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Cities in the developing world are paying a high price for their failure to provide water and sanitation services to all. Cities need smart investments in design and delivery of basic services.

On July 30, seven states in Northern India went completely dark. A catastrophic power failure brought commerce and daily life to a complete halt. But that was not all. On a scorching hot summer day, the main water stations in New Delhi also shut down, leaving nearly 17 million people with dry taps.

Although such urban water shortages make headlines, most people in cities are not so bad off. According to the Joint Monitoring Programme of UNICEF and the World Health Organization (WHO), almost 96 percent of the world’s urban population uses an improved source of water such as a pipe, covered well or borehole, compared with 81 percent of the rural population. In real numbers, this amounts to 653 million people in rural areas who still get their drinking water from unimproved sources such as lakes, rivers and ponds or from unregulated small vendors and tankers.

But these figures hide a couple of interesting stories: First, the number of people in rural areas who are using safer water is actually improving, and second, the number of people in urban areas who are using unsafe water is rising. Between 1990 and 2010, the number of urban residents who lacked access to safe water rose from 109 million to 130 million. The sanitation picture is even grimmer. Although, in the aggregate, urban areas are far ahead of rural ones in terms of access to sanitation, the situation in most cities in the developing world is far from satisfactory. While 724 million rural people gained access to sanitation in the last decade, the number of urban residents without improved sanitation grew by 183 million. Many of these are among the poorest in the world—living at or below the poverty line in informal settlements with few social and environmental services.

Paying the Price for Poor Services

In some of the largest slums in the world—Dharavi in Mumbai, Kibera in Nairobi, CitŽ Soleil in Port-au-Prince—hundreds of thousands live in crowded shanties, arranged around dirt tracks and open drains. They fetch water from public taps, hand pumps or nearby rivers, connect illegally to the main water supply with their own plastic pipes or wait for private water vendors who sell water by the bucket. They share toilets with other households, rely on public toilets that are often inaccessible for parts of the day and at night, and relieve themselves in open streams and ditches. Contaminated water and food cause disease outbreaks that have long been forgotten in the West and sicken hundreds of thousands of people.

According to WHO, unclean water is the cause of 1.8 million deaths from diarrhea each year—1.6 million of those dying are children under age 5. Every year, there are hundreds of thousands of cases of cholera, which is synonymous with dirty water and absent sanitation. Public health experts have suggested that forecasting and treating infectious disease outbreaks will become an even greater challenge as urban density increases in areas where basic services such as water, sanitation and solid waste disposal are hard to come by.

The absence of reliable services has other costs too. Ironically, the poor often pay more for their water than do those with household taps. The cost in time spent is also great. Women and children organize their days around fetching and storing water. In one Delhi slum, women said they used four separate water sources to satisfy their daily needs: the municipal tap, a dug well, tankers and an open drain.

Finding a clean and safe toilet presents greater challenges. The sanitation service delivery chain is broken at every point—from the availability of affordable latrines to the collection, treatment and disposal of fecal matter. Crowded living quarters and the high cost of installing and maintaining toilets are two reasons households cannot or do not invest in toilets. Millions rely on communal or public toilets that are poorly maintained and lack basic supplies such as toilet paper, water and soap. As urban populations grow, the numbers of people using shared facilities is also growing, especially in Sub-Saharan Africa. In cities such as Kumasi, Ghana, each public toilet serves close to 1,000 people daily, and people pay to visit each time.

Because the majority of unauthorized settlements lack basic wastewater management, most toilets are not connected to sewers. Waste is collected in underground tanks and emptied manually or by small trucks with pumps. Tanks are not emptied regularly, and human waste often overflows from them onto nearby land and waterways.

Poor services also have huge environmental costs. In India, only half to 80 percent of wastewater from large cities is treated at all. In Africa, less than 1 percent of wastewater is treated at the secondary level to remove more than just coarse suspended solids such as visible garbage and dirt. A World Bank study has calculated that water pollution attributed to poor sanitation has economic costs approximating $2.3 billion each year in Cambodia, Indonesia, the Philippines and Vietnam. Additional hundreds of millions of dollars are lost when land becomes too polluted for economic use. The combined costs of disease, declining productivity, environmental degradation and foregone tourism income amount to tens of billions of dollars lost across the developing world.

Policy Implications for the Developing World

More than half the world’s population lives in what are classified as urban areas. By 2025, another 1.2 billion will live in urban areas almost entirely in developing countries. Large numbers will move to established and new unplanned settlements in megacities that have traditionally received and become home to rural migrants. Many more will settle in what are now secondary or medium-sized cities such as Baranquilla, Colombia; Harbin, China; and Surat, India. According to estimates by U.N.-Habitat, almost a billion people already live in slums. While these slums continue to grow, new ones will crop up around larger cities and in what are now small towns.

