tag:theconversation.com,2011:/us/topics/water-and-sanitation-28220/articlesWater and sanitation – The Conversation2023-10-05T12:18:21Ztag:theconversation.com,2011:article/2149752023-10-05T12:18:21Z2023-10-05T12:18:21ZJohannesburg has been hit by severe water shortages: new plan to manage the crisis isn’t the answer<p><em>Johannesburg and its surrounds, at the centre of the industrial heartland of South Africa, have been hit by severe water cuts. Water interruptions have been happening <a href="https://theconversation.com/south-africas-biggest-cities-are-out-of-water-but-the-dams-are-full-whats-gone-wrong-192762">for years</a>, but they have been scaled up dramatically in recent weeks. The deteriorating situation recently forced the Minister of Water and Sanitation, Senzo Mchunu, to intervene. On 27 September he announced a new initiative – <a href="https://www.dws.gov.za/Communications/PressReleases/2023/MS%20-%20Water%20and%20Sanitation%20Ministry%20calls%20for%20improved%20water%20supply%20management%20in%20GP_F.pdf">“water-shifting”</a>. The proposal has echoes of “<a href="https://www.joburg.org.za/departments_/Pages/MOEs/city%20power/What-is-load-shedding.aspx">load-shedding</a>”, the term used for the planned power outages which have become a common feature of life for all South Africans. Anja du Plessis, a water management expert, explains the new water initiative.</em></p>
<h2>When did water outages start, and what are the latest developments?</h2>
<p><a href="https://www.gov.za/sites/default/files/gcis_document/202208/47133gon2327.pdf">Freshwater challenges</a> are a frequent occurrence in South Africa. These include increased pressure on the amount of freshwater available for use, unequal distribution and lack of access to clean water and sanitation services. </p>
<p>Gauteng province, the country’s economic hub, has not been spared. The water crisis has been driven by a number of factors: </p>
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<li><p>the <a href="https://theconversation.com/south-africas-biggest-cities-are-out-of-water-but-the-dams-are-full-whats-gone-wrong-192762">overall decay in the quality and state of water infrastructure</a> – it is at risk of total collapse in some areas</p></li>
<li><p>droughts </p></li>
<li><p>alleged corruption, which has affected the functioning of municipalities and municipal treatment plants.</p></li>
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Read more:
<a href="https://theconversation.com/cholera-in-south-africa-a-symptom-of-two-decades-of-continued-sewage-pollution-and-neglect-206141">Cholera in South Africa: a symptom of two decades of continued sewage pollution and neglect</a>
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<p>Neither the national nor regional water authorities have managed to find solutions to the water crisis. Rather, the situation has deteriorated. In the last few months some consumers, such as those living in the suburb of <a href="https://www.enca.com/top-stories/taps-still-dry-brixton-and-other-parts-joburg">Brixton</a>, west of central Johannesburg, have had dry taps for more than three weeks. </p>
<p>Water tankers have been brought in to provide supplies. But residents complain that these are <a href="https://www.dailymaverick.co.za/article/2023-09-22-johannesburg-waters-haemorrhaging-supply-continues-to-dry-up-leaving-desperate-residents-pleading-for-relief/">unreliable</a> and they don’t trust <a href="https://www.timeslive.co.za/news/south-africa/2023-09-29-explained-what-is-water-shifting-and-why-is-gauteng-introducing-it/">the quality of water</a>. Some people use it only to bath and flush toilets, and buy bottled water for drinking and cooking. </p>
<p>Three weeks ago the national and regional water authorities announced a plan that would spread the impact of water cuts between communities. The term the politicians coined for the new measures is “<a href="https://www.dws.gov.za/Communications/PressReleases/2023/MS%20-%20Water%20and%20Sanitation%20Ministry%20calls%20for%20improved%20water%20supply%20management%20in%20GP_F.pdf">water-shifting</a>”.</p>
<h2>What is ‘water-shifting’ and how will it work?</h2>
<p>The plan is to begin “sharing” water to take the pressure off the worst affected areas. By and large, high-lying areas of the city have been the <a href="https://www.timeslive.co.za/news/south-africa/2023-09-29-explained-what-is-water-shifting-and-why-is-gauteng-introducing-it/">hardest hit</a>.</p>
<p>The reason for this is that the <a href="https://mes100.com/docs/water-reticulation-benchmark/#:%7E:text=Water%20reticulation%20is%20water%20distribution,and%20delivered%20to%20its%20destination.">distribution of water</a> requires pressure, which comes from a water source – a reservoir or water tower. When pressure is lost within the system, high-lying areas are usually affected first as there is not enough pressure in the system to get the water to them. </p>
<p>Pressure is lost when reservoirs reach critically low levels. This can happen as a result of leakages, burst pipes, above-average water consumption or <a href="https://theconversation.com/power-cuts-in-south-africa-are-playing-havoc-with-the-countrys-water-system-197952">power outages which affect pump stations</a>. </p>
<p><a href="https://ewn.co.za/2023/09/22/water-systems-out-of-capacity-or-on-their-knees-warns-joburg-water">Any of these can</a> lead to pressure decreasing at a rapid rate. </p>
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Read more:
<a href="https://theconversation.com/power-cuts-in-south-africa-are-playing-havoc-with-the-countrys-water-system-197952">Power cuts in South Africa are playing havoc with the country's water system</a>
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<p>Johannesburg’s water utility, <a href="https://www.randwater.co.za/">Rand Water</a>, plans to shift water from a reticulation system with sufficient pressure to a struggling system. The idea is to provide an <a href="https://www.dws.gov.za/Communications/PressReleases/2023/MS%20-%20Water%20and%20Sanitation%20Ministry%20calls%20for%20improved%20water%20supply%20management%20in%20GP_F.pdf">equitable supply of water to municipal customers</a>. </p>
<p>Rand Water will implement water-shifting as an interim measure to assist in the recovery of struggling reticulation systems. An implementation date has not been given. </p>
<p>But <a href="https://www.johannesburgwater.co.za/">Johannesburg Water</a>, which is responsible for supplying water to the city’s residents, needs to <a href="https://www.dws.gov.za/Communications/PressReleases/2023/MS%20-%20Water%20and%20Sanitation%20Ministry%20calls%20for%20improved%20water%20supply%20management%20in%20GP_F.pdf">develop and present a water management plan</a> to address the crisis. </p>
<h2>Could this crisis have been avoided?</h2>
<p>In short, yes. The Gauteng province metropolitan councils are perfect examples of the effects of poor water governance and management as well as lack of political will <a href="https://theconversation.com/south-africas-biggest-cities-are-out-of-water-but-the-dams-are-full-whats-gone-wrong-192762">over the past two decades</a>. This has led to a lack of investment and underfunding of bulk water and sanitation infrastructure. </p>
<p>The result is that the water infrastructure, from water supply to treatment, storage, water resources and management, <a href="https://www.gcro.ac.za/outputs/map-of-the-month/detail/water-interruptions-gauteng/">has fallen into disrepair</a>. Also at play is a lack of planning and management of growing water demands due to increased population, migration and expansion of settlements. The poor <a href="https://mg.co.za/special-reports/2022-03-15-water-conservation-and-water-demand-management-in-johannesburg/#:%7E:text=Johannesburg%20Water%20sources%20its%20water,other%20areas%20of%20the%20country">management and overall lack of water and sanitation delivery and services</a> is another factor.</p>
<p>There have been frequent water cuts in the province over the past five years. An estimated 30% of the province’s residents reported frequent water interruptions in <a href="https://www.gcro.ac.za/outputs/map-of-the-month/detail/water-interruptions-gauteng/">2017/18</a>, increasing to 33% in <a href="https://www.gcro.ac.za/outputs/map-of-the-month/detail/water-interruptions-gauteng/">2020/2021</a>. </p>
<p>Johannesburg isn’t alone. The <a href="https://www.gov.za/sites/default/files/gcis_document/202208/47133gon2327.pdf">poor state of water infrastructure across the country</a> has been an issue for many years.</p>
<p>A detailed account was <a href="https://saice.org.za/downloads/SAICE-2022-Infrastructure-Report-Card.pdf">set out</a> by the South African Institution of Civil Engineering in 2022. It showed that the country’s water infrastructure had deteriorated to the point that it was at risk of failing. The report called for prompt action to avoid severe water supply shortages. </p>
<p>Unfortunately, this wasn’t heeded.</p>
<p>Other factors have contributed to the water crisis too. </p>
<p>Firstly, there’s been continuous high consumption by consumers, partly due to increased temperatures. The province’s residents consume an estimated <a href="https://twitter.com/Rand_Water/status/1580919219176189953">300 litres</a> (which includes water losses) each a day, compared to the global average of 173 litres. </p>
<p>Another factor has been the amount of water being lost. In Johannesburg, for example, a minimum of 41% of treated potable water supplied by Rand Water to Johannesburg Water is lost before it even reaches the consumer. This is referred to as <a href="https://ws.dws.gov.za/IRIS/releases/NDWR.pdf">non-revenue water by the municipality</a>. Water is primarily lost through leakages and bursting pipes, attributed to <a href="https://theconversation.com/south-africas-biggest-cities-are-out-of-water-but-the-dams-are-full-whats-gone-wrong-192762">poor operation and maintenance</a>.</p>
<h2>Is ‘water-shifting’ a solution?</h2>
<p>The Minister of <a href="https://www.dws.gov.za/Communications/PressReleases/2023/MS%20-%20Water%20and%20Sanitation%20Ministry%20calls%20for%20improved%20water%20supply%20management%20in%20GP_F.pdf">Water and Sanitation</a> has made it clear that this is an interim measure. </p>
<p>But even as an interim measure it will require a high level of political will as well as technical expertise <a href="https://www.timeslive.co.za/news/south-africa/2023-09-29-explained-what-is-water-shifting-and-why-is-gauteng-introducing-it/">to work</a>. </p>
<p>“Water-shifting” should not be a permanent measure or become the norm as it does not address the cause of the current crisis. Potable water will still be lost through leaking and burst pipes.</p>
<p>Relevant stakeholders, including the Department of Water and Sanitation, Rand Water and municipalities such as the City of Johannesburg need to stop the blame game and work together to address the primary causes of the water challenges, instead of the symptoms. The dilapidated state of water infrastructure needs to be addressed as a matter of urgency to avoid water rationing.</p><img src="https://counter.theconversation.com/content/214975/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anja du Plessis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>‘Water-shifting’ should not be a permanent measure. It does not address the cause of the current crisis.Anja du Plessis, Associate Professor and Water Management Expert, University of South AfricaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2092932023-07-19T12:22:24Z2023-07-19T12:22:24ZSolving water challenges is complex – learn how law, health, climate and Indigenous rights all intersect in developing solutions<figure><img src="https://images.theconversation.com/files/536663/original/file-20230710-27-7kilk5.jpg?ixlib=rb-1.1.0&rect=6%2C64%2C2038%2C1293&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Americans have come to expect abundant clean water, but there are many stressors on water quality and availability.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/clio1789/7578005278/in/photolist-cxDfXq-R8BLgr-PMPgBA-9cyTMV-QR4skU-6eyUbx-PRjrwu-QX7EYr-yT5M74-PMQ3KS-R5bmiK-iWdCxv-QTHQyn-2iJ2Rvv-21eLgQ-NCejiD-83hhrv-BMx5YX-c1AFu3-Bmjh8e-BMsbiK-EGz72e-2mhVwqZ-7TjMYT-6jgSAw-RTLtfw-cC3YHG-iVP9v-LksTds-MaEoR2-MhQpPr-Bmi8Ar-75tTCe-75tTDi-7SsCVE-cC4SQj-MqUfig-cChXK5-9AFPby-2kCF4ZL-2kCAWZH-MaErPB-QEQnju-5RaYCg-MaEnjV-9NyiQ7-2gjmCZn-2kCF6dN-86XPZU-21a1dr">Jessica/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p><em>In the U.S., most consumers take clean and available fresh water for granted, and water usually becomes front-page news only when there’s a crisis. And the past year has seen its share of water-related crises, whether it’s the <a href="https://theconversation.com/colorado-river-states-bought-time-with-a-3-year-water-conservation-deal-now-they-need-to-think-bigger-206386">effects of a prolonged drought in the U.S. Southwest</a> or floods that covered more <a href="https://theconversation.com/2022s-us-climate-disasters-from-storms-and-floods-to-heat-waves-and-droughts-196713">than one third of Pakistan</a> last year.</em></p>
<p><em>But seeing water problems as only environmental disasters does not capture the deeply interconnected nature of water in our society. To mark the release of the book “<a href="https://www.press.jhu.edu/books/title/33266/conversation-water">The Conversation on Water</a>,” a collection of previously published articles on water, The Conversation hosted a webinar with experts with a range of expertise and different perspectives on water issues and potential solutions.</em></p>
<p><em>The edited text and video clips below convey one or two of the key points each speaker made. The full <a href="https://www.youtube.com/watch?v=NhEyZC0xNOw&t=4s">webinar is available on YouTube</a>.</em></p>
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<figcaption><span class="caption">Indigenous scholar Rosalyn LaPier explains Native Americans’ efforts to gain legal personhood status for natural entities to protect waterways.</span></figcaption>
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<h2>Rosalyn LaPier, Professor of History, University of Illinois</h2>
<p>Native American tribes in the United States think of particular waterways – whether it’s a river, a lake, or an underground aquifer – as a part of the supernatural realm. Tribal communities make an effort to protect certain waterways because <a href="https://theconversation.com/for-native-americans-a-river-is-more-than-a-person-it-is-also-a-sacred-place-85302">it is a sacred place to them</a>, which benefits other people as well. The Taos Pueblo, for example, spent almost an entire century fighting for the Blue Lake in New Mexico because it was a sacred site. They wanted to protect not just the lake but also the watershed of the lake, which they succeeded in doing. </p>
<p>Today, tribes are using different approaches both within the federal legal system and tribal systems. One approach is to set aside water systems that they view as sacred and <a href="https://www.youtube.com/watch?v=d42L4hVJmrA">apply personhood status to them</a>. This has been done in other parts of the world and is beginning to be done in the United States as well, mostly now only within tribal communities. </p>
<p>There are different ways that <a href="https://theconversation.com/native-americans-decadeslong-struggle-for-control-over-sacred-lands-is-making-progress-189620">tribes are thinking more creatively</a>, but it’s connected back to their own religious expression. The reason they’re doing this is not necessarily to protect water from environmental degradation – it often is because of religion and religious practice. We have to distinguish between how we use water in America versus how we revere water in America. Tribes are addressing how to work within the system, because the United States does not protect sacred sites, especially Native American sacred places such as rivers, lakes or other water systems. </p>
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Read more:
<a href="https://theconversation.com/for-native-americans-a-river-is-more-than-a-person-it-is-also-a-sacred-place-85302">For Native Americans, a river is more than a 'person,' it is also a sacred place</a>
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<figcaption><span class="caption">Water law expert Burke Griggs explains how policy around agriculture encourages overuse rather than conservation.</span></figcaption>
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<h2>Burke Griggs, Professor of Law, Washburn University</h2>
<p>We’re pumping so much groundwater out of the planet right now that it has changed the way the Earth is rotating. It is a massive problem that is not very visible but is extremely worrisome. Agriculture uses anywhere between <a href="https://www.ers.usda.gov/amber-waves/2006/november/agriculture-dominates-freshwater-use-in-the-us/">80% and 95% of the water</a> that exists in the West. Rivers are just the icing on the cake of groundwater supplies, winter snowpack and reservoir storage. </p>
<p>Farmers are not breaking the law. They have property rights to pump this water. The fundamental problem is, since the 1850s, and especially since the 1950s, we’ve granted more water rights to pump and to divert than the water systems can support. That’s a bureaucratic problem. It’s called overappropriation.</p>
<p>There’s also a problem in farm policy. Ever since the 1970s, when the agricultural secretary famously said, <a href="https://www.agweek.com/opinion/considering-the-lessons-of-earl-butz">“Get big or get out”</a> and win the cold war for agriculture, we’ve seen the size of farms increase and get bigger and bigger. In order to make money and keep property, farmers have to continually borrow to add acreage, either as owners or as tenants. That in turn encourages them to pump more water to meet their bank loans and their other financial commitments.</p>
<p>So if people are not breaking the law, farmers are not stealing water – and if these subsidy systems promote overproduction and overpumping – what can the U.S. do?</p>
<p>The first thing to do is reform the subsidy system. Instead of rewarding overproduction and making a fetish out of grain yields, we should focus on conservation. We should pay farmers to not irrigate in sensitive areas and during years they don’t need to. </p>
<p>The state law system is critical, because most water rights are state rights. Here, I think it makes sense to make water rights more flexible. Farmers will be willing to trade less water use over the long term for more flexible water use year to year. Most water rights have an annual limit, and if you allow more variability there, then I think that gets us a long way.</p>
<p>Water conservation can happen, but you’ve got to understand water reform within the context of property rights. Property is a very creative tool, and markets can be very creative tools. </p>
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Read more:
<a href="https://theconversation.com/farmers-are-depleting-the-ogallala-aquifer-because-the-government-pays-them-to-do-it-145501">Farmers are depleting the Ogallala Aquifer because the government pays them to do it</a>
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<figcaption><span class="caption">Gabriel Filippelli of Indiana University explains how climate change is making it more challenging to build resilient water infrastructure.</span></figcaption>
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<h2>Gabriel Filippelli, Chancellor’s Professor of Earth Sciences and Executive Director of the Indiana University Environmental Resilience Institute</h2>
<p>In 2014, Toledo, Ohio, suffered a <a href="https://theconversation.com/climate-change-threatens-drinking-water-quality-across-the-great-lakes-131883">massive harmful algal bloom</a>, likely triggered by climate change and related runoff in that area. It occurred right over the only water intake line for the Toledo water system. That meant that they had to issue a rare warning – not only “do not drink the water,” but “do not boil the water,” because these harmful algal blooms produce a toxin that gets even worse if they’re boiled. It showed that a lot of our water systems are not particularly resilient because we built them for 1920 and not for today or tomorrow. </p>
<p>I and a lot of scholars are thinking through the challenges in water security in a lot of parts of the U.S. Around the Great Lakes in the Midwest there are these prolonged episodes of <a href="https://theconversation.com/for-a-flooded-midwest-climate-forecasts-offer-little-comfort-114140">flooding</a> and <a href="https://theconversation.com/what-is-a-flash-drought-an-earth-scientist-explains-194141">drought</a>. Flooding causes the redistribution of harmful algal blooms and pathogens like <em>E. coli</em> in waterways, which are very harmful. Of course, drought also causes its own stress on water supplies. </p>
<p>Unfortunately, a lot of water infrastructure is not built based on our understanding of water today. These massive sewer stormwater upgrades in a lot of cities are only built to hold the capacity of rainfall today, while in the Midwest extreme precipitation events are coming in fast and furious. </p>
<p>The US$2 billion <a href="https://www.in.gov/governorhistory/mitchdaniels/2980.htm">upgrade to Indianapolis’ water infrastructure</a> was built for the extreme rainfall events that we had in the year 2000. Here we are in 2023, and we already have about 15% more extreme rainfall events, and we’ll have another 15% more by 2050. </p>
<p>So rather than only relying on gray infrastructure consisting of tubes, tunnels and pipes to protect and secure our water systems and our safety, we have to also think about the role that <a href="https://theconversation.com/a-20-foot-sea-wall-wont-save-miami-how-living-structures-can-help-protect-the-coast-and-keep-the-paradise-vibe-165076">green infrastructure – nature-based solutions</a> – can play in augmenting some of those solutions. </p>
<p>We also should not be building new infrastructure based on the capacity we have today but based on the capacity we will have in the year 2050 and beyond. A lot of these very large infrastructure projects will and should last until then. </p>
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Read more:
<a href="https://theconversation.com/climate-change-threatens-drinking-water-quality-across-the-great-lakes-131883">Climate change threatens drinking water quality across the Great Lakes</a>
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<figcaption><span class="caption">Andrea K. Gerlak, water policy expert at the University of Arizona, talks about the progress cities around the world are making in water availability and equity.</span></figcaption>
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<h2>Andrea Gerlak, Director at the Udall Center for Studies in Public Policy and Professor in the School of Geography, Development, and Environment at the University of Arizona</h2>
<p>I’ve studied cities around the world and in the U.S., and at the end of the day, there is no perfect city that is doing everything right. But there are little examples. Since the pandemic, we’ve seen <a href="https://theconversation.com/water-quality-in-south-africa-reports-show-what-needs-to-be-fixed-and-at-what-cost-207538">South Africa make a large investment</a> at the city scale around water access and sanitation. Singapore has been focusing on <a href="https://www.voanews.com/a/east-asia-pacific_singapore-turns-sewage-clean-drinkable-water-meeting-40-demand/6209374.html">reusing a lot of their water supply</a>. It’s been imperfect, but we’ve seen some pretty good developments made by Australia’s First Nations to achieve <a href="https://pursuit.unimelb.edu.au/articles/returning-water-rights-to-aboriginal-people">their appropriate water allocations</a> through a legal process. </p>
<p>In the U.S., Tucson has won awards for its green infrastructure and, along with Los Angeles, views stormwater as a resource. Los Angeles recently announced that in the coming decade, the majority of their drinking water will come <a href="https://www.latimes.com/california/story/2023-02-21/progress-on-l-a-stormwater-capture-program-is-slowing">from capturing stormwater</a>, treating it and using it for potable water supply. </p>
<p>Other cities have been good at recognizing equity concerns, like <a href="https://water.phila.gov/green-city/">Philadelphia</a> and <a href="https://thechisholmlegacyproject.org/policy/baltimores-water-accountability-and-equity-act/">Baltimore</a>. Municipal ordinances have been changed to make water available to people who cannot afford to pay their water bills and whose homes would have historically been repossessed as a result. </p>
<p>There are shining moments here and there, but there’s not any perfect package or perfect city.</p><img src="https://counter.theconversation.com/content/209293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrea K. Gerlak has received funding from NOAA, the Inter-American Institute for Global Change Research, Lloyd's Register Foundation, and Morris K. Udall and Stewart L. Udall Foundation.</span></em></p><p class="fine-print"><em><span>Burke Griggs receives funding from the U.S. Department of Agriculture; U.S. Department of Commerce, Commercial Law Development Program; U.S. Department of State, Fulbright Commission. </span></em></p><p class="fine-print"><em><span>Gabriel Filippelli receives funding from the US National Science Foundation, the Environmental Protection Agency, the United States Geological Survey, the Honda Foundation, the Health and Hospital Corporation of Marion County, The American Chemical Society-Petroleum Research Fund, and DLA Piper.</span></em></p><p class="fine-print"><em><span>Rosalyn R. LaPier does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A webinar hosted by The Conversation brings together experts in law, health, policy and Indigenous affairs to explain some of the most pressing problems related to water in the US.Andrea K. Gerlak, Professor, School of Geography, Development and Environment, University of ArizonaBurke Griggs, Associate Professor of Law, Washburn UniversityGabriel Filippelli, Chancellor's Professor of Earth Sciences and Executive Director, Indiana University Environmental Resilience Institute, Indiana UniversityRosalyn R. LaPier, Professor of History, University of Illinois at Urbana-ChampaignLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2082092023-06-27T10:32:12Z2023-06-27T10:32:12ZCholera: vaccines can stop the spread, but the biggest deterrent is clean water<figure><img src="https://images.theconversation.com/files/533991/original/file-20230626-15-fqsnjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A member of the Syria Immunization Team holding cholera vaccinations.
