Memorandum submitted by Plan UK
EXECUTIVE SUMMARY
This submission has been prepared by the UK
division of Plan International, with strong input from Plan's
country offices. In addition to this, Plan UK is also a signatory
on the submission prepared by the UK Water Network.
The key points which Plan UK would like to highlight
in this submission are that:
— Water and sanitation services should
be developed in consultation with local communities. In particular,
Plan UK would like to see emphasis placed both on ensuring access
to the benefits arising from such services by children and young
people and their optimal engagement and participation in all stages
policies, programmes and operations relating to provision of these
services.
— Water and sanitation are a key human
right, and greater emphasis and attention needs to be placed on
the provision of these services. The Convention on the Rights
of the Child recognises access to clean water and adequate sanitation
as the right of every child. The UK government needs to ensure
that these rights are met internationally, that decisions regarding
resource allocation/choice of intervention are made on the basis
of equitable and inclusive analysis and that the sector is given
the relative priority it needs.
— Projects need to be more community
driven to ensure that they are appropriate and responsive to local
needs. Interventions in this sector should proactively reinforce
or promote efforts to develop an effective and decentralised governance
system, better able to meet criteria associated with transparency
and accountability in relation to the universal rights of different
people in specific contexts. Greater support should be given to
local initiatives to improve water and sanitation facilities so
that policies and programmes are not developed in a "top-down"
way.
INTRODUCTION
1. Plan International is a child-centred
community development organisation, so this submission focuses
on the access to and engagement of children in the water and sanitation
sector. This submission was prepared by Plan UK, with input from
a number of country offices—Plan China, Plan Tanzania, Plan
Malawi, Plan Uganda, Plan Ethiopia and Plan Egypt.
2. Clean water and improved sanitation facilities
are vital and affect every aspect of a child's life and development.
The persistent lack of access to reliable, safe water, improved
sanitation facilities and hygiene education continues to undermine
the health and survival of children. Young children are more vulnerable
than any other age group to the ill effects of unsafe water, insufficient
quantities of water, poor sanitation and lack of hygiene.[213]
3. UNICEF estimates that unsafe water and
hygiene claim the lives of more than 1.5 million children under
five years old from diarrhoea every year. It is therefore essential
that children are placed at the forefront of any strategy to improve
water and sanitation facilities. Children and young people should
also be consulted during the development of water and sanitation
programmes.
4. Water and sanitation are rarely given
the attention that they deserve in development strategies and
are areas that are often neglected. However, it has been estimated
that failing to provide water and sanitation may cost developing
countries $84 billion per year in lost lives, low worker productivity,
higher health-care costs, and lost education opportunities.[214]
5. This submission highlights the main areas
of concern regarding water and sanitation, as observed by Plan
country offices, and puts forward a number of recommendations
for DFID to consider, and implement, in their water and sanitation
policies.
KEY ISSUES
Violation of rights
6. Clean water and adequate sanitation facilities
are a basic human right. In ratifying the Convention on the Rights
of the Child (CRC), all countries except the US and Somalia have
committed themselves to fulfilling the right of children to adequate
sanitation, safe water and a pollution-free environment. The CRC's
article 24 also calls on States Parties to "ensure that
all segments of society, in particular parents and children, are
informed, have access to education and are supported in the sue
of basic knowledge of ... hygiene and environmental sanitation".[215]
The CRC thus underscores the right to safe drinking water, sanitation
and hygiene education as three, mutually reinforcing, elements
critical to survival, protection and development of children.
7. As clean water and improved sanitation
facilities are a basic human right, it is essential that there
is accountability in the provision of these services. Central
and local governments should be held accountable for providing
these services, whether directly or indirectly, and ensuring that
their programmes benefit the poorest communities and households.
The same applies for NGOs, who also need to be held accountable,
in cases where they are providing water and sanitation services.
Health
8. While some progress has been achieved
in realising rights of children to safe drinking water and sanitation,
the fact that many remain excluded is manifest in continued mortality
and morbidity due to water-borne diseases. There are persistent
public health problems in many countries relating to the interaction
of the issues of water supply, sanitation and hygiene, including
diarrhoeal diseases (eg cholera), ascariasis, giardiasis and schistosomiasis.
