Drinking-water, sanitation and hygiene in the WPR: Opportunities and challenges in the SDG era by Alexander Pascual

Drinking-water, sanitation and hygiene in the Western Pacific Region Opportunities and challenges i n the SDG era

© World Health Organization 2018 ISBN 978 92 9061 861 4 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercialShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/ igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/ rules). Suggested citation. Drinking-water, sanitation and hygiene in the Western Pacific Region: opportunities and challenges in the SDG era. Manila, Philippines. World Health Organization Regional Office for the Western Pacific. 2018. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. 1. Drinking water. 2. Hygiene. 3. Sanitation. I. World Health Organization Regional Office for the Western Pacific. (NLM Classification: WA675) Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, Fax. No. (632) 521-1036, email: wpropuballstaff@who.int Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Cover images (left to right) by WHO/Yoshi Shimizu, WHO/Aphaluck Bhatiasevi, and Freepik.com.

Contents Foreword �� ix Acknowledgements ��x Abbreviations �� xi Executive summary ��xiii 1

Introduction �� 1

1.1 Objectives of this document �� 1

1.2 Background information �� 1

1.3 What is new in WASH monitoring? �� 3

1.4 Why is the health sector involved in WASH? �� 9

Essential statistics on drinking-water, sanitation and hygiene �� 14

2.1 Drinking-water �� 14

2.2 Sanitation �� 19

2.3 Hygiene �� 24

2.4 Implications of the SDG WASH targets on the Western Pacific Region �� 26

2.5 Inequalities in drinking-water supply, sanitation and hygiene �� 33

Overall status of the WASH sector �� 39

3.1 Human right to drinking-water and sanitation �� 39

3.2 National sector organization �� 40

3.3 Human resources �� 47

3.4 Gender issues �� 50

3.5 Financing �� 52

Regional programmatic priorities �� 58

4.1 Drinking-water quality �� 58

4.2 WASH in schools �� 65

4.3 WASH in health-care facilities �� 69

4.4 WASH in climate change �� 73 Bibliographic references �� 77

Annexes Annex 1. Global, regional and national basic drinking-water coverage, 2000 and 2015 �� 81 Annex 2. Global, regional and national safely managed drinking-water coverage, 2000 and 2015 �� 83 Annex 3. Global, regional and national basic sanitation coverage, 2000 and 2015 �� 85 Annex 4. Global, regional and national safely managed sanitation coverage, 2000 and 2015 �� 87

iii

Annex 5. Selected tables derived from the 2016/2017 GLAAS survey in the Western Pacific Region �� 89 Annex 6. Glossary of selected terms used in this report �� 97 Annex 7. Sustainable Development Goals �� 99 Annex 8. Regional groupings considered in this report �� 100

Figures Fig. 1.

Composition of the different JMP drinking-water statistics �� 6

Fig. 2.

Composition of the different JMP sanitation statistics �� 6

Fig. 3.

Mortality rate attributed to exposure to unsafe WASH services (per 100 000 population) �� 10

Fig. 4.

Proportion of population with access to safely managed drinking-water services and other supply alternatives in Western Pacific countries and areas, 2015 �� 15

Fig. 5.

Proportion of the population in the Western Pacific Region and the PICs with access to different drinking-water options in 2000 and 2015, and comparison with the world aggregated statistics �� 16

Fig. 6.

Proportion of population with access to basic drinking-water services and population without access to basic drinking-water services in the Western Pacific Region and comparison with the world aggregated statistics, 2015 �� 16

Fig. 7.

Proportion of populations in the Western Pacific countries using different types of drinking-water services, 2015 �� 17

Fig. 8.

Population in the Western Pacific Region not using basic drinking-water, 2015 (population in millions) �� 17

Fig. 9.

Proportion of populations in the Western Pacific Region using drinking-water piped into their households, 2015 �� 18

Fig. 10. Proportion of the population in the Western Pacific Region and the PICs with access to different sanitation options in 2000 and 2015, and comparison with the world aggregated statistics �� 19 Fig. 11. Proportion of populations in the Western Pacific countries using safely managed sanitation and other types of sanitation options, 2015 �� 20 Fig. 12. Proportion of people using toilets flushing to sewers and proportion of people generating wastewater treated by treatment plants, Western Pacific Region, 2015 �� 21 Fig. 13. Proportion of people in the Western Pacific Region with access to different types of technologies, total, rural, urban, 2015 �� 22 Fig. 14.

Proportion of people in the Western Pacific countries using basic sanitation facilities and other types of sanitation options, and aggregated statistics for the Western Pacific Region, the PICs and the world, 2015 �� 23

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Fig. 15. Population in the Western Pacific Region not using basic sanitation, 2015 (population in millions) �� 23 Fig. 16. Proportion of population in Cambodia, Mongolia and Viet Nam using basic and limited handwashing facilities in 2015 �� 26 Fig. 17.

Change in the proportion of people with access to basic drinking-water services in the Western Pacific Region and the PICs between 2000 and 2015 and projection of change between 2015 and 2030 �� 27

Fig. 18. Proportion of people with access to basic drinking-water in 2015 and projected coverage in 2030, Western Pacific Region, PICs and comparison with the world aggregated statistics �� 28 Fig. 19. Population with access to basic drinking-water in 2000 and 2015 and projected coverage in 2030, Western Pacific Region and PICs �� 29 Fig. 20.

