The rapid urbanization if our planet, which began in the 19th century, is one of the most notable changes in modern times. While in 1950, 29% of the population lived in cities, that figure is estimated now in 50% and by 2030 that proportion will be 61%. In Africa, urbanization has followed a similar trend: it experienced a rapid shift from 15% in 1950 to 41 percent now. It is estimated that by 2030 54% of the population in that continent will be living in cities. Not only are more people living in cities but the cities themselves are becoming larger and more numerous. This situation poses unique problems related to the provision of water, sanitation and a healthy environment.
There are now 43 cities in Africa with populations of more than 1 million inhabitants. It is expected that by 2015 there will be 70 of them. Because of slow economic growth, lack of effective development policies and limited resources, infrastructure development has not kept up with the increasing needs for shelter and services in growing urban populations. At the same time, urban settlements in the developing countries are growing five times as fast as those in the industrialized countries.
This explosive growth of urban populations has resulted in African cities having overcrowded, informal settlements characterized by inadequate housing and poor infrastructures such as water supplies, sanitation and waste management services. This is the result, in part, of the fact that most cities, both in developed and developing regions are experiencing a polarization of their populations into affluent and poor neighborhoods. Modern trends are towards segregation rather than social integration between rich and poor neighborhoods.
This is the case for many African cities, where local governments have been unable to keep with the pace of change and as a consequence have also been unable to provide dwellers with proper infrastructures related to the provision of water and the collection, transportation, processing and disposal of waste materials.
In developing countries with economies under stress, waste management is a problem that often endangers health and the environment. However, it is a low priority problem for governments often besieged by other problems such as poverty, hunger, children’s malnutrition, water shortages, unemployment and even war. In that regard, fast-growing population, increasing poverty and its effects on living conditions are some of the problems facing cities in the developing world.
Water supply, sanitation and health are closely related issues. Poor hygiene, inadequate management of liquid or solid waste and lack of sanitation facilities are contributing factors in the death of millions of people in the developing world due to diseases that are easily preventable. In addition, people living in un-serviced or poorly serviced areas value the increased convenience and privacy associated with improved sanitation.
For example, lack of sanitation and inadequate disposal or storage of waste near houses can provide habitats for vectors responsible for several infectious diseases such as amebiasis, typhoid fever and diarrheas. Uncontrolled and inadequate landfills, for their part, are a big danger to the environment and a health risk to the population since they may lead to contamination of water and soil. The health risks associated with poor sanitation tend to be higher in densely populated low-income urban areas. At a global level, more than 5 million people die each year from diseases related to inadequate waste disposal systems.
Contamination of water leads to a whole range of diarrheal diseases such as cholera that kills 1.8 million people worldwide. An estimated 90 percent among them are children below five, mainly from developing countries. Most of the burden can be attributed to unsafe drinking water, inadequate sanitation and poor hygiene practices.
The children that are affected the most are those living in low-income urban areas. According to UNICEF, Infant Mortality Rates (IMRs) are almost always higher in poor urban areas than the national average and than those in rural areas. A great proportion of this high mortality among the children of the urban poor can be attributed to diseases common in urban areas such as diarrhea, tuberculosis and parasitic diseases (intestinal worms) that are frequently associated with lack of safe water and sanitation. Malnutrition in children is often a complicating factor.
Germs, particularly those present in water, food or on dirty hands are the most frequent cause of sickness worldwide. Although lack of safe water and sanitary facilities are significant problems, they are made even worse by ignorance in the general population, particularly mothers, about the connection between dirt, germs and childhood diarrhea.
Also, experience has shown that provision of clean water by itself only leads to minor health improvements. The most important factor is personal hygiene, with adequate public sanitation and clean water as additional, supporting components. Thus, while each of these factors is important in itself, they are more effective when they are combined. At the same time, hygienic behavior is not possible without a source of safe water and adequate means to dispose of human and other wastes.
Several naturally-occurring and human-made chemical substances present in drinking water can have a serious effect on health, particularly when present above a threshold level. Among chemicals that can be dangerous in high concentrations are fluoride, arsenic, lead, cadmium, mercury, nitrates and pesticides.
