Today UNICEF has a post looking at an oft-overlooked yet important problem in Haiti– a lack of proper sanitation and needed latrines. You can read UNICEF’s report on this front here, and check out the video below:

ONE has partners on the ground in Turkey for the 5th World Water Forum. Our partners will be providing guest blog posts throughout the week to keep us updated on the meeting’s proceedings. Stay tuned for more in this series!

As I was quoted in the Associated Press the other day,“In America, diarrhea is bad takeout, in Chad, it’s the difference between life and death.”

I’m here at the 5th World Water Forum in Istanbul to help coordinate a journalist workshop on the health aspects of water, sanitation and hygiene. Journalists have come from as far away as Indonesia, Laos and Peru to learn about this massive, but surmountable, challenge.

We want to bring attention to this under-reported issue, as more children die of diarrhea and other water and sanitation related diseases than die of HIV/AIDS, tuberculosis and malaria combined. Meanwhile, 80% of research and development funding for diseases that disproportionately affect the poor is spent on these “big three” diseases. We aim to point out this disparity, not to take away funding from the more well-known diseases, but to see that more resources go to solving the water and sanitation crisis.

What is also unique about preventing and treating diarrhea is that affordable solutions are available now. Ceramic water filters, rope pumps, and ecosan toilets are all effective and sustainable solutions.

Sessions this week at the World Water Forum are going to focus on vast array of topics, such as new technologies, entrepreneurship and child health. The issue of poor water and sanitation in schools will also be discussed by UNICEF. An astounding 50% of schools in the developing world do not have access to water and sanitation.

PATH, WSSCC (Water Supply & Sanitation Collaborative Council), and Water Advocates are a few of the organizers of the journalist forum. We hope that the workshop and forum will increase attention on the health aspects of the water and sanitation crisis. With 5,000 people dying each day due to dirty water, and poor sanitation and hygiene, this cannot wait.

-John Sauer, Water Advocates

Public indifference to the HIVAIDS epidemic was chronicled in 1987 in And the Band Played On: Politics, People, and the AIDS Epidemic. As the author Randy Shilts lamented, “Everyone responded with an ordinary pace to an extraordinary situation.” Thankfully now there is attention to this deadly disease, but it wasn’t always the case.

Another pandemic—namely more than two dozen diseases associated with poor sanitation—now faces the same kind of unresponsiveness. Every 20 seconds a child dies of sanitation-related diseases, which kill five times as many children as HIVAIDS. As an article in the New England Journal of Medicine documents, pathogens that cause diarrheal diseases, tracoma, and guinea-worm are among the culprits. You didn’t think you can die of diarrhea did you? Well you probably can’t but those living where open defecation is the norm can. Human excrement: it is the last taboo.

Pushback on this topic is very real. A TIME Magazine review of Rose George’s new book on sanitation suggested that “a series of articles was plenty on this topic.” One US government official refused to release a statement on World Toilet Day because of objection to the word “toilet.” Progress towards the Millennium Development Goal (MDG) target of halving the proportion of people without basic sanitation by 2015 will not be met, at current rates, until 2115. In fact, the original version of the MDGs didn’t have a sanitation target.

But advocacy efforts for sanitation are growing and they are calling for more to join their ranks.

On World Toilet Day, November 19, several organizations gathered on the US Capitol lawn—in advance of Barack Obama’s inauguration viewers—to draw attention to the fact that 2.5 billion people do not have even a simple, safe latrine. Life-sized figures were set up to demonstrate that people are forced to defecate on roadsides, behind bushes, and in plastic bags. The problem is so widespread that 75% of the schools in developing countries lack access to proper sanitation.

For now diarrhea does not have a celebrity champion, which would certainly help raise the profile of the problem, but there is plenty that the ordinary person can do. The Lancet Student suggests some great ways to take action to address the relentless sanitation crisis. Another simple action: forward this news story about World Toilet Day to everyone you know.

It’s time to put away our squeamishness about poop, feces, and excrement and confront this problem. Indeed people have died because we haven’t faced up to it—and that’s no joke. So let’s look at the solutions and technologies that exist and put our heads together about what we can do instead of talking about what we can’t say.