Change in the proportion of people with access to safely managed and basic sanitation services in the Western Pacific Region between 2000 and 2015 and projection of change between 2015 and 2030 and trends required to achieve SDG 6.2 and SDG 1.4 targets �� 30

Fig. 21. Change in the proportion of people with access to basic sanitation services in the PICs between 2000 and 2015 and projection of change between 2015 and 2030 and trends required to achieve SDG 1.4 target �� 31 Fig. 22. Proportion of population with access to safely managed sanitation services in selected countries of the Western Pacific Region and projected coverage in 2030 �� 31 Fig. 23. Proportion of population with access to basic sanitation services in selected countries of the Western Pacific Region and projected coverage in 2030 �� 32 Fig. 24. Population with access to basic sanitation in 2000 and 2015 and projected coverage in 2030, Western Pacific Region and the PICs �� 33 Fig. 25. Proportion of urban and rural populations in the Western Pacific Region, PICs and the world using basic drinking-water services, 2015 �� 33 Fig. 26. Proportion of urban, rural and national populations in the Western Pacific Region, PICs and the world using basic drinking-water services, 2015 �� 34 Fig. 27. Use of basic drinking-water facilities in selected countries by wealth quintile in 2015 �� 35 Fig. 28. Proportion of urban and rural populations in the Western Pacific Region and the world using safely managed sanitation services, 2015 �� 36 Fig. 29. Proportion of urban, rural and national populations in the Western Pacific Region, the PICs and the world using basic sanitation services, 2015 �� 36

Contents

Fig. 30. Population with and without access to safely managed sanitation services in urban and rural areas, Western Pacific Region and the world, 2000 and 2015 �� 37 Fig. 31. Reported annual government WASH budgets in the Western Pacific Region, most recent fiscal year (2015–2017) �� 52 Fig. 32 Reported annual government WASH budgets per capita in the Western Pacific Region, most recent fiscal year (2015–2017) �� 52

Tables Table 1. Targets and indicators for WASH SDG (water, sanitation and hygiene) �� 3 Table 2. The JMP ladder for drinking-water �� 4 Table 3. The JMP ladder for sanitation �� 5 Table 4. The JMP hygiene ladder �� 5 Table 5. JMP service ladders to monitor WASH in schools �� 66 Table 6. Status of drinking-water and sanitation coverage in schools of selected Western Pacific countries (%) �� 66 Table 7. What can be done at the national, district and local levels to improve drinking-water, sanitation and hygiene in schools? �� 69 Table 8. Service ladders for monitoring WASH in health-care facilities �� 71

Boxes Box 1.

The GLAAS 2016/2017 survey in the Western Pacific Region �� 8

Box 2.

Effect of improvement in drinking-water supply and sanitation on diarrhoeal disease risk �� 11

Box 3.

What can be done to accelerate health gains? �� 12

Box 4. What should be done to improve hygiene in the Western Pacific countries? �� 25 Box 5.

Suggested actions to advance the human right agenda on water and sanitation �� 40

Box 6.

What needs to be done on country policies and strategies? �� 41

Box 7.

The Thematic Working Group on Water, Sanitation and Hygiene �� 42

Box 8.

East Asia Ministerial Conferences on Sanitation and Hygiene (EASAN) �� 43

Box 9.

Key action on sector planning and coordination at the country level �� 44

Box 10. What needs to be done in monitoring and evaluation? �� 47 Box 11. What needs to be done for effective human resources development in the WASH sector? �� 49 Box 12. What needs to be done to address WASH gender issues at the country level? �� 51

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Box 13. What needs to be done to address O&M costs and efficiency? �� 54 Box 14. What can be done to increase the financial feasibility of attaining the WASH SDG targets? �� 56 Box 15. What can be done to implement the drinking-water quality framework in Western Pacific countries? �� 60 Box 16. What can be done to advance the WSP agenda in the Western Pacific Region? �� 62 Box 17. WHO International Scheme to Evaluate Household Water Treatment Technologies �� 63 Box 18. What can be done to advance the HWTS agenda in the Western Pacific Region? �� 64 Box 19. The Fit for School approach �� 67 Box 20. The Three Star Approach �� 68 Box 21. The water and sanitation for health facility improvement tool (WASH FIT) �� 70 Box 22. What needs to be done to improve WASH in health-care facilities? �� 72 Box 23. What to do to face the challenges of WASH in climate change? �� 74

