The real issue is universal access to affordable basic services

Why have global leaders endorsed partial Millennium Development Goal targets, asks Diana Mitlin, leaving millions without water, sanitation or healthcare?

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14 August 2012

Street in Karachi, Pakistan with overflowing sewage.

As global institutions and official development assistance agencies reflect on what should follow the Millennium Development Goals (MDGs), this is an opportunity to recognise their critical flaw — global leaders have endorsed partial MDG targets. 

Halving the proportion of people with inadequate incomes, halving the numbers who suffer from hunger and halving the proportion of people without safe water and basic sanitation are just some of the MDG targets set for achievement between 1990 and 2015. Would these global leaders offer piped water to only one child in a family or two?  Or, if extending piped water to an informal settlement, offer it to only half the residents – say those to the right of the water mains?

Significantly improving the lives of 100 million people living in slums – only around 10% of those living in urban areas in need of assistance – by 2020 would mean that this MDG goal would be achieved on paper. But what about the lives of the other 90% of slum dwellers?

Of course, setting global targets which offer to reach only some of those in need in a distant boardroom might not feel difficult, because they are less acute and less personal to the goal setters. They aren’t parents selecting which of their children should receive healthcare to treat diarrhoea, and which will have to go without. But the need for good quality water and sanitation that isn’t too costly is so important that its absence means that many will die young, or are likely to suffer from diseases that will blight their lives and their development.

Astonishing deficiencies

Despite all the promises, commitments and declarations made by governments and international agencies over that past four decades, the scale of the deficiencies in provision for water and sanitation in rural and urban areas is astonishing. In most sub-Saharan African nations and many Asian nations, less than a quarter of their urban population has water piped to their premises – see figure 1.  Most cities in sub-Saharan Africa and many in Asia have no sewers and no storm drains.  This includes many large cities with more than a million inhabitants. For many of the large cities that do have sewers and storm drains, these only serve 5-20% of their population.

For example, in Mumbai, India’s financial capital, approximately 60% of the 20 million inhabitants live in informal settlements (“slums”); three-quarters of these people do not have access to the city’s sewers and drainage system. Informal settlements may be provided with standpipes, although the supply of water from these standpipes is often irregular and not of drinking quality. Due to this lack of access, households in the city began connecting directly to the mains water supply– albeit illegally.  Interestingly, this subterfuge brought about results: the city has responded with a programme to provide household water connections.

Around the world sanitation remains in crisis; at present there are 50 people to one toilet seat. Nairobi’s informal settlements are home to at least 30% of the city’s population. On average, 71 people share each toilet. And only 12% of the toilets that do exist have a formal connection to a sewer.

Table showing the very low proportion of the urban population in many nations that receive water piped to their premises.

Factoring in high population densities

In a low-density rural settlement, the local eco-system can process human waste, just as it would the wastes from animals in the vicinity, but this natural process can’t occur in most cities. The negative health impacts created from a lack of water and basic sanitation facilities in many of the world’s cities are made worse by high population densities. The number of immediate neighbours, as well as the quality of water and sanitation services received all dramatically impact on people’s health. It’s perplexing then that population density is often forgotten when assessing basic sanitation service requirements. 

Recipe for disaster

There are hundreds of millions of families living in one or two rented rooms within a plot of land in an informal settlement. They might share the plot with eight or twelve other families, with very limited open space. In most cases, the best toilet provision they can hope for is a single pit latrine, shared between all the households.  But with so many sharing the toilet, it quickly fills up. 

When the latrine fills up there is no space to dig another pit. Even if there is a service to empty latrines, these are expensive and it is often difficult to get the equipment close enough to the latrine within dense informal settlements. For those who rent accommodation, landlords often save money by not providing this service.

With so many sharing each toilet, it is difficult to get access to it. So it is common in such settlements for residents to defecate in the open or into plastic bags or waste paper that is then thrown away – but there is usually no waste-collection service to remove this waste either.

Informal settlements are frequently built on flood-prone land that no one else wants – the inhabitants would likely be evicted if they chose better quality sites. Because these sites are illegal, local governments have rarely installed drains. When flooding occurs pit latrines often spread their contents all over the settlement. Such inadequate provision for sanitation will usually mean that all those people using shallow wells may also end up with their potable water contaminated with faecal matter.

What is human progress if it does not involve the acceptance that every child and adult is able to secure the basic needs required for good health? It is extraordinary that, in this age of prosperity, such basic values seem to have been forgotten. As the significance of inequality is documented and discussed among both government and development agency staff alike, surely a critical first step is a universal standard to provide safe and sufficient water, sanitation and drainage that reduces the risk of faecal contamination, and health care and emergency services for all.  

Find out more about the work of the Human Settlements group

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