En milliard mennesker har ikke noget toilet

Hedebølge i Californien. Verdens klimakrise har enorme sundhedsmæssige konsekvenser. Alligevel samtænkes Danmarks globale klima- og sundhedsindsats i alt for ringe grad, mener tre  debattører.


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Laurits Holdt

En ud af syv mennesker må forrette deres nødtørft under åben himmel. Flere hundrede millioner af dem har heller ikke adgang til vand og sæbe til at vaske hænder. Tilsammen giver det diarre-sygdomme alt for gode muligheder for at sprede sig.

NEW YORK, GENEVA, November 19, 2014—Global efforts to provide improved water and sanitation for all are gaining momentum, but serious gaps in funding continue to hamper progress, according to a new report from the World Health Organization on behalf of UN-Water.

The UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS 2014), published biannually, presents data from 94 countries and 23 external support agencies.

It offers a comprehensive analysis of strengths and challenges in water, sanitation and hygiene (WASH) provision within and across countries.

“Water and sanitation are essential to human health. Political commitment to ensure universal access to these vital services is at an all-time high,” said Dr Maria Neira, Director of the WHO Department of Public Health and the Environment.

“International aid for the sector is on the rise. But we continue to see major financial gaps at the country level, particularly in rural areas.”

Strengthened political commitment

Two thirds of the 94 countries surveyed recognized drinking-water and sanitation as a universal human right in national legislation.

More than 80% reported having national policies in place for drinking-water and sanitation, and more than 75% have policies for hygiene.

This strengthened political commitment at national levels is reflected in global discussions around the post-2015 Sustainable Development Goals (SDGs).

Universal and equitable access to water, sanitation and hygiene have been proposed as global targets by the Member State working group tasked with developing the SDGs.

“Now is the time to act,” says Michel Jarraud, Chair of UN-Water and Secretary-General of the World Meteorological Organization.

“We may not know yet what the post-2015 sustainable development agenda will look like. But we do know that water and sanitation must be clear priorities if we are to create a future that allows everyone to live healthy, prosperous and dignified lives.”

Increased aid, better targeting of resources

International aid for water and sanitation is on the rise: According to the report, financial commitments for WASH increased by 30% between 2010 and 2012—from US $8.3 billion to $10.9 billion.

Aid commitments are increasingly targeted to underserved regions, notably sub-Saharan Africa, Southern Asia and South-eastern Asia.

GLAAS 2014 also highlights the strengthened targeting of WASH resources for the poor: more than 75% of countries reported having specific measures in their national plans to provide water and sanitation for low-income populations.

“For our partners, especially at country level, GLAAS is key for achieving sound, evidence-based decision-making,” says President John Agyekum Kufuor, Chair of Sanitation and Water for All.

“The report guides governments in knowing where progress in WASH is being made and where more resources need to be allocated.”

“As we identify the financial and human resource gaps, governments and donors can be more strategic in supporting policies and in implementing sustainable programmes to ensure equitable access to water and sanitation for all people,” says Chris Williams, Executive Director of the UN-based Water Supply & Sanitation Collaborative Council (WSSCC).

Still major gaps

Despite these gains, 2.5 billion men, women and children around the world lack access to basic sanitation services.

About 1 billion people continue to practice open defecation. An additional 748 million people do not have ready access to an improved source of drinking-water.

And hundreds of millions of people live without clean water and soap to wash their hands, facilitating the spread of diarrhoeal disease, the second leading cause of death among children under five.

Many other water-borne diseases, such as cholera, typhoid and hepatitis, are prone to explosive outbreaks. Poor sanitation and hygiene can also lead to debilitating diseases affecting scores of people in the developing world, like intestinal worms, blinding trachoma and schistosomiasis. The report cites a number of key challenges, including:

Insufficient financing: Though international aid for the WASH sector has increased, national funding needs continue to outweigh available resources.

Eighty per cent (80%) of countries reported that current levels of financing are insufficient to meet their targets for drinking-water and sanitation.

Funding gap in rural areas: While a vast majority of people who lack access to basic sanitation live in rural areas, the bulk of financing continues to benefit urban residents.

Expenditures for rural sanitation comprise less than 10% of total WASH financing.

Weak national capacity to execute WASH plans: Despite strong political support for universal access to water and sanitation, fewer than one-third of the countries surveyed for this report have national WASH plans that are being fully implemented, funded and regularly reviewed.

Critical gaps in monitoring: Reliable data is vital to identify gaps in access to WASH services and inform policy decisions.

Though many countries have WASH monitoring frameworks in place, a majority reported inconsistent or fragmented gathering of data and weak capacity for analysis.

Neglect for WASH in schools, health facilities: Water and sanitation services in schools can ensure that children, especially girls, stay in school and learn lifelong hygiene habits.

In health clinics, WASH services ensure the privacy and safety of patients, particularly expectant mothers during delivery, and are essential to prevent and respond to disease outbreaks.

Yet, GLAAS data indicates that less than 30% of surveyed countries have national WASH plans for institutional settings that were being fully implemented, funded and regularly reviewed.

Investments pay off

Investments in water and sanitation yield substantial benefits for human health and development. According to WHO estimates, for every dollar invested in water and sanitation, there is a $4.3 return in the form of reduced health care costs for individuals and society.

Millions of children can be saved from premature death and illness related to malnutrition and water-borne diseases. Adults can live longer and healthier lives.

The benefits cut across many sectors. Economic and environmental gains include, for example, greater productivity in the workplace and reduced pollution of water and land resources.

Gains in quality of life include improved school attendance, greater privacy and safety—especially for women, children and the elderly—and a greater sense of dignity for all.

Download rapporten Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS 2014) (PDF, 108 sider)

Download rapportens hovedpunkter (PDF, 12 sider)