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Domestic Water and Sanitation
May 1982
>> This Is USAID >> USAID Policy Papers >> Domestic Water and Sanitation
[Download original document] II. Rationale for USAID Support of Water and Sanitation Programs
An important goal of U.S. development assistance -- indeed, perhaps the most important goal -- is to help developing countries bring about the conditions under which their citizens can look forward to full lives, sharing in the benefits of a sturdy and growing economy. As President Reagan noted recently, "In its ultimate form, development is human fulfillment - -an ability of all men and women to realize freely their full potential." The challenge for development assistance agencies and LDC governments alike is to identify the most critical obstacles to guaranteeing individual freedom and initiative, and to design and implement programs that overcome these obstacles with as few negative side effects for the individuals and communities involved as possible.
Very clearly, in countries where a life of chronic, energy-sapping illness and death at an early age is likely for most people, learning potential and the options for exercising individual initiative are extremely circumscribed. USAID's health policy paper, approved in 1980, highlighted the problems which continued poor health in LDCs poses for the achievement of important personal and national aspirations. This paper investigates and provides guidance on one of the most important vehicles for improving health and living conditions in LDCs: safe water and adequate sanitation.
The combination of unsafe drinking water and inadequate sanitation facilities constitutes one of the major causes of death and disability among the poor in developing countries. The World Health Organization estimates that more than 25,000 people (most of them children) die each day from water and hygiene-related diseases. 1 Less than one-half of the people in developing countries have reasonable access to reliable sources of safe drinking water and a satisfactory means of,excreta disposal. Most of those who lack reasonable access to these sources live in rural areas.
USAID's efforts to increase access2 to safe water supply, adequate waste disposal and sanitation in developing countries reflect U.S. interest in furthering economic growth by helping countries meet the basic needs of their populations.
Safe,3 convenient water supply and adequate sanitation is a fundamental component of a broad based economic growth strategy.4 Water-borne and sanitation-related diseases, particularly diarrheal disease and parasitic infections, are principal causes of morbidity and mortality among infants and young children in Less Developed Countries (LDCs). Lowering mortality and morbidity from water and sanitation related diseases is, of course, a goal in itself. It can also lead to increased productivity and decreased absenteeism among members of the labor force, and is therefore an important factor in promoting economic growth.5
To satisfy basic needs, water must be not only safe, but also available in quantities sufficient for personal hygiene and a healthful environment.6 Sufficient safe water is particularly necessary for the control of certain diarrheal diseases and skin and eye infections. Trachoma, for example-the leading cause of preventable blindness in the developing world-is in large measure a result of poor hygiene, as is epidemic typhus, spread by human body lice. 7
There has been considerable debate over the trade-off between water quantity and quality in improving health conditions. The issue appears to turn on the prevalence and mode of transmission of diarrheal and other diseases. Where these are almost entirely water-borne, or water-based, improving water quality is likely to be the most effective way to reduce disease incidence. Where diarrheal diseases are primarily "water-washed", as opposed to "water-borne", priority should be given to promoting the availability and use of water in greater quantity, and to improved domestic hygiene. 8
Improved access to convenient, reliable sources of safe water also has an impact on health through reducing the time and energy burden on the household. This benefit is of particular significance to women and children, who bear .the principal responsibility for seeking, drawing, and carrying water in the developing world. These responsibilities are particularly burdensome for pregnant and lactating women, who are already somewhat more vulnerable to disease and poor health.
Time saved as a result of more convenient sources of water has been used in subsistence agriculture, in child care, in leisure, and in income-generating activities -- all of which can contribute both to improved health and to increased income.9 Numerous studies have documented the importance which beneficiaries of water projects attach to these improvements in living conditions. 10
Indirect benefits of improved domestic water supply and sanitation may be even more important than the direct benefits listed above. For instance, some have suggested that the rate at which girls drop out of school is directly linked to the burden of domestic responsibilities they bear11; carrying water competes directly with school attendance since it can take anywhere from one-half hour daily in urban areas to 4-6 hours in difficult terrain, during dry seasons, or when numerous trips and substantial waiting time are required. Getting girls into school and making sure they stay in school is important not only for them but also for their families. There is mounting evidence that mother's education is directly related to family size (educated mothers have fewer children) and to child health: mortality among children whose mothers completed more than three years of primary school tends to be significantly lower than for children born to women with less schooling, regardless of income. 12
1WHO Rapid Assessment Report, 1980 (United Nations, Report of the Secretary General, International Drinking Water Supply and Sanitation Decade: Present Situation and Prospects, No. A/3567, July, 1980).
