Sanitation, drinking-water and health · sanitation facilities, or using open defecation by wealth...

Sanitation, drinking-water and health:Achievements and challenges ahead

© World Health Organization 2017

ISBN 978 92 9061 791 4

Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”.

Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules).

Suggested citation. Sanitation, drinking-water and health: achievements and challenges ahead. Manila, Philippines. World Health Organization Regional Office for the Western Pacific; 2017. Licence: CC BY-NC-SA 3.0 IGO.

Cataloguing-in-Publication (CIP) data. 1. Conservation of natural resources. 2. Drinking water. 3. Hygiene. 4. Sanitation. I. World Health Organization Regional Office for the Western Pacific. (NLM Classification: WC765).

Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing.

For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, Fax. No. (632) 521-1036, email: [email protected]

Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user.

General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use.

For inquiries and request for WHO Western Pacific Regional Publications, please contact the Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, Fax. No. (632) 521-1036, email: [email protected]

iii

Contents

Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .viAcknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viiSummary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .viii1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Justification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 What is being measured? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22. The TWG WSH countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.1 Overview of TWG WSH countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.2 Overall status of sanitation and drinking-water in TWG WSH countries . . . . . 63. Sanitation coverage in TWG WSH countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 3.1 Current status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 3.2 Sanitation inequities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3.2.1 Urban and rural disparities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 3.2.2 Economic and social inequities in sanitation coverage . . . . . . . . . . . . . 134. Drinking-water coverage in TWG WSH countries . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4.1 Current status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 4.2 Drinking-water inequities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 4.2.1 Urban and rural disparities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 4.2.2 Economic and social inequities in drinking-water coverage . . . . . . . . 195. The MDG drinking-water and sanitation target . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 5.1 Achieving the MDG sanitation target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 5.2 Achieving the MDG drinking-water target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226. Sustainable Development Goals and targets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257. Health and economic development in drinking-water and sanitation . . . . . 31 7.1 Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 7.2 Drinking-water and sanitation in health-care facilities . . . . . . . . . . . . . . . . . . . . 33 7.3 The challenge of urbanization in TWG WSH countries . . . . . . . . . . . . . . . . . . . . 34References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

AnnexesAnnex 1. Definitions of the post-2015 terms proposed by the JMP

(WHO and UNICEF, 2017) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Annex 2. Country and regional estimates of improved sanitation coverage

in TWG WSH countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Annex 3. Country and regional estimates of improved drinking-water coverage

in TWG WSH countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

iv

FiguresFigure 1. Proportion of urban, rural and total populations

in TWG WSH region using improved sanitation, 1990 and 2015 . . . . . . . . . . . . 6Figure 2. Proportion of urban, rural and total populations in TWG WSH region

using improved drinking-water sources, 1990 and 2015 . . . . . . . . . . . . . . . . . . . 7Figure 3. Proportion of population in TWG WSH region using improved, shared,

or unimproved sanitation facilities, or practising open defecation, 2015 . . . 7Figure 4. Proportion of population in TWG WSH region using different types

of drinking-water facilities, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Figure 5. Proportion of population in TWG WSH region using improved,

shared, or unimproved sanitation facilities, or practising open defecation, 1990 and 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Figure 6. Number of people in TWG WSH region using improved, shared, or unimproved sanitation facilities, or practising open defecation, 1990–2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Figure 7. Proportion of populations in TWG WSH countries using improved, shared, or unimproved sanitation facilities, or practising open defecation, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Figure 8. Distribution of population in TWG WSH region not using improved sanitation facilities, by country, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . .11

Figure 9. Proportion of urban and rural populations in TWG WSH region using improved, shared, or unimproved sanitation facilities, or practising open defecation, 1990 and 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Figure 10. Proportion of urban and rural populations in TWG WSH countries using improved sanitation, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Figure 11. Urban and rural populations in TWG WSH region not using improved sanitation, 1990–2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Figure 12. Percentage of population using improved, shared, or unimproved sanitation facilities, or using open defecation by wealth quintile, Lao People’s Democratic Republic, 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Figure 13. Percentage of population using improved, shared, or unimproved sanitation facilities or using open defecation by education level, Lao People’s Democratic Republic, 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Figure 14. Proportion of population in TWG WSH region using different types of drinking-water sources, 1990 and 2015 . . . . . . . . . . . . . . . . . . . . . . . . .15

Figure 15. Number of people in TWG WSH region using different types of drinking-water sources, 1990–2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Figure 16. Proportion of populations in TWG WSH countries using different types of drinking-water sources, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Figure 17. Distribution of population in TWG WSH region not using improved drinking-water sources, by country, 2015 . . . . . . . . . . . . . . . . . . . . . .17

Figure 18. Proportion of urban and rural populations in TWG WSH region using different drinking-water sources, 1990 and 2015 . . . . . . . . . . . . . . . . . . .18

v

Figure 19. Proportion of urban and rural populations in TWG WSH countries using improved drinking-water sources, 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Figure 20. Urban and rural populations in TWG WSH region not using improved drinking-water sources, 1990–2015 . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Figure 21. Percentage of population using different types of drinking-water sources by wealth quintile, Lao People’s Democratic Republic, 2012 . . . . . .19

Figure 22. Percentage of population using different types of drinking-water sources by education level, Lao People’s Democratic Republic, 2012 . . . . . .20

Figure 23. Change in the use of improved sanitation from 1990 to 2015 and MDG targets in TWG WSH region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Figure 24. Difference between sanitation coverage in 2015 and the MDG sanitation target in TWG WSH countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Figure 25. Change in the use of improved drinking-water sources from 1990 and 2015 and MDG targets in TWG WSH region . . . . . . . . . . . . . . . . . . . . . . . . . .23

Figure 26. Difference between drinking-water coverage in 2015 and the MDG drinking-water target in TWG WSH countries . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Figure 27. Distribution of causes of death among children under 5 years old in TWG WSH countries, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Figure 28. Deaths of children under 5 years old attributable to drinking-water, sanitation and hygiene in TWG WSH countries, 2012 (per 100 000 population) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

Figure 29. Under-5 mortality rate (per 1000 live births), 1990 and 2013 . . . . . . . . . . . .32Figure 30. Use of improved drinking-water and sanitation compared

with under-5 mortality rate in TWG WSH countries, 2013 . . . . . . . . . . . . . . . . .33Figure 31. Urban and rural populations in TWG WSH region, 1990 and 2015 . . . . . . .34

TablesTable 1. Drinking-water and sanitation categories of technologies

according to the JMP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Table 2. Proposed indicators for monitoring sanitation services . . . . . . . . . . . . . . . . . . .26Table 3. Proposed indicators for monitoring drinking-water services . . . . . . . . . . . . . .27Table 4. Proposed indicators for monitoring hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28Table 5. Contribution of JMP to SDG target 6.3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

vi

Abbreviations

DHS Demographic and Health SurveyGLAAS UN-Water Global Analysis and Assessment of Sanitation and

Drinking-WaterIBNET International Benchmarking Network for Water and Sanitation

UtilitiesISIC International Standard Industrial Classification of All Economic

ActivitiesJMP WHO and UNICEF Joint Monitoring Programme for Water Supply

and SanitationLSB Lao Statistics BureauMDG Millennium Development GoalMICS Multiple Indicator Cluster SurveyMoH Ministry of Health SDG Sustainable Development GoalTWG WSH Thematic Working Group on Water, Sanitation and HygieneUN United NationsUNICEF United Nations Children’s FundWASH water, sanitation and hygieneWHO World Health OrganizationWHS World Health Survey

vii

Acknowledgements

This document was prepared by the World Health Organization (WHO) for the Thematic Working Group on Water, Sanitation and Hygiene (TWG WSH).

Many thanks are extended to Dr Rokho Kim, Dr Mohd Nasir Hassan and Ms Seoyeon Jeong of the WHO Regional Office for the Western Pacific for their support with the preparation of this document. Special mention is made to Mr Alexander von Hildebrand of the WHO Regional Office for the Western Pacific for his overall management of the project. Without his leadership, managerial guidance and quality assurance, preparing this document would not have been possible.

Mr Jose Hueb was the author of the document.

viii

Summary

This report deals primarily with the analysis of the drinking-water and sanitation situation in the member countries of the Thematic Working Group on Water, Sanitation and Hygiene (TWG WSH), based on statistics published by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) Joint Monitoring Programme for Water Supply and Sanitation (JMP) updated in 2015. This document also provides key information on selected health and development issues for TWG WSH member countries. The member countries covered in this report are: Brunei Darussalam, Cambodia, China, Indonesia, Japan, the Lao People’s Democratic Republic, Malaysia, Mongolia, Myanmar, the Philippines, the Republic of Korea, Singapore, Thailand and Viet Nam. Previous documents prepared by WHO for the TWG WSH include extensive analyses of the drinking-water, sanitation and hygiene sector as a whole, based on country-level information.

A key finding of this report is that the TWG WSH region has succeeded in meeting the Millennium Development Goal (MDG) target for drinking-water and sanitation, which is to “halve, by 2015, the proportion of the population without sustainable access to safe drinking-water and basic sanitation” (UN, 2017). Individually, nine TWG WSH countries achieved the MDG sanitation target, but four countries (i.e. Cambodia, Indonesia, Mongolia and the Philippines) did not. All TWG WSH countries met the MDG drinking-water target except Mongolia, which fell short of the target by 13 percentage points.

Overall, 77% of people in the TWG WSH region are using improved sanitation facilities, whereas 94% are using improved drinking-water sources (UNICEF and WHO, 2015).

Despite an impressive effort made to provide drinking-water and sanitation infrastructure to the residents in this region, about one quarter of the population still lacks access to improved sanitation and 7% lacks access to improved drinking-water.

Water-related diseases, including diarrhoeal diseases, are significant causes of death among children under 5 years old in the region. Almost 30 000 people in the TWG WSH region, especially children under 5, die each year due to water, sanitation and hygiene-related diseases (WHO, 2014).

This document includes the following main sections:

Section 1: Introduction

This section provides the rationale for preparing this document as well as its objectives and the overall characterization of the indicators under presentation according to the WHO and UNICEF JMP.

ix

Section 2: The TWG WSH countries

This section presents an overall analysis of the status of drinking-water and sanitation in TWG WSH countries, showing how drinking-water and sanitation coverage evolved in the TWG WSH region from 1990 to 2015.

Section 3: Sanitation coverage in the TWG WSH countries

This section provides a more detailed analysis of the status of access to improved sanitation in TWG WSH countries, including key graphs showing how the status of these countries evolved over time. It includes statistics exposing different aspects of equity in sanitation service provision.

Section 4: Drinking-water coverage in TWG WSH countries

This section provides a detailed analysis of access to improved drinking-water in TWG WSH countries and presents statistics on different aspects of equity in drinking-water use.

Section 5: The MDG drinking-water and sanitation target

This section provides an analysis of the progress in achieving the MDG drinking-water and sanitation target for the region and analyses the individual progress of TWG WSH countries.

Section 6: Sustainable Development Goals and targets

This section provides an overview of the 2030 Sustainable Development Goals (SDGs) drinking-water and sanitation targets and insight into the implications to the region of coping with such targets.

