Soap, toilets and taps: How UNICEF supports water, sanitation and hygiene

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Soap, toiletsand tapsa oundation

or healthy childrenHow UNICEF sUpports watEr,saNItatIoN aNd HygIENE



t ble C n enI n t r o d u c t i o n

Global Access to Water and Sani ta t ion

WAS H Makes a D i erence

UNICEF’s Water, Sanitation and Hygiene Strategy

Good Hygiene is Cri tical to Good Health

A Toilet in Every Household

Improving Access to Sustainable Water Supplies

Ensuring Water Quality – in the Home and at the Source

WAS H in S chools

WAS H in E mergencies

WASH, Environment and Climate Change

Scaling up WASH

Soap, toilets and tapsa oundation

or healthy childrenHow UNICEF sUpports watEr,

saNItatIoN aNd HygIENE

UNICEF’ Mi i n

UNICEF is mandated by the United Nations General Assembly to advocate or the protection o children’s rights, tohelp meet their basic needs and to expand their oppo rtunities to reach their ull potential

UNICEF is guided by the Convention on the Rights o the Child and strives to establish children’s rights as enduring

ethical principles and international standards o behaviour towards children

Uni e N i n Millennium devel men g l

The Millennium Development Goals have been described by United Nations Secretary-General Ban Ki-moon as “ourcommon vision or building a better world in the twenty- rst century ”

In 2000, all 189 United Nations Member States committed to the Millennium Development Goals as well as to theMillennium Declaration Since then, the United Nations has expanded to 192 Member States and all are committedto the Goals and the Declaration

By 2015, all 192 United Nations Member States have pledged to:1 Eradicate extreme poverty and hunger2 Achieve universal primary education3 Promote gender equality and empower women4 Reduce child mortality5 Improve maternal health6 Combat HIV/AIDS, malaria and other diseases7 Ensure environmental sustainability8 Develop a global partnership or development

© United Nations Children’s Fund (UNICEF)February 2009

United Nations Children’s Fund3 United Nations PlazaNew York, NY 10017, USAWebsite: www unice org/

The interpretations expressed in this documentdo not necessarily re ect positions o the UnitedNations Children’s Fund



u NICEF’s long-standing support to improvingwater supply, sanitation and hygiene stems roma rm conviction, based on evidence, that these

are central to ensuring the rights o children to survive,grow and develop into healthy and ul lled citizens o the world In the broader context, UNICEF’s activitiesin Water, Sanitation and Hygiene (WASH) contribute tothe achievement o the Millennium Development Goals(MDGs)

While progress in water supply and sanitation is generallytracked through MDG target 7c – to halve, by 2015, theproportion o people without sustainable access to sa edrinking water and basic sanitation – the contributionWASH makes to other MDG targets, particularly relatedto child mortality, disease reduction, primary education,environmental sustainability, gender equality andpoverty reduction, is clearly recognized

The strong link with child mortality in particular isone reason why UNICEF, in its Medium Term StrategicPlan, has included WASH as a key component o across-sectoral package o high-impact interventions,together with health, nutrition, and HIV/AIDS, to achieverapid progress in child survival and developmentThis strong ocus on child survival and developmentis an organizational priority and, as such, has led tothe strengthening o the WASH component o UNICEFcountry programmes and renewed advocacy on inter-sectoral linkages with Governments and other partners

UNICEF also recognises the important contributionWASH makes to achieving the MDGs 2 and 3: to acuniversal primary education, and promote genderequality and empower women Having adequate anappropriate water supply and sanitation acilities inschools is a major actor in uencing whether childrand especially adolescent girls, attend school

UNICEF’s long history o practical support to watesupply in particular, dating back to the early 1960’s,given us a unique position o trust with our governmpartners in the countries in which we work Our paknow that they can rely on UNICEF to work with tha pragmatic and supportive manner UNICEF’s stanboth with government and ot her key sector stakeholenables us to play an important role in establishing maintaining the collaborations which are vital, in ormeet the challenges aced

UNICEF does not attempt to t ackle all the challengacross the broad spectrum which is the water supplysanitation sector There are some areas where we ha comparative advantage and track record o succesThere are other areas which are better covered by otorganizations This document outlines our activitiethose areas which are o key importance to UNICEoverall mission, against the overall perspective o tglobal challenges in water supply, sanitation, hygienand child survival and development It gives exampdrawn rom our work in A rica, Asia and Latin AmAnd it examines how UNICEF is preparing or newchallenges by building appropriate humans resourceleveraging partnerships and providing leadership wiand beyond the United Nations on water, sanitation hygiene

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Since 1990, 1 6 billion people have gained accessto sa e drinking water and 1 1 billion have gainedaccess to improved sanitation acilities There has

been a great deal o investment and notable progresshas been made However, the global community is stillunlikely to achieve the Millennium Development Goals(MDGs) target; to halve, by 2015, the proportion o people without sustainable access to sa e drinking waterand basic sanitation

The number o people who continue to su er rom a lack o access to improved water and sanitation is still ar toohigh The gures are well known: • More than 2 5 billion people, or 38 per cent o the

world’s population, lack adequate sanitation acilities• Almost one billion people still use unsa e drinking

water sources

The world is not on track to meet the MDG sanitatiotarget and A rica is o track or both water supplysanitation targets In A rica alone, 404 million mopeople will need to gain access to improved sanitatiand 294 million additional people require sa e wate2015 in order to meet the MDG targets

The number o people globally not using an improvwater supply has dropped below one billion Whilevery welcome news, attention now has to ocus on without access – most o whom are the poorest, moisolated and most marginalized

E orts must be increased and scaled up more e ectiand more quickly, to get back on track or reaching MDG targets And even i these targets are achievethe work o reaching every single person with imprwater supply and sanitation will need to continue

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Population to gain access to an improved sanitation acility annually (2006 - 2015) to meet the MDG sanitation tar

Source: UNICEF 2009, based on data in the WHO-UNICEF Joint Mon itoring Programme or Water Supply and Sanitation (JMP) 2008 Reportboundaries and the names shown and the designations used on these maps do not imply ofcial endorsement or acceptance by the United Nation

Source: UNICEF 2009, based on data in the WHO-UNICEF Joint Monitoring Programme or Water Supply and Sanitation (JMP) 2008 Report Note: Theboundaries and the names shown an d the designations used on these maps do not imply ofcial endorsement or acceptance by the United Nations

Population to gain access to an improved drinking water source annually (2006-2015) to meet the MDG drinking water target

