Targeting the excluded

Development Policy06 Mar 2013Catarina Fonseca

Specific targets are necessary to reduce inequalities in access to water, sanitation and hygiene services.

The vision for water, sanitation and hygiene (WASH) in the post-2015 development agenda is one of universal access to safe drinking water, sanitation and hygiene services in our time. “Our time” has a different meaning to different people, but the discussions tend to frame the goals to be achieved by 2030. In a recent blog for the IRC-International Water and Sanitation Centre, I described the key priorities and the guiding principles for reaching this vision as well as the fundamental difference between “access to improved/safe infrastructure” and “access to services”. Here I want to discuss one of the key priorities enshrined in the Human Rights framework for water and sanitation: reducing inequalities and the process required to achieve that.

Universality is about ensuring WASH services for all – even the hardest to reach – without exception. Currently, there is limited equality in access: the poorest are more likely not to have water and sanitation services than the wealthy; rural areas have much lower coverage than urban areas. As the latest JMP report shows, in many of the countries where access has increased, the increase is disproportionate, favouring those in the wealthier quintiles and living in urban areas. This is especially true for sanitation. The poorest 40 per cent of the population in Southern Asia have barely benefited from improvements in sanitation.

However, inequalities extend beyond wealth and geography: girls and women are more likely to bear the burden of water collection. Women without access to sanitation suffer the indignity of being forced to defecate in the open and are at risk from rape and assault, and the widespread lack of menstrual hygiene education and facilities to ensure that girls continue to attend school once they reach puberty, limits the participation of women in education and the workplace.

Many colleagues within and outside the sector believe that economic growth is a prerequisite to reducing inequalities. In this line of thinking development is triggered by enabling the middle classes to prosper and develop first. Improvements in water, sanitation, hygiene, and ultimately health and livelihoods, “emerge” from an increased desire for convenience, status and a wealthier future, driven by this newly empowered middle class. The role of the government and international protocols is then to “correct” the negative side effects this will bring. Believers in this approach shed doubts on targeting the poorest and most excluded because (local) governments need to plan and budget their services to target the whole population. Reaching the poorest (and universal access) can then only be achieved by making sure that entire geographic areas under their governance have adequate services.

These two approaches are not mutually exclusive. To sustain development and achieve universal service coverage does mean reaching “everyone” in a geographic area and for that to happen, there must be specific targets at international and country level, as well as country related interventions to improve services for the poorest. Furthermore, concerning global development goals which are to be achieved by everyone, the international community needs to take responsibility for setting, measuring and pursuing these targets (in addition to countries’ own responsibilities). Rising inequalities are a global concern, economically inefficient and will not deliver a better world in the future. Inequality has been identified as the number one risk in the latest risk assessment by the World Economic Forum (and the IMF and the Economist agree) as shown is this recently published report by Oxfam.

One example that illustrates this argument concerns access to improved sanitation in two neighboring countries: India and Bangladesh. India is a middle income country: it has grown tremendously economically in recent years, it has a space programme and has progressed steadily in access to water and sanitation. However, an analysis of who has gained access by wealth quintiles shows immense disparities. Most of the progress has been achieved in the upper income quintiles. Progress in the lowest quintile is almost negligible, which is reflected in the fact that nearly 60 per cent of those practicing open defecation in the World live in India . By comparison, Bangladesh is a lower income country, which has achieved notable progress in reaching the poorest with access to sanitation and hygiene. This is in part due to the approach of BRAC (the largest NGO in the world, which works closely with the government) which prioritises serving the poorest. There has been progress overall, also for the highest quintile, but not at the expense of stagnating coverage for the poorest.

The figure below provides an example of gaps in access to WASH services for different wealth quintiles. Similar analysis on the inequalities of access to WASH exists for other non-income based inequalities. Such inequalities are present in every country in the world: discrimination based on gender, age and disability status is consistent across the world while others based on ethnicity and caste are country-specific. The data available for WASH coverage implies that the gap to be covered for these countries is relatively large. They have a longer way to go to reach universal access. Therefore, discussions on what the post-MDG global targets should be concluded that success should also be measured in terms of reducing existing inequalities in access – between rich and poor, urban and rural dwellers, slums and formal urban settlements, and disadvantaged groups and the general population.

Halving the gap in access in all groups (wealth quintiles used as example)

Within the JMP post-2015 MDG working groups we have proposed to focus specifically on these “left behind” groups and express in the WASH targets a set of dates by which various levels of inequality reduction will have taken place within the next 15-20 years. Halving the proportion of the population without access to a defined level of service in each population sub group will necessarily require a relatively faster rate of progress in those most disadvantaged and therefore lead to a progressive ‘leveling up’ as illustrated in the figure.

This also implies a need to track patterns of discrimination and inequality in access to WASH services across countries so as to encourage targeted efforts to improve them. One of the challenges for the post-2015 development agenda overall is to improve the monitoring and analysis of different forms of discrimination and inequality. Disaggregated datasets will be required as well as methods to allow for identification of impact over time and monitoring improvements. Setting targets specifically for reducing inequalities in access to water, sanitation and hygiene services will enable countries to strike a balance between investing in sustainable and better services while at the same time investing in reaching the ones that have so far been left out.

At the moment WASH on-line consultations are taking place at and the consultations on inequalities have been published at Country and regional consultations have also started, an open discussion was held at the World Bank on 20 February, and the next High-level Panel meeting will take place in Bali.