The failure of governments in both rich and poor countries to prioritize basic sanitation is killing thousands of children every day, according to two reports released today by international aid agencies WaterAid and PATH. And a third report released yesterday suggests that the global economic crisis may increase the death rate, at least in Africa.

Public toilets in the developing world are fairly uncommon. Those that are available often fall into disrepair and disuse. Above, one of the glitzier example of public plumbing in the slums of Delhi, India.Kevin FergusonAll three reports offered this constructive advice: Promote access to drinking water, sanitation and hygiene together as part of national health care agendas. “It’s just unfathomable that so little development aid is going to stop this enormous global killer,” says John Sauer, communications director for Water Advocates, a nonprofit group that works with PATH and WaterAid. “There’s no excuse not to prioritize funding for very simple, low-cost interventions. This is solvable.”

The World Health Organization estimates that 28 percent of the 9.7 million children who die before the age of 5 every year do so because of poor sanitation and unsafe water. Ironically, that death rate may climb because “the recent and positive focus on … the delivery of health services” does not included preventative measures, such as providing proper sanitation, states the WaterAid report.

The WaterAid report does not call for diarrhea-prevention and treatment to be given preference over other diseases, just that it be included in the mix.

Likewise, the PATH report, titled Diarrheal Disease: Solutions to Defeat a Global Killer, notes that over the last decade, momentum has slowed, with declines in research and funding commitments and competing global health priorities. “The perceived lack of urgency and taboo nature of the illness may have also contributed to the current low level of awareness surrounding the issue,” states the PATH report.

Diarrhea, linked directly to unclean water and poor sanitation, is the second-biggest killer of young children, after acute respiratory infections, according to the WHO. That makes diarrhea, causing 17 percent of these deaths, more deadly than measles, malaria and HIV/AIDS combined, says WHO. When acute respiratory infections are factored in — hand washing with soap and clean water greatly reduces the incidence of respiratory infections, according to a 2005 report published in The Lancet — the mortality rate climbs to about 40 percent.

The reports did offer some good news. Some countries have learned to coordinate water and sanitation programs, says the WaterAid report: “Senegal is an example of a country that has got it right. The distribution of tasks and responsibilities between these structures was decided by an inter-ministerial decree, and the system is functioning well.” Ethiopia and Uganda have made some progress, as well, says the report.

Other evidence backs up these findings. For example, in Uganda, a six-month program to improve drinking water in the Soroti District found that households that obtained access to clean drinking water were more likely to improve their sanitation and hygiene practices as well. The Safe Drinking Water for Uganda (SDWU) pilot project, funded by Proctor and Gamble (P&G), and implemented by Population Services International and Africare from December 2007 through May 2008, “had a spill-over effect on other non-direct beneficiaries, who also adopted the hygiene practices promoted by the project,” according to Ruth Mufute, a regional director with Africare and author of the report. The project’s goal was to reduce the incidence of waterborne diseases among 1,500 persons by promoting the use of P&G’s PuR water disinfectant and better hygiene. However, lack of funding to support such projects means that residents typically revert to old habits, such as drinking from tainted wells, she says.

The fallout from the global financial crisis poses an additional impediment to expanding access to clean water, according to a report issued by AfricanEconomicOutlook.org, a coalition of intergovernmental agencies. The continent’s economic outlook has turned “decisively negative,” it said. “Growth in emerging economies is also expected to slow dramatically,” states the report. Economic growth in Africa is expected to be only 2.8 per cent in 2009, less than half of the 5.7 percent estimated for 2008.

The economic downturn could well impact childhood health. In central Africa, childhood mortality increased by 13 percent from 1991 to 2007. However, some countries with initially high mortality rates made remarkable progress in reducing childhood mortality, the report states. “A number of countries, even poor ones, have displayed noteworthy performances (Eritrea, Malawi and Namibia), raising the possibility that progress is possible with political will, adequate resources and targeted strategies,” states the report, which links poverty, poor sanitation and high rates of childhood mortality.

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What WaterAid suggests to reduce childhood deaths:

1. All national health plans should confirm clear links between country health information systems, particularly disease prevalence data, and the process of planning and budgeting.

2. All countries should have a mechanism for inter-ministry coordination on reducing child mortality, with a joint agenda to deliver relevant strategies.

3. All national health plans should contain an adequate strategy for environmental health.

Dr. Bindeshwar Pathak displays a beaker of colorless, odorless, pathogen-free liquid manure distilled from human excreta. The fertilizer is created using a low-tech, five-step process that includes sand and charcoal filtering and exposure to ultraviolet rays. Methane is captured and burned as cooking fuel.

Kevin Ferguson

DELHI, India — Ah, the Sulabh International Museum of Toilets! How’s that for a place to take the wife and kids on a Sunday afternoon?

It’s hard not to smirk when this museum’s name is first mentioned. It sounds like a roadside attraction, something you find just a ways down the road from the World’s Oldest Rug (St. Augustine, Fla.) and the World’s Largest Ball of Twine (Cawker City, Kan.).

