Drinking-water, sanitation and hygiene in the Western Pacific Region

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Drinking-water, sanitation and hygiene in the Western Pacific Region

Opportunities and challenges

on the threshold of the SDG era

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© World Health Organization 2018 ISBN 978 92 9061 861 4

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Cataloguing-in-Publication (CIP) data. 1. Drinking water. 2. Hygiene. 3. Sanitation. I. World Health Organization Regional Office for the Western Pacific. (NLM Classification: WA675)

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Annexes

Annex 1. Global, regional and national basic drinking-water coverage, 2000 and 2015 . . . 81

Annex 2. Global, regional and national safely managed drinking-water coverage, 2000 and 2015 . . . 83

Annex 3. Global, regional and national basic sanitation coverage, 2000 and 2015 . . . 85

Annex 4. Global, regional and national safely managed sanitation coverage, 2000 and 2015 . . . 87

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DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

iv

Annex 5. Selected tables derived from the 2016/2017 GLAAS survey

in the Western Pacific Region . . . 89

Annex 6. Glossary of selected terms used in this report . . . 97

Annex 7. Sustainable Development Goals . . . 99

Annex 8. Regional groupings considered in this report . . . 100

Figures

Fig. 1. Composition of the different JMP drinking-water statistics . . . 6

Fig. 2. Composition of the different JMP sanitation statistics . . . 6

Fig. 3. Mortality rate attributed to exposure to unsafe WASH services (per 100 000 population) . . . 10

Fig. 4. Proportion of population with access to safely managed drinking-water services and other supply alternatives in Western Pacific countries and areas, 2015 . . . 15

Fig. 5. Proportion of the population in the Western Pacific Region and the PICs with access to different drinking-water options in 2000 and 2015, and comparison with the world aggregated statistics . . . 16

Fig. 6. Proportion of population with access to basic drinking-water services and population without access to basic drinking-water services in the Western Pacific Region and comparison with the world aggregated statistics, 2015 . . . 16

Fig. 7. Proportion of populations in the Western Pacific countries using different types of drinking-water services, 2015 . . . 17

Fig. 8. Population in the Western Pacific Region not using basic drinking-water, 2015 (population in millions) . . . 17

Fig. 9. Proportion of populations in the Western Pacific Region using drinking-water piped into their households, 2015 . . . 18

Fig. 10. Proportion of the population in the Western Pacific Region and the PICs with access to different sanitation options in 2000 and 2015, and comparison with the world aggregated statistics . . . 19

Fig. 11. Proportion of populations in the Western Pacific countries using safely managed sanitation and other types of sanitation options, 2015 . . . 20

Fig. 12. Proportion of people using toilets flushing to sewers and proportion of people generating wastewater treated by treatment plants, Western Pacific Region, 2015 . . . 21

Fig. 13. Proportion of people in the Western Pacific Region with access to different types of technologies, total, rural, urban, 2015 . . . 22

Fig. 14. Proportion of people in the Western Pacific countries using basic sanitation facilities and other types of sanitation options, and aggregated statistics for the Western Pacific Region, the PICs and the world, 2015 . . . 23

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CONTENTS v Fig. 15. Population in the Western Pacific Region not using basic sanitation,

2015 (population in millions) . . . 24 Fig. 16. Proportion of population in Cambodia, Mongolia and Viet Nam

using basic and limited handwashing facilities in 2015 . . . 26 Fig. 17. Change in the proportion of people with access to basic

drinking-water services in the Western Pacific Region and the PICs between 2000 and 2015 and projection of change between 2015

and 2030 . . . 27 Fig. 18. Proportion of people with access to basic drinking-water in 2015

and projected coverage in 2030, Western Pacific Region, PICs and

comparison with the world aggregated statistics . . . 28 Fig. 19. Population with access to basic drinking-water in 2000 and 2015

and projected coverage in 2030, Western Pacific Region and PICs . . . . 29 Fig. 20. Change in the proportion of people with access to safely managed

and basic sanitation services in the Western Pacific Region between 2000 and 2015 and projection of change between 2015 and 2030

and trends required to achieve SDG 6.2 and SDG 1.4 targets . . . 30 Fig. 21. Change in the proportion of people with access to basic sanitation

services in the PICs between 2000 and 2015 and projection of change between 2015 and 2030 and trends required to achieve SDG 1.4

target . . . 31 Fig. 22. Proportion of population with access to safely managed sanitation

services in selected countries of the Western Pacific Region

and projected coverage in 2030 . . . 31 Fig. 23. Proportion of population with access to basic sanitation services

in selected countries of the Western Pacific Region and projected

coverage in 2030 . . . 32 Fig. 24. Population with access to basic sanitation in 2000 and 2015 and

projected coverage in 2030, Western Pacific Region and the PICs . . . 33 Fig. 25. Proportion of urban and rural populations

in the Western Pacific Region, PICs and the world using basic

drinking-water services, 2015 . . . 33 Fig. 26. Proportion of urban, rural and national populations

in the Western Pacific Region, PICs and the world using

basic drinking-water services, 2015 . . . 34 Fig. 27. Use of basic drinking-water facilities in selected countries by wealth

quintile in 2015 . . . 35 Fig. 28. Proportion of urban and rural populations in the Western Pacific Region

and the world using safely managed sanitation services, 2015 . . . 36 Fig. 29. Proportion of urban, rural and national populations

in the Western Pacific Region, the PICs and the world using basic

sanitation services, 2015 . . . 36

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Fig. 30. Population with and without access to safely managed

sanitation services in urban and rural areas, Western Pacific Region

and the world, 2000 and 2015 . . . 37

Fig. 31. Reported annual government WASH budgets in the Western Pacific Region, most recent fiscal year (2015–2017) . . . 52

