p ro b a b ly fallen w orld-w ide b u t th e

t h a n this: in N o u a k c h o tt, th e p u r c h a s e of

n u m b e r of people w ho rely on v en d o rs m a y

w a t e r is e s t im a te d to ab so rb 1 4 - 2 0 p e r c e n t of

h a v e gone up (the u r b a n p o p u la tio n in Africa,

th e b u d g e t for m o s t low -income h o u se h o ld s,32

A sia a n d L atin A m e ric a h a s g ro w n by over

w hile a ca se s t u d y in K a rto n K a s s a la

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

68 I

(K h arto u m ) found t h a t 35 p e r c e n t of h o u s e ­

Figure 2.3 Variations in average w a te r tariffs for selected Asian cities

hold incom e w e n t on p a y m e n t s to w a t e r v e n d o r s .33 As th is K h a rto u m c a se s t u d y n oted , p a y m e n t s for w a t e r come o ut of th e h o u s e ­ h o ld ’s food b u d g e t, e x a c e r b a t i n g th e p re v a le n c e of m a ln u tr itio n a n d so co n trib u tin g to high levels of child m o rtality. Table 2.9 s h o w s th e a v e r a g e m o n th ly ex p e n d itu re on w a t e r for a sa m p le of j u s t over 6 0 0 0 low-income N am ibian ho u seh o ld s living in in fo rm al s e t t l e m e n t s , b a c k y a r d s h a c k s an d is o late d dw ellings. 61 p e r c e n t of t h e s e h o u s e ­ holds h ave m u n icip al supplies. T h e figures sho w th e significance of w a t e r - r e l a t e d e x p e n d i­ t u r e s a s a n item of h o u seh old incom e. On a v e r a g e , 8 p e r c e n t of ho useh old incom e w e n t on w a t e r - a lth o u g h in c e rt a in lo catio ns, th e p ro p o rtio n w a s a s high a s 1 5 - 2 0 p e r cent. In m a n y of t h e c a s e s of c o m m u n itie s d e p e n d e n t on t r u c k e r s or v e n d o rs , g e tt in g 150 litres p e r h o u seh old p e r d a y w ould c o st more t h a n U S$1 a day. T h u s, m a n y hou seho lds w o uld be p a y in g more t h a n a d o llar a d a y if th e y u se d 150 litres a d a y (ie g e n e ra lly 2 0 - 3 0 litres p e r pe rso n p e r d ay), b u t t h i s volum e is no t g e n e ra lly sufficient for good hygiene. If th e y w e re to g e t en o u g h for good hy g ien e s a y 6 0 0 litres p e r h o u se ho ld p e r d a y - t h e co st w o u ld be s e v e r a l US do llars p e r day, w h ich for m ost low-income h o useh old s is fa r more t h a n t h e i r t o t a l incom e. Obviously no low-income ho useh old u se s 6 0 0 litre s a d a y w h e n t h e only w a t e r t h e y c a n g e t is from e xp ensiv e ven do rs. B ut t h i s is a re m in d e r t h a t t h e price of w a t e r is also a m ajo r c o n s t r a i n t on allo w ing m a n y u r b a n h o useh olds to g e t safe, a d e q u a t e sup plies of w a te r . H owever, ho u seh o ld s se rv e d by v e n d o rs w ou ld g e n e ra lly be even w o rs e off w ith o u t t h e s e supplies, a n d v en d o rs u su a lly o p e r a t e in a c o m p etitiv e m a r k e t w h e re th e high c o st of th e w a t e r t h e y supp ly re fle c ts th e high c o sts th e y face in o b ta in in g t h e w a t e r a n d / o r in tr a v e llin g w ith th e w a t e r to supply th e low -income hou seh olds. H ou seho lds t h a t h av e no to ile ts in th e i r h o m es m a y be s p e n d in g c o n sid e rab le su m s on usin g public toile ts. In K u m asi, G h a n a ’s second

0 .2

0 .4

0.6

0.8

1.0

Ave rage wa ter tariff (U S $ per cubic metre) Source. McIntosh, Arth ur C and Cesar E Yniguez (1997), Second Water Utilities Data Book, Asian Development Bank, Manila, 210 pages.

1.

l a r g e s t city, th e use of public to ile ts ju s t once a d a y by ea c h family m e m b e r c a n u se up 1 0 - 1 5 p e r c e n t of th e m ain incom e e a r n e r ’s w a g e s . 34 In m a n y In d ia n cities, low-income

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

69 T able 2.6 T h e v e r y l a r g e v a r i a t i o n s in th e c o s t of w a t e r in cities

W a te r tariff in Cairo35

Price paid per

Price o f 1 5 0 litres

litre (U S$)

per day (U S$)

0.0 0 0 0 4

Cooperative in S a n ta Cruz36

0 .0 0 0 2 5 - 0 .0 0 0 5 5

0.006 0 .0 4 - 0 .0 8

Price o f 600 litres per day (U S$) 0.024 0 .1 5 - 0 .3 3

Public ta p in B and un g37

0.0 0 0 2 6

0.04

0.16

Utility in Lim a38

0 .0 0 0 2 8

0.042

0.17

In dep end ent w a t e r provider in A suncion39

0 .00 0 3 5

0.05

0.2

House connection in B a nd un g40

0.0 0 0 3 8

0.06

0.23

Price of w a t e r from a stand pipe in O uagadougou41

0.00 0 4 8

0.072

0.29

W a te r ta riff in A m m a n 42

0.00 06 1

0.09

0.37

W a te r vendor in D h ak a (1 9 95 )43

0 .00 0 8 4

0.13

0.5

0.15-0.38

0 .6 -1 .5

Price paid for w a t e r to stan dp ip e o p e ra to rs in Nairobi44

0 .0 0 1 - 0 .0 2 5

Average paid by urban households in E a s t Africa with piped w a te r connection (1 9 9 7)45

0.001

0.15

0.6

W a te r tariff in R a m a lla h 46

0.0 01 11

0.17

0.67

W a te r from w a t e r point in H u ru m a (Nairobi)47

0 .0013

0.195

0.78

Kiosks in K a m p a la 48 S tand pip es in Dar es S alaam draw ing w a t e r from m a ins49

0 . 0 0 1 5 - 0 .0 0 7

0 .2 3 -1 .1

0 .9 -4 .2

0 .0015

0.23

0.9

0.002

0.3

1.2 1.2

Average paid by u rb an households in E a s t Africa t h a t lack piped w a t e r 50 Average price paid to vendors by low-income gro ups living in salinated a r e a s in J a k a r t a (1991 )51

0.002

0.3

W ate r tr u c k e r in Lim a52

0 .0 02 4

0.36

1.44

0 .0035-0.0075

0 . 5 3 - 1 .1 3

2 .1 -4 .5

H a n d c a rts delivering to homes in D ar es S a la a m 53 W ate r vendor in B andung (1 9 9 5 )34

0 .00 36

0.54

2.16

Price of w a t e r from ta n k e r s in L u an d a in 1 9 9 8 55

0 .0 0 4 - 0 .0 2

0 .6 -3 .0

2 .4 - 1 2 .0

Price of w a t e r from a h a n d c a rt in C o n a k ry 56

0.004

0.6

2.4

0 .0045

0.7

2.7

0 .0 0 5 4 - 0 . 0 1 0 8

o T— i 1 r-H 00 o

3 .2 4 - 6 .5

Average price paid to vendors in E a s t African urban a r e a s (1 9 9 7 )57 Bicycle w a t e r vendor in K am p ala, delivering to non-serviced a r e a 58 W a te r from public ta p in Lae (Papua New G uinea)59

0 .00 5 9 6

0.9

3.6

W a te r from vendor in Kibera (Nairobi)60

0 .0065

0.97

3.9

Tegucigalpa (US$1.75 p er b a rrel)61

0.0072

1.08

4.3

Vendor in Male (1 9 9 5 )62

0.011

1.7

6.6

Vendor in Kibera (Nairobi) during local w a t e r sh o r ta g e s 63

0.013

1.95

7.8

0.02

3.0

Those purch asing 55 gallon b arrels of w a t e r from vendors in

W ate r from a ta n k e r in L u an d a for tho se in a r e a s d is ta n t from w a t e r so u rc es64

people d e f e c a te in th e open b e c a u s e th e y

100 litre s a d a y w ould be s p e n d in g aro u n d

c a n n o t afford to u se public to i l e t s . 65

K s h 3 0 0 a m o n th on w a t e r ; a visit to th e to ile t

E ven w h e r e public facilities a r e provided

is K s h 2 - 3 , so even if e a c h fam ily m e m b e r only

w ith e v e r y a t t e m p t to keep d o w n co sts, m a n y

u se d th e to il e t once a day, in a five-m em ber

h o u se h o ld s still face difficulties pay in g .

h o u se h o ld t h a t is K s h l 0 - 1 5 a d a y or

C h a p te r 1 in c lu d ed a box a b o u t H u r u m a in

K s h 3 0 0 - 4 5 0 a m o n th . So a v e r y minimum

Nairobi. T he a v e r a g e hou se h o ld incom e is

level of w a t e r a n d s a n i t a t i o n provision w ould

KshSOOO a m o n th a n d t h e m ain a r e a s of daily

be t a k i n g up m ore t h a n 10 p e r c e n t of th e

e x p e n d itu r e are food, t r a n s p o r t , w a t e r a n d th e

incom e for th o s e w ith a v e r a g e incom es. In

u se of to ile t facilities. T he c o s ts of w a t e r an d

D h a k a , fam ilies w h o h av e to p u r c h a s e t h e i r

s a n i t a t i o n do n o t a p p e a r high; 20 litre s of

w a t e r by th e po t p a y 50 p a ise p e r 20-litre pot;

w a t e r c o s ts K sh2. B u t a h ou se h o ld t h a t used

th is do es no t seem ex p e n siv e since th is is

12.0

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

70 U S $ 0 .0 1 . B u t to g e t 100 litres a d a y w ould

Figure 2.4 The very large variations in the cost of w ate r from different providers in different cities

r e p r e s e n t a sig n ifica n t p ro p o rtio n of th e incom e of th e p o o re s t fam ilies. T he co st of

Water from a tanker in Luanda for thos e in are as distant from water s o urces

0.02

a c c e s s to a d e q u a t e w a t e r a n d to to ile ts is a b o u t 8 p e r c e n t of t h e p o o re s t fa m ilie s’

Vendor in Kibera (Nairobi) during water shorta ge

m o n th ly b u d g e t, b u t c an only be afforded by

0.0 13

red u cin g e s s e n tia l food c o n su m p tio n .66

Ve ndor in Male

C on nectio n c h a r g e s for w a t e r a r e often a

0.011

m a jo r b a r r i e r to low -income ho u seh o ld s g e tt in g Vendors in Tegucigalpa

b e t t e r provision. In L im a, w h e n t h e c o n t r a c t s for p r iv a tiz a tio n w e r e being p re p a r e d , c o n n e c ­

Vendor in Kibera (Nairobi

tio n c h a r g e s w e r e e s t im a te d to be U S $ 8 5 0 ; Public tap in Lae

th is sum w o u ld be re p a id ov er five y e a r s w ith an in t e r e s t c h a rg e of 1.2 p e r c e n t a m onth.

Bicycle water ve ndor in Kam pala

F ig u re s s u g g e s te d t h a t c o sts for a minim um co n su m p tio n of 22 cubic m e t r e s a m o n th w ould

Handcart in C onakry

be a b o u t U S$5 or 2 . 5 - 3 p e r c e n t of incom e for Tankers in Luanda

th e 43 per c e n t of L im a ’s r e s id e n ts w h o fell

Ve ndor in B a nd u ng

into th e lo w e s t incom e c a te g o ry . W he n th e

0.0036

c on nec tion c h a r g e w a s included, it w a s H an dcarts delivering to h o m e s in D ar e s Sa la a m

e s t im a te d t h a t w a t e r c o s t s w o u ld rise to 16

0.0035

p e r c e n t of incom e. P r iv a tiz a tio n did n o t t a k e Water trucke r in Lima

0.0024

Ve ndors in salinated areas in Jakarta

p lac e a n d , w h e n d iscu ssin g r e a s o n s for th e la c k of i n t e r e s t in g r e a t e r p ri v a te s e c t o r

0.00

in v o lv e m en t in P e ru , A lcazar, Xu a n d Z u lu a g a

St andpipes in D ar es S a la a m drawing water from m a ins

0.0015

su g g e s t t h a t ‘.. . t h e h ig h e r ta riffs com bined w ith co nn ectio n c h a r g e s w ou ld m a k e w a t e r

K i o s k s in K am pa la

0.0015

u na fford ab le to m a n y u n c o n n e c te d poor Water point in H u r u m a (Nairobi)

co n su m e rs, ev en c o m p a re d to w a t e r from

0.0013

v e n d o r s . ’67 H ouse connection in R a m a lla h

0.0011

Standpipe operat or s in Nairobi

Collignon a n d Vezina c o m p a re ho usehold con nection fees in te n E a s t a n d W e s t A frican

0.001

cities w ith g ro s s d om estic p ro d u c t (GDP) p e r Water vendor in D ha k a

0.00084

H ouse connection in A m m a n

0.00061

St andpipe in O u a g ad ou gou

0.00048

c a p ita . T he re s u lts provide a p o w erfu l s u m m a r y of how u n a t t a i n a b l e piped w a t e r m a y be for t h e poor. In G uinea a n d Cote d ’Ivoire, p e r c a p it a GDP e q u a lle d or e x c ee d e d th e cost of c o n n e c tin g to piped w a t e r supplies.

H o u s e connection in B a n d u n g

0.00038

H ouse connection, independent water provider in A su nc io n

0 00035

c a p i t a by th e following ra tio s: 5:1, 1.3:1, 4:1,

H o u s e connection in Lim a

0.00028

2.5:1 an d 4:1. C on ne ctio ns a re un affo rd a b le

Public tap in B a n d u n g

0.00026

H ouse connection, cooperative in Santa C ru z (cheapest)

0.00025

In Benin, B u rk in a Faso, K enya, M a u r ita n i a a n d U g a n d a , th e c o s ts e x c eed ed GDP p e r

for m o s t.68 A s t u d y in B a n g a lo re found t h a t th e c o st of c on nec tion c h a r g e s to piped w a t e r su pp lies w a s one of th e m ain c o n s t r a i n t s on ex te n d in g th e provision of piped su p p lies.69 Tariff in Cairo 0.00004

E ven th o s e w ith a c c e s s to piped w a t e r m a y h ave m ajo r pro blem s w ith th e i r supply. In

0

0.005

0.010

0.015

Price of water ( U S $ per litre) Sources: See Table 2.6

0.020

Lim a, 48 p e r c e n t of th o s e w h o a re co n n e c te d receive w a t e r s e r v ic e s for less th a n 12 h o u rs a day. (75 p e r c e n t of th e p o p u la tio n h av e a

T h e I m p a c t s o f D e f i c i e n t P r o v is i o n

71 w a t e r c o n n e c t io n .) M a n y fa m ilie s c a n n o t affo rd t h e i n v e s t m e n t re q u i r e d for a w a t e r

E x a m p le s of differentials in th e price of w a t e r within cities

s t o r a g e t a n k . 70 In t h e s t u d y of w a t e r a n d

Price o f water (US$)

s a n i t a t i o n prov ision in B a n g a lo r e m e n t io n e d e a r l i e r in t h i s c h a p t e r , n o t su r p ris in g ly , hig h e rin c o m e g r o u p s h a d m u c h g r e a t e r p ro v isio n for

150 litres

600 litres

K a m p a l a 76

w a t e r s t o r a g e w i t h i n t h e i r h o m e s , a llo w in g

Kiosks

r-H t-H 1 CO CVJ o

0.9 -4 .2

t h e m to h a v e su f fic ie n t w a t e r w h e n p iped

Bicycle w a te r vendors

0.81-1.6

3 .24-6.5

s u p p l ie s w e r e c u t . 71

L im a 7' Water trucker

0.36

1.44

Utility

0 .0 42

0.17

2.7

Time spent getting w a te r

A v e r a g e price in E a s t African urban

H o u s e h o ld s c o n n e c t e d to re lia b le p ip e d w a t e r

Vendors

0.7

s y s t e m s s p e n d no ti m e a t all f e t c h in g a n d

Households that lack piped water

0.3

1.2

c a r r y i n g w a t e r . H o u s e h o ld s t h a t h a v e no

Households with piped connection

0.15

0.6

w a t e r p ip e d to t h e i r h o m e o r y a r d o fte n h a v e

Dar e s S a l a a m 79

a r e a s 78

on e o r m o re p e r s o n s w h o s p e n d one to t w o h o u r s e a c h d a y g e t t i n g w a t e r . T h e ti m e t h a t

Standpipes drawing from mains

0.23

Handcarts delivering to homes

0.5-1.13

0.9 2.1 -4 .5

h a s to b e s p e n t q u e u in g a n d t h e n filling t h e w a t e r c o n t a i n e r s is a p a r t i c u l a r l y u n w a n t e d e x t r a b u r d e n , e s p e c i a ll y sin c e lo w -in co m e p e o p le o ften w o r k v e r y long h o u rs . Q u euin g for w a t e r w h e n long w a i t s a r e n e c e s s a r y a n d s u p p l ie s a r e u n c e r t a i n is a ls o a s o u r c e of te n s i o n a n d c a n p r e c i p i t a t e f i g h t s . 72 Q u euin g a t a t a p a n d c a r r y i n g w a t e r from t h e t a p to t h e h o m e t a k e s a w a y from ti m e t h a t could be

Table 2 .8 The c o st of w a t e r from hou se c o n n e c tio n s, public ta p s and w a t e r v e n d o r s in A sian cities

City

Cost o f water per cubic metre (US$)

u s e d in e a r n i n g a n in c o m e . In so m e c o m m u n i­ House connections Public tap

ti e s , p e o p le h a v e to q u e u e for h o u r s e a c h d a y -

Water vendor

fo r i n s t a n c e in S h a j a h m a l w ith i n t h e In d ia n

Bandung

0.38

0.26

3.6 0

c ity of A lig a r h , w h e r e t h e o nly w a t e r a v a il a b le

Bangkok

0.30

-

28.94

is from a m u n i c ip a l t u b e w e l l . 73 I n t e r v i e w s w ith

Chennai

0.30

0.58

-

a r a n g e of h o u s e h o l d s in 16 s i te s in n in e u r b a n

Chonburi

0 .38

-

19.33

Colombo

a r e a s in K e n y a , U g a n d a a n d T a n z a n i a in 1 9 9 7 fo un d t h a t t h o s e w i t h o u t p ip ed s u p p l ie s s p e n t a n a v e r a g e of 9 2 m i n u t e s e a c h d a y c o lle c tin g

0.04

0.02

-

Dhaka

-

0.08

0.84

Hanoi

0 .09

0.55

Karachi

0.10

0 1.14

w a t e r . 74 T h is r e p r e s e n t s a m o re t h a n th r e e fo l d

Kathmandu

0.18

0.24

i n c r e a s e c o m p a r e d to t h e l a t e 1 9 6 0 s , w h e n th e

Lae

2 .20

5.96

a v e r a g e ti m e co lle c tin g w a t e r in t h e s e s a m e

Male

5.08

-

2.61 -

11.20

Manila

0.29

Mumbai

0 .07

Phnom Penh

0.13

Port Vila

0.42

0.86

8.7 7

Seoul

0.25

14.13

21.32

a l l o c a t e d t h e r e s p o n s ib ility of c o lle c tin g w a t e r

Shanghai

0 .08

0.06

-

( g e n e r a ll y w o m e n o r c h ild ren ) o fte n h a v e to

Tashkent

0.01

0.02

-

Thimphu

0.03

0.05

-

s i t e s h a d b e e n 28 m i n u t e s a d a y . 75 In 1 9 9 7 , th o se using kiosks w ere spending a lm o st tw o h o u r s a d a y c o lle c tin g w a t e r . T h e p e r s o n s w ith i n a h o u s e h o ld w h o a r e

g e t up v e r y e a r l y to m a k e s u r e t h e r e is w a t e r

-

0 .0 7 -

2.15 0 .50 0.9 6

a v a i l a b l e in t h e m o r n in g . W a t e r is also v e r y

Source: Consumer su rv ey s from eac h city un d e r t a k e n by th e Asian Development Bank

h e a v y to c a r r y a n y d i s t a n c e a n d re q u i r e s m u c h

Data Book, Asian Development Ban k. Manila, 21 0 pages. Note t h a t some of the se cities

an d repo rt ed in McIntosh, A r th u r C and Cesar E Yniguez (1 997), Second Water Utilities

p h y s i c a l e ffort, so t h e a m o u n t of w a t e r u se d w ill be in f lu e n c e d by t h e d i s t a n c e t h a t it h a s to be c a r r ie d . If a h o u s e h o l d k e e p s its w a t e r

with v ery high cos ts for vendors ac tu al ly have a ve ry small proportions of th e ir p o pu la ­ tion serv ed by vendors (eg Seoul).

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

72 Table 2.9 Monthly expenditure on w ater: shack dwellers in Namibia

Average (mean) monthly income in Namibian dollars (Na$)

Average (median) monthly income (Na$)

Average (mean) expenditure on water (Na$)

Malthahohe Mariental Gibeon Keetmanshoop Windhoek

334 421 300 580 744

20.3 24.4

Dordabis Okahandja Otjiwarongo Karibib Usakos Swakopmund Walvis Bay Tsumeb Oshakati Rundu Average

486 447 462 626 421

250 300 200 500 611 310 300 300 600 300 500 1000 300 500 400 310

631 1221 411 794 436 554.3

Average (median) expenditure on water (Na$) 15.0 15.0 31.5 50.0 12.5

25.9 80.6 18.7 -

71.2 9.6 20.5 53.0 114.9 146.5 49.3 33.1 41.0 47.3

Mean % o f income on water

6.1 5.8 8.6 13.9 2.5 0 15.9 2.1

-

50.0 12.0 20.0 50.0 100.0 150.0 40.0 18.0 25.0 25.0

3.3 12.6 18.2 12.0 12.0 4.2 9.4 8.5

Median % o f income on water

Number o f households in survey’

6.0 5.0 15.8 10.0 2.05 0 16.7 4.0 3.3 16.7 20.0 15.0 13.3 3.6 6.3 8.1

84 321 140 217 2592 65 211 560 199 91 266 549 249 368 374

* Average household size is 4.5 persons Source: Namibia Housing Action Group (2000), information collected in 15 urban ar ea s in Namibia by the Shack Dwellers Federation of Namibia.

c o n su m p tio n d ow n to only 150 litres a da y

to co ver t h e e n tire u rb a n a r e a , w h ich m e a n t

(and m a n y use more t h a n th is) th i s still m e a n s

a n a v e r a g e of only one s ta n d p ip e for aro u n d

t h a t th e e q u iv a le n t of 8 - 1 2 full b u c k e ts of

2 5 0 0 i n h a b i t a n t s . 80 In m a n y a r e a s of L u a n d a ,

w a t e r h av e to be c ollected ea c h day. This

th e r e is one s t a n d p o s t for 6 0 0 - 1 0 0 0 p e r s o n s .81 T h e tim e n e e d e d to collect w a t e r is often

m e a n s c a r r y i n g a t o t a l w e ig h t of 150 kilos of w a t e r e a c h d a y from th e sta n d p ip e , w ell or

m a d e all t h e w o rs e by th e ir re g u la rit y of

kio sk to th e home. T h is often m e a n s hav ing to

supply. So n o t only does ea c h hou seh old have

lift th is w e ig h t high to allow it to be poured

to s h a r e a s ta n d p ip e w ith d o zens of o th e r

into a w a t e r t a n k . Not surprisingly, th o s e w ho

h ou se ho lds, b u t w a t e r is only a v a ilab le i n t e r ­

h a v e to fetch an d c a r r y w a t e r (usually

m itt e n tl y a t th e sta n d p ip e . C h a p te r 1 gave

w o m en ) often suffer se v e re b a c k problem s.

m a n y e x a m p le s of cities w h e re w a t e r w a s only

Lim ited q u a n ti ti e s of w a t e r m e a n i n a d e q u a te

av a ilab le in piped s y s te m s for a few h o u rs a

su pp lies for w a s h in g an d p e rs o n a l hygiene -

day.

an d for w a s h in g food, co ok ing u te n s ils a nd clo th e s - w ith all t h e im plicatio ns t h a t th is h a s for d is e a se , a s d escribe d earlier. One of t h e m o s t e asily m e a s u re d (and d ra m a ti c ) in d ic a to r s of th e tim e an d effort

Time and money lost to w ate r­ borne and other w ater-related diseases

n eed ed to g e t w a t e r is th e n u m b e r of p e rs o n s

It is obvious t h a t w h e r e w a t e r an d s a n i ta t io n

p e r t a p . Fig ure 2.5 s h o w s how it is comm on

provision is i n a d e q u a te , th e r e a re likely to be

for th o s e w h o are re lia n t on public t a p s in

la r g e c o s ts re la tin g to th e tim e a n d m o ney lost

A sian cities to h av e a t le a s t 2 0 0 o th e r people

to f a e c a l - o r a l a n d o t h e r w a t e r - r e l a t e d

co m p etin g for a c c e ss ; t h e s e a re city a v e r a g e s ,

d is e a se s. T h ere is s u rp ris in g ly little d e ta ile d

so m uch h ig h e r n u m b e r s of people p e r t a p are

re s e a r c h on this. A stu d y of Lim a m e ntio ne d

likely in t h e lo w est-in co m e a r e a s . In

e a r l ie r s u g g e s te d t h a t t h e m ed ica l c o sts and

N o u a k c h o tt, j u s t 1 79 s t a n d p ip e s w e re in s talled

lo st w a g e s from w a t e r - r e l a t e d d is e a s e s ‘w e re a

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

73 Figure 2.5 Proportion of selected Asian city populations served with public ta p s and number of persons per tap

a>

Q-

o L_

a>

_a

£ D C a> cn 03

< 10

20

30

40

50

60

P e r cent of p o p u la t io n s e r v e d by p ub lic tap s Source: McIntosh. Arthur C and Cesar E Ynigucz (1997), Second Water Utilities Data Book, Asian Development Bank, Manila. 210 pages.

high p a r t of ho useh old incom e for th e poor, 27

T h e y also re p r e s e n t a ro u n d half t h e u rb a n

p e r c e n t by one e s t i m a t e . ’82 T h e s tu d y in an

p o p u la tio n in t h e reg io n s w h e r e w a t e r a nd

in n er city bustee [slum] in K hulna

s a n i ta t io n provision is w o r s t . B ut it is r a r e for

(B a n g lad e sh ), also m en tio n e d earlier, sh o w e d

th e i r n e e d s an d p rio rities to be given much

t h a t 24 p e r c e n t of h o u se ho lds h a d lost la b o u r

c o n sid e ra tio n . This section s e e k s to re m e d y

d a y s due to an illness or a c c id e n t in th e m o nth

this.

p rio r to th e in terv iew , a n d th e a v e r a g e n u m b e r

T h o u s a n d s of sm a ll children still die

of la b o u r d a y s lo st w a s te n p e r m o n th . In

e v e r y d a y from p re v e n ta b le d is e a se s r e l a te d to

g e n e r a l , t h e p o o re s t ho u se h o ld s w ith in th is

th e in a d e q u a te provision of w a t e r a n d s a n i t a ­

bustee lo st m o s t w o r k d a y s to illness and

tio n in u r b a n an d r u r a l a r e a s . M a n y more live

in ju ry and also m o st incom e an d m uch th e

w ith r e p e a t e d b o u ts of d ia r r h o e a , w orm in fes­

h ig h e s t p ro p o rtio n of th e i r incom e. The

t a t io n s , skin infections, m a ln u tr itio n an d

p re s e n c e of a n i n c a p a c i t a t e d p rin cip al incom e

c h ro nically ch alle n g e d im m u ne s y s te m s a s a

e a r n e r in a ho useho ld w a s a sign ifica nt risk

r e s u lt of u n s a n i t a r y living en v iro n m e n ts. The

fa c to r for severe u n d e r-n u tritio n a m o n g y ou ng

effects a re often long te r m , a n d m a y include

children in th e h o u seh o ld .83 While th is stu d y

b o th p h y sic al a n d m e n t a l s tu n tin g . This

w a s looking a t all form s of a d u lt ill-health

v io la te s t h e rig h ts of millions of children - to

(including m a n y t h a t w e re n o t r e l a te d to

s u r v iv a l a n d h e a lt h , to o p tim a l d e v e lo p m en t

w a t e r an d s a n i ta t io n ) it is a re m in d e r of t h e

a n d to a d e c e n t s t a n d a r d of living. This sectio n

v e ry larg e econom ic im p a c t of th e h e a lth

lo ok s a t th e p r a c t ic a l re a litie s of i n a d e q u a te

b u rd e n s a s s o c ia te d w ith v e r y po or living con di­

provision for y o u n g children an d th e i r

tio n s a n d w o rk in g conditions.

c a re g iv e rs , a n d re v ie w s c u r r e n t k n o w le d g e of th e im plicatio ns for child ren ’s h e a lth an d

Im pacts on infants and U ai children84

g e n e r a l d evelo pm ent.