Contents

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Â© WHO / Jose Hueb / 2014

Part of Rewa river basin of Fiji

Foreword Preventable water-related diseases claim tens of thousands of lives in the Western Pacific Region. More than 14Â 000 people a year die from diarrhoeal diseases alone, due to a lack of safe drinking-water, inadequate sanitation and poor hygiene. Sufficient, affordable and safely managed drinking-water and sanitation and improved hygiene behaviours can cut this toll dramatically. Adopting the Sustainable Development Goals (SDGs) in 2015, the world community pledged to achieve universal coverage with safely managed drinking-water and sanitation services and to eradicate open defecation by 2030. The combination of safely managed water, sanitation and hygiene (WASH) will accelerate achievement of the SDGs. The Western Pacific Region made considerable progress from 1990 to 2015, with most countries achieving the Millennium Development Goal (MDG) targets for drinkingwater and sanitation. The proportion of people served with basic drinking-water and basic sanitation in 2015 amounted to 95% and 68%, respectively. Still, nearly 90 million people in the Region do not use a basic drinking-water facility and more than 400 million do not use a basic sanitation facility. The Region needs to measure progress made towards the ambitious targets of achieving universal coverage with safely managed drinking-water and sanitation services for all by 2030. Preliminary data have been obtained by the WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) for a few countries in the Western Pacific Region, showing that only 57% of the population uses safely managed sanitation services. However, information is still not available to calculate the regional statistics for safely managed drinking-water services. This report will provide urgently needed baseline information on the current WASH situation in countries for decision-makers in government and international partners, as well as other stakeholders in the Region. We hope the findings of this report help shed light on gaps and constraints, as well as provide guidance on actions to achieve universal coverage of WASH services and leave no one behind in the Western Pacific Region.

Shin Young-soo, MD, Ph.D. Regional Director

Acknowledgements This document was conceived from the understanding that the countries of the Western Pacific Region would greatly benefit from an integrated analysis of the findings of the two most relevant global WASH monitoring mechanisms managed by WHO and UNICEF (JMP) and by WHO (GLAAS). As a result of this vision, a decision was taken to prepare the current document, which is the practical result of such an endeavour. The document was prepared through the guidance of Rokho Kim and Rifat Hossain and was authored by JosĂŠ Hueb, consultant. The WHO Regional Office for the Western Pacific gratefully acknowledges the contributions of the following specialists who provided technical support over the development of this work and formulated comments and suggestions that contributed greatly to making this document more accurate and useful: Abram YC Abanil (GTZ Regional Fit for School Programme) In-Cheol Choi (WHO Regional Office for the Western Pacific) Jennifer de France (WHO headquarters) Bruce Allan Gordon (WHO headquarters) Fiona Gore (WHO headquarters) Rifat Hossain (WHO headquarters) Seoyeon Jeong (WHO Regional Office for the Western Pacific) Richard Johnston (WHO headquarters) Bonifacio Magtibay (WHO Regional Office for the Western Pacific) Bella Elisabeth Monse (GTZ Regional Fit for School Programme) Rokho Kim (WHO Regional Office for the Western Pacific) Margaret Montgomery (WHO headquarters) Elena Villalobos Prats (WHO headquarters) Angella Rinehold (WHO headquarters) Terrence Thompson (consultant)

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Abbreviations CLTS

community-led total sanitation

DALY

disability-adjusted life year

DFAT

Department of Foreign Affairs and Trade (Australia)

DFID

Department for International Development (United Kingdom of Great Britain and Northern Ireland)

EASAN

East Asia Ministerial Conference on Sanitation and Hygiene

GDWQ

Guidelines for Drinking-water Quality

GIZ

Deutsche Gesellschaft fĂźr Internationale Zusammenarbeit

GLAAS

UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water

HWTS

household water treatment and safe storage

JMP

WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene

MDG

Millennium Development Goal

NGO

nongovernmental organization

O&M

operations and maintenance

PICs

Pacific island countries and areas

SDG

Sustainable Development Goal

SEAMEO

Southeast Asian Ministers of Education Organization

SSP

sanitation safety plan

TWG WSH

Thematic Working Group on Water, Sanitation and Hygiene

United Nations

UN Environment

United Nations Environment Programme

UNICEF

United Nations Childrenâ&#x20AC;&#x2122;s Fund

UN-Water

United Nations Water

USAID

United States Agency for International Development

WASH

water, sanitation and hygiene

WHO

World Health Organization

WSP

water safety plan

WQP

Water Quality Partnership for Health

Abbreviations

ÂŠ UNICEF/Marc Overmars/2004

Water quality of lagoons can be compromised by inadequate sanitation. (Nonouti, Kiribati, 2004)