Fig. 32 Reported annual government WASH budgets per capita in the Western Pacific Region, most recent fiscal year (2015–2017) . . . 52

Tables

Table 1. Targets and indicators for WASH SDG (water, sanitation and hygiene) . . . 3

Table 2. The JMP ladder for drinking-water . . . 4

Table 3. The JMP ladder for sanitation . . . 5

Table 4. The JMP hygiene ladder . . . 5

Table 5. JMP service ladders to monitor WASH in schools . . . 66

Table 6. Status of drinking-water and sanitation coverage in schools of selected Western Pacific countries (%) . . . 66

Table 7. What can be done at the national, district and local levels to improve drinking-water, sanitation and hygiene in schools? . . . 69

Table 8. Service ladders for monitoring WASH in health-care facilities . . . 71

Boxes

Box 1. The GLAAS 2016/2017 survey in the Western Pacific Region . . . 8

Box 2. Effect of improvement in drinking-water supply and sanitation on diarrhoeal disease risk . . . 11

Box 3. What can be done to accelerate health gains? . . . 12

Box 4. What should be done to improve hygiene in the Western Pacific countries? . . . 25

Box 5. Suggested actions to advance the human right agenda on water and sanitation . . . 40

Box 6. What needs to be done on country policies and strategies? . . . 41

Box 7. The Thematic Working Group on Water, Sanitation and Hygiene . . . 42

Box 8. East Asia Ministerial Conferences on Sanitation and Hygiene (EASAN) . . . 43

Box 9. Key action on sector planning and coordination at the country level . . . 44

Box 10. What needs to be done in monitoring and evaluation? . . . 47

Box 11. What needs to be done for effective human resources development in the WASH sector? . . . 49

Box 12. What needs to be done to address WASH gender issues at the country level?. . . 51

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CONTENTS vii Box 13. What needs to be done to address O&M costs and efficiency? . . . 54

Box 14. What can be done to increase the financial feasibility of attaining

the WASH SDG targets? . . . 56 Box 15. What can be done to implement the drinking-water quality framework

in Western Pacific countries? . . . 60 Box 16. What can be done to advance the WSP agenda in the Western Pacific Region? . . . 62 Box 17. WHO International Scheme to Evaluate Household Water Treatment Technologies . . . 63 Box 18. What can be done to advance the HWTS agenda in the Western Pacific Region? . . . 64 Box 19. The Fit for School approach . . . 67 Box 20. The Three Star Approach . . . 68 Box 21. The water and sanitation for health facility improvement

tool (WASH FIT) . . . 70 Box 22. What needs to be done to improve WASH in health-care facilities? . . . 72 Box 23. What to do to face the challenges of WASH in climate change? . . . 74

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© WHO / Jose Hueb / 2014

Part of Rewa river basin of Fiji

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ix

Foreword

Preventable water-related diseases claim tens of thousands of lives in the Western Pacific Region. More than 14 000 people a year die from diarrhoeal diseases alone, due to a lack of safe drinking-water, inadequate sanitation and poor hygiene. Sufficient, affordable and safely managed drinking-water and sanitation and improved hygiene behaviours can cut this toll dramatically.

Adopting the Sustainable Development Goals (SDGs) in 2015, the world community pledged to achieve universal coverage with safely managed drinking-water and sanitation services and to eradicate open defecation by 2030. The combination of safely managed water, sanitation and hygiene (WASH) will accelerate achievement of the SDGs.

The Western Pacific Region made considerable progress from 1990 to 2015, with most countries achieving the Millennium Development Goal (MDG) targets for drinking- water and sanitation. The proportion of people served with basic drinking-water and basic sanitation in 2015 amounted to 95% and 68%, respectively. Still, nearly 90 million people in the Region do not use a basic drinking-water facility and more than 400 million do not use a basic sanitation facility.

The Region needs to measure progress made towards the ambitious targets of achieving universal coverage with safely managed drinking-water and sanitation services for all by 2030. Preliminary data have been obtained by the WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) for a few countries in the Western Pacific Region, showing that only 57% of the population uses safely managed sanitation services. However, information is still not available to calculate the regional statistics for safely managed drinking-water services.

This report will provide urgently needed baseline information on the current WASH situation in countries for decision-makers in government and international partners, as well as other stakeholders in the Region.

We hope the findings of this report help shed light on gaps and constraints, as well as provide guidance on actions to achieve universal coverage of WASH services and leave no one behind in the Western Pacific Region.

Shin Young-soo, MD, Ph.D.

Regional Director

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Acknowledgements

This document was conceived from the understanding that the countries of the Western Pacific Region would greatly benefit from an integrated analysis of the findings of the two most relevant global WASH monitoring mechanisms managed by WHO and UNICEF (JMP) and by WHO (GLAAS). As a result of this vision, a decision was taken to prepare the current document, which is the practical result of such an endeavour. The document was prepared through the guidance of Rokho Kim and Rifat Hossain and was authored by José Hueb, consultant.