Section 7: Health and economic development in drinking-water and sanitation

This section summarizes improved drinking-water and sanitation coverage in the region and includes a brief analysis of the health and social situation of the region. An attempt is made to demonstrate the link between drinking-water and sanitation and the health status of the population in the region.

Annex 1: Definitions of the post-2015 terms proposed by the JMP

This list presents the proposed definitions associated with the SDG drinking-water and sanitation targets, taking into account the definitions adopted during the MDG era.

Annex 2: Country and regional estimates of improved sanitation coverage in TWG WSH countries

This table summarizes the status of sanitation coverage in the TWG WSH region and in each country. It includes statistics from 1990, 2000, 2010 and 2015.

Annex 3: Country and regional estimates of improved drinking-water coverage in TWG WSH countries

This table summarizes the status of drinking-water coverage in the TWG WSH region and in each country. It includes statistics from 1990, 2000, 2010 and 2015.

© W

HO

/Yos

hi S

him

izu

Access to water for laundry and bathing

1

1.1 Justification

The Regional Forum on Environment and Health in Southeast and East Asian Countries is a platform that brings together the ministries of environment and ministries of health of member countries at regular intervals to fulfil the vision and objectives of its membership. The ministers of environment and ministers of health nominate high-level officials to represent their respective ministries. The high-level officials also serve as national communication focal points for the Regional Forum on Environment and Health and liaise with the Secretariat of the Regional Forum (United Nations Environment Programme and the World Health Organization). The membership of the Regional Forum comprises ten Southeast Asian countries (Brunei Darussalam, Cambodia, Indonesia, Lao People’s Democratic Republic, Malaysia, Myanmar, Philippines, Singapore, Thailand and Viet Nam) and four East Asian countries (China, Japan, Mongolia and the Republic of Korea).

The objective of the Regional Forum on Environment and Health is to strengthen the cooperation of the ministries responsible for environment and health within their respective countries by providing a mechanism for sharing knowledge and experiences, improving policy and regulatory frameworks at the national and regional levels, and promoting the implementation of integrated environmental health strategies and regulations.

The Thematic Working Group on Water, Sanitation and Hygiene (TWG WSH) is one of the seven intercountry thematic working groups established by the First Regional Forum on Environment and Health in Southeast and East Asian Countries on 9 August 2007 in Bangkok, Thailand. Currently, 13 of the 14 Regional Forum countries are collaborating members of the TWG WSH. This document provides an overview of the status of drinking-water and sanitation in member countries of the Thematic Working Group on Water, Sanitation and Hygiene (TWG WSH) based on the coverage estimates published by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) Joint Monitoring Programme for Water Supply and Sanitation (JMP) in 2015. The document also provides key statistics on health and development in the region.

The drinking-water and sanitation estimates presented in this document are calculated from national censuses and nationally representative sample household surveys, including Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS) and many other surveys conducted by national statistics offices.

1 Introduction

2

The countries included in this analysis are current members of the TWG WSH, namely: Brunei Darussalam, Cambodia, China, Indonesia, Japan, the Lao People’s Democratic Republic, Malaysia, Mongolia, Myanmar, the Philippines, the Republic of Korea, Singapore, Thailand and Viet Nam. (Note that Brunei Darussalam does not appear in most graphs as the JMP does not have statistics on drinking-water and sanitation coverage for this country.)

1.2 ObjectivesThe objectives of this document are:

zz to provide an overview of the status of sanitation, drinking-water and hygiene in TWG WSH countries;

zz to look into the implications for TWG WSH countries of the 2030 Sustainable Development Goals (SDGs) targets on water and sanitation;

zz to look into key health and development indicators to help characterize the drinking-water and sanitation status of TWG WSH countries; and

zz to provide the basis for discussion on how to accelerate investment to improve drinking-water, sanitation and hygiene in the TWG WSH region.

1.3 What is being measured?The United Nations Millennium Project Task Force on Water and Sanitation defines basic sanitation as “the lowest-cost option for securing sustainable access to safe, hygienic, and convenient facilities and services for excreta and sullage disposal that provide privacy and dignity while ensuring a clean and healthful living environment both at home and in the neighbourhood of users” (Lenton et al., 2005, p. iv). WHO refers to sanitation as the provision of facilities and services for the safe, hygienic disposal of human urine and faeces.

Safe drinking-water is defined by the United Nations Millennium Project Task Force on Water and Sanitation as “water that is safe to drink and available in sufficient quantities for hygienic purposes” (Lenton et al., 2005, p. iv). Safe drinking-water includes water used for drinking (direct ingestion), cooking and personal hygiene that is free from contamination by pathogens, hazardous chemicals or radiological hazards (WHO, 2008).

The JMP is unable to report on coverage according to the traditional definitions of safe drinking-water and basic sanitation because data available through household surveys are limited. Hence, the JMP reports on the use of improved technologies that would

© W

HO

/Yos

hi S

him

izu

Girl next to a water storage tank

3

likely fulfil the requirements of safe drinking-water and adequate sanitation. Such technologies are called “improved drinking-water” and “improved sanitation” and are shown in Table 1.

The fragile ecological balance and water-resources vulnerability in most TWG WSH countries require rethinking of what is safe and adequate. Some “improved” sanitation technologies may be hazardous to sources of drinking-water and the environment. Poorly maintained waterborne sanitation systems such as septic tanks can deteriorate groundwater quality. Public sewerage systems discharging untreated sewage into water bodies can cause serious harm to ecosystems. The discharge of raw sewage into rivers and coastal areas may also affect the food chain through fish and shellfish.

Table 1. Drinking-water and sanitation categories of technologies according to the JMP

JMP categories Description Technologies JMP categories Description Technologies

Improved sanitation facilities*

Sanitation facilities are likely to ensure hygienic separation of human excreta from human contact.

Flush or pour-flush to:

� piped sewer system

� septic tank � pit latrine

Ventilated improved pit (VIP) latrine

Pit latrine with slab

Composting toilet

Piped drinking-water on premises

Piped household water connection located inside the user’s dwelling, plot or yard.

Piped household water connection

Shared sanitation facilities

Sanitation facilities of an otherwise acceptable type shared between two or more households. Only facilities that are not shared or not public are considered improved.

Same as above but shared by two or more households

Other improved drinking-water sources

Sources likely to provide safe drinking-water outside households.

Public taps, standpipes, tube wells, boreholes, protected dug wells, protected springs, rainwater collection

Unimproved sanitation facilities

Sanitation facilities that do not ensure hygienic separation of human excreta from human contact.

Flush or pour-flush to elsewhere**

Pit latrine without a slab, or open pit

Bucket latrine

Hanging latrine

Unimproved drinking-water sources

Sources are unlikely to provide safe drinking-water.

Unprotected dug well, unprotected spring, cart with small tank/drum, bottled water***

Open defecation Human faeces are disposed of in open spaces, or open water bodies, or disposed of with solid waste.

Absence of sanitation facilities

Surface water River, dam, lake, pond, stream, canal, irrigation channels

* Only facilities that are not shared or public are considered improved.** Excreta are flushed to the street, yard or plot, open sewer, ditch or drainage way.*** Bottled water is considered to be unimproved when there is no other source of improved drinking-water for cooking and hygiene purposes.Source: based on WHO and UNICEF (2017).

© W

HO

/Yos

hi S

him

izu

Children playing near a stream

5

2 The TWG WSH countries

2.1 Overview of TWG WSH countries

Australia

China

Mongolia

Japan

Viet Nam

Malaysia

Papua New Guinea

New Zealand

CambodiaPhilippines

Lao People'sDemocratic Republic

FijiVanuatu

Solomon Islands

Samoa

Palau

Kiribati

Niue

Singapore

Tonga

Tuvalu

Federated States ofMicronesia

Marshall Islands

Cook Islands

Tokelau

Nauru

Republic ofKorea

BruneiDarussalam

Macao SARHong Kong SAR

Northern Mariana Islands

Guam

New Caledonia

Wallis & Futuna American SamoaFrench Polynesia

Pitcairn IslandsAustralia

China

Mongolia

Japan

Viet Nam

Malaysia

Papua New Guinea

New Zealand

CambodiaPhilippines

Lao People'sDemocratic Republic

FijiVanuatu

Solomon Islands

Samoa

Palau

Kiribati

Niue

Singapore

Tonga

Tuvalu

Federated States ofMicronesia

Marshall Islands

Cook Islands

Tokelau

Nauru

Republic ofKorea

BruneiDarussalam

Macao SARHong Kong SAR

Northern Mariana Islands

Guam

New Caledonia

Wallis & Futuna American SamoaFrench Polynesia

Pitcairn Islands

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part ofthe World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitationof its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.© WHO Regional Office for the Western Pacific 2009. All rights reserved.

The population of the TWG WSH countries (2213 million) represents 30% of the global population (7301 million) (UN, 2014). The proportion of the TWG WSH population using improved sanitation facilities is currently 77%, whereas the proportion using improved drinking-water facilities is 94% (UNICEF and WHO, 2015).

Most TWG WSH countries are vulnerable to the impacts of climate variability and change and are subject to a relatively high frequency of hazards such as cyclones, earthquakes, floods and drought, with serious consequences to water resources and drinking-water and sanitation facilities (IPCC, 2014).

6

2.2 Overall status of sanitation and drinking-water in TWG WSH countriesInadequate disposal of human excreta, lack of safe drinking-water and poor hygiene are associated with a range of water-related diseases, including diarrhoeal diseases. Improved sanitation and drinking-water and sound hygiene behaviours can significantly reduce the prevalence of diarrhoeal diseases, and significantly lessen the adverse health impacts of other disorders responsible for death and disease among millions of children in the TWG WSH region.

Significant progress was made between 1990 and 2015 in terms of access to improved sanitation facilities (Figure 1). Sanitation coverage increased by 24 percentage points during this time period. Despite such progress, one in four people overall does not use improved sanitation facilities, while in rural areas, one third of the population does not use improved sanitation facilities. Rapid population growth and urbanization, as well as the need to improve the quality of services, will continue to demand huge investments in sanitation over the next decades.

Figure 1. Proportion of urban, rural and total populations in the TWG WSH region using improved sanitation, 1990 and 2015

0

10

20

30

40

50

60

70

80

90

100

Urban coverage

Cove

rage

(%)

Rural coverage

1990 2015

75

87

42

65

53

77

Total coverage

Source: country coverage data from UNICEF and WHO (2015).

© W

HO

/Ter

renc

e Th

omps

on

A pour-flush latrine

7

Universal access to improved drinking-water sources has been nearly achieved for residents of urban areas in the TWG WSH region (Figure 2). There was an impressive increase of 23% in drinking-water coverage from 1990 to 2015 in the TWG WSH region. However, these impressive statistics hide the fact that many improved drinking-water facilities might not deliver safe drinking-water. The JMP statistics currently do not take into account water quality, affordability, water quantity per capita, etc. They only report on the use of improved technologies as defined in section 1.3 of this report.

Figure 2. Proportion of urban, rural and total populations in the TWG WSH region using improved drinking-water sources, 1990 and 2015

0

10

20

30

40

50

60

70

80

90

100

Urban coverage

Cove

rage

(%)

Rural coverage

1990 2015

96 97

59

91

71

94

Total coverage


About three quarters of the population in the TWG WSH region use improved sanitation facilities (Figure 3). The region’s sanitation coverage of 77% is 9 percentage points higher than the global coverage of 68%. Despite such high coverage, 13% of the population still uses unsanitary, unimproved facilities and 4% defecates in the open.

