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Access to Sanitation

Volume 554: debated on Monday 26 November 2012

Motion made, and Question proposed, That this House do now adjourn.—(Mr Swayne.)

Each year, 19 November marks world toilet day. While that might, at first hearing, sound rather comical, the issue it seeks to highlight is extremely serious—that of the continued lack of access to basic sanitation for about one third of the world’s population—and it was to mark that event and highlight again this important issue in Parliament that I sought this debate.

I acknowledge the work that the Government have been doing as part of the UK’s overall international development agenda, and I will refer to that further later, but water and sanitation still suffers from a lack of overall priority in political and investment terms, both nationally and internationally, compared with other aid portfolios, such as health and education, despite the fact that it impacts heavily on the achievement of other development objectives. The former Secretary-General of the United Nations, Kofi Annan, has noted that

“no other issue suffers such disparity between its human importance and its political priority.”

Clearly, without access to water, sanitation and hygiene, the progress that can be achieved in other areas is significantly constrained. The importance of access to clean water and sanitation cannot be understated. In the UK, the biggest step change in public health and mortality rates came as a result not of medical advances but of widened access to clean drinking water and adequate sanitation. During the late 19th century, as both water and sewerage infrastructure expanded dramatically, the life expectancy of an average member of the population in this country rose by 15 years—a remarkable increase delivered over a relatively short period. Indeed, the British Medical Association has recognised the commissioning of the sewerage system in London as the most important breakthrough in public health—of more significance even than the discovery of penicillin or the development of vaccines.

As a direct result of poor or non-existent sanitation infrastructure, people—the majority of them children—are dying of diseases that, with the provision of potable water and sustainable sanitation, are preventable. In fact, they could be almost entirely eliminated. By way of illustration, I point to the fact that the biggest killer of children under five in sub-Saharan Africa, and the second-biggest killer globally, are diarrhoeal diseases, the vast majority of which are entirely preventable conditions caused by inadequate sanitation and hygiene. More children under five die annually as a result of these diseases than from HIV/AIDS, malaria and measles combined. Indeed, the disease burden of malaria itself is also impacted on by the availability of open drainage channels and sewers, providing environments conducive to the breeding of mosquitoes that spread the disease.

Every day 2,000 mothers lose a child due to an illness caused solely by poor sanitation and dirty water. Even vaccines that hold out the hope of progress are less effective in the absence of water, sanitation and hygiene—WASH. But the impact of inadequate sanitation infrastructure is not limited to disease; it extends to the one in three women worldwide who risk shame, harassment and even physical attack simply seeking somewhere to defecate. This debate is timely, then, not only in the context of world toilet day but because yesterday marked the international day for the elimination of violence against women.

I want to draw on the everyday ordeal that the lack of access to sanitation is for people, especially women, who are the most acutely affected. Globally, 2.6 billion people lack access to basic sanitation, 1.25 billion of them women—one in three women in the world lack access to safe sanitation. Put simply, privacy, modesty, cleanliness and safety are almost impossible for those who have no access to sanitation facilities. Their experience often involves trading those factors against each other simply to survive. The reality is often shame, indignity, disease and even violence.

Some 526 million girls and women are without access to any form of sanitation. They are forced to defecate in bushes or ditches, or even in the open, their choice being between doing so in broad daylight, compromising their modesty and risking shame, or waiting until dark to cling to their dignity but risk their personal safety. A 2005 UN development programme report confirmed that the need to travel further from home to secure the family’s water can expose women and girls to sexual harassment and rape, which can also happen when women who lack safe nearby sanitation move about at night in search of privacy. It is estimated that women and girls in developing countries spend 97 billion hours each year searching for a place to go to the toilet—more than double the total hours worked every year by the entire UK labour force. An 18-year-old mother from Mozambique has described her arduous journey each day to defecate in the bush. Her ordeal involves crossing a dangerous bridge that has claimed the lives of many people who have fallen through it. Sometimes she feels so ashamed that she returns home without being able to reach the point she needs to reach, or she waits until dark to go, so that no one will see her. However, at night the journey is even more dangerous. A woman and a boy have been stabbed to death on that bridge, and one woman she knows of has been raped on the journey.

Even where public latrines are available, provision is rarely adequate. In the Kifumbira slum in Kampala, there are only four toilets for every 2,000 people, these consisting merely of holes into a cesspit, covered in faeces and maggots. Women worldwide have reported incidents of men hiding in public latrines at night, waiting to rob or assault those who enter them. In two slum districts in India, women reported incidents of girls under 10 being raped while on their way to use public toilets. In work carried out by WaterAid in Bhopal in India, 94% of the women interviewed said they had faced violence or harassment when going in search of a toilet, and more than a third had been physically assaulted. Amnesty International has also reported that women and girls in the slums of Nairobi were staying away from communal toilet facilities at night because of their fear of physical violence and rape. A WaterAid poll of women in Lagos in Nigeria revealed that 67% of women interviewed said they did not feel safe using a shared or community toilet in a public place.

