2015 Update and MDG Assessment

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1 Update and MDG Assessment

2 WHO Library CataloguinginPublication Data Progress on Sanitation and Drinking Water update and MDG assessment..water supply standards..sanitation trends..drinking water supply and distribution..program evaluation. I.World Health Organization. II.UNICEF. ISBN (NLM classification: WA ) UNICEF and World Health Organization All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, Avenue Appia, Geneva, Switzerland (tel: + ; fax: + ; The World Health Organization and UNICEF welcome requests for permission to reproduce or translate their publications whether for sale or for noncommercial distribution. Applications and enquiries should be addressed to WHO, Office of Publications, through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html) or to UNICEF, Division of Communication, United Nations Plaza, New York, USA (fax: + ; The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization or UNICEF concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization or UNICEF in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The figures included in this report have been estimated by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (www.wssinfo.org) to ensure compatibility; thus, they are not necessarily the official statistics of the concerned country, area or territory, which may use alternative rigorous methods. All reasonable precautions have been taken by the World Health Organization and UNICEF to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization and UNICEF be liable for damages arising from its use. Front cover: UNICEF/INDA/Pietrasik; Back cover: UNICEF/NYHQ/Pirozzi; Foreword: WaterAid/Mustafah Abdulaziz SECtION A Spread: WaterAid/ Nyani Quarmyne/ Panos; P Top: UNICEF/NYHQ/Noorani; Bottom: UNICEF/NYHQ/Pirozzi; P Top: UNICEF/NYHQ/Grarup, Bottom: UNICEF/NYHQ/Pirozzi; P: WaterAid/Mustafah Abdulaziz; P: UNICEF/NYHQ /Pirozzi; P: UNICEF/NYHQ/Phelps SECtION B Spead: WaterAid/ Mani Karmacharya; P: WaterAid/ DRIK/ Habibul Haque; P: UNICEF/NYHQ/Noorani; P: UNICEF/ NYHQ/Dean; P: UNICEF/NYHQ/Estey; P: UNICEF/ETHA /Ose; P: UNICEF/NYHQ/ Asselin; P: UNICEF/NYHQ/Pirozzi ANNExES P,: UNICEF/INDA/Vishwanathan; P,: UNICEF/NYHQ/McKeever; P: UNICEF/UGDA/Vassie; P: UNICEF/NYHQ/de Mun; P through P: UNICEF/NYHQ/Pirozzi; P: UNICEF/NYHQ/Grarup Design and Layout: Emerson, Wajdowicz Studies NYC / Edited by Anna Grojec (Audaz) Printed in the United States of America

3 Progress on Sanitation and Drinking Water Update and MDG Assessment

4 Foreword

5 The Millennium Development Goals (MDGs) the framework that has been a key part of efforts to build a better world for the past years challenged the global community to reduce by half the proportion of the population without safe drinking water and basic sanitation. Throughout this period, the WHO/UNICEF Joint Monitoring Program (JMP) has monitored. As the MDG era comes to a close, this report shows how far we have come. For example, in a major global achievement, the target for safe drinking water was met in, well ahead of the MDG deadline of. Over per cent of the world s population now has access to improved sources of drinking water. At the same time, the report highlights how far we still have to go. The world has fallen short on the sanitation target, leaving. billion without access to improved sanitation facilities. The JMP has also tracked and presented data that shed light on a number of other issues, including inequalities such as the gap between urban and rural residents, the gender burden of water collection and the persistent exclusion of the poor from water and sanitation services. The insights provided by the JMP data have enabled us to identify specific challenges and strengthen policymaking. For instance, we have seen that we must address not only the widespread need for sanitation, but also the difficult problem of open defecation, still practiced by almost a billion people. Open defecation is one of the clearest manifestations of extreme poverty. That is why, in, I launched a Call to Action on Sanitation on behalf of UN SecretaryGeneral Ban Kimoon. Our aim is to eliminate open defecation by and to strengthen the partnerships that can make this happen. Addressing the sanitation crisis goes to the heart of ensuring good health, a clean environment and human dignity for all. Robust data, insightful analysis and compelling presentation will be important as we transition to the Sustainable Development Goals and their imperative to leave no one behind. UNICEF and WHO, through the JMP, have shown leadership in initiating the debate about future targets for water, sanitation and hygiene, and in bringing stakeholders together to discuss a vision for the future. Water and sanitation are fundamental to human development and wellbeing. They are not just goals in their own right but also critical to the achievement of other development objectives such as adequate nutrition, gender equality, education and the eradication of poverty. Access to safe water and sanitation is also a human right, as recognized in by the United Nations General Assembly. The United Nations looks forward to working with its partners across the world to successfully meet the water and sanitation challenge. By that, we can make a life of dignity a reality for millions and millions of people around the world. Jan Eliasson Deputy SecretaryGeneral

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7 Progress on sanitation and drinking water: update and MDG assessment Foreword SECTION A Progress Update and MDG Assessment Introduction MDG Assessment Progress on Drinking Water, Progress on Sanitation, Progress in Reducing Inequalities Between Rich and Poor SECTION B TwentyFive years of WASH Monitoring Overview Establishing a Global Monitoring System Monitoring MDG Targets for Water and Sanitation Laying the Foundations for Post Monitoring ANNEXES : The JMP Method : Millennium Development Goals: Regional Groupings : Country, Regional and Global Estimates on Water and Sanitation : Trends in Urban and Rural Drinking Water Coverage, : Trends in Urban and Rural Sanitation Coverage, : Country, Area or Territory Estimates on Handwashing