</span> <span class="attribution"><span class="source">Anas Alkharboutli/picture alliance via Getty Images</span></span></figcaption></figure><p><em>South Africa has experienced outbreaks of cholera since January. The worst was in May in Hammanskraal, north of Pretoria, where <a href="https://www.gov.za/speeches/health-update-response-cholera-outbreak-south-africa-8-jun-2023-0000">nearly 30 people</a> died. Cholera is a bacterial disease which spreads via the faecal-oral route mostly through ingestion of contaminated food and water. It causes severe diarrhoea and dehydration, and in extreme cases death. The source of the outbreak in Hammanskraal is still not known. The World Health Organization (WHO) <a href="https://www.gtfcc.org/wp-content/uploads/2020/05/gtfcc-cholera-outbreak-response-field-manual.pdf">recommendations</a> for responding to a cholera outbreak include ensuring that communities have access to safe drinking water and sanitation, and treating sick people quickly. Oral cholera vaccines may be considered to contain ongoing outbreaks and to limit the spread. These vaccines have not been administered during the current outbreak in South Africa. The Conversation Africa spoke to vaccinologists Edina Amponsah-Dacosta and Julie Copelyn about the cholera vaccine and other ways to curb the outbreak.</em></p>
<hr>
<h2>Where do vaccines fit into the picture? How do they work?</h2>
<p>Poor access to safe water and sanitation are the key driving factors behind cholera transmission. Ensuring access to clean potable water, adequate sanitation and promoting hygiene practices are critical to preventing the disease. </p>
<p>Vaccinations are a <a href="https://pubmed.ncbi.nlm.nih.gov/29555219/">complementary</a> prevention and control strategy. These are particularly useful in endemic areas, outbreaks and humanitarian crises.</p>
<p>The aim of vaccination is to prevent infection with the bacterium that causes cholera: <em>Vibrio cholerae</em>. Vaccination can also reduce the risk of severe illness that requires hospitalisation. </p>
<p>The first widely used cholera vaccines were injectable formulations. They were first developed in the late 19th and early 20th centuries. But they had <a href="https://doi.org/10.1002%2F14651858.CD000974.pub2">side effects</a> like headaches, malaise, nausea, fever and rash and offered only limited immune protection.</p>
<p>In the <a href="https://pubmed.ncbi.nlm.nih.gov/21498389/">1980s</a> these vaccines were replaced by safer and more effective oral cholera vaccines. </p>
<p>The WHO has prequalified two types of oral cholera vaccines for commercial use globally. (This means it has assessed and assured their quality, safety and efficacy.) The prequalified vaccines consist of inactivated strains of <em>V. cholerae</em> only (Shanchol™ and Euvichol®); or in combination with a harmless form of the bacterial toxin (Dukoral®). Exposure to these inactivated or “killed” bacteria trigger the body to generate an immune response in the gut mucosa - the primary site of infection. This immune response is protective against future infection with the bacteria.</p>
<p>Studies have <a href="https://www.mdpi.com/2076-393X/9/12/1482">shown</a> that oral cholera vaccines are effective at preventing disease in the person who is vaccinated. It can also confer <a href="https://www.mdpi.com/2076-393X/9/12/1482">indirect or herd protection</a> by reducing the spread of <em>V. cholerae</em> within a highly vaccinated community. </p>
<p>New generation <a href="https://www.annualreviews.org/doi/abs/10.1146/annurev-micro-041320-033201">oral and injectable cholera vaccines</a> are currently in development.</p>
<h2>Who should be vaccinated and when?</h2>
<p>The decision to vaccinate should be informed by your level of risk, and how frequent and widespread the outbreak is.</p>
<p>The best time to administer oral cholera vaccines is before a person is exposed to the bacteria. </p>
<p>The WHO <a href="https://pubmed.ncbi.nlm.nih.gov/29555219/">recommends</a> vaccination with oral cholera vaccines in areas where cholera occurs regularly and in areas where there could be large outbreaks or epidemics of cholera. This includes humanitarian crisis situations. In such settings, access to safe water supplies and adequate sanitation may be hampered. Widespread vaccination is required in these settings to interrupt further spread of cholera.</p>
<p>In countries where outbreaks aren’t frequent, such as South Africa, mass vaccination against cholera is not necessary. Vaccination is not a replacement for provision of safe drinking water, adequate sanitation and good hygiene practices.</p>
<p>Under the current circumstances in South Africa, vaccination should be limited to those at high risk: people in continuous direct contact with cholera patients, working with laboratory specimens, or frequently exposed to contaminated food and water.</p>
<p>After complete vaccination it takes the body seven to 10 days to produce protective antibodies. Scientific evidence on how long this protection lasts is still developing. <a href="https://doi.org/10.3390/vaccines9121482">Existing evidence</a> suggests that immune protection from oral cholera vaccines could last for up to three years. </p>
<h2>What else can be done to avoid cholera?</h2>
<p>During sporadic cholera outbreak situations such as the current outbreak in South Africa, the priority should be early detection and appropriate management of people who have been infected. Water, sanitation and hygiene interventions must be implemented immediately in affected communities to interrupt further spread. </p>
<p>Such interventions include making safe drinking water accessible in instances where the water supply may be contaminated or unreliable, improving sanitation, and raising awareness about the importance of frequent hand-washing with soap and clean water. In addition, active disease surveillance must take place to monitor transmission patterns. </p>
<p>The current cholera outbreak in South Africa is a rude awakening. It suggests that the country may not have adequately applied the <a href="https://pubmed.ncbi.nlm.nih.gov/11203732/">lessons</a> learnt from <a href="https://www.nicd.ac.za/assets/files/CommDisBullMay09_Vol0702.pdf">previous outbreaks</a>. The most recent major outbreak affected all nine provinces with 1144 laboratory-confirmed cases and 64 deaths recorded between November 2008 and April 2009. </p>
<p>This is a reminder of the inequities and gaps in social development, as well as the unacceptable state of the country’s <a href="https://theconversation.com/cholera-in-south-africa-a-symptom-of-two-decades-of-continued-sewage-pollution-and-neglect-206141">wastewater treatment systems</a>. </p>
<p>Ultimately, if effective control of cholera is to be achieved, local authorities must execute their responsibility of ensuring that all citizens have access to safe water supply and adequate sanitation. </p>
<p>In addition, supporting cholera control efforts in neighbouring countries will reduce the risk of importation. This will require prioritisation in the African public health agenda backed by intensified investments in water, sanitation and hygiene interventions and oral cholera vaccines. </p>
<p>Fortunately, the South African-based bio-pharmaceutical company Biovac <a href="https://www.dst.gov.za/index.php/media-room/latest-news/3812-biovac-signs-deal-to-develop-and-manufacture-oral-cholera-vaccine-for-african-and-global-markets">recently secured the rights</a> to manufacture oral cholera vaccines. This is a significant step in meeting the growing demand for the vaccine across the region.</p><img src="https://counter.theconversation.com/content/208209/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The aim of vaccination is to prevent infection. In addition, vaccination is intended to reduce the risk of severe illness.Edina Amponsah-Dacosta, Research Officer / EIDM Specialist, University of Cape TownJulie Copelyn, Senior lecturer, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1994252023-02-16T14:27:52Z2023-02-16T14:27:52ZWater cuts in South Africa are hurting hospitals and clinics - there’s an increased risk of infections<figure><img src="https://images.theconversation.com/files/508956/original/file-20230208-23-ovwtlo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p><em>South Africa is a water scarce country. <a href="https://theconversation.com/changes-in-south-africas-rainfall-seasons-could-affect-farming-and-water-resources-147371">Changing</a> rainfall patterns and the escalating <a href="https://theconversation.com/power-cuts-in-south-africa-are-playing-havoc-with-the-countrys-water-system-197952">electricity crisis</a> are making the situation worse. Treating and distributing water requires electricity. Some of the country’s biggest cities have had to impose water restrictions and residents in other parts have gone <a href="https://www.iol.co.za/pretoria-news/news/residents-in-part-of-mamelodi-east-without-water-supply-for-13-months-ce20ee94-9cef-44cb-ad0c-4d0d63f9428a">months</a> without regular water supply. Unfortunately, health facilities have not been spared. There <a href="https://www.news24.com/news24/southafrica/news/just-in-joburg-water-crisis-two-public-hospitals-struggling-residents-fuming-as-reservoirs-run-dry-20221004">have been</a> numerous <a href="https://allafrica.com/stories/202208080266.html">media</a> reports of <a href="https://health-e.org.za/2022/03/24/water-shortage-free-state-hospitals-down-to-the-last-drop/">hospitals and clinics</a> around the country being hit by <a href="https://www.iol.co.za/news/south-africa/kwazulu-natal/department-of-health-intervenes-in-prince-mshiyeni-hospital-water-crisis-a2ed5015-03b4-4469-a935-9eaf75879eee">water shortages</a>. The Conversation Africa’s Ina Skosana spoke to epidemiologist Husna Ismail about the dangers of clinics and hospitals running out of water.</em></p>
<hr>
<h2>How common are hospital acquired infections?</h2>
<p>The World Health Organization (WHO) defines <a href="https://www.who.int/news/item/06-05-2022-who-launches-first-ever-global-report-on-infection-prevention-and-control">healthcare-associated infections</a>, or “hospital” infections, as those affecting patients admitted to a healthcare facility. These are infections not present at the time of admission. They also include infections that appear shortly after discharge. Healthcare-associated infections are a significant cause of illness and death in hospitals. </p>
<p>In low- and middle-income countries such as South Africa, the WHO estimates that <a href="https://www.who.int/news/item/06-05-2022-who-launches-first-ever-global-report-on-infection-prevention-and-control">15 out of every 100 patients</a> in hospitals will get an infection. In high-income countries the estimate is seven patients out of 100. </p>
<h2>Which are the major infections?</h2>
<p>Common types of <a href="https://www.nicd.ac.za/centres/centre-for-healthcare-associated-infections-antimicrobial-resistance-and-mycoses/">healthcare-associated infections</a> include bloodstream, cerebrospinal fluid, respiratory system, surgical sites, skin and soft tissue, and urinary tract infections. Intravenous and other devices are likely sources of infections in hospital settings. </p>
<p>Microorganisms such as bacteria, viruses, fungi and parasites cause infections. The most common bacterial agents are <em>Staphylococcus aureus</em>, <em>Klebsiella pneumoniae</em>, <em>Acinetobacter baumannii</em>, <em>Pseudomonas aeruginosa</em> and enterococci. </p>
<p>Patients are at higher risk of getting infections if they have underlying conditions. These include but are not limited to diabetes, renal failure and malignancies. Long stays in hospital, surgical or invasive procedures, insertion of medical devices, intravenous tubing, artificial joints replacement, also pose a risk. Patients may develop infection caused by microorganism with emerging antimicrobial resistance while on antimicrobial treatment or been treated a few months to a year before. This makes individuals with antimicrobial resistance less able to fight infection. </p>
<h2>Which infections are related to the availability of water?</h2>
<p>Delivery of quality healthcare should take place in a hygienically clean and safe environment. This environment must have an adequate supply of clean running water and good sanitation for both patients and staff. The cornerstone of all infection prevention and control programmes is hand hygiene. Hand wash stations with water, soap, clean towels or alcohol-based hand rub should be available in key areas such as toilets and at the points of care. Standards for water quality, sanitation and environmental health should be met. Hand sanitisers must have at least 70% alcohol by volume. </p>
<p>Pathogens such as <em>Legionella</em> and non-tuberculous mycobacteria can contaminate the deep infrastructure such as pipes and drains or outlets of hospital water distribution systems. Other bacteria and moulds tend to adhere to surfaces at or near taps and sinks. Hospital management teams should have systems to address Water, Sanitation and Hygiene (WASH) malfunction or other related issues such as infrastructure. </p>
<p>Infection prevention and control programmes in healthcare facilities are important approaches to help protect vulnerable patients, as well as staff and visitors. </p>
<h2>How can hospitals maintain infection control - even during water cuts?</h2>
<p>Municipal water supplies to hospitals and communities must be pathogen-free and regularly monitored. Municipalities should have water quality assurance systems in place to ensure clean water. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583638/#S8title">Contaminated municipal water</a> can cause outbreaks that affect community and healthcare settings. </p>
<p>Hospital management should have a risk assessment plan for water shortages. They should communicate with municipalities about the provision of an alternative supply of clean water to the affected areas. Possible solutions could include a permanent (quality assured borehole water) or temporary (watertanks) backup water supply. Those solutions must also be maintained properly to avoid contamination and subsequent infection of patients.</p><img src="https://counter.theconversation.com/content/199425/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In hospitals, infection prevention and control cannot be met without a hygienically clean, and safe environment that has an adequate supply of clean running water.Husna Ismail, Epidemiologist, National Institute for Communicable DiseasesOlga Perovic, Principal Pathologist, National Institute for Communicable DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1928842023-01-30T12:49:39Z2023-01-30T12:49:39ZInequality in access to basic services is a major problem in sub-Saharan Africa - but progress is being made<figure><img src="https://images.theconversation.com/files/504894/original/file-20230117-18-56vfnx.jpg?ixlib=rb-1.1.0&rect=2%2C34%2C528%2C396&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Where people live can determine their station in life. </span> <span class="attribution"><span class="source">Wendy Stone/Corbis via Getty Images</span></span></figcaption></figure><p>Economic activity and development are unevenly distributed across regions of the world and within any country. In other words, where someone lives can determine their economic and social well-being.</p>
<p>Take gross domestic product (GDP) per capita – the total value of a country’s economic output per person. In 2020, North American and Europe’s GDP per capita was more than <a href="https://ourworldindata.org/grapher/gdp-per-capita-worldbank">ten times</a> that of sub-Saharan Africa.</p>
<p>More than a third (38%) of people in sub-Saharan Africa were <a href="https://ourworldindata.org/grapher/share-of-population-in-extreme-poverty?country=BGD%7EBOL%7EMDG%7EIND%7ECHN%7EETH%7ECOD">living in extreme poverty</a> in 2019. The estimate for the rest of the world was less than 10%. </p>
<p>But there is limited research analysing levels and trends of spatial disparities in sub-Saharan Africa. This is due to a lack of comparable data on income and consumption across countries.</p>
<p>In a recent <a href="https://doi.org/10.1080/19376812.2022.2099916">analysis</a>, we used comparable data from demographic and health surveys to evaluate spatial inequality between regions within a country – such as disparities among South Africa’s nine provinces. We also studied inequality between individuals in more than 24 sub-Saharan African countries. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/child-nutrition-programmes-can-feed-inequality-model-from-south-africa-shows-how-context-shapes-lives-194096">Child nutrition programmes can feed inequality: model from South Africa shows how context shapes lives</a>
</strong>
</em>
</p>
<hr>
<p>We examined multiple dimensions of inequity. Our analysis considered assets as well as access to basic services. This is a useful way of measuring the extent and patterns of inequalities in sub-Saharan Africa.</p>
<p>The results show that spatial inequality remains significant in a number of countries in the region. Most have high levels of spatial and overall national inequalities. There are large variations among countries. </p>
<p>High and persistent spatial disparity within a country has a number of negative consequences. It means poverty doesn’t respond to economic growth. It also has implications for political and social stability. </p>
<p>Public policies that promote investment in infrastructure and basic services, as well as human capital and skills development, are critical for reducing spatial inequality.</p>
<h2>The research</h2>
<p>First, we used data from 24 sub-Saharan African countries totalling over 1.6 million observations. Indicators of living standards – for example ownership of durable assets like land and livestock, and dwelling conditions – formed the basis for comparing households.</p>
<p>Secondly, we used data on basic services, such as clean water and electricity, as a narrower measure of living standards. We also used this data to examine inequity trends across time. We used data from 27 countries, comprising around five million observations, from 1995 to 2018.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pandemic-underscores-gross-inequalities-in-south-africa-and-the-need-to-fix-them-135070">Pandemic underscores gross inequalities in South Africa, and the need to fix them</a>
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<p>In each country, we used the first administrative units (regions or provinces) as our spatial units.</p>
<p>Our research differed from recent <a href="https://doi.org/10.1016/j.euroecorev.2016.11.009">studies</a> that have used night-time lights data from satellites to analyse spatial inequality. </p>
<p>Night-lights data is useful in predicting economic activity in cities. But it tends to <a href="https://doi.org/10.1016/j.jdeveco.2020.102602">underestimate spatial inequality</a> in areas where primary activities such as agriculture are the main economic activity. This includes many sub-Saharan African countries.</p>
<h2>Findings</h2>
<p>Our analysis reveals high levels of within-country spatial and overall national (interpersonal) asset inequalities. Countries varied a lot.</p>
<p>Countries with high regional inequality included Mozambique, Ethiopia, Kenya and the Democratic Republic of Congo.</p>
<p>In 18 countries, regional inequalities accounted for at least one-fifth of overall national inequality.</p>
<p>These findings show that, in most sub-Saharan African countries, reducing spatial inequality can do a lot to reduce overall national inequality.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/unequal-power-relations-driven-by-poverty-fuel-sexual-violence-in-lake-chad-region-185918">Unequal power relations driven by poverty fuel sexual violence in Lake Chad region</a>
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<p>We show that spatial and national inequalities in access to basic services have declined significantly over time in most of sub-Saharan Africa. But the level of inequality and the change over time varies across countries. </p>
<p>Spatial inequalities in access to basic services remain relatively high in Sierra Leone, Mozambique and Niger. They are comparatively low in Gabon, Malawi, Comoros and South Africa.</p>
<h2>Reducing spatial inequalities</h2>
<p>Spatial inequality is a key component of national inequality in most countries in the region. So lowering spatial inequalities can reduce economic and social inequities.</p>
<p>There is some consensus that three factors contribute to spatial inequalities in <a href="https://doi.org/10.1017/9781108908702">developing countries</a>. These are:</p>
<ul>
<li><p>Initial differences in geography, such as environmental factors, natural resources and access to trade routes</p></li>
<li><p>The concentration of skills, economic productivity and amenities in a few locations </p></li>
<li><p>Political and fiscal policies</p></li>
</ul>
<p>But there is disagreement about which <a href="http://hdl.handle.net/10986/36843">policies</a> work best to reduce spatial inequalities. It’s important to understand a country’s context to identify solutions. High levels of <a href="http://dx.doi.org/10.2139/ssrn.780485">initial economic inequalities</a>, among other factors, are an obstacle to reducing poverty in sub-Saharan Africa. And regional disparities within a country are frequently <a href="https://doi.org/10.1093/acprof:oso/9780198728450.003.0007">associated</a> with social divisions such as religion and ethnicity. This leads to <a href="https://doi.org/10.1057/9780230582729_1">conflicts</a>.</p><img src="https://counter.theconversation.com/content/192884/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The research was supported by the African Research Universities Alliance (ARUA). Agence Française de Développement.