The only alternative for those women—if it could be called that—is to defecate at home. However, that too carries huge health risks and social consequences. One woman living in Kampala in Uganda has said that

“when someone knows you defecate in your house, your household is hated and people”

will not visit. In addition to the stigma attached to this choice, resorting to so-called “flying toilets”—plastic bags or buckets used at home—carries significant health risks, not only for the woman but for her family, as storing and disposing of waste and maintaining even basic hygiene is almost impossible. Women are more susceptible to urinary tract infections and dehydration by trying to limit going to the bathroom for long periods and drinking less water over the course of the day, and as a result are more likely to become seriously ill.

Further, as women are generally responsible for the disposal of human waste when provision is inadequate and for caring for others in the family who are affected by communicable hygiene-related diseases, they are more exposed to diseases such as dysentery and cholera than their male counterparts. This caring role and enhanced risk of contracting disease significantly restricts the degree to which women can be economically active and financially independent, and provide for the most basic needs of their family. That compounds the effect that a lack of provision of proper and private sanitation facilities has on girls’ ability to access education, particularly as they reach puberty.

Having outlined the problem, I want to turn my attention in the time remaining to the progress being made towards achieving millennium development goal 7, target 10—halving the proportion of people without sustainable access to safe drinking water and improved sanitation by 2015. Although we have met the target of halving the proportion of people without access to improved sources of water, the sanitation target is significantly off track. At the current rate of progress, it will be over 25 years before south Asia meets its sanitation MDG target and 70 years to achieve universal access. Even more starkly, it will be the 23rd century before sub-Saharan Africa meets its sanitation MDG target and 350 years before universal access is achieved. The failure to meet the water and sanitation target threatens the progress of many other millennium development goals and undermines wider development efforts. Without water and sanitation, nothing else really works.

I welcomed the UK Government’s commitment in April 2012 to double, to 60 million, the number of people whom they plan to reach with water, sanitation and hygiene promotion by 2015. I remain concerned, however, at the lack of clarity as to how the Government intend to ensure that that commitment will effectively target the areas and the people in the greatest need and as to how DFID will effect delivery on this scale through DFID’s current WASH budget.

Good governance and stewardship of international assistance by foreign Governments also remains a challenge to the effective implementation of the Government’s plans—a matter to which I am sensitive. For example, the freezing of international assistance to Uganda due to the risk of corruption will mean that people living in the slums of Kampala who have benefited from DFID projects will see no further improvement in their circumstances in the short term. Urgent consideration must therefore be given to how the most needy can be targeted on the ground, even in the most volatile and unstable regions, and to how this increased commitment can be accompanied by an increased number of advisers dedicated to WASH, in order to maximise the impact and value for money of WASH sector support. I believe that the UK should take the lead on this issue, encouraging multilateral partners—particularly the World Bank, the European Community and the African Development Bank—to increase investment and better to target WASH investments.

I believe that this is the time to give consideration to how the current trends will be addressed after the millennium development goals have expired in 2015. If present trends continue, 2.4 billion people will still lack access to safe sanitation facilities in 2015, so it is imperative to construct a post-2015 goal framework to include a commitment to universal access to basic water and sanitation services, including a specific target date of 2030. I also believe that post-2015 goals should better reflect the central importance of WASH to human health, education, welfare, economic productivity and gender equality, as well as reflecting the interdependence of those goals. Water, sanitation and hygiene targets and indicators must focus explicitly on reducing inequalities by targeting resources at poor and disadvantaged groups as a top priority.

The United Nations human development report estimates that for every £1 invested in this sector, £8 is returned in saved time, increased productivity and reduced health costs. It is therefore a wise investment as well as a necessary one, and its impact can be multiplied if the Government also collaborate with non-governmental organisations and charities, as well as with Governments, who can assist in providing education to local communities through church and community networks and supporting increased capacity among state and non-state players.

I therefore urge the Department for International Development to outline how it will achieve its commitment to improve WASH for 60 million people in its budget, how it will ensure that the neediest can be prioritised, even in volatile and difficult countries, and how it will take the lead in framing the goals for the post-2015 agenda and ensure that a goal for universal access to basic water and sanitation services remains a key priority.

I congratulate the hon. Member for Belfast East (Naomi Long) on choosing this subject for the debate. I should also like to thank the Minister, who I am sure has okayed my contribution this evening.

