Taps and Toilets: How Greater Access Can Radically Improve Africa's Future

8/4/2019 Taps and Toilets: How Greater Access Can Radically Improve Africa's Future

1/8

1

TAPSANDTOILETSHOWGREATERACCESSCANRADICALLYIMPROVEAFRICASFUTURE

Authors:MarkEshbaugh,EricFirnhaber,PatrickMcLennan,JonathanDMoyer,ErinTorkelson

AnaggressiveyetreasonableannualimprovementinwaterandsanitationforAfricawillleadto:n 18millionfewermalnourishedchildren

by2030

n US$75billionincreaseinGDPby2040n 17millionfewerpeoplelivingonless

thanUS$1,25adayby2050

INTRODUCTION

Accesstosafewaterandsanitationisafundamentalcomponentofhumandevelopment.InAfrica,morethan350millionpeoplelackaccesstosafedrinkingwater1andover530milliondonothaveaccesstosafesanitation.2ItappearsincreasinglylikelythatthecontinentwillfallshortofrelevantMillenniumDevelopmentGoals(MDGs).

Effectivepolicydecisionssupportedbytheinternationalcommunitycan,however,improvetheseconditions.Malawi,BurkinaFasoandGhanareducedthenumberofpeoplewithnoaccesstosafewaterbyanaverageof1,9percentagepointsperyearfrom19902008.Forsanitation,Angola,MadagascarandEthiopiareducedthenumberofpeoplewithnoaccessbyasimilarrate.Whatiftherestofthecontinentfollowedtheseexamples?

Improvingaccesstosafewaterandsanitationacross

Africaatratesofjustunder2percentagepointsannuallyascomparedwithbasecase

improvementswhicharecloserto0,5percentagepointswillreducethenumberofundernourishedchildrenby18millionby2030,increasethecontinentsGDPbyUS$75billionby20403andbring18millionpeopleoutofpovertyby2050.4Ontheotherhand,ifimprovementsstagnate,malnutritionandpovertywillincrease,andGDPgrowthwillbestymied.5

Achievinga2percentagepointannualimprovementinwaterandsanitationisnosmallfeat.WecalculatethatthepubliccostwillbenearlyUS$35billioninvestedoverthenext40years.ThisisinadditiontothebasecaseinvestmentofUS$110billionthatisrequiredtomaintaincurrentwaterandsanitationinfrastructureandbuildbasecaselevelsofnewinfrastructure.Wecalculatethatthelionsshareofincreasedinvestmentshouldgotowardsimprovementsinsafesanitationwithasmallershareforsafewater.6

Ourresultsabouttheeffectsofaccesstowaterandsanitationoninfantmortality,malnutrition,poverty,andeconomicgrowtharebrokendownfor52Africancountries.7Fulldatatablescanbefoundatwww.ifs.du.edu/afp.

IMPORTANCEOFWATERANDSANITATIONFORHUMANDEVELOPMENT

Lackofaccesstosafewaterandsanitationincreaseshealthrisksthatincludediarrhoea,malnutritionand

22 AUGUST 2011No.1


2/8

2

parasites.Theseconditionsreducequalityoflifeanddecreaseproductivity.Theextentofthesehealthproblemsishardtooverstate.In2004,theWorldHealthOrganisationestimatedthatnearly2milliondeathsandover64milliondisabilityadjustedlife

years(DALYs)8

relatedtodiarrhoealdiseaseswereattributabletounsafewaterandsanitation.9

Childrenaredisproportionatelyaffectedbyhealthconditionsresultingfromnoaccesstowaterandsanitation.Atleastonequarterofallchilddeathsandonefifthofthechilddiseaseburden(predominantlydiarrhoeaandunder-nutrition)arecausedbyinadequateaccesstowaterandsanitation.10ForAfrica,theunder-fivemortalityrateattributedtodiarrhoeais15,8per1000.Thisismuchhigherthantheaverageglobalunder-fivemortalityrateof8,9per1000. 11

