Clarissa Brocklehurst

Global Monitoring of Water Supply and Sanitation: History, Methods and Future Challenges

International monitoring of drinking water and sanitation shapes awareness of countries’ needs and informs policy, implementation and research efforts to extend and improve services. The Millennium Development Goals established global targets for drinking water and sanitation access; progress towards these targets, facilitated by international monitoring, has contributed to reducing the global disease burden and increasing quality of life. The experiences of the MDG period generated important lessons about the strengths and limitations of current approaches to defining and monitoring access to drinking water and sanitation. The methods by which the Joint Monitoring Programme (JMP) of WHO and UNICEF tracks access and progress are based on analysis of data from household surveys and linear regression modelling of these results over time. These methods provide nationally-representative and internationally-comparable insights into the drinking water and sanitation facilities used by populations worldwide, but also have substantial limitations: current methods do not address water quality, equity of access, or extra-household services. Improved statistical methods are needed to better model temporal trends. This article describes and critically reviews JMP methods in detail for the first time. It also explores the impact of, and future directions for, international monitoring of drinking water and sanitation.

Continuity in drinking water supply.

The benefits of having a continuous, piped supply of safe drinking water delivered to household premises are widely recognised. Piped supplies on premises not only reduce the time and effort required to collect water, and thereby increase the amount of water available for personal and domestic needs but also are more likely to provide water that meets required standards for drinking water quality. A recent systematic review of drinking water quality [1] confirmed that piped water supplies are less likely to be contaminated than other types of “improved” sources, such as hand pumps, protected wells, and springs. However, continuity of piped supplies—that is, the uninterrupted supply of water—and the associated health impacts, are under-studied. Two papers in this issue of PLOS Medicine each shed light on a particular aspect of continuity and are a very welcome addition to the literature. Jeandron and colleagues [2] show that in the city of Uvira, in the Democratic Republic of the Congo, there was a significant relationship between interruptions in the piped water supply and cases of suspected cholera. This association was seen even though many in the city used piped services indirectly (that is, they did not have household connections and used water from standposts and shared connections). The interruptions in the piped water supply thus represented a lost opportunity to protect a cholera-vulnerable population. In Hubli-Dharwad, in the state of Karnataka in India, Ercumen and colleagues [3] show that while upgrading the piped supply to provide continuous service for 10% of the population was associated with a notable reduction in typhoid among the poor in the beneficiary group, they did not find the expected decrease in diarrhoeal diseases. The paper suggests a number of possible reasons, including unhygienic storage of water due to the use of yard taps rather than taps in the house; the perceived threat of supply interruptions; heavy contamination of the immediate household environment due to widespread open defecation among children; and the continuing presence of open sewers. It is notable that the research in India found a strong relationship between the continuity of the supply and quality of the water delivered. Among water samples taken from households receiving a continuous supply, less than 1% did not comply with WHO guidelines for drinking water quality, compared with over one-third of samples in households that did not benefit from improvements and still had intermittent supply. The importance of continuous piped supply to households in order to protect health is clear. This link is not surprising given the engineering reality—that maintaining continuous positive pressure in a piped network and avoiding negative pressure at all costs prevents infiltration of contaminated soil water [4]. Continuous supply also removes the need to store water and makes water readily available for hygiene, such as handwashing. From a public health policy point of view, ideally, households should have continuous water supply, treated with chlorine, piped directly into the house, with accompanying improvements in the sanitary environment. For this reason, a new benchmark has been proposed to be included in the indicators used for monitoring progress towards the Sustainable Development Goals adopted by the United Nations (UN) General Assembly in September 2015. The new term “safely managed drinking water services” is proposed as the highest level of service countries should aspire to reach, and refers to a source of drinking water that is on premises, available when needed (that is, in the case of piped supplies, continuous), and free of faecal and priority chemical contamination. This represents a significant step up from the highest level of service used in monitoring during the period of the Millennium Development Goals: “improved drinking-water source,” which did not include measures of distance to the home, quality or continuity of water supplied, and included off-premises sources such as hand pumps, dug wells, and springs. Reaching this new benchmark at a global scale is undoubtedly ambitious. However, monitoring data [5] show it is not impossible. During the last 25 years, coverage of piped water on premises increased from 44% to 58% globally, so now well over half the world’s population benefits from this level of service. In those countries designated as developing countries by the UN, the use of piped water on premises has grown even faster, from 31% in 1990 to an estimated 49% in 2015, representing an additional 1.7 billion people with piped water connections. Progress in some regions has been even faster, and in Eastern Asia the number of people with piped water on premises skyrocketed from 30% to 74%, mostly as a result of rapid increases in China. Continuous, treated, piped supply to every household should be our ambition, even though achieving it may be many years in the future, and in many settings, interim arrangements with lower levels of service are going to be the reality. However, many countries have decided providing piped supply is worth the investment, and innovations are being rolled out in many places to find robust, inexpensive ways to provide this service in an affordable way. The studies in this issue of PLOS Medicine highlight the importance of continuous piped water supply, but also the pitfalls. Interruptions in the supply can negate the possible health benefits, and installing piped water without addressing other environmental concerns may not deliver the hoped-for health benefits. It must not be forgotten that piped water supplies require more than just infrastructure; good governance and competent management are needed to ensure continuous service.