The WHO Regional Office for the Western Pacific gratefully acknowledges the contributions of the following specialists who provided technical support over the development of this work and formulated comments and suggestions that contributed greatly to making this document more accurate and useful:

Abram YC Abanil (GTZ Regional Fit for School Programme) In-Cheol Choi (WHO Regional Office for the Western Pacific) Jennifer de France (WHO headquarters)

Bruce Allan Gordon (WHO headquarters) Fiona Gore (WHO headquarters)

Rifat Hossain (WHO headquarters)

Seoyeon Jeong (WHO Regional Office for the Western Pacific) Richard Johnston (WHO headquarters)

Bonifacio Magtibay (WHO Regional Office for the Western Pacific) Bella Elisabeth Monse (GTZ Regional Fit for School Programme) Rokho Kim (WHO Regional Office for the Western Pacific)

Margaret Montgomery (WHO headquarters) Elena Villalobos Prats (WHO headquarters) Angella Rinehold (WHO headquarters) Terrence Thompson (consultant)

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AbbREvIATIONS xi

Abbreviations

CLTS community-led total sanitation DALY disability-adjusted life year

DFAT Department of Foreign Affairs and Trade (Australia)

DFID Department for International Development (United Kingdom of Great Britain and Northern Ireland)

EASAN East Asia Ministerial Conference on Sanitation and Hygiene GDWQ Guidelines for Drinking-water Quality

GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit GLAAS UN-Water Global Analysis and Assessment of Sanitation and

Drinking-Water

HWTS household water treatment and safe storage

JMP WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene

MDG Millennium Development Goal NGO nongovernmental organization O&M operations and maintenance PICs Pacific island countries and areas SDG Sustainable Development Goal

SEAMEO Southeast Asian Ministers of Education Organization SSP sanitation safety plan

TWG WSH Thematic Working Group on Water, Sanitation and Hygiene

UN United Nations

UN Environment United Nations Environment Programme UNICEF United Nations Children’s Fund

UN-Water United Nations Water

USAID United States Agency for International Development WASH water, sanitation and hygiene

WHO World Health Organization

WSP water safety plan

WQP Water Quality Partnership for Health

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© UNICEF/Marc Overmars/2004

Water quality of lagoons can be compromised by inadequate sanitation. (Nonouti, Kiribati, 2004)

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ExECuTIvE SummARY xiii

Executive summary

This document is intended to provide relevant water, sanitation and hygiene (WASH) information to policy-makers and decision-makers in governments, bilateral and multilateral agencies, nongovernmental organizations, universities, consultants and civil society in general, to help policy- and decision-making at regional and national levels. Most of the findings of this document are based on the statistics and information provided by two major global monitoring initiatives, both counting on strong participation of the World Health Organization (WHO): the WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) and the WHO-led UN-Water initiative, Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS).

Both monitoring initiatives are tracking progress on the WASH Sustainable Development Goals (SDGs), including SDG 6, which aims at ensuring access to safely managed drinking-water and sanitation for all, and SDG indicator 1.4.1, which aims at ensuring that all men and women, in particular the poor and the vulnerable, have equal rights to economic resources, as well as access to basic services.

Improving WASH services is particularly relevant to WHO as contaminated drinking- water, inadequate sanitation and poor hygiene are linked to transmission of diseases such as cholera, diarrhoea, dysentery, hepatitis A, typhoid and poliomyelitis (polio).

Some 14 000 people in the Western Pacific Region, especially children under 5 years old, are estimated to die each year from diarrhoea as a result of unsafe drinking- water, inadequate sanitation and poor hygiene. Moreover, the overall disease burden, expressed as the number of years lost due to ill health, disability or early death (or disability-adjusted life years, DALYs) amounts to 758 (WHO, 2014a). Yet diarrhoea is largely preventable, and the deaths of these children could be avoided if these risk factors were addressed. In health-care facilities, both patients and staff are placed at additional risk of infection and disease when WASH services are lacking.

The indicators to measure progress towards universal WASH coverage make a distinction between basic services and well managed services. For drinking-water, basic services are those from an improved drinking-water source, provided collection time is not more than 30 minutes. To be considered safely managed, basic services need also to be located on premises, available when needed and free from contamination.

For sanitation, basic services are those provided by improved facilities and not shared with other households. In order to be safely managed, basic services must also be such that excreta are safely disposed of in situ or transported and treated off-site.

Unfortunately, the number of countries (11) for which estimates on safely managed services are available is insufficiently representative of the whole Western Pacific Region (37 countries and areas). The same applies to the Pacific island countries

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and areas (PICs), where information is not sufficient to determine statistics on drinking-water safety as well as the other parameters indicative of safe management (drinking-water available when needed, accessible on the premises and free from contamination).

However, information is available to determine statistics on access to basic drinking- water services. Impressive progress was experienced by the Region, with an increase of 15 percentage points in coverage with basic drinking-water services from 2000 to 2015. In 2015, 1.76 billion people in the Region (about 95% of the population) used improved sources of drinking-water that required no more than 30 minutes per round trip to collect water, and are thus considered as having access to basic drinking-water services. The PICs, on the other hand, practically stagnated from 2000 to 2015 with regard to drinking-water supply coverage, with only half of the population using a basic drinking-water facility in 2015.

With regard to sanitation, in 2015, only three fifths of the population in the Western Pacific Region used safely managed sanitation services. This means that nearly 790 million people in the Region did not have access to sustainably managed sanitation services. With regard to basic sanitation services in the Region as a whole, about one quarter of the population still did not use basic sanitation. The coverage of basic sanitation services in the PICs was extremely low in 2015, with only 36% of the population using these services. Statistics are unavailable for safely managed sanitation services in the PICs.