All these factors stress the need to carry out policies that ensure the provision of safe water to the population, particularly in marginal areas lacking basic health and social services.
These comments are particularly appropriate when one reflects on the fact that Africa has the lowest water supply and sanitation coverage of any other region in the world. It is estimated that 1 in 3 Africans have no access to improved water or to sanitation facilities. Even more seriously, the number of people lacking those basic services is increasing. Unless actions are taken now, the absolute number of people lacking basic services will increase from 200 million in 2000 to 400 million in 2020. The majority of those lacking basic services live in informal or suburban areas and rural communities.
In the last 2 decades, Benin has reported significant gains in terms of sanitation coverage and better access to drinking water. Thus, improved sanitation coverage increased from 12% in 1990 to 30% in 2006, while the proportion of the population that gained access to an improved water source increased by 37% since 1990.
According to the Mid-term review of Progress in Reaching Objectives in A World Fit for Children, considerable progress has been made in the field of provision of safe drinking water, particularly in rural areas in that country. This was possible thanks to Government funds and important external support, as well as to a decentralization process that transferred some responsibilities to the local authorities.
According to the same document, although there have been improvements in basic sanitation the degree of improvement is still very low. Among the components still needed to improve the situation are financial support as well as hygiene and communication components aimed at provoking behavioral change, particularly hand-washing as a way to eliminate the transmission of infections from fecal matter.
Despite progress, however, many Sub-Saharan countries will find it difficult to reach the Millennium Development Goals (MDGs) set for 2015, particularly the MDG 7 which stipulates to halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation.
This is evident when, according to the German Technical Cooperation (GTZ), “Today, it is becoming more and more evident that, in many Sub-Saharan African countries, official data on MDG progress in the area of water and sanitation do not reflect the real situation in the ground. In urban and presumable also in rural areas, coverage is overestimated which, as a result, means that the gaps to be bridged are underestimated.”
The Sustainable Sanitation Alliance has defined a set of conditions to address shortcoming of previous efforts to improve sanitation. Among those conditions to be addressed are the following:
* Capital-intensive solutions tend to be costly, energy-intensive and inflexible, failing to reach large proportions of the new slum poor.
* Importing sanitation models from the industrialized world and trying to implement centralized ‘one-size-fits-all’ solutions is in many cases neither appropriate nor sustainable. Planning approaches must be adapted to better allow for the planning and implementation of context-specific sanitation systems.
* Among recent innovations in sanitation planning are a more integrated planning approach (strategic sanitation planning), and a greater emphasis on the actual needs and means of the users encompassing close consultation with all stakeholders.
* We need to overcome the lack of integration between the various components of environmental sanitation: excreta, domestic and industrial waste-water, solid waste and storm water which are often run by separate agencies or institutions. Better use of synergies can lead to more sustainable and cost-effective solutions.
* To achieve adequate sanitation it is necessary to convince local authorities, utilities and donors that there should be effective commitment and participation by all stakeholders.
Several of these conditions are also applicable to improving the provision of safe water. In both cases, it is important to provide incentives for good practice. One such incentive could be increased financial aid to municipalities that succeed in implementing effective sanitation and safe water programs.
It is also important to move from implementing strategic planning process in a pilot municipality to disseminating results (through workshops, publications, exchange visits), followed by changes in legislation and procedures as necessary to replicating the process on a wider scale.
According to Hans van Damme, a special adviser to the Water Supply and Sanitation Collaborative Council, the constraints for improvement are neither financial nor technical –they are political, social and managerial. At the same time, local authorities have to empower people through self-reliance and support individuals and families in their efforts. At the same time, water-sector professionals should combine their technical skills with the ability to communicate those they serve.
Better water and sanitation services can improve everybody’s health and well-being, particularly women and children. The seriousness with which we approach this task will be a measure of our commitment for building communities better prepared to face the challenges related to their need for having better access to potable water and adequate sanitation.
- In this blog series, Dr. Cesar Chelala explores the many challenges presented by urbanization, the impact of urban migration, challenges to health, and challenges of providing clean water. - Ed.
Dr. Cesar Chelala is an international public health consultant.