-John Sauer, Water Advociates

Here are some other fast facts to keep in mind, as we commemorate World Toilet Day:

• 6 in every 10 Africans lack access to a proper toilet.
• In sub-Saharan Africa, 322 million people lack access to clean water and 463 million people lack access to adequate sanitation.
• Together, unclean water and poor sanitation are a leading cause of child mortality: an estimated 5,000 children die daily from diarrhea, which is spread through poor sanitation and poor hygiene. Universal access to improved sanitation could reduce diarrhea-related morbidity by more than a third.
• Studies have found that about half of girls who drop out of primary school in sub-Saharan Africa do so because of a lack of separate toilets and easy access to safe water.

So have a chuckle if you’d like, but remember to be especially grateful if you’re blessed with proper and clean sanitation today—because many people, unfortunately, are not. You can find more articles about World Toilet Day here, here, and here.

-Chris Scott

Finding the toilet in Stockholm

Last week a mix of water and sanitation experts gathered for World Water Weekin Stockholm, Sweden to mull over the world’s biggest public health crisis. The problem is that not enough people paid attention.

Each year over 2 million deaths could be prevented with improvements related to access to safe drinking-water, sanitation and hygiene. To put that in perspective, we have it within our grasp to prevent the equivalent deaths of 10 Asian tsunamis or 1,000 Hurricane Katrinas. Yet a major effort—like those that have been launched to address HIV/AIDS and malaria—to tackle the global drinking water and sanitation crisis remains elusive. The scope of this disconnect is baffling; water- and sanitation-related diseases (like relatively-easy-to-prevent diarrhea) kill more children each year than HIV/AIDS, malaria, and measles combined.

One reason why there hasn’t been a Herculean effort to address this global scourge is that we in the water and sanitation sector are not doing enough to influence how this issue is understood by others. We have not been proactive or coordinated enough to frame the issue to the media and the wider development community in an action-oriented “this-can-be-done” tone.

All too often, water and sanitation has been framed as a “privatization” issue instead of an “access” issue. This is problematic. The “privatization” frame is confusing. It too often results in a blame game that takes attention away from the end result of the sector’s work: getting water and sanitation to those who need it. Many of the most innovative, scalable solutions to the water and sanitation crisis are locally initiated approaches, such as the production of latrine slabs or ceramic water filters. They are put in place by a combination of actors: beneficiaries, communities, governments, local entrepreneurs, corporations and NGOs. The work of all of them is necessary to solve this problem.

There is a great need for the water and sanitation sector to reframe the issue so that those outside the sector understand what is at stake and become part of the solution. This effort will take leadership, resources, and working together (for more than one week in Stockholm). I propose “universal access” as the theme that guides this new direction. Developed countries have had universal access to water and sanitation for nearly 100 years. It makes no sense why the rest of the world can’t get universal access as well.

Another explanation why the water and sanitation crisis remains in the shadows is that “sanitation” specifically has been ignored. Let’s face it— diseases associated with sanitation, like diarrhea, do not have “disease appeal” for governments and donors. The result is that very few people in the general public even know that 2.5 billion people do not have access to improved sanitation—nearly half of whom actually have to resort to open defecation. Those who do learn are outraged and take action.

More resources must be devoted to recruiting sanitation champions. HIV/AIDS has a built-in constituency because many people have a direct connection with someone who has suffered from or died of HIV/AIDS. Malaria has David Beckham trumpeting its cause. Sanitation needs a brave soul to be its spokesperson.

It has become a joke in the sector that no one in their right mind would become a “sanitation spokesperson.” But this is no laughing matter. The lack of sanitation is one of the main reasons there isn’t greater progress towards enabling the world’s poor to meet their basic needs; malnutrition, poor education and disease burden are all exacerbated by inadequate sanitation. And the plight of the poor becomes more related to the survival of all as the world gets smaller each day.