Executive summary This document is intended to provide relevant water, sanitation and hygiene (WASH) information to policy-makers and decision-makers in governments, bilateral and multilateral agencies, nongovernmental organizations, universities, consultants and civil society in general, to help policy- and decision-making at regional and national levels. Most of the findings of this document are based on the statistics and information provided by two major global monitoring initiatives, both counting on strong participation of the World Health Organization (WHO): the WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) and the WHO-led UN-Water initiative, Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS). Both monitoring initiatives are tracking progress on the WASH Sustainable Development Goals (SDGs), including SDG 6, which aims at ensuring access to safely managed drinking-water and sanitation for all, and SDG indicator 1.4.1, which aims at ensuring that all men and women, in particular the poor and the vulnerable, have equal rights to economic resources, as well as access to basic services. Improving WASH services is particularly relevant to WHO as contaminated drinkingwater, inadequate sanitation and poor hygiene are linked to transmission of diseases such as cholera, diarrhoea, dysentery, hepatitis A, typhoid and poliomyelitis (polio). Some 14 000 people in the Western Pacific Region, especially children under 5 years old, are estimated to die each year from diarrhoea as a result of unsafe drinkingwater, inadequate sanitation and poor hygiene. Moreover, the overall disease burden, expressed as the number of years lost due to ill health, disability or early death (or disability-adjusted life years, DALYs) amounts to 758 (WHO, 2014a). Yet diarrhoea is largely preventable, and the deaths of these children could be avoided if these risk factors were addressed. In health-care facilities, both patients and staff are placed at additional risk of infection and disease when WASH services are lacking. The indicators to measure progress towards universal WASH coverage make a distinction between basic services and well managed services. For drinking-water, basic services are those from an improved drinking-water source, provided collection time is not more than 30 minutes. To be considered safely managed, basic services need also to be located on premises, available when needed and free from contamination. For sanitation, basic services are those provided by improved facilities and not shared with other households. In order to be safely managed, basic services must also be such that excreta are safely disposed of in situ or transported and treated off-site. Unfortunately, the number of countries (11) for which estimates on safely managed services are available is insufficiently representative of the whole Western Pacific Region (37 countries and areas). The same applies to the Pacific island countries

Executive summary

xiii

and areas (PICs), where information is not sufficient to determine statistics on drinking-water safety as well as the other parameters indicative of safe management (drinking-water available when needed, accessible on the premises and free from contamination). However, information is available to determine statistics on access to basic drinkingwater services. Impressive progress was experienced by the Region, with an increase of 15 percentage points in coverage with basic drinking-water services from 2000 to 2015. In 2015, 1.76 billion people in the Region (about 95% of the population) used improved sources of drinking-water that required no more than 30 minutes per round trip to collect water, and are thus considered as having access to basic drinking-water services. The PICs, on the other hand, practically stagnated from 2000 to 2015 with regard to drinking-water supply coverage, with only half of the population using a basic drinking-water facility in 2015. With regard to sanitation, in 2015, only three fifths of the population in the Western Pacific Region used safely managed sanitation services. This means that nearly 790 million people in the Region did not have access to sustainably managed sanitation services. With regard to basic sanitation services in the Region as a whole, about one quarter of the population still did not use basic sanitation. The coverage of basic sanitation services in the PICs was extremely low in 2015, with only 36% of the population using these services. Statistics are unavailable for safely managed sanitation services in the PICs. There is little information about hygiene behaviours in the countries of the Western Pacific Region. The major international household survey institutions have agreed on standardization of household survey questions on hygiene. For this reason, it is possible that far more information on this crucial issue will be available over the coming years. This document also addresses national WASH sector management, sector organization, human right to water, financing and crucial WASH priorities in the Region, and provides suggestions on how to tackle these issues at the country level. It is organized around the following sections: 1. Introduction deals with the objectives of the document and provides general background information on WASH in the Western Pacific Region. It also provides information on the WASH SDGs and how the international institutions responsible for monitoring such goals are managing to track progress at national, regional and global levels. A brief description of the main monitoring mechanisms to collect, analyse and disseminate WASH information is also presented in this section. Finally, reasons are provided to justify the involvement of the health sector in WASH issues. 2. Essential statistics on drinking-water, sanitation and hygiene provides statistics on the use of basic and safely managed WASH services concerning the Western Pacific Region and separately for the PICs. It discusses the immense challenges ahead for the Region, taking into account the requirement of attaining universal coverage with

xiv

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

safely managed services by 2030. It also discusses inequalities in access to WASH in terms of both geographical (urban and rural areas) and socioeconomic disparities (wealth quintiles). 3. Overall status of the WASH sector deals mainly with the findings of the GLAAS 2016/2017 survey conducted in selected countries of the Western Pacific Region. Information was obtained from other relevant sources as well, as indicated directly in the respective texts. Based on the findings of the GLAAS 2016/2017 survey, this section presents information on the countries in the Region concerning several important issues such as the right to drinking-water and sanitation, national sector organization, human resources and financing. 4. Regional programmatic priorities describes the main efforts of the WHO Regional Office for the Western Pacific in support of the WASH regional agenda, which ultimately aims at improving health through promotion and support for universal access to safely managed drinking-water supply and sanitation, and good hygiene behaviours. The Regional Office has been a major partner of relevant multilateral and bilateral agencies in organizing crucial high-level events and facilitating major international commitments in this area. The Officeâ&#x20AC;&#x2122;s programmatic WASH priorities in the Region are outlined briefly in this section. However, by no means is this list exhaustive. Any new subject area may be added whenever there is a perception of new important health hazard linked to WASH issues not considered in this section. Among the top priorities for the Regional Office are issues such as: drinking-water quality, including water safety planning and drinking-water guidelines; household water treatment and safe storage; WASH in schools; WASH in health-care facilities; and WASH in climate change. Most sections and subsections in this report present a discussion on each topic, followed by relevant statistics (where available) obtained from the JMP, GLAAS and other sources, as well as a set of key actions to be undertaken to move the respective agenda ahead. Annexes 1 to 4 are tables displaying in greater detail the basic and safely managed drinking-water and sanitation coverage statistics for the Western Pacific Region. The reader will realize that there are serious problems in terms of lack of data on safely managed drinking-water and sanitation for many countries in the Region. It is hoped that this problem will be overcome in future surveys. Annex 5 displays selected tables summarizing the findings of the 2016/2017 GLAAS survey conducted in the Western Pacific Region. Annex 6 contains a glossary of selected terms used in this report. Annex 7 provides the headings for the 17 SDGs adopted by world leaders on 25 September 2015. Such goals are aimed at ending poverty, protecting the planet and ensuring prosperity for all as part of a new Sustainable Development Agenda. Each goal has specific targets to be achieved by 2030. Annex 8 presents the regional groupings used in this report.