But when you visit the museum, the smirk evaporates. It’s not the museum itself — a rather small collection of lavatory oddities that includes a replica of Louis XIV’s throne with a hidden commode that allowed the monarch to evacuate his bowels while giving audience — that changes a visitor’s mind. Instead, it’s the trip to the museum through the streets of Delhi, India. There, where 18 percent of the population still defecates openly and where 20 percent of children who die under the age of five do so from water-borne diseases, the true purpose of the museum becomes evident: It’s a way to lure in visitors and introduce them to the Sulabh International Social Service Organization and its Sulabh Sanitation Movement.

Sulabh, which translates to “simple” in Hindi, is the brainchild of Dr. Bindeshwar Pathak, a Brahmin snoot-cum-egalitarian who has transformed the lives of millions of impoverished people across South Asia with the introduction of low-cost composting latrines. Because they require little or no water to operate, the latrines solve the problem faced by poor cities and rural areas alike: no sewage system.

Sulabh has also rescued and retrained more than 120,000 “scavengers,” members of the low-ranking Dalit caste in Indian society whose lifelong job is to empty household latrines, carrying the contents away in buckets on their heads. The practice is now illegal but continues in many rural areas. Sulabh’s organization offers scavenger families vocational training and formal education.

“I am a pragmatist,” says Pathak, when asked about the prospects of truly ending the practice. “What we are saying is that all castes are the same. Brahman can sit down with the Dalit.” That includes the dining room and the bathroom.

Pathak’s notions are, indeed, simple. The toilets come in 11 models, ranging from a handsome bamboo and mortar model that costs 1,600 rupees ($31), to the crème de la crème — a cement, brick and fiberglass dandy that costs about 14,000 rupees ($275). Each uses the same basic technology: two pits of varying size that are used alternately. When one pit is full, the incoming waste is diverted into the second pit. In about two years, natural processes transform the sludge, leaving it almost dry and pathogen free, thus safe for handling as manure. Pathak has also designed biogas cooking systems, which capture the methane from human excreta and pipe it right back into the kitchen stove, and water filtering systems that reclaim effluent for irrigation.

Simple? Yes. But in India, a nuclear power on one hand but also a place where it’s nearly impossible to find around-the-clock water service, simple is seldom easy. So, any progress in water and sanitation takes on special meeting.

The Stockholm International Water Institute (SIWI) recognized that much two weeks ago when it awarded Pathak the 2009 Stockholm Water Prize. SIWI is the world’s pre-eminent research and advocacy organization in the sector, and winning the prize is comparable to capturing a Nobel. King Carl XVI Gustaf of Sweden will present the Water Prize at a royal banquet in August.

Pathak models a low-cost toilet made of bamboo, mud and mortar. Price: 1,600 rupees ($31), including jute door.

Kevin Ferguson

“The results of Dr. Pathak’s endeavors constitute one of the most amazing examples of how one person can impact the well being of millions,” the Stockholm Water Prize nominating committee states in its citation. All told, 1.2 million residences and buildings use the Sulabh pour-flush toilets, and more than 10 million people each day use Sulabh-design public toilets, including the one just beside the museum’s entrance.

Pathak’s work remains just a drop in the chamber pot, however. More than 2.6 billion people in developing countries — the vast majority in South Asia — have no access to a toilet. And Sulabh’s message of urgency, though well known and lauded by humanitarians, doesn’t always penetrate the hearts and minds of policymakers in India. The result, according to the World Bank’s Water and Sanitation Program, is rank: 80 percent of surface water pollution in urban India is due to municipal sewage.

“Enough with holding a candle in the darkness,” says Gaurab Chandra, a coordinator at Sulabh International, referring to the exhortation attributed to Mahatma Gandhi that it is better to light a single candle than to curse the darkness. “We need a Halogen lamp here. Twenty of them.”

AquaFed’s Gerard Payen (Courtesy U.N.)

It was one of the few things all parties seem to agree on; who is responsible for that mismanagement and what should be done about it is where the attendees part ways.

A United Nations report, Water in a Changing World, released here today, spreads the blame around, chiding “water sector leaders,” including government ministers, private businesses and civil society groups, for failing to take action.

“Management of the world’s water resources requires reliable information about the state of the resource and how it is changing in response to external drivers such as climate change and water and land use,” the report states. “There is little sharing of hydrologic data, due largely to limited physical access to data, policy and security issues; lack of agreed protocols for sharing; and commercial considerations. This hampers regional and global projects that have to build on shared datasets for scientific and applications-oriented purposes.”

The result for the world’s freshwater supply is “bleak,” the report concludes.

In Africa, poverty reduction efforts are rarely coordinated with water policy or take into account wise management of water resources, says the UN report, despite findings of a strong correlation between investment in water infrastructure and economic growth. In many developing countries, public utilities do not do well because of low motivation, poor management, inadequate cost recovery and political interference,” states the report.