Diarrhoearesultingfrominadequateaccesstosafewaterandsanitationalsoleadstomalnutrition.Evenifhumanshaveaccesstosufficientcalories,diarrhoeacanstopthemfromabsorbingkeyvitaminsandnutrients,leadingtopoorhealthandstuntedgrowth.ThesizeofthemalnourishedchildpopulationinAfricaspeakstothisphenomenon.Twenty-eight%ofAfricanchildrenlivewithoutadequatenutritionalabsorption.Thisisabovethe

globalaverageof18%.12

ThehighnumberofDALYslostreducesboththequalityandsizeofthelabourforce,astimelosttodiarrhoeawouldotherwisebespentbychildreninschoolorbyadultsatwork.Thisreductionleadstodecreasedeconomicproductivity.AstudybytheWorldHealthOrganisationfoundthatimprovedwaterandsanitationserviceswouldreducediarrhoealepisodesbyroughly10%,leadingtoanannualreductioninhealth-relatedcostsofUS$7,3

billion.Thestudyalsofoundthatinvestinginwaterandsanitationfacilitieswouldrealiseasubstantialeconomicreturn.EachUSdollarinvestedwouldyieldaneconomicreturnofbetweenUS$3andUS$34,dependingontheregion.13

HISTORICALTRENDSINWATERANDSANITATIONACCESS

ThepercentageofpeopleinAfricawithaccesstosafewaterandsanitationislowerthananyotherglobalregion.Currently,only65%ofpeopleinAfricahaveaccesstosafewater,whileinAsiathatfigure

standsat88%,withLatinAmericaat93%andEuropeat99%.Thesituationissimilarforaccesstosafesanitation.InAfrica,only41%ofthepopulationhasaccesstosafefacilities,whileAsiahassanitationaccesslevelsof53%,LatinAmerica79%andEurope

95%.14

Whileimprovingaccesstowaterandsanitationisimportantatalllevelsofquality,thisanalysisfocusesonthepercentageofpeoplewithnoaccessatall.WeusewaterandsanitationaccessdatafromtheJointMonitoringProgrammeoftheWorldHealthOrganisationandtheUnitedNationsChildrensFund.15Table1revealshowdifferentmeasuresofaccessaretreatedbythisdatabase.Weusethreecategoriesofaccesstowaterandsanitationderivedfromthetablebelow:noaccess,improvedaccessandhouseholdconnection.16

Table1:Definitionsforwaterandsanitationaccessdata

Water SanitationNoAccess/Unimproved

Unprotectedwell,surfacewater,bottledwater

Opendefecationinfield,forestwater,orotheropenspaces/

Pitlatrinewithoutslab,bucketlatrine

Improved(Shared)

Publictap,tubewell,protectedwell

Anycategoryofhouseholdconnectionthatissharedamongmorethanonehousehold

Household

Connection

Piped

connectionindwellingorplot

Flushorpour

toilet,pitlatrinewithslab,compostingtoiletindwellingorplot

Source:WorldHealthOrganisationandUnitedNationsChildrens

FundJointMonitoringProject,TheDrinkingWaterandSanitation

Ladders,http://www.wssinfo.org/definitions-methods/watsan-

ladder/(accessedMarch2011).


3/8

3

DEVELOPINGTHREESCENARIOS

Forourscenariodevelopment,werankedallAfricancountriesbytheaverageannualchangeinpercentagepointsofpeoplewithnoaccesstosafewaterandsanitationfrom19902008.Thisallowedustoidentifythecountrieswiththelargestpositiveandnegativegrowth.17

Historically,thethreebestperformerswithrespectto

safewaterreducedtheportionofthepopulationwithnoaccessbyanaverageof1,9percentagepointsannually,whichisthesamerateofprogressasthethreebestperformerswithrespecttoaccesstosafesanitation.Theworstperformersincreasedthepercentageofpeoplewithnoaccesstosafewaterandsanitationby0,6%and0,3%,respectively.Forouranalysis,wecreatedthreescenariosthatextendto2030.