Executive summary

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DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Â© WHO/Yoshi Shimizu

Women washing clothes in the river. (Buka, Papua New Guinea, 2016)

Introduction 1.1 Objectives of this document This document is intended to provide relevant water, sanitation and hygiene (WASH) information to policy-makers and decision-makers in governments, bilateral and multilateral agencies, nongovernmental organizations (NGOs), universities, consultants and civil society in general to help policy- and decision-making at regional and national levels. The specific objectives are the following: zz To provide an overview of the status of drinking-water, sanitation and hygiene in the Western Pacific Region to support policies, strategies and programmes towards the common aim of achieving Sustainable Development Goal (SDG) 6 (Ensure availability and sustainable management of water and sanitation for all) and SDG target 1.4 (achieving universal access to basic services). zz To provide essential information for reflection on ways to streamline international and national efforts for WASH development in the Region. zz To provide the basis for discussion and advocacy work at all levels to accelerate investment for the attainment of universal coverage with safely managed drinking-water, sanitation and hygiene in the countries of the Western Pacific Region.

1.2 Background information A major effort is being exerted by selected United Nations (UN) institutions to provide coherent and reliable information on key water trends and management issues. During past decades, several initiatives, mechanisms and programmes, both within and outside the UN system, have been collecting information on the various aspects of the drinking-water and sanitation sector performance. Two major global monitoring initiatives count on strong leadership from WHO: the WHO and UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) and the WHO-led UN-Water Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS) initiative. The JMP has been monitoring, since 1990, the changes in national, regional and global drinking-water and sanitation coverage, establishing a large and authoritative database and presenting analysis of the indicators detailed in the original framework for the Millennium Development Goals (MDGs), and currently for SDG 6 (Ensure

availability and sustainable management of water and sanitation for all) and partly for SDG target 1.4 (achieving universal access to basic services). The JMP has helped to shed light on the nature of progress and the extent to which the ambition and vision of the MDGs have been achieved. It has also helped to identify priorities to be addressed by SDG 6. The JMP has been issuing regular global WASH reports addressing mainly the aspect of use of drinking-water and sanitation facilities worldwide. Another important monitoring and evaluation mechanism, GLAAS, is implemented by WHO on behalf of UN-Water. The objective of GLAAS is to provide policy- and decision-makers at all levels with a reliable, comprehensive and global analysis of investments and an enabling environment to make informed decisions for sanitation, drinking-water and hygiene. GLAAS reports are issued biennially, following data collection through questionnaires conducted around the world. Two major sets of information are collected: from WASH agencies at the country level; and from external support agencies, including bilateral and multilateral agencies. Following the adoption of the SDGs, the WHO Regional Office for the Western Pacific, in addition to collecting data on the overall WASH indicators, is also investing considerably in collecting relevant information on aspects of management and treatment of wastewater in the pursuit of expanded sanitation chain monitoring under the SDG framework. This is further complemented by efforts in the Region for monitoring of WASH outside of households, namely in health-care facilities and schools in particular. While the global monitoring programmes mentioned above provide excellent and authoritative information on important aspects of the water and sanitation sector, there has not yet been an opportunity to prepare a consolidated analysis addressing the special needs and characteristics of the Western Pacific Region that is based not only on the findings of the two reports but also on other reliable monitoring and evaluation efforts being conducted within and outside of the Region. For this reason, the Regional Office for the Western Pacific has decided to conduct such a consolidated analysis. Such an exercise would be extremely beneficial to Member States as an important instrument not only by providing a regional view of progress towards the achievement of WASH SDGs but also to identify problems and constraints that might potentially be hindering progress towards their respective targets. Moreover, the information collected and analysed through the above sources is used in this document to provide an overall analysis of the WASH sector and a succinct recommended set of strategic directions towards sector development in the Region, including a more holistic approach to monitoring for the Western Pacific. The WHO Western Pacific Region comprises 37 countries and areas and is home to more than one quarter of the worldâ&#x20AC;&#x2122;s population. The Region stretches over a vast area, from Mongolia in the north to New Zealand in the south, and from Central Asia in the east to the Southwest Pacific in the west, including most of the surface area of the Pacific Ocean. If the oceanic surface area is considered, it includes more than one third of the global surface area. Its land mass embraces the eastern half of the

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Eurasian land mass, the eastern part of South-East Asia and the whole land mass of Oceania. It includes 22 Pacific island countries and areas (PICs), across the span of the Pacific Ocean. With unique geographies and population groups, the Region is exceptionally diverse, and includes least-developed countries, rapidly emerging economies and developed nations.