In fact, some high-profile individuals have spoken out about the urgency of access to sanitation and they should be applauded. Matt Damon, Ashley Judd, Keira Knightley are a few. Would they be willing to form a Sanitation Celebrity Council to move this issue to its tipping point?

So the appeal I’d make to the 2,500 experts who went to Stockholm is to start a “universal access” campaign and to make sanitation—the most important medical advance since 1840—a major part of it. It’s time to elevate water and sanitation to the status that it enjoyed during the UN’s first Water Decade, which ended in 1990. This is, after all, the second Water Decade (2005-2015) in case we forgot. It’s time to get this done.

John Sauer works as Communications Director for Water Advocates in Washington, DC. His work focuses on the development and implementation of communications strategies to increase US support and action – in both the private and public sectors – for worldwide access to safe, affordable, and sustainable drinking water and adequate sanitation.

African development was again the subject of G8 discussions as world leaders gathered in Toyako, Hokkaido in northern Japan from July 7-9 for the 2008 G8 Summit. While the G8 was confronted with multiple global challenges, including climate change and a weakening global economy, the 2008 Hokkaido Summit marked an important “mid point” moment in the fight against poverty. The Hokkaido Summit came at the critical halfway point to both the Millennium Development Goals (MDGs) and the G8 Gleneagles promises to Africa. The G8 are dangerously behind on their landmark commitments to the region, having delivered only $3 billion of the promised $25 billion in additional assistance to Africa by 2010, according to the 2008 DATA Report.

After difficult negotiations, the G8 summit yielded small gains for the poorest. The bulk of G8 agreements on development and Africa and food security reiterated previous pledges rather than outlining new measures to get the group back on track. The G8 did announce plans for a new effort to tackle the global food crisis, though more details are needed to ensure its effectiveness and delivery. They highlighted the UN High-level meeting on the MDGs in September as an important opportunity to review progress and identify actions needed to overcome remaining challenges.

At a time when G8 credibility is at risk due to slow progress in delivering on commitments, there was a strong call for greater accountability in the G8 Communique. The G8 agreed to track progress against previous commitments in health, education, water and agriculture, as well as its compliance with anti-corruption measures.

Overall, the US, UK and Germany provided strong leadership in negotiations and have significantly increased their funding for Africa in recent years.

After the jump, the following brief overview of outcomes for Africa from the 2008 G8 Summit.

-Ben Hubbard

……

OVERALL DEVELOPMENT ASSISTANCE

Reiteration of 2005 commitment to increase aid to Africa by $25 billion by 2010

The G8 included a reiteration of its 2005 commitment to increase Official Development Assistance (ODA) to Africa by $25 billion a year by 2010 (starting from a 2004 baseline). The G8 also recommitted to their global target of an additional $50 billion by 2010. They did not commit to an accountable timetable for delivering on these 2005 promises. The G8 also made an important acknowledgement that ODA from G8 and other donors may need to increase after 2010 and therefore beyond their current commitments.

HEALTH & INFECTIOUS DISEASES

Reiteration of 2005 commitment to universal access by 2010; new commitment to make progress on malaria

The G8 identified the remarkable successes underway in the fight against infectious diseases as a result of G8 support. The G8 stated that they intend “to honor in full their specific commitments to fight infectious diseases, namely malaria, tuberculosis, polio and working towards the goal of universal access to HIV/AIDS prevention, treatment and care by 2010.” Importantly, the G8, for the first time, provided matrices showing G8 progress in implementing past commitments to ensure accountability. In addition, the G8 committed to work through public and private sector partnerships to deliver 100 million bednets by 2010 as part of a broader effort to deliver on existing malaria commitments.

HEALTH FINANCING

Reiteration of commitment to provide $60 billion for health

The G8 reiterated their 2007 Heiligendamm commitment to provide $60 billion to fight infectious diseases and improve health systems. However, this year the G8 assigned a five-year timetable to the commitment this year. While $60 billion is a large figure, it is not dedicated to Africa or to specific health outcomes nor is it all new financing. Moreover, it does not reflect the likely increases already in the pipeline. For example, the United States Congress passes a $50 billion five-year bill to fight AIDS, TB and Malaria this summer as expected, then the US alone would fill $50 billion of the $60 billion commitment, leaving very little for other donors to contribute.