1.OurfirstpointofreferenceistheInternationalFuturesbasecase,whichassumesbasiccontinuityofglobalpolicyandtrends,althoughitisnotanextrapolation.Thefullrangeofassumptionsinthebasecasescenariocanbefoundonline.18,19

2.Ouraggressivelyimproved scenarioreducesthenumberofpeoplewithnoaccesstowaterandsanitationby1,9%annuallyacrossthecontinent,whichistheaveragerateofthebestperformingcountries.

3.Ourstagnantscenario doesnotreplicatethenegativegrowthincountrieslistedabovebutinsteadstagnatesimprovementinaccesstowaterandsanitationat2010levelsacrossourtimehorizon.

THETOOL:INTERNATIONALFUTURES

WeusedtheInternationalFutures(IFs)modeltoanalysetrendsacrossawiderangeofkeyglobalsystems.20TheIFsmodelprovidesforecastsfor183

countriesto2100.IFsishousedattheJosefKorbelSchoolofInternationalStudiesattheUniversityofDenver,andisfreelyavailabletodownloadoruseatwww.ifs.du.edu/ifs.PleaseaccessdocumentationonthewebsiteorotherIFspublicationsformoredetail

onthemodelstructureandassumptions.

TheIFsmodeldrivesaccesstowaterandsanitationasafunctionofthefollowingvariables:governmentspendingonhealth,sizeofthetotalpopulation,sizeoftheurbanpopulation,averageyearsofeducationforthoseunder25,andtheabsolutenumberofpeoplelivingonlessthanUS$1,25perdayatpurchasingpowerparity.Ontheothersideofthefunction,accesstosafewaterandsanitationaffectsthemortalityratebyvarioussubcategories:infantmortality,lifeexpectancy,andlevelsofmalnourishment.ExtendeddocumentationofthemodelcanbefoundinthePatternsofPotentialHumanProgressImprovingGlobalHealthVolume.21

Water Sanitation

Country

Average

Annual

PercentageChange Country

Average

Annual

PercentageChange

Best

Performing

Malawi 2,2% Angola 2,11%

BurkinaFaso 1,94% Madagascar 1,83%

Ghana 1,6% Ethiopia 1,77%

Worst

Performing

SierraLeone -0,65% Mauritania -0,5%

Algeria -0,61% Liberia -0,28%

Sudan -0,44% Tanzania -0,22%

Table2Bestandworstperformersforaccesstowaterandsanitation

Source:InternationalFuturesTeamAnalysis.WorldHealthOrganisation/UnitedNations

ChildrensFundJointMonitoringProjectforWaterSupplyandSanitation,DataTables,

http://www.wssinfo.org/data-estimates/table/ (accessedMarch2010).


4/8

If each country in Africa were 100 people...and the number of Africans with access to water & sanitaon increased by 2% per year

INFANT MORTALITY PER 100 LIVE BIRTHSBY 2030:

CHAD

DRC

SOMALIA

= people affected with 2% intervention

= people affected without 2% intervention+

NUMBER OF PEOPLE IN 100 LIVING AT $1.25 PER DAYBY 2050:

DRC

MALI

IVORY COAST

NUMBER OF UNDERNOURISHED CHILDREN IN 100BY 2040:

DRC

ETHIOPIA

NIGERIA

4


5/8

ACCESS TO WATER AND SANITATION IN SUB-SAHARAN AFRICAIN 2010:

69%

40% 44% 16%

12%19%

No access to safe water: unprotectedwells, surface water, rain water

Improved access:any shared facilitiesNo access to sanitation: open defecation in field, forest, water, or other

open space, pit latrines, bucket latrines

Householdconnections

Improved access: public taps, tube wells,protected wells

Householdconnections

WATER

SANITATION

PROBABILITY OF STATE FAILUREBY 2030:

AFRICA

SOMALIA

BURUNDI

NIGERETHIOPIA

20% 40% 60% 80%

40%

55%

52%

51%50%

100%

CONTINENT-WIDE GDPBY 2050:

BASE CASE

AGRESSIVE CASE

INVESTMENT GDP PER CAPITA (MER)