1.3 What is new in WASH monitoring? 1.3.1 The WASH Sustainable Development Goals The year 2015 marked the transition between the MDG (1990–2015) and the SDG (2015–2030) periods. For WASH, MDG target 7c was aimed at halving the proportion of people without sustainable access to safe drinking-water and basic sanitation by 2015 (UN, 2014). Strict monitoring of this target was not possible during the 2000s as the international agencies tasked with this role did not have sufficient information and resources to measure access to “sustainable” and “safe” drinking-water and sanitation. To overcome this major issue, it was decided that monitoring would focus on the use of infrastructure that was likely to address safety and sustainability, using the indicators “improved drinking-water” and “improved sanitation”. The SDGs are far more ambitious than the MDGs in that their overarching aim is to end poverty in all its forms and to leave no one behind in the space of just 15 years. SDG 6 aims to ensure access to safely managed drinking-water and sanitation for all. It seeks to expand the MDG focus on drinking-water and basic sanitation to include water, wastewater and ecosystem resources, covering all the main aspects related to freshwater in the context of sustainable development (UN, 2016). The SDG WASH targets and indicators are presented in Table 1. Table 1.

Targets and indicators for WASH SDG (water, sanitation and hygiene) TARGETS

INDICATORS

Achieving universal access to basic services

1.4 By 2030, ensure all men and women, in particular the poor and vulnerable, have equal rights to economic resources, as well as access to basic services.

Proportion of population living in households

Drinkingwater

6.1 By 2030, achieve universal and equitable access to safe and affordable drinking-water for all.

Proportion of population using safely managed

Sanitation and hygiene

6.2 By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.

Proportion of population using safely managed

with access to basic services (including basic drinking-water, sanitation and hygiene)

drinking-water services

sanitation services

Proportion of population with a handwashing

facility on premises with soap and water available

Population practising open defecation

Water quality and wastewater

6.3 By 2030, improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse globally.

Proportion of wastewater safely treated Proportion of bodies of water with good

ambient water quality

Introduction

TARGETS

INDICATORS

6.4 By 2030, substantially increase water-use efficiency across all sectors and ensure sustainable withdrawals and supply of freshwater to address water scarcity and substantially reduce the number of people suffering from water scarcity.

Change in water-use efficiency over time

6.5 By 2030, implement integrated water resources management at all levels, including through transboundary cooperation as appropriate.

Degree of integrated water resources

Waterrelated ecosystems

6.6 By 2020, protect and restore water-related ecosystems, including mountains, forests, wetlands, rivers, aquifers and lakes.

Change in the extent of water-related

International cooperation and capacitybuilding

6.a By 2030, expand international cooperation and Amount of water- and sanitation-related capacity-building support to developing countries official development assistance that is part of a in water- and sanitation-related activities government-coordinated spending plan and programmes, including water harvesting, desalination, water efficiency, wastewater treatment, recycling and reuse technologies.

Stakeholder participation

6.b Support and strengthen the participation of local communities in improving water and sanitation management.

Water use and scarcity

Water resources management

Level of water stress: freshwater withdrawal as

a proportion of available freshwater resources

management implementation (0–100).

Proportion of transboundary basin area with an

operational arrangement for water cooperation ecosystems over time

Proportion of local administrative units

with established and operational policies and procedures for participation of local communities in water and sanitation management

Source: Adapted from UN (2016).

As SDG 6 focuses not only on the simple provision of services but also on their safe management, monitoring the wider elements of WASH – drinking-water quality as well as safe treatment of excreta and wastewater – becomes necessary.

1.3.2 Updated JMP ladders for WASH The JMP has introduced new drinking-water and sanitation ladders with a special focus on the WASH SDG targets and indicators. To the two previous ladders (drinkingwater and sanitation), a third ladder has also been added for hygiene, as indicated in Tables 2, 3 and 4. Table 2.

The JMP ladder for drinking-water

TYPE OF ACCESS

DEFINITION

Basic services

Drinking-water from an improved source*, provided collection time is not more than 30 minutes for a round trip, including queuing.

TYPE OF ACCESS

DEFINITION

Safely managed

Drinking-water from an improved source, provided collection time is not more than 30 minutes for a round trip, including queuing, that is located on premises, available when needed and free from faecal and priority chemical contamination.

Basic, not safely managed

Drinking-water from an improved source, provided collection time is not more than 30 minutes for a round trip, including queuing, that is not located on premises, or available when needed or free from faecal and priority chemical contamination.

Limited

Drinking-water from an improved source for which collection time exceeds 30 minutes for a round trip, including queuing.

Unimproved

Drinking-water from an unprotected dug well or unprotected spring.

Surface water

Drinking-water directly from a river, dam, lake, pond, stream, canal or irrigation canal.

*Improved sources include: piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered water. Source: WHO and UNICEF (2017a).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

At this stage, information on the availability of improved drinking-water sources on premises is scarce, as is information on the availability of drinking-water when needed and status of absence of contamination from faecal and priority chemical contamination in the Western Pacific. Therefore, many assumptions and concessions needed to be made so the statistics presented in the 2017 JMP Report could be calculated. When additional information becomes available, future reports might need to adjust the statistics presented in this report. Table 3.