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Me u in p e in w e su ln s ni i n

The WHO1 /UNICEF JointMonitoring Programme

or Water Supply andSanitation (JMP) is themechanism which tracksglobal progress towardsthe water supply andsanitation MDG targetsIn its 2008 report, theJMP highlighted the keyissues behind the globalcoverage estimates 2

t e s ni i n p c ice

The 2008 report breaks down the coverage gures intoour categories, i e people who:

• use improved sanitation• use shared acilities• use an unimproved acility• de ecate in the open

The results give some cause or optimism Signi cantreductions in the practice o open de ecation have takenplace in recent years, indicating that people are adoptingbetter sanitation practices

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The JMP also reports marked improvements in watersupply coverage between 1990 and 2006, resulting romimproved advocacy and increased commitment romthe global community during that time rame However,rural access to improved drinking water sources remainslow O the global population using unimproved sourceso drinking water, 84 per cent are rural inhabitants (746million people) In urban areas there is some concernthat coverage is not keeping pace with urban populationgrowth From 1990 to 2006 the world’s urban populationgrew by 956 million people, whereas use o an improvedwater supply in urban areas grew by only 926 million, i e30 million ewer

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The gures below show the changes in use o drinking water sources rom 1990 to 2006, or the various regionso the world 42% o people in Sub-Saharan A rica still use an unimproved source

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The gures below show the changes in use o sanitation acilities rom 1990 to 2006, or the various regions o the world In both A rica and Asia, big reductions in the practice o open de ecation have been seen

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t he immediate bene ts a householdreceives rom using an improved watersupply and improved sanitation make

achieving the MDG targets or water supplyand sanitation a highly worthwhile aim in itselHowever the impact o using sa e drinkingwater, basic sanitation and improved hygienepractices goes way beyond the convenienceo having the acilities WASH makes a majordi erence particularly in health, educationand socio-economic development WASH is asigni cant actor in terms o achieving almostall o the Millennium Development Goals

C e Evi ence wasH

Recently there has been considerable researchocus on the impacts o WASH, particularly in

terms o its contribution to reducing majorchildhood illnesses, such as diarrhoea andpneumonia, as well as the cost-e ectiveness o WASH programmes The evidence, researchedby highly respected academics and publishedin major research journals, such as The Lancet,makes a compelling case or investing in WASH

achievin he Mdg e e un ni i n h i e- n in bene 5

Below are some examples o the bene ts expected romachieving the MDG targets or water supply and sanitatio

Ec n mic bene• Total payback o US $7 40 per year or each US $1 p

year invested• 320 million productive days gained each year due to

improved health•

Time savings o 20 billion working days per year rommore convenient water supply and sanitation services

M e he l h chil en• 272 million school-attendance days gained each year

due to improved health• 1 5 billion additional healthy days each year or childre

under ve

Handwashing with soap

Household water treatment

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Source water treatment

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% reduction in morbidity rom diarrhoeal d

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MDG 4 – to reduce by two-thirds, between 1990 and2015, the under- ve mortality rate among children – isthe main ocus or UNICEF’s cross-sectoral approach tochild survival and development Together, the Health,Nutrition, HIV/AIDS and WASH programmes in UNICEFsupport a package o interventions that have the highestimpact on young child health

WASH also has signi cant impact on education outcomesand the achievement o MDG 2 – to achieve universalprimary education As will be described later in this

document, schools without adequate water supply andsanitation acilities are not able to o er their pupils themost supportive learning environment

As children grow into adults, the importance o improvedhygiene practices and use o sa e drinking water andbasic sanitation remains Recent evidence on the positiveimpact o handwashing by mothers and birth attendantson the survival rates o new-born children is just o neillustration o the importance o WASH throughout theli e cycle

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Ne b n in n Handwashing by birth attenbe ore delivery has been shto reduce mortality rates by19 percent, while a 44 percereduction in risk o death w

ound i mothers washed thhands prior to handling theinewborns6

Chil en un e ve e Poor WASH causes diarrhoeis the second biggest cause

death in children under ve Diarrhoea is an immediate cundernutrition

sch l- e chil en Children pre er to attend schaving adequate and privateWASH acilities Schools excellent opportunity or chto learn about hygiene pract

ol e i l Giving girls the knowledge acilities necessary or goo

menstrual hygiene is key totheir dignity, their privacy, teducational achievement, anhealth

M he n c e ive Handwashing with soap at ctimes is important or protethe health o the whole ambeing a role model, motherscare givers can also help instheir children the good hygipractices which will serve thli e

Chil en in eme encie During emergencies, childreespecially vulnerable to the o inadequate access to watsanitation services WASHcomponent o any emergenresponse

In p c ice...In Casamance, Senegal, a long-running c ivilinsurgency has made li e unstable or thelocal population UNICEF is working to ensurethat children can attend and stay in sa e,healthy schools through the ‘Building or Li e’programme

Construction o water points and separatetoilets blocks or boys and girls are a core

eature o the programme But the programmedoes ar more than simply provide acilities As the name implies, ‘Building or Li e’ bringsbene ts that will help keep children in schools, keep them healthy and give them skills whichwill help them in their lives and pass on to uture generations Students are taught skills thatinclude stress management and con ict prevention, environmental awareness, and health andhygiene practices

The programme’s bene ts reach ar beyond the basic WASH needs o the school day Theschools receive ood rations rom the World Food Programme, and the available clean watermakes it easier or the roster o volunteer mothers to prepare the daily meal and wash up

a terwards The water points also constitute an emergency stand-by or the community intimes o drought The toilet blocks are open or use outside o school hours by members o households who do not yet have their own household toilet — so long as they leave the cubiclesclean The high level o community involvement not only helps ensure that acilities will bemaintained into the uture, but also that the hygiene practices learnt by the children at school areadopted by the whole amily in the home

In this region o insecurity, revitalizing the schools helps in building a peace ul and vibrantcommunity, an essential oundation or a healthy and productive li e

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UN Secretary-General Ban Ki-moon speaks at the First Preparatory Meetingon the International Year o Sanitation 2008, at UNICEF House

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in its work in water, sanitation and hygiene, UNICEFdelivers long-term results by working closely withdeveloping country governments, bilateral agencies,

NGOs, the private sector, communities and householdsOur global WASH strategy aims to maximize the impactand sustainability o our own interventions and thee orts o the sector as a whole

