House of Commons - International Development

Select Committee on International Development Sixth Report

6 THE INTER-SECTORAL DIMENSIONS OF SANITATION AND WATER

139. As is indicated by the 2006 White Paper's emphasis on the inter-relationship between sanitation, water, education and health, DFID has moved away from seeing basic services as individual sectors towards treating them as a package of essential social services for achieving the MDGs.[275] The need for donors to strengthen the linkages between these basic services was emphasised repeatedly in the evidence that we received.[276] Paragraph 2 of this report describes how sanitation and water sit at the heart of the MDGs, with integral links to achieving all eight Goals. In this chapter we return to looking at how central sanitation and water are in progress towards development targets, particularly those relating to health and education.

140. In addition, this chapter will explore the integral links between water and the agricultural sector. Irrigation accounts for 70-90% of water usage in developing countries, and thus improving water productivity can assist food security, nutrition, and rural livelihoods.[277] The final sub-section of the chapter will briefly assess how effectively DFID and other donors link their work on water and on agriculture.

The interface between health, sanitation and water

141. More than half of the world's hospital beds are filled with people suffering from water-related diseases, illnesses that directly kill more than five million people each year.[278] Improving access to sanitation and clean water will have a significant impact on the global disease burden: improving a person's access to clean water reduces cases of diarrhoea by 25% and hygiene education including handwashing promotion reduces cases by 45%.[279] Young children tend to be the most vulnerable to the ill-effects of unsafe and insufficient water and poor sanitation and more than 1.5 million children under the age of five die from diarrhoea every year.[280]

142. Diarrhoea is by no means the only water-related disease that kills. Malaria, which is responsible for over one million deaths per year, is classed by the World Health Organisation (WHO) as a "water-associated vector-borne disease" whose transmission could be interrupted through improved water resources management. The WHO lists other significant water-borne diseases as intestinal nematode infections (e.g. hookworm), lymphatic filariasis, trachoma and schistosomiasis. Improvements to water and sanitation are by far the most sustainable solutions to these diseases, not least because of problems of drug resistance and affordability. [281] Water-related mortality is by no means confined to communicable diseases, with drowning the cause of around 280,000 preventable deaths each year and water contamination the cause of numerous negative health impacts.[282]

143. In most societies women have primary responsibility for obtaining household water and using it in food production and preparation, personal and family hygiene, washing, cleaning and caring for the sick. The average distance that women in Africa and Asia travel to collect water is six kilometres. Carrying heavy loads over long distances can lead to physical damage to the back and neck, and raises security risks of assault and rape.[283]

144. DFID works at several levels to help mitigate the health risks associated with unclean and insufficient water, from high level support to the Global Fund to Fight AIDS, TB and Malaria to funding an Arsenic Support Programme Unit to address the naturally occurring arsenic problem in Bangladesh's water.[284] Central to the effectiveness of these interventions is how well DFID links its work on the health and water sectors. In paragraph 23 we questioned how "joined up" DFID's sanitation and health strategies are, pointing out that sanitation was neglected in the last DFID target strategy on health. In paragraph 37, we recommended that DFID reconfigure its sanitation expertise so that sanitation becomes an integral part of health advisers' work within country programmes, and that DFID's Water, Sanitation, Energy & Transport Team in Policy Division should contain health advisory capacity.

145. Similarly, for DFID's multi-disciplinary approach to work effectively, far closer links will need to be built between DFID advisers working on water and those working on health. As we said in paragraph 32, there is currently no health adviser within Policy Division's Water, Sanitation, Energy & Transport Team. This raises questions about how an issue that relates closely to both the health and water sectors—say, the promotion of hand-washing—can be dealt with effectively within DFID. The links between water and health do not require actual staff reconfiguration in the way that sanitation-health links do, but the building of stronger co-working structures between water and health advisory cadres is a key priority. The Secretary of State assured us that both water and sanitation would be mainstreamed into the new DFID health strategy, to be published later in 2007.[285]

146. WaterAid were anxious that DFID should increase recognition that water and sanitation are essential public services as much as health or education are, both within country programmes and within the international aid architecture.[286] Their written evidence emphasised that to realise the linkages between the three sectors, DFID must ensure that cross-references to water and sanitation appear throughout health programming at country and international levels.[287] For DFID's multi-disciplinary approach to work effectively, closer links will need to be built between DFID advisers working on water and those working on health. We recommend that water and sanitation be mainstreamed across DFID's new health strategy to be published later in 2007, underpinned by explicit strategies to promote co-working between advisers working on water and advisers working on health.