$110 Billion

$145 Billion

$3 300 per capita

$3 400 per capita

5


6/8

6

EXPERIENCESONTHEGROUND

Whilepolicy-makingshouldbelocallyderivativeandcontextspecific,severalofthebest-performingcountriesprovideusefulinsightsonhowtomeettheMDGforwaterandsanitation.Ourbest-performingcountriesconfirmthatchallengeswithinthewaterandsanitationsectordonotresultfromtechnologicalorgeographicalconsiderations.Rather,themostimportantfactorsgoverningthedeliveryofwaterandsanitationarerelatedtothepublicpolicyenvironment,institutionalmanagement,financeandtheoverallsocialstructureofacountry.Thefirstthreefactorshavebeenexploredinsomedetailina2006UNreportonprogresstowardstheMDGs,22andtheforthhasbeenpositedbyJoseEstebanCastro.23

Ouraggressivelyimproved scenarioisbasedoncountrieslikeBurkinaFaso,whichhasshowna1,94%increaseeachyearinthenumberofpeoplegainingaccesstosafewater.BurkinaFasosNationalOfficeforWaterandSanitation(ONEA)hasbeentaskedwithimplementingtheActionPlanfortheIntegratedManagementofWaterResources(PAGIRE)andiswidelyconsideredtobeoneofthebestperformingutilitiesinWestAfrica.24Operatingviapublic-private

partnership,ONEAcovers42citiesandtownsandusesacross-subsidymodeltorecoupexpenditurefromtheendusers.ONEAhasprovidedwateraccessinurbanareasandsmalltownswithmorethan5000inhabitants,butlow-densityruralareashavenotbenefitedfromthisprogrammeandrequirespecialattention.Additionally,therehasbeensomesignificantcriticismregardingtheprivatisationofutilitiesandtheirdependencyonacostrecoverymodel.Analystshavesuggestedthatthismodeldoesnotadequatelyprovideforthewaterneedsofa

particularpopulation,insteadplacinglong-termmortgagesonthepoorestcountriesandfailingtoreachthemostvulnerablecitizens.25

Inreferencetosanitation,ouraggressivescenarioisbasedoncountrieslikeEthiopia,whichhasshowna1,77%increaseinaccesstosanitationeachyear.TheEthiopianGovernmentseessanitationasanimportantprecursortopovertyeradication,andhasthusemphasizedsanitationinpoliciesproducedbytheMinistriesofHealthandWaterResources.Unlike

othercountries,whichviewsanitationasacomponentofalargerwaterstrategy,Ethiopiahas

developedaspecificsanitationandhygienestrategythatfocusesonlow-costsanitationcoupledwithhygienepromotionaspartofahealthextensionprogramme.26Additionally,Ethiopiahasprioritisedthedeliveryofsanitationinruralareasandamong

themostvulnerablemembersofthepopulation.WhiletherehasbeensomedifficultyidentifyingtheMinistriesresponsibleforvariouscomponentsofsanitationdelivery,a2006memorandumofunderstandinghassinceclarifiedinstitutionalresponsibility.

Forallsixcountriesinthisstudythatshowedverypositiveresults,thefollowingfactorshavebeencrucialtotheirsuccess:strictlydefinedinstitutionalarrangements,clearpolicyframeworksandsubstantialdonorfunding.

FINDINGS

By2050,improvedaccesstowaterandsanitationincreasesAfricanGDPby3%overthebasecase,and6%overthepessimisticscenario.Thedifferenceinincomebetweenthebasecaseandtheimprovedcasein2050overUS$200billionislargerthanmosteconomiesinAfricain2011.27Thecumulative,discounteddifferencebetweenthesescenarios

acrosstimeapproachesUS$700billion,andmorethanpaysofftheadditionalinvestmentofUS$35billionoverthenext40years.

ImprovedaccesstowaterandsanitationoverthebasecasedramaticallychangeslevelsofundernourishedchildreninAfrica.By2030,thenumberofundernourishedchildrenisreducedby18million.By2040,fourcountrieshavemorethanonemillionfewerundernourishedchildrencomparedwithbasecaseimprovements.ThesearetheDemocraticRepublicofCongo(2,9millionfewerundernourishedchildren),Nigeria(1.9million),Ethiopia(1.7million)andNiger(1.3million).By2050,32Africancountriesreducethenumberofundernourishedchildrenbyover50%comparedwithbasecaseforecasts.28Fullresultsonacountry-by-countrybasiscanbefoundatwww.ifs.du.edu/afp.