UNICEF’s WASH Strategy was approved in 2006 andis valid up to 2015, the target year o the MDGs TheStrategy has two key targets: achievement o the MDGtargets or water supply and sanitation, and ensuringall schools have adequate water and sanitation acilitiesand hygiene education programmes The Strategy setsout three key areas o intervention, which togetherlead to the achievement o enhanced child survival anddevelopment, namely:

• Enabling Environments: ensuring policy, capacity, aviable private sector, partnerships and decentralizedmanagement are all in place to acilitate sustainableaccess to water and sanitation

• Behaviour Change: supporting the improvement o sustained hygiene, water sa ety and environmentalsanitation practices by users

• Water and Sanitation Services: greater choice ando sa e and reliable water supplies and clean, prisanitation acilities in households, communities aschools

UNICEF is putting a high priority on building up itsprogrammes in 60 countries with high child mortaliand low WASH coverage These countries are mainA rica, South Asia and East Asia WASH activitiecontinue to take place in another 36 countries, or ao 96 country WASH programmes

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Within the United Nations system, UNICEF workswith sister agencies on a variety o programmingcollaborations The UN Water inter-agency mechanis promoting more coherent approaches par ticularlyat the global level At the country level, UNICEFprogramming takes place within the context o theUnited Nations Development Assistance Framework(UNDAF) and, increasingly, the ‘One UN’initiativealso collaborates particularly closely with t he WaterSanitation Programme (WSP), the World Bank and A rican Development Bank

Based on the United Nations world map The boundaries shown on this map do not imply ofcial endorsement oracceptance by the United Nations

UNICEF’s 60 p i i C un ie wasH p mmin

UNICEF’ w e , s ni i n n H iene s e




The UNICEF Global WASH Strategy includes the ollowing principles which guide our WASH programming

1 ri h -b e mmin .WASH strategies and programmes will be guided by a rights-based approach2 w kin in-c un , i h ve nmen . The primary ocus will continue to be supporting governments, in the

context o their Poverty Reduction Strategy Plans (PRSPs) and sector-wide approaches (SWAPs), through theUNICEF country programme process and the UNDAF

3 w kin i h ne evel inn v ive che n leve e e u ce .UNICEF will use its positionas a lead WASH agency to encourage greater coordination and collaboration, improve knowledge management,use and sharing, and actively leverage resources or the sector

4 gen e . Women and girls have a central role in WASH, as the main providers o domestic water supply andsanitation and as maintainers o a hygienic home environment UNICEF will advocate or the ull involvement o women, particularly in decision-making roles, in all WASH activities

5 p - che .Meeting the rights o the poor to WASH is at the heart o the UNICEF mission UNICEFwill undertake concerted e orts in advocacy or the development o improved poverty-speci c approaches andimproved monitoring and mapping to identi y and e ectively reach the poor

6 Evi ence-b e v c c n mme e i n. UNICEF will aim to ensure that programme designs arebased on the best available in ormation and knowledge and that advocacy is based on rigorously analysedevidence

7 Le nin -b e che ui e b efec ive kn le e m n emen . UNICEF will seek to use its role as asector leader to encourage an open, enquiring and learning-based approach to providing WASH services to thepoor and will also support the consolidation o quality sector knowledge, both nationally and globally

UNICEF wasH gui in p inci le

UNICEF has important partnerships with key bilateralagencies and unding oundations, mobilising resourcesnot only to support UNICEF programmes but also

or the sector in general, within the mechanisms orharmonisation o aid assistance UNICEF also partnerswith many o the NGOs active in the sector, such asWaterAid and Plan International, at both global andcountry levels There are also partnerships with theprivate sector at both levels, a good example being theGlobal Public Private Partnership or Hand Washing withSoap

At country level our primary partnership is with thecountry government All UNICEF activities take placewithin the ramework o programmes o cooperation,which are developed jointly by the country governmentsand UNICEF This joint-planning process withgovernments ensures that UNICEF’s contribution tothe sector is strategic and ocused on using UNICEF’scomparative advantage to achieve the best results orthe sector Increasingly, the planning process or UNICEFcountry programmes is a sub-set o the broader sectordevelopment process, thus minimising the transactioncosts o working with UNICEF

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Beyond UNICEF’s contributions to improving WASH inindividual countries, UNICEF is also a global leader in thesector UNICEF’s position as Coordinator o UN Water’sTask Force on Sanitation enabled us to be a driving orcebehind the International Year o Sanitation (IYS) in 2008Together with WHO, we manage the Joint MonitoringProgramme or Water Supply and Sanitation, monitoringprogress towards MDG target 7c UNICEF is also the leadagency or the IASC (Inter-Agency Standing Committee)WASH Cluster, with major responsibilities or improvingglobal capacity to ensure adequate sa e water suppliesand sanitation during major natural and man-madeemergencies

UNICEF is committed to supporting the community in strengthening the evidenc

base and providing the data required oradvocacy and action We work closelyother partners to support coordinated resinto the impact o WASH interventionsincludes contributing to the Child HealthEpidemiology Re erence Group (CHERengaging with the London School o Hyand Tropical Medicine and other academinstitutions or urther research

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a ccess to improved water and sanitation acilitiesdoes not, on its own, necessarily lead to improvedhealth Evidence shows that handwashing with

soap is the single most e ective WASH intervention orreducing diarrhoea, the second leading cause o deathamongst children under ve years old Good hand-washing practices have also been shown to reduce theincidence o other diseases, notably pneumonia andother respiratory diseases, trachoma, scabies, and skinand eye in ections The promotion o hand-washing withsoap is also a key strategy or controlling the spread o Avian In uenza

Community awareness o the importance o handwashing can be quite high, however the challengeis to establish handwashing as a routine practiceper ormed in homes, schools and communitiesworldwide The key to increasing handwashing withsoap is to motivate behavioural change through a varietyo processes

Multi-media campaigns, community participation anacilitation, peer-to-peer education techniques, li e

skills-based hygiene lessons or school children, anthe encouragement o children to demonstrate goodhygiene to their amilies and communities are someo the components o UNICEF’s hygiene promotioprogrammes Involvement in hygiene promotionactivities can provide basic li e skills that help womand children build their con dence and becomeempowered in other areas o their lives

n p c ice...Ghana, a Public Private Partnership or the

Handwashing with Soap Programme” has resulted in a1-62% increase in handwashing with soap be ore eatinghis joint e ort involves many partners, including theovernment’s Community Water and Sanitation AgencyCWSA), the World Bank, UNICEF, WaterAid, and Unilever