</span></em></p>Lowering spatial inequalities can reduce economic and social inequities.Muna Shifa, Senior Researcher in Development Economics, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1821632022-05-10T13:49:59Z2022-05-10T13:49:59ZCommunity dialogue can show the way to meeting water needs: a South African case<figure><img src="https://images.theconversation.com/files/461597/original/file-20220505-21-k1sbzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Access to clean water is essential in preventing a number of infections. </span> <span class="attribution"><span class="source">Riccardo Mayer/shutterstock </span></span></figcaption></figure><p>About 842,000 people die every year from diarrhoea in <a href="https://www.sciencedirect.com/science/article/pii/S1438463918310484?via%3Dihub">rural communities</a> because they lack <a href="https://www.sciencedirect.com/science/article/pii/S1438463918310484?via%3Dihub">safe water</a> and <a href="https://washdata.org/sites/default/files/documents/reports/2019-07/jmp-2019-wash-households.pdf">adequate sanitation</a>. Water and sanitation are essential in preventing a number of other infections and hygiene-related diseases.</p>
<p>In South Africa, severe shortages of water and difficulties in accessing it have led to regular <a href="https://www.tandfonline.com/doi/abs/10.1080/09718923.2014.11893279">protests</a> in <a href="https://www.researchgate.net/publication/337244789_Exploring_service_delivery_protests_in_post-apartheid_South_African_municipalities_A_literature_review">municipalities</a> across the country. <a href="https://www.news24.com/News24/bushbuckridge-residents-protest-over-lack-of-water-20170613">Bushbuckridge</a>, a rural sub-district, is one.</p>
<p>The Bushbuckridge local municipality is among the driest areas in South Africa. Rainfall is low but the area is susceptible to occasional flooding. And the municipality <a href="https://zingelaulwazi.org.za/water-crisis-deepening-in-bushbuckridge-part-1/#:%7E:text=In%20the%20last%20ten%20years,getting%20worse%20day%20by%20day">struggles to supply potable water</a> to most villages in the area.</p>
<p>Within the municipality is the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429877">Agincourt</a> health and demographic surveillance site, a research programme established in 1992 to better understand population health in rapidly transitioning societies. The research population consists of 120,000 people living in 31 villages in 21,500 households. About 23% of households have no regular source of income and this has an impact on health. </p>
<p>Evidence <a href="https://pubmed.ncbi.nlm.nih.gov/31837832/">suggests</a> that involving marginalised <a href="https://pubmed.ncbi.nlm.nih.gov/31075120/">communities</a> in <a href="https://pubmed.ncbi.nlm.nih.gov/29062494/">setting priorities and designing collective action</a> can lead to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220489/">improved health outcomes</a> and ensure a more responsive and equitable health system.</p>
<p>But it is unclear how best to ensure <a href="https://www.cambridge.org/core/journals/primary-health-care-research-and-development/article/effective-and-meaningful-participation-or-limited-participation-a-study-of-south-african-health-committee-legislation/6F7F2276B2345E282E414658DC58A7A5#">effective and meaningful participation</a> in practice.</p>
<p>The Agincourt public health observatory provides an opportunity to try out approaches.</p>
<p>We engaged a cross-section of the community in Agincourt in a participatory action <a href="https://www.vapar.org/papers-and-reports">research process</a>. The aim was to find out which health topic was their priority and what they could do about it. The participants included community and religious leaders, traditional healers, community health workers, clinic committee members and family members. They were involved in decision making from the beginning of the process. This presented an opportunity to learn and to exercise control over decisions and actions affecting their lives. </p>
<h2>Water as a priority</h2>
<p>The participants as co-researchers identified lack of safe water as a priority health concern. They nominated women of reproductive age as a group whose voices were excluded, and recruited them to expand the process of exploring the topic. </p>
<p>Participants held weekly meetings where they used participatory action research methods and tools:</p>
<ul>
<li><p>ranking and voting to identify priority health topics</p></li>
<li><p>a “<a href="https://urbact.eu/problem-tree#:%7E:text=The%20PROBLEM%20TREE%20is%20a,shared%20understanding%20of%20the%20issue.">problem tree”</a> to understand lack of water from different perspectives</p></li>
<li><p><a href="https://www.siyavula.com/read/maths/grade-10/probability/14-probability-02">Venn diagrams</a> to identify different actors and their interaction and influence</p></li>
<li><p><a href="https://www.yourarticlelibrary.com/hrm/action-research-model-of-organisation-development-explained-with-diagram/35317">action pathways</a> to show steps towards desired goals through interconnected events. </p></li>
</ul>
<p>Participants talked about what was causing and contributing to their water challenges, what the impacts were, and what actions were needed most. They also took photographs and used these to define and share their experiences. These were a way to document, reflect on and communicate water issues in the community.</p>
<p>They said they often went without piped water for a long time. Infrastructure was unreliable or unavailable. Service delivery was inadequate. Water sources were informal and unregulated sources. Droughts added to the problem of poor supply. They all said they urgently needed a water tap in each household. </p>
<p>Participants also shared what they knew about interconnected social, behavioural and health impacts. Infectious diseases such as schistosomiasis, cholera, typhoid, and other intestinal infections were linked to lack of safe water. They reported on how lack of safe water compromised sanitation and the safety of women and girls. It contributed to hunger and malnutrition, and caused social unrest and protests. </p>
<p>Women and children had the biggest burden of collecting water. Participants said that water shortages drove people into poverty as time for work and education was lost. The physical strain of carrying water was also reported to affect health. </p>
<p>Participants attributed lack of safe drinking water to many issues. These included climate change, illegal connections, and poor planning by the government. Water was reported as being “stolen” through illegal connections and unmaintained infrastructure. Participants said municipalities took a long time to respond to issues raised by communities. </p>
<h2>Collective action</h2>
<p>Stakeholders representing rural communities and the authorities then collectively developed a local action plan. Their discussions centred on improving agency, control and power, and rebuilding a sense of community ownership. They committed to behavioural change and reorganisation of existing services and these actions were monitored through followup visits. </p>
<p>The local action plan was partially achieved, with three out of seven action items completed:</p>
<ul>
<li><p>river clean-up campaigns</p></li>
<li><p>awareness campaigns</p></li>
<li><p>dialogue between the communities and municipality. </p></li>
</ul>
<p>The greatest accomplishments were creation of dialogue in perceived safe spaces and collective implementation promoting mutual understanding and learning.</p>
<p>A key theme that emerged from the discussions was the value of partnerships between sectors. This was due to the cross-cutting nature of water as a resource, and its impact on health, economy, education, environment and social life. </p>
<p>It can’t be left to the department of water and sanitation alone to make water policy and to develop interventions. Sustainable solutions require other sectors to get involved too.</p>
<p>Embedding the process in an established public health observatory helped to create a neutral, mediated space for inclusive meaningful participation. </p>
<h2>Reflections and looking ahead</h2>
<p>Interactive workshops increased familiarity, ownership, and control of the process, and built mutual understanding relationships and trust. Facilitation was key in ensuring that discussions were focused, substantive, inclusive and respectful. Facilitators made sure that people’s experiences and knowledge were represented. The workshops were co-designed with participants, and located at suitable venues, times and dates. </p>
<p>Including stakeholders throughout the process (priority setting, design, implementation) has the potential to bridge the gap between theory and practice through production of relevant evidence for policy and planning. </p>
<p>Our process emphasised that allowing local voices to be heard in safe spaces increased people’s capacity to solve problems, learn and gain confidence. As one community stakeholder put it:</p>
<blockquote>
<p>There have been a lot of service delivery protests in communities, but they did not accomplish much; everyone realised that it is time to shift our ways of thinking and initiate dialogue, unite and collaborate and create sustainable partnerships to solve community problems.</p>
</blockquote><img src="https://counter.theconversation.com/content/182163/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathleen Kahn receives funding from the South African Medical Research Council, UK Medical Research Council, Department of Science and Innovation SA, and the National Institute on Aging of the National Institutes of Health (NIH), USA</span></em></p><p class="fine-print"><em><span>Lucia D'Ambruoso works for the University of Aberdeen, Scotland, UK. She receives funding from the Health Systems Research Initiative from Department for International Development (DFID)/ Medical Research Council (MRC)/ Wellcome Trust/ Economic and Social Research Council (ESRC) (MR/N005597/1, MR/P014844/1) . She/she is affiliated with the University of the Witwatersrand, Johannesburg.</span></em></p><p class="fine-print"><em><span>Jennifer Hove and Rhian Twine do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Evidence suggests that involving marginalised communities in setting priorities and designing collective action can lead to improved health outcomes.Jennifer Hove, PhD student in the school of public health, University of the WitwatersrandKathleen Kahn, Professor: Health and Population Division, School of Public Health, University of the WitwatersrandLucia D'Ambruoso, Senior Lecturer in Global Public Health, University of AberdeenRhian Twine, Honorary Senior Researcher in the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1783242022-03-10T14:58:43Z2022-03-10T14:58:43ZHow COVID has affected the control of neglected tropical diseases<figure><img src="https://images.theconversation.com/files/450893/original/file-20220309-18-1o0cwh.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A case of advanced liver pathology (hepatomegaly) due to schistosomiasis in a 5-year-old. </span> <span class="attribution"><span class="source">Prof Takafira Mduluza</span></span></figcaption></figure><p><a href="https://www.who.int/publications/i/item/who-wer9638-461-468">Neglected tropical diseases</a> is an umbrella term used to describe a group of 20 infectious diseases. These diseases affect over 1.7 billion people. They can disable, debilitate and even kill. The world’s most vulnerable and poorest are most affected. In the past, the diseases in this group have been overlooked internationally and poorly funded domestically: hence the “neglected” in the name. Some common neglected tropical diseases are <a href="https://www.cdc.gov/buruli-ulcer/index.html">Buruli Ulcer</a>, <a href="https://www.cdc.gov/dengue/">Dengue Fever</a> and <a href="https://www.cdc.gov/leprosy/">Hansen’s disease (also known as leprosy)</a>.</p>
<p>There are already <a href="https://www.who.int/data/gho/data/themes/neglected-tropical-diseases">tools to prevent and treat</a> these diseases. They include drugs, vector control, veterinary public health interventions and provision of safe water and toilets. </p>
<p>In the past 10 years there have been significant global efforts to control neglected tropical diseases. In 2012, pharmaceutical companies, donors, endemic countries and non government organisations came together to sign the <a href="https://unitingtocombatntds.org/resource-hub/who-resources/london-declaration-neglected-tropical-diseases/">London Declaration on Neglected Tropical Diseases</a>. Together, they committed to control, eliminate or eradicate ten of these diseases by 2020 and improve the lives of over a billion people. Support from the signatories ranged from <a href="https://accesstomedicinefoundation.org/access-to-medicine-index/best-practices/medicine-donations-for-neglected-tropical-diseases">donation of the essential medicines</a> to financing the <a href="https://schistosomiasiscontrolinitiative.org/about/how-money-is-spent">delivery and distribution</a> of the drugs, research, and funding for sanitation and safe water. These concerted global efforts have yielded successes and are grounds for optimism.</p>
<p>To date, <a href="https://www.eisai.com/news/2022/news202209.html#:%7E:text=Forty%2Dthree%20countries%20have%20eliminated,people%20remain%20threatened%20by%20NTDs.">600 million</a> people no longer require treatment for neglected tropical diseases. Cases of some of these diseases, such as leprosy, sleeping sickness and Guinea worm disease, are at an all-time low. Forty-four <a href="https://www.eisai.com/news/2022/news202209.html#:%7E:text=Forty%2Dthree%20countries%20have%20eliminated,people%20remain%20threatened%20by%20NTDs.">countries</a> have eliminated at least one neglected tropical disease as a public health concern. Most recently the <a href="https://theconversation.com/how-the-gambia-beat-trachoma-an-infection-that-causes-blindness-160716">Gambia</a> and <a href="https://www.who.int/news/item/21-02-2022-who-validates-saudi-arabia-for-eliminating-trachoma-as-a-public-health-problem#:%7E:text=On%2026%20January%202022%2C%20the,Region%20to%20achieve%20this%20milestone.">Saudi Arabia</a> eliminated trachoma, a bacterial infection which causes blindness.</p>
<p>However, this progress is now at real risk of reversal as a result of the <a href="https://www.who.int/teams/control-of-neglected-tropical-diseases/overview/ntds-and-covid-19">COVID-19 pandemic</a>. Drug programmes have been interrupted, health budgets re-prioritised and aid cut.</p>
<p>As I have <a href="https://pubmed.ncbi.nlm.nih.gov/27988094/">previously highlighted</a>, interrupting control programmes could lead to rebound infections and disease. These could be worse than the original levels. This is now an imminent reality for neglected tropical diseases if control programmes do not resume quickly enough.</p>
<h2>Interrupted disease control</h2>
<p>One of the most important tools to use against neglected tropical diseases is <a href="https://www.sightsavers.org/protecting-sight/ntds/mass-drug-administration/">national mass drug administration</a>. This involves treating every member of a population, regardless of their infection status, because treatment is cheaper than diagnosis and the drugs are safe. Typically the national treatment programmes are annual events conducted in schools or health centres. It takes time, effort and money to plan and implement these programmes. And it’s critical to maintain momentum. Every dollar spent on these programmes yields a significant return on investment. This is why neglected tropical disease control has been termed a <a href="https://unitingtocombatntds.org/news/new-report-investments-neglected-tropical-diseases-are-one-best-buys-development/?lang=fr">“best buy” in development</a>.</p>
<p>The pandemic has affected neglected tropical disease control in three ways.</p>
<p>First, mass drug administration was <a href="https://schistosomiasiscontrolinitiative.org/about/how-money-is-spent">stopped or interrupted</a> by the <a href="https://rstmh.org/news-blog/news/covid-19-who-issues-interim-guidance-for-implementation-of-ntd-programmes">lockdown and social distancing policies</a>. And disruptions in global trade and transportation affected supply chains. A recent <a href="https://www.who.int/news/item/24-09-2021-neglected-tropical-diseases-2020-preventive-chemotherapy-treatment-coverage-declines-due-to-covid-19-disruptions#:%7E:text=The%20survey%20indicated%20that%2C%20as,highest%20among%20all%20health%20services.">World Health Organisation survey</a> indicated that, as of early 2021, disruptions in neglected tropical disease control programmes occurred in 44% of countries. </p>
<p>Second, national governments in neglected tropical disease endemic countries have low health budgets. <a href="https://www.nature.com/articles/s41591-021-01268-y">Changing priorities</a> during and after COVID-19 has meant that the resources allocated to neglected tropical diseases may be shifted to <a href="https://www.who.int/teams/control-of-neglected-tropical-diseases/overview/ntds-and-covid-19">other diseases and health services</a>.</p>
<p>Third, a significant amount of funding for neglected tropical disease control programmes comes from international development partners and foreign governments. Post-COVID-19 economic contraction in their economies and shifts in funding priorities are threatening the gains made in controlling neglected tropical diseases. For example, <a href="https://unitingtocombatntds.org/news/our-response-to-the-uks-cuts-to-foreign-aid/">the UK</a> recently withdrew over £150 million of funding to neglected tropical disease programmes as part of cuts to the country’s aid budget. This <a href="https://www.telegraph.co.uk/global-health/science-and-disease/uk-government-cuts-almost-wipe-funding-tackle-neglected-diseases/">wiped</a> out a third of donor funding for tackling neglected tropical diseases, with an impact on treatments to <a href="https://unitingtocombatntds.org/news/our-response-to-the-uks-cuts-to-foreign-aid/">250 million people</a> and as many as 180,000 surgeries to prevent disabilities. </p>
<h2>Long term consequences</h2>
<p>Continued neglect of these diseases has dire consequences. Those affected continue to suffer the devastating diseases, associated health inequities and cycles of poverty. The effects of these diseases are pervasive and wide-ranging. </p>
<p>As long as neglected tropical diseases are a huge burden on health systems in endemic countries, these countries will continue to haemorrhage resources, finances and lives to these diseases. This will further weaken their health systems, compromising their ability for timely surveillance, detection and containment of the next epidemic. From the <a href="https://ghsagenda.org/">Global Health Security Agenda</a>, we know that weakened health systems anywhere in the world compromise health security globally. Local health security is the foundation for global health security, as COVID-19 has amply demonstrated.</p>
<p>The opportunity to put global attention back on neglected tropical diseases will come later this year when the London Declaration is superseded by the <a href="https://idpjournal.biomedcentral.com/articles/10.1186/s40249-021-00932-2">Kigali Declaration</a>. This high-level political declaration, led by Rwanda and Nigeria, aims to mobilise political will and secure commitments to achieve <a href="https://sdgs.un.org/goals">Sustainable Development Goals targets</a> for these diseases. </p>
<p>It is important to remember that controlling neglected tropical diseases is in the best interest of all countries – those where the diseases are endemic and those where they are not.</p><img src="https://counter.theconversation.com/content/178324/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Francisca Mutapi receives research funding from the Royal Society in the UK,
She is board member for Uniting to Combat Neglected Tropical Diseases.</span></em></p>Progress against neglected tropical diseases is now at real risk of reversal as a result of the COVID-19 pandemic.Francisca Mutapi, Professor in Global Health Infection and Immunity. and co-Director of the Global Health Academy, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1699812021-11-29T13:28:49Z2021-11-29T13:28:49ZMillions of Americans struggle to pay their water bills – here’s how a national water aid program could work<figure><img src="https://images.theconversation.com/files/433239/original/file-20211122-23-1fjipii.jpg?ixlib=rb-1.1.0&rect=38%2C15%2C5122%2C3420&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Water: an increasingly expensive necessity.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sink-water-royalty-free-image/1026241802">iStock via Getty Images</a></span></figcaption></figure><p>Running water and indoor plumbing are so central to modern life that most Americans take them from granted. But these services aren’t free, and millions struggle to afford them. A 2019 survey found that U.S. households in the bottom fifth of the economy spent <a href="https://mannyteodoro.com/wp-content/uploads/TeodoroSwaywitz-JAWWA-2020-Affordability-Snapshot.pdf">12.4% of their disposable income</a> on water and sewer services. News reports suggest that for low-income households, this burden has <a href="https://www.washingtonpost.com/business/2020/10/01/power-water-gas-bills/">increased during the pandemic</a>.</p>
<p>Since 1981, the federal government has helped low-income households with their energy costs through the <a href="https://www.acf.hhs.gov/ocs/low-income-home-energy-assistance-program-liheap">Low-Income Home Energy Assistance Program</a>. But there had not been a national water aid program until Congress created a temporary <a href="https://www.acf.hhs.gov/ocs/programs/lihwap">Low-Income Household Water Assistance Program</a> as part of the COVID-19 response. Now the House-passed <a href="https://rules.house.gov/sites/democrats.rules.house.gov/files/Section_by_Section_BBB_RCP117-18__.pdf">Build Back Better Act</a> includes US$225 million for grants to states and tribes to help reduce the cost of water services for low-income households. </p>