Infantmortalityisalsodramaticallyreduced.By2030,ouraggressivescenarioforecastsa20%reductionininfantmortality29overthebasecase.Inabsolutefigures,thistranslatestoroughlynine

fewerinfantdeathsper1000livebirths.Overthesameperiod,anaggressiveimprovementinwater


7/8

7

andsanitationreducesinfantmortalityby10livebirthsper1000for20countries,withthegreatestreductionsoccurringinChad(reductionof35per1000),Somalia(reductionof25)andtheDRC(reductionof21).Improvementsaremore

pronouncedwhencomparingtheaggressivescenariowiththestagnantscenario.Infantmortalitylevelsare30%higherinthestagnantcasethanintheimprovedscenario,withnearly14moredeathsper1000livebirthsin2030.

By2050,improvementsinwaterandsanitationleadto17millionfewerpeoplelivingonlessthanUS$1,25perday.ThegreatestreductionsinthenumberofpeoplelivinginpovertyoccurintheDemocraticRepublicoftheCongo(5.7millionfewerpeople),theIvoryCoast(1.4millionpeople)andMali(1.1millionpeople).TheseimprovementsinhumandevelopmenttakeplacewithanAfricanpopulationthatissignificantlyhigherinouraggressivescenariorelativetothebasecase.By2050,thepopulationofAfricais11millionpeoplelargerthaninthebasecase.

Thesewaterandsanitationscenariosalsohaveabearingontheprobabilityofstatefailureacrossthecontinent.Onaverage,theprobabilityofstatefailureis40%higherin2030ifnothingisdonetoimproveaccesstowaterandsanitationcomparedwithrapid

improvements.In16Africancountries,theprobabilityofstatefailureincreasesbymorethan20%in2030.ThelargestincreasesintheprobabilityofstatefailurebetweenastagnantandimprovedwaterandsanitationscenariooccurinSomalia(55%increase),Burundi(52%increase),Niger(51%increase)andEthiopia(50%increase).30

CONCLUSIONS

Improvementsinthemostbasiclevelsofaccesstowaterandsanitationcanhavesizeableimpactsonseveralkeyareasofhumandevelopment.Thisbriefhighlightstheimportanceofasustainedeffortbydomesticleadersandtheinternationalcommunitytopromoteaccesstothesebasicresources.Furtherresearchshouldexplorethegovernancestructuresandpoliciesmostconducivetoincreasingaccesstosafewaterandsanitationandtheroleofinternationalaidintheimprovementofthisinfrastructure.

NOTES

1NumberderivedfrommultiplyingthepercentageofpeopleinAfricawithnoaccesstosafewater(36,31%)bythepopulationof

sub-SaharanAfrica(1,005billion).BothfiguresarederivedfromtheInternationalFuturesmodelversion6.44.SeeFigure1foramoredetaileddescriptionofdifferentcategoriesofwateraccess.2NumberderivedbymultiplyingthepercentageofpeopleinAfricawithnoaccesstosanitationservices(53,09%)bythepopulationofsub-SaharanAfrica(1,005billion).BothfiguresderivedfromtheInternationalFuturesmodel,version6.44.SeeFigure1foramoredetaileddescriptionofdifferentcategoriesofsanitationaccess.3Allinformationpresentedinthispolicybriefrelatedtoaggregatesumsofmoneyacrosstimearecalculatedusinga3%discountrate.4