In p c ice...In Bangladesh, Shamina is a hygienepromoter, trained with UNICEFsupport and now working in hercommunity to help people improvetheir hygiene practices Shaminacomments, “Be ore this job I didn’trealize I could do anything Now Iwant a high-level managerial jobThe hygiene work gave me thecon dence that I can do it i I want ”

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The rst-ever Global Handwashing Day was launched on15th October 2008 This multi-partner global awareness-raising initiative was celebrated in 85 countries, withlarge and small events o ten involving the participationo children The ocus o Global Handwashing Day wason schools and school children Manycountries used it as an opportunity

to raise awareness and to launch year-round programmes in schools GlobalHandwashing Day is now set to become an annual event

In A ghanistan, or example, children promoted handwashing in televisionspots; in Bolivia, community handwashing airs were held; and in Yemen,mobile phone messages reached a million people In India, over 100 millionchildren signed pledges to wash their hands with soap be ore their mid-day meal And in Bangladesh, in one school, 1213 school children set theGuinness World Record or simultaneous handwashing with soap

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Sustaining hygiene behaviour change on a large scalerequires a multi-dimensional approach UNICEF is anactive member o the Global Public-Private Partnership

or Handwashing with Soap, which is a global initiativeaimed at promoting the use o handwashing with soap indeveloping countries Other members o the partnershipinclude the World Bank, the Water and SanitationProgramme, Academy or Educational Development,London School o Hygiene and Tropical Medicine, USAID,Bank-Netherlands Water Partnership, and various privatesector organisations The aim is to use public-privatepartnerships to promote handwashing with soap,implement large-scale handwashing interventions, anduse the lessons learnt to promote the approach on aglobal basis

Increasingly, UNICEF is working aroundthe world with private sector partners inrecognition o the key role they play inmaking soap widely available and creatingdemand or it At country level, UNICEFworks with national and multinational soapmanu acturing companies and marketingagencies in handwashing promotioncampaigns Harnessing the distribution

networks and marketing expertise o the private sector creates opportunitiesto work at scale At the global level, weare engaged with the private sector in anumber o ways, including an initiativewith Unilever to better understand whattriggers the behaviour change needed toincrease routine handwashing with soap

p iv e sec p neGlobalHandwashing Daywas celebratedacross primary andsecondary schoolsin Mongolia andlaunched new

e orts to change handwashing behaviour At onelocal primary school, a high-pro le, day-long event

was conducted and televised at schools in more thanten districts Drama and puppetry were per ormedby teachers and children to demonstrate theimportance o hand washing with soap Across thecountry, school children watched the televised mainevent and took part in various drawing and songcompetitions The drama and puppet show are nowregularly per ormed or young audiences

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improved sanitation will contribute to the preventiono the 1 75 million child deaths due to diarrhoeaeach year S anitation also contributes to reducing

malnutrition in children, improves the quality o li e anddignity o girls and women, protects the environment,and generates economic bene ts or communities andnations

En in o en de ec i nIn recent years, a number o organizations haveintroduced various community-based approachesto achieving sanitation improvement These includethe Total Sanitation approach led by the Governmentin India, School-Led Total Sanitation (SLTS) in Nepal,and Community-Led Total Sanitation (CLTS) in severalcountries, including India, Bangladesh and Zambia Theseapproaches ocus on the elimination o open de ecationin the community, developing an understanding in thecommunity that poor sanitation a ects everyone, andthat a collective approach is required Through suchinitiatives, communities have been able to achieveremarkable progress with very limited external support,including the elimination o direct hardware subsidies tohouseholds

UNICEF believes that the best approach to achieve open-de ecation- ree communities will vary rom country tocountry, depending on the conditions and culture Basedon the experiences to-date with the various community-based approaches, UNICEF has developed a set o basicprinciples or Community Approaches to Total Sanitation(CATS) Using these principles, sanitation programmes

can be tailored to the speci c context in a particularcountry UNICEF is using this approach to supportsanitation programmes in some 30 countries in Asia,A rica and Latin America

Worldwide application o these community approacheshas the potential to trans orm the rate o progress insanitation and bring the MDG sanitation target withinreach UNICEF is now working closely with governmentsand other partners in many countries to mainstream theapproach and make real impact at scale

policy nd advoc cy

To stimulate a rapid but sustainable expansion i n nationalsanitation programmes, UNICEF helps governmentpartners establish appropriate enabling environmentsincluding progressive policies, strategies, undingmechanisms and enhanced institutional capacity

Our advocacy work is based on documented evidence thasanitation programmes can be success ully implementedcan be scaled-up and can make a di erence in people’slives Building up the evidence base is being done inpartnership with key sector institutions, in a variety o country studies and applied research initiatives Forexample, in South Asia we are studying how water andsanitation in schools impacts the inclusion o childrenwho belong to groups perceived as being socially‘unclean’, including menstruating girls, and chil dren withcommunicable diseases

A woman in Zambia uses a trowelto smooth the cement slab of a newlatrine cover she is building.

In p c ice...In Pakistan, UNICEF supported pilotinCommunity Led Total Sanitation (CLTMardan District o the North West FroProvince Based on the experiences opilot project, the Government included

promotion o CLTS as one o the keyelements o the National Sanitation PoCurrently, CLTS is being scaled-up in aprovinces and regions o the country wthe support o the Government, UNICWater and Sanitation Programme-SoutAsia, WaterAid, Rural Support ProgramNetwork and other partners

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A boy, who uses awheelchair, leaves anewly built latrine nearhis home in BantulDistrict, Indonesia He isassisted by his mother

technologic l Innov ion

Improved Toilets for the Disabled Many toilets are too small to be easily used by disabledpeople, who o ten require an attendant to assist themFurther, as many disabled people cannot stand, the standardsquat plates used in many countries pose signifcanthygiene problems, as there is no clean area or the personto sit UNICEF works with governments, NGOs, schools andcommunities to address the challenges aced by the disabled

During the reconstruction ollowing the Yogyakartaearthquake in Indonesia, UNICEF worked with GermanNGO Arche noVa to build 90 wheelchair-accessible latrinesCurrently in India, UNICEF is developing a practical manual

or the construction o disabled- riendly toilets or schools,which will be adopted by state governments