<p>As an economist specializing in <a href="https://scholar.google.com/citations?user=Mm5zty4AAAAJ&hl=en&oi=ao">environmental and natural resource issues</a>, I’m encouraged to see this idea gaining support. But I also know from analyzing <a href="https://www.epa.gov/sites/default/files/2016-04/documents/dw-ww_utilities_cap_combined_508-front2.pdf">efforts at the local level</a> that these programs may be ineffective if they aren’t well designed. I believe the U.S. can learn lessons from Chile, which has run an effective national water assistance program for 30 years.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Y92ppqfu82w?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Much U.S. water infrastructure is aging and needs expensive repairs, which drives up water rates.</span></figcaption>
</figure>
<h2>Flaws in US local aid programs</h2>
<p>I have studied water and sewer customer assistance programs around the world and developed a <a href="https://waterassistanceprograms.org/">database</a> of examples run by U.S. utilities in cities including <a href="https://www.seattle.gov/utilities/your-services/discounts-and-incentives/utility-discount-program">Seattle</a>, <a href="https://water.phila.gov/drops/assistance/">Philadelphia</a> and <a href="https://www.circleofblue.org/2019/world/baltimore-council-approves-income-based-water-bills/">Baltimore</a>. Although there are hundreds of these programs, three major problems undercut their effectiveness.</p>
<p>First, because utilities have to fund their assistance programs from their own budgets, they typically charge “non-poor” customers higher rates and use those payments to subsidize low-income customers. State regulations <a href="https://efc.sog.unc.edu/resource/navigating-legal-pathways-rate-funded-customer-assistance-programs-guide-water-and/">often forbid this</a>, forcing utilities in those states to rely on voluntary donation programs to fund assistance. </p>
<p>Second, in areas with high poverty, too many customers need help and there are not enough non-poor customers to foot the bill.</p>
<p>Third, smaller and less well-funded utilities often do not have administrative capacity or expertise to design and implement their own customer assistance programs.<br>
These challenges have spurred <a href="https://bluntrochester.house.gov/news/documentsingle.aspx?DocumentID=2721">politicians</a> and <a href="https://www.urban.org/urban-wire/families-need-more-help-keep-lights-and-water-running-during-pandemic">policy experts</a> to call for a federal program – a step that the Environmental Protection Agency’s National Drinking Water Advisory Council <a href="https://www.epa.gov/sites/default/files/2015-09/documents/recommendations-of-the-ndwac-to-us-epa-on-its-nssa-criteria.pdf">recommended back in 2003</a>. </p>
<p><iframe id="YB1G3" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/YB1G3/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Learning from Chile’s experience</h2>
<p>Agencies such as the <a href="https://openknowledge.worldbank.org/handle/10986/32277">World Bank</a> often cite <a href="https://iwaponline.com/wp/article/20/6/1208/64207/Revisiting-the-distributional-impacts-of-water">Chile’s water aid program as a model</a>. Here’s how it works:</p>
<p>The program aims to ensure that households don’t pay more than 3% of their income for receiving a quantity of water to meet their essential needs. There is no consensus among experts on what this “lifeline” quantity of water should be, but Chile sets it at 15 cubic meters per month – about 4,000 gallons. </p>
<p>Eligible customers apply to their city government every three years. Once enrolled, they immediately see reductions in their bills, based on their poverty levels, for that first 15 cubic meters of water use. Each month, the water utility bills the city for subsidies it has provided to poor customers.</p>
<p>If households use more than 15 cubic meters of water per month, they pay unsubsidized prices for whatever they use above that level. This gives everyone an incentive to fix leaky pipes and appliances and conserve water. Regulators who set water prices are not involved in running the subsidy system or determining subsidy levels.</p>
<p>In the late 1990s, Chile launched a major expansion of its sewage treatment plants. Water utilities <a href="https://iwaponline.com/wp/article/20/6/1208/64207/Revisiting-the-distributional-impacts-of-water">raised their rates by 34% to 142%</a> between 1998 and 2015 to pay for this initiative. Because these rate increases outpaced growth in income, subsidies grew by 54% over the same time period. The takeaway: Chile found a way to pay for water and sewer investment while still protecting the poor.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1453120892918239234"}"></div></p>
<h2>How a US water aid program might work</h2>
<p>If the U.S. creates a national water aid program, key questions will include who is eligible and how much water is an “essential” quantity for households. The EPA estimates that an average U.S. household uses <a href="https://www.epa.gov/watersense/how-we-use-water">approximately 9,000 gallons per month</a>, but one-third of this is for gardens and lawns. Reliable national data on U.S. household water usage is nearly nonexistent, and there is no estimate of how much water low-income households use.</p>
<p>Program managers would need to collect information on utility water and sewer pricing structures, put it in a database and couple it with census data to estimate the number of eligible households in each state.</p>
<p>To estimate what a program like Chile’s might cost here, my team at Washington State University compiled a <a href="https://waterassistanceprograms.org/">database of water and sewer rates</a> as of December 2019. We included all U.S. cities with populations over 100,000, at least two cities per state, and made assumptions about rates for smaller cities and towns. </p>
<p>We estimate that a program covering the full cost of 4,500 gallons of water per month for households at or below the poverty line would cost approximately $11.2 billion annually if 70% of eligible households participate. In total, we estimate that 11.8 million households would receive an average subsidy of $67 per month. </p>
<p>Our project website includes a <a href="https://waterassistanceprograms.org/estimation">calculator tool</a> to estimate the annual federal cost based on different assumptions about eligibility, participation, the “essential” water quantity and the percentage discount on water bills.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p>
<h2>Another approach: Add money to SNAP payments</h2>
<p>Public policy scholar <a href="https://lafollette.wisc.edu/faculty-staff/faculty/manny-teodoro">Manny Teodoro</a> has suggested <a href="https://mannyteodoro.com/?p=2747">another way to deliver water aid</a>: topping up support that people receive to buy healthy food through the <a href="https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program">Supplemental Nutrition Assistance Program</a>, or SNAP. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/433266/original/file-20211122-15-7ngb8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Louisiana Purchase card, issued by the state the SNAP recipients." src="https://images.theconversation.com/files/433266/original/file-20211122-15-7ngb8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/433266/original/file-20211122-15-7ngb8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=384&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433266/original/file-20211122-15-7ngb8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=384&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433266/original/file-20211122-15-7ngb8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=384&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433266/original/file-20211122-15-7ngb8.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=483&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433266/original/file-20211122-15-7ngb8.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=483&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433266/original/file-20211122-15-7ngb8.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=483&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Providing water aid through SNAP would enable people to pay their water bills with state-issued electronic benefits transfer (EBT) cards.</span>
<span class="attribution"><a class="source" href="http://www.dcfs.louisiana.gov/page/electronic-benefits-transfer-ebt">Louisiana DCFS</a></span>
</figcaption>
</figure>
<p>This idea builds on a well-known program with a long track record. Low-income households would not have to file new paperwork to receive benefits. Delivering water aid this way could help renters, whose water costs often are rolled into their rent, and rural residents who use well water and have to pay for water treatment and maintenance costs out of pocket. </p>
<p>It would place less of an administrative burden on the <a href="https://mannyteodoro.com/?p=2774">large number of small U.S. water systems serving fewer than 500 people</a>. And it could be quickly implemented by adding water providers as approved vendors for electronic benefit transfer (EBT) card payments. </p>
<p>Eligibility for SNAP is set at 138% of the poverty line, and an estimated <a href="https://fns-prod.azureedge.net/sites/default/files/resource-files/Reaching2017-1.pdf">84% of eligible households</a> participate. With these parameters, we estimate that a program covering 100% of the cost of 4,500 gallons of water per month would cost $17 billion annually. The main weakness of this approach is that water and sewer rates vary across the country, so it risks providing too much or too little assistance to low-income households depending on where they live.</p>
<h2>Getting water prices right for everyone</h2>
<p>Access to a safe and affordable water supply and sewer services is codified in the U.N.’s <a href="https://www.un.org/waterforlifedecade/human_right_to_water.shtml">Human Right to Water and Sanitation</a>. The U.S. is a wealthy country, and my research group’s estimates show that the cost of a targeted program to help the poor pay their bills is reasonable. </p>
<p>Without federal funding, poor and marginalized households will continue to fall behind on their bills and experience the indignity and health risks of having their water turned off. </p>
<p>At the same time, the U.S. needs to make <a href="https://infrastructurereportcard.org/cat-item/drinking-water/">major investments in its water and sewer infrastructure</a> and manage the effects of drought and climate change. Economists broadly agree that <a href="https://www.nytimes.com/2014/10/15/business/economy/the-price-of-water-is-too-low.html">water should be more expensive in many places</a> to give local governments and ratepayers incentive to conserve and plan for a water-scarce future. I believe Chile’s experience shows how a national program can preserve this signal while directing most of its water sector subsidies toward protecting the poor. </p>
<p><em>Research Assistant <a href="https://www.linkedin.com/in/nicholas-kraabel-bbabaa155/">Nick Kraabel</a> assisted in estimating the nationwide costs discussed in this article.</em></p><img src="https://counter.theconversation.com/content/169981/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Cook has received funding to support research on customer affordability programs from the US Millennium Challenge Corporation. The opinions in this article do not represent views of MCC.</span></em></p>Should the U.S. help low-income households afford water service, as it does with heating and groceries? Chile does. An economist explains how it works there and how it could work here.Joseph Cook, Associate Professor of Economic Sciences, Washington State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1713112021-11-05T14:28:41Z2021-11-05T14:28:41ZSouth Africa’s local government is broken: could the 2021 election outcomes be the turning point?<figure><img src="https://images.theconversation.com/files/430506/original/file-20211105-10010-1o3i5eq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Supporters of main opposition Democratic Alliance wave the national flag ahead of the 2021 local elections. </span> <span class="attribution"><span class="source">EFE-EPA/Kim Ludbrook</span></span></figcaption></figure><p>South Africa’s <a href="https://results.elections.org.za/dashboards/lge/">2021 local government elections</a> are set to go down in history as a watershed moment in the country’s politics. Electoral support for the African National Congress (ANC) dropped below 50% for the first time since the party ascended to government 27 years ago. Although it won <a href="https://www.gov.za/speeches/glen-mashinini-final-results-municipal-elections-4-nov-2021-0000">161</a> of the 213 contested municipalities, the number of councils without a clear majority of any party nearly quadrupled from 18 to 70.</p>
<p>A significant portion of voters stayed away from voting stations. Most were former ANC voters, <a href="https://www.kas.de/documents/261596/10543300/The+South+African+non-voter+-+An+analysis.pdf/acc19fbd-bd6d-9190-f026-8d311078b670?version=1.0&t=1608">continuing the trend from previous elections</a>.</p>
<p>Counting all eligible voters rather than only those who registered, voter withdrawal has reached a critical level. Less than a third of eligible voters –- 12 million out of 42.6 million -– <a href="https://www.gov.za/speeches/glen-mashinini-final-results-municipal-elections-4-nov-2021-0000">made their crosses</a>. Rather than apathy, this represents a “deliberate” stayaway vote, as the political analyst Moeletsi Mbeki <a href="https://www.enca.com/analysis/sas-crisis-wont-be-solved-soon-moeletsi-mbeki">has argued</a>.</p>
<p>This concerted withdrawal should be read against the results of a recent survey by <a href="https://afrobarometer.org/">Afrobarometer</a>, an independent pan-African surveys network. It found that local councils garnered the least trust <a href="https://afrobarometer.org/sites/default/files/publications/Dispatches/ad474-south_africans_trust_in_institutions_reaches_new_low-afrobarometer-20aug21.pdf">out of 17 institutions in South Africa</a>. </p>
<p>Almost three-quarters –- 72% –- of respondents trust local councils “a little or not at all”.</p>
<p>This staggeringly low level of trust has to do with deepening socioeconomic misery. The South African economy was in recession before the COVID-19 pandemic. The economic destruction caused by the pandemic has pushed the <a href="https://www.aljazeera.com/economy/2021/8/24/south-africas-unemployment-rate-is-now-the-worlds-highest">unemployment rate to 44.4%</a>, when using the expanded definition that includes jobless people who have ceased seeking work.</p>
<p>The everyday struggle to survive becomes even harder in the face of a terminal deterioration in the provision of basic services by municipalities, such as water and sanitation, combined with corruption and infrastructural collapse that pose further threats to lives and livelihoods.</p>
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<a href="https://theconversation.com/south-african-voters-are-disillusioned-but-they-havent-found-an-alternative-to-the-anc-171239">South African voters are disillusioned. But they haven't found an alternative to the ANC</a>
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<p>A truism oft heard from politicians is that government cannot solve South Africa’s problems by itself. But what to do with a government that places impediments in the way of its citizens? This reality at local government level needs to be fixed for South Africans to regain their trust in the democratic process.</p>
<h2>Local government is broken</h2>
<p>More than half of people canvassed by market research group Ipsos believe that local governments <a href="https://www.enca.com/press-release/party-over-urgent-delivery-key">do not work optimally</a>. Voter perception of malfunctioning municipalities is confirmed by the oversight <a href="https://www.agsa.co.za/Portals/0/Reports/MFMA/201920/2019%20-%2020%20MFMA%20Consolidated%20GR.pdf">reporting of the Auditor-General</a>, Tsakani Maluleke.</p>
<p>She reported irregular expenditure of R26 billion (US$1.7billion) at municipalities in the 2019 to 2020 financial year. Only 27 out of the country’s 257 municipalities received clean audits. Moreover, 57 of municipalities failed to even submit the legally required audits.</p>
<p>Maluleke pointed to a lack of monitoring and supervision underpinning a lack of accountability, with resources being mismanaged and services not provided as they should be. </p>
<p>The Auditor-General’s conclusions accord with voter perceptions. The Ipsos survey found that almost a quarter of respondents thought that local councillors were incompetent or corrupt.</p>
<p>The perception of incompetence is further borne out by a <a href="https://www.ber.ac.za/knowledge/pkviewdocument.aspx?docid=15008">recent study</a> by the Bureau for Economic Research. It revealed that only about half of senior government officials and financial managers had qualifications appropriate to the posts they held.</p>
<p>The ANC’s controversial policy of <a href="https://www.researchgate.net/publication/321223498_The_African_National_Congress_ANC_and_the_Cadre_Deployment_Policy_in_the_Postapartheid_South_Africa_A_Product_of_Democratic_Centralisation_or_a_Recipe_for_a_Constitutional_Crisis">“cadre deployment”</a> plays a significant factor. The policy entails appointing party apparatchiks to key state positions. Selection is not done transparently. The result is civil servants deeming themselves to be accountable to the party rather than to voters.</p>
<p>This leads to incompetent people being put in charge of finances, including income management, debt collection and municipal projects. The Bureau for Economic Research found operational budgets were over-spent, while capital expenditure stalled at the 2009 level.</p>
<p>As a result, environmental and health catastrophes have hit many municipalities, including raw sewage polluting drinking water.</p>
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<a href="https://theconversation.com/south-africas-local-elections-new-entrants-likely-to-be-the-big-winners-170804">South Africa's local elections: new entrants likely to be the big winners</a>
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<p>The geographically central province of the Free State, a water catchment area, <a href="https://www.ufs.ac.za/templates/news-archive/campus-news/2021/june/research-to-fight-water-pollution-in-the-eastern-free-state">is in dire straits</a>. Residents in small towns, <a href="https://www.iol.co.za/saturday-star/news/day-and-night-we-smell-it-sewage-spills-make-life-hell-for-deneysville-residents-8e066221-2e91-4801-a2f0-a59d490c9c28">from the northern</a> to the <a href="https://www.sabcnews.com/sabcnews/free-state-community-up-in-arms-over-constant-sewage-spills/">southern parts</a> of the province, have struggled for years with untreated human waste and other pollution flooding residential areas.</p>
<p>The crucial <a href="https://www.britannica.com/place/Vaal-River">Vaal River</a>, the border between the economic heartland of Gauteng province and the Free State, has become severely contaminated. As one of only three major rivers in a water-scarce country, it provides drinking water to <a href="https://www.groundwork.org.za/Documents/water/The_Vaal_Inquiry_Final_Report_15022021_MHP.pdf">45% of Gauteng’s population</a>. Apart from the risk to human health, scarce fish species have been pushed close to extinction.</p>
<p>The disaster is due to perennial failure on the part of the Emfuleni municipality to sustain <a href="https://www.dailymaverick.co.za/article/2021-10-29-a-story-of-south-africa-emfuleni-residents-fed-up-with-vaal-river-pollution-inertia/">maintenance at its wastewater treatment plants</a>. </p>
<p>In a similar case, the Kgetleng Residents Association in Koster, North West province, won their <a href="https://cer.org.za/virtual-library/judgments/high-courts/kgetlengrivier-concerned-citizens-another-v-kgetlengrivier-local-municipality-others-interim-order-and-agreementcourt-order">court bid</a> in 2020 to take control of the municipal waterworks. The high court found that the municipality had violated its constitutional obligation of supplying potable water. </p>
<p>This is one among a number of cases in which residents step in where municipalities fail. But, as the Socio-Economic Rights Institute <a href="https://www.ber.ac.za/knowledge/pkviewdocument.aspx?docid=15008">argues</a>, this is not a sustainable solution.</p>
<p>Companies that attempted to bear the overwhelming costs of failing municipal services have eventually faltered. For example, one of the country’s largest poultry producers, Astral Foods, was <a href="https://www.iol.co.za/business-report/economy/treasury-gives-the-poorly-run-lekwa-municipality-three-years-to-get-its-finances-in-order-after-publishing-financial-recovery-plan-5ed746e6-a5ec-46b3-afd8-7a592b11a233">pushed into technical insolvency</a> after spending millions to compensate for the collapse in electricity and water provision in Standerton in Lekwa municipality, Mpumalanga province.</p>
<p>Infrastructure collapse has also had a major economic impact in Lichtenburg in Ditsobotla municipality, North West province. After years of engaging the local council with no result, dairy company Clover closed the country’s <a href="https://www.news24.com/fin24/companies/clover-closes-sas-biggest-cheese-factory-due-to-municipal-woes-in-the-north-west-20210608">largest cheese factory in Lichtenburg</a> and moved its operations to an existing factory elsewhere. The economically depressed region lost 330 jobs. </p>
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<a href="https://theconversation.com/south-africas-anc-dips-below-50-but-opposition-parties-fail-to-pick-up-the-slack-171253">South Africa's ANC dips below 50%. But opposition parties fail to pick up the slack</a>
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<p>Residents’ despair is exacerbated by corruption.<a href="https://www.corruptionwatch.org.za/">Corruption Watch</a>, an NGO that tracks corruption, found that one in six reports received from whistleblowers fingered local government. Irregularities occurred in procurement and staff appointments. Bribery was a common form of corruption, amounting to an extra <a href="https://theconversation.com/how-corruption-is-fraying-south-africas-social-and-economic-fabric-80690">tax on the poor</a> for state services that remain inefficient.</p>
<h2>Political appetite</h2>
<p>Given the colossal crises besetting local government, it remains to be seen whether newly elected councillors can win back the trust of the electorate. As these crises were in many cases created by the country’s political class, many voters will be sceptical about whether the appetite even exists to turn the dismal state of local government around. </p>