MeasuredbythoselivingonlessthanUS$1,25perday.5Comparingthestrongimprovementscenariowithastagnatescenarioproducesthefollowing:by2030therearenearly30millionmorechildrenlivingwithmalnutrition,by2040theGDPisUS$525millionlessandby2050thereareover28millionmorepeoplelivinginpoverty.6US$23billionincreaseoverbasecaseinvestmentinsanitationrelativetoUS$11billionincreaseoverbasecaseinwater(differencesduetorounding).7ThemodeldoesnotcalculatevariablesforWesternSahara,SeychellesoraseparationbetweenSouthandNorthSudan.8ADisabilityAdjustedLifeYear(DALY)isdefinedbytheWorldHealthOrganisationasthesumofyearsofpotentiallifelostduetoprematuremortalityandtheyearsofproductivelifelostdue

todisability.WorldHealthOrganisation,http://www.who.int/mental_health/management/depression/daly/en/(accessedMarch2010).9BarryHughes,RandallKuhn,CeciliaPeterson,DaleRothmanandJoseSolorzano,ImprovingGlobalHealth.PatternsofPotentialHumanProgress3(2011),OxfordUniversityPressandParadigmPublishers,PardeeCenterforInternationalFutures:UniversityofDenver,http://www.ifs.du.edu/documents 10LornaFewtrell,AnnettePrss-stn,RobertBos,FionaGoreandJamieBartram,Water,SanitationandHygiene:Quantifyingthehealthimpactatnationalandlocallevelsincountrieswithincompletewatersupplyandsanitationcoverage,WHOEnvironmentalBurdenofDiseaseSeries,No.15,WorldHealthOrganisation,Geneva(2007),43,45.11WorldHealthOrganisationStatisticalInformationSystem,http://www.who.int/whosis/whostat/en/index.html (accessedMarch2010).12WorldHealthOrganisationStatisticalInformationSystem,http://www.who.int/whosis/whostat/en/index.html (accessedMarch2010).13WorldWaterCouncil,http://www.worldwatercouncil.org/index.php?id=23(accessedMarch2010).14WorldHealthOrganisation/UnitedNationsChildrensFundJointMonitoringProjectforWaterSupplyandSanitation,DataTables,http://www.wssinfo.org/data-estimates/table/ (accessedMarch2010).

15Datawasoriginallygatheredfromnationalstatisticsofficesandinternationalsurveyprogrammesthroughnationallyrepresentativehouseholdsurveysandnationalcensuses.World


8/8

8

AFRICANFUTURESPROJECT

TheAfricanFuturesProjectisacollaborationbetweentheInstituteforSecurityStudies(www.issafrica.org)andtheFrederickSPardeeCenterforInternationalFutures(www.ifs.du.edu)basedattheJosefKorbelSchoolofInternationalStudiesatthe

UniversityofDenver.TheInstituteforSecurityStudiesisawidelyrecognizedpan-Africanthinktankspecializinginissuesofhumansecurity.ThePardeeCenteristhehomeoftheInternationalFuturesmodel,anintegratedapproachtounderstandinghuman

developmentandthebroadimplicationsofpolicychoices.Theseorganisationsleverageeachothersexpertisetoprovideforward-looking,policy-relevantmaterialthatframesuncertaintyaroundhumandevelopmentinAfrica.

Serieseditors:JonathanDMoyer([email protected])andErinTorkelson([email protected])

HealthOrganisation,http://www.wssinfo.org/definitions-methods/data-sources/ (accessedMarch2010);andWorldHealthOrganisation/UnitedNationsChildrensFundJointMonitoringProjectforWaterSupplyandSanitation,TheDrinkingWaterand

SanitationLadders,http://www.wssinfo.org/definitions-methods/watsan-ladder/(accessedMarch2010).16Dataonnoaccesstosanitationiscodedintwocategories:noaccessandotherunimprovedaccess.Wecombinethesetwodatasourcesintoonecategory,whichwerefertoasnoaccessfortheremainderofthisanalysis.17WorldHealthOrganisation/UnitedNationsChildrensFundJointMonitoringProjectforWaterSupplyandSanitation,TheDrinkingWaterandSanitationLadders,http://www.wssinfo.org/definitions-methods/watsan-ladder/ (accessedMarch2010).18TofurtherexploretheassumptionsmadethroughouttheIFsmodel,pleasevisitthefollowingURLandexploretheavailablepublications:http://www.ifs.du.edu/documents/reports.aspx

