The MDG Sanitation Target

In September 2001, the United Nations Millennium Summit agreed a set of time-bound and measurable goals aimed at combating poverty, hunger, illiteracy, environmental degradation and discrimination against women.

The seventh Millennium Development Goal (MDG) is to ensure environmental sustainability. The associated target 10 includes:

by 2015 to halve the proportion of people without access to improved sanitation

This target is challenging; the Joint Monitoring Programme of UNICEF and WHO reports that in sub-Saharan Africa in 2002, sanitation coverage was only 36%, compared with the 49% coverage needed to be on-track. Those countries in Asia that are off-track include both India and China, which are the most populous countries in the region.

WELL BRIEFING NOTE FOR CSD-13 Go Back

Supporting the Achievement of the MDG Sanitation Target

Potential actions

This Briefing Note identifies supporting actions that could be taken in order to assist in accelerating progress towards the sanitation target

Compiled by Peregrine Swann of DFID and Andrew Cotton of WEDC, 2005

Headline facts

This Briefing Note identifies supporting actions that could be taken in order to assist in accelerating progress towards the MDG sanitation target.

Governments need to move sanitation to the top of their agenda. Poor sanitation incurs huge costs to the national economy and has serious impacts on domestic life, particularly for women and children.
Sound national policies and institutional arrangements that are based on genuine needs articulated through national poverty reduction plans have to be put in place if progress in implementation is to be made.
Children are key agents of change for improved hygiene behaviour. Focusing on school sanitation and hygiene education is essential to achieve and sustain the target.
Demand for sanitation is not always clearly articulated and resources need to be devoted to promoting demand for sanitation and to ensure that local supply-side capacity is available.
A greater focus on operation, maintenance and financing is required in order to sustain improvements to sanitation.
Lack of capacity is a serious constraint that has to be addressed at both national and local levels.

Key Issues

Actions that could be taken are grouped in relation to recommendations of the UN Millennium Project Task Force report on Water and Sanitation. The report identifies a total of ten critical actions under key headings of: Governance; Finance; Capacity Building; and Interlinkages. For each of these ten critical actions, this Briefing Note proposes a number of supporting actions that could be made in order to assist in accelerating progress towards the sanitation target.

Governance Action 1

Governments and other stakeholders must move the sanitation crisis to the top of the agenda.

Encourage strong political commitment in partner governments to raise the profile of sanitation.
Encourage and assist governments to raise the profile of sanitation within departments of National Government that have a role to play, including ministries of Finance, Education, Health and Environment.
Raise awareness globally, regionally and nationally of the economic costs to national economies of “business as usual”.

Box 1. Costs and benefits to the economy

National economy

The cholera outbreak in Peru in 1991 cost the economy an estimated $1 billion in lost tourism and agricultural exports in 3 months
Water-related diseases cost the Indian economy 73 million working days each year
The return on $1 investment in sanitation and hygiene in low income countries is in the range $3 to $34.

Local economy

In Lesotho, local latrine builders working full-time to improve sanitation earned the mean monthly income for the country. 45% worked part-time for an additional income. This stimulated demand for local brick production.

Box 2. Contribution of Water and Sanitation to the MDGs

Goal 1: Poverty and hunger: A lack of water, unsafe sanitation and polluted environments are key links in the cycle of disease, malnutrition and poverty.
Goal 2: Universal primary education: Children suffering from diarrhoeal diseases have reduced learning capacity. Adolescent girls often stay away from school unless there are female-only latrines
Goal 3: Gender equality: Women suffer the indignity, health impacts and security risks caused by a lack of private sanitation and washing facilities and bear the burden of carrying water
Goal 4: Child mortality: Diarrhoea causes 1.7 million deaths per year mostly amongst children.
Goal 5: Maternal health: A healthy pregnancy and hygienic labour practices reduce the risk of maternal illness. Effective hand washing is simple, yet has a significant impact.
Goal 6: Disease: Of the global burden of disease, 23% is a result of poor environmental health, three quarters of which is attributable to diarrhoea – itself primarily a consequence of poor sanitation.

Governance Action 2

Countries must ensure that policies and institutions for water supply and sanitation service delivery, as well as for water resource management and development, respond equally to the different roles, needs and priorities of women and men.

Encourage partner governments to ensure that national and local policies, particularly Poverty Reduction Strategies or their equivalent, reflect the importance of sanitation.
Acknowledge the key role that women play as the principal managers of water and sanitation in the household and ensure that Menstrual Hygiene Management systems are in place in public buildings, particularly schools.
Work with governments to ensure that local demands are reflected in national development priorities.
Promote the “Call for Action” at global and national levels whereby all schools receive a basic package of water, sanitation and hygiene education by 2015.
Promote a more inclusive approach to sanitation that addresses the needs of disabled people to ensure their needs are better integrated into planning and service provision.