Children b e a r m u ch t h e g r e a t e s t b u rd e n of ill-

- an d ov er 80 p e r c e n t of t h e w o r l d ’s u rb a n

A round 1 billion children live in u rb a n a r e a s - close to half th e children in th e w orld

h e a lt h a n d p r e m a tu r e d e a th from dis e a se s

children live in Africa, A sia a n d L atin

r e l a te d to in a d e q u a te w a t e r a n d s a n i ta t io n .

A m e ri c a .85 Africa, one of th e le a s t u rb a n iz e d

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

74 re gions, a lr e a d y h a s m ore t h a n t w ic e a s m a n y

co m p arin g 1992 to 1 9 9 7 , in Mali w h e n

u rb a n children a s N o rth A m e ric a .86 It is

com p a rin g 1 9 8 7 an d 1 9 9 5 , in Z am b ia w h en

co m m on for b e tw e e n 45 an d 55 p e r c e n t of th e

co m p arin g 1992 an d 1 99 6 a n d in Z im babw e

u rb a n p o p u la tio n in low- a n d middle-income

w h e n c o m p arin g 19 88 a n d 1 9 9 2 .90

n a tio n s to be u n d e r 18 y e a r s of age. In m ost

M a n y m iddle-incom e n a ti o n s still h av e

s u b - S a h a r a n A frican n a tio n s more t h a n h alf

u r b a n child m o r ta l it y r a t e s of 50 to 1 0 0 . 91

th e u r b a n p o p u la tio n is in t h i s ag e g ro up , an d

T h e s e a re a v e r a g e figu res for e n tire u r b a n

su r v e y s in Yemen (1 9 9 1 ), Z am b ia (1 9 9 6 ),

p o p u la tio n s , an d a s s u c h o b sc u re th e h ig h er

Niger (1 9 9 8 ) an d Chad (1 99 6) found more

child m o r ta l it y r a t e s w ith i n t h e low er-incom e

t h a n 55 p e r c e n t. W ith in n a tio n s, sm a lle r

s e t t l e m e n t s . In a w e ll m a n a g e d city, th e

cities g e n e ra lly h av e h ig h e r p ro p o rtio n s of

difference in m o r ta l it y r a t e s for children

0 - 1 8 y e a r olds t h a n la r g e cities.87

b e t w e e n t h e lo w e s t a n d h ig h e s t incom e a r e a s is n o t v e r y la rg e ; in a b a d ly m a n a g e d city

Health burden for children

th e y c a n v a r y by a f a c t o r of 10, 20 or more.

A lth o u g h in f a n t a n d child m o r ta l it y r a t e s h ave

t h a t in f a n t m o r ta l it y r a t e s v a r i e d from 33 to

come dow n sig nificantly in m o s t n a tio n s in

2 0 9 p e r 1 0 0 0 live b i r t h s . 92 Table 2 .1 0 s h o w s

S u r v e y s in se v en s e t t l e m e n t s in K a r a c h i found

r e c e n t d e c a d e s, 1 .5 - 2 million children still die

h ow in f a n t an d under-five m o r ta l it y r a t e s

e a c h y e a r from w a t e r - an d s a n ita t io n - r e la t e d

v a r i e d in N airobi b e t w e e n v a rio u s in fo rm al

d is e a s e s ,88 a n d m a n y more a re d e b ilita te d by

s e t t l e m e n t s (w h ere a r o u n d h a lf t h e en tire

illness, pain a n d disco m fo rt - p rim arily from

c i t y ’s p o p u la tio n lives) a n d c o m p a r e d to

d ia r r h o e a l d is e a se s, in te s t in a l w o rm s , a n d

a v e r a g e s for Nairobi, u r b a n c e n tr e s in g e n e r a l

from v a rio u s eye a n d skin d is e a s e s a n d in fec­

a n d r u r a l p o p u la tio n s . In som e of t h e inform al

tio n s r e l a te d to insufficient w a t e r for w a s h in g .

s e t t l e m e n t s , under-five m o r ta l it y r a t e s w e r e

A lth o u g h in sufficient an d u n sa fe w a t e r

th r e e or four t i m e s th e a v e r a g e for Nairobi

su pp lies a n d s a n i ta t io n affe ct people of all

(and likely to be 1 0 - 3 0 ti m e s t h e r a t e s in

ag e s , child ren ’s h e a lt h a n d well-being is p a r t i c ­

high-incom e a r e a s ) .

u la r ly com prom ised. A p p ro x im a te ly 84 p er

T h ere a re differences of opinion r e g a r d in g

c e n t of th e global b u rd e n of d ia r r h o e a l disease

th e co n trib u tio n of w a t e r supp ly an d s a n i t a ­

is e x p e rie n c e d by children u n d e r five; 74 p e r

tio n to d e a t h a n d dis e a se . City-level d a t a from

c e n t of th e h e a lth b u rd en from h elm inth

Global U rban I n d i c a to r s sho w child m o r ta lity

(worm ) infections a ffe c ts children b e tw e e n 5

r a t e s to be g e n e ra lly more highly c o rr e la te d

an d 14.89

w ith a la c k of a c c e s s to p o ta b le w a t e r an d

In cities w ell se rv e d by piped w a te r,

s e w e r a g e c o n n e c tio n s t h a n w ith o th e r

s a n ita tio n , d ra in a g e , w a s t e rem ov al a nd a good

v a ri a b le s co m m o nly cited, such a s t h e n u m b e r

h e a lt h ca re s y s te m , child m o r ta lity r a t e s a re

of h o u se h o ld s below p o v e rt y lines o r th e a v a il­

g e n e ra lly aro u n d 10 p e r 10 00 live b ir th s and

ability of h e a lt h s e r v ic e s .93 Some s tu d ie s h ave

few if a n y child d e a t h s a re th e re su lt of w a te r -

e s ta b lis h e d ti g h t li n ks b e tw e e n en v ir o n m e n t

re la te d dise ase s. In cities or neigh bo urho od s

a n d h e a lt h even w h e n socio-econom ic v a ria b le s

w ith in a d e q u a te provision, it is comm on for

a r e held c o n s t a n t . 94 On t h e o t h e r h a n d , it is

in fa n t an d child m o r ta lity r a t e s to be 10 to 20

c le a r t h a t th e influence of w a t e r a n d s a n i t a ­

tim e s higher. M a n y low-income co u n trie s still

tio n is r e l a te d in com plex w a y s to t h e s e o th e r

h ave u rb a n under-five m o r ta lity r a t e s of

fa c to rs, an d t h a t th is re la tio n sh ip c a n v a r y

b e tw e e n 100 a nd 2 00 per 1 00 0 live b ir th s -

from p la ce to p lace . An a n a ly s is of

including Chad (1 90 in 1996), M a la w i (19 4 in

d e m o g ra p h ic an d h e a lt h s u r v e y (DHS) d a t a

1 992 ), Mali (172 in 19 95), M ozam bique (169

from G h a n a , E g y p t, Brazil a n d T h a ila n d , for

in 1 997 ), Z am bia (174 in 1996) a n d H aiti (135

i n s ta n c e , d e m o n s t r a t e s t h a t a lth o u g h socio­

in 1994). For som e n a tio n s for w h ich d a t a from

econom ic s t a t u s , a c c e s s to h e a lt h s e r v ic e s and

s u r v e y s w e re av ailab le for different y e a rs ,

levels of provision a re in t e r r e l a t e d in th e i r

under-five m o r ta lity r a t e s in u rb a n a r e a s

effects on th e h e a lth an d s u rv iv a l of u rb a n

in crea se d - for in s ta n c e in M a d a g a s c a r w h en

children, th e re la tiv e im p o rt a n c e of th e s e

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

75 Mortality ra te s for infants and young children in the informal settlem en ts of Nairobi

Location

Nairobi informal settlements (average) Nairobi informal settlements in: Central Makadara Kasarani Embakasi Pumwani Westlands Dagoretti Kibera National** R u ra l" Nairobi** Other urban*"

Neonatal mortality rate

Post-neonatal mortality rate

Infant mortality

Under-five mortality rate

Prevalence o f diarrhoea*

Prevalence o f diarrhoea with blood*

30.4

60.9

91.3

150.6

30.8

11.3

24.5 34.1 19.2 111.1 16.3 23.1 0.0 35.1

43.5 52.2 58.2

68.0 86.3 77.4

123.1 142.7

52.5 56.3

163.6 72.6 103.0 35.0 106.2

34.6 20.4 30.8 27.6 26.7 30.4 26.0

13.6 10.0 9.2 9.1 12.5 12.2 10.5

36.9

9.8

28.4 30.3 21.8 16.9

45.3 45.7

17.1 17.1

3.0 3.1

12.9 19.4

3.4 1.7

79.9 35.0 71.1

16.9 39.8

73.7 75.9 38.7 56.6

124.5 254.1 134.6 195.4 100.3 186.5 111.5 113.0 61.5 83.9

* Per cent of children under three yea rs of age with w at e ry diarrhoea and diarrhoea with blood during the two weeks preceding the survey. *• Based on the 1998 Kenya Demographic and Health Survey. Source: APHRC (2002), Population and Health Dynamics in Nairobi’s Inform al Settlem ents, African Population and Health Research Center, Nairobi, 256 pages.

f a c t o rs v a rie s from one site to a n o th e r . In

s e c tio n s of th e w o r l d ’s u rb a n p o p u la tio n . The

G h a n a , for in s ta n c e , e n v ir o n m e n ta l dif feren­

h e a lth b u rd en for children u n d e r five t h a t

ti a ls in d ia r r h o e a p re v a le n c e a re m o d e s t a ft e r

a r i s e s from d ia r r h o e a l d is e a s e s linked to i n a d e ­

socio-econom ic s t a t u s is co ntrolled for - p r o b a ­

q u a te w a te r , s a n i ta t io n an d hy g iene is up to

bly a reflection of th e f a c t t h a t provision is

24 0 ti m e s h ig h er in Africa t h a n in high-income

re la tiv e ly p oo r th r o u g h o u t u r b a n a r e a s and

n a t i o n s .97 As n o te d above, t h e im p a c t of

falls below th e th r e s h o ld a t w h ich e x p o su re to

d ia r r h o e a l d is e a se s on in fan t a n d child d e a th s

in fection beg ins to decline; o t h e r income-

ca n be c o n sid era b ly u n d e r- e s ti m a t e d since,

r e l a te d f a c t o rs a r e more sign ific ant h ere in th e

w h e n com bined w ith u n d e r-n u tritio n , th e y can

re la tiv e effects t h e y h av e for children. In

so w e a k e n t h e b o d y 's d efen ces t h a t d is e a se s

T h a ila n d , in e q u a litie s in e n v ir o n m e n ta l co nd i­

su c h a s m e a s le s a n d p n e u m o n ia becom e m ajo r

tio n s a re stro n g ly c o rr e la t e d to d ia r r h o e a

c a u s e s of child d e a t h . 98 In t e s ti n a l w o rm s also

p re v a le n c e , b u t n o t to m o r ta l it y - pro b ab ly

c a u s e se v e re p ain to t e n s of millions of u rb a n

b e c a u s e of w id e s p r e a d a c c e s s to a n d u se of

children an d u n d e rm in e th e i r n u tr it io n a l

h e a lt h s e r v ic e s .95

s t a t u s , r e t a r d t h e i r p h y sical d e v e lo p m e n t an d

R e g a rd le s s of differences from p lace to

co n tr ib u te to po or school a t t e n d a n c e an d

p lace, h o w ever, it is c le a r t h a t , w h e r e w a t e r

p e rf o r m a n c e .99 M a n y c a s e s tu d ie s in low-

an d s a n i ta t io n provision is in a d e q u a te ,

incom e s e t t l e m e n t s h a v e sh o w n th e high

children h av e h ig h e r r a t e s a n d in te n s ity of

p ro p o rtio n of children w h o h a v e deb ilitatin g

d ia r r h o e a l illness, w orm in fe sta tio n s , skin

in te s t in a l w o rm b u r d e n s .100 The p re v a le n c e

infection s a n d m a ln u tr itio n , an d t h a t im proved

am o n g children of v a rio u s skin a n d eye in fec­

provision (including in c r e a s e s in th e a m o u n t s

tio n s, su c h a s s c a b ie s an d t r a c h o m a , t h a t are

of w a t e r used) c o n tr ib u te to r e d u c tio n s in

a s s o c ia te d w ith a la c k of w a t e r sup p lies for

m orbid ity an d m o r ta lity .96

w a s h in g is also p a r t ic u l a r ly high a m o n g th o s e

D ia rr h o e a l d is e a s e s a r e still a p r i m a r y c a u s e of in f a n t a n d child d e a th for larg e

living in p oo r q u a lity h o m es a n d n e ig h b o u r­ h o o d s .101

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

76 D iarrh oea and in testin a l p a ra s ite s

c o m pen sated for by th e ir relative protection

con tribu te much to m alnutrition in children.102

from exposure to p a th o g en s , especially for

These links are complex and reciprocal: m a ln u ­

th ose children being breast-fed. The g r e a t e r

trition w e a k e n s the b ody ’s defences and

mobility of children a fte r infancy in creases

ca u se s children to be more vulnerable to

th e ir exposure, but th e ir acquired im munity

disease. But a t the sam e time, diarrh oeal

provides some p ro te c tio n .111 Bottle-fed infants

disease and intestina l p a ra s ite s contribute to

are a t especially high risk w h ere th e r e is

m a lnutrition by causing decreased food intake,

in a d e q u a te w a t e r an d s a n ita tio n provision.

im paired n u tr ie n t absorption and direct n u tr i­

W ith o u t clean w a t e r and hygienic conditions,

en t lo sses.103 Even a relatively mild infestation

bo ttles c a n n o t be sterilized and formula milk

of intestin al p a ra s ite s, for in sta n c e, can

c a n n o t be safely mixed. A su rv ey of the milk

consum e 10 p er cent of a child’s t o t a l energy

being fed to 149 children of betw e en 6 and 24

in take, a s well as interfering with digestion

m onths in a slum s e ttle m e n t in Varanasi, India

an d a b so rp tio n .104 U n sa n ita ry environm ents

found t h a t 53.7 pe r cent of the sam p les were

also co ntrib ute to m alnutrition by challenging

c o n ta m in a te d by b a cte ria. The odds of c o n ta m ­

children’s immune system s; n u tr ie n ts t h a t

ination w ere 25 tim e s a s high w h en feeding

would o th erw ise su pp ort g ro w th in stea d go

utensils w ere not properly clea n ed .112

to w a r d s su pporting th e im mune re s p o n se .105

A lthough HIV positive m others are w arn e d

D a ta from 84 countries indicate t h a t th e b est

a b o u t th e possibility of t r a n s m ittin g the

predictor of nu trition al s t a tu s , n ext to suffi­

disease to th e ir infants th ro u g h breast-feeding,

cient funds for food, is th e level of ac cess to

th e reality is t h a t m any of th e s e infants, if

w a t e r . 106

bottle-fed in environm ents t h a t do not support

The case is often made t h a t th e effect of

a d e q u a te hygiene, are a t even higher risk of

infection or d ia rrho ea on g ro w th is tr a n sie n t,

d ea th from diarrh oeal disease th a n from

and t h a t children generally c a tc h up quickly.

A IDS.113

This seem s to be tr u e if t h e y have stre tc h e s of

Children being w e a n e d from th e b re a s t

diarrhoea-free ti m e .107 B ut for m a ny children

are also a t high risk, as th e y first e nco un te r

living in ad verse conditions, d ia rrho ea in the

th e p ath o g en s in a c o n ta m in a te d environment.

early y e a r s m ay be too severe or too frequent

A prospective stu d y of urb an Filipino infants

to allow for catc h-up g ro w th , and it is asso ci­

found t h a t feeding even sm all am o u n ts of

a te d with continued low w eight or su b s ta n tia l

co n ta m in a te d w a t e r sup plem ents to breast-fed

shortfalls in gro w th w hen children are older.108

infants n early doubled th e ir risk of

Long-term im p a cts for children are not

d ia r rh o e a .114

re s tricted to health; re s e a rc h in poor urban

Children in child care ce n tre s and oth er

se ttle m e n ts in Brazil h a s rela ted early

institutio ns m a y also be more vulnerable.

d ia rrh o e al disease in children to im paired

Possibilities for disease tra nsm issio n are

cognitive functioning se v e ra l y e a r s la t e r . 109 Poor provision can affect gro w th in o the r

alw ay s higher w hen a n u m b er of children are to gether, and sev eral studies from u rb an a re a s

w a y s too; w hen w a t e r is a t a distance, this

in Latin A m erica have sh ow n higher ra t e s of

can co n trib u te to heavy w o rk lo ad s for older

dia rrho ea for children in day care c e n tr e s .115

children, causing them to burn calories t h a t

In a d e q u a te toilets or hand-w ashing facilities

th e y depend on for a d e q u a te nutrition.

m ay allow p a r a s ite s or disease to spread

C arrying overly heavy c o n ta in e rs can even

quickly from child to child, and from th ere

con tribu te to deformities in bone g r o w th . 110

th rou g h th e community.

Children’s vulnerabilities

no provision for toilets. Schools w ith several

Children’s vulnerability to p a th o g e n s is related

w ith very over-crowded facilities often have a

to both th e ir exposure and th e ir level of

few poorly m aintained pit latrines. Even w here

immunity. The less effective im mune system s

facilities are technically p res e n t, th e y m ay be

of infants and youn ger children are so m e w h at

poorly a d a p te d to th e use of children.116

It is common for schools to have little or hundred (or even th ou san d) children and often

T h e I m p a c t s o f D e f ic ie n t P r o v is io n

77 The impacts for mental and social development

w a t e r and sa n ita tio n an d children’s cognitive functioning. Any num ber of variables and complications would p resum ably m ediate and

R esea rch in u rb an Brazil and P eru h as dem on­

confound such a connection. Given th e in te r­

s t r a t e d stro ng connections b e tw e e n infection

m ed iate links t h a t have been established,

w ith d ia rrh o e al p a th o g e n s in th e first tw o

however, b e tw een provision and disease,

y e a rs of life and cognitive functioning when

disease and m alnutrition, and m alnutrition and

children a re b e tw ee n six an d nine. One stu dy

psycho-social perform ance, it m ak es sense for

controlled for cu rre n t n utritio na l s ta tu s ; the

all p ra c tic a l p urposes to acknow ledge th e

oth er for socio-economic s t a t u s and a m o u n t of

possibility and even likelihood of such a

schooling children had received.117 More g e n e r­

relationship in considering the im pacts of poor

ally, m alnutrition and stu n tin g have been

provision.

found in n um erous studies to be related to

The quality of provision is also linked to

children’s m e n tal and social developm ent, both

children’s psycho-social developm ent th ro ug h

in th e sho rt an d longer term . Children who

th e direct im pact t h a t th e s e services (or th eir

have suffered from early m alnutrition have

absence) m ay have on o pportunities for play

lower IQ levels and school a chievem ent, and

and learning. H ealthy children are driven by

more beh aviou ral problems l a t e r on.118 Some

curiosity, energy and a desire for com petence

of th e s e studies have found these effects

to explore th e world around them . Through

in dep end e n t of schooling or socio-economic

th e ir e n g a g e m en t w ith th e ir surroundings,

s ta tu s ; o thers have pointed to th e fact t h a t

th ey gain im p o rtan t information a b o u t the

s tu n te d children te n d to receive significantly

prop erties of objects, a b o u t c ause and effect,

less schooling th a n n on-stunted children.119

abo ut th e ir own cap a c ity to make things

For tho se children a tte n d in g school, p arasitic

happen. T hrough active play, th e y learn to use

in festatio ns continue to ta k e a toll, in p a r t as

th e ir bodies and to u n d e rs ta n d physical law s

a result of th e cognitive effects of an a e m ia

and sp a tia l relationships. T hrough th e diver­

a ss o ciate d w ith w orm s. A stu d y in Jav a, for

sity and repetition of activities, th e y gain a

in stanc e, found t h a t infection w ith hookw orm s

ran ge of skills and a growing sense of com p e­

had a significant ad verse effect on children’s

te n ce and a ss u ra n c e . A stim u latin g physical

w orking mem ory, w ith c onsequences for th e ir

en vironm ent is a basic su p p o rt for this active

reasoning ability and reading comprehension.

learning, and h as been recognized by m any

This association in creased w ith a g e . 120

major th e o r ists as fu n d am en tal for develop­

The effects of m aln utrition on children’s

m e n t .123 A c o n ta m in a te d environm ent is not

ca p a city to le arn are not well und erstoo d, but

necessarily less stim ulating, b u t it can require

it is hypothesized t h a t , becau se s tu n te d

caregivers to m ake difficult choices betw een

children are more listless and slow er to

protecting th e ir children’s h e a lth and allowing

develop and move around, th ey a re less

them free acc ess to play.

involved in in terac tio n w ith both th e ir social

Poor provision can limit op portunities for

and physical environment, and experience

older children too, in p a r t by limiting th e avail­

lo w er levels of th e stim ulation t h a t prom otes

ability of open sp ace for recreation, but also

cognitive dev elop m en t.121 Some re s e a rc h has

thro ug h the im p acts t h a t it can have on their

found higher levels of physiologic a ro u s a l in

time. M any children, m ost often girls, spend

stu n te d children, along w ith more inhibition,

hours each d ay collecting w a te r, and this can

an x ie ty and in a tten tio n th a n in non-stunted

interfere w ith school a t t e n d a n c e . 124 Girls’

children from th e sam e poor neighbourhoods. It

a tt e n d a n c e can also be affected by th e quality

is hypothesized t h a t higher cortisol levels in

of s a n ita tio n facilities in school, especially

th e s e children m a y be linked to poor cognitive

once th ey have s t a r t e d to m e n s t r u a t e .125 As

perform ance as well a s to th e ir decreased

described above, m any u rb an (and rural)

functional im m unity.122

schools have in a d e q u a te an d poorly

No res earch w a s found t h a t h a s e s t a b ­ lished a direct relationship betw een a ccess to

m ainta ine d facilities, and in some c a ses none.

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

78 What matters for children with regard to water and sanitation?

order for th e am o u n ts of w a t e r used by

Q u a n tity an d ac ce ssib ility v e rs u s

dram atic. In an u rban se ttle m e n t in P a p u a New

careg ivers to be significantly in c r e a se d .132 The effects for child h ealth can be

q u ality

Guinea, th e presence of a standpipe within the

Safe supplies of u n c o n tam in a ted w a t e r are

compound w a s a ssociated with a 56 per cent

vital, bu t th e re is a g en e ra l consensus t h a t

reduction in diarrho eal morbidity for children

w a t e r q u a n tity is a s or even more im p o rtan t

un der five.133 In Burkino Faso, m others with

th a n quality, especially for m ain tain ing

access to a t a p in th e ir y ard w ere three times

children’s h e a lt h .126 W a te r q uality m ay be

a s likely to use safe hygiene practices as those

more critical for th e health of children u nd er

fetching w a t e r from wells outside the ir

th ree y e a rs of age, while w a t e r q u an tity

com pound.134 In a stud y in Porto Alegre

becomes a crucial health d e te r m in a n t above

(Brazil), infants were four tim es a s likely to die

th e age of t h r e e .127 C ontam in ated w a t e r

in households using public stan dp ipes as in

co n trib u tes to o u tb re a k s of d isease, but too

those w ith w a t e r piped to th e h ouse.135

little w a t e r m ak es it difficult to m aintain the s a n i ta r y conditions t h a t prev ent c o n ta m in a ­

S to rin g w a te r

tion, an d t h a t are essential for controlling the

E ase of access is not th e only issue here. There

endemic disease t h a t c ontribu tes so heavily to

is also th e m a t te r of storage . No m a t t e r how

th e d e a th and rep eate d illness of m any

close th e source is, w hen w a t e r is not piped

children.128 S tudies from u rban a re a s in

directly into a house or y ard , it needs to be

B angladesh an d Niger, for in stance, find t h a t

stored in con tainers. Even w hen w a t e r is piped

faecal co ntam in atio n leading to dia rrh oe al

to th e house, it will have to be stored if the

disease and intestina l p a ra s ite s is more highly

flow is not regular. This can provide a num ber

co rrela ted to dirty h a n d s (a good ind icato r of

of o pp ortunities for con tam in atio n. It is a

th e accessibility of w a t e r supplies) t h a n it is to

p a rtic u la r problem in households w ith young

th e quality of drinking w a t e r . 129

children, w ho m ay dip dirty h an d s into a

Too little a tte n tio n is g enerally given to

sto ra g e bucket, or leave w a t e r scoops on the

this im p o rta n t asp e ct, a nd d istan ce to w a t e r

floor, contributing to co n tam in atio n and

points, regu larity of supply, and time spent

d is e a se .136 The p revalence of d iarrh o ea for

w a iting are serious concerns - especially for

sm all boys in Ethiopia, for in stance, w a s found

careg ivers dealing w ith young children.

to be significantly a s s o c iate d w ith drinking

A lthough 20 litres per person p er day is

w a t e r obtained by dipping from sto rag e

cu rren tly th e s t a n d a r d for household w a t e r

containers; by c o n tr a st, th e w a t e r source and

con su m p tion ,130 it h a s been e stim ated t h a t 30

th e a m o u n t of w a t e r consum ed w e re not signif­

to 40 litres a day a re th e minimum needed per

ica n t risk f a c t o r s .137 In a poor neighbourhood

person if drinking, cooking, la u n d ry and basic

of Abidjan, Cote d ’Ivoire, w h ere drinking w a t e r

hygiene are all ta k e n into c o n sid era tio n .131

is stored in most households, E. coli w a s found

W hen w a t e r is a t a distan ce an d needs to be

in only 1 pe r cent of source w a t e r sam ples, but

carried (or w h en it needs to be p u rch ased from

in 41 pe r cen t of stored w a t e r s a m p le s.138 In a

vendors), m any households w ith young

slum s e ttle m e n t in Nairobi, uncovered w a t e r

children w ho technically have a ccess to w a t e r

co n ta in ers w ere found to be the m ost signifi­

m ake do on far less t h a n th ey really need.

c a n t facto r influencing children’s recovery

Hands, food, utensils, floors, cooking su rfaces

from d ia r rh o e a .139 In peri-urban P eru, children

and children are all less likely to be kep t clean

in households w ith w a t e r stored in co n ta in ers

w h en w a t e r m ust be carried an y distance.

w ith o u t a t a p w e re tw ice as likely to have a

Even 100 m etres, a d istance t h a t has

high incidence of d iarrh oea (more t h a n seven

frequently been used to define a d e q u a te provi­

episodes a year) a s th ose who used con tain ers

sion, fails to g u a ra n t e e optimal use. In M alaw i

with t a p s . 140 An interven tio n tr ia l in a refugee

it w a s found t h a t w a t e r supply ha d to be

camp in M alawi found t h a t , w hen w a t e r w a s

broug ht to within a few y a rd s of th e house in

stored in con tainers w ith a cover and a spout,

T h e I m p a c t s o f D e f ic ie n t P r o v is io n

79 th e re w a s a 69 p er c e n t reduction in faecal

even frightening for young children. R eports

coliform levels in th e w a te r, a nd 31 pe r cent

from Malawi, Nepal, B urkina Faso and India

less d iarrh o ea in children u n d er five.141 One of

point out t h a t children rarely use latrin es

th e appealing fea tu res of w a t e r piped directly

before th e y are six or eight b ecause of th e risk

and regularly into th e house is th e fact t h a t

t h a t th e y might fall into the p i t .144 A survey

th ere is no need for a sto ra g e ta n k , an d t h a t

conducted by UNICEF’s India office found t h a t

th ose using th e w a t e r c a n n o t c o n ta m in a te the

only 1 per cent of children u nd er six use

supply.

latrines, t h a t th e stools of an additional 5 per c en t are th ro w n into latrin es, and t h a t the

S a n ita tio n

re m aind er end up in drains, s tre e ts or yards,

S a n itatio n -rela ted illnesses affect young

increasing the likelihood of c o n ta m in a tio n .145

children m ost heavily, in p a r t b ecause of th e ir

Considering th e nu m bers of young children in

low er im munity to path o g en s, but also b ecause

any poor se ttle m e n t, it is no w o n d er t h a t the

of th e ir behaviour. Small children have a drive

surroundings quickly become fouled even in

to play and explore, th ey a re in closer co n tac t

situ a tio n s w h ere provision m e ets in te rn atio n al

w ith the ground and th e y have less a p p re c ia ­

criteria for improved coverage.