The challenge in the next 50 years will be to provide water and sanitation services in areas that expand and contract with incoming and outgoing waves of migration, where large portions of the population lack basic land rights, property titles and regular sources of income, and where prior records of poor service delivery have created vicious cycles of underpayment of tariffs, underfunded municipal providers and unreliable services. Likely to top the policy agenda: questions of disparity in access; appropriate technology; budgeting for the real cost of maintenance, repair and upgrading; the role of local and international business partners; and the responsibility of international players, including bilateral and multilateral aid agencies and the nonprofit sector. Both financial and environmental sustainability will have to be considered as solutions are sought for already water-stressed regions.

First, governments must understand who pays how much and for what level of service. The poorest may be the ones with the least access to public utilities, but reducing tariffs does nothing to increase access when their homes are not connected to municipal systems. However, millions of households that are not among the poorest may pay some tariff for a low level of service. The most successful examples of improving service provision have come from cities such as Phnom Penh in Cambodia. There the utility and customers have reached a common understanding of the cost and quality of the service that will be provided, and the barriers and costs related to connecting to the provider have been lowered. Without transparent contracts, the underpayment (or nonpayment) and poor service cycle will continue unabated. Whether services are provided directly by government agencies, contractors or independent entities, consumers and providers should have clear and transparent obligations to each other.

Second, the lifetime costs of delivering services—not just the up-front capital costs of new infrastructure—should guide investment decisions. Millions of dollars are wasted when precious infrastructure becomes entirely unusable or renders a substandard service because of disrepair. In cities across the developing world, only a fraction of the municipal water supply actually reaches the consumer. The rest is termed “unaccounted-for water” and is lost to leakages caused by damaged pipes and theft. Wastewater treatment plants work at less than full capacity because of power cuts, missing and broken parts, or because they are overwhelmed and treat far less sewage than enters the pipes. Maintenance and repair of existing systems may be a more cost-effective way of reaching additional people than creating new infrastructure.

Third, it is time for new water and sanitation technologies to be developed, tested and marketed. Unfortunately, water and sanitation investments today look by and large as they did two centuries ago. The extensive water and sewage networks created in the West took decades to construct and expanded as cities grew slowly. The speed and extent of the demographic transformation in developing countries is unprecedented. The Asian Development Bank estimates it took 150 years for Europe to go from 9 to 51 percent urban population. In contrast, the urban population of China will increase from 11 to 51 percent in 61 years. Creating sophisticated water and sewage networks requires time as well as billions of dollars and substantial investments in roads, housing and electricity. Further, when water is already at a premium, many contend that using it to flush toilets is wasteful and shortsighted. In these countries, decentralized wastewater treatment and on-site sanitation products that may have smaller up-front and long-term costs might be good solutions. The Bill and Melinda Gates Foundation’s initiative to “reinvent the toilet” has brought much-needed attention to on-site sanitation technologies that could be implemented on a large scale through innovative alliances among international and local researchers, investors and businesses.

Fourth, international development agencies and philanthropies that provide millions of dollars to improve water and sanitation systems in developing countries must agree to transparent monitoring and reporting standards. In this regard, the water and sanitation sector has much to learn from other sectors, which have done a better job of developing indicators of success and failure, monitoring progress, and encouraging learning and innovation. When water and sanitation schemes fail, they do more than just waste resources; they help perpetuate inefficiencies and cycles of mistrust that are hard to break.

Finally, citizens, planners, engineers, businesses, and political and community leaders all play an important role in designing and delivering services. The traditional model of a large publicly managed utility serving organized businesses and houses off a grid-based network cannot serve the densely populated small settlements that dot the urban landscape in developing countries. Already, small businesses run kiosks that supply safe water to hundreds of thousands in East Asia’s cities, and new partnerships between large international businesses and nongovernmental organizations market affordable sanitation options to households. While it is the responsibility of national and local governments to ensure that basic services are available for all citizens, it is time to reconsider how they will partner with businesses and communities to meet this challenge.

In the 21st century, it seems unimaginable that such a large swath of humanity could be without the basic water and sanitation services that much of the world takes for granted. Yet for many of the nearly 15 million who move to urban areas in the developing world each month, access to safe, reliable and affordable water and sanitation remains out of reach. Smart investments in water and sanitation make people healthier, communities stronger, and cities safer and more productive. The challenge and the promise of urbanization lie in being able to address these issues equitably and sustainably.


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