Figure 3. Proportion of population in the TWG WSH region using improved, shared, or unimproved sanitation facilities, or practising open defecation, 2015

Improved 77%

Shared 6%

Unimproved 13%

Open defecation 4%


About three out of five people in the TWG WSH region use drinking-water through household connections from piped systems. Around 94% of the population has

8

access to some source of improved drinking-water (e.g. piped system, protected wells, protected springs), which is above the global coverage of 91%. The use of surface water for domestic use is still practised by 1% of the population in the TWG WSH region (Figure 4).

Figure 4. Proportion of population in the TWG WSH region using different types of drinking-water facilities, 2015

Piped onto premises 63%

Surface water 1%

Unimproved 5%

Other improved 31%


© W

HO

/Yos

hi S

him

izu

Children fetching drinking-water

9

3 Sanitation coverage in TWG WSH countries

3.1 Current status

Significant progress has been made in the TWG WSH region in terms of access to improved sanitation. About 77% of the TWG WSH region currently uses improved sanitation facilities, while 4% practises open defecation.

It is important to highlight that sanitation facilities classified as “improved” do not necessarily hygienically separate human excreta from humans. The household surveys used by the JMP to derive sanitation coverage do not systematically collect information on the quality and effectiveness of improved sanitation facilities. The term “improved sanitation” refers to types of facilities that are more likely than others to be sanitary. The JMP uses a variety of household surveys to estimate coverage, including DHS, MICS, World Health Surveys (WHS), and numerous national surveys and censuses. These instruments do not include an assessment of cleanliness, affordability, sustainability, and whether the sanitation facility effectively protects human and environmental health.

While the proportion of the population in the TWG WSH region using improved sanitation facilities increased by 24 percentage points from 1990 to 2015, the proportion of the population using unimproved sanitation was reduced by 18 percentage points over the same period of time (Figure 5).

Figure 5. Proportion of population in the TWG WSH region using improved, shared, or unimproved sanitation facilities, or practising open defecation, 1990 and 2015

0

10

20

30

40

50

60

70

80

90

100

Improved Shared Unimproved Open defecation

1990

Cove

rage

(%

)

2015

4

31

12

53

6

13

4

77


10

It is clear that a serious effort has been made in the region to reduce open defecation. The proportion of the population practising open defecation in 2015 has been cut to one third of the 1990 proportion.

The population using improved sanitation in the TWG WSH region nearly doubled from 1990 to 2015, benefiting almost 800 million people gaining access to improved facilities in this time period (Figure 6). Such an impressive achievement outpaced the population growth in the region (population growth: 25% in 25 years).

Despite a reduction to less than half of the population practising open defecation in 1990, more than 80 million people continued to practise open defecation in 2015 and more than 500 million people were still using unimproved or shared sanitation facilities or practising open defecation in the TWG WSH region.

Figure 6. Number of people in the TWG WSH region using improved, shared, or unimproved sanitation facilities, or practising open defecation, 1990–2012

0

500

1000

1500

2000

2500

Population practising opendefecation

Population using unimprovedsanitation

Population sharingimproved sanitation

Population using improvedsanitation

20001990

Popu

latio

n (m

illio

ns)

Year20152010

1233

90

496

159

1547

120

374

93

935

62

570

209

1706

135

29082


© W

HO

/Yos

hi S

him

izu

Women washing clothes in the river

11

Statistics on the use of improved sanitation by country are uneven in the TWG WSH region. Coverage ranges from 42% in Cambodia to 100% in Japan, the Republic of Korea and Singapore (Figure 7). Only three countries in the region have improved sanitation coverage below the world average of 68%. Open defecation is practised by at least 20% of the population in Indonesia, the Lao People’s Democratic Republic and Cambodia.

Figure 7. Proportion of populations in TWG WSH countries using improved, shared, or unimproved sanitation facilities, or practising open defecation, 2015

100 100 100 96

4

93

7

80

12

44

78

5

16

1 1

76

5

18

74

18

17

71

33

23

61

11

8

209

60

3147

38

42

NA0

10

20

30

40

50

60

70

80

90

100


Japa

n

Repu

blic

of Ko

rea

Singa

pore

Mala

ysia

Thail

and

Mya

nmar

Viet

Nam

China

Philip

pines

Lao P

eople

’s De

moc

ratic

Repu

blic

Indon

esia

Mon

golia

Cam

bodia

Brun

ei Da

russa

lam

Cove

rage

(%)

NA = not availableSource: country coverage data from UNICEF and WHO (2015).

Most people without access to improved sanitation in the TWG WSH region are residents of China, mainly because the population of this country represents two thirds of the region’s population and because one quarter of its population does not use improved sanitation (Figure 8). About 20% of the region’s population without access to improved sanitation facilities lives in Indonesia.

Figure 8. Distribution of population in the TWG WSH region not using improved sanitation facilities, by country, 2015

Cambodia 2

China 65Indonesia 20

Lao People‘s Democratic Republic 1Myanmar 2

Philippines 5

Thailand 1

Viet Nam 4

Japan 0Malaysia 0

Mongolia 0

Republic of Korea 0

Singapore 00 10 20 30 40 50 60 70 80

Percentage (%)


12

3.2 Sanitation inequities

3.2.1 Urban and rural disparities

There is significant disparity between urban and rural sanitation coverage in the TWG WSH region (Figure 9). While about nine in every 10 urban residents enjoy access to improved sanitation, only six in every 10 rural residents enjoy this type of service. Open defecation is practised by 6% of the rural population. In urban areas, only 2% of the population still practises open defecation.

Figure 9. Proportion of urban and rural populations in the TWG WSH region using improved, shared, or unimproved sanitation facilities, or practising open defecation, 1990 and 2015


0

10

20

30

40

50

60

70

80

90

100

1990

Cove

rage

(%

)

2015Year

Urban

5

16

4

75

7 4 2

87

0

10

20

30

40

50

60

70

80

90

100

1990

Cove

rage

(%

)

2015Year

Rural

3

40

15

42

6

23

6

65


Improved sanitation coverage in Cambodia is nearly three times greater in urban areas than in rural areas (Figure 10). In six out of 14 TWG WSH countries, the disparity between urban and rural coverage exceeds 20 percentage points. For the region as a whole, the disparity is 22 percentage points.

Figure 10. Proportion of urban and rural populations in TWG WSH countries using improved sanitation, 2015

Urban Rural

96100 100 100

9690

94 94

56

70

88 87 8784

787771 72

4743

66 65

30

64

Japa

n

Repu

blic o

f Kor

ea

Singa

pore*

Mala

ysia

Lao P

eople

’s De

moc

ratic

Repu

blic

Viet

Nam

Thail

and

Cam

bodia

China

Mya

nmar

Philip

pines

Indon

esia

Mon

golia

Regio

n

0

10

20

30

40

50

60

70

80

90

100

Cove

rage

(%

)

Country

*Singapore is totally urbanSource: country coverage data from UNICEF and WHO (2015).

13

Considerable progress has been achieved in reducing the number of people not using improved sanitation over the last 25 years, especially in rural areas. The number of rural residents without access to improved sanitation has been halved since 1990 (Figure 11).

Despite this impressive progress, 344 million rural residents and 162 million urban residents do not use improved sanitation and are thus exposed to severe risks of sanitation-related infectious diseases.

Figure 11. Urban and rural populations in the TWG WSH region not using improved sanitation, 1990–2015

0

100

200

300

400

500

600

700

800

Urban population not usingimproved sanitation

Rural population not using improved sanitation

1990 2000

Popu

latio

n (m

illio

ns)

2010Year

2015

699

142

579

166

415

172

344

162


3.2.2 Economic and social inequities in sanitation coverage

It is well known that higher-income households and people with better education have access to better sanitation facilities. Such economic and social inequities reflect similar situations globally. The socioeconomic status of a household is obtained by dividing the population in five equal parts (quintiles) based on a wealth index. The wealth index is a composite index composed of key asset variables, including means of transportation, radio, television, refrigerator, roofing materials, flooring type and number of animals; it is used as a proxy indicator of household-level wealth.

Although the available data do not allow for an analysis of economic and education inequities for the entire TWG WSH region, it was possible to obtain information to characterize one country as an example in the region. The graphs and text below reflect the situation of the Lao People’s Democratic Republic in this regard. The sanitation statistics presented in Figures 12 and 13 refer to one single household survey conducted in 2011–2012, whereas the JMP statistics are based on all the surveys conducted in the country. Therefore, the statistics presented in these figures may differ from those presented by the JMP.

14

In 2012, the richest 20% of the population in the Lao People’s Democratic Republic was almost eight times more likely to use an improved sanitation facility than the poorest 20% (Figure 12). Open defecation was practically nonexistent (3%) among the richest quintile. On the other extreme, 82% of the poorest quintile was likely to practise open defecation.

Figure 12. Percentage of population using improved, shared, or unimproved sanitation facilities, or using open defecation by wealth quintile, Lao People’s Democratic Republic, 2012

0 20 40 60

Wea

lth q

uint

ile

80Proportion of people served by wealth quintile (%)

100

Improved sanitation Shared facilities Unimproved facilities Open defecation

Poorest 12 826

Second 33 612 5

Middle 57 373 3

Fourth 86 104

Richest 97 3

Source: MoH and LSB (2012).

While open defecation was almost nonexistent among people with higher education, 59% of the population without education practised open defecation in 2012 in the Lao People’s Democrative Republic (Figure 13). While 95% of the population with higher education used improved sanitation, only 38% of the population without any formal education used this type of facility.

Figure 13. Percentage of population using improved, shared, or unimproved sanitation facilities or using open defecation by education level, Lao People’s Democratic Republic, 2012

0 20 40 60

Educ

atio

n le

vel

80Proportion of people served by education level (%)

100

None 38 5922

Primary 51 4342

Lower secondary 70 2433

Upper secondary 81 144 2

Post secondarynon tertiary 84 1213

Higher 95 32

Improved sanitation Shared facilities Unimproved facilities Open defecation


15

4 Drinking-water coverage in TWG WSH countries

4.1 Current status

Despite a high proportion of people using improved drinking-water sources (94%), about 63% of the population uses piped drinking-water on premises. As indicated in the introductory section of this report, people using drinking-water from improved sources are not necessarily using safe drinking-water. The household surveys used as a basis for the JMP analysis do not include an analysis of drinking-water quality. In addition, there is no information on whether the drinking-water used by households is affordable and provided in quantities according to basic requirements.

The proportion of people using piped water on premises more than doubled from 1990 to 2015, whereas the proportion of people using other types of improved facilities in 2015 dropped to three quarters of the 1990 value (Figure 14). This is a clear indication that the region is evolving towards the construction of centralized piped drinking-water systems with individual household connections.