tion of hygiene. This m ean s t h a t th e y are more

S trong links have been found in m any

likely to come into c o n ta c t w ith ex cre ta, th e

u rb a n comm unities b e tw e e n th e quality of

p rim a ry source of diarrh oeal disease and in te s ­

s a n i ta r y provision and ra t e s of d iarrho ea. In

tin a l p a ra s ite s, a s well as o th e r pa thogens.

u rban Brazil, th e risk fac to r m ost significantly

Where children are concerned, th e only safe

asso ciate d w ith incidence of d iarrh o ea, n ext to

sa n ita tio n m ethods are those t h a t eliminate all

the age of the child (under tw o), w a s th e lack

possibility for c o n ta c t w ith ex cre ta. Safe stool

of s a n ita tio n facilities.146 In P a k is ta n , infants

disposal is far more effective as a safeg uard

born in households w ith so a k p its w ere 60 per

a g a in s t disease t h a n any a m o u n t of h a n d ­

c en t more likely to die t h a n tho se with toilets

w a s h in g .142 Yet more th a n half of th e w o rld ’s

connected to undergrou nd s e w e r s .147 In Sri

urban households lack a s a n i ta r y m e an s for

L a n k a and Cebu, th e Philippines, u n s a n ita ry

disposing of hu m an w a ste .

disposal of children’s faeces (linked to the

C ha p ter 1 described how m an y low-

ab sen ce of a d e q u a te provision) w a s associated

income u rb a n s e ttle m e n ts are se rv ed by public

w ith a higher incidence of d ia rrh o e a in young

latrine s t h a t are filthy, foul smelling, crowded,

children, relative to children in households t h a t

and d is ta n t from m any of th e dwellings th ey

followed s a n i ta r y p ra c t ic e s .148 The higher

serve, causing m a n y people to defecate in th e

incidence of in testin al p a r a s ite s in u rb an

open. Such a rr a n g e m e n ts are particu larly

children, similarly, has been re p ea ted ly associ­

challenging for young children and th eir

a te d w ith sh ared toilets or a lack of

caregivers. Taking a young child an y d istance

connection to city se w e r s y s te m s .149 M ulti­

for toileting is im practical, especially when

c o u n try re search in 1996 explored w h e th e r

th e r e is likely to be a queue a t th e latrine. The

inc rem ental im provem ents in w a t e r and s a n i t a ­

WHO/UNICEF A ssessm en t 2000 s t a n d a r d s do

tion conditions resulted in in crem ental h ealth

not consider such public latrines to co nstitu te

effects for d iarrh o ea and n u trition al sta tu s.

ad e q u a te coverage. Yet even s h are d toilets,

The effects of improved provision were found

w hich are defined a s ‘im proved provision’, can

to be g r e a t e r for u rb an th a n for ru r a l dwellers.

presen t problems for young children. When

Im provem ents in s a n ita tio n had more of an

facilities are sh ared , m a in ten an ce frequently

im pact t h a n did im provem ents in w a t e r provi­

becomes an issue:143 neighbours rese n t it w hen

sion; in fa ct the benefits from improved w a t e r

children leave th in g s dirty, and children

only o ccurred w hen s a n ita tio n w a s also

th em selve s are a t higher risk of faecal c o n ta c t

im proved.150 Other re search, looking a t the

th a n th ey would be w ith private facilities. Pit

benefits of p a rtia l coverage, h as had mixed

latrine s p re s e n t a p a rtic u la r problem. The

findings. Work in u rb an Africa found t h a t the

da rk n e s s, smelliness and large openings of

provision of improved w a t e r an d s a n ita tio n to

most la trin es make the ir use u n p le a s a n t and

a sm all n um b er of households in an a re a may

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

80 M an ag in g children’s faeces in Lima

Research in Lima, Peru looked at the

greeted with shouting or slaps. As in

and disposed of in latrine or dump.

various w ays th a t small children’s

the case of diapers, faeces from

Although children were generally

faeces were dealt with in a densely

potties were emptied into latrines in

cleaned up with paper, 30 per cent

populated shanty town, where w ater

those households th a t had them, but

were found to retain some faecal

for the most p a rt w as purchased from

otherwise onto a rubbish dump or a

m a tte r on their clothes or bodies.

tankers, and where only some house­

nearby hillside commonly used for

Latrines were considered an

holds had latrines.

defecation. Most mothers felt th a t

unrealistic solution for children under

potties should be emptied and washed

the age of four because of flies and

Almost all children under one year were kept in diapers, which were

as soon as possible - but acknow l­

bad odours, but also because of the

washed daily because of limited

edged t h a t they were generally too

large openings and the need for small

stocks and rinsed a t least three times

busy to do this.

to avoid diaper rash. The costs in

children to be accompanied. Although

Because of the time commitment

some learned to manage latrines

term s of both w a te r and time were a

involved in training children and

strong motivation for getting children

keeping potties clean, only 20 per

independently over time, most children over three used the hill side, looking

out of diapers as soon as possible.

cent of small children actually used

for a spot th a t w as free of faeces and

Potties were considered the most

potties, and in most cases mothers

trash. Source: Iluttly, S R A. C F L a n a ta et al (1998),

hygienic solution a t this point, and in

simply allowed them to defecate

some cases training began as early as

directly onto the ground - although

'Feces, flies, and fetor: findings from a Peruvian

six months. But because mothers were

defecation aw ay from the home area,

s h a n ty town', Revista Panamerican de Salud

busy, potty training w as generally

and especially near a neighbour’s

inconsistent, and it w as common for

home, w as considered unacceptable.

e t al (1 999), 'Defecation pr ac ti ce s of young

children to defecate in their clothes -

Faeces were sometimes left on the

children in a Peru via n s h a n ty to w n ’, Social

a transgression most commonly

ground, and sometimes scooped up

Publica. Vol 4, No 2, page s 7 5 - 9 ; Yeager. B A C. S R A Huttly, R Bartolini, M Rojas, C F La n a ta

Science and M edicine, Vol 49 . No 4. page s 531-54.

infection w hen th e overall level of faecal

The quality of care and hygienic practices

c o n tam in atio n in th e environm ent is hig h .151

Poor provision also affects children th roug h

not a c tu a lly p ro te c t even th o se families from

But oth e r re se a rc h points to th e flip-side of

th e tim e b u rd en s t h a t it imposes on th e ir

th is phenom enon, indicating t h a t even p a rtia l

caregivers. M a naging w a t e r supplies, keeping

coverage reduces overall faecal co n tam ination

children clean and safe, dealing w ith w a s te

and low ers c o n ta c t b e tw e en susceptible

and e x c r e ta in the absence of a d e q u a te

children and o pportunities for infection.152

services, an d handling food and utensils

Clearly, it is im p o r ta n t for improved provision

hygienically can t a k e more hours th a n th e re

to reach a critical ‘tipping p o in t’ for th ings to

are in a d ay - and th e se challenges are often

ch ange substantially.

handled on top of ‘r e a l’ w ork. The sh eer

Drainage and w a s te collection

t a k e s its toll not only on th e ca p a c ity of

I n a d e q u a te d ra in a g e an d w a s t e collection pose

caregivers to provide care, but also on th e

p a r tic u la r problems for children, who te n d to

ca p a c ity of families to function optimally.

play w h e re v e r th e re is open land or interesting

Improving provision for w a t e r can not only

opportunities for exploration, and who m ay be

g re a tly inc re ase th e a m o u n t of w a t e r used for

d raw n to w a d e or play in sta n d in g w a t e r and

child hygiene but it can also inc re ase th e time

in d ra in a g e ditches, or to scavenge in piles of

m oth e rs spend on child care, including feeding

g a rb a g e . In m any com munities, it is impossible

and hy g ie n e.154

d ru d g e ry resulting from in a d e q u a te provision

for children to play outdoors and to avoid

The key to children’s environm ental

th e se h a z a r d s (see Box 2.4). Children b etw e en

h ea lth problems is often assum ed to lie in the

5 and 14 y e a r s old, for in stan c e, are dispropor­

education of ca regive rs in hygiene and o th e r

tio n a te ly affected by helm inths an d by such

protective m easures. Not only is h ea lth e d u c a ­

w a te r -b a s e d dise ase s as b ilh a rzia .153

tion perceived as a more affordable solution

T h e I m p a c t s o f D e f ic ie n t P r o v is io n

81 th a n in vestm en t in in f ra s tru c tu re , b u t exp eri­

c a n tly only w h en supplies w e re b ro u g h t ve ry

ence ha s also in dicated t h a t , in th e ab sen ce of

close to th e h o u s e ,161 or in th e Dominican

hygienic behaviour, im provem ents in provision

Republic, w h ere m oth ers revealed t h a t in

may have a minimal effect on health.

m any c a s e s t h e y w ere simply ‘too tired to boil

Hygienic p ra c tic e s such as hand-w ashing

w a t e r ’.162 In th e ir A ssessm en t 2000, WHO and

have been d e m o n s tra te d to result in impressive reductions in d is e a se .155 However, it still

UNICEF remind us t h a t ‘th e simple a c t of

re m ains u nc lea r how c han ge s in hea lth b e h a v ­

w ash ing h a n d s w ith soap and w a t e r can

iour are b est brou gh t about. A n um ber of

reduce diarrh o e al disease tran sm issio n by one-

stu dies have d em o n s tra te d t h a t inform ation

th i r d .’163 Such s t a te m e n ts are undoubtedly

does not reliably change behaviour, an d t h a t

tr u e for much of th e population. But t h e y tend

efforts to improve hygiene solely th rou gh

to overlook th e fa ct t h a t keeping tw o- and

he alth education m ay have little effect in the

three-year-olds clean in a c o n tam in ated

ab sen ce of supportive provision. In a s h a n ty

environm ent is far from ‘sim ple’. On the

to w n in Lima, P eru, for instan ce, w h ere k n o w l­

co ntrary , it can call for c o n s ta n t vigilance and

edge of th e im po rtan ce of han d-w ashing and

even for unrealistic restriction s on children’s

o th e r hygiene p ra c tic e s w a s high, only 13 per

play and socialization (see Box 2.4).

cent of faecal c on tam ina tion episodes were found to be in te rru p te d by w ashing.

A n o th e r critical consideration is th e fact t h a t caregivers seldom face th es e problems

R e se a rc h e rs concluded t h a t , w here w a t e r is

one a t a time. E nv iron m ental risk factors

sca rc e, education is unlikely to change hygiene

g enerally exist in clusters. It might be possible

p ra c t ic e s .156 In B u rkin a Faso, res earch into

for caregivers to respond effectively to an y one

facto rs affecting hygiene behaviour found t h a t

of them , but coping hygienically with daily

th e location of w a t e r sources w a s more im por­

ch allenges in th e absence of reasonable provi­

t a n t th a n h ealth education, income, m a te rn a l

sion is likely to mean a n u m ber of time

education or c u ltu re .157 In Sri L an k a, a case

consuming tas k s:

control stud y of environm ental and b e h a v ­ ioural risk fac to rs for unsafe disposal of

•

obtaining sufficient supplies of w a t e r for

•

ensuring t h a t sto red w a t e r does not

•

w ash in g potties or diapers, a n d /o r

children’s ex c re ta concluded t h a t latrine ownership m ay be a n e c e ss a ry condition for

hygienic living;

improving safe stool d isposal.158 Unhygienic p r a c t ic e s in some c ases are

become con tam in ated ;

determ in ed by beliefs t h a t ru n c o u n te r to

disposing safely of sm all children’s stools

formal biom edical k now ledge, a nd th e s e s i t u a ­

(often loose stools, and often th o se of

tio ns a re likely to be quite r e s is t a n t to

more th a n one child);

change. In u rb a n K a rach i, for in s tan ce, in fan t

•

ensuring t h a t latrin es are k e p t clean;

dia rrh o e a is freq uen tly considered to be

•

ensuring t h a t h an d s (and often th e body) are w a s h e d ev ery time a sm all child

re la te d to te e t h in g or th e w e a th e r, and so is considered a ‘n o r m a l’ e v e n t.159 Curtis and colleag ues point out t h a t simply telling people a b o u t th e likely h ealth benefits of a given

defecates or eats; and •

keeping sm all children a w a y from local sources of co nta m in atio n a s th e y play. In

b eh aviou r is unlikely to provide enough

addition, o th er m e a s u re s m ust be ta k e n

m otivation to c h an g e lifelong habits. W hen

to avoid the c o ntam in atio n of food.

m o th e rs believe t h a t d ia r rh o e a results from te e t h in g or from sittin g on dam p ground,

W hen th e s e challenges are compounded by

ex p la n a tio n s involving microbes are unlikely

crow ded and unfinished housing, an ab sen ce of

to have a g r e a t im p a c t.160 But non-compliance

safe play sp ace, long distan ce s to w o rk and

w ith hygienic p ra c tic e is not a lw a y s a

services and a lack of child care, th e difficul­

question of conflicting beliefs. It m ay be a

ties can become overw helm ing and

m a t t e r of time a nd ene rgy - a s in M alaw i, for

u nm an ag e ab le. It becomes far-fetched to

in s tan c e, w h ere w a t e r use in creased signifi­

assum e in th es e complex situ atio ns t h a t

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

82 T h e in fo rm a l s e t t l e m e n t of B a n s h i g h a t in K a th m a n d u

The informal se ttle m e n t of B a nshighat

th e drains a t every point in the

in K ath m an d u , Nepal, is criss-crossed

community.

by foul-smelling open d rains which run

w a sh e d clothes nearby. The drains are especially h azard o u s for children ju s t learning to

P are n ts are well a w a re of the

down to th e river nearby, carry ing

h ealth h a z a rd t h a t these drains

w alk . Everyone w a tc h e s th e s e little

w a s t e w a t e r from o th er p a rts of the

present, b u t th e ir a w a re n e s s is no

ones carefully, said one mother, but

city as well a s from this community.

m atch for th e ir children’s energy and

inevitably th e y trip and fall in a t some

Because there is no provision here for

drive to play. Even th e most vigilant

point. They a re scolded or b eaten

w a s te removal, all local g a rb ag e is

caregivers have trouble protecting

w hen th e y fall in, in an a t t e m p t to

also dumped into th ese drains. Plastic

children from th eir c o n tam in ated

im press on th em th e im portance of

bags, o range rinds an d broken glass

environment. One m o th e r described to

avoiding th e drains. Children who are

litter th e b an ks. A lthough most people

a re s e a rc h e r all th e m easures she took

not y e t mobile are a t low er risk - but

in the comm unity use th e river bank

to ensure t h a t h e r children did not

for those b etw e en a b o u t one and five

for defecation, some households have

touch w a t e r from the drains. While

ye ars, th e drain s and the generally

latrin es on th e w a y dow n to th e river,

she spoke, her son dropped his ball

dirty conditions presen t a c o n sta n t

and th ese also em p ty into the drains.

into th e drain behind her. He jumped

t h r e a t to health. D iarrhoea, worm

Small children in B an sh ig h a t do not

right in, retrie ved the ball, and co ntin­

in festations, skin problems and eye

use latrines, however, and th e y are

ued th ro w in g it b a c k and forth to

infections are a routine p a r t of life for

not allowed down by th e river.

o th er children. A n oth er small boy w a s

most small children in B anshighat.

Caregivers throw th e ir ex c re ta into

observed driving his ‘c a r ’ - a small

Source: S av e th e Children N o r w a y ( 2 00 2 ),

the d rains - the simplest w a y to keep

slab of wood - down to th e edge of

‘B a n s h ig h a t: p r e p a r a t o r y r e s e a r c h for ECD

the n arro w w a lk w a y s clean. This

th e drain, th rough the w ate r, and out

p r o g r a m m i n g ’, u n p u b li sh e d re p o r t , K a th m a n d u .

m ean s t h a t faecal m a t te r is p re sen t in

th e o ther side while his m oth er

c h ild re n ’s h e a l t h c a n r e a s o n a b ly be p r o te c te d

•

less able to cope w ith t h e illness (eg,

by h e a lth in fo rm atio n in t h e a b s e n c e of a p p r o ­

p e r s o n s w h o c a n n o t afford to go to a

p r ia t e provision.

d o c to r or p a y for m edicine; h o u se h o ld s w h o s e in c o m es a n d a s s e t b a s e s a r e so

V ulnerability and su sce p tib ility 164

low t h a t t h e t e m p o r a r y illness and i n c a p a c it y of a hou se h o ld m e m b e r m e a n s to o little m o n e y is a v a ila b le to b u y suffi­

T h e p r e s e n c e of a d is e a s e - c a u s in g a g e n t (for

c ie n t food a n d m e e t o t h e r nec es sitie s).

i n s t a n c e , one t h a t c a u s e s d ia r r h o e a l d ise ase ) d oes n o t n e c e s s a r ily m e a n t h a t it will h a r m

S u ch in d iv id uals o r h o u se h o ld s a r e g e n e r a lly

so m e o n e. T his also d e p e n d s on th e c h a r a c t e r i s ­

te r m e d v u ln e ra b le . B ut to e n s u re a more

tic s of th e individual, hou se h o ld or so c ial group

precise u n d e r s t a n d i n g (from w h ic h m ore a p p r o ­

e x p o s e d to it. C e rta in individu al or group

p r ia t e r e s p o n s e s c a n be developed), it is w o r t h

c h a r a c t e r i s t i c s ca n also influence th e s e v e r ity

distin g u ish in g b e t w e e n s u sc e p tib ility (w here

of t h e h e a lth im p a c t.

th e in c re a s e d risk is r e la te d to en d o g e n o u s

C e rta in people or h o u se h o ld s are m ore a t

fa c to rs su c h a s a p e r s o n ’s n u tr iti o n a l s t a t u s ,

risk from th e d is e a s e s a s s o c ia te d w ith i n a d e ­

th e s t a t e of th e i r im m une sy s te m or th e i r

q u a t e w a t e r a n d s a n i t a t i o n provision b e c a u s e

g e n e tic m a k e u p ) a n d v u ln e ra b ility (w h e re it is

t h e y are:

e x t e r n a l social, econom ic or c u l t u r a l co n d i­ tio n s t h a t in c re a s e th e risk - for in s ta n c e ,

•

less able to avoid th e m (eg, living in a

th r o u g h a n in c r e a s e d likelihood of e x p o s u re to

s e t t l e m e n t la c k in g provision for

e x c r e ta or less c a p a c i t y to cope w ith or a d a p t

p r o te c te d w a t e r , s a n i t a t i o n a n d

to a n y illness t h a t su c h ex p o s u re c a u s e s ) . 165

d ra in a g e ) ; •

W e a k body d e fe n c e s (in t u r n influenced

m ore affe c te d by th e m (eg, in f a n ts a r e a t

by a g e a n d n u tr iti o n a l s t a t u s ) m a k e people

m uch g r e a t e r risk of d e a t h from

more s u sc e p tib le to th e d is e a s e s r e la te d to

d ia r r h o e a l d is e a s e s t h a n old e r group s); or

in a d e q u a t e w a t e r a n d s a n i ta tio n , w h ile a

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

83 c o n sid e ra b le v a r i e ty of f a c t o rs influence th e i r v u ln e ra b ility to t h e s e d is e a se s, including:

in h a b i ta n t s avoid d isease b u rd e n s (and o th e r h a z a r d s a s s o c ia te d w ith p o or q u ality housing). The in co m e-enh an cin g p o te n tia l of im proved

•

•

•

income a n d a s s e ts , w hich influence th e

w a t e r a n d s a n i ta t io n provision is also often

in d iv id u al’s or h o u s e h o ld ’s ab ility to

fo rgo tten . Providing an accessib le piped w a t e r

afford good q u a lity hou sing w ith good

su p ply to city n e igh bo urho od s w h e re th e in h a b ­

provision for w a te r , s a n i ta t io n and

i t a n t s p reviously relied on expensive w a t e r

d ra in a g e , h e a lt h ca re a n d e m e r g e n c y

from v en d o rs c a n in c r e a se th e income available

re s p o n s e s in cluding p u rc h a s in g t h e m o s t

for food an d o th e r nec essities. Providing house

effective m edicines, a n d t a k i n g tim e off

or y a r d co n n e ctio n s to ho useholds w h o previ­

to r e c u p e r a t e w h e n sick or injured;

ously relied on public sta n d p ip e s w ith long

econom ic or so c ial roles, w h ic h can

q u e u e s provides g r e a t sa v in g s in tim e an d

in c r e a s e t h e e x p o su re to h a z a r d s (for

ph y sica l effort. As C h a p te r 7 will describe,

in s ta n c e , p a r t i c u l a r o c c u p a tio n s su ch a s

com m unity-built a n d -m a n a g e d public to ile ts in

pick ing th r o u g h e x c r e t a - c o n t a m in a t e d

M um ba i an d P u n e g re a t ly red u ced th e c o st of

g a r b a g e or p a r t i c u l a r t a s k s su ch a s being

using public to ilets. B e tt e r w a t e r a n d s a n i t a ­

respo n sib le for d isposing of h u m a n

tion provision can also m e a n m uc h less income

e x c r e t a w ith in a household);

lost b e c a u s e income e a r n e r s are u nab le to w o r k

t h e e x te n t of public, p ri v a te an d c o m m u ­

(b ecau se th e y are sick or nursin g o th e r sick

nity provision for h e a lt h c a re , including

family m em b ers) or b e c a u s e of th e n eed to p ay

e m e r g e n c y resp o n se to a c u t e diseases;

for t r e a t m e n t an d medicines.

an d •

In a n y city p op ulation , th e r e are p a r t i c u ­

individual, household or com m un ity

l a r g ro u p s w ith in th e low-income popu latio n

coping m e c h a n ism s for w h en d isease

t h a t face p a rtic u la rly high levels of risk from

o ccurs, for in s ta n c e , k n o w in g w h a t to do,

th e e n v iro n m e n ta l h a z a r d s a s s o c ia te d w ith

w h o to visit an d how to r e a r r a n g e individ­

in a d e q u a te w a t e r a n d sa n ita tio n . For in s tan ce,

u al/h o u se h o ld su rv iv al s t r a t e g i e s . 166

th e r e are p a r t ic u l a r gro up s w ho face th e most difficulty g ettin g a c c e ss to w a t e r an d w a sh in g

The k ey role t h a t a s s e ts h av e in helping low-

a n d b a th in g facilities, su c h as p a v e m e n t

income individuals or ho useh old s to avoid

dw ellers or th o s e w ho sleep in open sp ac es,

dep riv ation is now more w idely recognized.

p a r k s an d g ra v e y a r d s . S tr e e t children w ho

However, th is discussion g e n e ra lly co n c e n ­

h ave been a b a n d o n e d by th e i r families (or have

t r a t e s on th o s e a s s e ts t h a t are i m p o r t a n t for

r u n a w a y from h o m e )167 g e n e ra lly h a v e v e ry

g e n e r a t in g or m a in ta in in g incom e, or for

p oo r q u ality a c co m m o d a tio n (often sleeping in

helping low-income people to cope w ith

th e open or in public places) a n d g r e a t diffi­

economic s tre s s e s or shocks. Too little a t t e n ­

cu lty in finding p la ce s to w a s h , d e fe c a te and

tion h a s been given to th e role of good qu ality

o b ta in drinking w a t e r an d h e a lth services.

housing, in f ra s t r u c t u r e a n d serv ices in reducing

T h ere are also o th e r children in especially diffi­

low-income g r o u p s ’ vuln era bility by reducing

cult c ir c u m s t a n c e s w ho face p a r t ic u l a r

ex po su re to dise ase s, an d th e role of h ea lth

difficulties in g e tt in g provision; for in s ta n c e , a

ca re se rv ic e s an d em e rg e n c y se rv ic e s in r e d u c ­

stu d y by th e Indian NGO SPARC in

ing th e i r h e a lt h im p act. In th is sen se, it is th e

B o m b a y /M u m b a i identified children of

qu ality of housing an d th e provision for w a te r,

p a v e m e n t d w elle rs and c o n stru c tio n w o rk e rs

s a n i ta t io n an d d ra in a g e t h a t is th e a s s e t -

an d ‘h o te l b o y s ’ a s p a rtic u la rly v ulnerable,

re g a r d le s s of w h e t h e r th e ho use is ow ned,

alon g w ith s t r e e t ch ild ren .168 The children of

re n te d or b o rro w ed . The discussions of housing

co n s tru c tio n w o r k e r s w h o live on-site la c k

a s an a s s e t t e n d to c o n c e n t r a te on its c a p ita l

a c c e s s to schools, day c are, h e a lth facilities,

value or its p o te n t ia l inco m e-earnin g possibili­

w a t e r a n d sa n ita tio n . T h e re is also a need to

ties (through providing s p a c e for

con sid er th e p a r t ic u l a r p roblem s faced by th e

in com e-earnin g a ctiv itie s or for re n tin g out)

elderly an d th o s e w ith ph ysical disabilities,

r a t h e r t h a n its p o te n tia l role in helping its

w h o inev itably face much g r e a t e r difficulties in

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

84 fetching and c a r r y in g w a te r. T h ere are also

The opposition o f those living in a

th o s e gro u p s w ith in th e popu latio n of an y city

settlement to ‘outsiders' coming to use

t h a t face discrim inatio n in o b tainin g a c c e s s to

‘their’ public taps

good q u a lity housing a n d en v iro n m e n tal

W hen we w en t to g et w ater (from a neigh­

se rv ic e s b e c a u s e of th e i r ethnicity, skin colour,

bouring building because there were no

c a s te , sex or th e fa c t t h a t t h e y a re im m ig ran ts.

sup p lies in our settlem en t), when we p u t

The p a r t i c u l a r difficulties fac ed by tw o

the h a n d a a [w ater container] under the tap,

g ro u p s in g e tt in g b e t t e r w a t e r an d s a n i ta t io n

som e women w ould sp it fro m above, or they

provision or in suffering from th e im p a c ts of

w ould sh u t o f f the tap, or ta u n t us. We had

i n a d e q u a t e provision a re d iscu sse d here:

to be th ick-skin n ed to g et our water. When

w o m e n a n d re n te rs .

we w en t there again they w ould say things again, curse us, call us beggars, call us all

Women A d is p ro p o rtio n a te s h a r e of th e la b o u r and

kin d o f things, sayin g th a t these are dirty people, they d irty up the whole ground. T hey should not be given water.

h e a lt h b u rd e n of househo ld a n d n eig h b o u rh o o d w a t e r an d s a n i ta t io n in a d e q u a c ie s falls on

Som e in te r v i e w e e s m e n tio n e d th e need to go

w o m en . It is ty p ic a lly w o m e n w h o collect

a t n ig h t to o th e r s e t t l e m e n t s to g e t w a t e r

w a t e r from public s ta n d p ip e s , o ften q ueu ing

b e c a u s e th e in h a b i t a n t s w ou ld no t like th e m

for long p eriod s in th e p ro cess a n d often

using 'th e i r ' ta p s . ‘T h e re is a H a n u m a n Temple

h av in g to g e t up v e ry e a rly or go la te a t night

a little w a y a w a y from t h e s e t t l e m e n t w hich

to g e t th e w a te r. It w a s n o te d e a r l ie r j u s t how

h a d a ta p . B ut th e people t h e r e did no t w a n t

h e a v y w a t e r is to fetch a n d c a rry . It is

u s to go t h e r e b e c a u s e w e lived in a slum. We

ty p ic a lly w o m e n w h o h av e to m a k e do w ith

w o uld go a t nig h t, a t l a m , 1 .3 0 a m , 2 a m , w h en

often in a d e q u a te w a t e r su p p lies to c lea n th e

th e t a p w a s free an d t a k e w a t e r . ’

hom e, p re p a r e t h e food, w a s h th e u te n s ils an d do t h e lau n d ry . It is also w o m e n w h o ty p ically

The pressure placed on those at the public

c a re for t h e in f a n ts a n d children (including

standpipe not to take too much, or too long,

b a th i n g th e m ), both w h e n t h e y a r e w ell an d

by those waiting in the queue behind them

w h e n th e y a re ill. It is i m p o r t a n t no t to u n d e r ­

I f som ebody had a lot o f vessels then until

e s t i m a t e th is side of th e w a t e r b u rd e n . T h ere

they had fin is h e d fillin g them , they w ould

are no compelling i n t e r n a t io n a l s t a ti s ti c s ,

not allow other people to fe tc h water. T his

c o m p a r a b le to th e h e a lt h s t a ti s ti c s , d o c u m e n t­

w as how a lo t o f fig h ts g o t started.

ing th e la b o u r b u rd e n s of in a d e q u a te w a te r. Box 2.5 p r e s e n ts e x t r a c t s from th e a c c o u n t s of

N othing could be done w ith o u t fig h ts . U ntil

w o m e n in low -incom e s e t t l e m e n t s in P u n e

you fo u g h t and heard sw ear words you did

(India) a b o u t t h e difficulties th e y face (or used

not g e t w ater!... There w as j u s t one tap and

to face) g e tt in g w a t e r an d s a n i ta t io n . It is

there were 2 0 0 - 2 5 0 houses in the settle­

v e ry difficult for th o s e w ho h a v e n e v e r h a d to

m ent; m aybe more.

rely on public t a p s a n d public to ile ts to a p p r e ­ c ia te j u s t how tire so m e , tiring , stre ss fu l an d

In o t h e r in s ta n c e s , t h e r e a re co m m u n ity limits

in c o n v e n ie n t th is c a n be. It is also difficult for

on how m u c h w a t e r c a n be t a k e n - b u t th is

re s e a r c h to c a p tu r e th is - espec ially since

m e a n s t h a t it is difficult to d r a w en ou gh w a t e r

m o s t r e s e a r c h on w a t e r a n d s a n i ta t io n is

for all ho useho ld t a s k s . Of co urse, th is problem

tr y i n g to q u a n tify th e in a d e q u a c ie s in pro vi­

is m uch e x a c e r b a t e d if t h e r e is low p re s s u re in

sion. T h is box prov ides some in s ig h ts into

th e sy s te m (and so a slow flow of w a t e r from

q u a li ta t iv e a s p e c t s t h a t often go u n re co rd ed .

th e sta n d p ip e s ) , or w a t e r is only av a ila b le in

T h ese re v e a l m a n y difficulties t h a t w o m e n face

th e pipe for a few h o u rs a day.

in g e tt in g w a t e r a n d a c c e s s in g to ile ts t h a t ra r e ly come ou t in q u a n t i t a t i v e s tu d ie s, some of w h ic h a re d is c u sse d below.

