1.3 Contribute to hygiene and health through water and sanitation

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Priority for Action 1.3
“Contribute to hygiene and health through water and sanitation”
Coordinator: World Health Organisation (WHO)
Core group members
United Nations University – Institute for Water, Environment and Health
Académie de l'Eau
SARAR Transformacion


It is estimated that almost 10 % of the global burden of disease is associated with lack of access to adequate sanitation and safe drinking-water, of proper hygiene and of effective water management1. More specifically, diarrhoea is estimated to kill almost 2.4 million children under five every year2. This largely preventable burden affects not only individuals and families, but puts a burden on health care systems and economic productivity. In Africa alone, it is estimated that economic losses due to the lack of water and sanitation represent approximately 5 % of annual GDP (US$ 28.4 billion)3. Equity is a major cross-cutting issue in this context, and adverse impacts disproportionately affect women and female children as providers and carers within the household.

Improvements in sanitation have been demonstrated to reduce child mortality by more than 30 %4 and overall morbidity by almost 37 %5, especially when in combination with improved water supplies and handwashing with soap6,7. Improving access to safe water and basic sanitation has direct implications for better health, as it leads to the interruption of the transmission pathways for many gastro-intestinal and other infectious diseases. Furthermore, such access in the family home or community increases the likelihood of hygiene practices such as handwashing with soap. Without a convenient supply of adequate quantities of water, hygiene becomes a luxury compared to the need for water for consumption.

In the broader, ecological context, improved management of water resource and their use in agriculture, dams and urban drainage has a significant potential to reduce vector-borne diseases such as malaria, dengue and schistosomiasis.

It is essential to understand the linkages between water, sanitation, environment, hygiene and health in order to ensure sustainable practices that reduce transmission of these diseases in a local context. Moreover, handwashing with soap is a critical barrier in transmission of all infectious diseases (for example: influenza8), not just those related to contamination of water and food. Finally, it is impossible to ignore the broader health impacts associated with a lack of adequate water and sanitation, such as child malnutrition9.

Key elements of ensuring awareness and understanding of the benefits to health associated with improved water and sanitation include education, communication, applied research and development of the evidence base. This Priority for Action sets out targets to achieve these key elements through a focus on:

  • Developing modular education programmes for a variety of stakeholders;
  • Promoting national implementation of water safety frameworks;
  • Rolling out water safety plans and sanitation safety plans at the local scale;
  • Ensuring reporting of expenditures and funding flows within the WaSH sector;
  • Undertaking applied research to support evidence-based decision-making;
  • Facilitating uptake of household water treatment and storage through national policies; and,
  • Developing an integrated approach for cholera prevention.


1 Prüss-Üstün A., Bos R., Gore F. and Bartram J. 2008. Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health. World Health Organization: Geneva. Available from: http://www.who.int/quantifying_ehimpacts/publications/saferwater/en/index.html (Accessed May 2011)
2 UNICEF and WHO. 2009. Diarrhoea: Why children are still dying and what can be done. Available from: http://whqlibdoc.who.int/publications/2009/9789241598415_eng.pdf (Accessed May 2011).
3 UNEP. 2010. Clearing the Waters. Available from: http://www.unep.org/PDF/Clearing_the_Waters.pdf (Accessed May, 2011).
4 Esrey S.A., Andersson I., Hillers A. and Sawyer R. 2001. Closing the Loop. Ecological Sanitation for Food Security. Publications on Water Resources No. 18, SIDA: Stockholm. Available from: http://www.energyandenvironment.undp.org/undp/indexAction.cfm?module=Library&action=GetFile&DocumentAttachmentID=1044 (Accessed April 2009)
5 Bartram J., Lewis K., Lenton R. and Wright A. 2005. Focusing on improved water and sanitation for health. Lancet, 365(9461): 810 – 812
6 Fewtrell L., Kaufmann R.B., Kay D., Enanoria W., Haller L. and Colford J.M. 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis.” Lancet Infectious Diseases 5(1):42–52
7 Zwane A.P. and Kremer M. 2007. What Works In Fighting Diarrheal Diseases In Developing Countries? A Critical Review. The World Bank Research Observer Advance Access (May 4)
8 Rabie T. and Curtis V. 2006. Handwashing and risk of respiratory infections: a quantitative systematic review. Tropical Medicine and International Health. 11(3):258–267
9 Bartram J. and Cairncross J. 2010. Hygiene, Sanitation, and Water: Forgotten Foundations of Health. PLoS Med 7(11): e1000367. doi:10.1371/journal.pmed.1000367

TARGET TSG Coordinator(s) Regional Links*
Target 1: By 2015 develop ten modular education programmes, based on harmonized communication strategies, that foster a better understanding of linkages between water, sanitation, hygiene, food security and health to consumers, practitioners, policy/decision-makers and health promoters, and to deliver these programmes in 30 countries by 2018 United Nations University – Institute for Water, Environment and Health

French Water Academy
Target 2: By 2018, 50 countries have incorporated the water safety framework into their national water resources strategies, with a view to ensuring a coordinated and integrated water safety approach for drinking-water, the management and use of wastewater, and the management of recreational waters and water for irrigation

Health Australia

International Water Management Institute

University of Wales

Target 3: By 2021 the practice of water safety and sanitation safety planning will be fully rolled out in 90 middle and lower-income countries, at the policy, regulatory and operational levels, with the establishment of national health-based targets, the quantitative assessment of microbial risks, the implementation of cumulative health risk management and independent quality assessment International Water Association

World Health Organisation
Target 4: By 2015 at least 50% of countries report on total expenditures on water, sanitation and hygiene promotion, that include funding flows from governments, external sources and households, and have developed appropriate platforms for sharing experiences and coordinating actions on this process with the health and education sectors Sanitation and Water for All
Target 5: By 2015 establish 10 solid research projects in parts of the world selected for high water-associated disease burdens on multi-exposure to water contaminants and aquatic environments that by 2018 will have contributed at least 25 peer-reviewed articles to support evidence-based decision-making for managing water to protect health United Nations University – Institute for Water, Environment and Health

French High-Council for Public Health
Target 6: By 2015, 30 additional countries will have established national policies and/or regulations regarding household water treatment and safe storage; by 2018, 50 countries will have reached this target; the scale-up process will be based on a gradual and measurable increase of sound evidence of the public health benefits of this approach World Health Organisation
Target 7: By 2015 an evidence-based integrated approach for the primary prevention of endemic and epidemic cholera will have been anchored in 4 countries of Central Africa, with a major emphasis on ensuring sustainability through water and sanitation infrastructure development. By 2018, this approach will have been replicated in additional African high cholera incidence countries, pending on the ongoing cholera situation in 2015. World Health Organisation

Veolia Foundation
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