19DuetothedifferenceinJMPdefinitionsofimprovedandunimprovedwaterandsanitationaccess,forourforecastwedefinedourvariablesashouseholdconnection,improvedandnoaccess,groupingtogetherthehistoricaldefinitionunimprovedsanitationwithnoaccesstosanitation.20IFs:TheInternationalFutures(IFs)modellingsystem,version6.44wasusedforthedevelopmentofthisreport.IFswasinitiallydevelopedbyBarryHughesandisbasedattheFrederickS.PardeeCenterforInternationalFutures,JosefKorbelSchoolofInternationalStudies,UniversityofDenver,http://www.ifs.du.edu.2011.21BarryHughes,RandallKuhn,CeciliaPeterson,DaleRothmanandJoseSolorzano,ImprovingGlobalHealth.PatternsofPotentialHumanProgress3(2011),OxfordUniversityPressandParadigmPublishers,PardeeCenterforInternationalFutures:UniversityofDenver,http://www.ifs.du.edu/documents 22RobertoLenton,KristenLewis,andAlbertWright,Water,SanitationandtheMillenniumDevelopmentGoals,JournalofInternationalAffairs.Vol.61(2),(2008),249.23JoseEstebanCastro,Introduction,WaterandSanitationServices:PublicPolicyandManagement,JoseEstebanCastroandLeoHeller(eds),London:Earthscan,2009,36.

24InformationtakenfromaregionalinitiativebytheAfricanMinistersCouncilonWater,AfricanDevelopmentBank,EUWaterInitiative,WaterandSanitationProgrammeandUnitedNationsDevelopmentProgramme,GettingAfricaontrackto

meettheMDGsforwaterandsanitation:astatusupdateofsixteencountries,http://www.wsp.org/wsp/sites/wsp.org/files/publications/319200725615_312007101903_MDGs_All_final3_high.pdf (accessedMarch2011).25JoseEstebanCastro,Introduction,WaterandSanitationServices:PublicPolicyandManagement,JoseEstebanCastroandLeoHeller(eds),London:Earthscan,2009,36.26AfricanMinistersCouncilonWater,AfricanDevelopmentBank,EUWaterInitiative,WaterandSanitationProgrammeandUnitedNationsDevelopmentProgramme,GettingAfricaontracktomeettheMDGsforwaterandsanitation:astatusupdateofsixteencountries,http://www.wsp.org/wsp/sites/wsp.org/files/publications/319200

725615_312007101903_MDGs_All_final3_high.pdf (accessedMarch2011).27GDPatmarketexchangeratesin2000USdollars.28Thenumericalreductionin2030betweenthebasecaseandimprovedscenarioishigherthanthedifferencebetweenthetwoscenariosin2050,eventhoughthepercentagereductionisgreaterin2050.Thisisbecausethepercentageofundernourishedchildrenalsodropssignificantlyinthebasecaseafter2030.Formoreinformationonthisreduction,see:BarryHughes,RandallKuhn,CeciliaPeterson,DaleRothmanandJoseSolorzano,ImprovingGlobalHealth.PatternsofPotentialHumanProgress3,OxfordUniversityPressandParadigmPublishers,PardeeCenterforInternationalFutures:UniversityofDenver,2011,http://www.ifs.du.edu/documents29Infantmortalityreferstochilddeathsbeforetheirfirstbirthday.Thisismeasuredbydeathsper1000livebirths.30Forexample,iftherewasa10%probabilitythatNigerwillexperiencestatefailureoverthenext5years,a50%increaseinthatvaluewouldputtheirprobabilityofstatefailureat15%.ThevariableusedinIFsforthiscalculationisSFINSTABMAG.

Projectfundingthanksto:

ForeignAffairsandInternationalTrade,Canada;FrederickS.Pardee;theBritishHighCommission;thegovernmentsofDenmark,Finland,Germany,theNetherlands,Norway,Spain,SwedenandSwitzerland;andtheOpenSocietyFoundation

Documents

Taps and Toilets: How Greater Access Can Radically Improve Africa's Future