Ecological SanitationUNICEF participates in the Sustainable Sanitation Alliance,which promotes more sustainable, ecological approachesto sanitation Ecological sanitation aims not only to acilitatethe sa e disposal o human excreta but to do so in a waythat enables the recycling o the nutrients ound in humanwaste To-date UNICEF has supported small-scale pilot work on ecological sanitation in several countries and continues towork with members o the alliance to fnd ways in which theapproach can be used on a larger scale in a cost-e ective andculturally acceptable manner

In p c ice...In 2007 UNICEF helped devise a new rural sanitation policy in Eritrea, a country which currhas a very low sanitation coverage rate In recent years we have strengthened national trainininstitutes (in DR Congo, Viet Nam and other countries), helped to establish new sanitationcoordination mechanisms (such as in Sudan and Nigeria), and supported decentralizationinitiatives through the strengthening o local government capacity (in Indonesia, Colombia aelsewhere)

In p c ice...In 2007 in South Asiaalone, more than 10,000villages across the sub-region were declared ree

rom open de ecationand more than 15million latrines werebuilt through initiativessupported by UNICEFand other partners

UNICEF’s position as Coordinator o UN Water’s Task Forceon Sanitation enabled us to be a driving orce behind theInternational Year o Sanitation (IYS) in 2008 – a one-timeopportunity to put sanitation rmly on the map Ministerialsanitation con erences were held in East Asia, South Asia,A rica and Latin America – going a long way to in uencegovernment decision-makers For example at the A ricaSAN2008 Con erence, A rican ministers signed the eThekwiniDeclaration in which they aspire to allocate a minimum o 0 5% o GDP to sanitation and hygiene At country level,IYS-related initiatives helped to put sanitation on thenational and community development agendas UNICEFand our partners are now using the results and momentumo IYS as a springboard or uture action

INTERNATIONAL YEAR

SANITATIO

2008In p c ice...Community Led Total Sanitation (CLTS) in Zambia, spearheadedby UNICEF, has helped sanitation coverage increase rom 38%

to 93% across 517 villages during 2007 402 o the villages havebeen declared Open De ecation Free Over 14,500 toilets wereconstructed by households with no hardware subsidy andapproximately 90,000 people gained access to sanitation in lessthan a year It is estimated that 88% o toilets met the Government’sde nition o ‘adequate’ sanitation and 76% had hand-washing

acilities The approach has accelerated access to sanitation ar aster than previous sanitationapproaches (which used direct hardware subsidies) and has enabled communities to recognizethat they can make progress using their own available resources

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in 2006, or the rst t ime since monitoring o globalwater supply coverage began, the number o people in the world without access to an improved

water supply dipped below the one billion mark 8Nevertheless, with around 900 million people still inneed o access, much remains to be done Helpingpeople gain access to a sa e and convenient watersupply remains a key aspect o UNICEF’s WASHprogrammes The challenge goes beyond theprovision o new water points, with concerns oversustainability and water quality coming increasingly tothe ore ront

As with sanitation, UNICEF supports both the provisiono water supply services and the development o national enabling environments essential or scalingup and sustaining services UNICEF has built up areputation as a trusted partner, having worked inmany countries or over orty years This gives usaccess to the key policy-level discussions, such asSector-Wide Approaches (SWAPs), and the ability toin uence the use o the much greater resources o governments, multilateral development banks, private

unding oundations and others

In p c ice...In Bangladesh, only women tend to remaithe home during the day and it is not normacceptable or men to visit who are not pa

the close amily Since men have traditibeen engaged as pump repair mechanics, thas made repairing household handpumpsproblematic Through UNICEF-supportecommunity-based training o women as pmechanics, handpump maintenance hasimproved The women mechanics have agained an opportunity to earn income and their status in the community rise

In p c ice...UNICEF Zambia has supported indigenouprivate sector development or sustainabloperation and maintenance o water suppsystems by establishing Artisan AssociatioEach Artisan Association is required toregister with the National Registrar o Societies and the local authority providesa certi cate o letter o recognition so thathey are a ormally recognized entity Arhave been trained to improve technical skimarket their services, and sustain serviceprovision o high quality In some districthe average downtime o handpumps hasbeen more than halved and the number ocommunities approaching the local counciseek repair services has reduced dramatica

Im vin acce su in ble w e su lie




Inn v ive a che

UNICEF has a history o supporting key innovations in thedevelopment o rural water supply technology and ourcommitment to develop new and improved appropriateoptions continues For example, in sub-Saharan A rica, asubstantial increase in the number and pace o boreholesinstallations is required in order to meet the MDG targetson water supply UNICEF is working with key partners,such as the Rural Water Supply Network (RWSN), todevelop new methods o low-cost drilling to make iteasier or local drilling contractors to start up and operateas viable businesses UNICEF is also working closely withGovernments so that the new methods can be acceptedand mainstreamed in order to make an impact at scale

Through its WASH Section and Supply Division, UNICEFis also working to review the A rican handpumpmarket and explore ways in which it can operate moree ectively, to make pumps more a ordable, supplychains stronger, and repair and maintenance tasks easier

Ch llen e su in bili

Sustainability o community water supplies remains amajor challenge In some countries breakdown rateso ten exceed 50 per cent UNICEF is working with severalpartners to address the complex challenges aced,including the development o more e ective spare-partssupply chains, and introducing more realistic communitytari schemes to und operation and maintenance Weare also working with RWSN to explore alternatives tocommunity management o water points, to see i othermodels or ownership or operation and maintenancemight lead to a higher degree o sustainability

In p c ice...In much o A rica, boreholes are expeto drill and the number o boreholesdrilled per year is low This is sometimdue to the use o inappropriate heavydrilling rigs, when cheaper manual driltechniques would sufce UNICEF hasengaged hydrogeology consultants tomap out the potential areas or manualdrilling in 20 countries in A rica In CNigeria, Senegal, Niger and MadagascUNICEF has already seen small-scalemanual drilling enterprises develop viabusinesses, thus increasing the capacitythe sector to drill the boreholes that Aso urgently needs

Shiela, 25, who is nine months pregnant, walks to collect waterin Madhya Pradesh State, India She fetches water up to tentimes a day, and seldom has time to rest Proper rest is essentialfor optimal weight gain during pregnancy and healthy i nfantbirth weight

d u e n l uni ieAll over the developing world, women and girls spend hours everyday hauling water or their amilies rom distant sources This takesa physical toll on women over time, especially pregnant womenwho rarely get the chance to rest due to their water collectionresponsibilities Further, the several hours a day a woman spends

etching water are hours she might otherwise spend on activitieswhich could raise the quality o li e or hersel and her amily