Figure 14. Proportion of population in the TWG WSH region using different types of drinking-water sources, 1990 and 2015

0

10

20

30

40

50

60

70

80

90

100

Piped onto premises Other improved Unimproved Surface water

1990Year

Cove

rage

(%

)

2015

40

22

7

31 31

51

63


From 1990 to 2015, about 828 million additional people in the TWG WSH region gained access to improved drinking-water facilities, whereas 851 million additional people gained access to piped drinking-water on premises. This means that there has been a huge effort towards increasing coverage through centralized water systems and piped distribution systems (Figure 15). The population still using surface water as its source of

16

drinking-water is currently a small fraction of the 1990 value (12%). The population not using improved drinking-water has been reduced by 391 million over the last 25 years.

The use of surface water such as rivers, lakes and ponds as the primary source of drinking-water poses a huge threat to people with this type of access, especially children (Prüss-Üstün et al., 2008). Only a small quantity of water can be hauled daily, and serious microbial, parasites and chemical hazards are typical of this type of source.

Figure 15. Number of people in the TWG WSH region using different types of drinking-water sources, 1990–2015

Use of surface water

Piped water onto the household

0

500

1000

1500

2000

2500

Unimproved facilities

Other types of improved facilities

20001990

Popu

latio

n (m

illio

ns)

Year20152010

707

391

126

891

724

27984

1242

697

16530

1403

684

10224

552

Source: country statistics from UNICEF and WHO (2015).

Improved drinking-water coverage was above 60% in all TWG WSH countries (Figure 16).

Higher regional statistics hide a low performance of many countries in terms of quality of service. For example, in seven out of 12 countries for which information is available, less than 50% of the population uses drinking-water piped on premises.

Figure 16. Proportion of populations in TWG WSH countries using different types of drinking-water sources, 2015

100 98

2

96

21 1

73

22

4

57

41

2

43

49

53

28

48

20

4 1

27

71

1

24

40

32

4

22

65

112

21

55

12

12 5

73

8

14

NANA0

10

20

30

40

50

60

70

80

90

100

Piped onto the household Other improved Unimproved Surface water

Singa

pore

Japa

n

Mala

ysia

China

Thail

and

Philip

pines

Lao P

eople

’sDe

moc

ratic

Repu

blic

Viet

Nam

Mon

golia

Indon

esia

Cam

bodia

Mya

nmar

Repu

blic o

f Kor

ea

Brun

ei Da

russa

lam

Cove

rage

(%)

Country

NA = not availableSource: country coverage data from UNICEF and WHO (2015).

17

More than half of the people who are not using improved drinking-water facilities in the TWG WSH region live in China. This is followed by Indonesia, which is home to about one quarter of the population not using improved drinking-water (Figure 17).

Figure 17. Distribution of population in the TWG WSH region not using improved drinking-water sources, by country, 2015

Cambodia 3

Indonesia 26

Lao People‘s Democratic Republic 1

Mongolia 1

Myanmar 9

Philippines 7

Thailand 1

Malaysia 1

China 51

Brunei Darussalam 0Japan 0

Republic of Korea 0

Singapore 0

0 10 20 30 40 50 60Percentage (%)


4.2 Drinking-water inequities

4.2.1 Urban and rural disparities

People living in urban areas of TWG WSH countries are, on average, almost twice more likely to have water piped to their dwelling than their rural counterparts. While 80% of urban residents enjoy piped water, only 43% of rural citizens use this type of source (Figure 18).

In urban areas, the proportion of people with access to drinking-water piped on premises increased by 7 percentage points from 1990 to 2015; those with access to other types of improved facilities decreased by a similar amount (6 percentage points).

In rural areas, the proportion of people using piped drinking-water on premises nearly quadrupled over the last 25 years.

In urban areas, the use of surface water as a source of drinking-water has been practically eradicated in TWG WSH countries; however, about 7% of the rural population still uses drinking-water directly from rivers, lakes, streams and canals.

© W

HO

/Yos

hi S

him

izu

Woman fetching water

18

Figure 18. Proportion of urban and rural populations in the TWG WSH region using different drinking-water sources, 1990 and 2015

YearPiped on premises Other improved Unimproved Surface water

Year

0

10

20

30

40

50

60

70

80

1990

Cove

rage

(%

)

2015

Urban

23

3 1

73

17

3 0

80

0

10

20

30

40

50

60

70

80

90 90

100 100

1990

Cove

rage

(%

)

2015

Rural

48

31

1011

48

72

43


Cambodia has the highest disparity in the region between urban and rural improved drinking-water coverage (31 percentage points). Urban–rural disparity is less than 10 percentage points in nine out of 14 TWG WSH countries. Urban drinking-water coverage in the TWG WSH region is about 6 percentage points higher than rural coverage (Figure 19).

Figure 19. Proportion of urban and rural populations in TWG WSH countries using improved drinking-water sources, 2015

Urban Rural

100

Cam

bodia

Japa

n

Mala

ysia

Viet

Nam

Thail

and

China

Indon

esia

Philip

pines

Mya

nmar

Lao P

eople

’sDe

moc

ratic

Repu

blic

Mon

golia

Regio

n

0102030405060708090

100

Cove

rage

(%

)

100

69

100 98 9899 97 94 90 93

7486

6959

66

9791

9893 94

79

100

Singa

pore*

Repu

blic

of Ko

rea

10093

*Singapore is totally urbanSource: country coverage data from UNICEF and WHO (2015).

Most people not using improved drinking-water sources in the TWG WSH region live in rural areas (Figure 20).

The urban population not using improved drinking-water sources increased by 42% over the last 25 years, while the rural population not using improved drinking-water sources was reduced to less than one fifth of the 1990 value. The rural unserved population decreased by about 400 million people, while the urban unserved population increased by 10 million from 1990 to 2015.

19

These statistics indicate that investments in both urban and rural areas have been huge and overstepped population growth.

Figure 20. Urban and rural populations in the TWG WSH region not using improved drinking-water sources, 1990–2015

0

100

200

300

400

500

600

Urban population not usingimproved drinking-water

Rural population not using improved drinking-water

1990 2000

Popu

latio

n (m

illio

ns)

2010Year

2015

493

24

334

30

163

33

92

34


4.2.2 Economic and social inequities in drinking-water coverage

Household surveys conducted in TWG WSH countries lacked sufficient information to provide a regional perspective of improved drinking-water coverage according to education levels and wealth quintiles. Despite a lack of sufficient information to characterize the entire TWG WSH region in this regard, it was possible to obtain information to characterize one country as an example in the region. The Lao People’s Democratic Republic was selected to illustrate how economic aspects and education influence drinking-water coverage. The drinking-water statistics presented in this section refer to one single household survey conducted in 2011–2012, whereas the JMP statistics are based on all the surveys conducted in the country. Therefore, the statistics presented in these figures may differ from those presented by the JMP.

© W

HO

/Yos

hi S

him

izu

Water storage and station

20

In 2012, the richest 20% of the population in the Lao People’s Democratic Republic was nearly 20 times as likely to use piped drinking-water on premises as the poorest 20%. The poorest 20% of the population was four times more likely not to use an improved source of drinking-water than the richest 20% (Figure 21).

Figure 21. Percentage of population using different types of drinking-water sources by wealth quintile, Lao People’s Democratic Republic, 2012

0 20 40 60

Wea

lth q

uint

ile

80Proportion of people served by wealth quintile (%)

100

Piped onto dwelling, plot or yard Other improved Unimproved drinking-water

Richest 57 1033

Fourth 25 2649

Middle 14 3452

Second 7 3855

Poorest 3 4255


About 69% of the population with higher education uses drinking-water piped onto their property, whereas only 11% of the population without any formal education counts on this type of service (Figure 22). People with no formal education are twice as likely to use an unimproved source of drinking-water than those with higher education.

Figure 22. Percentage of population using different types of drinking-water sources by education level, Lao People’s Democratic Republic, 2012

None

Primary

Lower secondary

Upper secondary

0 20 40 60

Educ

atio

n le

vel

80Proportion of people served by education level (%)

100

11 3951

15 3352

24 2650

39 1843

Post-secondarynon-tertiary

43 1938

Higher 69 923

Piped onto dwelling, plot or yard Other improved Unimproved drinking-water


21

In September 2000, building on a decade of major United Nations conferences and summits, world leaders adopted the United Nations Millennium Declaration, committing their nations to a global partnership to reduce extreme poverty and setting out time-bound goals and targets to be achieved by 2015. These became known as the Millennium Development Goals (MDGs). MDG target 7.C is to “halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation” (UN, 2017). As information is not available to measure access to “safe drinking-water” and “basic sanitation”, the international community adopted the proxies “improved drinking-water” and “improved sanitation” to measure progress in coverage since 1990 (see section 1.3).

5.1 Achieving the MDG sanitation target

The MDG sanitation target, to halve the proportion of the population without sustainable access to adequate sanitation by 2015, has been met in the TWG WSH region. Between 1990 and 2015, the region experienced an increase in improved sanitation coverage of 26 percentage points, with millions of people gaining access to improved sanitation facilities.

The TWG WSH region exceeded the MDG sanitation target by 1 percentage points. Despite this major achievement, about one quarter of the population still lacks access to improved sanitation facilities (Figure 23).

Figure 23. Change in the use of improved sanitation from 1990* to 2015 and MDG target** in the TWG WSH region

100

100 100 99 100 9387 80

36 35

53

77

4857

7161 60

42

3

747678

100 10093

100 100 8696

93

7768

60

74 767968

73

51

NA

Sanitation coverage in 1990 Sanitation coverage in 2015 Achieved Not achievedSanitation MDG target (2015):

Cam

bodia

Japa

n

Mala

ysia

Singa

pore

Repu

blic

of Ko

rea

Viet

Nam

Thail

and

China

Indon

esia

Philip

pines

Mya

nmar

Lao P

eople

’sDe

moc

ratic

Repu

blic

Mon

golia

Bruu

nei

Daru

ssalam

Regio

n

0102030405060708090

100

Cove

rage

(%

)

Country

1990

data

not a

vaila

ble

1990

data

not a

vaila

ble

1990

data

not a

vaila

ble

* The JMP has not provided 1990 improved sanitation coverage statistics for the Lao People’s Democratic Republic, Mongolia and Myanmar. The MDG target was estimated for these countries based on 1995 data. ** The MDG target is achieved if the percentage point difference between sanitation coverage in 2015 and the MDG target is equal to or greater than –1%.Source: country coverage data from UNICEF and WHO (2015).

5 The MDG drinking-water and sanitation target

22

Four countries (the Philippines, Indonesia, Cambodia and Mongolia) failed to meet the MDG sanitation target. Two countries (Viet Nam and China) made every effort to expand coverage and achieve the MDG sanitation target even considering the difficulty posed by their very low coverage in 1990.

A country-by-country analysis of performance against the MDG sanitation targets shows that Cambodia and Mongolia have the biggest gaps, having missed the targets by 9 and 13 percentage points, respectively (Figure 24). The same analysis reveals the Lao People’s Democratic Republic and Viet Nam as the best performers, having exceeded the MDG sanitation target by 11 and 10 percentage points, respectively.