There is little information about hygiene behaviours in the countries of the Western Pacific Region. The major international household survey institutions have agreed on standardization of household survey questions on hygiene. For this reason, it is possible that far more information on this crucial issue will be available over the coming years.

This document also addresses national WASH sector management, sector organization, human right to water, financing and crucial WASH priorities in the Region, and provides suggestions on how to tackle these issues at the country level.

It is organized around the following sections:

1. Introduction deals with the objectives of the document and provides general background information on WASH in the Western Pacific Region. It also provides information on the WASH SDGs and how the international institutions responsible for monitoring such goals are managing to track progress at national, regional and global levels. A brief description of the main monitoring mechanisms to collect, analyse and disseminate WASH information is also presented in this section. Finally, reasons are provided to justify the involvement of the health sector in WASH issues.

2. Essential statistics on drinking-water, sanitation and hygiene provides statistics on the use of basic and safely managed WASH services concerning the Western Pacific Region and separately for the PICs. It discusses the immense challenges ahead for the Region, taking into account the requirement of attaining universal coverage with

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ExECuTIvE SummARY xv safely managed services by 2030. It also discusses inequalities in access to WASH

in terms of both geographical (urban and rural areas) and socioeconomic disparities (wealth quintiles).

3. Overall status of the WASH sector deals mainly with the findings of the GLAAS 2016/2017 survey conducted in selected countries of the Western Pacific Region.

Information was obtained from other relevant sources as well, as indicated directly in the respective texts. Based on the findings of the GLAAS 2016/2017 survey, this section presents information on the countries in the Region concerning several important issues such as the right to drinking-water and sanitation, national sector organization, human resources and financing.

4. Regional programmatic priorities describes the main efforts of the WHO Regional Office for the Western Pacific in support of the WASH regional agenda, which ultimately aims at improving health through promotion and support for universal access to safely managed drinking-water supply and sanitation, and good hygiene behaviours. The Regional Office has been a major partner of relevant multilateral and bilateral agencies in organizing crucial high-level events and facilitating major international commitments in this area. The Office’s programmatic WASH priorities in the Region are outlined briefly in this section. However, by no means is this list exhaustive. Any new subject area may be added whenever there is a perception of new important health hazard linked to WASH issues not considered in this section. Among the top priorities for the Regional Office are issues such as: drinking-water quality, including water safety planning and drinking-water guidelines; household water treatment and safe storage;

WASH in schools; WASH in health-care facilities; and WASH in climate change.

Most sections and subsections in this report present a discussion on each topic, followed by relevant statistics (where available) obtained from the JMP, GLAAS and other sources, as well as a set of key actions to be undertaken to move the respective agenda ahead.

Annexes 1 to 4 are tables displaying in greater detail the basic and safely managed drinking-water and sanitation coverage statistics for the Western Pacific Region. The reader will realize that there are serious problems in terms of lack of data on safely managed drinking-water and sanitation for many countries in the Region. It is hoped that this problem will be overcome in future surveys.

Annex 5 displays selected tables summarizing the findings of the 2016/2017 GLAAS survey conducted in the Western Pacific Region.

Annex 6 contains a glossary of selected terms used in this report.

Annex 7 provides the headings for the 17 SDGs adopted by world leaders on 25 September 2015. Such goals are aimed at ending poverty, protecting the planet and ensuring prosperity for all as part of a new Sustainable Development Agenda. Each goal has specific targets to be achieved by 2030.

Annex 8 presents the regional groupings used in this report.

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xviWomen washing clothes in the river. (Buka, Papua New Guinea, 2016) © WHO/Yoshi Shimizu

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1.1 Objectives of this document

This document is intended to provide relevant water, sanitation and hygiene (WASH) information to policy-makers and decision-makers in governments, bilateral and multilateral agencies, nongovernmental organizations (NGOs), universities, consultants and civil society in general to help policy- and decision-making at regional and national levels. The specific objectives are the following:

z

z To provide an overview of the status of drinking-water, sanitation and hygiene in the Western Pacific Region to support policies, strategies and programmes towards the common aim of achieving Sustainable Development Goal (SDG) 6 (Ensure availability and sustainable management of water and sanitation for all) and SDG target 1.4 (achieving universal access to basic services).

z

z To provide essential information for reflection on ways to streamline international and national efforts for WASH development in the Region.

z

z To provide the basis for discussion and advocacy work at all levels to accelerate investment for the attainment of universal coverage with safely managed drinking-water, sanitation and hygiene in the countries of the Western Pacific Region.

1.2 Background information

A major effort is being exerted by selected United Nations (UN) institutions to provide coherent and reliable information on key water trends and management issues. During past decades, several initiatives, mechanisms and programmes, both within and outside the UN system, have been collecting information on the various aspects of the drinking-water and sanitation sector performance. Two major global monitoring initiatives count on strong leadership from WHO: the WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) and the WHO-led UN-Water Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS) initiative.