The intersection of water, sanitation, gender and education

147. Sanitation and water are crucial determinants of the quality and quantity of education that children, especially girls, receive. There are several dimensions to this issue. The first of these concerns the time that women and girls spend collecting water. In many developing countries the responsibility for household water provision tends to be given to women and girls. There is a significant opportunity cost associated with this burden: in Ghana, for example, an estimated 700 hours per person per year is spent collecting water.[288] Water-fetching has a direct impact on girls' education: either they will have to fit their water tasks around schooling—making the journey very early or very late, bringing risks of walking alone in the dark and affecting girls' energy levels whilst at school—or they will become one of the estimated 44 million girls not in school.[289] Water-collecting limits the economic productivity of women and this perpetuates the wider gender inequalities which lead families to de-prioritise girls' education: a vicious circle is created.[290]

148. A second dimension to the intersection between water, sanitation and education is water-related illness: the WHO has estimated that 443 million school days are lost annually worldwide due to diarrhoeal disease.[291] Hygiene education in schools helps children understand and carry out potentially life-saving practices such as hand-washing after using the toilet.[292] A third concerns the presence of running water and toilets in schools. Girls who have reached menstrual age may be deterred from attending school if secure single-sex toilets and running water are unavailable, meaning that many girls across developing countries miss school for one week out of four.[293] WaterAid Bangladesh found that a school sanitation project with separate facilities for boys and girls helped to boost girls' school attendance by 11% per year, on average.[294]

149. By addressing sanitation and water, governments and donors can not only ensure that millions more children have their rights to education fulfilled, but can also make progress towards a wide range of development outcomes and significantly boost economic growth. Every year of lost schooling represents a 10-20 per cent reduction in girls' future incomes; children of mothers who receive five years of primary education are 40 percent more likely to live beyond age five and women with education are better able successfully to resist debilitating practices such as female genital cutting, early marriage and domestic abuse by male partners.[295]

150. It is significant that the group hit the hardest by lack of sanitation and water are the least well-educated and therefore the most silent—poor women and girls.[296] Stephen Turner, Deputy Director of WaterAid, believed that governments must urgently respond to this silent majority by recognising the intersection of gender, water, sanitation, health and education, and using a more holistic response: "It might mean that the starting point is not water in the community—it might be water in the schools or sanitation in the schools."[297]

151. Donors have a pivotal role in helping governments implement this holistic response. WaterAid's submission states that, "DFID has not given sufficient consideration to the impact of water fetching labour and the precedence it is given in household priorities over school attendance and that this burden falls overwhelmingly on girl children."[298] This is borne out by DFID's recent strategies on, firstly, education, and secondly, girls' education, both published in 2005. The first, a joint paper with HM Treasury called From G8 Commitment to Action: Education, makes no mention of water and sanitation whatsoever.[299] The second, Girls' Education: Towards a Better Future For All, makes a commitment to promote improved school sanitation and water facilities, but ignores the issues of water-carrying and education about water and sanitation.[300] Further evidence of DFID's lack of joined-up thinking is shown in the Government Response to our report on DFID's Departmental Report 2006, in which we expressed concern about DFID's work on gender and education, notably the deficient response to the missed 2005 MDG target to ensure equal enrolments of girls and boys in primary school.[301] In the section of the Government Response dealing with our concern, DFID does not mention water or sanitation in its description of its current gender and education strategies.[302] This is astonishing given the importance that DFID professes to attach to the intersection of the three basic social services.

152. We were pleased to see that DFID's new Gender Equality Action Plan, published in March 2007, does raise the issue of women and girls' water-fetching in connection with missed educational opportunities.[303] However, the fact that DFID's education strategies barely mention water and sanitation, and when they do, focus on school facilities to the exclusion of water-fetching and hygiene and sanitation education, indicates that DFID's multi-disciplinary approach contains substantial discrepancies. Mainstreaming water and sanitation across education strategies would promote collaboration between education advisers and advisers working on water and sanitation.

153. When we asked the Secretary of State whether DFID promotes the inclusion of sanitation and water in the curriculum, he told us that whilst DFID "certainly encourages schools" to ensure this, "DFID does not control the curriculum" in countries where it works.[304] We believe "encouragement" is not sufficient in ensuring that school-children take home crucial health messages about hygiene, clean water and sanitation and that DFID should work with education ministries to promote the embedding of these issues in curricula. DFID's education strategies do not do enough to stress the importance of sanitation and water promotion within schools. This needs to change if DFID is to deliver a properly integrated sanitation and water strategy. DFID should also work with education ministries on curriculum development and teacher training so that curricula include a water, sanitation and hygiene component.

154. When DFID produces its next update on its education strategy, it is vital that the issue of girls' water-fetching is addressed. DFID needs to develop strategies to tackle these issues including the wider gender inequalities in society that perpetuate the burden on women and girls of water-carrying as well as practical measures such as flexible school timetabling that allows girls to fit in water-related tasks in daylight hours and without being exhausted during lessons. Of course, expanding water supply and thereby reducing the journeys women and girls make to collect water will go hand-in-hand with these strategies. Involving women and girls in social service strategies from the start will help ensure that they are gender-sensitive. Finally, DFID's multi-disciplinary approach should ensure that water, sanitation, gender and education issues are mainstreamed across DFID's forthcoming health strategy.