Figure 24. Difference between sanitation coverage in 2015 and the MDG sanitation target in TWG WSH countries

0

0

0

0

Ja pa n

Re public of Korea

Si ngapore

Tha iland

Phi l ippines–5

I ndonesia–7

Ca mbodia –9

Mongolia –13

Re gi on 1

–15 –10 –5 0 5 10 15Percentage points (%)

Percentage points higher than MDG sanitation targetPercentage points gap to achieve the MDG sanitation target

Brune i Darussalam

Vi e t Na m

Ma l a ysia

Mya nma r

Chi na

La o Pe ople's Dem. Republic 11

10

3

3

2

NA


5.2 Achieving the MDG drinking-water target

The MDG drinking-water target, to halve the proportion of the population without sustainable access to safe drinking-water by 2015, has been met in the TWG WSH region. Between 1990 and 2015, the region as a whole saw an increase in improved drinking-water coverage of 23 percentage points.

The TWG WSH region exceeded the MDG drinking-water target by 9 percentage points (Figure 25). All TWG WSH countries achieved and exceeded the MDG drinking-water target except Mongolia, which fell short of the target by 13 percentage points. Despite very low coverage in 1990, Cambodia made a tremendous effort over the last 25 years, not only achieving the target, but also meaningfully exceeding it.

23

Figure 25. Change in the use of improved drinking-water sources from 1990* and 2015 and MDG target** in the TWG WSH region

Cam

bodia

Bruu

nei

Daru

ssalam

Mala

ysia

Singa

pore

Japa

n

Viet

Nam

Repu

blic

of Ko

rea

China

Mya

nmar

Indon

esia

Philip

pines

Thail

and

Lao P

eople

’s De

moc

ratic

Repu

blic

Mon

golia

Regio

n

0102030405060708090

100Co

vera

ge (%

)

CountryDrinking-water coverage in 1990 Drinking-water coverage in 2015 Achieved Not achievedDrinking-water MDG target (2015):

100

100 10

010

0 9890

98 9887

63 7194

67

84 8769

8158

76 7623

6453

929598

100 10095 96 94

81 8583 8592

7970

77

62NA 19

90 da

ta no

t ava

ilabl

e

1990

data

not a

vaila

ble

* The JMP has not provided 1990 improved drinking-water coverage statistics for the Lao People’s Democratic Republic and the Republic of Korea. The MDG target was estimated for these countries based on 1995 data. Similarly, the JMP has not provided 2015 improved drinking-water coverage statistics for the Republic of Korea. Data from 2010 were used. ** The MDG target is achieved if the percentage point difference between drinking-water coverage in 2015 and the MDG target is greater than –1%.Source: country statistics from UNICEF and WHO (2015).

Viet Nam and Cambodia show the best performance in the region, having exceeded the MDG drinking-water target by 17 and 14 percentage points, respectively (Figure 26). The region as a whole exceeded the MDG drinking-water target by 9 percentage points. Mongolia was the only country in the TWG WSH region that did not succeed in achieving the MDG drinking-water target.

Figure 26. Difference between drinking-water coverage in 2015 and the MDG drinking-water target in TWG WSH countries

Viet Nam

Cambodia

China

Lao People’s Democratic Republic

Thailand

Malaysia

Indonesia

Myanmar

Republic of Korea

17

14

12

6

4

3

2

2

2

0

0

0

Japan

Philippines

Singapore

Mongolia–13

Re gi on 9

–15 –10 –5 0 5 1510 20Percentage points (%)

Percentage points gap to achieve the drinking-water MDG targetPercentage points exceding the drinking-water MDG target


T E M P I M A G E

© W

HO

/Yos

hi S

him

izu

View of a river

25

On 25 September 2015, the United Nations General Assembly adopted a resolution titled “Transforming our world: The 2030 Agenda for Sustainable Development” (A/RES/70/1). The resolution proposed 17 Sustainable Development Goals (SDGs) with 169 associated targets addressing different aspects of sustainable development. The targets associated with SDG 6 – “ensure availability and sustainable management of water and sanitation for all” (UN, 2015, p. 20) – are as follows:

6.1 By 2030, achieve universal and equitable access to safe and affordable drinking-water for all

6.2 By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations

6.3 By 2030, improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse globally

6.4 By 2030, substantially increase water-use efficiency across all sectors and ensure sustainable withdrawals and supply of freshwater to address water scarcity and substantially reduce the number of people suffering from water scarcity

6.5 By 2030, implement integrated water resources management at all levels, including through transboundary cooperation as appropriate

6.6 By 2020, protect and restore water-related ecosystems, including mountains, forests, wetlands, rivers, aquifers and lakes

6.a By 2030, expand international cooperation and capacity-building support to developing countries in water- and sanitation-related activities and programmes, including water harvesting, desalination, water efficiency, wastewater treatment, recycling and reuse technologies

6.b Support and strengthen the participation of local communities in improving water and sanitation management

6 Sustainable Development Goals and targets

T E M P I M A G E

26

Targets 6.1, 6.2 and 6.3 are of greatest interest to this report. Different formulations of indicators to determine progress in achieving such targets have been proposed over the past few years by different groups, individuals and institutions. The SDG drinking-water, sanitation and hygiene indicators are presented in Tables 2, 3 and 4 (WHO and UNICEF, 2015). The baseline year for measuring progress is 2015. The contribution of the JMP to target 6.3 is indicated in Table 5.

Sanitation service ladder Proposed indicator Definition Data sources and

measurability

Safely managed sanitation

Percentage of population using safely managed sanitation services

Percentage of population using a basic sanitation facility that is not shared with other households and where excreta is safely disposed in situ or treated off-site. This multipurpose indicator also covers the domestic part of wastewater treatment of target 6.3.

Household surveys can provide information on types of sanitation facilities and disposal in situ. Administrative, population and environmental data can be used to estimate safe disposal/treatment of excreta.

Basic sanitationa Percentage of population using a basic sanitation service

Percentage of population using a basic sanitation facility not shared with other households.

Household surveys

Shared sanitation Percentage of population using a shared sanitation service

Percentage of population using a basic sanitation facility shared with other households.

Household surveys

Unimproved sanitationb

Percentage of population using an unimproved sanitation facility

Percentage of population using unimproved sanitation facilities, with or without sharing with other households.

Household surveys

Open defecation Percentage of population practising open defecation

Percentage of population defecating in bushes, fields, open water bodies or other open spaces.

Household surveys

Basic sanitation in schoolsc

Percentage of pupils enrolled in schools that provide basic sanitation services

Percentage of pupils enrolled in primary and secondary schools with basic sanitation facilities that are functional and separated for males and females on or near premises.

Institution surveys, administrative data, education management information systems

Basic sanitation in health-care facilitiesd

Percentage of patients using health-care facilities providing basic sanitation services

Percentage of beneficiaries using health-care facilities with basic sanitation facilities that are functional and separated for males and females on or near premises.

Institution surveys, administrative data, health management information systems

Table 2. Proposed indicators for monitoring sanitation services

a Basic sanitation facilities (MDG “improved sanitation” indicator) include the following: flush/pour-flush toilets to sewer systems, septic tanks or pit latrines, ventilated improved pit latrines, pit latrines with a slab, and composting toilets.

b Unimproved sanitation facilities (MDG “unimproved sanitation” indicator) include the following: flush/pour-flush latrines not connected to sewer/septic/pit, pit latrines without a slab, and hanging and bucket latrines.

c Basic sanitation in schools means at least one toilet/latrine for every 25 girls, at least one toilet/latrine for female school staff, at least one toilet/latrine and one urinal for every 50 boys, and at least one toilet/latrine for male school staff.

d Basic sanitation in health-care facilities means at least one toilet for every 20 users at inpatient centres, and at least four toilets – one each for staff, female, male and child patients – in outpatient centres.

Source: based on WHO and UNICEF (2015).

27

Drinking-water service ladder Proposed indicator Definition Data sources and

measurability

Safely managed water Percentage of population using safely managed drinking-water services

Percentage of population using a basic drinking-water source that is located on premises and available when needed; free of faecal (and priority chemical) contamination.

Household surveys can provide data on basic water on premises, availability when needed and if free from contamination via direct water quality testing. Official drinking-water regulators can provide data on compliance with national standards.

Basic watera Percentage of population using basic drinking-water services

Percentage of population using a basic drinking-water source with a total collection time of no more than 30 minutes for a round trip including queuing.

Household surveys

Unimproved waterb Percentage of population using inadequate sources of drinking-water

Percentage of population using unimproved drinking-water sources or basic drinking-water sources with a total collection time of more than 30 minutes.

Household surveys

Surface waterc Percentage of population using water directly from surface water sources

Percentage of population using surface water sources.

Household surveys

Basic water in schools Percentage of pupils enrolled in schools providing basic water services

Percentage of pupils enrolled in primary and secondary schools with a functional basic drinking-water source on or near premises and water points accessible to all users during school hours.


Basic water in health-care facilities

Percentage of beneficiaries using health-care facilities providing basic water services

Percentage of beneficiaries using health-care facilities with a functional basic water source on premises and water points accessible to all users at all times.


Table 3. Proposed indicators for monitoring drinking-water services

a Basic drinking-water sources (MDG “improved drinking-water” indicator) include the following: piped water into dwelling, yard or plot (on premises); public taps or standpipes; boreholes or tubewells; protected dug wells; protected springs and rainwater. Packaged drinking-water is considered to be a basic source if households use a basic water source for other domestic purposes.

b Unimproved drinking-water sources (MDG “unimproved” indicator) include the following: unprotected dug well, unprotected spring, cart with small tank/drum, and bottled water.

c Surface water includes rivers, dams, lakes, ponds, streams, canals and irrigation channels.


28

Hygiene indicators Proposed indicator Definition Data sources and measurability

Handwashing at home Percentage of population with handwashing facilities with soap and water at home

Percentage of population with handwashing facilities with soap and water in the household.

Household surveys

Handwashing in schools Percentage of pupils enrolled in schools with basic handwashing facilities

Percentage of pupils enrolled in primary and secondary schools with functional handwashing facilities with soap (or ash) and water available to girls and boys.


Menstrual hygiene management in schools

Percentage of pupils enrolled in schools with basic menstrual management facilities

Percentage of pupils enrolled in primary and secondary schools with adequate and appropriate sanitation facilities for washing, change management and disposal of menstrual waste. These facilities must offer privacy, safety and dignity to menstruating students and teachers.


Handwashing in health-care facilities

Percentage of beneficiaries using health-care facilities with basic handwashing facilities

Percentage of beneficiaries using health-care facilities with adequate hand hygiene supplies (running water, liquid soap, single-use towels/alcohol-based hand rinse) available at key locations.


Basic menstrual hygiene management in health-care facilities

Percentage of beneficiaries using health-care facilities with basic menstrual management facilities

Percentage of beneficiaries using health-care facilities with improved separated sanitation facilities for females that provide privacy; soap, water and space for washing hands, private parts and clothes; and places for changing and disposing of materials used for managing menstruation.


Table 4. Proposed indicators for monitoring hygiene


© W

HO

/Yos

hi S

him

izu

A girl washes her hands before lunch at a kindergarten

29

Wastewater ladder Proposed indicator Definition Data sources and measurability

Safe treatment of wastewater Percentage of wastewater safely treated

Proportion of wastewater generated through domestic (sewage and faecal sludge) and industrial sources safely treated compared to total wastewater generated through domestic and industrial sources.