T h e I m p a c t s o f D e f ic ie n t P r o v is io n

85 The scramble to get water among those living in settlements dependent on water

to use the toilet. The outsiders who come

tankers

here fo r a short tim e vandalise and steal,

Frequently, d a u g h te r s are kep t out of school to

and the rest o f the settlem ent gets a bad

m ake sure t h a t w a t e r can be obtained when

name.

They live on rent. E veryone eats, they have

th e t a n k e r comes.

Conflicts fo r those who defecate in the open The difficulties of getting to public toilets

f u s t today, there was a fig h t between the

We have no toilets: we use two toilets in

women from 6am till 9am. Som ebody had

A m bedkar Nagar. I t is outside our settle­

dirtied the drain. They throw garbage in the

m ent, fiv e m inutes away. People from two

drains. A n d i f we go to tell them not to,

settlem ents use the fo u r toilets - two fo r

they say ‘You are not our leader. Take care

men and two fo r women. We have to stand

o f your own house and w a stes!’ I t is not

in a queue fo r h a lf an hour. T hat is why the

only the women who say this: my husband

men all go under the bridge and only the

said ‘D o n ’t you have any other work? Cook

women use the toilets. Children also go out

lunch fo r the children.’ I said ‘OK, I ’ll leave

in the open.

it, i t ’s a big fig h t, they are sw earing...’ Som ebody had defecated in the drain today.

How disgusting it is to use public toilets that are not well maintained

I took two mugs o f water from my house and threw them on it. They said ‘W hy do

E ven now, insects climb up our legs. They

you want to wash it away? We are fig h tin g

do not clean the toilets properly.

about it .’ I said, ‘D on’t fig h t: I w ill pour water on it', and I asked them i f they

I f you go to see the toilets, they are so dirty

wanted me to sweep it away. B u t they said

that a person cannot p u t a fo o t in them, but

‘You are not a sw eeper.’ I told them to go

we have no choice and we have to go there.

ahead and fig h t. The fig h t is probably still

The children squat in the road, to the extent

going on.

that you cannot walk along the road.

The difficulties in managing shared stand­ The toilets are very dirty. The cleaner does

pipes and toilets

not come regularly. For two or three days or

Such difficulties include raising th e funds to

more, they do not clean. R ags and cloths

g et them , g ettin g the re lev an t a u th o r ity to

accumulate inside. Men have better toilets.

install th em , allocating p a y m e n ts am ong users,

Though we have a toilet, built by the corpo­

g ettin g th e t a p s mended and keeping the

rator, it does not have water, or electricity,

s h ared toilets clean.

collecting p ay m e n ts, ta k i n g responsibility for

and it is not cleaned. I t is alw ays very

The box below illu s tra tes in some detail

dirty. There is a lot o f dirty g ra ffiti on the

w h y w o m en are more vulnerable th a n men to

walls, and the filth brings insects and

m a ny environm ental h a z a rd s asso cia te d with

animals, and the children fa ll sick. I t is

in a d e q u a te w a t e r an d san ita tio n provision,

dark, there is no light there, and there are

b ecause of g e nd er relatio ns (ie, a s a result of

mosquitoes.

th e p a rt ic u l a r social and economic roles t h a t w omen have in regard to w a t e r and sanitatio n,

Blaming others for the dirty toilets, especially tenants and outsiders

d eterm ined by social, economic and political s tru c tu r e s). T hey are also p a rtic u larly su s ce p ­

The same people who dirty the toilets can

tible to m any environm ental h a z a rd s w hen

also m ake a com plaint about the dirtiness.

p re g n an t, since th e reproductive system is

I t is not alw ays possible to know who

p a rtic u larly sensitive to adv erse environm ental

dirties the toilets. They are people from

conditions. The d iseases linked to in a d e q u a te

within the settlem ent who are outsiders.

w a t e r and san ita tio n provision (and th e ir role in malnutrition) con tribu te to m an y of the

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

86 W omen from P u n e t a l k a b o u t th e difficulties th e y face w ith w a t e r an d s a n i ta t io n

tap). W hen we w e n t to g e t w a t e r

This box reproduces e x tr a c ts from

and g et tw o handaas of w a t e r first...

interview s u n d e rta k e n in some of the

There is no drain ag e in our are a

(from a neighbouring building b ecause

21 informal settle m e n ts in Pune

becau se it is on th e hill. There is no

the re w ere no supplies in our s e t tl e ­

su rvey ed during 2002. More th a n

road even now. W hen my children

ment), w hen we p u t the handaa under

75 0,0 0 0 people live in informal s e ttle ­

w ere v e ry small, and if I left early

th e ta p , some women would spit from

m ents or slums. The settle m e n ts were

then my children would follow me one

above, or they would sh u t off th e ta p ,

distributed th ro u g h o u t th e city and

by one and w alk in the drain. I would

or t a u n t us. We had to be thick-

rep resen ted a v ariety of situations:

go fo rw ard to fill my handaa and on

skinned to get our w ater. When we

settle m e n ts in th e c e n tral p a r t of the

coming bac k people would tell me to

w e n t th ere again th e y would say

city had ample w a t e r supplies while

h u rry becau se th e children were

th ings again, curse us, call us

settle m e n ts in o u ter zones had less

drinking from the drain. So half my

begg ars, call us all kind of things,

th a n a d e q u a te supplies. Some s e ttle ­

mind w a s on th e w a t e r and half on

saying t h a t th ese are dirty people,

m ents are close to a river or canal

th e children. And on top of t h a t the re

they dirty up th e whole ground. They

and some are not; some are on level

w a s the hu rry to go to work.

ground and some on slopes; some are

If I w e n t to the o th e r side (to

should not be given w ater. Even if it w a s a g ov ernm ent ta p , th e y would

recognized by th e g overnm ent as

d raw w a t e r from th e ta p in the men’s

say t h a t it w a s not our right and t h a t

slums (m eaning t h a t th e governm ent

toilet) th e n all th e men sitting th ere to

th ey would not give us w ater. They

ac c e p ts some responsibility for provid­

b athe would soap th em selv es ... we

would say ‘The slum people are dirty,

ing services) and some are not. Some

would say ‘Brother, please move a

w hy should we give them w a t e r .’ They

of th e interview ees mention the

b it’. They would not listen. ‘Wait, we

would scold us. We would still go

im provem ents in provision for public

are g etting l a t e . ’ So much, we would

there. The whole day would be ta k e n

toilets since th e municipal corporation

cry! People would be telling me t h a t

up in fetching w ater. We would go a t

introduced a major p ro gram m e to

my children w ere jumping in th e drain,

8am or 8 .3 0 a m ... and we would go

su pp ort the building of toilets by

and here w ere th ese men w ith soap

b ack a t 12 noon. L a te r we would have

com m unity organ ization s an d NGOs.

suds. All this, and th ey used to use

to go again. Even th en we did not get

Some also mention M ahila Milan,

such dirty w o rd s w h en we were

enough w ater. We had to go round

savings groups formed by th e in habi­

w aiting for w ater. We would sta n d in

looking for w ater.

ta n t s of informal settle m e n ts, which

line for th e ta p and p u t out our

also lobbies for improved services.

handaas, and they would sa y such

Sangita Chavhan

dirty thin gs t h a t I used to cry. I

I live in th e Patil E s ta t e slum.

Jyoti R S Bhende

th o u g h t t h a t a fter th e elections we

Previously, I used to g et w a t e r from

I live in Jaib hav ani N a g a r on th e hill

would get w ater... They [politicians]

th e co urt in handaas. There w ere no

side and I am n e ar th e top of th e hill.

c a nv ass for the elections, and don’t

ta p s in our slum. We used to go to the

My se ttle m e n t had a problem since

come back! [A politician] w a s elected,

toilet n e a r th e river side. The insects

the re w a s no w a t e r an yw here in it.

but did not come b ack to m eet us.

used to climb up our legs. I used to go

There w ere ju s t th re e t a p s n ear the

Then Mahila Milan cam e to our s e t tl e ­

to the toilet in th e bungalow w here I

toilet, and th e can al a t th e bottom. If

m ent. All us w omen cam e together.

w orked. We w e n t to defecate under

we w e n t to th e can al and it w a s not

We explained to everybody how we

th e bushes. When we got w a t e r from

dry, we had to get down th e whole hill

would benefit. T h a t w a s w hen we

th e court, th e n we w e n t to the toilet

and th e n climb up again. Before t h a t

w ere told t h a t ta p s would come to our

w ith w ater. It would ta k e us tw o to

the re w a s no w a t e r in our settlem en t.

settlem e n t. The pipes and ta p s were

th ree hours to g e t a handaa of w ater.

We had to g e t it from n e a r th e public

laid for the p a s t th ree years. But

Then, in th e elections, Qazi Saheb [a

toilets. If th e men had to go th e toilet,

w hen will th e w a t e r come out of

local politician] cam e and a rra n g e d

they would fill th eir ca n s from t h a t

them? W hen we opened the stopcock

for tap s. Each house had a ta p , but

ta p and we had to fill from t h a t sam e

and w a t e r cam e out with [sufficient)

th ere w a s no provision for toilets.

tap.

pressure, all the children and women

Even to d a y the toilets are a s th ey are.

Once it ha pp ene d t h a t the toilet

w ere u nd er th e pipe!

It t a k e s one to one-and-a-half hours to use the toilet. And even now, insects

w a s blocked, but nobody paid a t t e n ­ tion to it. The floor w a s broken and

Manda Hadvalaya

climb our legs. They do not clean the

w a t e r g a th e re d there from th e outside

I live a t C h a n d ram a N a g a r n e a r the

toilets properly. They made open

urinals, and mixed w ith th e small

m ental hospital. In my se ttle m e n t

drains, b u t all th e children defecate in

children’s shit. There w e re insects

before 1997 there w ere a lot of

them . And people th ro w w a s te s into

which flew outside and all of those

problems regarding w ater. Some of us

them . If we sit in our doorw ay, the

insects fell into our handaas [w ater

w e n t to P a nch sheela N a g a r (a neigh­

stink of the drain re aches us. We c a n ’t

containers]. I get up in th e morning

bouring s e ttlem en t which had a public

sit th ere and eat. The children have to

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

87 sit inside and study. They have made

Children also go out in the open. We

ca n ’t hold it back. How can you stop

a road, but it is not proper. E verything

live n e a r th e river, so children go n e a r

it? T h a t is w hy th e p rim a ry problem

is thro w n into the road. Women come

the river.

w a s toilets! Now M ahila Milan has

th ere, and t h a t is w here th ey all

Fatima Abdul Khan

we do not have to stan d in queues,

throw th e ir dirt. People fall sick,

I live in Patil E s ta te , Gulli N umber 3,

and th e r e is no tension a b o u t the

coughing and so on. The children get

n e a r the river. There w ere a lot of

toilet. There is w a t e r in th e toilet 24 hours a day, and th ey are very

made such a nice a r r a n g e m e n t t h a t

b ack from w o rk and w ash th e ir faces

diarrhoea. When th ey come to tak e

problems regarding w a t e r earlier on,

the g a rb ag e aw ay, all the dirt flies up

b u t now it is a bit easier. Those who

ordered and clean. Once I sit down in

onto the doors. They throw all th e dirt

have w a t e r t a p s would leave them

th e toilet, I don’t feel like g etting up

a t th e door. Even the w a t e r in the

running and not sh u t them off. If we

for a couple of hours! Really, I have a

drain does not flow properly.

told them , th ey would ru n after us

toilet a t home y et I like t h a t toilet so

and s t a r t a fight. Before th a t , we had

much t h a t I go an d sit in it. Mahila

Padma Gore

just one ta p . We would dig a hole in

Milan h as made such nice toilets for

I live in D a tta w a d i, V ig h n ah arta

the ground and collect subsoil w ater.

us t h a t th ey feel like a bungalow. Ever

Nagar. I w ork for Mahila Milan in my

T h a t w a s w h a t w e dran k . We used to

since the org anization built th e toilets

s ettlem en t, and have done so since

s train it. We used to g et one handaa

th ere has been less sickness. The

1997. My se ttle m e n t lies along the

and one bucket. We did not get a th ird

small children now don’t fall sick at

river. It ru n s alm ost into th e w ater,

handaa. We w e n t th ro ug h so much

all. I know it for sure. Previously, my

r a t h e r th a n stopping a t th e river

difficulty. Now our c o rp o ra to r has

father-in-law, h usb and and children

banks. We are afraid, because if e xtra

given us a line and a ta p , but the

would go to the doctor regularly. But

w a t e r flows into the river it c a rries off

women do not m aintain th e cleanli­

ever since th e to ilets have been built

our houses. In 1997, our houses w ere

ness around th e tap.

th e re is no dirt, and t h a t is w hy th ere

carried off by th e w a te rs , and then,

We have a lot of problems with

is no sickness. Sickness happened

w ithin fifteen days, M ahila Milan

the toilet. Previously we used to go to

becau se of the toilets. They would get

cam e to our se ttlem en t. Mahila Milan

th e toilet on th e river b a n k - one side

blocked, insects would come out of the

told us a b o u t them selves, abo ut

for th e men and th e oth er for the

cham bers. Some would tell children to

savings and so on, and we began

women. Even now [some people

defecate outside the toilets, or inside,

w orking with them .

continue to do this): those who are

and som etim es over the drains. But

Previously, I used to p ay Rs50

sensible u n d e rs ta n d , and others don’t.

now the re is such a good a rr a n g e m e n t

per month for w a t e r to a person called

The toilets are very dirty! They clean

for the small children t h a t th ey go

P aw ar. We did not have drinking

them once a w e ek or once a month.

happily to th e toilet. The toilets make

w a t e r and electricity in our s e t tl e ­

Insec ts come out of them . The toilet

a big difference in my settlem en t. And

ment. We used to fill 10 or 15

building is five m inutes aw ay. In the

th e environment is much clea ner for

handaas. For the rest - w ashing

lad ies’ toilets th ere are six se ats, and

th e children. The condition is so good.

clothes or utensils - we used w a te r

in th e men’s th ere are also six. We

from th e river. Later, a fte r Mahila

sta n d in lines.

Milan cam e to us, we got one ta p -

Surya Kaborkar I come from S anjay P ark ,

b etw een 28 houses. We got electricity

Sukubai Dengle

V im an d arsh an, Lohegaon Road. There

in the sam e way. Before Mahila Milan

I live in K a m g a rp u tla V asahat. I have

are ab ou t 280 houses here. There has

cam e to our se ttle m e n t w e did not

had w a t e r since th e beginning, ever

been a b ranch of M ahila Milan here

have steps to come down th e slope,

since I cam e to live here. The w a t e r is

for th e p a s t four months. About 80 of

but th e y built some. Then th e y got us

close to us. T h a t is w hy th ere is no

us w omen save with M ahila Milan. In

a streetligh t, and now w e go to and

problem about w ater. Our difficulty

four m onths w e have deposited

fro in t h a t light. Mahila Milan [did

w a s w ith toilets, but ever since

R s 2 2 -2 3 ,0 0 0 ... We have ju st one

th ese things] for us: la t e r on the

M ahila Milan built toilets we have not

problem - th e se ttle m e n t is on

municipal au th o rities also helped, but

had any tension. This y e a r all the

military land. T h a t is w h y th e re can

M ahila Milan b egan the process.

toilets have been completed, and now

be no am enities (including piped

we do not have to queue. Even the

w a te r) and no drains. Mahila Milan

toilets in A m bed kar Nagar. It is

w a t e r is properly a rra n g e d . Before

has now built toilets. The toilets are

outside our settlem en t, five m inutes

this, I had to get up very early. Using

clean. But cleanliness alone is of no

aw ay. People from tw o s e ttlem e n ts

the toilet w a s a source of tension.

use, becau se th e d rains are very dirty.

use the four toilets - tw o for men and

There would be a queue of 10 or 20

The m ilitary does not allow any

tw o for women. We have to sta n d in a

w omen; som etimes th ere w ere even

am en ity an d t h a t is w hy th e re are lots

queue for half an hour. T h a t is why

30. Sometim es, a w om an would

of problems. There are toilets but

th e men all go u n der th e bridge and

defecate on the ste ps if th e w a it w a s

th ere is no w a t e r in th e toilets. We

only th e women use th e toilets.

too long. If you have d iarrh o ea, you

have to get a ta n k e r and fill the

We have no toilets: we use tw o

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

I live in N etaji Nagar, Survey num ber

overhead t a n k s above th e toilets. We

we used to g et w a ter. But [the supply

g et only tw o ta n k e r s a day. They do

w a s interm ittent:] w a t e r would come

8. I have been living in the settlem e n t

not provide enough for all the houses.

one day and not th e nex t... We did

for the p a s t 15 yea rs. W ate r is not a

Two ta n k e r s come from th e c o rp o ra ­

not have enough w a t e r for several

problem, now th ere are ta p s in each

tion. We are n e a r a disused quarry, so

y ears. There w ere a lot of fights;

house. Five y e a rs ago th ere w ere a lot

in m any homes the men and children

ev eryd ay there would be fights, people

of problems; there w ere no t a p s in the

go to the q u a rr y for a bath . In some

would th ro w each o th e r 's handaa

house. We had to bring w a t e r from

houses the clothes and even vessels

a w a y etc. The w a t e r cam e from the

outside. We did not have to go far.

are tak en to the q u a rr y for w ashing.

pipe from th e toilet. T h a t w a t e r we

There w a s a municipal ta p w hich w a s

We ta k e only b a th w a t e r for the

would fill for drinking and for

very crowded. We had to get up a t

w omen, drinking w a t e r and w a t e r for

w ashing. In our a r e a th e system w a s

4am to fill our con tainers. There w as

th e utensils from the ta n k e rs. T h a t is

t h a t the vessels w ere p u t in place in

a queue till 10am...

w hy we need five to seven handaas.

th e morning; handaas and so on were

We do not have any a rr a n g e m e n t

left a t th e ta p , an d once w a t e r came

clean er does not come regularly. For

ex cep t for th e tan k er. The ta n k e r

to the ta p , we would fight and fill out

tw o or th re e days or more, th ey do

comes som etimes a t 11am or 12 noon,

containers. Sometim es som eo ne’s

not clean. R ag s and cloths ac cum ulate

or a t 1pm. We do not know w hen it

handaa would be stolen, and

inside. Men have b e tte r toilets. We

will come.

som etim es th ere would be fist fights.

have to pay R s20 per month. The

This is w h a t happened. Our relations

toilets have been built by the c o rp o ra ­

Chhaya Waghmare

w ith each oth er would be spoiled

tion. Avinash Savle, [a politician] who

I live in S anjay P ark . The ta n k e r s

becau se of th e conflicts over w ater...

w a s elected, got new toilets built for

come right in th e middle of th e s e t tl e ­

Though we have a toilet, built by

The toilets a re v ery dirty. The

th e men. Women do not have a new

ment. People on th is side put th eir

th e corporator, it does not have w a ter,

toilet. Already, th ree or four doors to

vessels on th is side and people on the

or electricity, and it is not cleaned. It

th e toilets are broken and th ey are not

o ther side put th e ir vessels on the

is a lw a y s very dirty. There is a lot of

clean; it is dirty all the time. They

o th er side. W hen th e ta n k e r comes,

dirty graffiti on the w alls, and the

don’t come to clean them , sometimes

everybody k no w s a b o u t it. All the

filth brings insects and anim als, and

even for a w eek.

women and children g a th e r there. We

the children fall sick. It is d ark , th ere

p u t th e vessels th ere earlier, in the

is no light th ere, and th e r e are

could be done w ith o u t fights. Until

morning, and leave them th e re till the

mosquitoes. The day before y e ste rd a y

you fought and h eard sw e a r w ords

ta n k e r comes. Everybody has th eir

tw o girls w ere ad m itted [to the hospi­

you did not g et w ater!... There w as

specific place in th e queue but only

tal]: one is th ree m onths an d the oth er

ju s t one ta p and th ere w ere 2 0 0 - 2 5 0

th eir vessels will be there. Everyone

is nine months. They had vomiting and

houses in th e settlem ent; maybe more.

has a pipe, and w hen the ta n k e r

diarrhoea.

There w a s a n o th e r ta p , but it w a s

There used to be fights. Nothing

very far aw ay, it too k us half an hour

comes the pipe h as to be p u t into the ta nker. One person is needed to go on

Chhaya Raju Gaikwad

to go th ere. We would get betw een

top of th e ta n k e r to put their pipe into

I live in D a tta w a d i ... th ere used to be

four and te n handaas of w ater... We

th e tanker. One person is needed

tw o t a p s b etw een 45 houses. It w a s

would go to th e ta p a t night, a t 12

below to suck out th e w a t e r by

so crowded t h a t we could not get any

midnight or la m . If our man w a s in

mouth, and then everybody fills their

w a ter. Even a t 1 1 - 1 2pm, we could

th e house we would get him to fetch

handaas. Sometim es people do not get

not get w ate r. We used to fill our

th e w a ter, or we would do it

w ater. I have a small sister who used

co ntain ers in th e evening. At th e end

ourselves. The ta p w a s free a t night.

to go to school. She studied till the

of 1997, we got houses, and in 1998

We could not g et to it during th e day.

second or third sta n d a rd , but we have

we got tap s; we had to pay R 275 and

Now th ey have given us w a te r ; one

kept her a t home to fill th e w a te r

we got a ta p in th e house. The river is

ta p b etw ee n five houses. Previously,

w h en ev er th e ta n k e r s arrived, since I

close to us, so w hen we got w a t e r it

w a t e r would be available from 4am to

have to go out to w ork. T h a t is w hy

w a s OK if w e ju s t had enough for

9am. After 9am the w a t e r would

h er schooling w a s abandoned. For 22

b a th s and to clean the house. We used

stop... We h ad to pay R 50 0 each [for

y e a rs we have been g etting ta n k e r

to w ash th e utensils and clothes a t

th e new tap]. The w a t e r is free.

w ater. Previously th ere w a s j u s t one

th e river... We have a toilet. It w as

ta nker, b u t now, becau se there were

built th ree y e a rs ago, and th ere are

Suman Babban Pande

fights, th ere is an o th e r one.

ju s t th re e toilets b e tw een 45 houses.

I live on 21 4 D an d e k a r S treet,

Men also go there, and we have to go

opposite L ok m any a Nagar. Previously,

Sona Vaitale

out in the open also. In some a re a s

we had such a problem with w a t e r

I live a t W ad ar Basti, Y erawada. Five

th ey have to go out in th e open too.

t h a t we had to g e t up a t 5am. If we w e n t to the ta p la t e r th a n th a t , then

or six y e a rs ago th e re w a s a munici­ pal connection, with tw o t a p s w here

Rehana Azim Sheikh

th e o th er women would put our

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

89 vessels aside and put th eir own

a big problem w ith th e drains. Just

The w a t e r cam e in th e morning a t

vessels u nd er the ta p instead. If you

today, th e r e w a s a fight b e tw een the

3am or 4am . There w ere 1 5 - 2 0

w a n te d to fight, you could fight every

women from 6 am till 9am. Somebody

houses a t t h a t time. There w ere lots

day. I did not fight, I would sit

had dirtied the drain. They throw

of fights, bec au se the w a t e r w a s not

quietly: ‘OK, if you w a n t to put aside

g a rb ag e in the drains. And if we go to

th ere for the whole day and it would

my vessels, do i t ’. Sometim es I had to

tell them not to, th ey say ‘You are not

stop a t 9am. Everybody w a n te d a lot

t a k e drinking w a t e r from D a ttaw a d i.

our leader. Take care of your own

of w ater. They would fetch w a t e r in

There w a s no provision for bathing.

house and w a s te s ! ’ It is not only the

w h a te v e r vessels th ey had. They

They had made m oris [small enclo­

women who say this: my hu sban d said

would get up early in th e morning and

sures for bathing] along th e road, but

‘Don’t you have any oth er w ork? Cook

p u t the vessels in a line. They would

th e corporation demolished them.

lunch for the children.’ I said ‘OK, I ’ll

sta n d in a queue and w a it for their

Then we made moris in th e houses.

leave it, i t ’s a big fight, th ey are

tu r n to fill th eir vessels. If somebody

We would dig holes, have a b a th and

sw e a rin g ...’ Somebody had defecated

had a lot of vessels then until they

th en fill buckets and th ro w th e w a te r

in th e drain today. I took tw o mugs of

had finished filling them , th ey would

on the o th er side. This is th e co nv en­

w a t e r from my house and th rew them

not allow o th er people to fetch w ater.

ience we had. Then V andana Tai w a s

on it. They said ‘W hy do you w a n t to

This is how a lot of fights got sta rte d .

elected an d she gave us t a p s in the

w ash it aw ay? We are fighting about

houses. She cleaned the open drains

it . ’ I said, ‘Don’t fight: I will pour

Noorshah Salim Sheikh

outside our doors and closed them .

w a t e r on i t ’, and I asked th em if th ey

I live on H arris Bridge, Gandhi Nagar.

These are th e good things she did for

w a n te d me to sw eep it aw ay. But th ey

My slum is on th e B o m bay-Poona

us. For w a t e r we had to go here and

said ‘You are not a s w ee p e r.’ I told

Road. This se ttle m e n t is 2 0 - 2 5 y e a rs

there; I fell down several times. We

them to go ahe ad and fight. The fight

old. Previously, the re w ere few houses

had to get up a t 5am. Sometim es, if it

is probably still going on. We also

and th e r e w ere a lot of problems

w a s late and I w a s in a hu rry and

have a problem w ith w ater. There is a

regarding w ater. There w a s a pipeline

worried about w h e th e r I would get

lot of w a t e r b u t [the pressure is too

running u n d e r the bridge and the

w a t e r or not, I would slip and fall

low and] it does not come to our level,

w a t e r used to leak from it. People

down. There w a s a lot of tension

and we have to buy it instead. Today

would sta n d w ith a vessel on their

ab o u t w ater. We would fill th e d ru m s

the re w a s no w a t e r in the taps.

head to c atc h the w a t e r as it fell. There w a s no o th e r w a t e r to be had.

a t night an d fetch w a te r until 12 at night. And then in th e morning again

Neelam Sathe

we had to get up a t 5am for w ater.