Gérard Payen, president of AquaFed, an international federation of private water companies, and an adviser on water issues to the U.N Secretary General, shifts much of the blame on governments. “There is plenty of water on the planet,” says Payen. “Where increasing uses or climate change create scarcity, strong political will and commitment are needed to allocate and manage water satisfactorily.”

Three billion people — nearly one-half of the world’s population — have no access to tap water in their home or in their village. That means they must carry water every day or pay high prices for delivery. One of the reasons for that, says Payen, is governments’ poor allocation of water between agriculture, industry and domestic uses.

The Organization for Economic Co-operation and Development (OECD), a Paris-based group of 30 relatively prosperous nations, has taken a similar line, saying that integrated water-resources management is needed to better allocate water between agriculture, other uses and environmental needs.

Maude Barlow, Council of Canadians national chairperson and senior adviser on water to the president of the U.N. General Assembly, agrees that mismanagement is to blame. But Barlow, who led activists here protesting the commoditization of water, blames private businesses and governments.

Water management has also been given short shrift by economic stimulus packages launched by the United States, China and Korea and other countries, says Angel Gurría, secretary general of the OECD. “The green is being stressed but not the blue,” he says. “Particularly for water-saving, shovel-ready projects” to repair aged and damaged water pipelines. The United Nations says the total cost of replacing aging water supply and sanitation infrastructure in industrial countries could be as high as $200 billion per year.

Up to 20 percent of water in the developed world is lost due to leakage; in the developing world, it is as high as 70 percent, he says.

Likewise, Jamal Saghir, director of energy, transport and water at the World Bank, says there are insignificant funds earmarked for water investment in the stimulus packages of the United States and other countries responding to the economic crisis.

The World Water Forum concludes on Sunday.

Ferguson is a freelance journalist based in Arlington, Mass.

“Everyday, thousands of children die as a result of complications due to consumption of unclean water,” Turkish President Abdullah Gul said in opening remarks. “There is significant discrepancy and injustice between different regions and countries around the world in terms of daily water compensation.”

A throng 28,000 strong is attending the triennial event, including three princes, three presidents, five prime ministers or heads of state, 90 ministers, hundreds of non-governmental organizations and private-sector representatives — and a coterie of about 100 demonstrators who gathered today to protest the privatization of public water and wastewater systems and were forcibly removed by Turkish police.

Few, if any, of the attendees question whether climate change is having an impact on water supplies. Evidence, from withering vineyards in California to inoperable nuclear reactors in France to a rise in water-borne diseases and infant mortality, is inescapable. Indeed, climate change’s impact on fresh water supplies is in many ways easier to spot than other climate trends.

“The rainy season used to start in late September, but over the past five years, we’ve been witnessing delays,” Samer Talozi, professor of Water Resources & Irrigation Engineering at the Jordan University of Science & Technology, tells Grist. “This year it only started in mid-January.

This has affected farmers and farming communities the most. The delay in the rainy season is shortening the growing season; reducing the amount of water available in the summer for irrigated agriculture; and limiting the options of rain fed agriculture during the rainy season.”

Likewise, manufacturing can be seriously hurt by climate change. Eleven of the world’s 14 largest semiconductor manufacturers — which require ultra clean water for manufacturing silicon chips — are in the Asia-Pacific region, where water scarcity is a growing problem. A water-related shutdown at a fabrication plant could result in a $100 million to $200 million in missed revenue in a quarter, according to a report released this month by Pacific Institute, Oakland, Calif., and Ceres in Boston.

The stakes for human health are particularly high. According to the World Health Organization, climate change will likely:

• contaminate coastal surface and groundwater resources due to sea level rise, resulting in saltwater intrusion into rivers, deltas, and aquifers;
• increase water temperatures, leading to more algal and bacterial blooms that further contaminate water supplies;
• and contribute to environmental health risks associated with water.

For instance, changes in precipitation patterns are likely to increase flooding, and as a result mobilize more pathogens and contaminants. It is estimated that by 2030 the risk of diarrhea will be up to 10 percent higher in some countries due to climate change. Diarrhea kills 2.2 million children every year, the vast majority of them under the age of five and living in Ethiopia, India and other developing countries.

Access to sanitation has improved only marginally in recent years, according to Dave Trouba, communications director for the Water Supply and Sanitation Collaborative Council (WSSCC) in Geneva, which operates under the auspices of the WHO. The number of those without basic sanitation has declined to 2.5 billion from 2.6 billion in the past few years.

“We’re on track to reach the U.N. Millennium Development Goals for access to clean water, but we’re way off track the Millennium Development Goals for sanitation,” says Trouba. “Sanitation isn’t rocket science. It’s hard work.”

The U.N. goal is, by 2015, to halve the proportion of people without sustainable access to safe drinking water and basic sanitation. More than 800 million people worldwide lack access to clean water.

The World Water Forum continues through March 22.

Ferguson is a freelance journalist based in Arlington, Mass.