To build on the monitoring framework of the JMP, data sources could include AQUASTAT, GLAAS, IBNET, population density, and land-use/land-cover data from earth observations. The calculation of the indicator value as derived from the framework is the amount treated (off-site and on-site) divided by the total amount of waste produced. Data on treatment of domestic wastewater will come from the above data sources. Data on volumes of industrial wastewater can be estimated from inventories of industries, which will be available in the majority of Member States disaggregated by ISIC classifications. The breakdown of treated wastewater can be calculated based on compliance records, related to national standards. Unless verified otherwise, through audited compliance records, the waste generated will be considered untreated.

Table 5. Contribution of JMP to Target 6.3

GLAAS, Global Analysis and Assessment of Sanitation and Drinking-Water; AQUASTAT, Global Information System on Water and Agriculture; IBNET, International Benchmarking Network for Water and Sanitation Utilities; ISIC, International Standard Industrial Classification of All Economic Activities; JMP, WHO and UNICEF Joint Monitoring Programme for Water Supply and Sanitation.Source: based on WHO and UNICEF (2015).

The proposed targets are ambitious, especially given the lack of baseline data and national reporting systems for many of the criteria. For TWG WSH countries, the implications would be significant as the time frame might be too short to provide drinking-water, sanitation and hygiene services to billions of people over the next 15 years.

© W

HO

/Yos

hi S

him

izu

Women washing clothes

31

The most effective way to prevent deaths and illnesses from diarrhoea and other water- and sanitation-related diseases is to provide adequate sanitation and drinking-water services. Such diseases hinder the learning capacity of millions of school-aged children in the TWG WSH region. This section provides an overview of the status of water and sanitation, as well as social and health-related issues in the region.

7.1 Health

Diarrhoeal disease, which is largely attributable to unsafe drinking-water, unimproved sanitation facilities and inadequate hygiene, is still a major cause of under-five mortality in selected TWG WSH countries, including Viet Nam and the Lao People’s Democratic Republic (Figure 27). In half of the TWG WSH countries, diarrhoeal disease is responsible for over 6% of all deaths of children under 5 years old.

Despite the appalling number of deaths due to diarrhoeal disease among children under 5 years old, the situation has improved considerably because of overall improvements in drinking-water sources and sanitation facilities, and because of more effective policies and practices in case management.

0

10

20

30

40

50

60

70

80

90

100

Japa

n

Repu

blic o

f Kor

ea

Singa

pore

Mala

ysia

Thail

and

Mya

nmar

Viet

Nam

China

Philip

pines

Lao P

eople

’s De

moc

ratic

Repu

blic

Indon

esia

Mon

golia

Cam

bodia

Brun

ei Da

russa

lam

Perc

enta

ge of

deat

hs (%

)

Country

Injuries

Other diseases

Congenital anomalies

Neonatal sepsis

Birth asphyxia

Prematurity

Pneumonia

Malaria

Measles

HIV/AIDS

Diarrhoea

12 11 8 8 7 7 6 4 3 2 2 1 1 1

11 1

1

22 3 5

1

1 1 2 2

11 19 1716

1517

16

14 8 6 74 3

8

22 12 1616

2117

19

16 23

9

2425

33 26

7 14 1312

1212

11

15 8

4

98

6 7

6 7 8

5

67

6

25

2

32

2 1

16 610

167

1311

1329

39

2627

23 25

1921

1818 18 18

16

23

17

24

2223 22 26

3 88 9 8 9 7

135

147 11 10 6

Figure 27. Distribution of causes of death among children under 5 years old in TWG WSH countries, 2013

Source: WHO (2015).

7 Health and economic development in drinking-water and sanitation

32

As indicated above, case management has improved in many TWG WSH countries, but high mortality rates due to diarrhoeal disease remain in low-income countries (Figure 28). Almost 30 000 people in the TWG WSH region – especially children under 5 years old – die each year due to water, sanitation and hygiene-related diseases.

Figure 28. Deaths of children under 5 years old attributable to drinking-water, sanitation and hygiene in TWG WSH countries, 2012 (per 100 000 population)

0

20

40

60

80

100

120

140

Japa

n

Repu

blic o

f Kor

ea

Singa

pore

Mala

ysia

Thail

and

Mya

nmar

Viet

Nam

China

Philip

pines

Lao P

eople

’sDe

moc

ratic

Repu

blic

Indon

esia

Mon

golia

Cam

bodia

Brun

ei Da

russa

lam

Deat

hs p

er 1

00 0

00

Source: WHO (2014).

In most TWG WSH countries, the under-5 mortality rate in 2013 was less than half the value in 1990. However, comparing extremes between countries, such as Japan and the Lao People’s Democratic Republic, it is clear there is room for huge improvement (Figure 29). The reduction of the under-5 mortality rate in China is remarkable: the rate in 2013 was less than one quarter of the 1990 value.

Figure 29. Under-5 mortality rate* (per 1000 live births), 1990 and 2013

1990 2013

Cam

bodia

Japa

n

Mala

ysia

Singa

pore

Repu

blic o

f Kor

ea

Viet

Nam

Thail

and

China

Indon

esia

Philip

pines

Mya

nmar

Lao P

eople

’s De

moc

ratic

Repu

blic

Mon

golia

Brun

ei Da

russa

lam

0

20

40

60

80

100

140

120

180

160

Unde

r-5 m

orta

lity r

ate

(per

100

0 liv

e bi

rths

)

Country

* Defined as the probability of a child born in a specified year dying before reaching the age of 5 years.Source: WHO (2013).

33

Drinking-water and sanitation coverage and under-5 mortality are clearly linked. Although other risk factors exist, drinking-water, sanitation and hygiene fundamentally influence this indicator (Figure 30).

Figure 30. Use of improved drinking-water and sanitation compared with under-5 mortality rate in TWG WSH countries, 2013

0

10

20

30

40

50

60

70

80

90

100

0 20 40 60 80

Cove

rage

with

impr

oved

drin

king

-wat

er a

nd sa

nita

tion

(%)

Under-five mortality rate (deaths per 1000 live births)

Cambodia (water)China (water)Indonesia (water)Japan (water)Lao People's Democratic Republic (water)Malaysia (water)Mongolia (water)Myanmar (water)Philippines (water)Republic of Korea (water)Singapore (water)Thailand (water)Viet Nam (water)Cambodia (sanitation)China (sanitation)Indonesia (sanitation)Japan (sanitation)Lao People's Democratic Republic (sanitation)Malaysia (sanitation)Mongolia (sanitation)Myanmar (sanitation)Philippines (sanitation)Republic of Korea (sanitation)Singapore (sanitation)Thailand (sanitation)Viet Nam (sanitation)

Sources: WHO (2013); UNICEF and WHO (2015).

7.2 Drinking-water and sanitation in health-care facilities

In many health-care facilities in the TWG WSH countries, handwashing facilities are not available and toilets are in disrepair. Water, sanitation and hygiene (WASH) in health-care facilities are fundamental for reducing health care–related infections, increase trust and uptake of services, increase efficiency and decrease cost of service delivery. In low- and middle-income countries, WASH facilities in many health-care facilities are absent. Data from 54 countries, representing 66 101 facilities worldwide, show that 38% of health-care facilities do not have an improved water source, 19% do not have improved sanitation and 35% do not have water and soap for handwashing. This lack of adequate facilities compromises the ability to provide safe and quality care and places both those providing and those seeking care at considerable and preventable risk (WHO and UNICEF, 2017a). In Cambodia, although 91% of the health-care facilities had improved drinking-water systems, only 39% had sanitation facilities and only 15% basic hygiene facilities (WHO, 2017).

34

The WHO/UNICEF global action plan that was launched in 2015 aims at ensuring that all health-care facilities in all settings have adequate and safely managed WASH services by 2030. To realize this aim, global task teams composed of WASH and health professionals have been established to drive progress in four main areas: advocacy and policy, monitoring, evidence and research, and standards and facilities. Within all four streams of work there is a focus on national action and solutions, documenting lessons learned, and working jointly with health sector colleagues to drive change in key areas such as quality universal health coverage; maternal, newborn and child health; infection prevention and control; and antimicrobial resistance (WHO and UNICEF, 2017b).

Achieving the target of universal coverage of health-care facilities with safely managed WASH services requires a huge effort. Such effort cannot even be determined quantitatively by the Western Pacific Regional Office as there is a lack of information for generating baseline statistics on this issue. Because there is little reliable information on the status of drinking-water and sanitation facilities in health-care facilities in the TWG WSH countries, it is desirable that future national surveys include questions and response categories on this subject.

7.3 The challenge of urbanization in TWG WSH countries

The TWG WSH region has gone through rapid urbanization over the last 25 years. While the urban population more than doubled from 1990 to 2015, the rural population had a reduction of nearly 20% over the same period of time (Figure 31). The TWG WSH region, which was predominantly rural in 1990 (about 68% of the population was made up of rural residents), is now predominantly urban (about 56% of the population is composed of urban residents).

Unfortunately, the JMP statistics do not capture information on the use of drinking-water and sanitation in peri-urban areas. Moreover, because of the urban-rural dichotomy, it is not clear whether the peri-urban areas are counted as urban or rural in national or global statistics. This issue will need to be resolved if a better characterization of risk groups and challenges is to be achieved.

Figure 31. Urban and rural populations in the TWG WSH region, 1990 and 2015

0

500

1000

1500

2000

2500

Rural

Urban

1990Year

Popu

latio

n (m

illio

ns)

576

1200

1242

971

2015

Source: UN (2014).

35

References

Hutton G (2012). Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage. Geneva: World Health Organization (http://www.who.int/water_sanitation_health/publications/2012/global_costs/en/, accessed 16 August 2017).

IPCC (2014). Summary for policymakers. In: Climate change 2014: Impacts, Adaptation, and Vulnerability. Part A: global and sectoral aspects. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. New York, NY: Cambridge University Press; 1–32 (http://www.ipcc.ch/pdf/assessment-report/ar5/wg2/ar5_wgII_spm_en.pdf; accessed 16 August 2017).

Lenton R, Wright A, Lewis K (2005). Health, dignity and development: What will it take? New York, NY: UN Millennium Project Task Force on Water and Sanitation.

MoH and LSB (2012). Lao PDR Social Indicator Survey 2011-12 (Multiple Indicator Cluster Survey/Demographic and Health Survey). Vientiane: Ministry of Health and Lao Statistics Bureau (http://dhsprogram.com/pubs/pdf/FR268/FR268.pdf, accessed 16 August 2017).

Prüss-Üstün A, Bos R, Gore F, Bartram J (2008). Safer water, better health: Costs, benefits and sustainability of interventions to protect and promote health. Geneva: World Health Organization (http://apps.who.int/iris/bitstream/10665/43840/1/9789241596435_eng.pdf; accessed 16 August 2017).

UN (2014). World urbanization prospects: The 2014 revision [CD-ROM]. New York, NY: United Nations.

UN (2015). Transforming our world: The 2030 Agenda for Sustainable Development. New York, NY: United Nations (https://sustainabledevelopment.un.org/post2015/transformingourworld/publication, accessed 16 August 2017).

UN (2017). Millennium Summit [website]. New York, NY: United Nations (http://www.un.org/millenniumgoals/bkgd.shtml, accessed 16 August 2017).