I live in Y eshwant N a g a r in Y erawada.

distance a w a y from the se ttle m e n t

There w ere m any t a p s but we had to

There used to be a huge problem in

w hich had a ta p , but th e people th ere

queue up. And the [other women]

our a re a . About 1 0 -1 5 y e a rs back we

did not w a n t us to use it becau se we

would not give me w a t e r until th ey

had to fetch w a t e r from th e bathroom

lived in a slum. We would go a t night

had fetched th eir w ashin g w a t e r and

in th e men’s toilet block; there w a s

a t l a m , 1.30am, 2 am w h en th e ta p

drinking w ater.

also a toilet for w om en but the re w as

w a s free and fetch w ater... Toilets

no ta p th ere. We fetched our w a te r

w ere built and a w o m an from our

Helen Babban Mayekar

from th ere, for drinking and for o ther

organization w a s asked to ta k e care

I live on Ram Takri, n e a r th e Blind

things. A p art from this th e men would

of it. But becau se some people dirtied

School, Survey num ber 109, H a d a p s a r

have th e ir b ath s there. While th e y had

the place so much, the w om an got a

are a . I have been here for six months.

th eir b a th s we had to w a it outside.

bad nam e - people claimed t h a t she

There used to be a lot of problems

Once th eir b a th s w ere over we w e n t

did not m aintain cleanliness. Some

regarding w a t e r in my settlem e nt.

inside and fetched w ater. Some of the

people would pay her on tim e and

There w a s only one ta p and w a t e r

boys w ere so bad t h a t only w hen the

some would not. She w a s removed...

w a s sold: one handaa-kalsi [container]

girls came and w a n te d w a t e r would

Now th ere is a n o th e r c a r e t a k e r there.

cost 25 paise (a q u a rt e r of a rupee). If

they go and have a bath. When they

The sam e people who dirty the toilets

a w om an w a n te d e x tra, she w a s

sa w th e girls w aiting, they would rub

can also make a complaint a b o u t the

allowed only four handaas and th e rest

on more soap and b a th e for longer.

dirtiness. It is not a lw a y s possible to

would have to be filled later. People

They would not move a t all and they

know who dirties th e toilets. They are

used to fight. Then I got a ta p in my

w ere sham eless. M any days w ere

people from w ithin the se ttle m e n t who

own house. My h usb and is a TV

w a s te d like this. Then a co rp o rato r

are outsiders. They live on rent.

mechanic and I have studied till the

came, he w a s not elected then. He

Everyone e ats , th e y have to use the

ten th s ta n d a rd in English. But I did

sa w t h a t all th e w omen had to fetch

toilet. The outsiders who come here

not get a job and now I sell v e g e ta ­

w a t e r from th e b athroom , th e y even

for a short time vandalise and steal,

bles. There w ere so m any problems,

had to fetch drinking w a t e r from

and th e older settlem e n t gets a bad

and I have given 25 paise for one

th ere, so he got us tw o t a p s outside.

name.

handaa of w a te r before now... There is

We used to fetch w a t e r from there.

There is a H an um an Temple a short

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

90 Bhamabai Laxman Jagtap

photos of th a t one, because there have

every five families, and many people

I live in Gandhi Nagar, Pimpri. Mahila

been explosions there. It is so dirty,

who had money [joined th e scheme].

Milan has been in our area for the

and there is no [ventilation to allow)

Others contributed, and wrote a letter

past one-and-a-half years. For 10-15

the foul air to go out, and explosions

to the corporation, and got the tap a

years we had lots of problems with

occur. If you go to see the toilets, they

little lower down the hill and now we

w ater, electricity and so on, but then

are so dirty th a t a person cannot put

fetch w a te r from there. Now w a te r is

we got w a te r taps, one or two in each

a foot in them, but we have no choice

provided properly.

lane. Even then there were long

and we have to go there. The children

queues for water. It w as not conven­

squ at in the road, to the extent th a t

but the children’s toilet is not good. It

ient for us all to queue a t one tap...

you cannot walk along the road.

is just a small drain which has been

Toilet facilities are also provided,

placed in an empty space. Children

Those who lived nearby could stand in the queue, but those who lived far

Tabassum Sheikh

squat in the drain. Once a boy w as

a w ay could not get water. In my lane,

I am from Sangam Wadi and live on

squatting there when some officers

I got the women together. There were

the upper side. I came here in 1987

came. They called his father and fined

2 0 -2 5 women and I told them: ‘We

and there w as a (municipal) corpora­

him Rs50. My son also used to squat

have this problem with water, and we

tion toilet, which w as a t the top. On

there, but his father picked him up

have to get our own ta p'... I collected

the wall of the toilet there w as a tap

and brought him into the house. He

R25 from each woman, and with th a t

from which everybody took water.

did not w an t to have to pay the Rs50

we put in a pipe, and we wrote to the

Almost 50 families took w a te r from

fine. Because there is no children's

municipality and told them th a t we

there. There were two women in the

toilet, small children of three or four

needed w a te r here, and we are ready

settlem ent who were fighters. If they

years have nowhere to go. They sit in

to pay for it. They gave us a tap in

did not get any w a te r they would

the drain.

our lane immediately...

break the tap. Once the ta p w as

Source: SPARC w a t e r and sa n it at io n study in

broken, the others could not get w ater

Pune. A more det ailed ac c o u n t of thi s will be

but they are not clean. The one up the

either... Then [someone proposed a]

published in Environm ent and Urbanization, Vol

hill is not OK. We have even ta ken

scheme to provide one tap between

Each settlement also has toilets,

15. No 2. October 2003

serio u s h ea lth problem s faced by m o th e rs and

m o s t of t h e il ln e s s e s a n d in ju rie s from w h ic h

t h u s a ls o to t h e i r c a p a c i t y to co p e w i t h diffi­

i n f a n t s a n d c h il d re n su f fe r (in clu d in g t h o s e

c u lt ie s d u ri n g p r e g n a n c y , c h il d b ir th a n d t h e

r e l a t i n g to i n a d e q u a t e w a t e r a n d s a n i t a t i o n ) .

p o s t - p a r t u m p e rio d , to p r o d u c e a s t r o n g

C a rin g for t h e sic k a n d h a n d li n g a n d l a u n d e r ­

h e a l t h y b a b y a n d to b r e a s t- f e e d a n d c a r e for

ing so iled c lo t h e s a r e p a r t i c u l a r l y h a z a r d o u s

i t . 169 T h e y also h a v e a role in t h e v e r y high

t a s k s w h e n w a t e r s u p p l ie s a n d s a n i t a t i o n a n d

m a t e r n a l m o r t a l i t y r a t e s e v id e n t in m o s t low-

w a s h i n g fa c ilitie s a r e i n a d e q u a t e .

a n d m id dle -in co m e n a t i o n s (a l th o u g h t h e

T h e p e o p le w ith i n a h o u s e h o l d w h o a re

a b s e n c e o r v e r y p o o r q u a l i t y of h e a l t h s e r v i c e s

r e s p o n s ib le fo r w a t e r co lle c tio n a n d its u se for

for c h ild b e a r i n g w o m e n is t h e m a i n c a u s e ) . 170

l a u n d r y , c o o k in g a n d d o m e s ti c h y g ie n e also

W o m e n a r e g e n e r a l l y f a r m o re s e v e r e ly

su ffer m o s t if s u p p l ie s a r e c o n t a m i n a t e d a n d

a ff e c te d t h a n m e n b y p o o r q u a l i t y a n d o v e r ­

difficult to o b t a i n - a n d t h e s e p e o p le a re

c r o w d e d h o u s i n g c o n d it io n s a n d b y t h e

g e n e r a l l y w o m e n or girls. W om en o fte n suffer

i n a d e q u a t e p ro v isio n of w a t e r , s a n i t a t i o n a n d

m o re t h a n m e n from ch ro n ic b a c k p a in ,

h e a l t h c a r e (a n d als o s c h o o ls a n d n u rs e r ie s )

b e c a u s e t h e y h a v e to c o lle c t w a t e r from w e lls

b e c a u s e t h e y t a k e m o s t r e s p o n s ib ility for

or pu blic s t a n d p i p e s .

lo o k in g a f t e r i n f a n t s a n d c h ild re n , c a r i n g for sick fam ily m e m b e r s a n d m a n a g i n g t h e h o u s e ­

A s t u d y of h o u s e h o l d e n v i r o n m e n t a l m a n a g e m e n t in A c c r a n o te d t h a t :

h o ld . 171 It is g e n e r a l l y w o m e n w h o a re re s p o n s ib le for t h e d is p o s a l of h u m a n w a s t e s

H o u seh o ld a n d neighbourhood level environ­

w h e n p ro vision for s a n i t a t i o n is i n a d e q u a t e ,

m en ta l p ro b lem s do n o t receive the

a n d t h i s e x p o s e s t h e m to d i s e a s e s a s s o c i a t e d

a tte n tio n th ey d eserve in e n viro n m en ta l

w ith c o n ta c t w ith h u m a n ex creta. T he fact

d ebates a n d th is prob a b ly reflects, a t lea st

t h a t w o m e n t a k e m o s t r e s p o n s ib i li ty for child

in p a rt, a fo r m o f gender d iscrim ination:

c a r e m e a n s t h a t t h e y also h a v e to co p e w ith

once the w a ter has le ft th e ta p , the fu e ls

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

91 have been purchased, and more generally

l a t r i n e s or o t h e r facilities; n o n - t e n a n t

the environm ental problem s have entered

r e s id e n t a n d a b s e n t e e la n d l o r d s m a d e

the home, they are considered less im por­

d ecis io n s a b o u t lo cal facilities, w ith t e n a n t s

ta n t ‘p r iv a te ’ problem s. B u t since ‘p r iv a te ’

b ein g given r e s p o n s ib ility for k e e p in g facili­

environm ental problem s tend also to be

t i e s c l e a n . 175

‘w o m en ’s ’ problem s, the seem ingly rational em phasis on ‘p u b lic ’ problem s can easily

In M u k u r u K w a R eu ben , a low-income s q u a t t e r co m m u n ity in Nairobi, th e re s id e n ts

m ask a lack o f concern fo r w o m e n ’s

h a v e b een denied a c c e s s to to ile t facilities by

p r o b le m s } 12

la n d lo rd s w ish in g to m axim ize t h e i r r e n t a l incom e. As a c o n se q u e n c e , 215 to ile ts w e re

T h e se g e n d e r- re la te d or se x -re la te d dif feren­

p lace d on th e p e rip h e ry of t h e s e t t l e m e n t of

ti a ls a re obviously r e l a te d to th e

1 0 ,0 0 0 people. A t night, w h e n it is u n sa fe to

discrim in a tio n t h a t w o m e n face in m a n y

w a lk a b o u t th e s e t tl e m e n t , r e s id e n ts relieve

s e c to rs . For in s ta n c e , one of th e re a s o n s t h a t

th e m s e lv e s in th e a r e a s o u tsid e th e i r s h a c k s .

w o m en h ave difficulty finding b e t t e r q u a lity

T h e la c k of facilities e x p la in s t h e p re s e n c e of

hou sin g w ith a d e q u a t e w a t e r an d s a n i ta t io n

‘flying t o i l e t s ’, in w h ic h people w r a p th e

provision is th e d is crim in atio n th e y face in

e x c r e t a in p la s tic b a g s or n e w s p a p e r and

o b tain in g e m p lo y m e n t, in w h a t t h e y a re paid

th r o w it a w a y . T h e h o u se s a r e built close

w h e n t h e y do find w o r k , in p u rc h a s in g or

t o g e t h e r w ith som e p a t h w a y s only 4 0 cm w ide.

ren tin g hou sin g a n d in o b ta in in g credit.

As a c o n se q u e n c e of th e l a c k of facilities, t h e s e p a t h w a y s b eco m e d r a i n a g e c h a n n e ls and

Renters

often a re blocked w ith s t a g n a n t w a t e r and g a r b a g e . T h e to ile ts c o n sist of j u s t cloth or

W h ils t m u c h of t h e d isc u ssio n a b o u t a c c e s s to

s a c k w alls an d v e r y sh a llo w pits. The to ilets

w a t e r a n d to s a n i t a t i o n re f e rs to w h ich

fill up v e ry fast, an d w h e n it ra in s t h e y o v e r­

h o u s e s a n d s e t t l e m e n t s o b ta i n p rovision,

flow a n d th e s e t t l e m e n t is co vered w ith h u m a n

t h e r e a r e also is s u e s a b o u t w h o re c e iv e s

e x c r e t a . S u b s e q u e n tly t h e r e a re fr e q u e n t

prov ision w ith in h o u s e s a n d s e t t l e m e n t s . An

o u t b r e a k s of s a n i ta t io n - r e la t e d d is e a s e s such

e s t i m a t e d 29 p e r c e n t of t h e p o p u la t io n of

a s ty p ho id, c h o le ra an d d y se n te ry . A s one

K a t h m a n d u a r e r e n t e r s w h o n e g o t i a t e p ro v i­

re s id e n t p u t s it: ‘T he w a s t e co m es into our

sion for w a t e r w ith t h e i r la n d lo rd s . ‘Unlike

ho u ses an d in th e m o rn ing w e ju s t scoop it out

m a n y S o u th A sian citie s, m a n y of t h e p o o r

an d life go es o n .’176

live in s o cially h e t e r o g e n e o u s c o m m u n it ie s r a t h e r t h a n in w ell b o u n d e d slum a n d s q u a t ­ t e r a r e a s . D e sp ite th i s , t h e i r a c c e s s to w a t e r s e r v ic e s is n o t c o m p a r a b l e to t h a t of t h e i r

a

Restricting economic development

w e a l t h i e r n e i g h b o u r s . ’173 E x p e r ie n c e s from

The discussion of th e c o sts of i n a d e q u a te

e ls e w h e r e s u g g e s t t h a t t h e s e e x p e r i e n c e s a re

w a t e r an d s a n i t a t i o n provision in t h i s c h a p te r

p e r h a p s m ore c om m o n t h a n th i s q u o te

h ave c o n c e n t r a t e d on th e c o sts to th o s e w ho

im plies. In S o u th A frica, r e n t e r s n o rm a lly

are m o st d irectly a ffected . O th er c o s ts n eed to

als o h a v e to n e g o t i a t e t h e i r a c c e s s to w a t e r

be co nsid ered, including th e im p a c t on la b o u r

a n d s a n i t a t i o n pro visio n w i t h t h e i r la n d lo rd s ,

p ro du ctiv ity, an d th e ab ility of cities an d

a n d it is co m m o n for la n d l o r d s to r e s t r i c t

n a ti o n s to a t t r a c t p ri v a te in v e s tm e n t.

a c c e s s ; fo r e x a m p l e , to an o u ts id e t a p .

T able 2 .1 1 i l l u s t r a t e s th i s by c o n s i d e r ­

T e n a n t s in C o c h a b a m b a (Bolivia) also face

ing t h e lo s s e s in P e r u in 1 9 9 1 a s a r e s u l t of

p a r t i c u l a r p ro b le m s w i t h w a t e r a n d s a n i t a ­

t h e c h o le r a ep id e m ic . T he a p p e a r a n c e of

t i o n . 174 ‘T h e r e ’s no w a t e r ’ c o m p l a in e d one

c h o le r a in L a ti n A m e r i c a n c itie s c a m e a s a

t e n a n t ; ‘T h e l a c k of c le a n lin e s s - no bo dy

s h o c k to t h e region; it h a d n o t b e e n se e n for

c le a n s , e s p e c ia lly n o t in t h e t o i l e t ’ sa id

d e c a d e s a n d it h a d b e e n a s s u m e d t h a t

a n o th e r . In low -in com e a r e a s of D h a k a ,

i m p r o v e m e n ts in w a t e r , s a n i t a t i o n , s e w e r a g e

t e n a n t s a r e n o t ‘a l l o w e d ’ to ow n tu b e w e ll s ,

t r e a t m e n t a n d food s a f e t y h a d e li m i n a te d th e

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

92 I t is a ls o o b v io u s t h a t a c i t y ’s c a p a c i t y Loss in th e time of cholera; P eru, 1991

Item

to a t t r a c t n ew in v e s tm e n t (p e rh a p s US$ thousand

e s p e c i a l l y f o r e ig n i n v e s t m e n t ) is in f l u e n c e d by t h e q u a l i t y of p r o v i s io n fo r w a t e r , s a n i t a ­

27,972

Exports Imports

233

Tourism

147,120

Subtotal; external market losses

175,325

t i o n a n d d r a i n a g e . C it ie s w i t h i n t e r m i t t e n t w a t e r su p p lie s m u s t im pose a h e a v y b u rd e n on a ll b u s i n e s s e s t h a t n e e d r e g u l a r s u p p l i e s a l t h o u g h t h e c o s t m a y b e in t h e e x t r a p r o v i ­

Internal fisheries

32,568

s i o n s t h a t b u s i n e s s e s h a v e to m a k e t o e n s u r e

Street food vendors

15,850

r e g u l a r s u p p l i e s (for i n s t a n c e , l a r g e s t o r a g e

Cholera p atien t care

29,053

t a n k s or ta p p in g o th e r w a t e r so u rc es) r a t h e r

Absence from w ork due to illness

17,586

t h a n in p r o d u c t i o n lo s t w h e n w a t e r is n o t

8292

Absence from w ork due to death Future absence from work due to death (post-1991)

233,764

Subtotal: internal m arket losses

337,112

Total losses

512,437

a v a i l a b l e in t h e p ip e . H o w e v e r , it m a y o n ly be i n f l u e n c e d b y t h e q u a l i t y of p r o v i s io n for t h e f a c t o r y or o ffice in w h i c h t h e i n v e s t m e n t is m a d e a n d / o r fo r t h e h o u s i n g of s e n i o r s ta ff. One c a n p o i n t t o t h e s u c c e s s of P o r t o

Benefits:

A l e g r e o r S i n g a p o r e in a t t r a c t i n g f o r e ig n

P harm aceutical industry

(5534)

International donations

(11,602)

i n v e s t m e n t a n d a r g u e t h a t t h i s m u s t in p a r t be d u e to t h e h ig h q u a l i t y of t h e s e c i t i e s ’

T otal benefits

(17,136)

e n v i r o n m e n t a l i n f r a s t r u c t u r e : a ll o r v i r t u a l l y

T otal n et loss

495,301

p iped w a t e r su p p lies an d s a n ita tio n . B ut

all b u s i n e s s e s a n d h o u s e h o l d s h a v e t h e i r o w n

Note: Net loss in 1991: U S$ 23 2 million, app ro xi m at el y 1 per cen t of P e r u ’s GDP Compare this with the cost of providing s ta n d p o s t w a t e r supplies for P er u' s 5.9 million

th e re are o th e r ex a m p le s such a s B a n g alo re (s e e C h a p t e r 1), w i t h i t s g r e a t s u c c e s s in

un se rv ed population; a t a mea n cost of USS41 pe r head = U S$ 24 2 million. Source: This ta ble w a s d r a w n from a p r e s en ta tio n by S an d y Cairncross. The s ta ti st ic s

a t t r a c t i n g h ig h t e c h n o l o g y i n d u s t r i e s in a

come from P et r e r a, M and A M ontoya (1 99 2) , PAHO Epidem iological Bulletin, Vol 13,

c it y w h e r e p r o v i s io n fo r w a t e r , s a n i t a t i o n

No 3, pa g e s 9 - 1 1 ; the costs of providing s ta nd pi pe supplies comes from WHO and UNICEF (2 000), Global Water Supply and Sanitation A ssessm ent 2 0 0 0 Report, World Health Or ganization. Geneva.

a n d d r a i n a g e is v e r y i n a d e q u a t e fo r m u c h of t h e p o p u l a t i o n . Or, in t h e P h i l i p p i n e s , t h e s u c c e s s of C eb u in a t t r a c t i n g f o r e ig n i n v e s t ­ m en t, d esp ite v e ry in a d e q u a te w a te r and

d i s e a s e , j u s t a s t h e y h a d in E u r o p e a n d N o r th

s a n i t a t i o n p r o v i s io n fo r m u c h of t h e

A m e r i c a in t h e l a t e 1 9 t h a n d e a r l y 2 0 t h

p o p u l a t i o n . 178

c e n t u r y . 177 A p a r t from t h e t h o u s a n d s of d e a t h s an d t h e m u c h l a r g e r n u m b e r of p e o p le w h o w e r e s e r io u s l y ill, t h e r e w a s also t h e d e v a s t a t i n g e c o n o m ic im p a c t . A s t u d y by P e t r e r a a n d

Improved provision for water and sanitation and poverty reduction

M o n t o y a s h o w e d t h e v e r y l a r g e lo s s e s to t h e

T h e q u e s t io n of h o w m u c h im p ro v e d w a t e r a n d

P e r u v i a n e c o n o m y in 1 9 9 2 a s a r e s u l t of t h e

s a n i t a t i o n p ro v isio n c o n t r i b u t e s to p o v e r t y

e p id e m ic - so m e U S $ 2 8 million from lost

re d u c t io n w ill be d i s c u s s e d in m o re d e ta i l in

e x p o r t s a n d U S $ 1 4 7 million from lo ss in

C h a p t e r 6. B u t c e r t a i n p o in t s from t h e s e c t io n s

t o u r is m e a r n i n g s - w i t h o t h e r h ig h c o s t s su c h

a b o v e n e e d h ig h lig h tin g . Good q u a l i t y w a t e r

a s p a t i e n t c a r e , t h e lo s s e s t o t h o s e w h o e a r n e d

a n d s a n i t a t i o n p ro v isio n n o t only b r i n g s m a j o r

a living a s s t r e e t food v e n d o r s a n d from

h e a l t h b e n e f i ts b u t also:

fish e rie s, a n d t h e lo s s e s d u e to d e a t h a n d a b s e n c e from w o r k . T h e n e t loss to th e

•

for in c o m e e a r n e r s , in c r e a s e d in co m e

P e r u v i a n e c o n o m y w a s a r o u n d U S $ 2 3 2 million

from le s s ti m e off w o r k b e c a u s e of illn es s

in j u s t t h i s o ne y e a r, w h ic h is a b o u t t h e s a m e

or t h e n e e d to n u r s e sic k fam ily

a s t h e c o s t of p ro v id in g s t a n d p o s t w a t e r

m e m b e r s , a n d le s s e x p e n d i t u r e on

s u p p lie s for P e r u ’s u n s e r v e d p o p u la t io n .

m e d i c in e s a n d h e a l t h c a re ;

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

93 s u p p o r t fo r h o u s e h o l d e n t e r p r i s e s t h a t

l o w e r o v e r a l l c o s t s fo r t h o s e w h o , p r i o r

n e e d w a t e r a n d t h a t a r e i m p o r t a n t fo r

to i m p r o v e d s u p p l i e s , h a d t o re l y on

in c o m e e a r n i n g ;

expensive w a te r vendors; and

b e t t e r n u t r i t i o n (eg , le s s foo d lo s t to

a r e d u c e d r i s k of flo o d s t h a t c a n d a m a g e

d ia rrh o e a l d iseases an d in te stin a l

a n d d e s t r o y h o u s i n g , w h i c h is o f t e n a

w orm s);

l o w - i n c o m e h o u s e h o l d ’s m a i n c a p i t a l

le s s t i m e a n d p h y s i c a l e f f o r t n e e d e d b y

a s s e t a n d a ls o w h e r e t h e y s t o r e o t h e r

th o s e co llectin g w a te r ;

a s s e t s . P r o t e c t i o n fro m f lo o d in g a ls o o f t e n l e a d s t o i n v e s t m e n t in i m p r o v i n g a n d e x te n d in g housing.

N otes and referen ces 1.

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in developing countries: a challenge for health

2 1 s t c e n t u r y ’, C h ap ter 6 in David

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43.

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Teklem ariam , S, T G etaneh et al (2000), ‘Environm ental d e te rm in a n ts of d iarrh ea l

Epidem iology, Vol 18, No 4, p ages S 1 6 - S 1 9 . 149

zone, south w e s t E th io p ia ’, Ethiopian M edical Journal, Vol 38, No 1, p ag es 2 7 - 3 4 .

Mahfouz, el-Morshedy et al 1997, op cit; Ludwig, Frei et al 1999, op cit.

morbidity in under-five children, Keffa-Sheka 150

Esrey, S A (1996), ‘Water, w a s te , and w ell­ being: a m ulticoun try s t u d y ’, American Journal

T h e I m p a c t s o f D e f i c i e n t P r o v is io n

99 o f E pidem iology, Vol 143, No 6, pages

166.

151.

Feacham , R, M Guy et al (1983), ‘E x creta

coping and policy’, in Vulnerability: How the

disposal facilities and in te stinal parasitism in

Poor Cope, ID S Bulletin, Vol 20, No 2, April,

u rban Africa: prelim inary studies in

p ages 1-7 ; Corbett, Jane (1989), ‘Poverty and

B o tsw an a , G hana and Z am b ia’, Transactions

sickness: th e high costs of ill-health’, in

o f the R oyal Society o f Tropical Medicine and

Vulnerability: How the Poor Cope, ID S Bulletin,

H ygiene, Vol 77, No 4, p ages 5 1 5 - 5 2 1 .

Vol 20, No 2, April, p a g e s 5 8 - 6 2 ; an d P ry e r 1989, op cit. The lite ra tu re on ru ra l poverty

152. Root, G P (2001), ‘S an itatio n , community

153.

environments, and childhood dia rrh o e a in

w a s th e first to develop a detailed u n der­

r u r a l Z im bab w e’, Journal o f Health, Population

stand ing of w h a t underpins vulnerability for

and N utritio n, Vol 19, No 2, p age s 7 3 -8 2 .

poorer groups, but this enco uraged urban re s earch ers to also develop vulnerability

S a tt e r t h w a i te et al 1996, op cit.

fram ew o rk s - see for instance Moser, Caroline

154. P rost, A and A D Negrel (1989), ‘Water,

155.

156.

This list d ra w s from C ham bers, Robert (1989), ‘Editorial introduction: vulnerability,

608-623.

tr a c h o m a and conjunctivitis’, Bulletin o f the

0 N (1996), ‘Confronting crisis: a s u m m a ry of

World Health O rganization, Vol 67, No 1, pages

household responses to poverty and v u ln e r a ­

9-18.

bility in four poor u rb an co m m u nities’,

See for in stan ce Curtis, Cairncross and Yonli

Environm entally Sustainable Development

2 00 0, op cit; Vaz, L and P Jha (2001), ‘Note

Studies and M onographs Series, No 7, The

on the h ealth im pact of w a t e r and san itatio n

World Bank, W ashington, DC, 19 pages; and

se r v ic e s’, CMH Working paper Series, No

Moser, Caroline 0 N (1998), ‘The a ss e t

WG5, Commission on Macroeconomics and

vulnerability fram ew ork: re assessing u rb an

Health, Geneva; Victoria et al 1988, op cit.

poverty reduction s t r a t e g i e s ’, World

Gilman, R H, G S M arquis, G V entura, M

Development, Vol 26, p a g e s 1 -1 9 .

Campos et al (1993), ‘W a te r cost and av ail­

167. It is useful to distinguish b e tw e e n children

ability: key d e te rm in a n ts of family hygiene in

who w o rk in th e s t re e t but live in a stable

a P eruvian s h a n ty to w n ’, American Journal o f

home, usually with th eir p a ren ts, and children

Public Health, Vol 83, No 11, pag es

who live and w o rk on th e streets . UNICEF

1554-1558.

has su gg ested th re e categories. The first is

157.

Curtis, Kanki, M erten s et al 1995, op cit.

‘children on th e s t r e e t ’, which is much the

158.

M erten s, T E, S Jaffar, M A Fernando, S N

la r g e st cate g o ry of ‘stre e t children’; th ese are

Cousens an d R G Feacham (1992), ‘E x creta

children who w ork on th e stre e ts but have

disposal behaviour and latrine ow nership in

strong family connections, m ay a tt e n d school

relation to th e risk of childhood dia rrh o ea in

and, in most cases, retu rn home a t the end of

Sri L a n k a ’, International Journal o f

the day. The second cate g o ry is ‘children of

Epidem iology, Vol 21, No 6, pages

th e s t r e e t ’; th e se see the stre e t as th e ir home

1157-1164.

and seek shelter, food and a sense of com m u­

Qureshi, A F and M A Lobo (1994), ‘Socio-

nity am ong th e ir companions there. But ties

anthropological d ete r m in a n ts and home

to th eir families exist, even if th ey are remote

m a n a g e m e n t in childhood d iarrho ea in a

and th e y only visit th e ir families infrequently.

159.

s q u a t t e r se ttle m e n t of K arachi, P a k is ta n ’,

The th ird cate g o ry is ‘aban do ned children’;

Journal o f Tropical Pediatrics, Vol 40,

th ese are difficult to distinguish from children

December, p age s 3 7 8 - 3 8 0 .

of th e s t re e t since th e y u n d e rta k e similar

160.

Curtis, Kanki, Cousens et al 1997, op cit.

activities and live in similar w ays. However,

161.

Lindskog and Lundqvist 1998, op cit.

th ese children have no ties w ith their families

162.