The JMP has been monitoring, since 1990, the changes in national, regional and global drinking-water and sanitation coverage, establishing a large and authoritative database and presenting analysis of the indicators detailed in the original framework for the Millennium Development Goals (MDGs), and currently for SDG 6 (Ensure

Introduction

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availability and sustainable management of water and sanitation for all) and partly for SDG target 1.4 (achieving universal access to basic services). The JMP has helped to shed light on the nature of progress and the extent to which the ambition and vision of the MDGs have been achieved. It has also helped to identify priorities to be addressed by SDG 6. The JMP has been issuing regular global WASH reports addressing mainly the aspect of use of drinking-water and sanitation facilities worldwide.

Another important monitoring and evaluation mechanism, GLAAS, is implemented by WHO on behalf of UN-Water. The objective of GLAAS is to provide policy- and decision-makers at all levels with a reliable, comprehensive and global analysis of investments and an enabling environment to make informed decisions for sanitation, drinking-water and hygiene. GLAAS reports are issued biennially, following data collection through questionnaires conducted around the world. Two major sets of information are collected: from WASH agencies at the country level; and from external support agencies, including bilateral and multilateral agencies.

Following the adoption of the SDGs, the WHO Regional Office for the Western Pacific, in addition to collecting data on the overall WASH indicators, is also investing considerably in collecting relevant information on aspects of management and treatment of wastewater in the pursuit of expanded sanitation chain monitoring under the SDG framework. This is further complemented by efforts in the Region for monitoring of WASH outside of households, namely in health-care facilities and schools in particular.

While the global monitoring programmes mentioned above provide excellent and authoritative information on important aspects of the water and sanitation sector, there has not yet been an opportunity to prepare a consolidated analysis addressing the special needs and characteristics of the Western Pacific Region that is based not only on the findings of the two reports but also on other reliable monitoring and evaluation efforts being conducted within and outside of the Region. For this reason, the Regional Office for the Western Pacific has decided to conduct such a consolidated analysis. Such an exercise would be extremely beneficial to Member States as an important instrument not only by providing a regional view of progress towards the achievement of WASH SDGs but also to identify problems and constraints that might potentially be hindering progress towards their respective targets. Moreover, the information collected and analysed through the above sources is used in this document to provide an overall analysis of the WASH sector and a succinct recommended set of strategic directions towards sector development in the Region, including a more holistic approach to monitoring for the Western Pacific.

The WHO Western Pacific Region comprises 37 countries and areas and is home to more than one quarter of the world’s population. The Region stretches over a vast area, from Mongolia in the north to New Zealand in the south, and from Central Asia in the east to the Southwest Pacific in the west, including most of the surface area of the Pacific Ocean. If the oceanic surface area is considered, it includes more than one third of the global surface area. Its land mass embraces the eastern half of the

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INTRODuCTION 3 Eurasian land mass, the eastern part of South-East Asia and the whole land mass

of Oceania. It includes 22 Pacific island countries and areas (PICs), across the span of the Pacific Ocean. With unique geographies and population groups, the Region is exceptionally diverse, and includes least-developed countries, rapidly emerging economies and developed nations.

1.3 What is new in WASH monitoring?

1.3.1 The WASH Sustainable Development Goals

The year 2015 marked the transition between the MDG (1990–2015) and the SDG (2015–2030) periods. For WASH, MDG target 7c was aimed at halving the proportion of people without sustainable access to safe drinking-water and basic sanitation by 2015 (UN, 2014). Strict monitoring of this target was not possible during the 2000s as the international agencies tasked with this role did not have sufficient information and resources to measure access to “sustainable” and “safe” drinking-water and sanitation. To overcome this major issue, it was decided that monitoring would focus on the use of infrastructure that was likely to address safety and sustainability, using the indicators “improved drinking-water” and “improved sanitation”.

The SDGs are far more ambitious than the MDGs in that their overarching aim is to end poverty in all its forms and to leave no one behind in the space of just 15 years.

SDG 6 aims to ensure access to safely managed drinking-water and sanitation for all.

It seeks to expand the MDG focus on drinking-water and basic sanitation to include water, wastewater and ecosystem resources, covering all the main aspects related to freshwater in the context of sustainable development (UN, 2016). The SDG WASH targets and indicators are presented in Table 1.

Table 1. Targets and indicators for WASH SDG (water, sanitation and hygiene)

TARGETS INDICATORS

Achieving universal access to basic services

1.4 By 2030, ensure all men and women, in particular the poor and vulnerable, have equal rights to economic resources, as well as access to basic services.

z

Proportion of population living in households with access to basic services (including basic drinking-water, sanitation and hygiene) Drinking-

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

z

Proportion of population using safely managed drinking-water services

Sanitation

and hygiene 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.

z

Proportion of population using safely managed sanitation services

z

Proportion of population with a handwashing facility on premises with soap and water available

z

Population practising open defecation Water

quality and wastewater

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.

z

Proportion of wastewater safely treated z

Proportion of bodies of water with good ambient water quality

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TARGETS INDICATORS

Water use

and scarcity 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.

z

Change in water-use efficiency over time z

Level of water stress: freshwater withdrawal as a proportion of available freshwater resources

Water resources management

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

z

Degree of integrated water resources management implementation (0–100).

z

Proportion of transboundary basin area with an operational arrangement for water cooperation Water-

related ecosystems

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

z

Change in the extent of water-related ecosystems over time

International cooperation and capacity- building

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.

z

Amount of water- and sanitation-related official development assistance that is part of a government-coordinated spending plan

Stakeholder

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

z

Proportion of local administrative units with established and operational policies and procedures for participation of local communities in water and sanitation management

Source: Adapted from UN (2016).