UN and WHO (2014). UN-Water Global Analysis and Assessment of Sanitation and Drinking-water (GLAAS) 2014 – report: Investing in water and sanitation: increasing access, reducing inequalities. Geneva: World Health Organization (http://www.who.int/water_sanitation_health/publications/glaas_report_2014/en/, accessed 16 August 2017).

UNICEF (2012). Water, sanitation and hygiene (WASH) in schools. New York: United Nations Children’s Fund (http://www.unicef.org/publications/files/CFS_WASH_E_web.pdf, accessed 16 August 2017).

UNICEF and WHO (2015). Progress on sanitation and drinking water – 2015 update and MDG assessment. Geneva: United Nations Children’s Fund and World Health Organization (http://apps.who.int/iris/bitstream/10665/177752/1/9789241509145_eng.pdf?ua=1, accessed 16 August 2017).

36

WHO (2008). Guidelines for drinking-water quality. Third edition: Incorporating the first and second addenda. Volume 1: Recommendations. Geneva: World Health Organization (http://www.who.int/water_sanitation_health/dwq/fulltext.pdf, accessed 16 August 2017).

WHO (2013). World health statistics 2013. Geneva: World Health Organization (http://www.who.int/gho/publications/world_health_statistics/2013/en/; accessed 16 August 2017).

WHO (2014). Preventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries. Geneva: World Health Organization (http://apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf; accessed 16 August 2017).

WHO (2017). Achieving quality universal health coverage through better water, sanitation and hygiene services in health care facilities: a brief focus on Cambodia and Ethiopia. Geneva: World Health Organization (http://www.who.int/water_sanitation_health/publications/uhc-thru-better-wash.pdf, accessed 16 January 2018).

WHO and UNICEF (2013). Progress on sanitation and drinking-water: 2013 update. Geneva: World Health Organization (http://apps.who.int/iris/bitstream/10665/81245/1/9789241505390_eng.pdf, accessed 16 August 2017).

WHO and UNICEF (2015). WASH POST-2015: proposed indicators for drinking water, sanitation and hygiene. Geneva: World Health Organization and United Nations Children’s Fund (http://www.who.int/water_sanitation_health/monitoring/coverage/wash-post-2015-rev.pdf?ua=1/; accessed 16 August 2017).

WHO and UNICEF (2017). WASH in the 2030 agenda: New global indicators for water, sanitation and hygiene. Geneva: World Health Organization and United Nations Children’s Fund (https://washdata.org/reports, accessed 17 August 2017).

WHO and UNICEF (2017a). Progress on drinking water, sanitation and hygiene: 2017 update and SDG baselines. Geneva: World Health Organization and United Nations Children’s Fund (https://washdata.org/report/jmp-2017-report-final-en, accessed 16 January 2018).

WHO and UNICEF (2017b). WASH in health care facilities: global action to provide universal access by 2030 [website]. Geneva: World Health Organization (https://www.washinhcf.org/home/, accessed 16 January 2018).

World Bank (2017). GDP per capita (current US$) [website]. Washington, DC: World Bank (http://data.worldbank.org/indicator/NY.GDP.PCAP.CD, accessed 16 August 2017).

37

AnnexAnnex 1. Definitions of the post-2015 terms proposed by

the JMP (WHO and UNICEF, 2017)Open defecation: defecation in which excreta of adults or children are deposited (directly or after being covered by a layer of earth) in the bush, a field, a beach or other open area; are discharged into a drainage channel, river, sea or other water body; or are wrapped in temporary material and discarded.

Basic drinking-water service at home: households are considered to have a basic drinking-water service when they use water from an improved source (pre-2015 JMP definitions in rural areas; piped water into dwelling, yard or plot, or a standpipe/public tap or a tubewell/borehole in urban areas) with a total collection time of 30 minutes or less for a round trip, including queuing.

Basic handwashing facilities at home: handwashing facilities, with soap and water, available near sanitation facilities and where food is prepared or consumed.

Adequate sanitation facilities in schools and health centres: facilities that effectively separate excreta from human contact, and ensure that excreta do not re-enter the immediate environment. An adequate school or health centre sanitation facility:

zz is located in close proximity to the school or health centre;zz is accessible to all users, including adults and children, the elderly, and those

with physical disabilities;zz provides separate facilities for males and females (boys and girls at school), and

for adults and children;zz is equipped with handwashing stations that include soap and water and are

inside or immediately outside the sanitation facility;zz provides adequate menstrual management facilities in sanitation facilities that

are used by women and girls of menstruating age;zz at schools, provides at least one toilet per 25 girls and at least one toilet for

female school staff, as well as a minimum of one toilet plus one urinal (or 50 centimetres of urinal wall) per 50 boys, and at least one toilet for male school staff;

zz at inpatient health centres, includes at least one toilet per 20 users; andzz at outpatient health centres, includes at least four toilets – one each for staff,

female patients, male patients and child patients.

Basic drinking-water service in schools: water from an improved source on premises (in rural, pre-2015 JMP definitions; in urban, piped water into school, yard or plot or a stand pipe/public tap or a tubewell/borehole) capable of delivering sufficient water at all times for drinking, personal hygiene and, where appropriate, food preparation, cleaning and laundry.

Basic drinking-water service in health centres: water from an improved source on premises (in rural, pre-2015 JMP definitions; in urban, piped water into health centre

38

yard or plot or a stand pipe/public tap or a tubewell/borehole) capable of delivering the minimum quantity of water that is required for different situations in the health-care setting as defined by WHO (2008). Drinking-water points are accessible to all users, including those with disabilities, throughout the school day.

Adequate menstrual hygiene management facilities in schools and health centres: facilities that provide privacy for changing materials and for washing hands, private parts and clothes with soap and water; include access to water and soap within a place that provides an adequate level of privacy for washing stains from clothes and drying reusable menstrual materials; include disposal facilities for used menstrual materials (from collection point to final disposal).

Adequate handwashing facilities in schools and health centres: handwashing facilities, with soap and water, available inside or immediately outside sanitation facilities, where food is prepared or consumed, and in patient-care areas.

Intermediate drinking-water services at home: households are considered to have intermediate drinking-water service when they use water from an improved source (pre-2015 JMP definitions in rural areas; piped water into dwelling, yard or plot, or a tubewell/borehole in urban areas) located on their premises, which delivers an acceptable quantity of water with only moderate levels of discontinuity (non-functional for no more than two days in the last two weeks), water quality at source meets a threshold of less than 10 colony-forming units (cfu) Escherichia coli (E. coli ) per 100 millilitres year-round, and the water point is accessible to all household members at the times they need it.

Adequate sanitation at home: each of the following sanitation facility types is considered as adequate sanitation for monitoring progress towards the household sanitation targets, if the facility is shared among no more than five families or 30 people, whichever is fewer:

zz a pit latrine with a superstructure, and a platform or squatting slab constructed of durable material (a variety of latrine types can fall under this category, including composting latrines, pour-flush latrines, and ventilated improved pit latrines);

zz a toilet connected to a septic tank; orzz a toilet connected to a sewer (small bore or conventional).

Safe management of household excreta: the containment, extraction and transport of excreta to a designated disposal or treatment site, or the safe reuse of excreta at the household or community level, as appropriate to the local context. The share of households with safely managed excreta is defined as the fraction of households whose excreta:

zz are carried through a sewer network to a designated location (e.g. treatment facility);

zz are hygienically collected from septic tanks or latrine pits by a suction truck (or similar equipment that limits human contact) and transported to a designated location (e.g. treatment facility or solid waste collection site); or

zz are stored on site (e.g. in a sealed latrine pit) until they are safe to handle and reuse (e.g. as an agricultural input).

39

Annex 2. Country and regional estimates of improved sanitation coverage in TWG WSH countries

Coun

try

Year

Urba

n po

pu-

latio

n (t

hou-

sand

s)

Rura

l po

pu-

latio

n (t

hou-

sand

s)

Tota

l san

itatio

n co

vera

ge (%

)Ur

ban

sani

tatio

n co

vera

ge (%

)Ru

ral s

anita

tion

cove

rage

(%)

Chan

ge in

pro

port

ion

of

popu

latio

n us

ing

impr

oved

sa

nita

tion

from

199

0 to

20

12 (p

erce

ntag

e po

ints

)Im

prov

ed

Unim

prov

ed

Impr

oved

Unim

prov

ed

Impr

oved

Unim

prov

ed

Shar

ing

impr

oved

Othe

r un-

impr

oved

Open

de

feca

tion

Shar

ing

impr

oved

Othe

r un-

impr

oved

Open

de

feca

tion

Shar

ing

impr

oved

Othe

r un-

impr

oved

Open

de

feca

tion

Brun

ei Da

russ

alam

1990

169

88

NA20

0023

696

2010

302

98

2015

331

98

Cam

bodi

a

1990

1408

7649

30

889

193

1365

00

694

3920

0022

7299

5116

36

7543

68

4310

26

82

2010

2846

11 51

934

72

5774

101

1524

63

67

2015

3254

12 42

342

83

4788

120

030

73

60

Chin

a

1990

308 1

6785

7 262

483

427

685

243

402

499

2820

0045

9 383

821 0

4559

433

475

519

150

342

5

2010

669 3

8669

0 435

714

241

836

110

593

362

2015

779 4

7962

2 108

765

181

876

70

643

312

Indo

nesia

1990

54 63

312

4 000

357

1840

618

1219

246

2149

2620

0087

758

121 1

8047

814

3166

99

1634

817

41

2010

120 1

5512

0 521

5710

1023

709

714

4411

1332

2015

137 4

0011

8 309

6111

820

7210

513

4712

1229

Japa

n

1990

94 54

627

703

100

00

010

00

00

100

00

0

020

0098

873

26 84

210

00

00

100

00

010

00

00

2010

115 2

8212

070

100

00

010

00

00

100

00

0

2015

118 5

7282

4610

00

00

100

00

010

00

00

Lao P

eopl

e's D

emoc

ratic

Rep

ublic

1990

655

3589

NA20

0011

8442

0428

19

6266

38

2317

19

73

2010

2118

4277

592

534

864

37

451

648

2015

2712

4308

713

323

944

11

562

537

Mala

ysia

1990

9068

9143

864

64

904

51

834

58

1020

0014

515

8905

914

32

934

30

884

44

2010

20 05

182

2595

40

196

40

094

40

2

2015

22 89

877

5396

40

096

40

096

40

0

Mon

golia

1990

1246

938

6531

31

NA20

0013

7010

2848

2610

1665

322

126

1821

35

2010

1833

880

5730

211

6632

11

3726

532

2015

2106

817

6031

09

6632

11

4330

-128

40

Coun

try

Year

Urba

n po

pu-

latio

n (t

hou-

sand

s)

Rura

l po

pu-

latio

n (t

hou-

sand

s)

Tota

l san

itatio

n co

vera

ge (%

)Ur

ban

sani

tatio

n co

vera

ge (%

)Ru

ral s

anita

tion

cove

rage

(%)