UNICEF supports initiatives which bring water closer to where peoplelive, making the task o etching water quicker, easier and sa er






su in w e Qu li s em

At national and global levels, UNICEF supportsgovernment e orts to address water quality concerns ina systematic ashion For example, UNICEF produced ahandbook on the basics o arsenic mitigation, as well ascommissioning an expert report on the likely globalextent o arsenic contamination o water supplies Thesetwo publications are being used to alert countries as towhether they might ace a potential arsenic problem,and steps they can take to ascertain the extent o anyproblems and how they might mitigate the impact

We are also working with our government partners tocomplement their water quality testing programmeswith the more risk-based approach o using watersa ety plans, as promoted in the latest WHO Guidelines o Drinking Water Quality9

In Bangladesh, UNICEF supported the testio over one million hand pump installations

or arsenic contamination Those with arselevels less than the Bangladesh standard wepainted with green spouts Those with highlevels were painted red

In p c ice...In Guinea, UNICEF has developed a stpartnership with the non-governmentalorganization PSI or the production ochlorine or household treatment o water The partnership has resulted innationwide publicity campaign, includihygiene messages, the creation o a nanetwork o sales points, and the sale omore than 350,000 bottles o “SurEau”

E ic in guine w mGuinea worm disease is a pain ul, debilitating disease,contracted when people drink water rom contaminatedponds or wells Since the mid 1980s, a global coalition oorganizations, including UNICEF, has worked towards thegoal o eradicating guinea worm From over 3 5 million cworldwide in 1986, there were only 10,053 cases reportedin 2007 The goal o eradicating guinea worm disease is nwithin reach The lessons learnt during the guinea wormcampaign, with its key emphasis on ensuring householddrinking water sa ety, can be used to help scale up otherprogrammes tackling water quality problems




inadequate water supply and sanitation acilitiesin schools, not only are a health hazard, but alsoa ect school attendance, retention and educational

per ormance Reliable data showing the global coverageo water supply and sanitation acilities in schools is notavailable However the limited data collected in a ewcountries in A rica and Asia has ound that adequate

acilities exist in maybe less than one third o schoolsField experience in most UNICEF programmes tends tosupport this view

The target o ensuring that all schools have adequatechild- riendly water supply and sanitation acilities andhygiene education programmes by 2015 is the secondkey target o UNICEF’s Global WASH Strategy Thetarget has also been endorsed at the World Summit onSustainable Development and by the Commission orSustainable Development

By the end o 2007, UNICEF was supporting WASH-in-schools activities in 86 countries in all regions where wework, double the number o countries in 2002 In 2007alone, we helped to equip a total o 12,588 schools withwater and/or sanitation acilities, bene ting an estimated3 6 million school children

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In p c ice...In Malawi, India, Viet Nam and other countries, child- riendly sanitation designs developedwith UNICEF support have been adopted as the government standard UNICEF and partnersdemonstrate new technologies in schools – such as ecological sanitation toilets and roo toprainwater harvesting systems – taking advantage o the receptiveness o children to new ideasand the visibility o schools within communities

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In p c ice...In 2006, UNICEF began piloting a ‘WAin-Schools’ initiative in 50 Child- rienSchools in China Within two years, a50 pilot schools were teaching hygieneeducation and 22 had built school latrinwith hand washing acilities, bene tin15,000 students Though the initiativesmall, it was success ul, enabling UNIto advocate or the government to expathe programme The model has beenadopted by several local governments,and the Chinese Ministry o Educationincluded WASH-in-Schools as part o Child Friendly School National Standa

In p c ice...In Bangladesh, UNICEFadvocacy helped ensurethat WASH in schools wasincluded in the revision o the sector-wide approach

or primary education

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Im ve de i n

Together with our partners, and with the participationo children themselves, we also help to develop locally-appropriate child- riendly toilet and handwashing acilitydesigns that incorporate key criteria such as privacyand security or girls and user- riendliness or smallerchildren In particular, in Malawi and Kenya, UNICEF isworking with school girls on the design o appropriateurinals These can be a cheap and e ective way o increasing the number o acilities available to girlsduring recess

wasH-in-sch l all Level

Local UNICEF supports the strengthening o WASH-in-schools,though provision o acilities, planning and developmento operation and maintenance systems with schoolmanagement committees and local communities,training o teachers, and hygiene promotion or teachersand children

National UNICEF supports national policy development,establishing monitoring systems, developing designstandards or water supply and sanitation systems,hygiene education curriculum development UNICEFalso supports advocacy to ensure adequate governmentsupport or WASH in schools, including allocation o budget

Global UNICEF works with partners to increase political andpro essional support or school WASH initiatives throughparticipation in key education sector processes suchas Education or All (EFA) and the UN Girls’EducationInitiative (UNGEI), through the sponsorship o school-themed side meetings at major WASH sector orums

(such as during the Stockholm Water Week meetings andthe World Water Forums) and through the organizationo stand-alone events such as the 2005 Ox ord WASH inSchools Roundtable Global meeting

a equ e wasH F cili ieKee gi l in sch l

Adolescent girls are especially vulnerableto dropping out as many are reluctant tocontinue their schooling because toilet andwashing acilities are not private, not sa eor simply not available When schools haveadequate acilities – in particular ones that

acilitate menstrual hygiene – a major obstacleto attendance is removed In India andBangladesh innovative menstrual hygieneprojects have demonstrated how this issue canbe incorporated into broader WASH-in-schoolsinterventions and how women and girls canbe empowered through improved menstrualhygiene management




UNICEF re n in Eme encie

Humanitarian emergencies, be they rapid onset, chronic,natural or man-made, inevitably cause disruption tobasic services People are less likely to be able to drink sa e water, use basic sanitation acilities and maintainimproved hygiene practices In recent times this hasbeen experienced even in developed countries, or

example during the 2007 oods in England and the 2005Hurricane Katrina in New Orleans, USA

Children, especially those under the age o ve, areparticularly vulnerable to the diseases which can resultduring emergencies These diseases include diarrhoea,cholera, typhoid, respiratory in ections, skin and eyein ections, which are all likely to occur when watersupplies and sanitation services are disrupted

