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Last update: May 2013

World Fit For Children Goal Millenium Development Goal
Reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one third. MDG 7 - Target 10: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation.

Explore the new estimates

The new water and sanitation estimates are available for viewers to explore using Google tools. Click here to access them at the base of the "Country and Regional Data" page.

The challenge



Progress on Sanitation and Drinking - Water - 2013 Update [Eng]






Access to adequate water supply is not only a fundamental need and human right. Access to water supply also has considerable health and economic benefits to households and individuals. Equitable access to improved drinking-water and sanitation is of fundamental importance to health, and will speed the achievement of all eight MDGs.i
On the other hand, the lack of access to adequate water contributes to deaths and illness, especially in children. Children under five represent 90 per cent of all deaths caused by diarrheal diseases.ii Approximately 2,000xii children die per day from diarrhoeal diseases. Of these deaths 88%--or around 1,800xiiiper day--are due to poor drinking water, lack of sanitation and poor hygiene. Thus, the improvement of access to water is a crucial element in the reduction of under-five mortality and morbidity.


Globally, improving water, sanitation and hygiene has the potential to prevent at least 9.1 per cent of the disease burden, or 6.3 per cent of all deaths. iii


Women and children spend millions of hours each year fetching water. The chore diverts their time from other important activities (for example attending school, caring for children, participating in the economy, relaxation). 
Water and sanitation interventions are cost effective across all world regions. These interventions were demonstrated to produce economic benefits ranging from US$5 to US$46 per US$1 invested.iv Investment in hygiene promotion, sanitation and water services is also among the most cost-effective ways of reducing child mortality.v

Principal transmission routes of disease

Water based disease transmission by drinking contaminated water is responsible for significant outbreaks of faecal-oral diseases such as cholera and typhoid and include diarrhoea, viral hepatitis A, cholera, dysentery and dracunculiasis (Guineaworm disease).

Water-washed disease occurs when there is a lack of sufficient quantity for washing and personal hygiene, which facilitates, among others, the spread of skin and eye infections e.g. trachoma).

Diarrhoea is the most important public health problem affected by water and sanitation and can be both waterborne and water-washed. Hygiene promotion which includes the simple act of washing hands with soap and water can prevent one third of diarrhoeal disease and is therefore key in the prevention of waterborne diseases.

New challenges

During the last decade, new problems that are driven by environmental concerns and socio-economic aspects have emerged.


Most frequent diseases related to poor water supply and sanitation

Diarrhoea: Diarrhoeal disease accounts for the deaths of approximately 2,000xii children every day.

Intestinal worms (Helminths): Worldwide, these soil-transmitted parasites infest more than one billion people due to a lack of adequate sanitation.vi Depending upon its severity, infestation leads to malnutrition, anaemia, retarded growth, and diminished school performance.

Trachoma: Blinding trachoma is hyperendemic in many of the poorest and most remote rural areas in 57 countries of Africa, Asia, Central and South America, Australia and the Middle-East. Overall, Africa is the most affected continent: 27.8 million cases of active trachoma (68.5% of all cases globally) occur in 28/46 countries in the African Region.vii Trachoma affects about 84 million people of whom about 8 million are visually impaired.viii Studies found that providing adequate water supply could reduce the infection rate by 25%.

Schistosomiasis: Schistosomiasis is a chronic disease caused by parasitic worms. Over 230 million people require treatment for schistosomiasis yearly. The number of people treated for schistosomiasis rose from 12.4 million in 2006 to 33.5 million in 2010.ix Studies found that adequate water supply and sanitation could reduce infection rate by 77%.

Cholera: Cholera is an acute diarrhoeal disease that can kill within hours if left untreated. There are an estimated 3–5 million cholera cases and 100 000–120 000 deaths due to cholera every year.x Cholera is a world-wide problem, especially in emergency situations, that can be prevented by access to safe drinking water, sanitation and good hygiene behaviours.

Expanding agriculture and manufacturing business not only increasingly use water but also contribute to pollution of valuable sources of surface and ground water. The over-extraction of water by industry has led to a reduced water table in parts of the world.


Climate change is likely to lead to increased water stress, meaning that drinking water requirements will face increasing demand from competing uses of water such as agriculture and industry. An increased prevalence of extreme weather events and climate-related natural disasters could result in greater loss of functioning infrastructure.xi


Problems of contamination of water supplies with naturally occurring inorganic arsenic, in particular in Bangladesh and other parts of South Asia, or fluoride in a number of countries, including China and India, have affected the safety of water supplies.


For more details on the water environment and its problems and challenges, please visit the UNICEF website.



i Eradicate extreme poverty and hunger; achieve universal primary education; promote gender equality and empower women; reduce child-mortality; improve maternal health; combat HIV and AIDS, malaria and other diseases; ensure environmental sustainability and develop a global partnership for development.


ii UN Water, Tackling a Global Crisis: International Year of Sanitation 2008, 2008 (http://esa.un.org/iys/docs/IYS_flagship_web_small.pdf)


iii A., Bos, R., Gore, F. & J. Bartram, Safer water, better health: costs, benefits and sustainability of interventions to protect and promote health. Prüss-Üstün, WHO, 2008 (http://whqlibdoc.who.int/publications/2008/ 9789241596435_eng.pdf)


iv Hutton G, L Haller, & J. Bartram, ‘Global cost-benefit analysis of water supply and sanitation interventions’. Journal of Water and Health 2007:5.4;481-502, 2007 (http://www.iwaponline.com/jwh/005/0481/0050481.pdf)


v Gunther, I., & G. Fink, ‘Water and sanitation to reduce child mortality : the impact and cost of water and sanitation infrastructure’, Policy Research Working Paper 5618, The World Bank Development Economics Prospects Group, Washington D.C., 2011.


vi World Health Organization. Soil-Transmitted Helminths. (http://www.who.int/intestinal_worms/en/index.html) Accessed Feb 29, 2012.


vii World Health Organization. Trachoma. (http://www.who.int/gho/neglected_diseases/trachoma/en/) Accessed Feb 29, 2012.


viii World Health Organization. Priority Eye Diseases. (http://www.who.int/blindness/causes/priority/en/index2.html) Accessed Feb 29, 2012.


ix World Health Organization. Schistosomiasis. (http://www.who.int/mediacentre/factsheets/fs115/en/index.html) Accessed Feb 29, 2012.


x World Health Organization. Cholera. (http://www.who.int/mediacentre/factsheets/fs107/en/index.html) Accessed Feb 29, 2012.


xi WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, Drinking Water: Equity, safety and sustainability – 2011 Thematic Report, 2011 (http://www.wssinfo.org/fileadmin/user_upload/resources/report_wash_low.pdf)


xii Derived from CHERG, 2012 and IGME, 2012.


xiii Using attributable fraction from Global Burden of Disease, 2001.