Mclennan, J D (2000), ‘To boil or not: drin k ­ ing w a t e r for children in a p eriurb an b a r r io ’,

and are entirely on th eir own. 168. Patel, Sheela (1990), ‘Street children, hotels

Social Science and Medicine, Vol 51, No 8,

boys and children of pavem e nt dwellers and

p ages 1 2 1 1 - 1 2 2 0 .

construction w orkers in Bombay: how they meet their daily needs’, Environment and

163. WHO and UNICEF 20 00 , op cit. 164.

Mitlin and David S a t t e r t h w a i te (2001),

169. World Bank (1990), World Development Report

E nvironm ental Problems in an Urbanizing

1990; Poverty, Oxford University Press,

World: Finding Solutions fo r Cities in Africa,

Oxford.

A sia and Latin Am erica, E a rth s c a n Publications, London, 470 pages. 165.

Urbanization, Vol 2, No 2, October, pages 9 -2 6 .

This section d ra w s on Hardoy, Jorge E, Diana

170.

Germain, Adrienne, Sia Nowrojee and Hnin Hnin Pyne (1994), ‘S etting a new agenda:

Tony McMichael a t th e London School of

sexu al and reproductive health an d r i g h ts ’,

Hygiene an d Tropical Medicine helped develop

Environm ent and U rbanization, Vol 6, No 2,

this distinction.

October, pages 1 3 3 - 1 5 4 .

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

100 171.

See for instance Beall, Jo and Caren Levy

174

overview p ap er prepared for th e P re p a r a to r y

social h o u sing ’, E nvironm ent and U rbanization,

Committee for H a b ita t II, Geneva; Lee-Smith,

Vol 9, No 2, October, p ag es 1 1 9 -1 3 9 .

Diana and C atalina Hinchey Trujillo (1992),

175

Shireen A k h te r (2001), W aterAid Bangladesh

w omen and su stain able d ev elop m ent’,

Urban Programme E valuation, Planning

Environm ent and U rbanization, Vol 4, No 1,

A ltern ativ es for Change and P a th w a y Ltd,

April, p ages 7 7 - 8 4 . See also Songsore, Jacob

D hak a, page 47. A condensed version of this

and Gordon M cG ranah an (1998), ‘The politi­

report will be published in th e October 2003

cal economy of household environm ental

issue of E nvironm ent and Urbanization. 176

Musyimi, Jennifer (2002), ‘When n a tu re calls:

epidemiology in th e G reate r A ccra

th e sa nita tion case a t M uk uru Vijijini’,

M etropolitan A r e a ’, World D evelopment, Vol

N ew sletter o f the Nairobi Inform al Settlem ents Coordination C om m ittee, page 10.

26, No 3, pages 3 9 5 - 4 1 2 for a detailed a n a ly ­

173.

H a n c h e tt, Suzanne, Mohidul Hoque Khan and

‘The stru g g le to legitimize subsistence:

m an age m en t: gender, environm ent and

172.

Richmond, P a ttie (1997), ‘From te n a n t s to owners: experiences w ith a revolving fund for

(1994), ‘Moving to w a rd s th e gendered c ity ’,

sis of this for Accra.

177

WHO 1992, op cit.

Songsore and M c G ranah an 1998, op cit, page

178

Etem adi, Felisa U (2000), ‘Civil society p a r t ic ­

409.

ipation in city governance in Cebu City’,

E thering to n, Wicken and B a jra c h a ry a 2002,

Environm ent and U rbanization, Vol 12, No 1,

op cit, page 24.

p ag es 5 7 - 7 2 .

CHAPTER

Explaining Deficiencies in Urban Water and Sanitation Provision

Introduction M any factors co ntribu te to the in ad equ a c ies in

by dia rrho eal d iseases (and a t low unit costs).

w a t e r and s a n ita tio n provision t h a t are

Indeed, th e re are various exam ples of cities

described in C h ap ter 1, and to th e very serious

w h ere good q uality community-level h ealth

implications t h a t th e s e have for h ealth and

care services have co ntrib u ted much to reduc­

well-being described in C ha p te r 2. These

ing infant and child mortality, and rapid

factors a c t a t every level from th e m ost local

tr e a t m e n t for w ater-b orn e d iseases has played

to th e intern atio nal. Figure 3.1 illu s tra te s this

a key role.1 But rapid an d effective h ealth care

by highlighting some of th e facto rs t h a t can

w hen someone falls sick (or is injured) does

con tribu te to c o n ta m in a te d w a t e r causing high

not a d d re s s the c a u se s of th e illnesses or

levels of diarrh o ea l disease in a s q u a t te r

injuries. Rapid tr e a t m e n t m ay save th e lives of

s e ttle m e n t, from th e m ost im mediate or ‘proxi­

m any infants and children, b u t w ith o u t

m a t e ’ cause (such a s th e i n h a b i ta n t s ’ use of

add ressin g th e ca u se s th e very high risk of

drinking w a t e r t h a t is c o n ta m in a te d with

infection rem ains un changed. Curative

h um an faeces) th ro ug h v arious c o n tribu tory

responses, effective as th e y are, do not prevent

c au ses (poor q uality w a t e r and s a n ita tio n

re-infection. Nor do th e y eliminate days lost to

provision, in p a rt because of th e s e t t l e m e n t ’s

illness. As far a s children are concerned,

illegal sta tu s) an d underlying ca u se s (w eak

c u ra tive responses do not ad d ress th e ac co m ­

an d ineffective local governm ent, lack of

pan ying s e tb a c k s to th e ir overall he alth and

in ve stm e nt by n atio n al gov ern m en t a nd low

development.

priorities given to w a t e r and s a n ita tio n by m a n y in tern a tio n a l agencies). If th e goal is to reduce th e he alth burden from p eople’s infection th rou gh con tam in ate d

Focusing on medical solutions to w a te rand san itation -related h e a lth problems also ignores th e m any non-health im plications of poor provision t h a t w ere described in C h apter

w ate r, with so m any contributing facto rs it is

2 - th e time burdens a nd physical efforts for

difficult to know w here limited resources

those w ho collect w a te r, the high prices paid

should be focused. T here has been a ten den cy

to vendors or to those m ana gin g t a p s (which

am ong m any go ve rn m en ts an d in te rn a tio n a l

for m ost low-income households come out of

a gencies to focus on relieving th e sym ptom s -

funds t h a t would o th erw ise have been spen t

for instan ce, on ensuring th e availability of

on food), th e c o n stra in ts on play for children in

oral rehy dratio n sa lts for th e rapid tr e a tm e n t

c o n ta m in a te d environments, and so on. Finally,

of diarrh oea l d iseases - r a t h e r th a n addressing

while oral rehy dration sa lts can be given a t

th e causes. T here are good reaso n s for doing

home, m an y h ealth care responses to w a te r-

so a nd th e w id er availability of oral re h y d r a ­

r ela ted diseases require the in terv ention of

tion sa lts and th e know ledge of how to use

tra in e d medical personnel and the supply of

them h as con tribu ted to a su b s ta n tia l redu c­

medicines, and p re s e n t a continual burden on

tion in the d e a th s and disease b urd en s caused

alrea d y over-taxed h ealth services. In m any

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

102

UNDERLYING CAU SES

CONTRIBUTORY C AU SES

PROXIMATE C AU SES

Source: UNICEF (2002), Poverty and Exclusion Among Urban Children, Innocenti Centre, Florence.

lo catio n s , t h e n ee d for h e a lt h c a re se rv ic es

m e n t an d t h e in s ti tu t io n a l s t r u c t u r e n eed ed to

ex c e e d s t h e c a p a c i ty to deliver - w h ich

collect u s e r c h a r g e s to allow t h e in v e s tm e n t

u su a lly re s u lts in long q u e u e s for th o s e

c a p it a l to be repaid . V ery often, t h e s e in s t i t u ­

s e e k in g t r e a t m e n t (an d m a n y people being

ti o n a l s t r u c t u r e s an d fin a n c ial s y s te m s are

d is c o u ra g e d from s e e k i n g t r e a t m e n t ) an d

la ckin g.

i n a d e q u a t e su pp lies of m edicines. A d e q u a te w a t e r a n d s a n i ta t io n pro vision, by p re v e n tin g

E ven w h e re th e focus is on im proving provision for low-income hou seh olds, cost-

a sig nifican t p rop ortion of t h e d is e a se b u rd e n

re c o v e r y m a y be possible. As C h a p te r s 6 an d 7

in low -income s e t tl e m e n t s , w ou ld in c r e a s e th e

will describe, th e r e a re m a n y e x a m p le s of

c a p a c i ty of h e a lt h s e r v ic e s to m a n a g e o th e r

p ro je c ts o r p r o g r a m m e s t h a t g r e a t ly im proved

p re s sin g h e a lt h problem s.

w a t e r an d s a n i t a t i o n provision for low-income

One re a s o n w h y m o s t n a ti o n a l g o v e r n ­

ho u seh o ld s w h e re c o s ts w e re fully recovered.

m e n t s a n d in t e r n a t i o n a l a g e n c ie s h av e focused

T h e y sh o w t h a t in m a n y c ir c u m s t a n c e s , th e

on a d d re s s in g s y m p to m s r a t h e r t h a n c a u s e s is

co st of im proved provision is n o t th e problem.

t h a t th is is m uch sim p ler (and m a y a p p e a r

B ut t h e c o n s t r a i n t is th e ex is te n c e of a local

ch e a p e r). For la r g e cities, it is often v e ry

o rg a n iz a tio n ( w h e th e r public, p ri v a te c o m m e r­

ex pen sive to in s ta ll good q u a lity s y s te m s for

cial, p ri v a te non-profit, NGO o r CBO b ased )

w a t e r an d s a n i ta t io n b e c a u s e t h e r e is so little

t h a t c a n develop t h e so lu tion s t h a t a r e m ost

ex istin g i n f r a s t r u c t u r e , or th e in f r a s t r u c t u r e

a p p r o p r ia t e to t h a t loca lity an d its in h a b i­

t h a t e x is ts is in n eed of re p l a c e m e n t or

t a n t s , build efficiently (so unit c o s ts a re k e p t

s u b s t a n t i a l u p g ra d in g ; th e c o sts p e r perso n

do w n a n d t h e g a p b e tw e e n co st an d c a p a c i ty

se r v e d m a y n ot be high, b u t w h e n w a t e r an d

to p a y is minim ized), a n d s e t up a n d m a n a g e a

s a n i ta t io n s y s te m s h a v e to be in s ta lle d to

co st-re c o v e ry sy s te m so t h a t u s e r s c an an d

se r v e s e v e r a l h u n d re d t h o u s a n d (or s e v e r a l

will pay. T his is t h e c r u x of t h e problem in

million) people, th e t o t a l c o sts a re high. In

m o s t cities. It is also no t help ed by p riv a te

m a n y u rb a n c o n te x t s , t h e d is a d v a n t a g e of high

se c t o r provision, w h e re th e e x p an sio n of c o v e r­

c o sts is c o u n te r e d by a high w illing ne ss to p a y

ag e is influenced by w h e t h e r a rap id r e t u r n on

a m o n g u n s e r v e d or poorly s e r v e d po p u latio n s,

a n y in v e s tm e n ts c a n be m a d e r a t h e r t h a n a

so t h e is sue is n o t so m u c h t h e high c o st bu t

lo n ger-te rm view w h ich a c c e p t s t h a t t h e co sts

t h e fin an c ial sy s te m t h a t s u p p o r ts th e in v e s t­

of ex te n d in g provision c a n be funded by u s e r

E x p l a in i n g D e f i c i e n c i e s in U r b a n W a t e r a n d S a n it a t io n P r o v is io n

103 Table 3.1 The range of causes contributing to inadequate w a te r and sanitation in urban areas Underlying causes acting at the regional, national and international

Contributory causes acting at the city or municipal level

Proximate causes acting at the household and neighbourhood level

Water shortages

Limited household capacity to pay

level National governments not providing support (political choice, debt burden, etc) International agencies not providing support

Rapid population growth overwhelming Illegal status of many settlements agencies or utilities responsible for provision Ineffective local institutions (including Constraints on ‘do-it-yourself’ provision city and municipal government) for households or communities (including absence of w ater locally) Refusal of w ater and sanitation agencies to work in informal settlements

c h a r g e s b u t w ith a lo n g er tim e horizon a n d

a n d s a n i t a t i o n provision in u r b a n a r e a s (see

less o r ie n ta tio n to profit.

C h a p te r 4).

A d d re ssin g th e la c k of a n y local o r g a n i­

A n o th e r co m m o n e x p la n a tio n for th e

za tio n able to do t h i s is often politically

in a d e q u a c ie s in w a t e r an d s a n i ta t io n provision

c o n tro v e rsia l, especially if it re q u ire s c h a n g e s

is c it ie s ’ v e r y rap id p o p u la tio n g ro w th , w h ic h

in th e d is trib u tio n of pow er, a u t h o r i t y an d

o v e rw h e lm s a n y local c a p a c i t y to im prove and

re s o u r c e s b e tw e e n dif ferent levels of g o v e r n ­

e x te n d provision. T his is c e rt a in l y a valid

m e n t an d c h a n g e s in t h e q u a lity of local

r e a s o n in m a n y p la c e s b u t it is a p oo r g e n e r a l

g o v e r n m e n t ’s ‘g o v e r n a n c e ’ in t e r m s of its

e x p la n a tio n , b e c a u s e w a t e r a n d s a n i ta t io n

re s p o n siv e n e s s, acc o u n ta b ility , t r a n s p a r e n c y

provision is v e ry good in m a n y cities t h a t h av e

a n d e n g a g e m e n t w ith civil society. It can be

g ro w n v e r y ra p id ly a n d v e ry in a d e q u a te in

p a r t ic u l a r ly difficult, or im possible, if th e

m a n y cities a n d s m a lle r u r b a n c e n t r e s w h ich

b a c k g r o u n d cond itio ns a r e u n fa v o u r a b le - for

h a v e g ro w n v e r y slowly, or h a v e s to p p e d

in s ta n c e , econom ic recession (depleting both

gro w in g , or even h a v e declining p o p u latio n s.

th e c a p a c i ty to in v e s t by p rov id ers a n d th e

As a l a t e r sectio n in t h i s c h a p t e r d e scrib es, a

c a p a c i t y to p a y by u se rs), im possible d ebt

c i t y ’s rap id g r o w th usu ally reflects its gro w in g

b u rd e n s (dep leting in v e s tm e n t c a p a c ity ) or

p ro s p e rity ; m a n y ra p id ly g ro w in g c ities have

p o litical conflict o r w a r (m ak in g b e t t e r lo cal

m a n a g e d to develop th e in s titu tio n s to im prove

g o v e rn a n c e impossible).

w a t e r an d s a n i ta t io n provision, in p a r t

M a n y o t h e r e x p la n a tio n s a re p u t fo r w a r d

b e c a u s e it is e a s i e r to do so w ith an ex p a n d in g

for th e in a d e q u a c ie s in w a t e r a n d s a n i ta t io n

economy, in p a r t b e c a u s e m a in ta in in g th e i r

provision in cities. One of th e m o s t c om m on is

econom ic s u c c e s s d e p e n d e d on th e m doing so.

t h a t th e r e a re s h o r t a g e s of fresh w a t e r w h ich

C h a p te r 1 also described how w a t e r an d

c o n s t r a in im proved provision, in p a r t b e c a u s e

s a n i ta t io n provision is often v e ry p o or in

cities h av e po lluted o r over-used lo cal

s m a ll e r u rb a n c e n tr e s , including t h o s e t h a t are

re s o u rc e s. B ut as th is c h a p t e r will outline an d

n o t grow in g rapidly.

C h a p te r 4 will develop in m ore d etail, th is is

Table 3.1 lists t h e r a n g e of c a u s e s t h a t

n o t a good g e n e r a l e x p la n a tio n b e c a u s e w a t e r

will be th e focus of th e re s t of th is c h a p te r : th e

a n d s a n i ta t io n provision is v e r y in a d e q u a te in

p r o x im a te c a u s e s t h a t a c t in t h e s e t tl e m e n t

m a n y cities w ith p le n ty of fresh w a t e r -

itself a t h o useh old or n e ig h b o u rh o o d level, th e

including som e of th e w o r l d ’s la r g e s t cities.

c o n tr ib u t o r y c a u s e s t h a t a c t a t th e city or

T h e re also a p p e a r s to be no a ss o c ia tio n

m u n ic ip a l level, a n d th e u n d e rly in g c a u s e s

b e tw e e n a r e a s facing w a t e r s t r e s s a n d th e

a c tin g a t t h e reg io nal, n a ti o n a l a n d i n t e r n a ­

p ro p o rtio n of people w ith i n a d e q u a te w a t e r

tio n a l level.

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

104 rig hts can be tr a n sfe r re d betw een properties

Proximate causes

but not be tw een persons, so public utility com panies do not w a n t to ex tend service

This section will focus on th e ca uses of in a d e ­

c o n tr a c ts to s q u a t t e r s for fear t h a t th e y will

q u a te provision a t comm unity and household

face legal action from th e ow ner.5 In Cordoba

level, and examine how poverty, th e pressure

(A rgentina) th e lack of land title is a major

to settle in w a te r- a n d /o r sanitation-deficient

re ason for non-connection; 5 per cent of th e 14

a re a s , rapid population grow th and u n resp on ­

pe r cen t of households t h a t are not connected

sive utilities combine to c re a te w a t e r and

to th e main n e tw o rk in t h a t city are occupying

s a n ita tio n deficiencies.

priv ate and s t a te land w ith o u t title s.6

Illegal status of many settlements

W a te r Supply a nd S e w e ra g e A u tho rity are

G overnm ent officials w o rk ing for th e D h a k a also re lu c ta n t ‘to legitimize slums by providing them with public facilities ( w a te r p o in ts)’, It is common in cities in Africa, Asia and Latin

although a fte r long n ego tiation s th e re has

A m erica for b e tw e en a q u a r t e r an d a half of

been some w illingness to achieve a com pro­

th e population to live in informal or illegal

m ise.7

s e ttlem en ts, m eaning t h a t some a s p e c t of th e

The absence of land titling is also a

occupation of th e land or its developm ent for

problem in th ose cases w here private sector

housing is illegal.2 This h as considerable

involvement h a s been sou gh t a s th e best

im p ortance for w a t e r an d san itatio n provision

m eans to extend supply.8 The lack of a legal

since public or official private w a t e r and

title m ay mean t h a t th e re is no legal req u ire­

s a n ita tio n providers m ay be forbidden by law

m ent for th e concessionaire to ex ten d the

from op eratin g in such settlem e nts.

service to th es e families. For in sta n c e, in

Alternatively, the preconditions n e c e ss a ry for

C a rta g e n a (Colombia), while th e World Bank

them to o p e ra te th e re m ay not be p re s e n t (for

sug ge sted t h a t one-third of residen ts did not

in stance, house plots m ay not have formal

have run nin g w a t e r and s a n ita tio n in 1999,

ad dresses, in h a b ita n ts m ay lack legal

th e concessionaire a rg u ed t h a t over 90 per

do cum en ts t h a t allow th e m to become regis­

cen t of resid ents w ere served by th e w a t e r

tered, or householders m ay lack docum ents

n e tw o rk as it excluded s q u a t te r s from its

t h a t show w h e re plot bou nd aries are and who

calc u latio n s.9 In G re a te r Buenos Aires, a study

o w ns each plot).

show ed how the majority of req u es ts for

For instan ce, in Ja m aica, informal neigh­

s a n ita tio n services from th ose living in infor­

bourhoods with insecure te n u r e suffer from

mal se ttle m e n ts h ad been refused by th e

p a rticu larly bad supplies b ecause th e National

priv ate utility, primarily due to th e lack of

W a te r Commission of J a m a ic a requires proof of

land te n u re , but also be cau se of:

landow nership before installing a connection. The law is being changed so t h a t th ose s q u a t ­

•

th e d istance b e tw ee n informal s e t tl e ­

•

th e irreg u la r u rban layout t h a t c h a r a c ­

ting on public land can receive w a te r ; for households sq u a ttin g on private land it will be

m ents an d existing s e w e r n etw o rk s;

sufficient to have verbal perm ission from the p rivate landow ner.3 In m a ny cities in India, a

teriz es m an y of th e settlem ents; •

th e cost of c o nstru ctio n in zones below

large proportion of th e poor live in slums on

th e w a t e r ta ble restriction (m any low-

p rivate lands or as te n a n t s in a re a s t h a t have

income se ttle m e n ts in Buenos Aires are

not been officially recognized as slums, and

on low-lying land, a t risk of flooding);

th e y c a n n o t g e t an individual connection

and

b ecau se th e w a t e r and s a n ita tio n a u th o rity provides individual connections only w here

•

th e u tility ’s lack of confidence t h a t costs would be recovered and reg ular

households can provide proof of ow nership of

p a y m e n ts for services made by in habi­

p rop erty and a recent receipt for p a y m e n t of

t a n t s . 10

p rop erty t a x . 4 In Central A merica, c o n tr a c tu a l

E x p l a in i n g D e f i c i e n c i e s in U r b a n W a t e r a n d S a n it a t io n P r o v is io n

105 H ow ever, t h e r e a re m a n y d e g re e s of illegality,

a n illegal s e t tl e m e n t , it re q u ire s a long p ro c e s s

a n d w a t e r an d s a n i ta t io n a g e n c ie s m a y have

of n e g o tia tio n , j o u r n e y s to t h e office w h e re th e

no difficulties in w o rk in g in m a n y illegal s e t t l e ­

r e g i s tr y is lo c a te d , fam ilia rity w ith provincial

m en ts. For in s ta n c e , th e y m a y rou tinely

g o v e rn m e n t p ro c e s s e s a n d k n o w le d g e of how

s u p p o r t w a t e r a n d s a n i ta t io n provision in

to co m p le te t h e p ro ces s. For local g o v e r n ­

‘illegal su b-divisions’, w h e re th e la n d is n ot

m e n ts, it re q u ire s p ro fe ssio n al s u p p o r t (for

occu pie d illegally b u t no official perm issio n

i n s ta n c e la w y e r s an d su rv e y o rs) w h ic h t h e y

w a s o b ta in e d to develop t h e land for housing.

often lack . T h ere a r e often co m p lic a te d or

In some cities, m o s t of t h e inform al s e t t l e ­

con flictu al re la tio n s b e tw e e n p oliticians and

m e n t s co n sist of ho m es d evelope d on illegal

civil s e r v a n t s . If t h e illegal s e t t l e m e n t aro se

sub-divisions. T he ho m es n e v e r receiv ed official

from th e illegal o ccu p a tio n of p ri v a te land , th is

ap p ro v a l, b u t th e o c c u p a tio n of th e la n d is

ad d s a f u r t h e r co m plication b e c a u s e th e t r a n s ­

legal, so w a t e r a n d s a n i ta t io n c o m p a n ie s have

fer of th e land from th e p r i v a te o w n e r n e e d s to

fe w e r w o rri e s a b o u t in v es tin g in th e m ,

be n e g o ti a te d an d c o m p e n s a tio n a g re e d (which

e sp e cially w h e n m a n y middle- a n d upper-

is often expensive) o r th e p ro c e s s of e x p r o p r ia ­

incom e g ro u p s live in illegal sub-divisions.

tion g on e th r o u g h . P a r t of th e problem is t h a t

C om p anies m a y ro u tin ely provide s e r v ic e s if

official s t a n d a r d s for sub-divisions for housing

th o s e living in a n illegal s e t t l e m e n t h av e

are too high: if s m a lle r lot sizes w e re p e r m it­

re a c h e d a n a g r e e m e n t w ith th e a u th o r it ie s or

te d , it w ou ld allow more legal sub-divisions; if

w ith th e w a t e r a n d s a n i ta t io n ag ency . In m a n y

s m a ll e r fr o n ta g e s w e re p e rm it te d , it w ou ld

cities, illegal s e t t l e m e n t s develop w ith th e

re d u c e u n it c o s ts for in f r a s t r u c t u r e . The stu d y

to l e r a n c e , a p p ro v a l or even s u p p o r t of local

in B u eno s A ires also h ig hligh ts th e f a c t t h a t

g o v e rn m e n ts , an d h ere a g a in th e ris k s of

t h e p r i v a te utilities w e re n o t p r e v e n t e d from

eviction a r e red u ce d . In som e cities, th e r e is a

ex te n d in g provision to illegal s e t t l e m e n t s in

long t r a d it io n of illegal la n d o c c u p a tio n and

m o s t i n s ta n c e s an d it w a s m ore t h e s e u ti li ti e s ’

d e v e lo p m e n t a n d a n a c c e p t e d (if often long

u n w illin g n es s to do so t h a t e xp lain ed t h e lack

a n d inefficient) p ro c e s s by w h ich th e in h a b i­

of provision - b e c a u s e th e possibilities of profit

t a n t s lobby for b a sic i n f r a s t r u c t u r e , a s

w e re less c e rta in .

describ ed in t h e sec tio n on L a tin A m e ric a in C h a p te r 1. So a lt h o u g h it is c le a r t h a t th e illegal o r inform al n a tu r e of m a n y s e t tl e m e n t s in cities does in hibit im proved w a t e r a n d

Community capacity to develop autonomous solutions

s a n i t a t i o n provision by th e official (public or

L a t e r c h a p t e r s include m a n y c a s e s tu d ie s of

p riv a te ) p ro vid ers, th e e x t e n t to w h ic h it does

re m a r k a b l e co m m u n ity a c tio n t h a t h a s

so v a rie s g r e a t ly b e tw e e n c ities a n d b e tw e e n

im proved w a t e r a n d s a n i ta t io n pro vision in

s e t t l e m e n t s w ith in cities. In a d d ition , small-

low -income a r e a s . B ut it should be reco gn ized

s c ale prov iders m a y be less r e l u c t a n t to in v e st

t h a t th e r e a r e m a n y c o n s t r a i n t s on th is. It is

in inform al s e t tl e m e n t s , a n d people w ho

no e a s y t a s k to g e t a g r e e m e n t from all th o s e

develop th e i r o w n h om e s in illegal s e t tl e m e n t s

in la r g e s e t t l e m e n t s w ith diverse p o p u la tio n s

m a y also in v e s t in b e t t e r provision if t h e y a re

to c o o p e r a t e in plan n in g , insta llin g, funding

co nfiden t t h a t th e y will n o t be evicted.

a n d m a n a g i n g a piped w a t e r supply, se w e rs

One i m p o r t a n t c o n s t r a i n t on im proving

an d d ra in s. T h e re m a y be no rea d ily a v a ilab le

provision in m a n y illegal s e t t l e m e n t s is th e

lo cal w a t e r so u rc e to t a p , so n e g o ti a ti o n s a re

co m p lex ity of m oving from illegal to leg al

n eed ed to g e t a c c e s s to o t h e r s o u r c e s - for

s t a t u s , an d th e m a n y public a g e n c ie s w h o se

in s ta n c e , to w a t e r m ain s. It also re q u ire s

a g r e e m e n t is n eed ed to do so. T his w a s

co n sid e rab le te c h n i c a l e x p e rtis e to design and

h ig h lig h te d in a s t u d y in B uenos A ire s .11 H ere,

in s ta ll s y s te m s t h a t will w o rk p ro p e rly and

t h e r e is a leg al b a sis for pro viding legal te n u r e

will no t n eed c o n s t a n t m a i n te n a n c e . It is also

to illegal s e t t l e m e n t s b u t th e p ro c e s s is compli­

more difficult to in stall w a t e r an d s a n i ta t io n

c a te d , e xp en sive a n d n e e d s m a n y different

s y s te m s in s e t t l e m e n t s t h a t la c k c learly

ag e n c ie s to a g re e to it. For th e i n h a b i t a n t s of

d e m a r c a t e d p lots, re g u l a r plo t la y o u ts , and

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

106 a c c e s s r o a d s an d p a t h s to e a c h house; it is

Household capacity to pay

t r i c k y to m a k e d r a i n a g e an d s e w a g e n e tw o r k s o p e r a t e in s e t t l e m e n t s la c k in g r e g u l a r solid

T h ere is an obvious ju stific a tio n for se e k in g

w a s t e collection se r v ic e s a n d h av in g high silt­

co st-re c o v e ry w h e n im proving w a t e r an d

load s in s u r fa c e run-off. And if th e s e t tl e m e n t

s a n i ta t io n provision, b e c a u s e if im proved p ro vi­

is a t risk of eviction - w h ich is often th e ca se

sion c a n p a y for itself th is m e a n s t h a t th e

- no ho useho ld will w a n t to in v e s t its limited

q u a lity of provision c a n be m a i n ta i n e d an d

re s o u rc e s in a w a t e r an d s a n i ta t io n sy s tem

t h e r e a r e no c o n s t r a i n t s on e x p a n d in g provi­

w h e n th e m e m b e rs m ig ht be ev icted a t an y

sion. A chieving co st-re c o v e ry is p a r t ic u l a r ly

tim e.