8 Section A Progress Update and MDG Assessmen

9 t

10 Introduction Update and MDG Assessment Years Progress on Sanitation and Drinking Water In the Member States of the United Nations signed the Millennium Declaration, which later gave rise to the Millennium Development Goals (MDGs). Goal, to ensure environmental sustainability, included a target that challenged the global community to halve, by, the proportion of people without sustainable access to safe drinking water and basic sanitation. The WHO/UNICEF Joint Monitoring Program for Water Supply and Sanitation (JMP), which began monitoring the sector in, has provided regular estimates of towards the MDG targets, tracking changes over the years to. In, global coverage of the use of improved drinking water sources and sanitation facilities stood at per cent and per cent, with respective MDG targets of per cent and per cent by. The challenges were huge, as the global figures hid vast disparities in coverage between countries, many of which were battling poverty, instability and rapid population growth. The JMP has monitored the changes in national, regional and global coverage, establishing a large and robust database and presenting analysis not only of the indicators detailed in the original framework for the MDGs, but also many other parameters. The analysis has helped shed light on the nature of and the extent to which the ambition and vision of the MDGs have been achieved. It has also helped to identify future priorities to be addressed in the post Sustainable Development Goals. Despite significant in water and sanitation, much still remains to be done. This report shows how the world

11 has changed since. It provides an assessment of towards the MDG target, and insight into the remaining challenges. Section A provides an overview of against the parameters specified in the MDG target for water and sanitation, in both urban and rural areas. It presents data for the world as a whole, and compares across regions. The report goes on to examine trends over the MDG period by region and by level of service. It pays particular attention to the numbers of people who have gained the highest level of service in drinking water supply piped water on premises and those with no service at all, who use surface water for drinking and practise open defecation. In order to understand the nature of, it is important to look carefully at the way improvements in water and sanitation have benefited different socioeconomic groups. This report sheds light on equality gaps between urban and rural dwellers, and between the richest and poorest segments of the population. It presents several new ways to visualize on extending service to the poor, designed to reveal the nature of inequalities and give the reader insight into the great challenge that still exists in ensuring that reaches everyone. The JMP was established in and is celebrating its Jubilee Year in. Section B provides a retrospective analysis of the evolution of water, sanitation and hygiene monitoring over the past years. Section A: Progress Update and MDG Assessment Introduction

12 MDG Assessment Drinking Water Update and MDG Assessment Key messages n The global MDG target for drinking water was met in n per cent of the global population now uses an improved drinking water source n Five developing regions met the drinking water target, but the Caucasus and Central Asia, Northern Africa, Oceania and subsaharan Africa did not n. billion people have gained access to an improved drinking water source since n per cent of the global urban population uses improved drinking water sources, compared with per cent of the rural population n Eight out of ten people still without improved drinking water sources live in rural areas n The least developed countries did not meet the target, but per cent of the current population has gained access to improved drinking water sources since n In, million people still lack improved drinking water sources The MDG target for drinking water has been met MDG target % coverage % surface water other improved Piped on premises Trends in global drinking Fig. water coverage and Fig. MDG target (%), Five developing regions achieved the MDG target for drinking water % point change Use of improved drinking water (%) World Developed regions Developing regions Least developed countries Target not met target met Oceania SubSaharan Africa Caucasus and Central Asia Southeastern Asia Southern Asia Northern Africa Western Asia Latin America and the Caribbean Eastern Asia Use of improved drinking water sources and MDG target in, and percentage point change from to Years Progress on Sanitation and Drinking Water countries have met the MDG drinking water target Fig. MDG target achievement for drinking water TARGET MET GOOD PROGRESS MODERATE PROGRESS LIMITED OR NO PROGRESS insufficient data or not applicable The JMP tracks for countries, areas and territories, including all UN Member States. Statistics in this report refer to countries, areas, and territories.

13 MDG Assessment Sanitation Key messages n The global MDG target for sanitation has been missed by almost million people n per cent of the global population now uses an improved sanitation facility n The only developing regions to meet the sanitation target were the Caucasus and Central Asia, Eastern Asia, Northern Africa and Western Asia n. billion people have gained access to an improved sanitation facility since n per cent of the global urban population, and per cent of the rural population, uses improved sanitation facilities n Seven out of ten people without improved sanitation facilities, and nine out of ten people still practising open defecation, live in rural areas n The least developed countries did not meet the sanitation target, and only per cent of their current population has gained access to improved sanitation since n In,. billion people still lack improved sanitation facilities The world has missed the MDG sanitation target MDG target % Open Defecation Shared coverage % Trends in global Fig. sanitation coverage and Fig. MDG target (%), Four developing regions achieved the MDG sanitation target % point change Use of improved sanitation (%) World Developed regions Developing regions Least developed countries Target not met target met SubSaharan Africa Oceania Southern Asia Southeastern Asia Eastern Asia Latin America and the Caribbean Northern Africa Western Asia Caucasus and Central Asia Use of improved sanitation and MDG target in, percentage point change from to Section A: Progress Update and MDG Assessment Only countries have met the MDG sanitation target MDG Assessment Fig. MDG target achievement for sanitation TARGET met GOOD PROGRESS MODERATE PROGRESS LIMITED OR NO PROGRESS insufficient data or not applicable

