Healthy Dialogues: March 2011
March 16, 2011
The Healthy Dialogues blog strives to create a dynamic space for conversations about current topics in health. We pick experts, from both inside and outside CSIS, to provide a range of views on a single topic. We hope that by stringing our experts’ responses together, an interesting and complex picture of the topic will be created. An integral component of this blog is you! If you have a topic you'd like us to address in the future, tell us. If you have a question you'd like us to answer next, ask it. We want to hear what's on your mind.
With World Water Day on March 22nd, the Global Health Policy Center decided to make water the theme of this month's blog. The World Water Day theme this year is "Water for Cities: Responding to the Urban Challenge." We will be looking at water from four different angles: urban water challenges; women and the water sector; water resources and climate change; and Water, Sanitation, and Hygiene (WASH) sustainability. We will highlight one of these themes every week for four weeks, asking different questions of our panelists.
This month the Global Health Policy Center is excited to have an impressive group of contributing writers answer questions about water. The writers include:
Kathy Baczko, Director of Global Partnerships, WASH Advocacy Initiative
Katherine Bliss, Director of the Project on Global Water Policy and Deputy Director and Senior Fellow, Global Health Policy Center
Ned Breslin, CEO, Water for People
Sally Cowal, Senior Vice President and Chief Liaison Officer, Population Services International
Bjorn von Euler, Director of Philanthropy, ITT
Paul Gunstensen, Funding Manager at Water and Sanitation for the Urban Poor (WSUP)
George Hawkins, General Manager of the District of Columbia Water and Sewer Authority (DC Water)
Kristina Kohler, Director, North America Office, International Water Association
John H. Matthews, Director, Freshwater Climate Change, Conservation International
Peter G. McCornick, Nicholas Institute for Environmental Policy Solutions, Duke University
Andy Narracott, Chief of Party for the African Cities for the Future Program
Jeff Seabright, Vice President, Environment and Water Resources for the Coca-Cola Company
Steven Solomon, Author of Water: The Epic Struggle for Wealth Power and Civilization
Q: Research shows that in developing countries women and girls who suffer disproportionately from poor access to safe water and sanitation services. How does improving water and sanitation management and access empower women, and how can women help resolve global water and sanitation challenges?
At Coca-Cola, water is vital to the sustainability of our business. We're working with partners in countries around the world to help manage water resources responsibly. As we've engaged in these partnerships, one of the things we've learned is how important access to water and sanitation is to the empowerment of women and girls.
Let’s look at just a couple of the facts:
- On average, women and girls in developing countries walk more than three miles a day, 15 hours a week, fetching water. That daily grind keeps them away from school and from more productive work.
- The lack of adequate sanitation for adolescent girls contributes to lower school attendance. Of the 120 million school-age children not attending school, the majority are girls. As a direct result, women account for two-thirds of global illiteracy.
These facts perpetuate cycles of gender inequality and general poverty. Reversing this situation and supporting initiatives that promote access to water for women and girls is fundamentally a women’s empowerment issue. It ‘s also a world empowerment opportunity, because a real driver for change and growth of our world in the twenty-first century will be women. The truth is that women already are the most dynamic and fastest-growing economic force in the world today. Yet today in Africa, women and girls spend over 40 billion hours per year collecting water. Imagine what could be accomplished if that time was liberated for other opportunities. Creating a climate of success for women globally is smart business for any company, especially a consumer facing company like Coca-Cola...
Two important developments over the last decade are converging to offer a monumental opportunity to advance the lives of millions of women and girls around the world. These women have been held back from healthy, productive lives due to lack of access to safe water, sanitation and hygiene (WASH).
The first development is the growing movement that positions women as agents of change and leaders, rather than victims. There has been a recent surge of investment in programs to educate, empower and advance women and girls, by offering them tools to improve their lives and engaging them as active participates and decision makers at all levels of development. This new movement has shown global leaders that by investing in women, essential and sustainable changes can be made.
The second notable development is the demonstrable progress in providing sustainable safe drinking water to those in need. About 87% of the world now has access to safe drinking water. However, there is still a lag in the delivery of sanitation. Only 60% of the world’s population has access to basic sanitation. Progress indeed – but not fast enough and with large discrepancies in areas such as Sub Sahara Africa and South East Asia. Each year 2.2 million people in developing countries die from preventable disease associated with lack of access to WASH, and 90% of those deaths are children under the age of five...
Women in most of the developing world have the primary responsibility for managing their household’s water supply. Unfortunately, that is not always their choice. Too often, where water is scarce, women are the ones forced to fetch it -- often traveling long distances on foot, sometimes two or three times a day.
As the primary person responsible for her family’s water supply, a woman gains influence over her family and community. She becomes responsible not only for her family’s water, but also for their health. Research shows that including women in public health projects designed to improve water and sanitation significantly and positively impacts the projects’ long term results. Thus, women in the developing world are the key to resolving global water and sanitation health challenges.
