Last update: November 2006

	Progress for Children: A report card on water and sanitation (No. 5)
	Meeting the MDG drinking water and sanitation target: the urban and rural challenge of the decade [PDF]

The Challenge

Lack of sanitation is a major public health problem that causes disease, sickness and death. Highly infectious, excreta-related diseases such as cholera still affect whole communities in developing countries. Diarrhoea, which is spread easily in an environment of poor hygiene and inadequate sanitation, kills about 2.2 million people each year, most of them children under five. Despite the success in reducing child mortality from diarrhoeal disease, the overall health burden has not decreased over the decade. Improvements in safe water supply, and in particular in hygiene and sanitation, could reduce the incidence of diarrhoea by about one fifth and the number of deaths due to diarrhoea by more than half.

Progress in sanitation has suffered from limited political commitment and demand. At the World Summit on Sustainable Development in Johannesburg an international sanitation target was formulated, which was adopted retroactively by the United Nations as an official Millenium Development target. Since then sanitation featured as the main topic on ministerial conferences held in Africa (AfricaSan) and South Asia (Sacosan), as well as on the agenda of the 12th and 13th meetings of the UN-Commission on Sustainable Development. Meeting the sanitation target means that an average of 140 million people per year need to gain access to sanitation every year until 2015. Compared to the average of 86 million per year that gained access between 1990 and 2004, this poses a huge challenge to governments and the international community alike.

Role of behaviour

Simply providing access to improved water and sanitation does not imply the use of the services nor the much expected health benefit. The promotion of fundamental behaviour changes is key to integrating the appropriate use of services into daily routine and needs to start in childhood. School health and hygiene education programmes are, therefore, an integral part of every water and sanitation programme.

Please click here to view the behaviours which brake the fecal-oral transmission cycle.

School Sanitation and Hygiene

In many countries throughout the world schools have very poor sanitation. In such circumstances, schools become unsafe places where diseases are transmitted easily. In addition, poor sanitation in school buildings impairs children's growth and development, limits school attendance and negatively affects students' ability to concentrate and learn. About 40% of the world's 400 million school-age children are infested with intestinal worms. About 1 in 10 school-age African girls do not attend school during menstruation or drop out at puberty because of the lack of clean and private sanitation facilities in schools.

Economic Impact

Inadequate sanitation, through its impact on health and environment, has considerable implications for economic development. People miss days at work due to sickness resulting from excreta-related diseases. The increasing pollution of rivers and shorelines negatively affects businesses such as tourism and agriculture that are often vital to nations' economies. Moreover, lack of excreta management poses a fundamental threat to global water resources.