14 Progress Update and MDG Assessment Progress on Drinking Water, Update and MDG Assessment The MDG target called for the proportion of the population without sustainable access to safe drinking water to be halved between and. During the MDG period it is estimated that, globally, use of improved drinking water sources rose from per cent to per cent. The MDG target of per cent was surpassed in, and in,. billion people use an improved drinking water source. There are now only three countries with less than per cent coverage, compared with in. Despite the achievements of the MDG period, a great deal remains to be done. Behind the global headline figures, huge disparities in access remain. While many developed regions have now achieved universal access, coverage with improved drinking water sources varies widely in developing regions. The lowest levels of coverage are found in the countries designated as the least developed countries by the United Nations, particularly those in subsaharan Africa (Fig. ). In the absence of nationally representative data on the safety of drinking water for the majority of countries, the agreed proxy indicator for monitoring sustainable access to safe drinking water during the MDG period has been use of an improved drinking water source (see Annex for further information on the JMP method). Years Progress on Sanitation and Drinking Water Countries in which less than % of the population uses improved drinking water sources are all located in subsaharan Africa and Oceania % % % <% insufficient data or not applicable Fig. Proportion of the population using improved drinking water sources in % % % <% insufficient data or not applicable

15 More than a third of the current global population gained access to improved sources of drinking water since Fig. Western Asia Southern Asia SubSaharan Africa Southeastern Asia Eastern Asia Latin America and the Caribbean Northern Africa Oceania Caucasus and Central Asia Least developed countries Proportion of population who gained access to an improved drinking water source since (%), by region Developing regions World Section A: Progress Update and MDG Assessment Globally,. billion people have gained access to an improved drinking water source since. In most regions, over one third of the population gained access during the MDG period (Fig. ). Developing regions with low baselines and those experiencing rapid population growth have had to work much harder to maintain and extend coverage. Although subsaharan Africa missed the MDG target, over per cent of the current population gained access since. In, it is estimated that million people worldwide still use unimproved drinking water sources, including unprotected wells and springs and surface water. The majority of them now live in two developing regions (Fig. ). Nearly half of all people using unimproved drinking water sources live in subsaharan Africa, while one fifth live in Southern Asia. SUBSAHARAN AFRICA, SOUTHERN ASIA, EASTERN ASIA, million people lack access to improved drinking water sources SOUTHEASTERN ASIA, OTHER REGIONS, Progress on Drinking Water, Fig. Population without access to improved sources of drinking water in, by region

16 All regions have increased access to improved sources of drinking water since Update and MDG Assessment SubSaharan Africa Southern Asia Oceania Eastern Asia Northern Africa Western Asia Developing regions Developed regions World Fig. Southeastern Asia Caucasus and Central Asia Trends in drinking water coverage (%), by region Latin America and the Caribbean Least developed countries Piped on Premises Other surface water Years Progress on Sanitation and Drinking Water Use of improved drinking water has increased in all regions of the world since, but rates of have varied during the MDG period. Coverage in Eastern Asia increased dramatically by percentage points and exceeded the MDG target, with over half a billion people gaining access in China alone. Access in Southern Asia and Southeastern Asia also rose steeply, by and per cent respectively, and these regions also met the target. SubSaharan Africa fell short of the MDG target but still achieved a percentage point increase in the use of improved sources of drinking water. This means million people gained access during the MDG period an average of, people per day for years. Over the same period, the Caucasus and Central Asia and Oceania achieved increases of just per cent and per cent, respectively, and also missed the target. The least developed countries have faced the greatest challenges in meeting the MDG target, given low coverage and high population growth. Half of these are classified by the World Bank as fragile situations, and many have been affected by conflict during the MDG period, but have nevertheless made. Between and, the proportion of people in least developed countries using improved drinking water sources increased from per cent to per cent, but use of piped water on premises only increased from per cent to per cent. Significant proportions of the population in subsaharan Africa and Oceania continue to use rivers, lakes, ponds and irrigation canals as their main source of drinking water. Since the proportion of the population using surface water has been more than halved in subsaharan Africa, but remains largely unchanged in Oceania. It should be kept in mind throughout this report that data from Oceania are limited. Estimates for each of the small island states in the region draw upon a very small number of data points, many of which date back several years, making it difficult to produce robust estimates for. The World Bank, Harmonised List of Fragile Situations,, <http://siteresources.worldbank.org/extlicus/resources// FYFragileSituationList.pdf>, accessed May.