HEALTH SYSTEMS

New commitment to work toward WHO minimum health worker density

The G8 continued the increasing donor attention to building health systems as a focus of health ODA. They said, “The G8 members will work towards increasing health workforce coverage towards the WHO threshold of 2.3 health workers per 1000 people, initially in partnership with the African countries where we are currently engaged and that are experiencing a critical shortage of health workers.” The mention of the quantitative WHO endorsed baseline of 2.3 health workers per 1000 people is a firm target, but there were not financial commitments made to reach this outcome. A majority of the health portion of the communiqué was focused on health systems and a more comprehensive approach to health development. This is a departure from past G8 Summits. In addition, a separate Summit document titled the “Toyako Framework for Action on Global Health” spells out, in even greater detail, the importance of health systems strengthening in meeting G8 commitments and improving overall health. The G8 “welcomed” this contribution but its recommendations were not adopted in a binding manner.

MATERNAL & CHILD HEALTH

Acknowledgement of need to address slow progress in improving maternal and child health

A separate paragraph on maternal and child health was included in this year’s communiqué. It included recognition that many countries are seriously off-track in their progress towards meeting the MDGs on these two areas. The G8 committed to blending HIV/AIDS programs with sexual and reproductive health programs, a critical part of reducing maternal mortality.

WATER AND SANITATION

Reiteration of the Evian Water Action Plan with stronger accountability

The G8 acknowledged, on numerous occasions throughout the Communique, the cross-sectoral impact of water and sanitation and the slow pace of progress in meeting the water and sanitation MDG targets. The G8 committed to “reinvigorate” their efforts to implement the Evian Water Action Plan from 2003, in which they agreed to prioritize the water and sanitation sector within overall aid levels. Importantly, the G8 also committed to preparing a progress report on G8 efforts in the sector by the 2009 summit. Although the communiqué recognizes the International Year of Sanitation and calls upon national governments to prioritize sanitation, the G8 made no new commitments or financing targets towards scaling up access to sanitation

EDUCATION

Commitment to fill $1 billion 2008 funding shortfall for FTI endorsed countries

The G8 promised to meet the $1 billion funding shortfall for Fast Track Initiative (FTI) endorsed countries in 2008. They also committed to monitoring G8 support to the FTI in a report to be delivered at the 2009 Summit. G8 leaders identified the critical shortages of teachers in Africa and the need to focus on improving learning outcomes in conjunction with increasing access. They also said they would promote synergies between the education sector and other development sectors through, for example, school feeding programs. The G8 did not include the phrase “no country seriously committed to Education for All shall fail for lack of resources,” which marks a retreat from past communiqués.

GLOBAL FOOD SECURITY

Announced plans to establish a new global partnership on agriculture and food security

The G8 announced that since January 2008, they have collectively committed more than $10 billion, for short and long term efforts to respond to the global food price crisis. They did not provide a breakdown of this figure by donor or purpose and did not stipulate a time period over which it would be spent.

The G8 acknowledged that tackling the global food price crisis will require “leadership, ambition, and an appropriate scale of resources.” Without spelling out concrete measures, the G8 announced their intention to launch a new global partnership on agriculture by the time of the UN General Assembly meeting in September. The global partnership would coordinate the international response and ensure a comprehensive strategy to tackle food security in the medium and long term. The partnership would strengthen and build on existing international institutions and facilitate coordinated financial and technical support around country-led processes and local leadership. As part of the partnership, the G8 intends to create a global network of high-level experts on food and agriculture to provide science-based analysis on global needs and future risks.

The G8 called for open and efficient agricultural and food markets and for the removal of export restrictions on food, signaling their support for a process at the WTO that is working to put in place a set of guidelines and agreements on global trade restrictions such as export bans that prolong and aggravate rising food prices or hinder humanitarian purchases of food commodities.