Chan

ge in

pro

port

ion

of

popu

latio

n us

ing

impr

oved

sa

nita

tion

from

199

0 to

20

12 (p

erce

ntag

e po

ints

)Im

prov

ed

Unim

prov

ed

Impr

oved

Unim

prov

ed

Impr

oved

Unim

prov

ed

Shar

ing

impr

oved

Othe

r un-

impr

oved

Open

de

feca

tion

Shar

ing

impr

oved

Othe

r un-

impr

oved

Open

de

feca

tion

Shar

ing

impr

oved

Othe

r un-

impr

oved

Open

de

feca

tion

Mya

nmar

1990

10 35

031

773

NA20

0013

067

35 38

662

917

1279

127

256

820

16

2010

16 30

935

622

7711

66

8313

31

7410

88

2015

18 46

935

695

8012

44

8413

21

7711

66

Philip

pine

s

1990

30 10

131

848

5714

1415

6917

77

4612

1923

1720

0037

238

40 41

464

168

1272

175

656

1412

18

2010

42 28

851

156

7017

49

7618

24

6617

413

2015

45 17

356

630

7418

17

7819

03

7118

110

Repu

blic

of Ko

rea

1990

31 73

211

240

100

00

010

00

00

100

00

0

020

0036

607

9370

100

00

010

00

00

100

00

0

2010

39 70

187

5310

00

00

100

00

010

00

00

2015

41 03

187

1910

00

00

100

00

010

00

00

Singa

pore

1990

3016

099

099

0

120

0039

180

100

00

010

00

00

2010

5079

010

00

00

100

00

0

2015

5619

010

00

00

100

00

0

Thail

and

1990

16 64

939

934

875

08

8910

01

864

010

620

0019

570

42 77

391

60

389

101

092

40

4

2010

29 27

037

132

937

00

9010

00

964

00

2015

33 95

233

449

937

00

9010

00

964

00

Viet

Nam

1990

13 95

854

952

362

2339

654

724

292

2643

4220

0019

716

61 17

253

323

2177

48

1145

327

25

2010

27 06

461

983

704

215

885

70

624

277

2015

31 38

462

003

785

161

945

10

704

251

Regi

on

1990

575 6

981 2

00 11

953

431

1275

516

442

340

15

2420

0079

5 707

1 182

366

625

258

796

123

514

3411

2010

1 091

684

1 042

671

736

174

846

82

605

287

2015

1 242

380

970 5

5877

613

487

74

265

623

6

NA

= n

ot a

vaila

ble

Sour

ce: b

ased

on

WH

O a

nd U

NIC

EF (2

015)

Annex 2. Country and regional estimates of improved sanitation coverage in TWG WSH countries (Cont.)

41

Annex 3. Country and regional estimates of improved drinking-water coverage in TWG WSH countries

Coun

try

Year

Urba

n po

pula

-tio

n (t

hou-

sand

s)

Rura

l po

pula

-tio

n

(tho

u-sa

nds)

Tota

l (%

)Ur

ban

(%)

Rura

l (%

)Pr

opor

tion

of

popu

latio

n th

at

gain

ed a

cces

s to

impr

oved

drin

k-in

g-w

ater

from

19

90 to

201

5 (p

erce

ntag

e po

ints

)

Prop

ortio

n of

po

pula

tion

that

ga

ined

acc

ess t

o pi

ped

wat

er in

to

the

hous

ehol

d fr

om 1

990

to

2015

(per

cent

-ag

e po

ints

)

Impr

oved

Unim

prov

edIm

prov

edUn

impr

oved

Impr

oved

Unim

prov

ed

Tota

l im

prov

ed

Pipe

d

onto

the

hous

ehol

dUn

im-

prov

edSu

rfac

e w

ater

Tota

l im

prov

ed

Pipe

d

onto

the

hous

ehol

dUn

im-

prov

edSu

rfac

e w

ater

Tota

l im

prov

ed

Pipe

d

onto

the

hous

ehol

dUn

im-

prov

edSu

rfac

e w

ater

Brun

ei Da

russ

alam

1990

169

88

NANA

2000

236

96

2010

302

98

2015

331

98

Cam

bodi

a

1990

1408

7649

232

4235

3415

4026

220

4236

5219

2000

2272

9951

427

3127

5732

2617

382

3329

2010

2846

11 51

964

1619

1786

618

659

521

20

2015

3254

12 42

376

2112

1210

075

00

697

1615

Chin

a

1990

308 1

6785

7 262

6728

267

9778

21

5611

359

2945

2000

459 3

8382

1 045

8047

164

9781

21

7129

236

2010

669 3

8669

0 435

9166

81

9785

30

8646

122

2015

779 4

7962

2 108

9573

41

9887

20

9355

52

Indo

nesia

1990

54 63

312

4 000

699

256

8925

101

612

318

1813

2000

87 75

812

1 180

7815

184

9128

81

685

266

2010

120 1

5512

0 521

8420

142

9331

70

768

204

2015

137 4

0011

8 309

8722

112

9433

60

799

183

Japa

n

1990

94 54

627

703

100

940

010

097

00

100

860

0

04

2000

98 87

326

842

100

970

010

098

00

100

910

0

2010

115 2

8212

070

100

980

010

099

00

100

950

0

2015

118 5

7282

4610

098

00

100

990

010

095

00

Lao P

eopl

e's

Dem

ocra

tic R

epub

lic

1990

655

3589

4070

343

36NA

2000

1184

4204

4511

2827

7237

235

384

2933

2010

2118

4277

6722

2310

8256

162

605

2614

2015

2712

4308

7628

204

8664

140

696

247

Mala

ysia

1990

9068

9143

9076

91

9588

50

8665

122

820

2000

14 51

589

0594

865

197

933

089

749

2

2010

20 05

182

2597

942

110

099

00

9282

62

2015

22 89

877

5398

961

110

010

00

093

865

2

42

Coun

try

Year

Urba

n po

pula

-tio

n (t

hou-

sand

s)

Rura

l po

pula

-tio

n

(tho

u-sa

nds)

Tota

l (%

)Ur

ban

(%)

Rura

l (%

)Pr

opor

tion

of

popu

latio

n th

at

gain

ed a

cces

s to

impr

oved

drin

k-in

g-w

ater

from

19

90 to

201

5 (p

erce

ntag

e po

ints

)

Prop

ortio

n of

po

pula

tion

that

ga

ined

acc

ess t

o pi

ped

wat

er in

to

the

hous

ehol

d fr

om 1

990

to

2015

(per

cent

-ag

e po

ints

)

Impr

oved

Unim

prov

edIm

prov

edUn

impr

oved

Impr

oved

Unim

prov

ed

Tota

l im

prov

ed

Pipe

d

onto

the

hous

ehol

dUn

im-

prov

edSu

rfac

e w

ater

Tota

l im

prov

ed

Pipe

d

onto

the

hous

ehol

dUn

im-

prov

edSu

rfac

e w

ater

Tota

l im

prov

ed

Pipe

d

onto

the

hous

ehol

dUn

im-

prov

edSu

rfac

e w

ater

Mon

golia

1990

1246

938

5326

2027

7744

185

222

2355

11-2

2000

1370

1028

5623

2420

7439

233

322

2642

2010

1833

880

6324

307

6934

310

502

3020

2015

2106

817

6424

324

6633

340

592

2516

Mya

nmar

1990

10 35

031

773

585

1527

8017

812

511

1831

223

2000

13 06

735

386

676

1320

8517

69

602

1624

2010

16 30

935

622

788

148

9118

72

723

1711

2015

18 46

935

695

818

145

9319

70

743

188

Philip

pine

s

1990

30 10

131

848

8425

124

9143

72

779

167

818

2000

37 23

840

414

8733

94

9249

71

8317

116

2010

42 28

851

156

9040

73

9356

61

8826

75

2015

45 17

356

630

9243

53

9459

60

9030

64

Repu

blic

of Ko

rea

1990

31 73

211

240

9197

963

067

7NA

2000

36 60

793

7093

8798

972

075

4620

1039

701

8753

9893

100

990

088

6420

1541

031

8719

9810

099

00

Singa

pore

1990

3016

010

010

00

010

010

00

0

00

2000

3918

010

010

00

010

010

00

020

1050

790

100

100

00

100

100

00

2015

5619

010

010

00

010

010

00

0

Thail

and

1990

16 64

939

934

8729

112

9674

40

8410

142

1028

2000

19 57

042

773

9238

71

9775

30

9021

91

2010

29 27

037

132

9651

40

9776

30

9632

40

2015

33 95

233

449

9857

20

9876

20

9837

20

Viet

Nam

1990

13 95

854

952

639

2116

9043

46

560

2618

3518

2000

19 71

661

172

7715

1211

9451

33

724

1513

2010

27 06

461

983

9124

63

9759

30

899

74

2015

31 38

462

003

9827

11

9961

10

9710

21

Regi

on

1990

575 6

981 2

00 11

971

3122

796

733

159

1131

10

2332

2000

795 7

071 1

82 36

682

4514

496

753

172

2521

720

101 0

91 68

41 0

42 67

191

588

197

783

084

3713

31 2

42 38

097

0 558

9463

51

9780

30

9143

72

NA

= n

ot a

vaila

ble

Sour

ce: b

ased

on

WH

O a

nd U

NIC

EF (2

015)

Annex 3. Country and regional estimates of improved drinking-water coverage in TWG WSH countries (Cont.)

A summary of the WASH status in the TWG WSH region

Sanitation statistics in TWG WSH region Drinking-water statistics in TWG WSH region

� As of 2015, about 1.7 billion people (77% of the TWG WSH region population) have access to improved sanitation – an increase of 82% from 1990.

� About 500 million people (about one quarter of the region’s population) still do not have access to improved sanitation.

� Seven out of 10 people without improved sanitation facili-ties live in rural areas.

� About 82 million people still practise open defecation in TWG WSH region – three quarters live in rural areas.

� The TWG WSH region exceeded the MDG sanitation target by 1%. Despite this major achievement, one quarter of the region’s population still lacks improved sanitation.

� While the target in 2015 was 76%, the projected coverage is 77%.

� While nine countries met the MDG target for sanitation, four countries remain off-track. The JMP has no statistical information on coverage for Brunei Darussalam.

� About 70% of people in TWG WSH region who are not using improved sanitation live in rural areas – 65% are in China.

� Nearly 30 000 children under 5 years old in TWG WSH region die each year due to infirmities attributable to unsafe drinking-water, unsanitary excreta disposal and poor hygiene.

� As of 2015, nearly 2.1 billion people (94% of the TWG WSH region population) have access to an improved drink-ing-water source – an increase of 66% from 1990.

� Nearly 1.4 billion people now use piped water on premises, an increase of 150% from 1990.

� About 830 million people gained access to improved drinking-water sources since 1990. However, over 120 million people still do not use improved drinking-water sources.

� The TWG WSH region exceeded the MDG drinking-water target by 9%. The target in 2015 was 85% and the current coverage is 94%.

� Excepting Mongolia, all TWG WSH countries met the MDG target for drinking-water coverage.

� More than 70% of the population without improved drink-ing-water sources live in rural areas.

� Half of the people in TWG WSH region without improved drinking-water sources live in China.

� Drinking-water and sanitation coverage and under-5 mortality rates are linked. This report demonstrates that under-5 mortality rates drop dramatically as water and sanitation coverage increases.

Sanitation, drinking-water and health · sanitation facilities, or using open defecation by wealth...

Documents

Transcript of Sanitation, drinking-water and health · sanitation facilities, or using open defecation by wealth...