17 Global ruralurban disparities have decreased, but large gaps remain Fig. Urban Piped on premises Other Rural Trends in drinking water coverage (%), by rural and urban residence The MDG water and sanitation targets called for reporting on in both rural and urban areas. In the majority of the global population ( per cent) lived in rural areas, but since then the situation has reversed, and in the proportion living in urban areas is per cent. It is estimated that per cent of the urban population now uses improved drinking water sources, compared with per cent of the rural population. Fig. shows that the gap in coverage between rural and urban areas has steadily decreased since. But while rural coverage has increased rapidly, urban coverage has stagnated. The number of people without access in rural areas has decreased by over half a billion, but the number without access in urban areas has not changed significantly. JMP estimates are based on national surveys and censuses. Official definitions of urban and rural vary across countries and may not be directly comparable. While all surveys are representative of total urban and rural populations, samples may not be representative of all population subgroups or those living in specific geographic locations, including informal settlements or remote rural areas. surface water Urban coverage with piped water on premises has also remained largely unchanged since, whereas rural coverage has almost doubled. However, the gap between access to piped water on premises in urban and rural areas remains large. Four out of five people living in urban areas now have access to piped drinking water on premises, compared with just one in three people living in rural areas. In, the vast majority of those who do not have access to improved drinking water sources live in rural areas. It is estimated that per cent of the people using unimproved sources and per cent of people using surface water live in rural areas. Nearly three quarters of the. billion people gaining access to an improved drinking water source over the MDG period use piped water on premises. Over half of the million people gaining access to improved drinking water sources in rural areas and over three quarters of the. billion people gaining access in urban areas are using piped water. However, the balance between increases in piped water on premises and increases in other improved sources has varied widely between regions. Fig. shows that in most developing regions, coverage gains over the MDG period have been driven by gains in access to piped water on premises. This is particularly striking in Eastern Asia, which contributed million new users of piped water on premises, with million gaining access in China alone. Piped water on premises also dominated in Latin America and the Caribbean, Western Asia and Northern Africa. In these regions the number of users of other improved sources declined over the MDG period. By contrast, in Southern Asia, Southeastern Asia and subsaharan Africa, coverage gains over the MDG period have been mainly driven by other improved sources. Since, million people in Southern Asia and million people in subsaharan Africa gained access to other improved sources, such as wells and springs. The rate of increase in piped water coverage has generally been higher in rural than in urban areas (Fig. ). As a result, during the MDG period the ruralurban gap in access to piped water on premises has narrowed in all regions, except for Oceania, where neither urban nor rural coverage has changed. In subsaharan Africa, urban coverage has declined by ten percentage points. Section A: Progress Update and MDG Assessment Progress on Drinking Water,

18 Piped water on premises has driven coverage gains in some regions, while wells and springs have dominated in others Update and MDG Assessment Fig. Eastern Asia Southern Asia Latin America and the Caribbean Population gaining access (millions) to piped water on premises Southeastern Asia Western Asia Northern Africa SubSaharan Africa Population gaining access to improved drinking water sources and piped water on premises ( ) Caucasus and Central Asia to improved water SOURCES Oceania Years Progress on Sanitation and Drinking Water In most regions, use of piped water on premises has increased faster in rural areas, but urban coverage remains higher Western Asia Northern Africa Latin America and the Caribbean Eastern Asia Caucasus and Central Asia Southern Asia South eastern Asia Oceania SubSaharan Africa Rural Rural Urban Urban Fig. Ruralurban gap in coverage of piped water on premises by region (%),

19 While most regions recorded an overall increase in access to piped water on premises, a small number of countries have increased coverage of this higher level of service by more than percentage points (Fig. ). By increasing access from per cent to per cent, China significantly boosted the regional average for Eastern Asia. Despite slow regional in subsaharan Africa, Botswana, Egypt and Senegal all increased coverage by more than a third, as did Belize, El Salvador, Guatemala and Paraguay in Latin America and the Caribbean. Of the million people still using unimproved drinking water sources, those who use surface water face the greatest risks to their health and wellbeing. Those with no service at all, who have not benefited from any investment, are increasingly concentrated in three regions (Fig. ). Rural populations are particularly disadvantaged, accounting for per cent of the people using surface water. Seven out of ten of the million people relying on water taken directly from rivers, lakes and other surface waters live in subsaharan Africa, eight times more than any other region. Sixteen countries have increased access to piped water on premises by at least percentage points Paraguay Botswana China Egypt El Salvador Belize Guatemala Senegal Plurinational State of Bolivia Honduras Thailand Azerbaijan million people still use surface water, and two thirds live in subsaharan Africa SubSaharan Africa, other regions, SOUTHEASTERN ASIA, southern asia, Section A: Progress Update and MDG Assessment Progress on Drinking Water, Mauritania Ecuador Fig. Population using surface water in, by region Morocco Georgia Fig. Percentage point increase in access to piped water on premises

20 Progress Update and MDG Assessment Progress on Sanitation, Update and MDG Assessment The MDG target called for halving the proportion of the population without sustainable access to basic sanitation between and. During the MDG period, it is estimated that use of improved sanitation facilities rose from per cent to per cent globally. The global MDG target of per cent has therefore been missed by nine percentage points and almost million people. Despite encouraging on sanitation, much unfinished business remains from the MDG period. In addition to the shortfall against the global target, large disparities in access still exist. Almost all developed countries have achieved universal access, but sanitation coverage varies widely in developing countries. Since the number of countries with less than per cent of the population using an improved sanitation facility has declined slightly, from to, and countries with the lowest coverage are now concentrated in subsaharan Africa and Southern Asia (Fig. ). Nearly one third of the current global population has gained access to an improved sanitation facility since, a total of. billion people. However, the proportion gaining access varies across developing regions (Fig. ). Western Asia and Northern Africa have provided access to per cent and per cent of the current population since. By contrast, subsaharan Africa has provided access to In countries, areas or territories, less than half the population uses improved sanitation in Years Progress on Sanitation and Drinking Water Fig. % Proportion of the population using improved sanitation facilities in % % <% % % % <% insufficient data or not applicable INSUFFICIENT DATA OR NOT APPLICABLE