The G8 provided a comprehensive outline of their intended mid-to long term response to food and agriculture, which included reversing the decline in aid and investment to the agriculture sector, fully implementing the Comprehensive Africa Agricultural Development Programme (CAADP), achieving a 6.2% annual growth rate in agriculture productivity, supporting research and development, improving infrastructure and food security early warning systems, helping countries adapt to climate change, and ensuring compatibility between policies on sustainable bio-fuel production and food security.

The G8 tasked their Experts Group to monitor the implementation of their Hokkaido commitments and continue to work with the UN-World Bank High Level Task Force on the Global Food Crisis.

TRADE AND INVESTMENT

Reiteration of previous commitments

The G8 acknowledged the impressive growth rates achieved by African countries in recent years and reiterated their support for measures that will lead to increased trade and private investment. Some of these measures include: strengthening the financial sector, improvements in domestic revenue generation, development of road and power networks, boosting agriculture productivity, supporting good governance. It also underscored the importance of the Doha Development Agenda negotiations, particularly the upcoming ministerial meeting on July 21, and committed to work urgently towards the completion of the negotiations. However, the G8 statements on trade did not reiterate the important 2005 commitment to “make trade work for Africa”. The G8 reiterated but did not add to its 2005 commitment to provide $4 billion in trade related assistance in line with the WTO Hong Kong Ministerial conference. The G8 also signaled their full commitment to implement duty-free and quota-free market access for products originating from Least Developed Countries.

GOVERNANCE AND THE FIGHT AGAINST CORRUPTION

Reiteration of previous commitments on UNCAC and OECD Convention; support for anti-corruption measures, including StAR Initiative and Africa Peer Review Mechanism

The G8 called for ratification of the UN Convention Against Corruption (UNCAC) by all countries and for the development of a review system to ensure compliance (Germany, Italy and Japan have still not taken action on the Convention). The G8 underscored their support for asset recovery efforts, namely the Stolen Asset Recovery (StAR) Initiative at the World Bank and called for more technical assistance to help developing countries implement the Convention and undertake asset recovery efforts. The G8 endorsed an annual accountability report that will detail actions each G8 country is taking to implement previous anti-corruption commitments.

DEBT SUSTAINABILITY

Committed to deepen aid dialogue with development partners

G8 leaders expressed their desire to deepen aid dialogues with emerging donors, especially around the issue of debt sustainability. The G8 highlighted the importance of borrowers and lenders pursuing sustainable lending practices so that the gains made from G8 debt cancellation are not wiped away.

PEACE AND SECURITY

No new commitments

The G8 reiterated their commitment to promoting peace on the continent by enhancing Africa’s peacekeeping capabilities through support of the Africa Peace Security Architecture and Africa Standby Force. Support will include training and equipment, sustainable and flexible funding for peace operations, and peace building support for humanitarian, reconciliation, stabilization, recovery and reconstruction efforts.

ZIMBABWE

Pledged to impose further measures (financial and other) against those responsible for the violence; recommended a UN envoy to support mediation efforts

In a separate statement, the G8 condemned the recent election in Zimbabwe and said they would not accept the legitimacy of a government that does not reflect the will of the Zimbabwean people. The G8 pledged to take financial and other measures against individuals responsible for the violence and also called for the appointment of a special envoy of the UN Secretary-General to report on the situation and support regional efforts to mediate between the opposition and the government.

More information:
All 2008 G8 Summit documents are available here.

From a Tuesday Reuters article:

“Investing approximately $10 billion per year can halve the proportion of people without basic sanitation by 2015,” [the U.N. statement] said.

The U.N.’s drive for better sanitation will involve regional conferences and public campaigns to raise awareness and implement projects to improve sanitation in developing countries through public and private partnerships.

UK-based charity WaterAid said the absence of clean toilet facilities, access to safe water and efficient sanitation was directly related to the spread of diseases that killed 1.8 million children a year.

It estimated the economic cost of not investing in sanitation and clean water at $38 million a year resulting from infant deaths, lost work days and school absences due to disease.”

Read the full article here.

-Virginia Simmons