[return to text]2According to the World Health Organization (WHO) definitions, "reasonable access" in urban areas denotes a public fountain or tap not mere than 200 meters from a house; in rural areas "reasonable access" implies that members of a household do not have to spend a "disproportionate part of the day" obtaining water for the family ("World Health Statistical Report," World Health Organization, Vol. 29, No. 10, 1976). Access is a somewhat subjective term, varying according to the perceptions of a given society and with topography (e.g., reasonable access may be defined in relation to available alternative water sources only, or the energy and time required to haul water over a distance considered when the terrain is flat).
[return to text]3In this context, ":safe" is a term of art, often used interchangeable with "potable," "clean," etc. to mean water of sufficient quality that it can be used, untreated, without major risk of contracting serious disease. "Safe" does not imply quantifiable standard, see pp. 8-9.
[return to text]4 "Foreign Assistance Act of 1961, Amended." U.S. Agency for International Development, "Basic Human Needs Discussion Paper," 1977.
[return to text]5Evidence of the indirect links between improved water supply and overall economic growth is found in Saunders, Robert J. and Jeremy J. Warford, Village Water Supply, Baltimore: John Hopkins University Press (for the World Bank), 1976; Feacham, Richard et. al., Water, Health, and Development, 1978; White, Gilbert F., et. al., Drawers of Water, University of chicago Press, 1972; and Feacham, Richard, et. al. (eds.), Water Wastes and Health in Hot Climates, Chichester: John Wilen & Sons, 1977.
[return to text]6It is generally agreed that 20-40 liters per capita per day is the minimum required to assure adequate supplies for consumption, sanitation, and hygiene.
[return to text]7Feacham, 1977 and 1978, op. cit.
[return to text]8Feacham, et. at., 1978, cit., p. 217, Thus both water quantity and water quality are important to health, and should be addressed in project design. The minimal quantity needed to promote health is at least 20-40 liters per capita per day. Additional quantities are desirable; however, as quantity exceed about 100 liters per capita per day marginal health benefits decline. The most important quality parameter is microbiological purity. This is best assured by selection of nonpolluted, protected sources, and, if necessary water treatment (purification). Given the scarcity of resources in most developing countries, investments in additional improvements in quality and quantity should be weighed against providing these minimal services to a larger population.
[return to text]9For an excellent discussion of some of the difficulties involved in quantifying the health and economic benefits of improvements in water supply and sanitation, see White, Gilbert F., et. al., 1972, op. cit.
[return to text]10Time saved in rural Thai village where water was provided in or near the home made possible economically productive activities - such as crafts and small vegetables gardens. Villagers cited increased craft activities and more gardening and farming as the most beneficial consequences of the piped water systems. (Dworkin, D. and B.L.K. Pillsbury, "The Potable Water Project in Rural Thailand, "USAID Project Evaluation Report No. 3, Washington, D.C. 1980). Findings such as these have been cited in numerous recent studies. See, for instance, White, et. al., 1972, op. cit.
[return to text]11Russell, Annemarie, "Report on the Situation of Women in the Target Village of the UNICEF Domestic Water Supply Project in Bahr El Ghazal Province, Sudan," Khartoum: UNICEF, 1979.
[return to text]11Russell, Annemarie, "Report on the Situation of Women in the Target Village of the UNICEF Domestic Water Supply Project in Bahr El Ghazal Province, Sudan," Khartoum: UNICEF, 1979.
[return to text]12Cochran, Susan, The Effects of Education on Health, Washington, D.C. IBRD Working Paper 405, 1980.
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