21 Five regions have provided access to over one third of the current population since Fig. Western Asia Northern Africa Southeastern Asia Eastern Asia Latin America and the Caribbean Southern Asia Caucasus and Central Asia SubSaharan Africa Oceania Proportion of the population who gained access to improved sanitation since (%), by region Least developed countries Developing regions World Section A: Progress Update and MDG Assessment less than per cent of the current population. Despite failing to meet the target of halving the proportion of the population without access, Southern Asia nevertheless managed to provide access to per cent of the current population. In it is estimated that. billion people globally still use unimproved sanitation facilities. The vast majority live in just three regions (Fig. ), with percent in Southern Asia. There are now twice as many people using unimproved sanitation facilities in subsaharan Africa than in Eastern Asia. The nearly million people who would have been served if the MDG target for sanitation had been met is equal to the number of unserved people in subsaharan Africa. SOUTHERN ASIA,. billion people do not use an improved sanitation facility, and most live in just three regions SUBSAHARAN AFRICA, EASTERN ASIA, SOUTHEASTERN ASIA, LATIN AMERICA AND the CARIBBEAN, OTHER REGIONS, Progress on sanitation, Fig. Population without improved sanitation in, by region

22 Use of improved sanitation has increased in all regions except Oceania Update and MDG Assessment SubSaharan Africa Oceania Southern Asia Eastern Asia Northern Africa Western Asia Developing regions Developed regions World Fig. Southeastern Asia Trends in sanitation coverage (%), by region Latin America and the Caribbean Caucasus and Central Asia Least developed countries Shared open defecatiion Years Progress on Sanitation and Drinking Water Use of improved sanitation facilities increased in all regions, except for Oceania, but rates of varied widely. The Caucasus and Central Asia, Eastern Asia, Northern Africa and Western Asia were the only developing regions to meet the MDG target. Eastern Asia dramatically increased coverage by percentage points to meet the target. Southeastern Asia also achieved a significant increase, of per percentage points, but narrowly missed the target. While Southern Asia and subsaharan Africa had similarly low levels of coverage in ( per cent and per cent, respectively), the former increased coverage by percentage points, while the latter only achieved a per cent increase. In Southern Asia, which had the lowest baseline coverage in, million people gained access to improved sanitation facilities during the MDG period an average of, people per day for years. Over the same period, improved sanitation coverage in subsaharan Africa and Oceania has stagnated. However, the vast majority ( per cent) of those without access to improved sanitation in Southern Asia still practise open defecation, compared with per cent in subsaharan Africa and just per cent in Oceania. Between and, open defecation declined in all regions, with the most dramatic reductions seen in the least developed countries (from per cent in to per cent in ), representing an important first step on the sanitation ladder. Globally, it is estimated that per cent of the urban population now uses improved sanitation facilities, compared with per cent of the rural population. Inequalities in access to improved sanitation between rural and urban areas have decreased during the MDG period. The number of people without access to improved sanitation in rural areas has decreased by per cent, and open defecation rates have decreased from per cent to per cent.

23 Despite, sanitation coverage in rural areas still lags behind urban areas others, most notably in subsaharan Africa and Southern Asia (Fig. ). More households use shared sanitation facilities in these two regions than in all other regions combined. Fig. Urban Rural improved Shared Urban and rural trends in sanitation coverage (%) Open defecation Use of shared sanitation is widespread in both urban and rural areas. The total number of people sharing is greater in urban ( million) than in rural settings ( million). However, among those who use sanitation facilities of an otherwise improved type, the proportion that share these facilities with others is similar in urban ( per cent) and rural ( per cent) areas. Fig. shows that in some countries the proportion of people sharing is higher in urban areas (as in Ethiopia, Nigeria and Uganda), while in others the proportion is higher in rural areas (notably in West Africa). The nature of sharing can differ considerably, from sharing a facility with a small number of close neighbours to using facilities shared by many households. In order to differentiate, some have recommended setting a threshold, such as five or more households, known as limited sharing, and to include the population served by limited sharing in the improved category. Others argue that even limited sharing has negative impacts on health and should not be considered improved. Section A: Progress Update and MDG Assessment During the same period, the urban population grew dramatically, by per cent, whereas the rural population grew by just per cent. Seven out of ten of the. billion people gaining access to improved sanitation since live in urban areas, but the proportion without access has declined by just per cent. Despite made during the MDG period, sanitation coverage in rural areas continues to lag behind urban areas. Globally, seven out of ten people without improved sanitation, and nine out of ten people practising open defecation, live in rural areas. The JMP sanitation ladder differentiates between improved facilities and those of an otherwise improved type that are shared by more than one household. Limited data are available on sharing in many countries, but it is estimated that million people worldwide are sharing sanitation facilities of an otherwise improved type in. Use of shared sanitation is more common in some regions than Fig. SOUTHERN ASIA, SUBSAHARAN AFRICA, EASTERN ASIA, Of the million people sharing sanitation of an otherwise improved type, two thirds live in subsaharan Africa and Southern Asia SOUTHEASTERN ASIA, LATIN AMERICA AND the CARIBBEAN, OTHER REGIONS, Population using shared sanitation facilities of an otherwise improved type, Progress on sanitation,