Take Adama Yakuba in Nigeria, for example. She, like the other women in her rural village, would fetch water for her family from a nearby stream. Her kids often became ill after drinking it, so she knew the water wasn’t clean or safe. But, she didn’t know what to do about it. Despite her best efforts to keep her kids healthy, her four year old daughter died due to a particularly severe case of diarrheal disease...
Question: The development community has increasingly embraced the concept of “sustainability” as it relates to WASH services. However, there is disagreement as to what constitutes sustainability and how to measure it. What does sustainability mean to your organization? What practices encourage service provides and implementers to ensure WASH programs are sustainable?
The debate around "sustainability" is somewhat surprising. Arguments rage over the issue for reasons I still struggle to fully understand. Simply put, sustainability means that water flows, toilets are used and hands are washed, forever. Not for awhile or for the operational life for a particular piece of hardware, but rather to the point that children grow up expecting water to flow, expecting toilets to be available to them at all times, and unthinkingly wash their hands.
Measuring this also tends to be overcomplicated. At Water For People, we look at the following for water supply:
- Quantities – the volume of water provided per day meets government standards (as standards vary from country to country). If quantities diminish, then sustainability is threatened
- Quality – water quality meets government standards or if not, is at least known to communities/families so they can decide whether the efforts associated with treatment merit the costs
- Access – number of users, within government defined distances, and most importantly – water supplies expanding with populations over time
- Down Time – less than 1 day/month for basic Operations &Maintenance and repairs. More than this means women and children are back in polluted rivers and streams fetching water
- Finance – we look at 3 key times and link them to finance. Within 3 years after construction, communities/owners/government (or a combination of these) should have demonstrated the ability to collect money and maintain the system to the conditions explained above. After 6 years, communities/owners/government (or a combination of these) should be able to pay for the most expensive part, and after 10 years there should be enough money in place to replace the infrastructure. Truthfully, this time frame is more likely for handpumps than for more expansive gravity fed schemes, so this may need to be reconsidered
Bjorn von Euler
For years, the water sector has hidden a dirty little secret: more than 50 percent of all water projects fail, and less than five percent are visited after completion. Today we are sweeping yet another secret under the rug: investment in the water cause is suffering and financial flows are insufficient to achieve the MDG targets for water and sanitation.
Clearly, we have a problem with sustainability – from both a programmatic and financial perspective. The good news is that we can overcome these obstacles.
At the forefront of the programmatic sustainability challenge – our ability to deliver on the idea that safe water and sanitation solutions truly endure and NGO and government aid can empower beneficiary communities to succeed long-term – is a simple solution. Monitor results, and not just today – but today, tomorrow, next year, and 10 years from now...
Every era has its own WASH sustainability challenges - taken together, they teach the universal lesson of its necessity for every society in history’s basic development and prosperity, and sometimes for the rise (and decline) of great powers and turning points of human civilization.
Take ancient Rome. The grandeur and manpower strength of the Roman Empire and its robust capital of 1 million people was sustained by its 11 gravity-fed aqueducts that brought clean, wholesome water—in amounts comparable to what we enjoy today--over a 306 mile network through settling and distribution tanks to supply 1,352 public fountains and basins for drinking, cooking, and cleaning, 11 huge imperial baths, 856 free or inexpensive public baths, private homes, before flushing out the city’s waste to the Tiber through an extensive sewer network.
The first aqueduct was completed under the Appia Antica in 312 B.C. and two more were added to meet Rome’s expansions following the Punic Wars and the Republic’s heyday. But discord, then civil war caused neglect in maintaining Rome’s water system, and the city and state itself began to totter...
Question: What are the implications for climate change on global water resources? What strategies should governments in developing countries adopt to adapt to the impact of climate change on water? What roles can NGOs and the private sector play?
Peter G. McCornick
We already know that the combined effects of a number of major drivers, including climate change, are causing varied, somewhat unpredictable, and increasingly severe effects on water resources. While efforts to determine the specific impacts of climate change on the local hydrological conditions need to continue, prudent decision makers are already incorporating these additional uncertainties into their planning processes, and considering how to secure and sustain water resources for the population, production systems and the environment. These processes also need to consider how to practically improve the resilience of the systems and how they can recover from the more severe floods and droughts. In the developed world much of this is already happening. In the developing world progress is understandably slower, yet the need is arguably greater.
The specific actions required depend on many local factors, including the anticipated effects of climate change in that area, the relative fragility of the present water resources situation, existing levels of investment in water management facilities and institutions, and the overall governance conditions in the country and the communities. In the developing world, the basic capacity, in terms of human capabilities and physical infrastructure, is barely adequate, and in many cases is deteriorating.
In the Ethiopian highlands, where a number of communities rely on water harvesting as a source of domestic water supply for at least part of the year, the anticipated changes in the seasonality of rainfall could make such techniques less reliable...