As SDG 6 focuses not only on the simple provision of services but also on their safe management, monitoring the wider elements of WASH – drinking-water quality as well as safe treatment of excreta and wastewater – becomes necessary.

1.3.2 Updated JMP ladders for WASH

The JMP has introduced new drinking-water and sanitation ladders with a special focus on the WASH SDG targets and indicators. To the two previous ladders (drinking- water and sanitation), a third ladder has also been added for hygiene, as indicated in Tables 2, 3 and 4.

Table 2. The JMP ladder for drinking-water

TYPE OF

ACCESS DEFINITION TYPE OF

ACCESS DEFINITION

Basic services

Drinking-water from an improved source*, provided collection time

is not more than 30 minutes

for a round trip, including

queuing.

Safely managed

Drinking-water from an improved source, provided collection time is not more than 30 minutes for a round trip, including queuing, that is located on premises, available when needed and free from faecal and priority chemical contamination.

Basic, not safely

managed

Drinking-water from an improved source, provided collection time is not more than 30 minutes for a round trip, including queuing, that is not located on premises, or available when needed or free from faecal and priority chemical contamination.

Limited Drinking-water from an improved source for which collection time exceeds 30 minutes for a round trip, including queuing.

Unimproved Drinking-water from an unprotected dug well or unprotected spring.

Surface water Drinking-water directly from a river, dam, lake, pond, stream, canal or irrigation canal.

*Improved sources include: piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered water.

Source: WHO and UNICEF (2017a).

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INTRODuCTION 5 At this stage, information on the availability of improved drinking-water sources

on premises is scarce, as is information on the availability of drinking-water when needed and status of absence of contamination from faecal and priority chemical contamination in the Western Pacific. Therefore, many assumptions and concessions needed to be made so the statistics presented in the 2017 JMP Report could be calculated. When additional information becomes available, future reports might need to adjust the statistics presented in this report.

Table 3. The JMP ladder for sanitation

TYPE OF

ACCESS DEFINITION TYPE OF ACCESS DEFINITION

Basic services

Use of improved facilities* that are not shared with other households.

Use of improved facilities that are not shared with other households and where excreta are safely disposed of in situ or transported and treated offsite.

Basic, not safely managed

Use of improved facilities that are not shared with other households and where excreta are not safely disposed of in situ or transported and treated offsite.

Limited Use of improved facilities shared between two or more households.

Unimproved Use of pit latrines without a slab or platform, hanging latrines or bucket latrines.

Open defecation Disposal of human faeces in fields, forests, bushes, open bodies of water, beaches or other open spaces, or with solid waste.

*Improved facilities include flush/pour flush to piped sewer systems, septic tanks or pit latrines; ventilated improved pit latrines, composting toilets or pit latrines with slabs.

Similar to information on drinking-water, information on safe treatment of excreta and wastewater in the Region is also scarce. For instance, it is difficult to determine which latrines are safely managed and how to obtain information on their performance; the same is the case with regard to septic tanks. Some septic tanks may not be watertight, or may be discharging to open drainage or are not maintained regularly. Considering that septic tanks such as the latter ones are not safely managed, it is challenging to find ways to capture this information and take it into account when deriving estimates.

Table 4. The JMP hygiene ladder

TYPE OF ACCESS DEFINITION

Basic Availability of a handwashing facility* on premises with soap and water.

Limited Availability of a handwashing facility on premises without soap and water.

Unimproved No handwashing facility on premises.

*Handwashing facilities may be fixed or mobile and include a sink with tap water, buckets with taps, tippy-taps, and jugs or basins designated for handwashing. Soap includes bar soap, liquid soap, powder detergent and soapy water but does not include ash, soil, sand or other handwashing agents.

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6

Figs. 1 and 2 show schematically how the detailed statistics on different drinking- water and sanitation interact in the composition of the JMP coverage indicators.

Fig. 1. Composition of the different JMP drinking-water statistics

Improved Unimproved

Basic Limited

Basic, safely not managed

Accessible premiseson

Free from contami-

nation Available

when needed Surface

water

Piped systems Non-piped

facilities

Total population

Notes:

a. Safely managed drinking-water is being currently estimated by the JMP as the smallest of the three indicators: accessible on premises, available when needed and free from contamination.

b. Safely managed drinking-water is estimated only when statistics on the proportion of people with access to drinking- water free from contamination are known.

Source: based on definitions in WHO and UNICEF (2017a).

Fig. 2. Composition of the different JMP sanitation statistics

Wastewater treated Disposed

in situ Emptied and treated

Sewer connections Septic tanks Basic, not

safely managed

Safely managed Basic

Limited (shared)

Improved Unimproved

Open defecation

Total population Latrines and

others

Source: based on definitions in WHO and UNICEF (2017a).

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INTRODuCTION 7 In this report, any statistics on using basic services refer to the totality of the population with access to improved services subtracted by the population with access to limited services (see Figs. 1 and 2). When statistics on “safely managed” services are available, the totality of access to basic services is broken down into access to safely managed and access to “basic services, but not safely managed”, as follows:

Access to basic services = safely managed (known) + basic, but not safely managed (known).

When statistics on “safely managed” are unknown, but the totality of access to basic services is known, then it is understood that such a “totality” includes the two unknown elements. In this case, the equation is as follows:

Access to basic services (known) = safely managed (unknown) + basic, but not safely managed (unknown).