24 Shared sanitation is widespread in both urban and rural settings Sixteen countries have reduced open defecation rates by at least percentage points Ethiopia Nepal Cambodia Update and MDG Assessment Sharing of improved facilities, rural Sharing of improved facilities, urban Viet Nam Pakistan Percentage of population using improved sanitation Fig. facilities, who share these facilities with others, Fig. rural and urban () Angola Bangladesh India Haiti Morocco Plurinational State of Bolivia Honduras Peru Guinea Benin Malawi Reduction in the proportion of population practising open defecation, from to (%) Years Progress on Sanitation and Drinking Water Most countries still have very limited data on sharing of sanitation facilities (only per cent have more than four surveys), even though the number of household surveys and censuses that collect information on sharing has increased substantially during the MDG period, from in to over in. For even fewer countries only in is it possible to distinguish limited sharing from any sharing. During the MDG period, the elimination of open defecation has been increasingly recognized as a top priority for improving health, nutrition and productivity of developing country populations. In, more than half the population in countries practised open defecation, and more than ten percent in countries. Open defecation has since declined by at least ten percentage points in of these countries, and by more than percentage points in. Sixteen countries have reduced open defecation by more than percentage points during the MDG period (Fig. ). Ethiopia achieved the largest decrease in the proportion of the population practising open defecation (from per cent in to per cent in ), a reduction over five times greater than the regional average for the same period. Open defecation was practised by. million Ethiopians in and. million in an average reduction of over percentage points per year over years. The Southern Asia region, where the number of open defecators is highest, has also made significant improvements. Bangladesh, Nepal and Pakistan have all achieved reductions of more than percentage points since. The per cent reduction in open defecation in India alone represents million people, and significantly influences regional and global estimates. Open defecation rates have been decreasing steadily since, and it is estimated that fewer than one billion people ( million) now practise open defecation worldwide. Two thirds live in Southern Asia, nearly three times as many

25 Substantially faster is needed to eliminate open defecation, especially in Southern Asia and subsaharan Africa Keeping up with population growth Is on water and sanitation keeping up with population growth? Population growth has varied greatly by developing region. In Eastern Asia, the population has increased by a fifth ( per cent) since, whereas in subsaharan Africa it has almost doubled ( per cent), and in Oceania it has increased by per cent. In the latter two regions the increase in access to sanitation has not kept up with population growth, with only per cent of the additional population gaining access in each region (Fig. ). Fig. Trends in population practising open defecation, by region as in subsaharan Africa. However, the number of people practising open defecation in Southern Asia has declined only moderately, from million in to million in, a reduction of just per cent (Fig. ). During the same period the number of people practising open defecation has actually increased in subsaharan Africa, and the region now accounts for a greater share of the global total than in. All other regions recorded a reduction in open defecation in population terms between and. SOUTHEASTERN ASIA SOUTHERN ASIA SUBSAHARAN AFRICA OTHER REGIONS EASTERN ASIA LATIN AMERICA AND CARIBBEAN Population growth has outpaced gains in sanitation and drinking water coverage, especially in urban areas National Sanitation Urban Sanitation National Water Urban Water Eastern Asia Southeastern Asia Northern Africa Latin America and the Caribbean Caucasus and Central Asia Western Asia Southern Asia Oceania SubSaharan Africa Caucasus and Central Asia Latin America and the Caribbean Eastern Asia Western Asia Northern Africa Southeastern Asia Southern Asia Oceania SubSaharan Africa Eastern Asia Southern Asia Southeastern Asia Latin America and the Caribbean Western Asia Northern Africa Caucasus and Central Asia SubSaharan Africa Oceania Caucasus and Central Asia Latin America and the Caribbean Southern Asia Southeastern Asia Eastern Asia Western Asia Oceania Northern Africa SubSaharan Africa Fig.... Keeping Up Keeping Up Ratio of population gaining improved water and sanitation to population increase ( ) Section A: Progress Update and MDG Assessment Progress on sanitation, Population growth in urban areas has been a key feature of population dynamics in all regions, with the most pronounced changes taking place in four regions where the urban population has more than doubled: subsaharan Africa (an increase in urban population of per cent), Eastern Asia ( per cent), Southeastern Asia ( per cent) and Western Asia ( per cent). In Eastern Asia, gains in access to drinking water and sanitation not only kept up with, but far exceeded, population growth. By contrast, subsaharan Africa registered a decline in water or sanitation coverage in urban areas in out of countries.