155. DFID has not given adequate attention to the impact of women and girls' water-fetching burden in its education strategies. The Department needs to help governments develop strategies addressing the time burden associated with collecting water that keeps girls out of school. These should encompass tackling wider social inequalities that perpetuate women and girls' water-fetching burden, expanding water supply so that journey times are reduced and practical school-based strategies such as flexible timetabling.

The links between water and agriculture

156. Agriculture is the biggest consumer of water in developing countries: irrigation accounts for 70-90% of water consumption in these countries. Yet just 3.7% of arable land in sub-Saharan Africa is irrigated, compared to 26% in India and 44% in China.[305]

157. As water availability becomes increasingly constrained due to climate change and global economic and population growth, many countries will have to face difficult decisions about the way water is used and prioritise how much water they can afford to use for agricultural purposes. This clearly points to the need for efficient water resources management and for donors to help build the capacity and institutions that underpin the equitable allocation of water between different sectors.[306] Professor Franks from the University of Bradford highlighted that urbanisation will also increase the constraints on rural water use: towns and cities will use increasing amounts of water as they grow. This, Professor Franks said, makes it all the more important for DFID to focus on water and land use.[307]

158. We were concerned to see that DFID's water strategy does not substantially address agriculture, and equally that DFID's agriculture strategy makes little mention of water.[308] In its 2003 publication, DFID: Maximising Impact in the Water Sector, the National Audit Office highlighted that DFID's assistance to the water sector has "focused predominantly on improving access to water and sanitation, and other sub-sectors, such as water for food, have received less attention."[309]

159. Whilst we are supportive towards DFID remaining highly focused on sanitation and water, it is important that the use of water for agriculture is mainstreamed across the Department's water and sanitation strategies. Expanding water supply cannot be considered without addressing water for agriculture because the two go hand-in-hand: making progress on water availability will also improve food security, nutrition and rural livelihoods.

160. The Commission for Africa recommended that, as part of a wider set of measures to promote agricultural and rural development, donors must increase funding of irrigation by 50% before 2010: this should double Africa's arable land under irrigation by 2015.[310] Ian Curtis, Senior Adviser on Growth in DFID's Africa Policy Department, highlighted that DFID is involved in some policy work on securing good irrigation investments through the Comprehensive African Agricultural Programme.[311] However, irrigation is not a major area of financing for DFID.[312]

161. Addressing irrigation does not necessarily just involve large-scale agricultural development such as infrastructure: Dr. David Tickner from WWF-UK was concerned that donors should not focus on large projects at the expense of addressing efficient water use at community level—the micro-level decisions that people make daily about how to use their water.[313] In South Africa, a micro-level project of this kind has managed also to create social benefits. A joint government and civil society initiative called 'Working for Wetlands' has addressed the problem of invasive vegetation, such as acacia and eucalyptus trees, which extract large quantities of water from the ground. The project trained unemployed rural poor people to remove this invasive vegetation and to restore wetlands, simultaneously addressing water resources management and unemployment.[314]

162. We are concerned that DFID's water strategy does not sufficiently address agriculture, and equally that DFID's agriculture strategy makes little mention of water. DFID's focus on achieving the sanitation and water MDG should not be to the exclusion of focusing on water for agriculture, an essential component of meeting MDG1 which seeks to halve the number of people suffering from hunger. Strategies for promoting the productive use of water for food, including irrigation, should be pursued both through high-level donor engagement—particularly seeking the achievement of the Commission for Africa's recommended increase in funding of irrigation by 50% before 2010—and through national water resources management strategies which encourage the efficient use of water at the community level.

275 DFID, Eliminating World Poverty: Making Governance Work for the Poor, Cm 6876, July 2006, paras 6.3-6.4 and Ev 71 [DFID]. Back

276 For example, Ev 170 [WaterAid], Ev 250 [Halcrow Group Ltd], Ev 258 [David Hall and Emanuele Lobina, PSIRU, University of Greenwich] and Ev 272 [Institution of Civil Engineers]. Back

277 Ev 88 [DFID] Back

278 Ev 158 [Tearfund] Back

279 Ev 158 [Tearfund] Back

280 Ev 289 [Plan UK] Back

281 Ev 333 [WHO] Back

282 Ev 333 [WHO] Back

283 Ev 171 [WaterAid] Back

284 Ev 99 [DFID] Back

285 Q 264 [Hilary Benn] Back

286 Ev 181 [WaterAid] Back