Further explanations on the methodological changes introduced by the JMP can be found in the WHO and UNICEF publication, Progress on drinking water, sanitation and hygiene: 2017 update and SDG baselines (2017a), or on the JMP website:

washdata.org.

1.3.3 The UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS)

GLAAS objectives are defined as, at the global, regional and national level, monitoring the inputs (in terms of human resources and finance) and the enabling environment (in terms of laws, plans and policies, institutional and monitoring arrangements) required to sustain and extend drinking-water, sanitation and hygiene systems and services to all, and especially to the most vulnerable population groups (WHO, 2017a).

Finance was chosen as the main focus of the 2016/2017 survey because not only is finance the most crucial aspect influencing any sector planning, it is also a strong driver of progress or constraints in all the other dimensions monitored by GLAAS (see Box 1). While the GLAAS 2017 report had a finance focus, all areas of the enabling environment (governance, monitoring and human resources) were also covered by some countries and are being used for the analyses in this regional report. Because the GLAAS 2016/2017 survey offered the alternative to respondent countries of choosing a shorter questionnaire focused mostly on finance, most of the countries of the Western Pacific Region chose this latter option; therefore, the broader aspects of WASH sector development were not covered. For this reason, this regional report also used information from previous GLAAS surveys where needed.

Because GLAAS will help to monitor SDG 6 targets on means of implementation (6.a and 6.b), the GLAAS 2016/2017 survey included specific questions that are required for SDG monitoring. GLAAS has also expanded survey questions to cover

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8

safely managed drinking-water and sanitation systems, faecal sludge management, wastewater and regulation (WHO, 2017a).

1.3.4 Remarks about the statistics presented in this document

The regional drinking-water and sanitation coverage statistics presented in this document refer to the Member States of the WHO Western Pacific Region. Not all graphs and, accordingly, not all analyses include all the countries of the Region.

Where the JMP or GLAAS could not provide statistics and information for certain countries, they were not included in graphs and tables.

In many instances, analysis of the PICs is presented separately from the analysis for all Western Pacific countries as their population is a fraction of the overall population in the Region. Australia and New Zealand – although included in the analysis for the Western Pacific Region – are not included in the analysis for the PICs. The information available on WASH in the PICs is far from what would be desirable for an unequivocal analysis of this sector. Hence, the corresponding analysis on the PICs conducted in this report reflects what is possible to present taking into account the scarcity of information.

The countries comprising the Western Pacific Region and the PICs are presented in Annex 8 of this report.

Box 1. The GLAAS 2016/2017 survey in the Western Pacific Region

The Global Analysis and Assessment of Water and Sanitation (GLAAS) surveys assess data from several different sources, including country and global data on sanitation and drinking-water coverage; donor aid flows; health, economic and development indicators;

and data from regional sector and multisector assessments. GLAAS gathers data at both country and external support agency levels to fill key information gaps.

The GLAAS 2016/2017 was the most successful GLAAS survey ever conducted in the Western Pacific Region. A total of 13 countries, 97 WASH country professionals and 3 international consultants participated actively not only in providing the information requested by the questionnaires but mainly in creating an enabling interministerial and interagency environment in each country, which served as a coordination and planning tool for governments, institutions and actors influencing and requiring WASH service delivery. The GLAAS survey in countries in the Western Pacific Region helped in assessing the state of the enabling environment, including financial and human resources inputs being directed to sanitation, drinking-water and hygiene, while identifying barriers and enablers.

It was an extremely well-coordinated and participatory exercise with outputs that went beyond the initial expectations. As a result of this exercise, many countries are seriously considering developing further their respective information and evaluation mechanisms to help measure their progress towards the WASH SDG targets and to help orient their action towards such an endeavour.

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INTRODuCTION 9

1.4 Why is the health sector involved in WASH?

Contaminated drinking-water, inade quate sanitation and poor hygiene are linked to transmission of diseases such as cholera, dysentery, hepatitis A, typhoid and polio. Absent, inadequate, or inappropriately managed drinking-water and sanitation systems expose individuals to preventable health risks. This is true not only with regard to the population in general but is also particularly the case in health- care facilities, where both patients and staff are placed at additional risk of infection and disease when drinking-water, sanitation and hygiene services are lacking.

Globally, 15% of patients develop an infection during a hospital stay, with the proportion much greater in low-income countries;

nearly 1 million deaths are linked

to unhygienic births (WHO, 2017b). Furthermore, limited WASH services adversely impact the experience of care, care-seeking and health staff morale, all of which have adverse impacts on health (Blencowe and Graham, 2010).

Almost 240 million people globally are affected by schistosomiasis, which is an acute and chronic disease caused by parasitic worms contracted through exposure to infested water. Insects that live or breed in water carry and transmit diseases such as dengue fever, chikungunya, malaria and yellow fever, etc. Some of these vectors breed in clean, rather than dirty water (such as Aedes aegypti, Aedes albopictus, etc.) and household drinking-water containers can serve as breeding grounds. The simple intervention of covering water storage containers can reduce vector breeding and may also reduce faecal contamination of water at the household level (WHO, 2017b).

Similarly, the inadequate management of urban, industrial and agricultural wastewater leads to major health hazards due to direct exposure of humans to contamination or through microbial or chemical contamination of drinking-water sources.