26 Progress Update and MDG Assessment Progress in Reducing Inequalities Between Rich and Poor Update and MDG Assessment In previous reports, the JMP has drawn attention to inequalities in access to drinking water and sanitation between rural and urban areas, rich and poor, and other groups and the general population. The MDG target called for countries to halve the proportion of the population without access, but it is important to ask who has benefited from made during the MDG era, and who has been left behind. An equity tree (Fig. ) is a useful way of visualizing multiple overlapping inequalities in access to water and sanitation between regions of the world, among countries within a region, between rich and poor, and between urban and rural areas within a given country. The example in Fig. shows that the poorest fifth of the rural population in Kazakhstan has the same level of piped water coverage as subsaharan Africa. Inequalities between rich and poor are found in all countries. In those countries where data from national surveys allow for the classification of households into wealth quintiles, it is possible to analyse inequalities in access to drinking water and sanitation between rich and poor in rural and urban areas. Analysis of trends is particularly important in order to assess whether inequalities in access and service levels are being ively reduced over time. Trends in coverage by wealth quintile can be analysed for countries in most developing regions over the period Years Progress on Sanitation and Drinking Water Access to piped water on premises depends on location and wealth, as shown in Kazakhstan Piped water on premises (%) World Armenia Richest urban Latin America and the Caribbean Western Asia Northern Africa Belarus Georgia Urban Eastern Asia Azerbaijan Poorest urban Kazakhstan Caucasus and Central Asia Kyrgyzstan Republic of Moldova Richest rural Uzbekistan Tajikistan Southeastern Aisa Southern Asia Rural Oceania SubSaharan Africa Poorest rural Fig. Equity tree for piped water on premises, Kazakhstan

27 Use of improved water and sanitation facilities varies by wealth quintile in urban and rural areas Urban coverage of improved sanitation by wealth quintile (%) Coverage of improved drinking water by urban wealth quintile (%) Fig. Urban coverage of improved sanitation (%) Use of improved drinking water and sanitation facilities by urban and rural wealth quintile, % (). Fig. shows sanitation and drinking water coverage for each wealth quintile in both rural and urban areas. Each country is represented by a vertical set of five dots arranged according to average coverage for that country. The vertical spread of the dots shows the extent to which coverage varies between the richest and the Urban improved drinking water coverage (%) Rural coverage of improved sanitation by wealth quintile (%) Coverage of improved drinking water by rural wealth quintile (%) Rural coverage of improved sanitation (%) Rural improved drinking water coverage (%) poorest quintiles in each country. The differing patterns of dots also highlight variations in the relative gaps between the richest, fourth, middle, second and poorest quintiles. Coverage estimates for wealth quintiles are based on a limited subset of surveys and may therefore differ from JMP national estimates for the same country. richest Fourth Middle Second poorest richest Fourth Middle Second poorest Section A: Progress Update and MDG Assessment Progress in reducing inequalities between rich and poor

28 Update and MDG Assessment Years Progress on Sanitation and Drinking Water Gaps remain in access to improved sanitation by wealth quintile in urban areas Use of improved sanitation by urban wealth quintile (%) Thailand Mexico Egypt Armenia Jordan Tunisia Kazakhstan Uzbekistan Paraguay Kyrgyzstan Lao People s Democratic Republic Jamaica Viet Nam Yemen Guatemala Dominican Republic Iraq Belize Angola Cambodia Republic of Moldova Pakistan Colombia Honduras Peru Philippines Indonesia Nicaragua India Namibia Mongolia Senegal Zimbabwe Cameroon Rwanda Central African Republic Nepal Mozambique Niger Bangladesh Comoros Guinea Mali Zambia Gabon Swaziland Nigeria Côte d Ivoire Haiti Burkina Faso United Republic of Tanzania Sierra Leone Chad Burundi Kenya Benin Lesotho Malawi Democratic Republic of the Congo GuineaBissau Togo Uganda Ethiopia Ghana Madagascar The gap between the richest and poorest quintiles is an important measure of inequality. In general, the differences in coverage between the richest and poorest quintiles appear to be greater for sanitation than for drinking water (the dots on the sanitation figures are more widely spread apart). Inequalities in sanitation appear equally pronounced in urban and rural areas, while inequalities in access to drinking water are less pronounced in urban areas (the dots are closer together). Another way to visualise inequalities is shown in Fig.. Countries are ordered by urban sanitation coverage in the middle wealth quintile, and the position of the dots for each country illustrates the gap between the different wealth quintiles. Progressive reduction of inequalities between wealth groups implies decreasing the gap between the wealth quintiles while increasing overall levels of coverage for the population. In some countries, like Cambodia, there is a wide gap between the poorest quintile and the others; this is known as bottom inequality. In other countries, such as GuineaBissau, there is a wide gap between the richest quintile and the others, known as top inequality. Some countries have very large gaps between the richest and poorest quintiles, for instance, India and Namibia. In other countries the quintiles are more evenly spread and either have equally low coverage, as in the Democratic Republic of the Congo, or equally high coverage, as in Uzbekistan. poorest Second Middle Fourth richest Fig. Use of improved sanitation facilities by urban wealth quintile (%),