im p o r t a n t for CBO- or NGO-based provision, T h e re a r e also th e difficulties po sed by

b e c a u s e g e tt in g a c o n s t a n t su b sid y from an

t h e differing i n t e r e s t s of t e n a n t s a n d o w n e r s in

e x t e r n a l so u rce is difficult or im possible. T h ere

m a n y s e t tl e m e n t s , espe cially if m a n y of th e

are also m a n y c ase s tu d ie s s h o w in g how pro vi­

la n d o w n e r s do n o t live in t h e s e t tl e m e n t .

sion h a s b een im proved a n d c o s ts re cov ered, a s

C h a p te r 2 n o te d t h e difficulties t h a t t e n a n t s

d e sc rib ed in C h a p te r s 6 a n d 7. B ut th e diffi­

often face in in form al s e t t l e m e n t s or

cu lty in g e tt in g full c o st-rec o v ery in v e ry

te n e m e n t s in g e tt in g a c c e s s to w a t e r and

low-income s e t t l e m e n t s should n o t be u n d e r ­

sa n i ta t io n , even if piped w a t e r is a v a ilab le.

e s t im a te d . It is com m on for la r g e s e c tio n s of

T e n a n ts face p a r t i c u l a r p roblem s, e sp ecia lly if

th e p o p u la tio n of cities in Africa, A sia and

(as is fr e q u e n tly t h e c ase) la n d lo rd s a re re lu c ­

L atin A m erica to h ave in com es t h a t a re so low

t a n t to allow th e m to organ ize . In m a n y cities

t h a t t h e y c a n n o t afford sufficient food. One of

too , t h e p o litical sy s te m h a rd ly e n c o u ra g e s

th e k ey re a s o n s w h y so m a n y people live in

local o r g a n i z a ti o n s to develop.

inform al s e t t l e m e n t s is b e c a u s e t h e y c a n n o t

Finally, t h e r e a re t h e difficulties t h a t i n t e r n a t i o n a l a g e n c ie s face in su p p o r tin g

afford to sp e n d m uch (if an y th in g ) on housing. The m ain re a s o n w h y so m a n y low-income

co m m u n ity -b a se d sy s te m s . All t h e official aid

h o useh old s u se po or q u a lity w a t e r s o u r c e s is -

ag e n c ie s an d d e v e lo p m e n t b a n k s h a v e , by

a g a in - t h a t t h e s e a re m u ch c h e a p e r o r free. It

t h e i r v e ry s t r u c t u r e , to w o r k w ith an d th r o u g h

is w o r th recalling v a rio u s e x a m p le s from

n a ti o n a l g o v e rn m e n ts . No n a ti o n a l g o v e rn m e n t

C h a p te r 2: th e w o m e n in P u n e w h o h a d to use

is going to view w ith a n y fa v o u r a n i n t e r n a ­

a c a n a l to do t h e i r l a u n d r y to sa v e money; th e

tio n a l a g e n c y s te e r in g funds d ire ct to CBOs.

h o u se h o ld s t h a t re fra in e d from using p a y

T h e re a re in s t a n c e s w h e r e official a g e n c ie s

to i le t s a n d d e f e c a te d in t h e open to sa v e

h a v e s t e e r e d s u p p o r t d irec t to com m unity-

money. E x te r n a l s p e c ia lists m a y c o n sid e r it

d ire c te d s c h e m e s for w a t e r a n d s a n i ta t io n w ith

r e a s o n a b le to e x p e c t low -income h o u seh olds to

c o n sid erab le s u c c e s s, a n d v a rio u s i n t e r n a t io n a l

s p en d 5 p e r c e n t of th e i r in com e on w a t e r an d

NGOs h a v e also s u p p o r te d c o m m u n ity -b ase d

s a n i ta t io n , b u t for m a n y low-income g ro up s

provision, a s C h a p te r 6 will d escrib e. B ut th e s e

th is is a h e a v y fin an cial b u rd e n . Box 3.1

a re t h e ex cep tio n s, a n d c u r r e n t i n t e r n a t io n a l

d escrib es th e difficulties of re a c h in g t h e poor

funding s y s te m s do n o t lend th e m s e lv e s to a

in B a n g l a d e s h ’s tw o la r g e s t cities, D h a k a a nd

larg e e x p an sio n of th is. T h e re a re also g ro u n d s

C h itta g o n g . A t o t a l of 1 1 3 0 h o u se h o ld s w e re

for q u estio n in g w h e t h e r focusing on s u p p o r tin g

in te rv ie w e d in 146 low -income a r e a s , including

im proved c o m m u n ity provision does n o t simply

a mix of ‘b e n e f i c ia r y ’ h o u se ho lds (those w ithin

avoid th e more fu n d a m e n ta l problem t h a t

th e p ro je ct a r e a s ) a n d no n-b en eficiary h o u s e ­

n eed s a d d re s s in g - th e w e a k n e s s of official

holds. H ere, even w ith im proved provision

w a t e r an d s a n i ta t io n p rov id ers - a lth o u g h a s

th r o u g h w a t e r p o in ts provided by non-profit

C h a p te r s 6 a n d 7 w ill d escribe, effective

in s titu tio n s, it w a s still difficult to r e a c h th e

co m m u n ity provision h a s often helped ch a n g e

v e ry po or w ith in p r o g r a m m e s t h a t ach ieve

t h e a p p ro a c h of m u nicipal a u th o r it ie s , a n d on

cost-recov ery . T h e s u r v e y found t h a t a th i rd of

o ccasion h a s been th e re s u lt of m unicipal

ho u seh o ld s h a d m o n th ly in com es of less t h a n

a u t h o r i t i e s ’ ow n su p p o r t.

U S $ 5 0 , w hile th e p o o re s t h a d m o n th ly in com es below U S $ 10 .

E x p l a in in g D e f i c i e n c i e s in U r b a n W a t e r a n d S a n it a t io n P r o v is io n

107 Box 3.1 R e a c h in g th e po or in u r b a n a r e a s of B a n g la d e s h

The W aterAid Bangladesh Urban

addressing th e needs of the poorest,

to use semi-enclosed “h ang la t r i n e s ”

P roject w a s initiated in 1996 with a

th e frequency of p ay m en t differs.

t h a t drain into ditches or w a te r

pilot project in collaboration with one

Some projects are based on cha rge s

bodies... ’ The survey found t h a t

local NGO, D ush tha S h a s th y a Kendra.

collected each month while others

among beneficiary households, 24 per

The pro gram m e h a s since ex panded to

charge per pot of w ate r. It is evident

cent used hang latrines, 8 per cent

include activities with six additional

t h a t some people do not earn suffi­

used slabs over w ater, 3 per cent used

NGO p a rt n e r s w orking in 168 low-

cient income to ta k e p art; one NGO

slabs over d rains and 0.4 per cent

income settlem e n ts. The services

staff m em ber sug gested t h a t this

used open spaces. In non-beneficiary

provided are hygiene education and

p e rc e n ta g e w a s as high as 40 p er cent

households, 39 per cent used hang

the co nstructio n of w a t e r and s a n i t a ­

in some of th e a r e a s in w hich th ey

latrin es, 4 p er cen t used slabs over

tion facilities (w a te r points connected

w orked.

w a ter, 4 per cent used slabs over

Generally it is felt t h a t some

to th e city supply n etw o rk , tubew ells,

drains an d 2 per cen t used open sp aces. A latrine for each household is

household latrines, san itatio n blocks

w a t e r should be offered to th e very

for small groups of households and

poor on a ch arita ble basis, b u t access

considered to be the b est solution but

comm unity latrines).

may be re stric ted in some c ases and

th ere are m any a r e a s in which there is

the q u a n tity made available is likely

simply insufficient space, or w here

the project is active, 160 are in Dhaka

to be small. Some of those unable to

households c an n o t afford it.

and e ight are in Chittagong. These

afford w a t e r can be employed as

Households pay th e full cost of such

settle m e n ts are home to an estim ate d

c a re t a k e rs for th e project. Public

latrines, generally over a tw o -yea r

9 2,0 00 households. The program m e

w a t e r h y d ra n ts providing free w a te r

period.

h as so ug ht to improve w a t e r and

are an a lte rn a tiv e source b u t th ere

s an ita tio n provision with cost-

are often long queues for th ese, and

recovery, as th e only w a y in which

access is often difficult as th e y are

‘muscle men’, who are widely used by

the inte rve ntio ns can reach large

placed on th e edges of slum areas.

go v ernm ent agencies and NGO

Of th e 168 settle m e n ts in which

Paying for w a t e r by th e pot a s it

num bers of households. But this is a

The com m unity m an ag e m en t com m ittees function alongside local

projects to support w a t e r and s a n i t a ­

challenge, given th e very low incomes

is collected is likely to be more e x pe n­

tion projects. A difficult issue is how

of m any households. A th ird of house­

sive th a n a single monthly paym ent.

to m a n a g e th ese individuals. They

holds in the slums have monthly

On cu rren t ra te s it is e stim ated t h a t

may seek to prevent im provem ents or

incomes of less th a n US$50; some

roughly US$2 will be required for a

influence th e operation. The agencies

have monthly incomes of less th a n

family of four using the minimum

t h a t WaterAid sup po rts to implement

U S$10. The em phasis placed on cost-

am ou nt of safe w a t e r for drinking,

this prog ram m e all seek to establish

recovery within th e program m e has

cooking, bathin g and laundry. About

or s tre n g th e n local comm ittees. All

tend ed to encourage NGOs to imple­

20 p er cent of th is charge is the cost

th e agencies recognize t h a t com m it­

m en t the program m e in th e more

of th e w ater, which has to be paid to

te e s play a vital role b u t acknow ledge

stable settlem en ts, in which a t least a

the D h ak a W a te r and S anitation

t h a t it is hard to ensure t h a t they

proportion of th e population can

Agency. This cha rg e is ab ou t 8 per

w o rk effectively. Generally, the

afford to pay for services.

cent of the p oorest families’ monthly

poorest are not involved in com m ittees

budget and can only be afforded by

and hence th eir persp ectives and

reducing essential food consumption.

in terests may be u nder-represented in

An a s s e s s m e n t of th e program m e surveyed 1130 households: roughly

Community latrines, toilet blocks

half w ere program m e beneficiaries

decision-making.

and half non-beneficiaries. More th an

and individual latrin e s have improved

98 p er cen t of th e beneficiaries have

provision in th e low-income s e ttle ­

Mohidul Ho que K h an (2 0 0 3 ) , ‘W at er, s a n it a ti o n

a c cess to w a t e r in th eir s e ttlem e n ts

ments. However, ‘th e g re a t majority of

a n d hy gie ne in B a n g l a d e s h slu ms ; a s u m m a r y of

com pared to 77 per cent in non­

slum dwellers continue to practise

beneficiary a reas. In regard to

open defecation n ear w a t e r bodies or

Contributory ca u ses

Source: H a n c h e t t . S u z a n n e , Sh ire e n A k h t e r and

W a t e r A i d ’s B a n g l a d e s h U rb an P r o g r a m m e Ev a lu a t io n ', E n viro n m en t and U rbanization, Vol 15, No 2.

The w e a k n e s s /in c a p a c ity of local utilities

T his s e c tio n will focus on w h a t c o n t r i b u te s to

One i m p o r t a n t c h a n g e in t h e p e r c e p tio n of t h e

in a d e q u a t e w a t e r a n d s a n i t a t i o n provision a t

problem of w a t e r a n d s a n i t a t i o n provision in

th e level of t h e to w n or city.

u r b a n a r e a s over t h e l a s t t e n y e a r s h a s been t h e in c re a s e d rec o g n itio n of th e poor

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

108 p e rf o rm a n c e of c o m p a n ie s or u tilities w ith

t h a t h a v e e x p e rie n c e d t h e m o s t rap id in c r e a s e s

resp onsibility for w a t e r (and usu ally s a n i t a ­

in t h e i r u rb a n p o p u la tio n a s a p ro p o rtio n of

tion). This is b e s t i l l u s tr a t e d by th e t w o W ater

th e i r t o t a l p o p u la tio n (ie, u r b a n i z a ti o n levels),

U tilities D ata B o o ks p ro d u c e d by t h e A sian

b u t th is is n o t so. In deed , som e of t h e regions

D ev elop m en t B an k for th e A sian an d Pacific

w ith t h e la r g e s t in c r e a s e s in u rb a n i z a ti o n

Region - th e first in 19 9 3 , th e sec o n d in

levels h av e a c h ie v ed m uch b e t t e r levels of

1 9 9 7 . 12 T h e se co n d of t h e s e re v ie w e d th e

pro vision t h a n som e reg ion s w ith sm a lle r

p e rf o rm a n c e of 50 w a t e r utilities in 31 n a tio n s

in c re a se s. I t m ig h t be e x p e c te d t h a t w a t e r and

(the sectio n on A sia in C h a p te r 1 d rew m uch

s a n i ta t io n provision is p a r t ic u l a r ly b a d in v e ry

on t h i s review ). It h igh ligh ted n o t only th e

rap id ly g ro w in g cities, b u t t h i s is only p a r t ly

i n a d e q u a c ie s in th e p e rf o rm a n c e of m a n y utili­

so. M a n y of t h e w o r l d ’s m o s t rap idly g ro w in g

tie s (including low p ro p o r tio n s of city

cities ov er th e la s t 50 y e a r s h av e v e ry good

p o p u la tio n s s e r v e d an d in t e r m i t t e n t se rv ic es),

w a t e r a n d s a n i ta t io n provision, an d m a n y

b u t also in a d e q u a c ie s in m a n a g e m e n t (poor

m u ch slo w e r g ro w in g c ities or s m a lle r u rb a n

billing a r r a n g e m e n t s , w a t e r p rices w ell below

c e n tr e s h a v e v e r y p oo r provision. It m ig ht be

th e c o sts of provision, over-staffed utilitie s an d

ex p e c te d t h a t it is t h e v e r y la r g e cities t h a t

high p ro p o rtio n s of u n a c c o u n te d -fo r w a te r ) .

face in s u rm o u n ta b le pro blem s in ac q u ir in g

T h e re w e re cities w h e r e utility p e rf o rm a n c e

fresh w a te r . M a n y of th e w o r l d ’s la r g e s t cities

w a s good a n d w h e re t h e c o n s u m e r su r v e y

t o d a y a re 5 0 - 2 0 0 ti m e s la r g e r t h a n th e y w e re

sh o w e d high c o n s u m e r s a tis f a c tio n , b u t th e s e

100 y e a r s ago - a n d since p e r c a p it a w a t e r

w e r e th e e x c e p tio n s r a t h e r t h a n th e r u l e . 13

use h a s also gone up d ra m a tic a lly , t h i s can

In r e g a r d to finance for c a p it a l in v e s t­

m e a n t o t a l fresh w a t e r u se of 2 0 0 - 1 0 0 0 tim es

m en t, m a n y utilities w e re d e p e n d e n t on g r a n t

m ore t h a n 100 y e a r s ago. While m a n y of th e

financing, in cluding te n t h a t w e r e 100 p e r c e n t

w o r l d ’s la r g e s t cities face s e rio u s problem s

d e p e n d e n t on g r a n t financing. H owever, utili­

w ith o b ta in in g sufficient fresh w a te r , th is is

tie s in nine of th e cities re v ie w e d h a d re s o rte d

often m ore due to po or w a t e r m a n a g e m e n t.

to c o m m ercia l financing, w ith four (Chonburi,

W h a t is more su r p ris in g is t h e n u m b e r of larg e

C h ian g m a i, Tianjin a n d M an ila) using local

cities t h a t do n ot fac e s e rio u s w a t e r s h o r ta g e s .

a u t h o r i t y bonds.

The qu estio n is th u s : Why, w h e n cities h av e

This review also h ig hligh ted th e difficulty of b a la n c in g th e n eed to keep dow n prices w hile e n su r in g sufficient r e v e n u e s to allow

g ro w n so m u ch, h ave th e y no t r u n o ut of w ater? This se ctio n re v ie w s t h e s ca le of u rb a n

good q u a lity provision a n d c o v e ra g e . However,

ch a n g e w orld-w ide ov er t h e la s t 50 y e a r s and

it also s t r e s s e d t h a t good m a n a g e m e n t limits

co n sid ers w h e r e rapid u r b a n g r o w th is a n

th is trade-off; m a n y of t h e u tilities w ith th e

im p o r t a n t fa c t o r in ex p laining i n a d e q u a te

h ig h e s t w a t e r prices w e r e also th o s e w ith poor

w a t e r and s a n i t a t i o n provision.

q u a lity m a n a g e m e n t (including high ra t io s of

levels of u n a c c o u n te d -fo r w a t e r ) . The

The expansion of urban and city populations15

WHO/UNIC EF A s s e s s m e n t 2 0 0 0 identified

B e tw e e n 1 9 5 0 a n d 2 0 0 0 , th e w o r l d ’s u rb a n

in a d e q u a te c o st-re c o v e ry a n d i n a d e q u a te

p o p u la tio n in c r e a s e d m ore t h a n fourfold a n d

o p e ra tio n a n d m a i n te n a n c e a s tw o of th e

now, close to 50 p e r c e n t of th e w o r l d ’s

st a f f to th e n u m b e r of c o n n e c tio n s an d high

prin cip al c o n s t r a in t s on t h e d e v e lo p m e n t of

p o p u latio n live in u rb a n c e n tr e s. M a n y a s p e c t s

w a t e r su p p ly an d s a n i t a t i o n - an d b o th are

of u r b a n c h a n g e in t h e la s t 50 y e a r s a re

larg e ly th e r e s u lt of th e w e a k n e s s or i n c a p a c ­

u n p re c e d e n te d , in cluding n ot only th e level of

ity of w a t e r a n d s a n i ta t io n a g e n c i e s .14

u rb a n iz a tio n an d th e size of th e w o rld 's u rb a n p o p u la tio n b u t also th e n u m b e r of c o u n tr ie s

Rapid population growth It m ig h t be e x p e c te d t h a t w a t e r a n d s a n i ta t io n provision in u r b a n a r e a s is w o r s t in n a tio n s

be com ing more u r b a n iz e d an d th e size a nd n u m b e r of v e ry la r g e c it ie s .16 J u s t tw o c e n tu r ie s ag o t h e r e w e r e only t w o ‘m illion-cities’ w orld-w ide (ie, c ities w ith 1

E x p l a in i n g D e f i c i e n c i e s in U r b a n W a t e r a n d S a n it a t io n P r o v is io n

109 million or m ore in h a b i ta n t s ) : London an d

D allas-F orth W o rth an d V an c o u v er a re a m o n g

Beijing (then called Peking). By 1 9 5 0 , th e r e

th o s e w h o se p o p u la tio n s in c r e a s e d by b e tw e e n

w ere 85; by 2 0 0 0 , 3 8 8 (see Table 3.2). A larg e

fiftyfold an d one-hundredfold, a n d all (or close

(a nd inc rea sing ) p ro portio n of t h e s e million-

to all) th e i r in h a b i t a n t s h av e piped w a t e r

cities a re in Africa, A sia a n d L atin A m erica.

supplies. This is no t to s a y t h a t v e ry rap id

Som e h ave p o p u la tio n s t h a t g re w m ore t h a n

g r o w th does n o t po se pro b lem s for th e public

tw e n ty f o ld b e tw e e n 1 9 5 0 a n d 2 0 0 0 , including

or p ri v a te co m p a n ie s respo nsible for w a t e r an d

Abidjan, D a r es S a la a m , D h a k a , K a m p a la ,

s a n i ta t io n , b u t often th e y h av e n o t proved

K in s h a s a , Nairobi, L ago s, L u s a k a , R iy adh ,

in s u p erab le .

T iju a n a , U lsan a n d Yaounde. M a n y o th e r s g re w more t h a n te nfold, including A m m a n ,

L a rg e c ities n e v e r figure in t h e list of c itie s w i t h t h e m o s t r a p i d g r o w t h r a t e s ,

B hopal, C a m p in a s, C uritiba, D o uala,

a lt h o u g h t h e y obviously did w h e n t h e y w e re

F a is a la b a d , H a r a r e , K h a rto u m , K hulna,

sm aller. T h e l a r g e r a c i t y ’s p o p u la tio n a t th e

L u a n d a , M a p u to , S a n t a Cruz, S u r a t a n d m a n y

b egin n in g of a n y perio d for w h ic h g ro w th

Chinese cities. B rasilia, th e fe d e ra l c a p it a l of

r a t e s a r e bein g c a lc u la te d , t h e l a r g e r th e

Brazil, did no t e x is t in 1 9 5 0 a n d now h a s m ore

d e n o m i n a to r u s e d to divide t h e i n c r e m e n t in

t h a n 2 million in h a b i ta n t s . H ow ever, v e ry

t h e c i t y ’s p o p u la tio n to c a l c u l a t e t h e g r o w th

rap id city g r o w th is no t only a f e a t u re of low-

r a t e . In a n y n a ti o n u n d e rg o in g rap id u r b a n i z a ­

a n d middle-income n a tio n s. S e v e ra l c ities in

tio n , a n a n a ly s is of in te r - c e n s u s p o p u la tio n

th e USA h a d s p e c t a c u l a r g r o w th r a t e s : th e

g r o w t h r a t e s for all u r b a n c e n tr e s u su a lly

p o p u la tio n s of L a s V egas a n d F o rt L a u d e rd a le

h ig h lig h ts som e s m a ll u r b a n c e n t r e s w ith

hav e g ro w n m ore t h a n tw e n ty f o ld in th e la s t

p o p u la tio n g r o w th r a t e s of b e t w e e n 7 a n d 15

50 y e a r s , a n d th o s e of O rlando, W e st Palm

p e r c e n t a y ear. It is v e r y r a r e for a n y city

B each , P h o e n ix a n d R iv ersid e-S an B ern ard in o

w ith a million or m ore i n h a b i t a n t s to ac h ie v e

h a v e g ro w n more t h a n tenfold.

p o p u la tio n g r o w th r a t e s of 7 p e r c e n t a y e a r;

W h a t is even m ore s p e c t a c u l a r is th e

w ith in t h e UN’s d a t a s e t of c ity p o p u la tio n s ,

m u ltip lic atio n in size since 19 0 0 . M a n y of

all t h e cities t h a t h a d a million or m ore i n h a b ­

t o d a y ’s la r g e cities w e r e so sm all in 1 9 0 0 t h a t

i t a n t s in 1 9 9 0 h a d p o p u la tio n g r o w th r a t e s of

th e i r p o p u la tio n h a s m ultiplied by b e tw e e n

less t h a n 7 p e r c e n t a y e a r du rin g t h e 1 9 9 0 s,

one-h un dredfold an d th ree -h u n d red fo ld . In

a n d m o s t h a d a n n u a l a v e r a g e g r o w th r a t e s of

som e c a se s , no su c h c a lc u la tio n is possible

less t h a n 3 p e r c e n t a y e a r, w hile som e h a d

b e c a u s e th e cities did n o t e x is t in 19 0 0 . If w e

s h r in k in g p o p u la t io n s (sho w ing up a s n e g a tiv e

t a k e only u r b a n c e n tr e s t h a t a lr e a d y h a d

grow th rates).

1 0 ,0 0 0 o r more i n h a b i t a n t s in 19 0 0 , m a n y of

H ow ever, for w a t e r a n d s a n i ta t io n u tili­

t h e i r p o p u la tio n s h a v e m ultiplied m ore t h a n

tie s, t h e a b s o lu te n u m b e r of people a d d e d to a

o ne-hundredfold du rin g th e 2 0 t h c e n tu r y ,

c it y ’s p o p u la tio n e a c h y e a r is prob ab ly a more

including Belo H orizon te (now w ith more th a n

re le v a n t in d ic a to r of g ro w th . Using th is in d ic a ­

3 0 0 ti m e s its 1 9 0 0 po p u latio n ), P u s a n , L ago s,

tor, m a n y of th e la r g e s t cities figure

S a n Diego, C a s a b la n c a , C h itta g o n g , R iy ad h,

prom inently. D h a k a , Delhi an d M u m b ai g rew

D h a k a , L u a n d a , Los A n geles, T a m p a - S t

by more t h a n 3 0 0 , 0 0 0 p e rs o n s a y e a r during

P e te r s b u r g , B an d u n g , D a r es S a la a m an d

th e 1 9 9 0 s. Even Mexico City a n d S ao Paulo -

D ak ar. T h e re a re v e r y la r g e v a r i a ti o n s in th e

b o th w ith low p o p u la tio n g r o w th r a t e s (below

q u a lity a n d e x te n t of w a t e r a n d s a n i ta t io n

2 p e r c e n t a y e a r) an d m ore people moving out

provision a m o n g th e cities on th is list; some

t h a n in du rin g th e 1 9 9 0 s - h a d v e r y larg e

h a v e v e r y high levels of provision - n o t only

a n n u a l a v e r a g e in c r e m e n t s to t h e i r p o p u la ­

th o s e in high-income n a tio n s (the USA and

tio n s du ring t h e 1 9 9 0 s (aro u n d 2 5 0 ,0 0 0

S a u d i A ra b ia ) b u t also Belo H orizon te a n d , in

p e rs o n s a y e a r) . (A gain, j u s t to avoid an

co m p a riso n to m o s t cities in its region, D ak ar.

a s s u m p tio n t h a t th is is a p h e n o m e n o n only in

Cities such a s P o rto A legre a n d S âo Paulo

low- a n d middle-income n a tio n s, m etro p o lita n

(Brazil) a n d Seoul (S outh K orea) a n d , w ithin

Los A ng eles g re w by a ro u n d 2 0 0 ,0 0 0 in h a b i­

high-income n a tio n s, H ou sto n , S a n José,

t a n t s a y e a r du rin g th e 19 90 s.)

W a t e r a n d S a n i t a t i o n i n t h e W o r l d ’s C i t i e s

n o Table 3.2 T h e d is trib u tio n of th e w o r l d ’s u rb a n p o p u la tio n by re g io n , 1950-- 2 0 1 0

Region

1950

1970

1990

2000

Projection fo r 2010

U rb an p o p u la tio n (millions of in h a b i ta n t s ) World

751

1357

22 86

2862

Africa

32

82

197

295

426

Asia

244

501

1023

1376

1784

Europe

287

424

521

534

536

70

164

313

391

470

110

171

213

243

273

8

14

19

23

26

World

29.8

36.8

43.5

47.2

51.5

Africa

14.7

23.1

31.8

37.2

42.7

Asia

17.4

23.4

32.2

37.5

43.0

Europe

52.4

64.6

72.1

73.4

75.1

Latin America and th e Caribbean

41.9

57.6

71.1

75.4

79.0

N orthern America

63.9

73.8

75.4

77.4

79.8

Oceania

61.6

71.2

70.8

74.1

75.7

World

100

100

100

100

100

Africa

4.3

6.1

8.6

10.3

12.1

Asia

32.5

37.0

44.8

48.1

50.8

Europe

38.3

31.3

22.8

18.7

15.3

9.3

12.1

13.7

13.7

13.4

14.6

12.6

9.3

8.5

7.8

1.0

1.0

0.8

0.8

0.8

Latin America and th e C aribbean N orthern America Oceania

3514

P e r c e n t a g e of p o p u la tio n living in u r b a n a r e a s

P e r c e n t a g e of th e w o r l d ’s u r b a n p o p u la tio n living in:

Latin America and th e C aribbean N orthern America Oceania

N ote: M a n y of th e figu res for 2 0 0 0 d r a w on n a t i o n a l c e n s u s e s held in 1 9 9 9 , 2 0 0 0 or 2 0 0 1 , b u t so me a r e b a s e d on e s t i m a t e s or pr o je cti o n s from s t a t i s t i c s d r a w n from c e n s u s e s held a r o u n d 1 99 0 . T h e r e is al so a gr ou p of c o u n t r ie s (mos tly in Africa) for w h ic h t h e r e a r e no c e n su s d a t a since th e 1 9 7 0 s o r e a rl y 1 9 8 0 s so all f igures for th e ir u r b a n (and r u r a l ) p o p u la ti o n s ar e b a s e d on e s t i m a t e s a n d pro jec tion s. Source: S t a t i s t i c s d r a w n or d eri ved from Un ited N at io ns (2 0 0 2 ) , World U rbanization P rospects; T he 2 0 0 1 Revision; D ata Tables and H ighlights, P op ul at io n Division, D e p a r t m e n t of Ec on om ic an d Soci al Affairs, Un ited N a ti o n s S e c r e t a r i a t , E S A / P / W P / 1 7 3 , Un ited N ati o ns , New York, 181 p ag e s.