9. Diarrhoea, a disease of dirty water,
is the biggest killer of under-fives in poor countries, resulting
in 4,000 preventable deaths every day.[216]
10. In Malawi, for instance, the average
child suffers six episodes of diarrhoea per year, which is a considerable
drain on their already poor health and nutrition status. Despite
improvements in adoption of oral rehydration therapy, many die,
and diarrhoea remains one of the leading causes of death in children
under five. Children living close to lakeshores or swamps are
particularly hard hit with an almost 100 percent infection rate
of schistosomiasis. The deleterious effects of the disease are
enormous, especially for the kidneys and bladder. Poor sanitation
and hygiene is also associated with polio, scabies, trachoma,
hookworm and guinea worm. Poor environmental management also favours
mosquito breeding, contributing to deaths from malaria, the number
one killer of children under five.
11. Poor sanitation and hygiene and the
lack of a close, reliable water supply poses an increased risk
of spreading opportunistic diseases among the weak or sick, especially
those with HIV/AIDS. Increased diarrhoea coupled with poor access
to a sanitary facility contributes to an increasing amount of
pathogens in the environment thus widening the risks of diarrhoeal
diseases to others, especially young children who crawl around
on the ground.
12. Water-borne diseases play a part in
the insidious interplay between malnutrition and disease that
retards the growth of children's bodies and minds. A child with
one or more of the above diseases is less likely to absorb micro-nutrients
or energy from food, thus precipitating the downward spiral of
ill health and malnutrition which leads to poor growth (stunting)
and can result in death by malnutrition itself, or by anemia,
malaria or measles. Children in the womb are affected as maternal
malnutrition from diarrhoea and helminthes contributes to low
birth weight of children.
13. The nutrition status of women and girls
is also compromised through the large energy expenditures in water
collection. Typically, in Sub-Saharan Africa, women and girls
expend a third of their calorific intake on water collection,
and equivalent energy of one meal per day.[217]
Developing safe water sources closer to the home would contribute
to reducing high-energy loss by girls and women.
14. These health manifestations, caused
as they are by the transmission of germs through contaminated
water and food, owe their continued presence to weaknesses in
capacity at the household and community levels, especially low
day-to-day access to potable water and adequate sanitation facilities
in communities, health centres and schools, as well as continued
poor hygiene practices at these same levels, including unsafe
disposal of solid and liquid wastes.
Non-health manifestations
15. The success of education programmes
is frequently undermined by lack of investment in water and sanitation.
Hygiene, sanitation, and water in schools can contribute to improved
child health, welfare, higher attendance of children, particularly
girls, and improved learning capacity. Separate budgets for the
construction of facilities for girls in schools can ensure that
gender sensitive sanitation becomes a reality.
16. The recent increase in school enrolments
due to the advent of free primary school education in many countries
has increased the demand for water and sanitation facilities.
For those schools with sanitation facilities, latrine pits are
filling up faster than the authorities can empty them or build
new ones, and resources for new ones are scarce. In Malawi, for
example, although up to 58% of all primary schools have some water
supply, only about 20% of all primary schools have sanitation
and water supply facilities that could be deemed adequate.
17. Hygiene education in schools can be
a catalyst for the kind of awareness and behaviour change that
the sector so urgently requires. However, providing hygiene education
without providing safe water and good sanitation facilities in
the schools' catchment communities is unproductive.
18. Efforts to inculcate improved hygiene
practices at school and at home have been hampered by the low
priority given the subject. At home this is in part due to the
typical unwillingness to discuss the topic. At school, the subject
of sanitation and hygiene has generally been an add-on to the
curriculum, necessitating extra time to teach—time that
many teachers do not have, given recent increased enrolments and
pressure on teachers to successfully ensure that students pass
examinable subjects such as mathematics, language and writing.
Many teachers are also not trained to teach subjects such as hygiene
education.
Gender
19. In many countries, water collection
is primarily the responsibility of women and girls. Therefore
girls' education is often distracted disproportionately by the
constant necessity to fetch water, sometimes from considerable
distance.