John H. Matthews
Water suffers from an awareness gap: many aspects of our food, energy, forestry, and health care securities intimately depend on freshwater, but these linkages are often ignored. When demand is low or water is plentiful, sloppy coordination usually has few consequences. But water resources are also among some of the most responsive aspects of the global climate system. I believe that one of the most difficult challenges for developing economies will be managing water resources in ways that do not make poor nations and communities poorer, generate international conflict, or trash freshwater and riparian ecosystems. In practice, this will mean that policymakers will have to build and operate water infrastructure to function under a much larger range of conditions than we can accurately predict today. And that also means that climate-sustainable water policy will need to be incorporated beyond the water ministry and merge into agriculture, energy, urban planning, health, and even foreign policy.
In March 2010 I visited eastern Nepal. Dirt roads followed small rivers up deep valleys, and we passed many new and under-construction hydropower plants. We got out and talked to the dam operators: are you producing as much energy as you projected? Who consumes your electricity? How is your river changing? Many new dams were producing significantly less electricity than had been predicted, and dam operators compensated by diverting more water than planned. In some cases, four kilometers of river below a diversion dam showed bone-dry stone. Since several dams were usually built back to back, once-continuous rivers alternated between small reservoirs and dry riverbeds. Why was this happening?
The primary reason is that mainstream water resource management assumes that flow and precipitation data gathered during planning stages accurately reflects past and future patterns. Climate change nullifies this assumption. Infrastructure that operated effectively for decades under this model is beginning to diverge from its intended climate...
Question 1: Cities throughout the world are growing at unprecedented rates. Many are struggling to provide new services for expanding populations while maintaining aging infrastructure. What are the particular challenges public officials face in extending and maintaining urban public water and sanitation services, and what are some lessons that can be gleaned from successful management practices?
Over the last three days, the international community convened in Cape Town, South Africa for World Water Day (WWD) to address the challenges and solutions focused on this year’s theme: Water for Cities: Responding to the Urban Challenge.
To understand the issues at hand, let’s first frame the context:
- Half of the world’s population today lives in towns and cities, and this number is expected to increase to two-thirds over the next decades.
- 95% of this growth will be in developing countries, already challenged with millions of people living in slums and squatter developments lacking adequate drinking water and sanitation facilities.
- Most of this growth will be in cities of 1 to 5 million people covering hundreds of thousands of municipalities.
The implications of this future urban expansion seem overwhelming when one considers the enormity of current-day challenges such as the need to not only build new infrastructure but also replace aging infrastructure, identify and remove emerging new contaminants, respond and prepare for disasters and climate change, consider the options for water efficiency and reuse, decide trade-offs between water and energy, in addition to address the complex and multi-dimensional social, health and economic challenges inherent to slum developments lacking adequate drinking water and sanitation services for the poor. Not to be overlooked is the need to address the treatment of wastewater which increases as access to drinking water and sanitation solutions are also expanded.
It’s 7:30 a.m. in the District of Columbia. A newborn child opens her eyes for the first time at United Medical Center, east of the Anacostia River. A visitor from Wichita brushes her teeth, in a hotel room high above the museums and monuments that will capture her imagination for the rest of her stay. And the President of the United States strums his fingers on his desk, listening to his key advisers on the challenges of the hours ahead.
These are three very different starts to the same day. But what all three people have in common, along with some 16 million others every year, is that none of them could start their days without the life-giving service we provide.
Water is life. And to be sure, throughout history and around the world, lives have been lost by the millions for lack of access to clean water and sanitation. In the United States, most of us are fortunate to have both.
Andy Narracott & Paul Gunstensen
In Water and Sanitation for the Urban Poor (WSUP)'s annual gathering of program staff and partners last year, public officials from 14 utilities and municipalities voiced a range of interlinking and complex challenges they faced in extending and maintaining urban water and sanitation services in their cities. They boiled down into three critical areas: lack of capacity and incentives; proven effective models; and channelling of finance to where it’s most needed.
Capacity and incentives: A recent survey found that one of the most common constraints to effective water and sanitation service provision is a lack of capacity and resources at the local level. Low capacity, inefficient and financially weak service providers in large part account for the poor quality of urban services; many cities do not recover their operation and maintenance costs from user charges and fare poorly on performance parameters such as availability of water, non-revenue water (NRW) and staff efficiency. This results in a cycle of poor services, lagging revenue collection, weak finances, inadequate maintenance, deteriorating assets and lagging coverage. This situation is compounded by political influence at senior management level and the regular rotation of these positions with the challenges this brings.
Effective models: A range of approaches to addressing inadequate WASH have been attempted in the challenging circumstances presented by low income urban areas, including interventions by NGOs operating at a traditional scale and level of impact. However, as the negligible progress in urban areas attests, these have not proven viable for sustainable scaling up to achieve city-wide impact. There is limited practical evidence of effective, sustainable and scalable methods of improving WASH services to urban poor men, women and children – and a lack of demonstration of such evidence through training. As a result, service providers fail to invest in low income areas, or only do so using traditional approaches. In the absence of alternative provision, small independent providers (SIPs) emerge which operate outside regulatory frameworks.