Box 3. Bangladesh experience of good policies combined with strong partnerships

The Government of Bangladesh approved a sound policy for water supply and sanitation in 1998 that set out the roles of the main players in the sector. Specifically the policy encourages the government to act in the role of facilitator rather than implementer with use of NGOs and the private sector as key stakeholders to respond to the demand of communities. This policy has allowed space for the private sector and NGOs to deliver services in both water supply and sanitation. Such programmes as the Community Led Total Sanitation, initiated by WaterAid with its partner organisations such as the Village Education Resource Centre (VERC), is an example of this collaboration between major stakeholders when a spirit of partnership is promoted. The very large sanitation programme implemented by the Government of Bangladesh and UNICEF that focuses on hygiene promotion and education as its central theme has linked with the work of NGOs such as VERC and is probably key to the strong political interest that the government politicians have shown in sanitation, resulting in the SACOSAN Conference in November 2003. Bangladesh has set itself a target of total sanitation by 2010, well in advance of the MDG target.

Box 4. Clear roles and responsibilities for sanitation in South Africa

South Africa is one of the relatively few examples of successful sanitation policy that translates into programming and
The striking feature of the South Africa sanitation policy is the multi-sectoral approach to sanitation provision. Though sanitation is housed in a particular department, the programme development and implementation is actually to be achieved by multi-sectoral partnership involving the household, local government, NGOs, private sector, provincial government and the central government.
The institutional and organisational framework defines the roles and responsibilities of various levels in the provision of sanitation services. The households are responsible for the provision of household sanitation, while the local government is responsible for sanitation services. Provincial government supervises the local governments while the central government maintains quality control and assurance. The policy also recommends linkages with other programmes that have an impact on sanitation.
This offers a useful lesson to others on how to adapt the strong areas and improve on the weak areas in order to make policies effective.

Governance Action 3

Governments and donor agencies must simultaneously pursue investment and reforms.

Focus financial support to situations that simultaneously tackle reforms and investment, thereby enhancing institutional capacity and policy reforms while also installing infrastructure and expanding services.

Box 5. Scaling up sanitation in India

The experience of the state of Maharashtra in India of scaling-up sanitation has also led to significant changes in the national instruments for supporting sanitation. In June 2003, the Government of India announced the ‘Nirmal Gram Puraskar’ which is based on the Maharashtra approach of providing a fiscal reward for sanitation outcomes (for villages that are free of open defecation), rather than a subsidy for the construction of sanitation facilities. In addition, in November 2003, the Government of India identified the “principle of movement from a low subsidy to a no subsidy regime in sanitation” as a priority for States in developing a Memorandum of Understanding with the Government. The Government has subsequently also approached the World Bank for a loan of Rs 4,100 crore (approximately $500 million) in 2005/6 to focus on a national outcomes – oriented approach to rural sanitation.

Governance Action 4

Governments and donor agencies must empower local authorities and communities with the authority, resources and professional capacity required to manage water supply and sanitation service delivery. Encourage and assist partner governments to:

clarify the roles and responsibilities of different departments at different levels of government with respect to sanitation;
establish budgetary and fiscal decentralisation in accordance with those roles and responsibilities; and
clarify the roles and responsibilities of the different actors within the service delivery framework (public, private, community, household) with respect to: policy and strategy development; financing; service provision; operation & maintenance; sanitation promotion and hygiene education.

Box 6. Allocation of resources to local governments in Uganda

Uganda is promoting a Fiscal Decentralisation Strategy whereby increasing amounts of resources are being devolved to over 50 rural districts and over 15 urban municipalities around the country. The amount of resources allocated to each local government is published in the national press and generates a good degree of debate. Money is allocated primarily on the basis of population levels, but over time, more thought is being given to other factors such as poverty levels and current access rates to water and sanitation services.

Finance Action 5

Governments and utilities must ensure that users who can pay do pay to fund the operation, maintenance and expansion of services – but they must also ensure that the needs of the poor households are met. Work with partner governments is needed to:

ensure investment is targeted where global and national monitoring indicators suggest it is most needed (for example, rural and peri-urban sanitation in low income countries);
ensure both national and decentralised budgets and financial plans reflect the priority given to sanitation in national poverty reduction and development strategies;
ensure policies on subsidies are coherent, transparent, equitable and targeted, taking account of the private and public dimensions of sanitation (for example ensuring adequate sanitation in public buildings);
ensure budgets for school sanitation are commensurate with policy commitments for the basic package of water, sanitation and hygiene education;
identify and support efforts of national and local government, and civil society to promote and establish innovative financing mechanisms targeted at the poor; and
identify and promote innovative and sustainable means of financing to minimise dependence on international aid funds.