20. Likewise, adolescent girls are disadvantaged
when it comes to poor or inadequate sanitation, especially in
schools. Where sanitation facilities are lacking in schools, older
girls may not attend for reasons of dignity, especially when they
reach puberty.[218]
In extreme cases, girls drop out of school because of embarrassment
or risk of being sexually assaulted because of no protection or
privacy when going to the toilet. It is estimated that as many
as one schoolgirl in every ten in Sub-Saharan Africa, is negatively
affected by the lack of sanitation in schools.[219]
21. Girls and women need greater privacy
for personal hygiene than men. In the absence of private sanitation
facilities, there have been cases where women limit their food
and water intake so they can relieve themselves under cover of
darkness.[220]
However, night-time trips to fields or roadsides may put them
at risk of physical attack.
22. According to prevailing gender norms
in many countries, women and girls have the responsibility not
only for water collection, but also for sanitation improvements
and in keeping the general household and child's living environment
clean. Despite this responsibility, it is the men who make most
decisions regarding water and sanitation services at family and
community level. The exclusion of the participation of women and
girls is an example of specific capacity shortcoming that compromises
decision-making and overall effectiveness of water, sanitation
and hygiene practice at the household and community levels. Similarly,
the exclusion of men's participation in implementing water, sanitation
and hygiene activities compromises their effectiveness.
Geographical Considerations
23. Of the more than 280 million children
under five living in households without access to improved sanitation
facilities, almost two-thirds of them live in South Asia (106
million) and Sub-Saharan Africa (75 million).
24. China and India are crucial if the Millennium
Development Goal (MDG) 7 target is to be met, because of their
huge populations with no access to hygienic sanitation and clean
water supply. In China alone, roughly 80.75 million individual
household latrines would have to be constructed in rural China
by 2015 to meet this target.[221]
25. Some of the big development institutions
are leaving China to focus on poorer countries, but financial
support is still needed, particularly in the rural areas of the
east and south and the north-west. Nine provinces of China are
still at the lowest end of sanitation development with the percentage
of people with proper sanitation as low as 10%. In the rural areas,
only 68% of the population has access to safe drinking water and
29% to adequate sanitation.
26. This problem of rural areas lacking
access to water and sanitation facilities can be seen in a number
of countries. Official statistics show that only half of Malawi
households enjoy their right of access to safe drinking water.
Most of those without access are the poor in peri-urban informal
settlements and in rural areas. Actual access to safe drinking
water may be even lower due to poor operations and maintenance
of community water systems and resulting long periods of break
down. At any one time, approximately 30% of all water systems
are out of action and the average time it takes to fix them is
10 days. This, in effect, increases the coverage gap by as much
as 15% and when this happens, there is little option for a household
but to fetch water from an unprotected source.
27. While so called traditional pit latrines
are widely used in Malawi (upwards of 70% of households nation
wide) these lack simple improvements such as covers (which prevent
access to flies) and child-safe apertures, they may still pose
an on-going health risk. Households with flush toilets continue
to account for a small share of urban dwellings. If traditional
pit latrines are discounted, data suggests that upwards of 90%
of households do not have safe toilet facilities.[222]
Urbanisation
28. Rapid population growth in many countries
increases the demand for new water points and sanitation facilities
and services. In particular, high levels of migration to low income
areas in urban centres aggravates resource strains and increases
water pollution.
29. Many countries have congested areas
and urban slums with poor access to all social services and facilities,
including water and sanitation services. Pressure is increased
in parts of cities which are already suffering from water scarcity
problems. In particular, greater attention should be given to
ensure `good governance' and the inclusion of poor people in consultation
and decision making processes with regard to efforts (often driven
by IFIs) to promote the privatisation of water and sanitation
provision services in urban areas, the assumption being that these
will be coupled with residual plans to offset the costs of private
provision to low income households.
Lack of understanding and priority
30. In Malawi, until recently, a key constraint
to sanitation and hygiene promotion was the absence of a coherent
sanitation policy and guidelines, and confusion on the lead ministry.