<p>But perhaps the plunging election turnout – particularly shocking in a country where people struggled for democracy – may finally jolt the political elite into action.</p><img src="https://counter.theconversation.com/content/171311/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christi van der Westhuizen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The 2021 local government elections signals widespread disillusionment with representative democracy that only a sea change in service delivery can fix.Christi van der Westhuizen, Associate Professor, Centre for the Advancement of Non-Racialism and Democracy (CANRAD), Nelson Mandela UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1547152021-02-23T17:51:16Z2021-02-23T17:51:16ZWe now treat half the world’s wastewater – and we can make inroads into the other half<figure><img src="https://images.theconversation.com/files/383019/original/file-20210208-23-1bu74ak.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3988%2C2155&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">DedMityay / shutterstock</span></span></figcaption></figure><p>Humans flush away vast amounts of water every day. When managed correctly, this wastewater is collected and undergoes treatment to remove pollutants that can otherwise threaten human and environmental health. In my latest research I estimated that <a href="https://essd.copernicus.org/articles/13/237/2021">more than 50%</a> of the world’s domestic and manufacturing wastewater now follows this pathway, rather than the <a href="https://www.unwater.org/water-facts/quality-and-wastewater-2/">previous estimates of just 20%</a>.</p>
<p>While this sounds like good news, it comes with a caveat. Treatment rates vary drastically across the world, and are especially low in many developing countries. An estimated <a href="https://www.un.org/en/observances/toilet-day">4.2 billion people</a> lack access to safe sanitation and there are around <a href="https://www.who.int/news-room/fact-sheets/detail/drinking-water#:%7E:text=Inadequate%2520management%2520of%2520urban%252C%2520industrial,%252C%2520sanitation%252C%2520and%2520hand%2520hygiene.">829,000 deaths</a> from diarrhoea attributed to unsafe water and sanitation every year, so there is clearly still a long way to go. This challenge will be further compounded by rapid population growth and industrialisation. These factors threaten to increase the production of wastewater much faster than infrastructure can be developed.</p>
<p>Inevitably, a lack of financial resources is a key barrier to improved wastewater management. Centralised collection and treatment, which has proved very effective at reducing untreated flows in urban environments, can be prohibitively expensive. Yet wastewater has a <a href="http://www.unesco.org/new/en/natural-sciences/environment/water/wwap/wwdr/2017-wastewater-the-untapped-resource/">largely unrealised economic potential</a>, and doing something useful with it could pay for improved management and treatment, promoting both social and environmental benefits.</p>
<h2>Combating water scarcity</h2>
<p>The most obvious use is reuse it as clean water to augment freshwater supplies, which are becoming more scarce in many regions. Wastewater remains a largely untapped resource, with <a href="https://essd.copernicus.org/articles/13/237/2021">just 11%</a> currently reused. Individual projects are showing us the potential, with the <a href="https://www.water-technology.net/projects/sulaibiya/">Sulaibiya Wastewater Treatment and Reclamation Plant</a> in Kuwait capable of fulfilling a staggering 26% of the country’s total water demand.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/383040/original/file-20210208-21-xsk2kp.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Four maps of the world." src="https://images.theconversation.com/files/383040/original/file-20210208-21-xsk2kp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/383040/original/file-20210208-21-xsk2kp.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=254&fit=crop&dpr=1 600w, https://images.theconversation.com/files/383040/original/file-20210208-21-xsk2kp.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=254&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/383040/original/file-20210208-21-xsk2kp.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=254&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/383040/original/file-20210208-21-xsk2kp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=319&fit=crop&dpr=1 754w, https://images.theconversation.com/files/383040/original/file-20210208-21-xsk2kp.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=319&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/383040/original/file-20210208-21-xsk2kp.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=319&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Wastewater production (cubic metres per capita), collection, treatment and reuse (all as %). Wastewater reuse is particularly high in Gulf and North African countries.</span>
<span class="attribution"><a class="source" href="https://essd.copernicus.org/articles/13/237/2021/#&gid=1&pid=1">Jones et al / Earth System Science Data</a>, <span class="license">Author provided</span></span>
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<p>Reusing water has the benefit that the supply is largely climate-independent, and more predictable than conventional water sources. Treated wastewater may also represent the cheapest source of freshwater where renewable supplies are highly limited. For example, reuse of treated wastewater for cooling a <a href="https://timesofindia.indiatimes.com/city/nagpur/nmc-to-become-nations-first-city-to-reuse-91-sewage/articleshow/67494230.cms">powerplant in Nagpur, India</a> has reduced operational costs and increased resilience to droughts, while massively reducing the pressure on freshwater sources.</p>
<p>Conventional water sources (such as rivers and lakes) also benefit from treatment as it reduces wastewater contamination. This is essential for reducing <a href="https://iopscience.iop.org/article/10.1088/1748-9326/abbfc3">quality-driven water scarcity</a>, which is the main reason people are left without drinking water in some regions. Improving ambient water quality is essential for minimising disease and preventable loss of life.</p>
<h2>From ‘waste’ to resource</h2>
<p>Wastewater is typically enriched with nutrients from both human and food waste, and these resources can be recovered as a result of treatment. Nutrients such as phosphorus and nitrogen can be converted into fertiliser, generating revenue while also reducing environmental risks such as eutrophication (when excess nutrients enter water bodies and cause algae growth). For example, the <a href="http://uswateralliance.org/resources/one-water-spotlight-stickney-water-reclamation-plant#:%7E:text=It%2520is%2520only%2520fitting%2520that,world's%2520largest%2520nutrient%2520recovery%2520facility.">Stickney Water Reclamation Plant</a> near Chicago in the US, one of the world’s largest treatment plants, can recover 85% of the phosphorus found in residential wastewater and creates 10,000 tonnes of fertiliser each year for local agriculture.</p>
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<span class="caption">Stickney, with downtown Chicago visible in the distance top left.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/104929419@N03/10193216966">Metropolitan Water Reclamation District of Greater Chicago</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<p>Wastewater can also be a <a href="https://www.wri.org/blog/2017/03/wastewater-best-hidden-energy-source-youve-never-heard">source of energy</a> meaning treatment can become self-sufficient in energy, both increasing the reliability of operations and decreasing the economic costs. Producing energy from wastewater can also have many interconnected environmental benefits, such as reducing the emissions and water pollution associated with sludge disposal. Energy recovery has proven viable at smaller scales, such as at the <a href="https://sanivation.com/naivasha">fecal sludge treatment plant in Naivasha</a>, Kenya, which serves 10,000 people and produces 350 tonnes of biomass fuel per month.</p>
<p>New innovations will continue to drive improved treatment, but financial mechanisms to support and promote implementation must be accelerated. Wastewater reuse must be accompanied by proper monitoring and regulation in order to ensure that these applications are safe. Issues of <a href="https://theconversation.com/its-public-attitudes-to-recycled-sewage-that-need-better-treatment-not-the-water-29735">public acceptance</a> must also be overcome – many people still don’t like the idea of drinking reused sewage water. But, with <a href="https://www.sdg6monitoring.org/indicators/target-63/">one of the UN’s sustainable development goals</a> calling for the halving of untreated wastewater flows and a substantial increase in reuse by 2030, now is the time to realise that opportunities do exist and we really can do more with the water that disappears down the drain.</p><img src="https://counter.theconversation.com/content/154715/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edward Jones does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Treatment rates are still low in many developing countries.Edward Jones, PhD Candidate, Department of Physical Geography, Utrecht UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1425772020-07-29T14:14:43Z2020-07-29T14:14:43ZAfrica’s high density urban settlements: cut the red tape and slash the cost of housing<figure><img src="https://images.theconversation.com/files/348373/original/file-20200720-18366-11dttb0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">African urban dwellers pay 55% more in rentals than their counterparts in other cities in the world. </span> </figcaption></figure><p>The challenges of informal settlements have once again been thrown into the spotlight in the midst of the current pandemic. Research has shown that some of the most at-risk populations and therefore the <a href="https://blogs.worldbank.org/sustainablecities/cities-crowding-and-coronavirus-predicting-contagion-risk-hotspots">potential hotspots</a> of COVID-19 are in informal settlements where density is above the threshold needed for social distancing. </p>
<p>The consequences of this have already become apparent. In the Western Cape province of South Africa, <a href="https://coronavirus.westerncape.gov.za/files/atoms/files/Suburbs%20towns%20cases%20-%203%20July%202020.Western%20Cape.pdf">informal settlements continue to exceed</a> residential suburbs in the number of COVID-19 cases. Nearly <a href="https://www.aljazeera.com/news/2020/06/coronavirus-pandemic-exposes-south-africa-brutal-inequality-200612161408571.html">12% of the province’s infections are in Cape Town’s largest low-income settlement of Khayelitsha</a>, even though it is home to just 6% of the population.</p>
<p>At the same time, some of the densest cities in the world, such as Singapore, have managed the outbreak the best. <a href="https://www.theigc.org/blog/in-defence-of-density/">The demon is therefore not density itself</a>. Rather it’s the fact that many African governments have not planned and made the investments in informal settlements to manage the downsides of density – including contagion. </p>
<p>This is particularly evident with water and sanitation infrastructure. Only an estimated <a href="https://www.oecd.org/water/GIZ_2018_Access_Study_Part%20I_Synthesis_Report.pdf">56% of the urban population across Africa</a> has access to piped water. This makes the minimum standard of <a href="https://www.who.int/water_sanitation_health/emergencies/WHO_TN_09_How_much_water_is_needed.pdf?ua=1#:%7E:text=The%20Sphere%20Standards%20suggest%20a,levels%20for%20health%20and%20hygiene.">20 litres per person a day</a> to attain essential levels of health and hygiene near impossible.</p>
<p>The South African government has allocated <a href="https://www.news24.com/news24/southafrica/news/covid-19-r2-billion-allocated-to-upgrade-informal-settlements-20200708">R2 billion</a> to upgrading slums to improve access to water and sanitation facilities. This could have a significant impact not only on the current pandemic, but <a href="https://www.theigc.org/wp-content/uploads/2020/06/WASH-policy-brief_updated2020.pdf">on health</a> overall. </p>
<p>However, upgrading informal settlements may only be a temporary solution. For well-managed density, which will be crucial in preventing and fighting the pandemics of the future, governments across Africa must also tackle the regulatory environment that keeps the costs of building large-scale affordable housing high and thus restricts its supply.</p>
<h2>Bridging the gap between formal and informal</h2>
<p>Across the world, a house will often be the most important asset a family can own. Even when ownership is not an option, rent can make up a substantial portion of overall household consumption. This is particularly true for African cities, where urban dwellers face a <a href="http://documents1.worldbank.org/curated/en/854221490781543956/pdf/113851-PUB-PUBLIC-PUBDATE-2-9-2017.pdf">55% price premium</a> on rent compared to other cities in the world. </p>
<p>This is driven by a number of factors, including poorly functioning land markets coupled with the fact that <a href="http://documents1.worldbank.org/curated/en/854221490781543956/pdf/113851-PUB-PUBLIC-PUBDATE-2-9-2017.pdf">construction costs as well as registering property formally are more expensive</a> than elsewhere.</p>
<p>Governments have tried to address this in a number of ways, from housing voucher schemes, used frequently in the <a href="https://www.cbpp.org/research/introduction-to-the-housing-voucher-program#:%7E:text=The%20Housing%20Choice%20Voucher%20Program,housing%20on%20the%20open%20market.">US</a>, which allows poorer households to select where they want to live, to large scale government public housing programmes, as is being undertaken in <a href="https://www.theguardian.com/cities/2017/dec/04/addis-ababa-ethiopia-redesign-housing-project">Addis Ababa</a>. </p>
<p>However, there are often fundamentals that need to be resolved to make formal housing markets operate efficiently to better serve the urban poor. Land rights, and the ability of residents to use their property as collateral, are a distortion which limits private investment. Another is formal density restrictions, which are mostly far too strict in developing contexts, and push up the cost of housing prices. In Dar es Salaam, for example, <a href="https://www.wri.org/wri-citiesforall/resources/videos/opening-doors-world-can-african-cities-deliver-promise-growth">the minimum lot size is 375m²</a> – as compared to 28m² in Philadelphia, US, at early stages of development.</p>
<p>With the share of Africa’s population living in urban areas set to reach <a href="https://www.worldbank.org/en/events/2015/06/01/urbanization-in-africa-trends-promises-and-challenges">50% by 2030</a>, the demand for housing is also rising quickly. The supply of an affordable and decent quality housing stock is not keeping up, resulting in the further proliferation of informal settlements.</p>
<h2>In-situ upgrading</h2>
<p>Informal settlements are often located quite centrally within cities. Research has shown that <a href="https://www.theigc.org/wp-content/uploads/2015/04/GalianiShelterStorm.pdf">people often choose</a> to live in these settlements, rather than in others with better quality housing, because they are closer to economic activity. </p>
<p>Within these settlements dense social networks are formed and therefore in-situ upgrading schemes to improve liveability have the major benefit of maintaining locational and network advantages of settlements. At the same time, upgrading programmes can signal that governments are officially recognising settlements – an important (but insufficient) step to formalisation.</p>
<p>There are costs to in-situ upgrading too. Retrofitting permanent infrastructures where people have already settled can be up to <a href="https://www.theigc.org/research-themes/cities/cities-that-work/urban-land-use/">three times more expensive</a>. Furthermore, the central location of some of the land may mean that residential settlement is <a href="https://www.theigc.org/wp-content/uploads/2016/02/Franklin-igc_housing.pdf">not the most efficient use</a> of that land in a rapidly growing cities. And informal settlements may be located in dangerous areas prone to flooding or landslides. </p>
<p>In addition, upgrading increases the value of the land and property in that area. The unintended consequence of such schemes can be gentrification. This was the case with the attempts to upgrade the <a href="https://www.theigc.org/blog/kampalas-missing-houses/">Namuwongo slum</a> in Kampala, where higher costs forced residents to move and establish informal settlements elsewhere.</p>
<h2>The conditions of resettlement</h2>
<p>Where the challenges outweigh the benefits, and <a href="https://www.theigc.org/wp-content/uploads/2019/03/informal-settlements-policy-framing-paper-March-2019.pdf">there is clear economic and social reasoning</a>, relocation of people to greenfield sites is another option. But it’s important that these sites have been planned and serviced before people settle. This was done, for example, in various <a href="http://personal.lse.ac.uk/michaels/Michaels_Nigmatulina_Rauch_Regan_Baruah_Dahlstrand-Rudin_SitesServices.pdf">Tanzanian cities in the 1970s and 1980s</a>. </p>
<p>Residential plots on the outskirts of the cities were serviced primarily with water mains and roads. People were then invited to relocate to these plots for a fee. Interestingly, this was done at the same time as some informal settlements in other areas in Tanzania underwent upgrading programmes, allowing a comparison of both interventions to be studied 30 years later. </p>
<p>It is clear that the settlements receiving sites and services fared significantly better than those that were upgraded – they were better planned and currently have <a href="https://www.theigc.org/reader/informal-settlements-and-housing-markets/setting-the-right-regulatory-environment/">land values up to five times higher</a>.</p>
<p>Moving people to another site is not always feasible. In some cases, the land may simply not be available. More importantly, evidence shows that <a href="https://pubs.aeaweb.org/doi/pdf/10.1257/app.20150397">even where relocation is voluntary, residents may not want to move</a>. </p>
<p>In Tanzania, the sites and services programme was actually stopped as the initial capital investments were high and could not immediately be recouped by the fees paid. </p>
<p>This comes back to the fact that the value of a home is far more than the bricks and mortar. It’s about proximity to opportunities and social networks. Governments need to find ways of making alternative options more attractive to residents, through strong dialogue and understanding of their priorities, as well as compensation which reflects that.</p>
<h2>The key is well-managed density</h2>
<p>Short-term measures to upgrade informal settlements as announced by the South African government are essential when thinking about tackling COVID-19. However, given that <a href="https://www.theigc.org/blog/in-defence-of-density/">emerging evidence</a> shows that the majority of the transmission is through extended contact of people in small spaces, longer term policy considerations and investments will be needed to ensure density is well managed across the board. </p>
<p>To increase the liveability and resilience of Africa’s cities over the long term, we don’t need to reduce density. We need well-managed density achieved by addressing the regulatory limitations that keep formal housing at unattainable costs, as well as those that prevent township residents from investing in their properties.</p><img src="https://counter.theconversation.com/content/142577/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Astrid R.N. Haas is affiliated with the International Growth Centre. The views represented here are her own and do not necessarily reflect the views of the IGC.</span></em></p><p class="fine-print"><em><span>Victoria Delbridge does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The demon is not density but rather that African countries have not planned and made the investments necessary to manage the downsides of the type of density found in informal settlements.Astrid R.N. Haas, Policy Director, International Growth CentreVictoria Delbridge, Head of the Cities that Work initiative, International Growth CentreLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1350702020-04-05T08:33:15Z2020-04-05T08:33:15ZPandemic underscores gross inequalities in South Africa, and the need to fix them<figure><img src="https://images.theconversation.com/files/324047/original/file-20200330-146712-1kabufb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Per-Anders Pettersson</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>Now more than ever, South Africans are painfully aware of the inequalities that continue to play out in the country. In people’s pre-COVID-19 lives, the realities of living in a country that is <a href="https://www.worldbank.org/en/country/southafrica/overview">among the most unequal</a> in the world were easily overlooked. The pandemic shines a very bright light on this reality. It asks us to fundamentally address them – not just at this time of the pandemic, but as a social justice imperative.</p>
<p>As messaging about preventing the coronavirus ramped up, the consequences of inequalities in the provision of basic service provision in the country have become clear. These disparities between rich and poor are reflected across a range of <a href="https://www.gov.za/speeches/minister-lindiwe-sisulu-interventions-curb-spread-coronavirus-covid-19-25-mar-2020-0000">interventions</a> that have been put in place to manage the pandemic and its social and economic consequences. These include access to water, housing circumstances, as well as people’s <a href="https://theconversation.com/south-africa-can-and-should-top-up-child-support-grants-to-avoid-a-humanitarian-crisis-135222">very high dependence on social grants</a> and the informal sector for income.</p>
<h2>Five areas where inequality is starkest</h2>