Some 14 000 people in the Western Pacific Region, especially children under 5 years old, are estimated to die each year from diarrhoea as a result of unsafe drinking- water, sanitation and poor hygiene. Yet diarrhoea is largely preventable, and the deaths of these children could be avoided if these risk factors were addressed (WHO,

Children fetching drinking-water. (Mongolia, 2015)

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10

2014a). Fig. 3 displays the mortality rate due to the absence of safe drinking-water, sanitation and hygiene for selected countries in the Region. It is believed that although the number of deaths attributable to diarrhoeal diseases (which in turn are caused by lack of safe drinking-water, sanitation and hygiene) are relatively low, the morbidity statistics are exceedingly high, exhausting scarce health-care resources that could be otherwise used to address other pressing needs. Unfortunately, reliable statistics to corroborate this statement are unavailable.

Fig. 3. Mortality rate attributed to exposure to unsafe WASH services (per 100 000 population)

13.9 12.4

10.4

5.6 5.1

3.1 3.0 2.0

0.6 0.4 0.4 0.2 0.1 0.1 0.0 0.0

0.8

12.4

0 2 4 6 8 10 12 14 16

Lao People's Democratic Republic Papua New Guinea Solomon Islands Cambodia Philippines Mongolia Fiji Viet Nam New Zealand China Malaysia Republic of Korea Japan Singapore Australia Brunei Darussalam Western Pacific Region Global

Mortality rate (per 100 000 population)

*Information is not available for all countries in the Western Pacific Region. Due to the large population in China, the statistics from this country substantially affect the aggregated statistics for the Region.

Source: WHO (2014a).

There is clear evidence that well-managed drinking-water and sanitation systems reduce considerably the risk of diarrhoeal diseases. Box 2 quantitatively demonstrates how the improvements in terms of quality of services lead to substantive reductions in risk.

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INTRODuCTION 11 Box 2. Effect of improvement in drinking-water supply and sanitation on diarrhoeal disease risk

The risk of diarrhoeal disease decreases as people in low- and middle-income countries use different levels of drinking-water and sanitation alternatives. For drinking-water, five levels were studied, namely:

• Systematically managed piped drinking-water with continuity and good safety.

• Basic piped drinking-water on premises (drinking-water piped into the household without certainty of its continuity and safety).

• Other improved sources (public taps and standpipes, boreholes and tubewells, protected wells and springs, rainwater collection).

• Unimproved: surface water (rivers, lakes), unprotected wells, springs, improved sources farther than a 30-minute round trip for collecting water.

• Effective household drinking-water treatment and safe storage.

One of the results of the study shows risk reduction attributed to moving from one drinking-water option to another, as seen in the following diagram. It is obvious that

a huge risk reduction occurs when moving from any option to well-managed piped drinking-water services.

For sanitation, the following levels of sanitation options were studied:

• Community sanitation or sewer connections: those living in

communities with access to a sewerage system or other systems removing excreta entirely from the community.

• Improved sanitation without sewer connections: those using improved on- site sanitation facilities (septic tank, ventilated improved latrine, pit latrine with slab, composting toilet).

• Unimproved sanitation (pit latrines without a slab or platform, hanging latrines, bucket latrines and open defecation).

The results of the study with regard to risk reduction attributed to moving from one sanitation option to another can be seen in the following diagram. It is obvious that huge health gains occur when moving from any option to a well-managed sanitation system.

Source: WHO (2014a).

Unimproved source of drinking-water

Improved point source of drinking-

water

Basic piped drinking- water on premises

Piped drinking- water, systematically

managed

Drinking-water efficiently treated and safely stored in

the household

HIGH

LOW

RISK TO HEALTH

11%

14%

73%

23%

38%

28%

45% Unimproved

sanitation

Improved sanitation without sewer

connections

Improved sanitation (including sewer

connections)

Community sanitation or sewer connections

HIGH

LOW

RISK TO HEALTH

16%

28%

73%

69%

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12

According to the commitments agreed globally concerning SDG 6, the aim is to achieve universal coverage by 2030 with safely managed drinking-water, sanitation and hygiene as indicated in Table 1. However, while such targets are not achieved, Box 3 proposes a few key interventions that would effectively accelerate health gains.

Box 3. What can be done to accelerate health gains?

Investing in safely managed drinking-water and sanitation infrastructure and services is the long-term solution to accrue a maximum of health benefits for the developing communities in the Western Pacific Region. WASH infrastructure is costly, and although it is fundamental to achieving a sustainable management of services, implementing the different phases of project development is a long-term endeavour. Under the current SDG 6 commitments, the ultimate aim of infrastructure project development is to achieve universal coverage with safely managed services by 2030. However, shorter-term solutions are available and should be promoted while the long-term infrastructure is not yet in place. Most of these interventions might be essential even when traditional infrastructure is already in place. They should include at least the following:

• For drinking-water, improved point sources availability and household water treatment and safe storage are fundamental. For sanitation, basic, sanitary, well-managed on- site facilities and promotion of hygiene behaviours, especially handwashing, are also fundamental.

• For both drinking-water and sanitation it is crucial to invest in the establishment and implementation of both water safety plans (WSPs) and sanitation safety plans (SSPs) as a condition to protect health and as a contribution to the process towards safe management of WASH systems.

• Improvement of WASH in schools and health settings can lead to substantial health gains.

It is advisable for these short-term interventions to be implemented without missing the perspective of broader sector plans, including adequate infrastructure, conducive to the sustainable attainment of the WASH SDG targets.

Drinking-water, sanitation and hygiene in the Western Pacific Region