I speak as the co-chair of the all-party parliamentary group on child health and vaccine preventable diseases. The other co-chair is Lord Avebury. I tabled an early-day motion recently on this subject, and it now has quite a number of signatures. I am also vice-chairman of the Council of Europe public health committee.

Diarrhoea is the most common cause of childhood illness and kills about 760,000 children each year. Around 90% of those deaths are caused by a lack of access to safe water, adequate sanitation and hygiene. Those deaths are preventable. Vaccines against rotavirus, the most common and severe diarrhoea in children, are critical, and their availability is a major development in public health. However, those vaccines should not be seen as a silver bullet for tackling diarrhoea; nor can they address the other health impacts of a lack of sanitation.

Reducing deaths from the top killers of children requires the prioritisation of interventions across different sectors, including health, nutrition, hygiene, water and sanitation. We must apply the package of prevention and treatment solutions that we know to be effective, and this must be built on solid collaboration between health systems and the water and sanitation sector.

This was reinforced last year when I visited health care facilities in Bangladesh and Kenya, where we were launching a programme of vaccination. I witnessed extremely successful vaccination programmes in both countries, which were helping to protect children against terrible diseases such as pneumonia. During my visit, however, I was struck by the poor levels of basic sanitation and access to clean water at many of the health care facilities we visited. This emphasised to me how important it is to ensure that preventive measures such as vaccines are coupled with improvements in sanitation and access to clean water.

I also saw on these visits small wards packed with up to 25 children, with the mothers in the same ward. I saw three babies in one incubator, and I saw a single oxygen cylinder with five or six lines coming out of it. It is all the basic stuff that is missing there. The vaccination was great—it is absolutely superb—and the efforts of the medics and nursing staff in each of these hospitals was just brilliant. The common basic hygiene and sanitation, however, are just not there.

It so happens that I will be in Geneva tomorrow with the Earl of Dundee, who is the chairman of my Council of Europe committee. We are going to be in discussions with the World Health Organisation, UNESCO and the Global Alliance for Vaccines and Immunisation. The issue of sanitation is one that we want to raise, because this is a global problem that needs to be tackled globally. I wanted to make only a short contribution; I will be interested to hear the Minister’s response.

I thank the hon. Member for Belfast East (Naomi Long)for calling what I think is the second debate this year on this important issue. Making progress on the appalling world statistics on access to sanitation is vital to the health and well-being of poor people. I commend the hon. Lady for her efforts on this topic. If I may put it this way, I think she has become one of Parliaments supreme champions—if not Parliament’s main champion—on this issue.

It is truly shocking that in 2010, 2.5 billion people—nearly 40% of the global population—remained without access to the improved sanitation that would have protected their health. Even more shocking is the fact that 1.1 billion people have no form of toilet at all. This is why the UK Government have given sanitation such a high priority. The previous Secretary of State announced in April this year that the UK would increase its ambition and reach 60 million people with sustainable access to water, sanitation and hygiene. As I said in my speech in March, providing these services is the bread and butter of development. I have seen for myself in my visits to countries such as Yemen and Bangladesh, which the hon. Member for Heywood and Middleton (Jim Dobbin) has mentioned, how effective DFID sanitation programmes are on the ground.

On the commitment given back in April, I appreciate that we are just six or seven months on, but is the Minister in any position at all to tell us what progress has been made towards that 60 million target in 2015? Is progress really being made?

Since the announcement was made only recently, it is probably a little premature to report on progress because results come after the investment has been made in the area, but I undertake to keep the hon. Gentleman and the House fully informed of our progress. Through debates such as this, we will continue to treat this as a highly important topic.

We know the enormous impact that the lack of a basic toilet has on people’s health and livelihoods. People who do not have adequate sanitation are far more likely to get sick than those who do, and it is often young children who suffer the most. The World Health Organisation estimates that up to 2.4 million deaths could be avoided each and every year simply by providing good sanitation, safe water and good basic hygiene.

Poor sanitation does not only cause sickness. As the hon. Lady pointed out, women who lack toilets are at a much higher risk of sexual and other violence as they try to find secluded and private places. Without a decent toilet, women and girls cannot manage their menstrual periods privately and with dignity. Having nowhere to safely clean and dry their rags can lead to reproductive tract infections, which can be the most horrid things.

We know from the United Kingdom’s own history the importance of sanitation to the economy and health of our people. This very Chamber was closed during the “great stink” of 1858. Not long afterwards, improvement in the treatment of London’s sewage led to a great improvement in the health of our capital city. We also know from the World Bank that providing sanitation in poor countries will deliver broader economic benefits, and will mean that such countries do not suffer unnecessary economic losses. It has been estimated that countries lacking widespread access to sanitation lose between 1% and as much as 9% of their GDP every year.