<p><strong>Living circumstances:</strong> The preventive measures have highlighted inequalities in living circumstances. Take the case of hand washing. <a href="https://www.ohchr.org/Documents/Issues/Housing/InformalSettlements/SERI.pdf">The 1.1 to 1.4 million</a> people who live in informal settlements in South Africa don’t have access to water in their homes or in their yards. An estimated 19% of the <a href="https://businesstech.co.za/news/general/62749/sa-population-flocking-to-cities/">nearly 19 million people living in rural areas</a> lack access to reliable supply of clean water; 33% <a href="http://12.000.scripts.mit.edu/mission2017/case-studies/water-access-in-south-africa/">do not have basic sanitation</a>. This makes regular hand washing difficult. And social distancing or quarantining is near impossible when water access and ablutions are communal, and where settlements are overcrowded. </p>
<p><strong>Livelihoods:</strong> For many people at the upper end of the wage spectrum, working remotely has been relatively easy, with limited impact on their ability to earn a living. Such workers are in the formal labour market. They are protected by both a legal and <a href="https://www.iep.utm.edu/soc-cont/">social contract</a> as well as a safety net of <a href="https://www.labourguide.co.za/uif/907-uif-unemployment-benefits">unemployment benefits</a>. </p>
<p>Small business owners will be under significant pressure in the coming weeks and months. But they will be partially cushioned by the <a href="https://www.cnbcafrica.com/news/2020/03/25/these-are-the-relief-measures-being-offered-to-south-africas-small-businesses-during-lockdown/">business support measures</a> announced by the government.</p>
<p>In contrast, the most vulnerable workers will struggle without support at this time. Casual workers (like many domestic workers), those who are self-employed (such as Uber drivers), and those working in the informal economy are not protected by legal contracts. </p>
<p>In general these workers, <a href="https://theconversation.com/south-africas-informal-sector-creates-jobs-but-shouldnt-be-romanticised-122745">who make up over 20% of South Africa’s workforce</a>, cannot access unemployment benefits. They will be under enormous pressure financially, potentially unable to feed themselves and their families.</p>
<p>President Cyril Ramaphosa has made it clear that the government is aware of these challenges <a href="http://www.thepresidency.gov.za/speeches/message-president-cyril-ramaphosa-covid-19-pandemic">and will move to ensure support</a>. But it remains to be seen what that entails. </p>
<p><strong>Education:</strong> Inequalities in education were also immediately evident when school were closed. While private schools and many suburban public schools were able to switch to technology-supported learning relatively easily, most public schools were not. </p>
<p>The directive by the Department of Basic Education was to ensure that learning continued by <a href="https://www.education.gov.za/COVID19.aspx">providing workbooks and worksheets</a> online. But, many parents will be facing the very real struggle of supporting their families in a locked down economy. This, and other problems, including limited access to technology and data, means that many parents will struggle to supervise their children’s learning. </p>
<p>Equally concerning is how this will affect education outcomes in the longer term. <a href="http://www.ci.uct.ac.za/sites/default/files/image_tool/images/367/Child_Gauge/South_African_Child_Gauge_2015/Child_Gauge_2015-Schooling.pdf">Analysis</a> already shows how learning backlogs in the early years, forged in an unequal education system, are compounded over time. Further backlogs under the current situation are likely to have long-term effects.</p>
<p><strong>Access to the internet:</strong> Manuel Castells, a sociologist concerned with the internet age and inequality, notes in his book <a href="https://books.google.co.za/books?id=Q1Mo-3ObWWgC&printsec=frontcover&dq=internet+galaxy+castell&hl=en&sa=X&ved=0ahUKEwi9l_aZjrroAhW9SBUIHWnADz8Q6AEIKDAA#v=onepage&q=internet%20galaxy%20castell&f=false">The Internet Galaxy</a>:</p>
<blockquote>
<p>The fundamental digital divide is not measured by the number of connections to the Internet, but by the consequences of both connection and lack of connection.</p>
</blockquote>
<p>At universities and other higher education institutions, wealthier students have been able to switch to online learning quickly, while poorer students battle with high data costs. </p>
<p>Inequalities in access to data further entrench existing inequalities in education and livelihoods during the COVID-19 crisis.</p>
<p><strong>Food security:</strong> The effects of panic buying on the food security of people with <a href="https://theconversation.com/panic-buying-in-the-wake-of-covid-19-underscores-inequalities-in-south-africa-134172">limited income has received attention</a>. But a less well-known impact of the measures is that over 9 million children will not receive a daily, nutritious meal while schools remain closed. </p>
<p>The National School Nutrition Programme potentially has positive effects on <a href="https://www.ajol.info/index.php/sajchh/article/view/178328">reducing stunting and obesity</a>. In the face of prolonged school closures, these children face increased food insecurity, with potential long-term consequences for their health.</p>
<p>There have been <a href="https://www.goodthingsguy.com/people/students-make-food-parcels/">heartwarming responses</a> from the public to ensure that food packs are provided to children. But it is simply not possible to reach the over 9 million children who depend on this meal.</p>
<h2>What can be done?</h2>
<p>The measures <a href="http://www.thepresidency.gov.za/speeches/statement-president-cyril-ramaphosa-escalation-measures-combat-covid-19-epidemic%2C-union">announced</a> by President Ramaphosa to mitigate the problem reflect an understanding of how existing inequalities will affect especially the most vulnerable people, and a willingness to address the problem.</p>
<p>Social protection measures that can quickly provide a <a href="https://blogs.worldbank.org/impactevaluations/what-can-low-income-countries-do-provide-relief-poor-and-vulnerable-during-covid">safety net</a> are crucial at this time. But, the current social protection system provides a safety net only to those outside of the labour market – children, older people, and people with disabilities. Unemployment benefits accrue to those in formal employment who contribute to the Unemployment Insurance Fund. This leaves the vast majority of working-age adults without a safety net at this time. </p>
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<strong>
Read more:
<a href="https://theconversation.com/south-africa-can-and-should-top-up-child-support-grants-to-avoid-a-humanitarian-crisis-135222">South Africa can – and should – top up child support grants to avoid a humanitarian crisis</a>
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<p>While there have been relatively quick changes to existing mechanisms to provide <a href="https://businesstech.co.za/news/business/385757/exceptional-tax-measures-for-south-africa-to-combat-covid-19-pandemic/">support to small, medium and micro enterprises</a> there are, as yet, no measures to protect informal and casual workers and ensure cash injections into vulnerable households.</p>
<p>The country needs to devise a social contract to better address the vulnerabilities that low-wage, casual and <a href="https://www.wiego.org/publications/reshaping-social-contract-emerging-relations-between-state-and-informal-labor-india">informal workers face daily</a>.</p>
<p>The country must also move towards having low-cost, reliable internet access that can open up opportunities for learning and work for its most vulnerable citizens. Basic services – such as clean water, electricity and sanitation – must also be of a quality that not only promotes people’s right to dignity, but also help protect people from the effects of such a pandemic as COVID-19. </p>
<p>This pandemic highlights how crucial it is to fundamentally address the inequalities that exist in South African society. If a social justice imperative does not push us to do so, perhaps the realisation of mutual connections, borne of a pandemic that knows no class or race lines, will.</p><img src="https://counter.theconversation.com/content/135070/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Graham does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While small businesses will be partially cushioned by government support measures, there’s no support for the most vulnerable workers.Lauren Graham, Associate professor at the Centre for Social Development in Africa, University of Johannesburg, University of JohannesburgLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/917242018-02-20T14:37:28Z2018-02-20T14:37:28ZWhy your tourist toilet habits are bad for locals – and the environment<figure><img src="https://images.theconversation.com/files/206809/original/file-20180216-50550-1yppnws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>While many prospective holidaymakers actively seek a change in cuisine or climate when choosing their destination, standardised sanitation usually remains a must.</p>
<p>You might think that the preference for a porcelain pew is harmless, but in reality it can put a serious strain on both the local population and the environment. In fact, many of the most pervasive problems associated with tourism can be seen through the toilet bowl.</p>
<p>Research suggests that in some locations <a href="https://www.sciencedirect.com/science/article/pii/S0261517711000793">up to 40% of water is consumed by tourists</a>. Tourists tend to splash out <a href="https://www.tourismconcern.org.uk/wp-content/uploads/2014/09/Unit2-Resource-A-1.pdf">far more per day on average</a> than local residents, who are often <a href="https://www.sciencedirect.com/science/article/pii/S0160738312000047">outcompeted</a> by industry for water access. Using limited freshwater supplies to flush tourists’ toilets means less for residents’ drinking, cleaning and cooking needs.</p>
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<img alt="" src="https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207106/original/file-20180220-116360-1g3sdxp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Don’t be scared.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-style-japan-toilet-415484425?src=dQP67N10AKsBsw_E8TjrIg-1-3">Heemsuhree/Shutterstock</a></span>
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<p>Environmentally, the sheer volume of incoming tourists can come at a high price. Local sewage facilities often struggle to cope with the influx of human waste. Many small islands with limited infrastructure, <a href="https://www.researchgate.net/profile/Michelle_Mycoo/publication/249023794_Sustainable_Tourism_Using_Regulations_Market_Mechanisms_and_Green_Certification_A_Case_Study_of_Barbados/links/5591255108aed6ec4bf69627.pdf">such as Barbados</a>, have no choice but to pump raw sewage straight into the sea, putting vast swathes of the Caribbean’s coral reefs at risk.</p>
<p>This defecatory deluge also depletes limited water reserves. In Cape Town, hotels are having to <a href="http://www.independent.co.uk/travel/news-and-advice/cape-town-drought-water-shortage-luxury-five-star-hotels-day-zero-laundry-showers-toilet-flush-pool-a8191966.html">abruptly limit guests’ water usage</a> as the city suffers drought. In Bali, fast-growing tourism demand is linked to <a href="http://www.idepfoundation.org/en/bwp/summary">rapid depletion of the island’s water resources</a>.</p>
<h2>Sanitation solutions</h2>
<p>These economic and environmental harms often stem from a misplaced sense of cultural superiority that accompanies us to the bathroom. The internet is awash with travellers’ <a href="https://thetravelmanuel.com/why-malaysia-has-the-worst-toilets-in-the-world/">toilet horror stories</a>, written with apparently little social sensitivity or willingness to compromise.</p>
<p>Those fortunate enough to be able to travel might want to remind themselves of UN estimates for 2017, which suggest that <a href="http://www.unwater.org/new-publication-whounicef-joint-monitoring-programme-2017-report/">61% of the global population</a> – roughly 4.5 billion people – lack access to a toilet or latrine that disposes of waste safely. Westerners tend to judge other cultures harshly, when really they should be judging global inequality, poverty and politics.</p>
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<p>Perhaps some judgement should be reserved for people in rich countries themselves, where bathroom norms aren’t exactly perfect. For example, <a href="https://www.theguardian.com/lifeandstyle/2015/may/18/truth-about-poo-doing-it-wrong-giulia-enders-squatting">squatting</a> rather than sitting is better for the colon. Rather than a sight to be avoided, a glance at one’s waste before flushing can in fact be a <a href="https://www.cnwl.nhs.uk/wp-content/uploads/Healthy_Bowel-_Patient_Information_leaflet.pdf">quick and easy health check</a>. Embarrassment about bodily functions is inhibiting when holidays are meant to be liberating.</p>
<p>Different sanitation solutions suit different situations. The <a href="http://www.worldbank.org/en/news/feature/2017/11/17/world-toilet-day-2017">World Bank</a> and the <a href="https://www.worldwildlife.org/magazine/issues/fall-2016/articles/sustainable-toilets-and-their-role-in-freshwater-conservation">WWF</a> have both worked to celebrate toilet innovations across the world that challenge preconceptions and improve sustainability. For instance, <a href="http://www.worldbank.org/en/news/feature/2017/11/17/world-toilet-day-2017">urine-diverting privies in Bolivia</a> are an integral link in a chain that converts waste into fertiliser for growing crops. Cranfield University is developing the <a href="http://www.nanomembranetoilet.org/">Nano Membrane Toilet</a>, which converts waste into clean water and energy, without the need for external power or water.</p>
<p>Some Western tourist locations are already rethinking their taste in toilets. Composting toilets introduced in various Scottish nature reserves have proved <a href="https://www.fvl.org.uk/files/2314/5933/7417/Eco-loo_Case_Studies.pdf">highly popular with visitors</a>. Melbourne Zoo and other attractions have implemented <a href="https://www.zoo.org.au/about-us/vision-and-mission/environmental-sustainability/saving-water">water conservation and recycling measures</a> in restrooms, including waterless urinals. The increasing use of such practices by authorities and businesses will only help to challenge harmful expectations when people travel further afield.</p>
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<h2>Potty training</h2>
<p>There are also simple changes that tourists can make when going to the bathroom that will have a positive impact on the environment and local communities, and possibly even lead to more interesting holiday experiences.</p>
<p>Remember that different ecological settings require different bathroom styles. Always avoid flushing wipes and other non-biodegradables. In water stressed areas, be conscious of your water usage. Don’t demand what local people don’t have. The threat of extreme drought has forced Cape Town luxury hotels to ask guests to limit the length of showers, turn off the tap while brushing their teeth, and <a href="http://www.independent.co.uk/travel/news-and-advice/cape-town-drought-water-shortage-luxury-five-star-hotels-day-zero-laundry-showers-toilet-flush-pool-a8191966.html">let it mellow if its yellow</a>, but actions like these could benefit locals in tourist destinations across the developing world.</p>
<p>Support small businesses. Their toilets may not always be gleaming, but the experience might be more memorable. While luxury tourism in developing countries <a href="https://theconversation.com/is-it-ethical-to-take-a-luxury-holiday-in-a-developing-country-80984">rarely benefits those in need</a>, going local is one way to contribute. </p>
<p>Lastly, nurture your sense of adventure. If you want to live like a local, you should defecate like one. Pack your hand sanitiser and spare toilet roll, and immerse yourself in local culture. Get ready to try out new facilities, not just whatever commode is à la mode. There are <a href="http://www.traveller.com.au/traveller-10-the-worlds-top-toilets-gzs1l0">toilet attractions</a> dotted all over the globe that are well worth a visit. For example, why not try the <a href="https://www.theguardian.com/world/2012/nov/09/south-korea-toilet-theme-park">Haewoojae Museum</a> in South Korea, solely dedicated to celebrating the lavatory.</p>
<p>We shouldn’t expect all toilets to look the same. Tourism is about challenging expectations, exploring alternatives and expanding horizons. For the sake of the environment and the vulnerable, it is high time that we became more open-minded and adventurous with our toilette when travelling. After all, when in Rome, wipe as the Romans wiped (using a <a href="https://www.theatlantic.com/health/archive/2016/01/ancient-roman-toilets-gross/423072/">wet sponge on a stick</a>, apparently).</p><img src="https://counter.theconversation.com/content/91724/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brendan Canavan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you want to live like a local when on holiday, you should defecate like one.Brendan Canavan, Senior Lecturer in Marketing, University of HuddersfieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/899092018-01-31T23:29:48Z2018-01-31T23:29:48ZWhat Colin Kaepernick can teach us about citizenship<figure><img src="https://images.theconversation.com/files/204311/original/file-20180131-157470-1y4896n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Colin Kaepernick, centre, and his San Francisco teammates kneel during the national anthem before an NFL football game in 2016. </span> <span class="attribution"><span class="source">(AP Photo/Marcio Jose Sanchez, File)</span></span></figcaption></figure><p>Colin Kaepernick played in only one NFL game in 2017, yet he made Time magazine’s short list for “<a href="http://time.com/time-person-of-the-year-2017-colin-kaepernick-runner-up/">Person of the Year</a>” and GQ named him “<a href="https://www.gq.com/story/colin-kaepernick-will-not-be-silenced">Citizen of the Year</a>.” </p>
<p>Kaepernick started a movement of players <a href="https://www.gq.com/story/colin-kaepernick-will-not-be-silenced">kneeling during the U.S. national anthem</a> to call attention to systemic racism and the de-humanization of Black lives. His protest reflects a broader statement that many Americans, in particular Black Americans and people of colour, do not have equal protections or safe access to even basic services. In short, they are not treated as citizens.</p>
<p>But, along the way, some football fans argued the protest he inspired did not belong within <a href="https://theconversation.com/protests-not-welcome-in-the-spectacle-of-sports-84817">the NFL</a>. Others corrupted his message as <a href="http://time.com/4477383/colin-kaepernick-says-he-is-not-ant-american-and-respects-the-military/">anti-American</a>. Some restricted Kaepernick’s argument to one that spoke out solely against <a href="http://www.nbcsports.com/chicago/chicago-bears/49ers-qb-colin-kaepernick-anthem-protest-about-change-not-just-police-violence">police brutality</a> in the African-American community.</p>
<p>We believe the fundamental tenet of Kaepernick’s message — racial injustice and social exclusion — is also critical when it comes to understanding and addressing recent environmental hazards and disasters in the United States.</p>
<p>The unequal outcomes of environmental harm - for example, why some areas seem so hard hit by storms or droughts, while others bounce back quickly - can be better understood when framed within a broader conception of “citizenship.” The many meanings of “citizen” have been a key focus for social scientists throughout history, including Aristotle, Cicero, Rousseau and Arendt; it has also been a primary focus of our research group at the University of British Columbia where we work on water governance and access.</p>
<h2>Many ways to think about citizenship</h2>
<p>According to <a href="https://www.uscis.gov/citizenship/learners/citizenship-rights-and-responsibilities">U.S. Citizenship and Immigration Services</a>, citizenship is not bound by race, religion or status — but by the shared values of freedom, liberty and equality. </p>
<p>In this sense, being an equal “citizen” means you feel welcomed and safe, that you have a voice in changing the status quo and that you’re governed by the same set of laws and principles as all other citizens. Any person, from a <a href="https://www.dar.org/">Daughter of the American Revolution</a> to a newly arrived <a href="https://www.nytimes.com/interactive/2016/08/30/us/syrian-refugees-in-the-united-states.html">Syrian refugee</a>, is part of this notion of citizenship. </p>
<p>But this is an idealized vision of citizenship — it is not reality.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/203609/original/file-20180126-100929-1098b4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/203609/original/file-20180126-100929-1098b4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/203609/original/file-20180126-100929-1098b4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/203609/original/file-20180126-100929-1098b4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/203609/original/file-20180126-100929-1098b4m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/203609/original/file-20180126-100929-1098b4m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/203609/original/file-20180126-100929-1098b4m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Colin Kaepernick was named GQ magazine’s <em>Citizen of the Year</em> in 2017 for his activism.</span>
<span class="attribution"><span class="source">(AP Photo/Rick Scuteri)</span></span>
</figcaption>
</figure>
<p>Kaepernick’s protest is about what and who makes a team and a nation. The debate over Kaepernick’s action can be extended to look at the important ways environmental justice is connected to notions of citizenship. </p>
<p>Preliminary results from our recent fieldwork in South Africa and Ghana — places where the relatively well off have no trouble accessing a full range of services while the poor have limited access to drinking water and sanitation — suggest that one’s sense of belonging and inclusion are strongly tied to the ability to access basic environmental services. </p>