Designing water-pricing policy, tariffs and subsidies to help the poor

The structure and level of water tariffs have a great impact on the poor – as well as on the sustainability and coverage of water utilities. This article explains how, and suggests that subsidies n...

Policy review of the means of implementation targets and indicators for the sustainable development goal for water and sanitation

The Sustainable Development Goals, adopted by the Member States of the United Nations in September 2016, contain both ‘Outcome’ and ‘Means of Implementation’ targets. However, there is generally weak evidence linking the Means of Implementation to outcomes, they are imperfectly conceptualised and inconsistently formulated, and tracking their largely qualitative indicators will be difficult. In this paper, we analyse and critique the Means of Implementation targets of the Sustainable Development Goal on water and sanitation (SDG6). Improvements are recommended that would reflect: the considerable investment needed to attain SDG6; the important role of the state, including government leadership and planning; the utility of disaggregating financial and capacity-building assistance; and the need for people to realise their rights to information, voice and remedy. Recommendations are also made for relevant indicators, including indicators that are applicable to governments in both aid-providing and aid-receiving countries.

Editorial: China–Africa relations

This issue of Waterlines examines three very different themes: the involvement of China in the water and sanitation sector in Africa; the performance of rural water supplies delivered by handpumps; and the question of how to pay – and who should pay – for the full costs of water services.

The 2014 Sanitation and Water for All High Level Meeting: what does it tell us about how developing countries are tackling inequalities?

The 2014 High Level Meeting (HLM), held on 11 April 2014 in Washington, DC, was the largest meeting the Sanitation and Water for All partnership has yet convened. It was attended by 42 developing countries, 12 donors, and four development banks, as well as senior representatives from UN agencies and civil society. Twenty developing countries were represented at the level of their minister of finance, and in addition, 35 ministers responsible for water and sanitation attended. At SWA HLMs, developing countries and donor partners present commitments designed to overcome the barriers holding back progress towards universal access. In April 2014, 43 countries prepared and tabled more than 300 commitments. An analysis was carried out to examine responses to the call for commitments that specifically targeted inequalities, revealing that 26 countries, 60 per cent of those that tabled commitments, made 46 commitments that could be considered to address inequalities, either through direct intervention or strength...

Strategic sanitation planning – it's all very well, but . . .

The Strategic Sanitation Approach offers a conceptual model of sanitation development, but how useful is it in practice? A pilot project in Bharatpur, India has been trying to answer this, and two years after its inception some important lessons have been learned.