The world is frequently faced with natural disasters. Last month, we saw Hurricane Sandy wreak havoc in the Caribbean before hitting the eastern seaboard of the United States. Floods, in particular, lead to disease because people have to live with dirty flood waters containing pathogens from waste that has not been disposed of. That is what leads to devastating epidemics of cholera and other diseases. Good sanitation is essential to reducing the unacceptable human cost of such disasters. It can be critical in helping communities to rebuild themselves more quickly after floods. Work supported by the Department for International Development during the 2010 floods in Pakistan showed that sanitation could really help a community to recover.

How can we start to tackle the huge unmet needs for sanitation? Well, we can start by listening to women. Sanitation is important to them, often much more important than it is to men. One study in Indonesia found that, in urban communities, women listed sanitation as their second priority for improving their communities—after improved job opportunities—while men ranked it seventh.

We need to foster and respond to demand. A latrine that is wanted is one that will be used and maintained. Approaches based on demand, such as a programme called Community-Led Total Sanitation, are proving very effective in ensuring the uptake of sanitation. We also need to keep sanitation simple. Expensive and water-hungry sewerage systems are not the answer if we want to improve sanitation for poor people. Simple technologies, such as pit latrines, are affordable and effective ways of providing the safe sanitation that we want to see.

As was mentioned by the hon. Member for Dumfries and Galloway (Mr Brown), the United Kingdom’s ambition is for 60 million people to have sustainable access to water, sanitation and hygiene in the countries that are furthest from meeting the millennium development goal. We have a strong track record of supporting those basic services. A portfolio review of water, sanitation and hygiene projects supported by DFID showed that UK aid in the sector was well targeted at the poorest.

The principal means by which the UK will meet our target of 60 million people is through programmes developed and managed by our offices in African and Asian countries. We currently have sanitation and water programmes in 15 countries. We are looking into how we can expand our existing programmes, and have already identified additional results that could be achieved in Ethiopia, Liberia, Sierra Leone, Tanzania and Zimbabwe. That builds on the successful experience of our country programmes. For example, our support in Bangladesh through UNICEF has reached more than 30 million of the poorest people in that country. We are continuing our support in Bangladesh by working through BRAC, a major national non-governmental organisation with a good record of helping the poorest. The Department also funds programmes to deliver improved sanitation through other interventions. For instance, in Yemen we are funding a nutrition programme, implemented by UNICEF, which will provide sanitation in 300 schools and benefit nearly 250,000 children.

We will achieve those results through a number of partnerships with organisations such as the Water and Sanitation Program, Water and Sanitation for the Urban Poor, and WaterAid. To complement those activities, we have been exploring the potential of new programmes to reach more people who currently lack access to sanitation, in more countries, through partnerships with the UN, civil society and the private sector.

In response to the hon. Member for Heywood and Middleton, the UK Government are the leading donor of the Global Alliance for Vaccines and Immunisation, which delivers new and underused vaccines to the world’s poorest countries. UK support alone will vaccinate 80 million children and save 1.4 million lives by 2015. GAVI will roll out the rotavirus vaccine as part of its programme, protecting against diarrhoea which, as the hon. Gentleman said, is one of the leading child killers in the world, accounting for 450,000 deaths each year. With UK support, GAVI plans to help the vaccination against rotavirus of up to 50 million children in at least 40 of the world’s poorest countries by 2015.

We need solid evidence to underpin our investments, and to that end the Department for International Development is funding key research programmes to improve our evidence base. The sanitation and hygiene applied research for equity programme is developing new and robust evidence on the benefits of sanitation, and on how sanitation and hygiene behaviours can be improved most effectively. The Department has started a new programme of operational research to improve value for money and efficiency in our programmes. As part of that, we will test and evaluate innovative ways of providing sanitation services to poor people in urban areas, in partnership with the Bill and Melinda Gates Foundation.

Support for sanitation is also about creating the right incentives for Governments to mobilise their own resources. In June this year, the UK Government sent a strong message of our political commitment with the recognition of the right to sanitation. The Government will place an emphasis on the delivery of basic sanitation services to poor people in the long term. We will continue to invest in programmes to provide sanitation, and use the Sanitation and Water for All partnership to encourage other donors, Governments in developing countries, and civil society to do the same.

I say to you, Madam Deputy Speaker, all hon. Members, and in particular the hon. Member for Belfast East who initiated this debate, that the Government will do their utmost in this area. I hope that Members of the House will continue to support us in that essential work.

Question put and agreed to.

House adjourned.