Although current policy in the water sector demonstrates the government's
dedication to ultimately transfer `ownership' of water points
to communities, the translation of policy into reality has revealed
obstacles. Major constraints include the lack of specific legislation
on community "ownership", a lack of reliable spare parts
delivery systems, difficulties with reimbursable procurement,
poor training of communities and a non-standardisation of technologies,
especially for hand-pumps.[223]
31. Furthermore, national policy for the
water sector particularly for rural and peri-urban areas is not
well understood at lower levels in government, and is hardly understood
at all, at community level. The lack of a good communication strategy
that articulates national policy into understandable language
for the average non-technical person is a key constraint. Because
the water policy is poorly understood, politicians and others
often give conflicting messages to communities such as promising
free water services and operation and maintenance support, including
recurrent costs for upkeep. Many organisations, including UNICEF
and NGOs use different criteria for evaluating water projects,
often within the same communities, thus adding to the confusion.
32. In China, as in many countries, sanitation
improvement is not at the top of the government's agenda and the
country lacks a long-term, national policy on environmental sanitation.[224]
THE ROLE
OF DONORS
General recommendations to DFID on the provision
of water and sanitation
33. The UK government should ensure that
it endorses the fact that access to clean water and adequate sanitation
is a human right in the international arena.
34. DFID should increase funding to the
water and sanitation sector and highlight the economic, social
and health benefits of improved water and sanitation facilities
to help stimulate domestic investment in, and support to, the
sector.
35. DFID should develop a sector-wide approach
to make planning more comprehensive and ensure that everyone,
at all levels, is held accountable in the provision of these services.
36. DFID should support governments to increase
water resources planning and management capacity, as well as generate
clarity on institutional mandates, with due attention to operations
at local level.
37. DFID should encourage and support governments
to improve water and sanitation governance, including through
stakeholder consultation and to establish appropriate mechanisms
for the coordination of water and sanitation issues at national
level. Attention should be paid to the water and sanitation sector
in all Poverty Reduction Strategy Papers (PRSP).
38. DFID should encourage governments to
be accountable, transparent and responsive in every stage of their
water and sanitation programmes and should ensure that there is
a good flow of information both to and from the donors with regard
to the government, civil society and the target communities.
39. DFID, and all other donors, should ensure
that they always remain accountable to the target groups. DFID
should ensure that all water and sanitation facilities are developed
in consultation with local communities and in particular that
children and young people are consulted during this process.
40. DFID should ensure that inappropriate
technologies are not imposed on governments and communities.
41. DFID should work on a mechanism to hold
NGOs, especially northern NGOs, accountable to the communities
in the way that they deliver water and sanitation services, as
NGOs sometimes lack expertise and capacity to deliver high quality
programmes in this sector.
What should the role of donors and governments
be in the provision of water supply to poor people?
42. Donors should enhance accountability
and equality in the overall process of delivering water services
to the poor. Poverty and inequality are so closely linked that
one cannot address absolute poverty without addressing inequality,
most of which is rooted in structures of domination and oppression
as well as in the concentration of power and wealth.
43. Governments should emphasise and promote
the active participation of communities, the private sector, NGOs
and local government in the supply of water to poor communities.
44. Governments need to ensure that they
are accountable and transparent in the provision of water and
sanitation facilities.
45. Both donors and governments should urgently
increase the amount of resources that are allocated to the sector.
Oxfam calculates that meeting the MDG7 to halve the number of
people without access to clean water would cost $4 billion a year
for the next ten years.[225]
46. Both donors and governments should ensure
that they increase the capacity of local communities through participation,
training, empowerment and ownership of water and sanitation programmes.
They should also ensure that they explore how best the existing
local capacity can be utilised in the provision of these services.
Plan would particularly like to encourage the participation of
children and young people in the management of water and sanitation
programmes.
47. Both donors and governments should ensure
that they establish a practical strategy to reach the grassroots
level, especially disadvantaged and marginalised groups, such
as children, women, disabled people and the poorest of the poor.
They also need to develop a better understanding of the constraints
in this sector.
48. Both donors and governments should ensure
that water and sanitation programmes are linked with other programmes,
such as food security, nutrition, health and education.
49. Both donors and governments should ensure
that the soft-ware elements, such as hygiene education and environmental
awareness, are an integral component of the service.
Co-operation, co-ordination and capacity-building
between and with water operators, governments and donors (including
public-public and public-private partnerships)
50. This is a critical issue if effective
and efficient water and sanitation services are to be introduced
on sustainable bases. Donors and governments need to ensure that
they work in a coordinated way and that they keep the public,
civil society and the private sector informed of, and involved
in, any developments.
