The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations. Final boundary between the Republic of Sudan and the Republic of South Sudan has not yet been determined. *Dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties.
The world has missed the MDG sanitation target by almost 700 million
The world has missed the MDG sanitation target by almost 700 million
Source: WHO/UNICEF JMP Progress on Sanitation and Drinking Water: 2015 Update and MDG assessment
Universal access to adequate sanitation is a fundamental need and human right. Securing access for all would go a long way in reducing illness and death, especially among children. Since 1990, 2.1 billion people have gained access to an ‘improved’ form of sanitation, such as flush toilets or latrine with a slab. This means that, in 2015, 68 per cent of the global population was using such facilities – an impressive accomplishment but still far from the 2015 Millennium Development Goal target, which has been missed by nearly 700 million people. In 2015, 2.4 billion people still lack an improved sanitation facility and among them almost 950 million people still practised open defecation. The data reveal pronounced disparities, with the poorest and those living in rural areas least likely to use an improved sanitation facility. Questions also remain about the full sanitation chain (containment, emptying, transport and treatment) and whether excreta are safely reused or returned to the environment.
Gains in access to improved sanitation since 1990 have varied substantially between regions and only four developing regions met the MDG target by halving the proportion of the population with improved sanitation facilities. Progress has been particularly remarkable in Eastern Asia and Southern Asia, where coverage of improved sanitation has increased by at least 25 percentage points since 1990. In contrast, gains have been more moderate in sub-Saharan Africa and Oceania – the two regions where coverage remains below 40 per cent.
COVERAGE BY COUNTRY
Despite encouraging progress on sanitation, much unfinished business remains from the MDG period. In addition to the shortfall against the global target, large disparities in access still exist. Almost all developed countries have achieved universal access, but sanitation coverage varies widely in developing countries. Since 1990 the number of countries with less than 50 per cent of the population using an improved sanitation facility has declined only slightly, from 54 to 47, and countries with the lowest coverage are now concentrated in sub-Saharan Africa and Southern Asia.
Open defecation refers to the practise of defecating in fields, forests, bushes, bodies of water or other open spaces. Defecating in the open is an affront to dignity and risk to children’s nutrition and to community health. During the MDG period, the elimination of open defecation has been increasingly recognized as a top priority for improving health, nutrition and productivity of developing country populations.
Open defecation rates have been decreasing steadily since 1990, and it is estimated that fewer than one billion people (946 million) now practise open defecation worldwide. Two thirds live in Southern Asia, nearly three times as many as in sub-Saharan Africa. However, the number of people practising open defecation in Southern Asia has declined only moderately, from 771 million in 1990 to 610 million in 2015, a reduction of just 21 per cent (Fig. 4). During the same period the number of people practising open defecation has actually increased in sub-Saharan Africa, and the region now accounts for a greater share of the global total than in 1990. All other regions recorded a reduction in open defecation in population terms between 1990 and 2015. Greater efforts are needed in order to ensure the availability and use of adequate sanitation facilities.
DISPARITIES BETWEEN RICH AND POOR
There is a strong relationship between wealth, as measured by household assets, and use of improved sanitation facilities. In many countries increases in rural coverage have not been equitably distributed with the wealthy gaining most of the benefits. Figure 5 shows improved sanitation coverage for each wealth quintile in both rural and urban areas. Each country is represented by a vertical set of five dots arranged according to average coverage for that country. The vertical spread of the dots shows the extent to which coverage varies between the richest and the poorest quintiles in each country. The differing patterns of dots also highlight variations in the relative gaps between the richest, fourth, middle, second and poorest quintiles. These data demonstrate the extent to which the poorest continue to be disadvantaged – especially in urban areas – and that in many countries they have not benefitted from gains in sanitation coverage.
MONITORING THE SANITATION CHAIN
JMP monitoring during the MDG period has focused primarily on the public health impacts of sanitation. A sanitation facility is considered improved if it hygienically separates human excreta from human contact, but this indicator does not address the subsequent management of faecal waste. Safe management comprises several stages along the ‘faecal waste management chain’, from containment through emptying, transport, treatment, and reuse or disposal.
A new Global Integrated Monitoring Initiative is being developed to monitor elements of sustainable water and sanitation management that were not previously covered under MDG monitoring. The JMP is collaborating with this initiative on the development of a mass-balance framework for monitoring and classifying faecal waste flows as ‘safe’ and ‘unsafe’ for different purposes. As shown in the schematic, a key starting point is determining how many people use different broad classes of sanitation (sewerage, septic tanks, pit latrines and open defecation) – information that can be obtained from surveys included in the JMP database.
The world has made great strides in increasing access to drinking water and sanitation for billions of people but progress has been uneven.
This joint WHO/UNICEF report documents the gains that have been made since 1990 and highlights substantive disparities such as those between regions, rural and urban areas and for marginalized groups.
Looking back on 25 years of water, sanitation and hygiene monitoring, the report provides a comprehensive assessment of progress since 1990. The MDG target for drinking water was achieved in 2010 but the world has missed the sanitation target by almost 700 million people. In 2015, 663 million people still lack improved drinking water sources, 2.4 billion lack improved sanitation facilities and 946 million still practice open defecation.
WHO/UNICEF JOINT MONITORING PROGRAMME FOR WATER SUPPLY AND SANITATION
Since 1990, WHO and UNICEF have tracked progress on global water and sanitation goals through the Joint Monitoring Programme for Water Supply and Sanitation (JMP). The JMP monitors trends in coverage; helps build national monitoring capacity in developing countries; develops and harmonises questionnaires, indicators and definitions to ensure comparability of data over time and among countries; and informs policymakers of the status of the water supply and sanitation sector through annual publications. The JMP draws guidance from a technical advisory group of leading experts in water supply, sanitation and hygiene, and from institutions involved in data collection and sector monitoring. Further information about the JMP and its methodology can be found at the JMP website.
The JMP estimates for handwashing are based on information collected in household surveys such as Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS). Household surveys are usually conducted by national institutes of statistics, carried out by trained national staff who collect information on a wide range of health and living conditions through face-to-face interviews. Nationally owned and independently verifiable, these data sources provide national governments with a periodic update of the status and progress with respect to handwashing. Increasingly household survey data allow for assessing disparities in access by marginalized populations and geographic areas.
DEFINITION OF HANDWASHING FACILITIES WITH SOAP AND WATER
The presence of soap and water at a designated place is used a proxy for handwashing behaviours. Households are considered to have access if enumerators observe a place for handwashing and both water and soap are available.