UNICEF has a major role to play in responding toemergencies Our ocus is on protecting and assistingchildren and women, ensuring that their rights are

ul lled even under emergency conditions In itsCore

Commitments for Children in Emergencies , UNICEF hout minimum standards o response or any emergsituation These describe the li e-saving actions whUNICEF will take within the rst six-to-eight weekan emergency, along with the longer-term role in thesubsequent weeks and months Responding to watesupply, sanitation and hygiene needs is a key compoo the Commitments Given our long-standing prein a large number o countries in the world, to getheour long experience o supporting water, sanitationhygiene activities, UNICEF is uniquely placed to suthe WASH sector response to any emergency

In recent years UNICEF has seen the number and scemergency WASH interventions increase signi canta point where t he expenditure on emergency responmakes up more than 40% o UNICEF’s total globalexpenditure on WASH Recent responses have inclthe 2004 Tsunami, the 2005 Pakistan earthquake andSouth Asia oods o 2007, as well as chronic emerin Dar ur, Sudan and the Democratic Republic o C

In p c ice...In North Sudan, UNICEF has worked closely with sector partners to tackle the recurring problemo cholera and acute watery diarrhoea (AWD) The partnership instituted a programme o improved chlorination o water supplies, hygiene education and ensuring availability o suppliesand capacity to respond quickly to any outbreak As a result, the number o cholera/AWD casessigni cantly reduced rom 9,973 cases in 2006 to 335 cases in 2008 and number o deaths rom362 to 16 in the same period

The results have been even better in Dar ur, where no cholera or acute watery diarrhoea caseswere reported in 2007 and 2008, despite the difcult working conditions This result has beenmade possible through continuous advocacy with the government, a coordinated response by allsector partners, coordination between health and WASH sectors, and timely unding rom donorand government

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IasC gl b l wasH Clu e Le

Within the overall context o re orm o the UnitedNations system, the Inter-Agency Standing Committee(IASC) adopted a ‘Cluster Leadership’ ramework, aimed atproviding more clarity and predictability in humanitarianresponse during emergencies Nine sectoral clusters weredesignated, each with a lead agency, with UNICEF beingchosen as the lead agency or the WASH Cluster Thesystem came into e ect on 1 st January 2006

Since then, UNICEF has been working with clusterpartners to increase global capacity or WASHcoordination and response in emergencies, as wellas providing WASH Cluster leadership during majoremergencies which have occurred Through learningand re ection, the cluster system has enabled a processo continual improvement in WASH Cluster responseThis is now being taken orward through a series o training programmes or cluster members around theworld, as well as the preparation o toolkits and guidancedocuments To-date, the WASH Cluster has been active inemergencies in over 22 countries

Eme enc p e e ne

Preparedness is critical i UNICEF is to live up to thecommitments it makes to protect and assist children andwomen during emergencies Emergency preparednessand response planning takes place regularly within everycountry ofce The response plans include: emergencysta deployment; pre-positioning o strategic supplies;development o long term agreements with bothsuppliers and implementing partners (such as watertrucking providers); advance coordination arrangementswith government counterparts and other sectoralstakeholders Our longstanding presence in-countryand strong relationship with government enable us toplay an important role in the development o nationalpreparedness and response plans Our position as WASHCluster Lead Agency rein orces the need or us to beactive in supporting governments to strengthen countrypreparedness or emergencies

UNICEF has developed a list o essential WASHemergency supplies, to be held in stock orrapid deployment in order or UNICEF tomeet its Core Commitments or Childrenin Emergencies These e orts complementa broader ongoing initiative by the IASCGlobal WASH Cluster to map existing WASHstockpiles maintained by UN agencies, NGOs,governments and other respondents

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e nshrined in the Convention on the Rights o theChild is the right o children to have access to a sa ephysical environment Ensuring environmental

sustainability is one o the Millennium DevelopmentGoals (MDG 7) UNICEF works to ensure its activities areimplemented in an environmentally sustainable manner,and we are committed to integrating environmentalconsiderations in both our development and emergencyprogramming

Climate change is one o the greatest environmentalchallenges acing the global community, and will havea worldwide e ect on water sustainability, which in turnwill impact child health and wellbeing Water stress andwater scarcity will occur due to changes in the seasonalrain and snow patterns, coupled with increased demanddue to continued population growth There is emergingevidence that climate-induced changes in temperatureand precipitation patterns will increase water-relatedin ectious diseases, especially diarrhoeal diseases Inaddition, there is already evidence that climate change isresulting in rising sea levels, increased cyclonic activity,and increased intensity and requency o oods anddroughts

These outcomes add urgency to UNICEF’s mandateto address the water, sanitation and hygiene needs o the vulnerable We see our actions alling into severalcategories:

C n l i h e l i e e– already a oundationo UNICEF’s work in WASH, this takes on even moresigni cance in the ace o predictions that diarrhoealdisease may become more widespread Sa e water,adequate sanitation and good hygiene practices will bevital to protect communities

Eme enc e e ne n e n e– willbecome even more important in the light o increasingoccurrences and greater severity o natural disasters,such as oods and cyclones

a en i n e u in bili i ue- waterextraction must consider current and potential waterstress, and sanitation must be planned to protect watbodies rom contamination UNICEF is developinways to include these considerations in all WASHprogramming This has particular signi cance oras much o our programming has, in the past, beenbased on groundwater We must be especially sensito the sustainable use o this resource

a i n e ie– predictions o increasedrain all variability open up new opportunities or ce ective, efcient and sustainable water technologiessuch as rainwater harvesting and storage through rocatchment and arti cial recharge o aqui ers

re ucin c b n in – long term mitigation wmean adoption o new solutions in the water sectorreduce environmental impact and energy dependencon water resources Water li ting technology suchsolar and wind pumps o er new options which UNIinvestigating

p lic v c c - through advocacy and policydevelopment, UNICEF is assisting countries to ensuthat environmental considerations and response toclimate change are on national agendas and withinpolicy and planning instruments

In p c ice...Rural communities in northern Lao PDR are

acing water source shortages Many springsources are drying up due to actors includingclimate change, de orestation and changesin land use Providing water to schools andcommunities situated at high elevations is amajor challenge UNICEF Lao PDR is using adesign developed by UNICEF Cambodia tobuild erro-cement rainwater harvesting tanksat schools The tanks require signi cantly lessmaterial, making them more cost-e ectivethan traditional tanks Even in remote, relativelyarid regions o Northern Lao where unreliablerain all conditions persist, this technology canprovide substantial sa e drinking water orchildren and communities