<p>Kaepernick’s message can (and should) be extended to recent environmental crises, including in Flint, Mich., and Puerto Rico. This is a broader interpretation of Kaepernick’s message that demands our attention.</p>
<h2>Differentiated citizenship in Flint</h2>
<p>In making dinner, filling a glass with water or taking a shower, we rarely consider how a faucet is connected to being a citizen. But many people do not enjoy easy access to drinking water — as the case of Flint has so powerfully shown. </p>
<p>In 2014, <a href="http://edition.cnn.com/2016/01/20/health/flint-water-crisis-timeline/index.html">the town’s water source</a> was changed to the Flint River from the Detroit Water and Sewerage Department. This cost-saving mechanism, combined with <a href="https://www.pbs.org/newshour/science/study-confirms-lead-got-flints-water">inadequate water treatment</a> procedures, exposed Flint’s mostly Black residents to lead contamination from their aging pipes.</p>
<p>Residents noticed the difference. Yet their repeated requests to local and state officials were rebuffed until evidence showed the water was dangerous and imperilled the health of thousands, particularly children. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/203606/original/file-20180126-100919-nl57xf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/203606/original/file-20180126-100919-nl57xf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/203606/original/file-20180126-100919-nl57xf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/203606/original/file-20180126-100919-nl57xf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/203606/original/file-20180126-100919-nl57xf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/203606/original/file-20180126-100919-nl57xf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/203606/original/file-20180126-100919-nl57xf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=475&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Signs warned students at the Flint Northwestern High School in Flint, Mich. about dangerous drinking water in May 2016.</span>
<span class="attribution"><span class="source">(AP Photo/Carolyn Kaster File)</span></span>
</figcaption>
</figure>
<p>It costs <a href="http://nbc25news.com/news/local/51-days-left-of-funding-for-bottled-water-in-flint">$117,400 a day</a> to provide bottled water and filters to Flint’s residents, yet they still live with serious lead contamination. As do <a href="https://www.reuters.com/investigates/special-report/usa-lead-testing/">many other U.S. communities</a>.</p>
<p>There is a jarring contrast between Flint and nearby towns that are <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2016/02/08/heres-the-political-history-that-led-to-flints-shocking-water-crisis/">affluent with a majority white population</a>. While residents of Flint are citizens, they are being excluded from equal benefits and protections. </p>
<p>Our research highlights the often underlying issues of citizenship — protection and belonging — behind environmental problems. If we want to address these crises we must better understand the root causes.</p>
<h2>Citizenship divides our political opinions</h2>
<p>Just as mutual strength and support unite a team, “citizenship” is a common thread that unites Americans — as it does people in all countries. Unfortunately, in the U.S., notions of citizenship have resulted in polarized political debates. Too often, citizenship is treated as a clear-cut issue of who belongs and has the legal status to stay or travel. </p>
<p>President Donald Trump’s <a href="https://www.washingtonpost.com/world/national-security/trump-border-wall-gets-18-billion-price-tag-in-new-request-to-lawmakers/2018/01/05/34e3c47e-f264-11e7-b3bf-ab90a706e175_story.html">border wall</a> and <a href="https://www.nytimes.com/2017/12/15/us/politics/visa-waiver-program-restrictions-homeland-security.html">unconstitutional visa bans</a> to keep Muslims out of the U.S. are two clear cases of citizenship as status. </p>
<p>But the in-custody deaths of <a href="http://www.bbc.com/news/world-us-canada-32400497">Freddie Gray</a> and many others, the <a href="http://www.detroitnews.com/story/news/michigan/flint-water-crisis/2017/03/07/flint-water-conference/98862674/">drinking water crisis in Flint</a> and, most recently, <a href="http://thehill.com/opinion/energy-environment/365901-puerto-rico-needs-congress-to-be-bolder-on-disaster-relief">Puerto Rico’s miserly</a> <a href="http://thehill.com/opinion/energy-environment/365901-puerto-rico-needs-congress-to-be-bolder-on-disaster-relief">disaster aid</a> after <a href="https://www.theatlantic.com/science/archive/2017/10/what-happened-in-puerto-rico-a-timeline-of-hurricane-maria/541956/">Hurricane Maria</a> serve as examples of a different type of citizenship, one where “citizens” do not have equal access to protection and justice in their daily lives.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/203608/original/file-20180126-100915-3v5dly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/203608/original/file-20180126-100915-3v5dly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/203608/original/file-20180126-100915-3v5dly.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/203608/original/file-20180126-100915-3v5dly.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/203608/original/file-20180126-100915-3v5dly.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/203608/original/file-20180126-100915-3v5dly.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/203608/original/file-20180126-100915-3v5dly.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A boy stands in front of a police cordon following the funeral of Freddie Gray in Baltimore on Apr. 27, 2015.</span>
<span class="attribution"><span class="source">(AP Photo/Matt Rourke)</span></span>
</figcaption>
</figure>
<p>Kaepernick has challenged us to rethink whether these values and rights are held equally across our differences. He has highlighted another way of thinking about citizenship: One that moves away from a strictly legal definition to involve inclusion, belonging, equity and protection — facets of everyday life.</p>
<h2>Rethinking our public policy</h2>
<p>Over 3.4 million U.S. citizens live in Puerto Rico. While the damage from Hurricane Maria may exceed US$30 billion, Trump made sure to <a href="http://deadline.com/2017/09/donald-trump-tweet-puerto-rico-broken-infrastructure-massive-debt-1202176860/">blame</a> Puerto Rico’s “broken infrastructure” and “old electrical grid” for the scale of the island’s suffering and damage. </p>
<p>Trump’s <a href="http://www.newsweek.com/puerto-rico-recovery-100-days-hurricane-maria-760965">own reasoning</a> suggests that broader forces of social exclusion are at play. Kaepernick’s kneeling can serve to raise awareness for environmental discrimination in Puerto Rico. Even as officials admit that as much as one third of the island’s citizens do not have access to the power grid, FEMA has announced it is cutting off <a href="https://www.npr.org/sections/thetwo-way/2018/01/29/581511023/fema-to-end-food-and-water-aid-for-puerto-rico">emergency electricity and water supplies</a>. </p>
<p>The island’s short- and long-term vulnerability highlight the need to ensure that our public policy strives to provide equal access to services and protections for everyone.</p>
<p>Kaepernick and those participating in <a href="https://twitter.com/search?q=%23takeaknee&src=typd">#TakeaKnee</a> say they love America, but wholeheartedly believe the country can do better in upholding the principles of equality and justice ostensibly woven into the U.S. flag.</p>
<p>We hope that as Kaepernick’s message continues, it will extend into everyday facets of inclusion, equal protection and belonging — from getting a glass of clean water to receiving federal aid following a disaster.</p>
<p>Where Trump’s State of the Union speech touted “merit-based immigration,” the border wall and the visa lottery system as somehow unrelated to the fear-mongering over immigrants, Kaepernick is pushing us to interrogate what it means to be a citizen. </p>
<p>A team supports, welcomes and respects its members, and society must also strive for this. Something to think about during the Super Bowl, especially if during the national anthem, NFL players take a knee.</p><img src="https://counter.theconversation.com/content/89909/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Scott McKenzie receives funding from the Social Sciences and Humanities Research Council of Canada and the University of British Columbia. He is affiliated with the EDGES research group at the University of British Columbia and the International Water Resources Association.
</span></em></p><p class="fine-print"><em><span>Sameer H. Shah receives funding from the Social Sciences and Humanities Research Council of Canada. He is affiliated with the EDGES research group at the University of British Columbia.
</span></em></p>Much of the discussion about “Take a Knee” has overlooked the issues of justice and social exclusion, and especially environmental matters. That’s something to think about during the Super Bowl.Scott McKenzie, PhD Candidate, Institute for Resources, Environment and Sustainability (IRES), University of British ColumbiaSameer H. Shah, Assistant Professor of Climate Adaptation, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/876242018-01-15T15:14:13Z2018-01-15T15:14:13ZHow creating a water poverty map for all of Africa can help sound policies<figure><img src="https://images.theconversation.com/files/194988/original/file-20171116-8006-1ee6qym.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women collecting water in Mali echo a common scene across Africa.</span> <span class="attribution"><span class="source">Reuters/Benoit Tessier</span></span></figcaption></figure><p>African countries are behind the global curve when it comes to providing people with clean water and sanitation services. A <a href="http://www.who.int/water_sanitation_health/publications/2014/jmp-report/en/">joint monitoring report</a> by the World Health Organisation and UNICEF shows that 89% of the world’s population has access to clean water sources. In sub-Saharan Africa, the figure is 64%. Globally, 64% of people have access to decent sanitation services. But this is true for less than a third of sub-Saharan Africa’s population.</p>
<p>This lack of access can be fatal, particularly for children. The absence of clean water and basic sanitation is among the <a href="http://www.un.org/millenniumgoals/pdf/MDG%20Report%202010%20En%20r15%20-low%20res%2020100615%20-.pdf">leading causes</a> of mortality among those younger than five all across the continent. It also places a huge burden on Africa’s women. It is they who must walk long distances to gather water from streams, ponds and wells. </p>
<p>Research has <a href="https://www.gov.uk/dfid-research-outputs/water-food-and-livelihoods-in-river-basins">also showed</a> how unreliable water supply is simultaneously a cause and result of poverty. South African water researcher Dr Anthony Turton coined the phrase “<a href="http://www.awiru.co.za/pdf/trutonanthony9.pdf">water poverty</a>” to describe societies that cannot cope with the problem of water scarcity.</p>
<p>This prompted the development of the <a href="http://portals.wi.wur.nl/files/docs/ppme/Water_poverty_index.pdf">Water Poverty Index</a> by ecological and environmental economist Professor Caroline Sullivan in 2002. The index allows researchers to produce an <a href="http://armspark.msem.univ-montp2.fr/bfpvolta/admin/biblio/SullivanWaterPovertyIndex.pdf">integrated assessment</a> of water stress and scarcity, linking physical estimates of water availability with socioeconomic variables that reflect poverty. </p>
<p>There’s wide agreement that the index is useful and reliable. But its indicators are <a href="https://link.springer.com/article/10.1007/s11205-012-0218-2">not appropriate for all contexts</a>. That’s why I set out <a href="http://www.tandfonline.com/doi/full/10.1080/07900627.2016.1219941">to create</a> a set of indicators that can be applied in the African context. These indicators include a country’s seasonal variability of rainfall; a nation’s water investments and how efficiently it uses water in agriculture and industry. Another indicator is a country’s <a href="http://hdr.undp.org/en/content/human-development-index-hdi">Human Development Index</a>, which takes into account factors like life expectancy, education and average income. </p>
<p>This allowed me to map Africa’s water poverty situation, giving a good sense of how different this is across countries on the continent. </p>
<p>My <a href="http://www.tandfonline.com/doi/full/10.1080/07900627.2016.1219941">findings</a> offer a transparent analysis for policymakers, governments and organisations that deal with water issues. They can use the information from the index to assess the opportunities and risks involved with interventions. They’ll also have a better understanding of the socioeconomic factors that affect different African countries’ water management policies rather than treating the whole continent as a homogeneous mass. </p>
<p>What will work in Seychelles, which has a low level of water poverty, will not necessarily be useful in Djibouti, whose water poverty levels are high.</p>
<h2>New indicators for Africa</h2>
<p>I chose 15 indicators from 22 variables to compute five components for the African Water Poverty Index: resources, access, capacity, use and
environment. </p>
<p>The results are mapped across a number of water poverty maps that I developed. They show that water poverty follows a complex, diverse spatial pattern. Africa’s most economically developed countries are also its most water-scarce. These are located mainly in northern and southern Africa and includes Libya, Algeria, Tunisia and South Africa. Water-rich but lower income countries are mainly concentrated in the sub-Saharan region – places like Gabon, Central African Republic and Congo. </p>
<p>This suggests that as some countries grow and attract more people looking for work, their water resources will become more pressurised. These countries must put long term, sustainable water management plans in place so they don’t run short of water – a scenario that would <a href="https://www.water.ox.ac.uk/wp-content/uploads/2015/04/SCHOOL-OF-GEOGRAPHY-SECURING-WATER-SUSTAINING-GROWTH-DOWNLOADABLE.pdf">greatly hamper</a> further economic development and growth. </p>
<p>The index also suggests what form these plans might take. North African countries, for instance, ought to pay more attention to improving the use of scarce water resources in agriculture and other sectors. Higher water efficiency and consumer conservation programmes are required. </p>
<p>In the sub-Saharan region, meanwhile, access to piped water and sanitation facilities remains generally very low. These countries may be “richer” in water than their northern counterparts, but this reality is not experienced by many residents. Anyone working in the water sector in these countries ought to be focusing on how to improve access to safe water and effective sanitation.</p>
<h2>A useful tool</h2>
<p>My hope in creating this Africa-focused index is that policymakers, politicians and development experts will be able to apply the data. Such a multidimensional assessment of water poverty for the continent could make a big difference to management and planning.</p><img src="https://counter.theconversation.com/content/87624/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hatem Jemmali does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Developing a map of African countries’ water poverty levels offers a transparent analysis for policymakers, governments and organisations that deal with water issues.Hatem Jemmali, Assistant Professor of Economics and Econometrics, Université de la ManoubaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/777532017-07-12T08:03:09Z2017-07-12T08:03:09ZWe make fake poo in a laboratory – to improve sanitation in Bangladesh<figure><img src="https://images.theconversation.com/files/172775/original/file-20170607-29566-3bofjh.jpg?ixlib=rb-1.1.0&rect=0%2C810%2C4008%2C2334&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No flush.</span> <span class="attribution"><span class="source">Author provided</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Across the world, almost three billion people do not have the luxury of a flushing toilet. Instead they rely on static sanitation systems, like <a href="http://www.sswm.info/content/single-ventilated-improved-pit-vip">pit latrines</a> to deal with their waste. As these are not often connected to a sewer, they require manual emptying and disposal. </p>
<p>Poor understanding of the risks involved means that untreated sludge is often thrown into nearby fields and rivers. The impact of this can be devastating. Germs found in faecal sludge cause illnesses such as diarrhoea which results in the deaths of more than <a href="http://sanitationdrive2015.org/resources-2/fast-facts/">750,000 children under five every year</a>. </p>
<p>Yet it is estimated that every dollar invested in better sanitation returns up to US$5.50 in <a href="http://sanitationdrive2015.org/resources-2/fast-facts/">social and economic benefits</a>. These come through increased productivity, reduced healthcare costs and prevention of illness and early death. </p>
<p>A crucial part of improving sanitation lies in researching and developing simpler, more efficient ways of treating sludge in places where a sewerage and centralised waste water treatment is not available.</p>
<p>My research is part of a partnership with the engineering firm <a href="http://www.burohappold.com/">Buro Happold</a> (BH) who were asked by <a href="http://www.wateraid.org/bd">WaterAid Bangladesh</a> to find a sludge treatment technology which was effective, practical and affordable. </p>
<p>After considering options which included <a href="http://www.sswm.info/category/implementation-tools/wastewater-treatment/hardware/site-storage-and-treatments/anaerobic-di">biogas</a> and pit additives – products used to try and reduce sludge volume – the company opted for unplanted drying beds. They are simple in design and make use of the reasonable amount of sunshine in Bangladesh.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/176897/original/file-20170705-30023-1wc4cta.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176897/original/file-20170705-30023-1wc4cta.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176897/original/file-20170705-30023-1wc4cta.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176897/original/file-20170705-30023-1wc4cta.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176897/original/file-20170705-30023-1wc4cta.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176897/original/file-20170705-30023-1wc4cta.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176897/original/file-20170705-30023-1wc4cta.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Manual emptying.</span>
<span class="attribution"><span class="source">sswm.info</span></span>
</figcaption>
</figure>
<p>Drying beds dry out the sludge through the processes of evaporation and drainage. As it loses water, the temperature within the sludge rises, killing off some of the germs it contains. Once dried to a suitable consistency for removal, the sludge is composted to allow safe use in agriculture as a soil conditioner.</p>
<p>My research aims to better understand the sludge drying process in these beds in order to estimate the time necessary before it is safe to remove, preventing untreated sludge being emptied into the environment.</p>
<h2>Poo factory</h2>
<p>To do this, it’s necessary to make sludge in the laboratory, which replicates the chemical and physical properties of the real stuff as closely as possible. By doing so we can perform safe, reproducible drying tests to ascertain how real sludge will dry in a tropical climate.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/172774/original/file-20170607-29552-1qnxf28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/172774/original/file-20170607-29552-1qnxf28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/172774/original/file-20170607-29552-1qnxf28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/172774/original/file-20170607-29552-1qnxf28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/172774/original/file-20170607-29552-1qnxf28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/172774/original/file-20170607-29552-1qnxf28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/172774/original/file-20170607-29552-1qnxf28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Drying bed.</span>
<span class="attribution"><span class="source">Celia Way Buro Happold 2013</span></span>
</figcaption>
</figure>
<p>Aside from being full of germs, faecal sludge is highly variable in terms of its chemical and physical composition. <a href="https://www.ncbi.nlm.nih.gov/pubmed/7359576">One study</a> investigating the “output” of a group of healthy similarly aged men on a controlled diet for three weeks found noticeable differences in the chemical composition of their poo. Such variation is further amplified between different countries, climates and diets.</p>
<p>The main chemical components of poo are fats, carbohydrates (fibre), nitrogenous material, minerals (mainly potassium, calcium and phosphorous) and microorganisms. In 2006 <a href="http://papers.sae.org/2006-01-2180/">scientists developed</a> a simulant for human poo to test the design of a waste collection system for a crew exploration vehicle for NASA.</p>
<p>Using the known chemical composition, the NASA researchers developed a “recipe” that consisted of cellulose to represent the carbohydrates, yeast for the microorganisms, peanut oil for fats and carbohydrates, plus potassium chloride, calcium phosphate and water.</p>
<p>Unfortunately the sludge that is dried on the drying beds in Bangladesh is slightly different to fresh poo as it has spent time either in a pit or a septic tank stabilising. This means that easily degradable components in fresh poo (carbohydrates, proteins and sugars) are broken down, leaving behind more stable ones. NASA’s recipe for fresh poo needed to be altered for our experiments to account for the changes and to better represent the characteristics of real faecal sludge.</p>