T h e a v e r a g e size of t h e w o r l d ’s l a r g e s t cities

to be p a r ti c u la r l y poor. In d ee d , a s d e s c rib e d in

h a s also in c re a s e d d r a m a tic a lly . In 2 0 0 0 , th e

C h a p te r 1, m o st of th e w o r l d ’s l a r g e s t cities

a v e r a g e size of t h e w o r l d ’s 100 l a r g e s t cities

h av e r e la tiv e ly good provision in c o m p a riso n to

w a s a r o u n d 6.2 million in h a b i t a n t s . This

o th e r cities a n d s m a lle r u r b a n c e n tr e s in th e

c o m p a r e s to 2.1 million i n h a b i t a n t s in 19 5 0 ,

s a m e co u n try .

a r o u n d 7 2 5 , 0 0 0 in 1 9 0 0 a n d j u s t u n d e r

t h a t h a d p o p u la tio n s of 1 million or more

P attern s of grow th and ch an ge in the distribution of the w o r ld ’s urban population

i n h a b i t a n t s , t h e city or m e tr o p o lita n a r e a w ith

M ost of th e w o r l d ’s u r b a n p o p u la tio n is now

2 0 0 , 0 0 0 in 1 8 0 0 . 17 W hile t h e r e a r e v a rio u s e x a m p le s of cities over t h e l a s t t w o m illennia

s e v e r a l million i n h a b i t a n t s is a r e la tiv e ly new

o u tsid e E u ro p e a n d N o rth A m e r ic a (Table 3.2).

p h e n o m e n o n : L ondon w a s th e first to r e a c h

A sia alo n e c o n t a in s close to h a lf th e w o r l d ’s

th is size in t h e se co n d h a lf of t h e 1 9 th

u r b a n p o p u la tio n , even if m ore t h a n th re e -

c e n t u r y . 18 By 2 0 0 0 , t h e r e w e r e 39 cities w ith

fifths of its people still live in r u r a l a r e a s .

m ore t h a n 5 million i n h a b ita n ts . H ow ever, a

Africa, w h ic h is g e n e r a lly p e rc e iv e d as

review of th e q u a lity a n d e x t e n t of w a t e r an d

o v e r w h e lm in g ly r u r a l, now h a s a la r g e r u r b a n

s a n ita tio n provision in t h e w o r l d ’s la r g e s t

p o p u la tio n t h a n N o rth A m e ric a or W e s te rn

cities also s h o w s no obvious te n d e n c y for th e s e

E urope. T h e u r b a n p o p u la tio n of A frica, A sia

E x p l a in i n g D e f i c i e n c i e s in U r b a n W a t e r a n d S a n it a t io n P r o v is io n

11 1 a n d L atin A m e ric a an d th e C arib b e a n is now

h a p p e n a ro u n d 2 0 0 7 . M a n y n a ti o n s h a d m uch

n e a r l y t h r e e tim e s t h e size of t h e u rb a n

s l o w e r u r b a n p o p u la tio n g r o w th r a t e s t h a n

p o p u la tio n of th e re s t of th e w orld. UN p ro je c ­

a n t i c i p a t e d d urin g t h e 1 9 8 0 s a n d 1 9 9 0 s , in

tio n s also s u g g e s t t h a t u rb a n p o p u la tio n s a re

p a r t b e c a u s e of s e r io u s econom ic pro blem s.

g ro w in g so m uch f a s t e r t h a n r u r a l p o p u la tio n s

For m o s t n a ti o n s , u r b a n p o p u la t io n g r o w th

t h a t 85 p e r c e n t of th e g ro w th in th e w o r l d ’s

r a t e s also fell b e c a u s e of falling fertility r a t e s .

p o p u la tio n b e tw e e n 2 0 0 0 an d 2 0 1 0 will be in

For som e, it w a s also b e c a u s e of rising m o r t a l ­

u r b a n a r e a s , a n d v ir tu a lly all th is g r o w th will

ity r a t e s . By t h e la t e 1 9 9 0 s , t h i s in clu ded

be in Africa, A sia a n d L a tin A m erica.

high a n d in c r e a s i n g levels of m o r ta l it y from

Levels of u rb a n i z a ti o n in c e rt a in regions

H IV /A ID S. T his is p a r t i c u l a r l y a p p a r e n t in

in c r e a s e d d r a m a ti c a ll y b e tw e e n 1 9 5 0 an d

c e r t a i n s u b - S a h a r a n A frican n a ti o n s w ith high

2 0 0 0 (Table 3.2); for in s ta n c e , from 15 to 37

levels of in fectio n a n d th e a b s e n c e of d r u g s to

p e r c e n t in Africa a n d from 17 to 3 7 p e r c e n t

co n tro l it, a n d t h i s is r e s h a p in g u r b a n tr e n d s

in Asia. P a r t i c u l a r sub-regions h a d even la r g e r

in m a n y n a t i o n s . 25

c h a n g e s - for in s ta n c e , 27 to 65 p e r c e n t in W e s te rn A sia an d 3 9 to 68 p e r c e n t in E a s t e r n

An economic logic to city growth and urban

E u ro pe. H ow ever, th e g r o w th r a t e s of u rb a n

change

p o p u la tio n s an d t h e r a t e s of in c r e a se in levels

T h e a s s o c ia tio n b e tw e e n a n a ti o n ’s p e r c a p it a

of u rb a n iz a tio n a re no t u n p re c e d e n te d ; m a n y

incom e an d its level of u rb a n i z a ti o n is w ell

c o u n tr ie s in W e s te rn E u rop e, th e USA an d

k n o w n - ie, in g e n e ra l, t h e h ig h e r t h e per

J a p a n h a d perio ds w h e n t h e i r levels of u r b a n ­

c a p it a in com e, th e h ig h e r t h e level of u r b a n i z a ­

iza tio n in c r e a s e d as ra p id ly .19

tion. M ost of th e n a ti o n s w ith th e m o s t rap id

H ow ever, c e r t a in p o in ts r e g a r d in g u rb a n ch a n g e n eed e m p h a s is, a s o utlin ed below.

in c r e a s e in th e i r level of u rb a n i z a ti o n b e tw e e n 19 6 0 a n d 1 9 9 0 also h a d th e m o s t rap id econom ic g r o w t h ,26 a n d th is is unlikely to h ave

Smaller and fe w e r large cities than expected

c h a n g e d du rin g th e 1 9 9 0 s .27 In 2 0 0 0 , th e

R e c e n t c e n s u s e s sh ow t h a t t h e w o rld t o d a y is

w o r l d ’s five la r g e s t eco no m ies (the USA,

also less u r b a n iz e d a n d less d o m in a te d by

China, J a p a n , In d ia an d G erm any ) h a d 9 of th e

la r g e cities t h a n h a d b een a n ti c ip a t e d . For

w o r l d ’s 16 m ega -c ities a n d 4 6 p e r c e n t of its

in s ta n c e , Mexico City h a d 18 million people in

million-cities. By 2 0 0 0 , all b u t tw o of th e

2 0 0 0 , 20 n ot th e 31 million people p re d ic te d 25

w o r l d ’s 16 m eg a-citie s a n d more t h a n tw o-

y e a r s a g o . 21 C a lc u t ta h a d a ro u n d 13 million by

th i r d s of its million-cities w e re in th e 20

2 0 0 0 , n o t th e 4 0 - 5 0 million t h a t h ad been

la r g e s t ec onom ies. Sim ilarly, w ith in e a c h of

p re d ic te d du rin g t h e 1 9 7 0 s .22 S ao P aulo, Rio

th e w o r l d ’s regio n s, m o s t of th e l a r g e s t cities

de J an eiro , Seoul, C h en n ai (formerly M a d r a s )

are c o n c e n t r a t e d in th e la r g e s t eco no m ies -

a n d Cairo a r e a m o n g t h e m a n y o th e r la r g e

for in s ta n c e , B razil a n d Mexico in L a tin

cities w h ic h by 2 0 0 0 h a d s e v e r a l million in h a b ­

A m e rica, a n d China, In dia, In d o n es ia an d

i t a n t s f e w e r t h a n h a d b een p re d ic te d in th e

S o u th K orea in A sia. One of th e m a in r e a s o n s

l a te 1 9 7 0 s an d e a rly 1 9 8 0 s. In ad dition , th e

w h y t h e w o rld is less u rb a n iz e d in 2 0 0 0 t h a n

a c t u a l n u m b e r of m ega-cities w ith more t h a n

e x p e c te d is t h e slow econom ic g r o w th (or

10 million i n h a b i t a n t s in 2 0 0 0 is m uch sm a lle r

econom ic decline) t h a t m a n y low- an d middle-

t h a n ha d been e x p e c t e d .23

incom e n a ti o n s e x p e rie n c e d for m uch of th e period since 1 9 8 0 . T h is helps explain slo w e r

Lower levels of urbanization

p o p u latio n g r o w th r a t e s for m a n y cities in

T h e w o r l d ’s u r b a n p o p u la tio n in 2 0 0 0 w a s

Africa a n d L a tin A m e ric a . P a r t of th is is also

2 7 0 million f e w e r t h a n h a d b e e n p re d i c te d 20

r e l a te d to s t r u c t u r a l a d ju s tm e n t policies,

y e a r s p re v io u sly ,24 a n d th e d a te on w h ich th e

w h ich b ro u g h t declines in e m p lo y m e n t, falling

w o r l d ’s u r b a n p o p u la tio n is e x p e c t e d to

re a l inco m es an d declining u r b a n w e lfare, an d

e x c e e d its r u r a l p o p u la tio n h a s also been

w h ich p rov ed to be less su ccessfu l t h a n hoped

d elay e d ; th is t r a n s i t i o n h a d b ee n e x p e c t e d in

in s t im u la t in g econom ic g r o w t h .28

t h e l a t e 1 9 9 0 s b u t now it is p re d i c te d to

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

112 P a r t of th e re a s o n for la r g e cities n ot

What role for water within urban change?

ru n n in g ou t of w a t e r is t h a t m ost of th e

T h e size of th e p o p u la tio n in ea c h of th e

w o r l d ’s larg e c ities t o d a y w e re founded in

5 0 ,0 0 0 or so u rb a n c e n tr e s in th e w o r ld 29 an d

a r e a s w ith rich a g r i c u lt u r a l p o te n tia l, w hich

e a c h u r b a n c e n t r e ’s r a t e of c h a n g e a r e influ­

also m e a n s plentiful fresh w a t e r availability.

e n ced by e x t e r n a l f a c t o rs an d by fa c to rs

M ost w e re founded an d g re w to be i m p o r t a n t

r e l a te d to e a c h c e n t r e ’s ow n p a r t i c u l a r local

cities before m o torize d t r a n s p o r t , so no m a jor

c o n t e x t - including its site, loc atio n, n a t u r a l

city could be too fa r from its m ain s o u r c e s of

r e s o u rc e e n d o w m e n t (of w h ic h fresh w a t e r

fresh food. M o s t of t h e w o r l d ’s la r g e s t cities

a v a ilab ility is p a r t ic u l a r ly im p o rta n t),

t o d a y h a v e long h is to ries a s cities. M o s t of th e

d em o g r a p h ic s t r u c t u r e , e xisting e conom y and

la r g e s t u r b a n c e n tr e s in E u ro pe, L a tin

i n f r a s t r u c t u r e (the le g a c y of p a s t d ecisions

A m e ric a , A sia an d N orth A frica t o d a y h ave

a n d in v e s tm e n ts ) a n d t h e q u a lity a n d c a p a c i ty

been i m p o r t a n t u r b a n c e n tr e s for c e n tu r ie s . Of

of its public in s titu tio n s. E x t e r n a l influences

th e 3 8 8 million-cities w o rld w id e in 2 0 0 0 , more

r a n g e from th e n a t u r a l re s o u rc e e n d o w m e n ts

th a n th re e-fifth s w e r e a lr e a d y u r b a n c e n tr e s

in its s u r ro u n d s to tr e n d s w ith in t h e reg ion al

2 0 0 y e a r s ag o, w hile more t h a n a q u a r t e r

a n d n a ti o n a l economy, an d d ecisions m a d e by

h a v e b een u r b a n c e n tr e s for a t le a s t 5 00

n a ti o n a l g o v e rn m e n ts a n d t h e 3 0 ,0 0 0 or so

y e a r s . 30 One k ey r e a s o n w h y t h e S p a n is h

g lobal c o rp o r a tio n s w ho co n tro l a sign ifican t

founded Mexico City w a s b e c a u s e of th e fertile

s h a r e of th e w o r l d ’s economy.

soil an d good w a t e r av aila b ility t h a t w ere

A lth o u g h th i s bo ok in c lu d e s d e ta i ls of

a lr e a d y s e rv in g one of t h e w o r l d ’s l a r g e s t

m a n y c ities fa c in g s e r io u s w a t e r s h o r t a g e s , it

cities a t t h a t tim e, th e A z te c city of

also n e e d s to c o n s id e r w h y th e p ro b le m s are

T e n o c h titla n .31 The fo un de rs of B u eno s Aires

n o t m o re s e r io u s. F o r in s t a n c e , w h y w a s it

w e re influenced by its e x c ellen t fa rm in g p o t e n ­

p ossible for th e l a r g e s t c ities in L a tin

tia l, e a s y m ar itim e a c c e s s , good land

A m e ric a (M exico City, S a o P au lo , B u eno s

co m m u n ic a tio n s a n d p ra c t ic a l ly unlim ited

A ires) to g ro w to sizes t h a t a re h u n d r e d s of

v olu m es of w a t e r . 32 A lth o u g h t h e r e is still a

t i m e s t h e size t h a t t h e i r fo u n d e r s could h ave

te n d e n c y to discu ss ‘r u r a l ’ an d ‘u r b a n ’

en v is a g e d , w ith fresh w a t e r u s e s t h a t m u s t be

s e p a r a t e l y o r to se e ‘a g r i c u l t u r a l ’ a n d ‘u r b a n ’

t h o u s a n d s of t i m e s g r e a t e r t h a n t h o s e of th e

a s so m eh o w in opposition, c o m p etin g for

e a r l y cities, w i t h o u t r u n n i n g o u t of w a t e r ?

re s o u rc e s, m a n y m ajo r cities t o d a y ow e th e i r

W h e n t h e s e colo nial c ities w e r e fou nd ed

initial p ro s p e rity to being se rv ic e c e n tr e s for

d u rin g t h e 1 6 th c e n tu r y , a c ity w ith 5 0 , 0 0 0

p ro s p e ro u s a g ric u ltu re an d p ro s p e ro u s

i n h a b i t a n t s w a s a big c ity in E uro p e. The

fa r m e r s .33 The fa c t t h a t so m a n y of th e

sa m e q u e s tio n c a n be a s k e d for m o s t m a jo r

w o r l d ’s l a r g e s t cities a re old cities also m e a n s

c itie s in L a ti n A m e ric a ; a c a re f u l rev iew of

t h a t m a n y a r e lo c a te d on la rg e , n av ig ab le

provision for w a t e r in L a tin A m e r i c a ’s la r g e s t

riv ers, b e c a u s e t h e s e w e r e th e m ain t r a n s p o r t

citie s c alled T h ir sty C ities h ig h lig h ts n o t so

a r t e r i e s w h e n t h e y w e re founded. T h ere is also

m u c h s e r io u s w a t e r s h o r t a g e s a s i n a d e q u a c ie s

th e obvious poin t t h a t in d u s trie s t h a t n eed

in m a n a g e m e n t a n d in efficien t u se of e x is tin g

w a t e r do n ot choose cities w h e re t h e y c a n n o t

r e s o u r c e s . T h e s a m e q u e s t io n c a n be a s k e d of

g e t w a t e r - w h e t h e r from a piped w a t e r

t h e la r g e A sia n an d A frica n cities. A g ain,

sy s te m or d ire c t from g ro u n d or s u r fa c e w a t e r

th e r e a r e c ities w ith v e r y s e r io u s w a t e r s h o r t ­

so u rc es. So w a t e r a v a ila b ility h a s long influ­

a g e s , b u t su c h s h o r t a g e s a r e n o t e v id e n t in

en ced th e loc atio n of in d u s trie s (and t h u s

m a n y of t h e la r g e s t c ities. In a d d itio n , t h e r e

w h e re u rb a n c e n tr e s grow ).

is no c le a r a s s o c ia ti o n b e t w e e n t h e a v a il a b il­

T h e re a r e c i r c u m s t a n c e s t h a t e n c o u ra g e

ity of fresh w a t e r p e r p e rs o n a n d t h e q u a lity

th e fo u n d atio n an d e a rly d e v e lo p m e n t of cities

a n d e x t e n t of provision for p ip ed w a t e r ;

w h e re w a t e r r e s o u rc e s a re more limited. For

in d e ed , m a n y c itie s w ith t h e w o r s t provision

i n s ta n c e , th e location of m a n y s u b - S a h a r a n

for p iped w a t e r h a v e plen tiful fresh w a t e r

A frican cities w a s d e te r m in e d by colonial

s u p p lie s a v a il a b le locally.

re g im es, w h ich avoided riv e r v a lle y s b e c a u s e

E x p l a in i n g D e f i c i e n c i e s in U r b a n W a t e r a n d S a n it a t io n P r o v is io n

113 of th e prob lem s of m a l a r i a or o th e r insect-

tion utilities w ith little or no in v e s tm e n t

b orne d is e a se s. S u ch site s m a y h a v e h a d

c a p a c i ty a s d escribe d earlie r); an d h ig h er

plentiful w a t e r for sm all colonial cities (which

levels of g o v e rn m e n t t h a t a r e un w illing to

colonial reg im es k e p t sm all by a p a rth eid -lik e

allo w local in s titu tio n s th e re s o u rc e s an d

c o n tro ls on th e rig h ts of non-colonials to live in

re v e n u e -ra is in g p o w e r s t h e y n eed to b ecom e

u rb a n a r e a s ) b u t h a v e now gro w n too larg e for

more effective. This se ctio n looks a t th e c riti­

lo cal s o u r c e s to supply. M a n y of t h e w o r l d ’s

cal role t h a t lo cal g o v e r n m e n t h a s in

la r g e s t cities a re also s e a p o rts , a n d w hile

d e v e lo p m e n t in g e n e ra l, including th e provision

som e a r e b eside la r g e fresh w a t e r rivers,

of a d e q u a t e w a t e r an d s a n i ta t io n , w h e t h e r or

o th e r s a r e n o t an d suffer from limited local

n o t a g o v e r n m e n t a g e n c y is a c tu a lly re s p o n s i­

g r o u n d w a t e r re s o u r c e s an d th e n eed to go fa r

ble for provision. The d iscussion is focused

inland to t a p n e w res o u rces.

more on th e political an d in s ti tu t io n a l f r a m e ­ w o r k for e n su r in g good w a t e r an d s a n i ta t io n

War and civil conflict

provision t h a n on t h e p e rf o rm a n c e of w a t e r

W a rs a n d civil conflicts a re a key p a r t of th e

a n d s a n i ta t io n a g e n c ie s (w hich w a s discussed

e x p la n a tio n of w h y w a t e r a n d s a n i t a t i o n prov i­

earlier).

sion (and m uch else besides) is so in a d e q u a te , esp ecially in s u b - S a h a r a n Africa. For in s ta n c e , millions of people fled to u rb a n a r e a s in A ngola, M oz am b iq u e a n d th e S u d a n during civil w a r s t h e r e d u rin g t h e 1 9 8 0 s an d 1 9 9 0 s, j u s t a s t h e y h a d done in Z im b a b w e /R h o d e s ia during th e lib eratio n s t r u g g le of t h e 1 9 7 0 s .34 It is difficult to k n o w th e e x a c t dim en sion s of t h e s e m o v e m e n ts - for in s ta n c e , A ng ola h a s had no full c e n su s since 1 9 7 0 . 35 Yet d u rin g th e 1 9 8 0 s , t h e r e w e re h uge p o p u la tio n d is p la c e ­ m e n ts in A ngola, a s m a n y r u r a l a r e a s w e re in s e c u re an d people fled to sm a ll t o w n s and in lan d c ities a s w ell a s m ain cities n e a r th e A tla n tic c o a s t. The p ost-e le c tio n w a r from 19 92 to 2 0 0 2 affe c te d th e in lan d cities more, so d isp laced p o p u la tio n s h e a d e d to th e cities on th e A tla n tic c o a s t . 36 The n u m b e r of i n t e r n a ­ ti o n a l refu g ee s in Africa an d E u rop e rose to u n p re c e d e n t e d levels du rin g th e 1 9 9 0 s a n d a co n sid e rab le p ro p o rtio n c a m e to live in cities, for refuge or s e e k in g n ew b a s e s for t h e i r liveli­ ho o d s.37 F am in es h ave also influenced u rb a n tr e n d s in m a n y A frican n a ti o n s o ver th e la s t 50 y e a r s , esp ecia lly w h e re u rb a n c e n tr e s provide r u r a l p o p u la tio n s w ith a g r e a t e r ch a n c e of surviv al.

The developmental role of local government W ith in E u ro p e a n d N o rth A m e ric a (and in high-incom e n a ti o n s e ls e w h e r e ), u rb a n p o p u la ­ tio n s h a v e becom e so used to th e w e b of local in s ti tu t io n s t h a t se r v e , s u p p o r t a n d p ro t e c t th e m t h a t t h e y fo r g e t th e i r im p o rta n c e . T h ey as s u m e t h a t th e y will h a v e w a t e r of drink ing q u a lity piped to th e i r hom es, s a n i ta t io n and e le c tric ity 24 h o u rs a day, t h a t t h e i r g a r b a g e will be co lle cted r e g u la rly a n d t h a t t h e co sts will re p r e s e n t a v e r y sm all p a r t of th e i r incom e. T h e re a re schools a n d h e a lt h c e n tr e s to w h ich even th e lo w est-in com e h o u seh olds h a v e a c c e s s . T h e re a re e m e r g e n c y se rv ic e s av a ilab le to all. T h ere a re local politician s on w hom d e m a n d s can be m a de a n d to whom g r i e v a n c e s ca n be voiced. L eg islatio n an d c o u rts p r o t e c t people from eviction, d is c rim in a ­ tion , e x p lo ita tio n a n d pollution. T h ere a re s a f e ty n e ts for th o s e w ho lose th e i r jobs or fall sick, an d p en sio n s to s u p p o r t th o s e w h o retire. T h ere a r e la w y e r s , o m b u d s m en , c o n s u m e r g ro u p s a n d w a t c h d o g s to w ho m people c a n t u r n if th e y feel t h a t t h e y h a v e b een c h e a te d . T h ere a re also leg al s y s te m s a n d police forces t h a t m a y n o t h ave elim in a te d c o rr u p tio n bu t

Weak city and municipal government I n a d e q u a t e city g o v e rn m e n t g e n e ra lly h a s tw o a s p e c t s : local g o v e rn m e n t s t r u c t u r e s a n d in s ti­ tu t io n s t h a t a r e w e a k , u n d er-fu nd ed a n d often u n r e p r e s e n t a t i v e (including w a t e r a n d s a n i t a ­

h a v e limited its in fluence over a c c e s s to basic s e r v ic e s a n d livelihoods. All of th is is possible b e c a u s e of local g o v e rn m e n t in s titu tio n s o v ers een by d e m o c r a tic s t r u c t u r e s . E ven if som e s e r v ic e s a r e pro vided by p ri v a te c o m p a ­ nies, non-profit in s titu tio n s or n a ti o n a l or

W a t e r a n d S a n it a t io n in t h e W o r l d ’s C i t i e s

114 provincial public agencies, th e fra m ew o rk for

groups t h a t are im p o rta n t providers of some of

provision and quality control is provided by

these. The quality of service provided by all

local g ov ern m ents or local offices of n ation al

th e s e institu tion s will also depend on w h e th e r

or provincial go vernm ents. While co verage for

th e y are overseen by robust, effective

some services m ay be s u b -stan d a rd a nd some

dem ocratic processes, including th e values this

gro ups ill-served, th e broad web of provision

implies such as each in stitution ’s a c c o u n ta b il­

a d e q u a te ly serv es th e v a s t m ajority of th e

ity to citizens and tr a n s p a r e n c y in the

population.

ge ne ratio n, allocation and use of public

This is not th e case for m ost of th e u rb an

resources. Local g ov ern m en ts (or local offices

(and rural) population living in low- and most

of regional or n atio n a l g overnm ents) also have

middle-income nations. The basic s t r u c tu r e of

a critical role in protectin g w a t e r quality from

g overnm ent agencies, supervised by elected

pollution by local com m ercial and in d ustrial

politicians who are able to m eet th e ir responsi­

esta blish m en ts, and ensuring t h a t ente rp rises

bilities, is a t b e st only p artia lly p re s e n t and a t

do not co ntraven e environm ental regulations.

w o rst non-existent. Local g ov ernm en ts are

Much of th e discussion am ong in t e r n a ­

also often rooted in un dem o cratic s tru c tu r e s

tio nal agencies of th e ‘b ig ’ issues - such as

t h a t favour local elites, p a tr o n - c l ie n t rela tion ­

g r e a t e r equity, g r e a t e r justice (and p rotecting

ships t h a t limit th e c a p a city of low-income

h um an rights), p rotecting key resources,

groups to dem and th e ir rights, and corruption.

achieving g r e a t e r d em ocracy and reducing

P e rh a p s th e m ost pressing issue for improving

poverty - ta k e s place w ith o u t discussing the

w a t e r an d sa n ita tio n in u rban a r e a s is the

local institu tio ns needed to ensure progress in

developm ent of acco un table, effective local

th es e are a s . The discussion a b o u t improving

g ov ern m ents - or if th is is impossible, o the r

w a t e r a nd s a n ita tio n provision is no exception.

local institu tio ns t h a t a re acco un ta ble and responsible to th ose lacking a d e q u a te w a t e r

T h e w e a k n e s s e s in l o c a l a u t h o r i t i e s

and s a n ita tio n provision. Local in stitu tio ns are

A ssessing th e quality of local g o vernm ents is

also critical for m an y o th e r asp e c ts related to

difficult. M any a s p e c ts are not easily

w a t e r and s a n ita tio n - th e in v estm en ts and

m easu red, such as accountability, t r a n s ­

good m a n a g e m e n t needed u p stream of the

paren cy and com m itm ent to ensuring t h a t all

w a t e r pipes in acquiring sufficient fresh w a te r

citizens are served by th e rule of law.

an d en suring its quality, and d o w n stream of

S ta tis tic s can show th e n um ber or proportion

sew ag e and drain ag e sy stem s to p ro tec t w a t e r

of people w ith piped w a t e r supplies, but as

q uality and w a t e r users. Local institutions

C h a p te r 1 discussed, v ery ra re ly are there

need to provide th e rule of law th ro ug h which

s ta tis tic s on th e q uality of th e w a te r, the

th e rig h ts and e n titlem e n ts of all groups

regularity of supply and o th e r key qu alitative

(including low-income groups) an d th e public

aspe cts. It is also difficult to com pare th e

good are p ro tecte d - w hich includes th e right

cities by th e size of th e ir revenue base and the

of low-income (or other) groups to organize

scale of th e ir in v estm en ts in in fra stru c tu re

an d to dem and b e tt e r provision. Local in s titu ­

w ith o u t know ing precisely w h a t role th e ir

tions need to provide th e web of health

g ov ern m en ts have in in f ra stru c tu re provision;

services t h a t help reduce th e health and

low in v estm en ts per person m ay simply reflect

economic im pact of w a te r- re la te d diseases.

th e fact t h a t it is regional a u th o rities or o the r

They need to provide schools and day care

providers w ho supply m ost investm ent for

services w hich help prom ote good p ers o n a l and

w a t e r and sa nita tio n, r a t h e r t h a n w e a k local

en viro nm en tal hygiene. If local g overnm ent

governm ent. In addition, given its im portance

agencies are not th em selv es th e providers of

for development, th e re is re m a rk a b ly little

w a t e r an d s a n ita tio n , it falls on them to

in te rn atio n al res earch on th e quality of local

provide the fra m ew o rk within which provision

governm ent and on th e quality of its re latio n­

is g u a ra n te e d , s t a n d a r d s ensured and, for

ship with civil society (local governance).

services t h a t are n a t u r a l monopolies, prices controlled among th e private , NGO or CBO

A re search initiative in th e early 1990s so ug ht to collect com parable sta tis tic s from a

E x p l a in i n g D e f i c i e n c i e s in U r b a n W a t e r a n d S a n it a t io n P r o v is io n

115 F i g u r e 3 .2 I n f r a s t r u c t u r e e x p e n d i t u r e p e r p e r s o n in 1 9 9 0 ( s e l e c t e d c i t i e s )

2500

2000