Reservoirs, such as this one in Yemen, provide increased water storageto help ensure water supply to vulnerable communities when adaptingto rain all variability

wasH, Envi nmen n Clim e Ch n e




d espite the real progress made, the world is stilllikely to miss the MDG target or sanitation Sub-Saharan A rica is o -track or both the MDG water

and sanitation targets And even i the targets are met,millions o people will still be without access to improved

acilities in 2015 Thus it is imperative that progressis made more quickly, and on a larger scale, than iscurrently being achieved

UNICEF’s long-term position as a trusted partner o government gives us a unique position to in uencethe adoption o policies and strategies which lead tosustainable solutions or WASH at scale With the rightblend o internal capacity and vibrant partnerships,UNICEF programmes can make a di erence to the paceo progress

accele in n sc lin u C ve e

The WASH sector is vast with numerous government,NGO, multi-lateral, donor and private sector actorsOur strategy emphasises cooperation – working tocreate partners out o stakeholders Only when wework together in a coordinated manner, utilizing allcomparative advantages, can we comprehensively

address the problems at hand and at the scalenecessary Thus, in all our country programmes weengage in sector-wide processes and aim to work inaccordance with the principles o the Paris Declarationon Aid E ectiveness UNICEF also places particularimportance on coordination with our UN sister agencies,through processes such as the UNDAF (United NationsDevelopment Assistance Framework) and the ‘One UN’initiative

One o the biggest contributions UNICEF can makeis the scaling up o community-based approaches tohousehold sanitation, hygiene behaviour, especiallyhandwashing with soap, and household water treatmentand storage UNICEF also takes a lead in developinginnovative technologies to address past shortcomingsand to o er cheaper, more sustainable options toindividuals and communities

t il in p mme he Nee E ch C un

The translation o the UNICEF Global WASH Strategy intoaction-oriented WASH programmes in the countries inwhich UNICEF works depends on the individual nationalcontext, including recognition o sub-national variationsand disparities In each country UNICEF goes through acountry programme planning process with governmentpartners and key sector stakeholders, to determine howbest UNICEF can bring added value to the sector Insome countries, especially where government capacity islimited, UNICEF might take more o a role in managemento implementation o major water supply, sanitation andhygiene promotion programmes In other cases, UNICEF’s

ocus might be more towards the acilitation o sector-wide approaches and sector policy development

p vi in he requi e C ci

UNICEF employs over 400 WASH pro essionalsworldwide The vast majority – over 90 percent – abased in country ofces They are supported by anetwork o regional and headquarters senior WASHsta who provide advice and direction on policy andstrategy WASH sta are also guided by country of

management teams who help to ensure that WASHprogrammes are in line with the overall strategicdirection o UNICEF and contribute e ectively to cprogrammes o support or children

To respond to the changing nature o the WASH secand UNICEF’s role within it, we need to ensure thathave the right sta with the right skills at all levelsare responding to this challenge by care ully planniexternal recruitment, training existing sta in newapproaches, improving career pathways or nationaand exploring partnerships with relevant organisatioto access sta with particular expertise

Fun in u wasH p mme

We are working in more countries than ever be oreprogrammes within countries are expanding and ourexpenditure levels are increasing

In 2007, we supported WASH activities in 96 countthe most ever WASH expenditure has grown steadiover the years and now exceeds US$300 millionannually The bulk o these unds come rom our partners (including bilateral agencies, UNICEF natio

committees and others)

Despite the recent signi cant increase in overall unto UNICEF WASH programmes, about hal the pricountries are unable to implement the ull strategy to inadequate unding Our e orts continue to obtthe nancial resources needed to support the necessWASH programmes in all our priority countries

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En n e1 World Health Organization

2 All data in this section rom World Health Organisationand United Nations Children’s Fund Joint MonitoringProgramme or Water Supply and Sanitation (JMP)Progress o Drinking Water and Sanitation: Special Focuson Sanitation UNICEF, New York and WHO, Geneva, 2008

3 Hutton G, Bartram J Regional and Global Costs o Attaining the Water Supply and Sanitation Target (Target10) o the Millennium Development Goals World HealthOrganisation, Geneva, 2008

4 Fewtrell, Lorna, Rachel B Kau mann, David Kay, WayneEnanoria, Laurence Haller and Jr, John M Col ord, 2005Water, sanitation, and hygiene interventions to reducediarrhoea in less developed countries: a systematic review and meta-analysis. The Lancet In ectious Diseases, Volume5, Issue 1, January 2005, Pages 42-52

5 Prüss-Üstün A, Bos R, Gore F, Bartram J Sa er water, betterhealth: costs, bene ts and sustainability o interventionsto protect and promote health World Health Organization,Geneva, 2008

6 Rhee, Victor; Luke C Mullary; Subarna K Khatry; JoanneKatz; Steven C LeClerq; Gary L Darmastadt; James MTielsch; Arch Pediatr Adolesc Med. 2008; 162 (7) 603-608

7 Not including neo-natal deaths State o the WorldsChildren, UNICEF 2008

8 JMP 2008, which published coverage gures as o 2006

9 Guidelines or drinking water quality, incorporating rstaddendum Vol 1, Recommendations 3rd Edition WHO

2006

ph C e iCover © UNICEF/HQ07-0404/Giacomo PirozziPage 2 © UNICEF/08/Christine NesbittPage 4 © UNICEF/NYHQ2004-0941/NooraniPage 8 © UNICEF/China/Zheng AnningPage 10 © UNICEF Senegal/2008/Bakker

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Bottom: © UNICEF/ZambiaPage 23 © UNICEF/Bangladesh/Paul EdwardsPage 24 © UNICEF/HQ99-0854/Roger LeMoynePage 25 © UNICEF/MAP/SujanPage 26 © UNICEF/HQ06-2815/Anita KhemkaPage 27 Top: © UNICEF Chad/Arjen van der Wal

Bottom: © UNICEF Chad/Silvia GayaPage 28 © PSI MalawiPage 29 © ASF/PSI DRCPage 30 © UNICEF/HQ07-1724/Christine NesbittPage 31 Top : © UNICEF/NYHQ2007-0556/Nesbitt

Bottom: © UNICEF/NYHQ1998-0837/NooraniPage 32 © UNICEF/NYHQ2006-0427/PirozziPage 34 © UNICEF/NYHQ2006-0342/PirozziPage 35 © UNICEF/NYHQ2005-1603/PirozziPage 36 © UNICEF/Paul Sherlock Page 38 Top : © UNICEF/NYHQ2006-0559/Noorani

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Documents

Soap, toilets and taps: How UNICEF supports water, sanitation and hygiene