Finance Action 6

Efforts to reach the water and sanitation target must focus on sustainable service delivery, rather than construction of facilities alone.

Ensure partner governments give particular attention to allocating appropriate budgets to operation and maintenance.
Investigate the use of waste as a resource as a means of improving environmental sustainability and reducing the financial burden of waste treatment.
Investigate means of financing operations and maintenance of urban sewerage as a priority: for example, use of cross-subsidies between water supply and sanitation systems.

Capacity Building Action 7

Governments and their civil society and private sector partners must support a wide range of water and sanitation technologies and service levels that are technically, socially, environmentally and financially appropriate.

Ensure government policies, strategies and programmes have the flexibility to promote the use of locally appropriate and affordable technical options for latrines.
Promote the development of capacity building strategies that reflect the roles and responsibilities assigned through decentralisation.
Focus technical assistance on knowledge transfer, dissemination and networking on lessons learned from technologies and programmes that have worked.
Promote south-south information exchange, through networking of local resource centres, public and private training institutions.

Box 7. Limited technology choice in Mozambique

The National Programme for Low-cost Sanitation in Mozambique of the 1990’s adopted the technology of a domed slab placed over a pit for peri-urban sanitation provision and a small square slab to upgrade traditional rural latrines. While the limited technology options enabled rapid, well managed construction of latrine components, the restriction limited options for up-grading existing and new latrines in a demand-responsive manner.

Box 8. Capacity development in a decentralised environment

Capacity development has turned out to be a key issue in the Indian state of Kerala, where a decentralised development process has been underway for some years; this includes devolution of budgets previously held by central line departments down to local government bodies. Some of the elements of success are due in part to what is perhaps a unique system whereby retired professionals are brought in as local expert advisers on a voluntary basis. This complements a system where basic training is rolled out from state level to the panchayats – but not yet at the scale required.

Capacity Building Action 8

Institutional, financial and technological innovation must be promoted in strategic areas along with innovative capacity building strategies at the local level in the context of the service delivery framework. Strategies should address:

the need for skill requirements which are relatively new to the sector, for example in promotion, marketing, micro credit and finance;
how local service provision can be scaled up in the light of increased demand, for example through developing local small and medium enterprises; and
mainstreaming hygiene issues into capacity development

Interlinkages Action 9

Within the context of national poverty reduction strategies based on the Millennium Development Goals, countries must elaborate coherent water resources development and management plans that will support the achievement of the goals.

Promote the inclusion of sanitation issues in the develpment of water resource management plans

Interlinkages Action 10

The United Nations system organisations and their member states must ensure that the UN system and its international partners provide strong and effective support for the achievement of the water supply and sanitation target and for water resources management and development.

Promote the role of UN Water in focusing attention on the MDG targets and associated actions.
Encourage governments to build capacity in integrated planning, monitoring and evaluation.

Key References

The United Nations Millennium Project, Task Force on Water and Sanitation (2004). Achieving The Millennium Development Goals For Water And Sanitation: What Will it Take?
United Nations, November, 2004.
UNICEF WHO, (2004). Meeting the MDG Drinking Water and Sanitation Target: a mid term assessment of progress.
WELL, (2004). MDG Briefing Note 1 The Poverty MDG: what water, sanitation and hygiene can do. www.lboro.ac.uk/well/resources/Publications/Briefing%20Notes/BN%20Povertyl.htm
Hutton, G. and Haller, L., (2004). Evaluation of the Costs and Benefits of Water and Sanitation Improvements at a Global Level. Water, Sanitation and Health Protection of the Human Environment. WHO, Geneva. www.who.int/water_sanitation_health/en/wsh0404.pdf Pg 9-14.
UNICEF/IRC, (2005). “Call for Action Statement” Roundtable on Water, Sanitation and Hygiene Education for Schools, Oxford, U.K., 24-26 January 2005.
DWAF, (2001). National Sanitation Policy, Department of Water and Forestry. www.dwf.gov/za/dr_ws/content/lids/pdf/summary.pdf
'Nirmal Fram Ouraskar' Guidelines, RGNDWM, June 2003. www.ddws.nic.in/Data/CRSP/NGP.htm
Saywell, D.L. and Hunt, C., (1999). Sanitation Programmes Revisited, WELL Task No.16, WELL, Loughborough University, UK

For further information contact:

Andrew Cotton (WELL)

Water, Engineering and Development Centre (WEDC)

Loughborough University

Leicestershire LE11 3TU UK

Email: well@lboro.ac.uk

Phone: 0 (44) 1509 228304

Fax: 0 (44) 1509 211079

Peregrine Swann (DFID)

p-swann@dfid.gov.uk

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