The JMP ladder for sanitation

TYPE OF ACCESS

DEFINITION

TYPE OF ACCESS

Basic services

Use of improved facilities* that are not shared with other households.

Safely managed

Use of improved facilities that are not shared with other households and where excreta are safely disposed of in situ or transported and treated offsite.

Basic, not safely managed

Use of improved facilities that are not shared with other households and where excreta are not safely disposed of in situ or transported and treated offsite.

DEFINITION

Limited

Use of improved facilities shared between two or more households.

Unimproved

Use of pit latrines without a slab or platform, hanging latrines or bucket latrines.

Open defecation

Disposal of human faeces in fields, forests, bushes, open bodies of water, beaches or other open spaces, or with solid waste.

*Improved facilities include flush/pour flush to piped sewer systems, septic tanks or pit latrines; ventilated improved pit latrines, composting toilets or pit latrines with slabs. Source: WHO and UNICEF (2017a).

Similar to information on drinking-water, information on safe treatment of excreta and wastewater in the Region is also scarce. For instance, it is difficult to determine which latrines are safely managed and how to obtain information on their performance; the same is the case with regard to septic tanks. Some septic tanks may not be watertight, or may be discharging to open drainage or are not maintained regularly. Considering that septic tanks such as the latter ones are not safely managed, it is challenging to find ways to capture this information and take it into account when deriving estimates. Table 4.

The JMP hygiene ladder DEFINITION

TYPE OF ACCESS

Basic Limited Unimproved

Availability of a handwashing facility* on premises with soap and water. Availability of a handwashing facility on premises without soap and water. No handwashing facility on premises.

*Handwashing facilities may be fixed or mobile and include a sink with tap water, buckets with taps, tippy-taps, and jugs or basins designated for handwashing. Soap includes bar soap, liquid soap, powder detergent and soapy water but does not include ash, soil, sand or other handwashing agents. Source: WHO and UNICEF (2017a).

Introduction

Figs. 1 and 2 show schematically how the detailed statistics on different drinkingwater and sanitation interact in the composition of the JMP coverage indicators. Fig. 1.

Composition of the different JMP drinking-water statistics

Surface water Unimproved

Total population

Limited Non-piped facilities Basic, not safely managed

Improved Basic

Safely managed

Accessible on premises

Available when needed

Piped systems

Free from contamination

Notes: a. Safely managed drinking-water is being currently estimated by the JMP as the smallest of the three indicators: accessible on premises, available when needed and free from contamination. b. Safely managed drinking-water is estimated only when statistics on the proportion of people with access to drinkingwater free from contamination are known. Source: based on definitions in WHO and UNICEF (2017a).

Fig. 2.

Composition of the different JMP sanitation statistics Open defecation

Unimproved

Total population

Limited (shared) Basic, not safely managed

Improved

Latrines and others Disposed in situ

Basic Safely managed

Emptied and treated Wastewater treated

Source: based on definitions in WHO and UNICEF (2017a).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Septic tanks

Sewer connections

In this report, any statistics on using basic services refer to the totality of the population with access to improved services subtracted by the population with access to limited services (see Figs. 1 and 2). When statistics on “safely managed” services are available, the totality of access to basic services is broken down into access to safely managed and access to “basic services, but not safely managed”, as follows: Access to basic services = safely managed (known) + basic, but not safely managed (known). When statistics on “safely managed” are unknown, but the totality of access to basic services is known, then it is understood that such a “totality” includes the two unknown elements. In this case, the equation is as follows: Access to basic services (known) = safely managed (unknown) + basic, but not safely managed (unknown). Further explanations on the methodological changes introduced by the JMP can be found in the WHO and UNICEF publication, Progress on drinking water, sanitation and hygiene: 2017 update and SDG baselines (2017a), or on the JMP website: washdata.org.

1.3.3 The UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) GLAAS objectives are defined as, at the global, regional and national level, monitoring the inputs (in terms of human resources and finance) and the enabling environment (in terms of laws, plans and policies, institutional and monitoring arrangements) required to sustain and extend drinking-water, sanitation and hygiene systems and services to all, and especially to the most vulnerable population groups (WHO, 2017a). Finance was chosen as the main focus of the 2016/2017 survey because not only is finance the most crucial aspect influencing any sector planning, it is also a strong driver of progress or constraints in all the other dimensions monitored by GLAAS (see Box 1). While the GLAAS 2017 report had a finance focus, all areas of the enabling environment (governance, monitoring and human resources) were also covered by some countries and are being used for the analyses in this regional report. Because the GLAAS 2016/2017 survey offered the alternative to respondent countries of choosing a shorter questionnaire focused mostly on finance, most of the countries of the Western Pacific Region chose this latter option; therefore, the broader aspects of WASH sector development were not covered. For this reason, this regional report also used information from previous GLAAS surveys where needed. Because GLAAS will help to monitor SDG 6 targets on means of implementation (6.a and 6.b), the GLAAS 2016/2017 survey included specific questions that are required for SDG monitoring. GLAAS has also expanded survey questions to cover