29 Access to improved sources of drinking water by wealth quintile in rural areas Egypt Thailand Jordan Belize Pakistan Nepal Mexico Viet Nam Philippines Kazakhstan Dominican Republic Armenia India Tunisia Guatemala Paraguay Kyrgyzstan Namibia Republic of Moldova Uzbekistan Plurinational State of Bolivia Comoros Malawi Iraq Bangladesh Jamaica Mongolia Peru Burundi Ghana Lesotho Benin Colombia Zimbabwe Burkina Faso Rwanda Cambodia Honduras Côte d Ivoire Indonesia Swaziland Lao People s Democratic Republic Guinea Gabon Uganda Yemen Mali Nicaragua Ethiopia Senegal Kenya Niger Central African Republic Haiti Cameroon Nigeria United Republic of Tanzania GuineaBissau Chad Togo Sierra Leone Mozambique Democratic Republic of the Congo Angola Madagascar Use of improved drinking water by rural wealth quintile (%) Fig. shows that the gaps in access between the richest and poorest wealth quintiles are generally smaller for rural drinking water than for urban sanitation. Similar patterns are observed, however, with examples of both bottom inequality (as in Iraq) and top inequality (Madagascar). In other countries, the quintiles are more evenly spread and either have equally low coverage (for instance, Guinea Bissau) or, as in the case of the Dominican Republic, the desirable outcome of equally high coverage. Section A: Progress Update and MDG Assessment Progress in reducing inequalities between rich and poor poorest Second Middle Fourth richest Fig. Use of improved drinking water sources by rural wealth quintile %, ()

30 While gaps between the richest and poorest wealth quintiles in Southeastern Asia have narrowed, only Thailand has eliminated inequality in urban sanitation Use of improved drinking water sources among the poorest is catching up with the richest in rural areas of Latin America Update and MDG Assessment Population using improved sanitation (%) Cambodia Lao People s Democratic Republic Richest Viet Nam Poorest Thailand Trends in use of improved sanitation in the richest Fig. and poorest urban wealth quintiles, Fig. Population using improved drinking water (%) Plurinational State of Bolivia Paraguay Colombia Mexico Richest Poorest Trends in use of improved drinking water in the richest and poorest rural wealth quintiles, Years Progress on Sanitation and Drinking Water Inequalities between the richest and poorest per cent of the population are found in all regions, but vary across rural and urban areas and according to the type and level of service. Using a subset of data from a few countries, it is possible to assess how the gap between the richest and poorest quintiles has changed during the MDG period. Fig. shows the change in access to urban sanitation for the richest and poorest wealth quintiles in four countries in Southeastern Asia, where the gap between the two groups exceeded percentage points in. Ideally, among the poor would be faster than among the rich, allowing the gap to narrow and ultimately disappear, forming a distinctive triangle shape in the figure. Between and, access to improved sanitation did increase more rapidly among the poorest, but significant gaps remain in three of the countries. Only Thailand has so far succeeded in closing the gap between rich and poor. In four countries in Latin America and the Caribbean, access to improved drinking water in rural areas is far higher among the richest than the poorest. But in all four countries, the poorest have made faster than the richest since. Mexico and Paraguay have performed well in terms of rapid increases among the poorest. In Colombia, unfortunately, a drop in coverage among the richest has accelerated the narrowing of the gap. The majority of the global population practising open defecation live in rural areas of Southern Asia. Fig. shows that in, rates of open defecation were high among the richest and extremely high among the poorest. Since, rates of in reducing open defecation and closing the gap between rich and poor have varied widely. All countries achieved significant reductions amongst the richest, and three countries succeeded in eliminating open

31 Reductions in rural open defecation have been primarily among the richest in Southern Asia, except in Bangladesh Use of piped water on premises is declining among the poorest wealth quintile in urban areas in several countries in the Caucasus and Central Asia Population not practising open defecation (%) India Nepal Pakistan Bangladesh Richest Poorest Trends in reduction of open defecation in the richest Fig. and poorest rural wealth quintiles Fig. Population not practising open defecation (%) Georgia Kazakhstan Kyrgyzstan Uzbekistan Richest Poorest Trends in use of piped water on premises in the richest and poorest urban wealth quintiles, Section A: Progress Update and MDG Assessment defecation among this group. Progress among the poorest has been slower, and in India there has been very little change over the last years. Bangladesh is the only country in the region where has been faster among the poorest and the gap has been reduced. A markedly different pattern is seen in the Caucasus and Central Asia. In four countries in this region, access to piped water on premises is nearly universal for the richest, and has been since. Among the poor, use of piped water on premises is at least percentage points lower, and has decreased since in all four countries, widening the inequality gap. In addition to measuring inequalities in existing coverage across quintiles and assessing changes in absolute and relative coverage among the richest and poorest quintiles, another useful measure of in reducing inequalities is the rate at which coverage is changing amongst the poorest. Fig. shows the current rate of open defecation among the poorest in rural areas and the annual rate at which open defecation has been reduced since. Countries in the green zone above the diagonal line are achieving a rate of reduction that will lead to elimination of open defecation by, while those that are below will take longer to achieve elimination. The figure also shows that a number of countries have negative rates of change and are experiencing an increase in open defecation amongst the poorest. Only countries (out of ) for which these data are available are currently on track to eliminate open defecation among the poorest in rural areas by. Progress in reducing inequalities between rich and poor

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