51. The communities should be actively involved
in any programmes so that the management and technology selection
suits their needs. The water and sanitation sector should be developed
in a way that uses participatory approaches rather than just being
a top down process.
52. In most countries, there is more than
one key government ministry involved in the sector. The ministries
need to coordinate amongst themselves and donors must ensure that
they keep ministries informed and do not become caught up in internal
`turf struggles'.
53. DFID should ensure that they help governments
to develop the appropriate legal and regulatory frameworks (and
enforcement capacity) to ensure the optimum performance of the
private sector.
How can DFID support replication and scaling up
of `best-practice' water and sanitation provision?
54. DFID should help build the capacity
of governments and civil societies by providing financial and
technical resources.
55. The scaling up of good practices and
experiences needs to take place at a national, regional and global
level and DFID can play an important role in facilitating this
by bringing in examples from elsewhere, whilst recognising that
there is no `one size fits all' solution. DFID should help with
the documentation and dissemination of experiences and best practices
among all stakeholders.
56. DFID should ensure that it focuses on
supporting initiatives to promote the software components of the
sector, rather than simply focusing on the hardware components
which most donors and governments concentrate their efforts on.
57. DFID should promote a rights based approach
to the water and sanitation sector and ensure that there is proper
progress towards community participation in all programmes that
it supports.
58. DFID should ensure that it focuses its
funding on projects which benefit the poorest communities and
households and that it supports work to increase access of water
and sanitation facilities by the most excluded and marginalised
groups.
The role of aid in supporting the private sector's
involvement in water and sanitation
59. DFID should support governments to develop
appropriate regulatory frameworks and enforcement capacity, to
ensure that there is adequate oversight of the private sector
in the provision of water and sanitation services in developing
countries.
60. DFID should help to ensure that the
local private sector is able to participate in the provision of
water and sanitation services, but are not able to control the
process. DFID should help to build the capacity of the local private
sector so that they can contribute to the development of the water
and sanitation sector.
61. DFID should support the creation of
a conducive, but regulated, environment for investment, so that
companies are able to invest in water and sanitation facilities
in poor countries.
62. DFID should help to document effective
mechanisms and models for water and sanitation services that have
resulted in positive and lasting pro-poor outcomes.
How can donors promote gender and child equity
in relation to processes of policy design, management and access
to water supply and sanitation?
63. DFID should support projects which increase
the access of the poorest communities to water supply and sanitation
facilities. In most countries, the collection of water at a domestic
level is entirely the responsibility of women and children. Therefore,
providing more accessible water supply for communities reduces
the physical hardship of fetching water from distant and difficult
terrain that many women face and frees up their time for other
activities. This also helps to reduce the physical risk that many
women and children face by collecting water from distant places.
64. DFID should ensure that it supports
projects which guarantee separate and private sanitation facilities
for women and girls at home and in schools.
65. DFID should ensure that all projects
and programmes in the water and sanitation sector actively involve
women and children / young people, from the consultation and development
phase.
October 2006
213 UNICEF, Progress for Children: A Report Card
on Water and Sanitation, September 2006. Back
214
WaterAid, Dying for the Toilet, 2005, http://www.wateraid.org.uk/documents/plugin-documents/dying-for-toilet-full-report.pdf. Back
215
Convention on the Rights of the Child, Office of the High Commissioner
for Human Rights, the United Nations, 20 November 1989, http://www.unhchr.ch/html/menu3/b/k2crc.htm. Back
216
Oxfam International, In the Public Interest: Health, Education
and Water and Sanitation for All, 2006. Back
217
Lechtig and Doyle, 1992. Back
218
UNICEF, Progress for Children: A Report Card on Water and Sanitation,
September 2006. Back
219
Doyle and Mudege, 1999. Back
220
UNICEF, Progress for Children: A Report Card on Water and Sanitation,
September 2006. Back
221
Statistic provided by Plan China. Back
222
DHS Malawi, 2000. Back
223
Information provided by Plan Malawi. Back
224
Information provided by Plan China. Back
225
Oxfam International, In the Public Interest: Health, Education,
and Water and Sanitation for All, 2006. Back
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