<p>As part of the Bill and Melinda Gates Foundation’s <a href="http://www.gatesfoundation.org/What-We-Do/Global-Development/Reinvent-the-Toilet-Challenge">Reinvent the Toilet Challenge</a> in 2014, the <a href="http://prg.ukzn.ac.za/">Pollution Research Group</a> in South Africa altered the NASA recipe. They included the dietary supplement psyllium husk and miso paste for fibre, removed potassium chloride, added polyethylene glycol to aid water retention, active yeast to represent bacteria and changed cellulose to <a href="http://www.ebay.co.uk/gds/Fine-Papermaking-with-100-Cotton-Linter-What-is-it-/10000000004063910/g.html">cotton linters</a> and shredded tissue.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/172773/original/file-20170607-6583-1vjja2j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/172773/original/file-20170607-6583-1vjja2j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/172773/original/file-20170607-6583-1vjja2j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/172773/original/file-20170607-6583-1vjja2j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/172773/original/file-20170607-6583-1vjja2j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/172773/original/file-20170607-6583-1vjja2j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/172773/original/file-20170607-6583-1vjja2j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Faecal Sludge Simulant.</span>
<span class="attribution"><span class="source">Naomi Deering University of Bath 2017</span></span>
</figcaption>
</figure>
<p>We further altered this recipe to replace cotton linters with hemp as it was more readily available. Active yeast was replaced with brewer’s yeast as it is easier to purchase in bulk.</p>
<p>Now that we have a suitable simulant for faecal sludge we are able to conduct tests on drying beds to better predict the drying behaviour of the sludge in a tropical climate. This could lead to the use of such beds on a much larger scale, meaning that instead of being left dangerously untreated, the poo has somewhere better to go.</p><img src="https://counter.theconversation.com/content/77753/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Naomi Deering receives funding from the EPSCR via grant EP/L016869/1.</span></em></p>It’s a dirty scientific job – but it could save lives.Naomi Deering, Postgraduate Researcher in Faecal Sludge Management, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/666902016-10-20T15:29:06Z2016-10-20T15:29:06ZEquitable access is key to meeting water, sanitation and hygiene targets<figure><img src="https://images.theconversation.com/files/142318/original/image-20161019-20336-ip8sko.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman carries water she has collected from the Turkwel River near Lodwar in Turkana County, north-west Kenya.</span> <span class="attribution"><span class="source">Rob Hope/REACH</span></span></figcaption></figure><p>The UN’s millennium development goal target of halving the amount of people with access to safe drinking water has been met. The same is sadly not true of the sanitation target. And the transition to the <a href="https://sustainabledevelopment.un.org/sdgs">sustainable development goals</a> for water and sanitation has created even more ambitious targets. These will require real change within this sector to achieve them by the 2030 deadline.</p>
<p><a href="https://sustainabledevelopment.un.org/sdg6">Goal 6</a> of the sustainable development goals, released in 2015, involves ensuring availability and sustainable management of water and sanitation for all. The indicators which will be used to track progress were only <a href="http://unstats.un.org/unsd/statcom/47th-session/documents/2016-2-IAEG-SDGs-Rev1-E.pdf">agreed in March</a> 2016. It’s early days, so changes and shifts might not be visible to those outside the sector. </p>
<p>I’m happy to report that there are shifts towards greater equity in access – which is important because, as research has previously shown, progress in the provision of water and sanitation tends to benefit wealthier populations. The poor are left out in the cold.</p>
<p>The sustainable development goals aim to provide access to all. but to achieve this will take major changes in the sector. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=231&fit=crop&dpr=1 600w, https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=231&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=231&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=290&fit=crop&dpr=1 754w, https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=290&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/140915/original/image-20161007-21433-14m7fbw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=290&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Targets for access to water, sanitation and hygiene: then and now.</span>
</figcaption>
</figure>
<h2>Equality in access</h2>
<p>The millennium development goal focus of halving the number of people without access to water meant that the target could be achieved without helping the poorest. By 2012, <a href="http://www.wssinfo.org/">the Joint Monitoring Programme, or JMP,</a> analysed progress toward the targets by wealth. This highlighted how progress was often greatest for the wealthiest, while there was little change <a href="http://www.wssinfo.org/documents/?tx_displaycontroller%5btype%5d=wealth_quintiles">for the poorest</a>. </p>
<p>Senegal is an example how different progress can be for the richest and poorest in a country which met the MDG target on water. The progress the country made was unequal. In urban areas, access to improved water sources decreased for the poorest between 1995 and 2012. In rural areas, rapid progress for the second wealthiest group still left them 17 years behind that of the wealthiest.</p>
<p>Across the sector there is now a focus on how to extend access to water, sanitation and hygiene services to those who are most marginalised, but also to those who are least able to afford to pay. The target is to make water affordable for all. But this is the one area not currently captured in the SDG indicators. Extending sustainable services to all will require different financing models to address both construction and maintenance, and this remains a key topic under discussion.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=464&fit=crop&dpr=1 754w, https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=464&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/142248/original/image-20161018-15137-13b2wnd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=464&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Senegal met the MDG target for water, but progress was unequal.</span>
<span class="attribution"><span class="source">WHO/UNICEF Joint Monitoring Programme</span></span>
</figcaption>
</figure>
<h2>A better level of access</h2>
<p>There are three key critical areas in which the bar for what is considered access is being raised: safer water quality, integration of hygiene, and safe management of sanitation.</p>
<p>By the end of the MDG period it was clear that <a href="http://www.wssinfo.org/definitions-methods/watsan-categories/">improved water sources</a> did not equate to safe drinking water. A rapid assessment of <a href="http://www.wssinfo.org/water-quality/">drinking-water quality</a> in five countries – Ethiopia, Jordan, Nicaragua, Nigeria and Tajikistan – demonstrated the gap between improved water sources and safe water. Over half of protected dug wells did not provide safe water and nor did around a third of protected <a href="http://www.wssinfo.org/fileadmin/user_upload/resources/report_wash_low.pdf">springs and boreholes</a>. </p>
<p>These results <a href="http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862012000300015&lng=en&nrm=iso&tlng=en">showed</a> that in Nigeria the proportion of the population with access to safe water was <a href="http://www.who.int/bulletin/volumes/90/3/11-094284/en/">15%, or 22 million people</a> lower than estimated based on the MDG indicator. Similar results were found for 4 of the 5 countries included in the study, with a 7-16% decrease in access when water quality was taken into consideration.</p>
<p>Going forward, the SDG indicator for safely managed drinking water services is <a href="http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-WASH-Post-2015-Brochure.pdf">defined</a> as:</p>
<blockquote>
<p>a basic drinking water source which is located on premises, available when needed and free of faecal and priority chemical contamination.</p>
</blockquote>
<p>A basic drinking water source is an improved drinking water source with a round trip collection time of no more than 30 minutes including queuing. Where existing data is available, there will be reports against this indicator in the coming year. </p>
<p>But data is not widely available. This will be one of the major outcomes from the SDG for water: millions more people across the globe will have their water sources monitored, with increasing pressure on those that provide water services to ensure water isn’t just available, that it is also safe to drink. The area is already seeing progress with the implementation of water quality testing being expanded in household <a href="http://mics.unicef.org/methodological_work/3/WATER-QUALITY">surveys</a>.</p>
<p>How this data will be made available to water users and decision makers at a local level is not yet clear. But it is essential that this is addressed in the coming years to help deliver safe accessible drinking water for all.</p>
<h2>The hygiene gap</h2>
<p>There is often limited attention given to hygiene. The inclusion of hygiene in target 6.2 is the result of sustained <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000367">advocacy and research work</a> within the sector.</p>
<p>About 28 countries in sub-Saharan Africa have been included in <a href="http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-Update-report-2015_English.pdf">surveys</a> demonstrating that, on average, only 13% of the population have access to a handwashing facility at home with soap and water. That is around half the population that had access to sanitation in those same countries, and about one fifth of those with access to water. The inclusion of hygiene in the sustainable development goals will ensure the sector continues to build on this important work. </p>
<h2>Safe sanitation</h2>
<p>The emphasis in the millennium development goals was on toilet infrastructure only. This has left what has been described as the <a href="http://www.thedailystar.net/city/untreated-faecal-sludge-huge-threat-health-1225666">second generation sanitation challenge</a>: how to remove excreta building up in pit latrines and septic tanks and how to treat it?</p>
<p>Many toilets aren’t accessible to emptying trucks, or are at risk of collapse if they are emptied. Where equipment is available for desludging, waste is still commonly dumped into waterways as treatment works do not have the capacity. Raising awareness of these issues and communicating them through <a href="http://sfd.susana.org/about/the-sfd">shit flow diagrams</a> is crucial. The sector is changing how it works to address the whole faecal sludge management chain.</p>
<p>The sustainable development goals add new dimensions to evaluating access to drinking water and sanitation, and now hygiene. In the millennium development goals infrastructure was a focus, but with the sustainable development goals it will expand to include management and behaviour change. Progress against the SDG targets for water, sanitation and hygiene may appear slow as these are incorporated into such initiatives.</p><img src="https://counter.theconversation.com/content/66690/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katrina Charles receives funding from the UK Department of International Development.</span></em></p>Progress in terms of water and sanitation has traditionally favoured those with money. But the hope with the SDG’s is that this gap will be plugged in the future.Katrina Charles, Lecturer and course director in Water Science, Policy and Management, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/588202016-06-09T13:14:19Z2016-06-09T13:14:19ZAfrica is failing to close the gap on providing water and sanitation<figure><img src="https://images.theconversation.com/files/125111/original/image-20160603-11585-pgzw5j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Africa, more than 315,000 children die every year from diarrhoeal diseases caused by unsafe water and poor sanitation.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The United Nations Sustainable Development Goal of ensuring access to clean water and sanitation for all <a href="https://sustainabledevelopment.un.org/?menu=1300">by 2030</a> is an ambitious target for Africa. According to new <a href="http://afrobarometer.org/publications/ad76-lack-of-safe-water-and-sanitation-spurs-growing-dissatisfaction">research</a> by non-partisan research network Afrobarometer, nearly half of Africans don’t have access to clean water and two-thirds lack access to sewage infrastructure. Improvements in both of these areas have been made in the past decade, but huge numbers of Africans still live without these basic necessities.</p>
<p>The lack of access to water and sanitation has not gone unnoticed by people living in Africa. Almost half of the continent’s citizens are not happy with the way their governments are handling water and sanitation. </p>
<p>The global Millennium Development Goals’ target for drinking water was met in <a href="http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-Update-report-2015_English.pdf">2010</a>. About 2.6 billion people have gained access to improved sources of drinking water since 1990. Five developing regions met the drinking water target, but the Caucasus and Central Asia, Northern Africa, Oceania and sub-Saharan Africa did not. In the area of sanitation, the target was missed by nearly 700 million people. The only developing regions to <a href="http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-MDG-assessment-snapshot-in-English.pdf">meet the sanitation target</a> were the Caucasus and Central Asia, Eastern Asia, Northern Africa and Western Asia.</p>
<p>Lack of access to water and sanitation is a matter of life and death. Contaminated water and inadequate sanitation help transmit diseases like diarrhoea, cholera, dysentery and typhoid. In Africa, more than 315,000 children die every year from diarrhoeal diseases caused by unsafe water and <a href="http://www.wateraid.org/what-we-do/the-crisis/statistics">poor sanitation</a>. Globally, deaths from diarrhoea caused by unclean drinking water are estimated at 502,000 each year, most of them of <a href="http://www.who.int/mediacentre/factsheets/fs391/en/">young children</a>.</p>
<h2>The situation on the ground</h2>
<p>To assess the situation on the ground, the research looked at 36 African countries in 2014/2015 and asked nearly 54,000 citizens about their access to water and sanitation. This was in addition to recording direct observations in the thousands of surveyed communities. </p>
<p>We found that almost half (45%) of Africans went without enough clean water for home use during the past year, while one in five (19%) did so many times or always. One-third of surveyed communities (36%) lacked access to a piped-water system, and two-thirds (68%) lacked access to sewage infrastructure. </p>
<p>The infrastructure situation has improved somewhat over the past decade. Across 18 countries that Afrobarometer has tracked since 2005, the share of communities enjoying piped-water supplies increased by 14 percentage points, and sewerage has been extended to an additional 8% of communities.</p>
<p>Even for those who live in zones with the necessary infrastructure, however, access to clean water and toilets is often difficult. More than half (51%) of those surveyed said they had to leave their compound to access water. One in five had to leave their compound to use a latrine, and another 8% had no access at all to a latrine or toilet, even outside their compound.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/125671/original/image-20160608-3492-1ytjoi8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/125671/original/image-20160608-3492-1ytjoi8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/125671/original/image-20160608-3492-1ytjoi8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=313&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125671/original/image-20160608-3492-1ytjoi8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=313&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125671/original/image-20160608-3492-1ytjoi8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=313&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125671/original/image-20160608-3492-1ytjoi8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=393&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125671/original/image-20160608-3492-1ytjoi8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=393&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125671/original/image-20160608-3492-1ytjoi8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=393&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">About 45% of people in Africa go without sufficient clean water for home use.</span>
<span class="attribution"><span class="source">Afrobarometer</span></span>
</figcaption>
</figure>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/125672/original/image-20160608-3477-1nnahs9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/125672/original/image-20160608-3477-1nnahs9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/125672/original/image-20160608-3477-1nnahs9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=313&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125672/original/image-20160608-3477-1nnahs9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=313&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125672/original/image-20160608-3477-1nnahs9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=313&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125672/original/image-20160608-3477-1nnahs9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=393&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125672/original/image-20160608-3477-1nnahs9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=393&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125672/original/image-20160608-3477-1nnahs9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=393&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rural residents fare far worse when it comes to access to water and sanitation.</span>
<span class="attribution"><span class="source">Afrobarometer</span></span>
</figcaption>
</figure>
<p>Rural residents are far worse off than their urban counterparts when it comes to access to water and sanitation. Two-thirds (66%) of rural respondents had to go outside their compound to access water, compared with 30% of urbanites. About 27% had to go outside the compound for a toilet and 11% had no access at all to a toilet. This is compared with 12% in urban areas, where just 3% had no access to toilet facilities.</p>
<p>Experiences vary widely across countries. Almost 74% of citizens in Gabon and 72% in Liberia reported going without enough water at least occasionally, compared with 8% in Mauritius and 15% in Cape Verde. Going without enough water many times or always affected more than one-third of citizens in Madagascar (42%), Gabon (39%), Guinea (38%) and Togo (37%).</p>
<p>By region, Central Africa had the highest proportion of respondents who said they went without enough water at least once (55%), while North Africa recorded the lowest (33%). Rural residents were more likely than their urban counterparts to experience water scarcity (50% vs 39%).</p>
<h2>Where water ranks as a priority</h2>
<p>Water supply ranked fifth in importance across 36 countries when citizens were asked about the most important problems facing their country. It followed unemployment, health, education and infrastructure/transport. But it was well ahead of concerns about political violence, corruption, electricity, crime and security, and agriculture. And water supply was the top problem identified in water-poor countries like Burkina Faso, Guinea and Niger.</p>
<p>On average, a majority (55%) of citizens rated their government’s performance in handling water and sanitation services as fairly bad or very bad. These negative appraisals were the majority view in all regions except North Africa, but even there, 46% rated their government’s handling of water and sanitation services as bad.</p>
<p>And public dissatisfaction is increasing. Across the 18 countries that Afrobarometer has tracked over the past decade, negative public ratings of government performance in providing water and sanitation services increased from 41% in 2005/2006 to 55% in 2014/2015. They worsened dramatically in Madagascar, where there was an increase of 47 percentage points in fairly/very bad ratings, followed by Ghana (28-point increase in negative ratings), Senegal (23 points), Botswana (16 points), Mali (15 points) and South Africa (13 points).</p>
<p>These declining performance ratings should be a red flag for democratic governments that are still unable to provide their citizens with these most basic services. Safe and readily available water is a human right and an important contributor to public health. Improved access to safe water and sanitation boosts economic growth, contributes to poverty reduction, and is fundamental to achieving the goals of improved health and education, greater food security, and improved environmental sustainability.</p>
<p>So modest improvements in coverage of water supply and sewerage systems are set alongside significant declines in government performance ratings. Perhaps this seeming incongruity indicates that citizens’ expectations about the quality of infrastructure and services that they should receive (or even demand) from their governments are rising.</p>
<p>Other questions still require further exploration, for example the question of whether progress can best be realised through local control and/or nongovernmental organisations or foreign investment, or whether centralised government investment, management and control of water infrastructure is the better approach.</p><img src="https://counter.theconversation.com/content/58820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There have been modest improvements in water and sanitation provision in Africa, but there is still a long way to go. Most citizens rate their governments’ performance in this sphere poorly.Corah Walker, PhD Student, Department of Political Science, Michigan State UniversityCarolyn Logan, Deputy Director of the Afrobarometer & Associate Professor in the Department of Political Science and MSU’s African Studies Center, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.