Introduction

Box 1. The GLAAS 2016/2017 survey in the Western Pacific Region The Global Analysis and Assessment of Water and Sanitation (GLAAS) surveys assess data from several different sources, including country and global data on sanitation and drinking-water coverage; donor aid flows; health, economic and development indicators; and data from regional sector and multisector assessments. GLAAS gathers data at both country and external support agency levels to fill key information gaps. The GLAAS 2016/2017 was the most successful GLAAS survey ever conducted in the Western Pacific Region. A total of 13 countries, 97 WASH country professionals and 3 international consultants participated actively not only in providing the information requested by the questionnaires but mainly in creating an enabling interministerial and interagency environment in each country, which served as a coordination and planning tool for governments, institutions and actors influencing and requiring WASH service delivery. The GLAAS survey in countries in the Western Pacific Region helped in assessing the state of the enabling environment, including financial and human resources inputs being directed to sanitation, drinking-water and hygiene, while identifying barriers and enablers. It was an extremely well-coordinated and participatory exercise with outputs that went beyond the initial expectations. As a result of this exercise, many countries are seriously considering developing further their respective information and evaluation mechanisms to help measure their progress towards the WASH SDG targets and to help orient their action towards such an endeavour.

safely managed drinking-water and sanitation systems, faecal sludge management, wastewater and regulation (WHO, 2017a).

1.3.4 Remarks about the statistics presented in this document The regional drinking-water and sanitation coverage statistics presented in this document refer to the Member States of the WHO Western Pacific Region. Not all graphs and, accordingly, not all analyses include all the countries of the Region. Where the JMP or GLAAS could not provide statistics and information for certain countries, they were not included in graphs and tables. In many instances, analysis of the PICs is presented separately from the analysis for all Western Pacific countries as their population is a fraction of the overall population in the Region. Australia and New Zealand â&#x20AC;&#x201C; although included in the analysis for the Western Pacific Region â&#x20AC;&#x201C; are not included in the analysis for the PICs. The information available on WASH in the PICs is far from what would be desirable for an unequivocal analysis of this sector. Hence, the corresponding analysis on the PICs conducted in this report reflects what is possible to present taking into account the scarcity of information. The countries comprising the Western Pacific Region and the PICs are presented in Annex 8 of this report.

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Contaminated drinking-water, inadeÂ quate sanitation and poor hygiene are linked to transmission of diseases such as cholera, dysentery, hepatitis A, typhoid and polio. Absent, inadequate, or inappropriately managed drinking-water and sanitation systems expose individuals to preventable health risks. This is true not only with regard to the population in general but is also particularly the case in healthcare facilities, where both patients and staff are placed at additional risk of infection and disease when drinking-water, sanitation and hygiene services are lacking. Globally, 15% of patients develop an infection during a hospital stay, with the proportion much greater in low-income countries; Children fetching drinking-water. (Mongolia, 2015) nearly 1 million deaths are linked to unhygienic births (WHO, 2017b). Furthermore, limited WASH services adversely impact the experience of care, care-seeking and health staff morale, all of which have adverse impacts on health (Blencowe and Graham, 2010).

ÂŠ WHO/Yoshi Shimizu

1.4 Why is the health sector involved in WASH?

Almost 240 million people globally are affected by schistosomiasis, which is an acute and chronic disease caused by parasitic worms contracted through exposure to infested water. Insects that live or breed in water carry and transmit diseases such as dengue fever, chikungunya, malaria and yellow fever, etc. Some of these vectors breed in clean, rather than dirty water (such as Aedes aegypti, Aedes albopictus, etc.) and household drinking-water containers can serve as breeding grounds. The simple intervention of covering water storage containers can reduce vector breeding and may also reduce faecal contamination of water at the household level (WHO, 2017b). Similarly, the inadequate management of urban, industrial and agricultural wastewater leads to major health hazards due to direct exposure of humans to contamination or through microbial or chemical contamination of drinking-water sources. Some 14â&#x20AC;Ż000 people in the Western Pacific Region, especially children under 5 years old, are estimated to die each year from diarrhoea as a result of unsafe drinkingwater, sanitation and poor hygiene. Yet diarrhoea is largely preventable, and the deaths of these children could be avoided if these risk factors were addressed (WHO,

Introduction

2014a). Fig. 3 displays the mortality rate due to the absence of safe drinking-water, sanitation and hygiene for selected countries in the Region. It is believed that although the number of deaths attributable to diarrhoeal diseases (which in turn are caused by lack of safe drinking-water, sanitation and hygiene) are relatively low, the morbidity statistics are exceedingly high, exhausting scarce health-care resources that could be otherwise used to address other pressing needs. Unfortunately, reliable statistics to corroborate this statement are unavailable. Fig. 3.

Mortality rate attributed to exposure to unsafe WASH services (per 100Â 000 population)

16 14

13.9 12.4

12 10.4 10 8 5.6

5.1

3.1 3.0

Global

Brunei Darussalam

Australia

Singapore

Japan

Republic of Korea

Malaysia

0.8

China

Viet Nam

Fiji

Mongolia

Philippines

Cambodia

Solomon Islands

Papua New Guinea

Lao People's Democratic Republic

0.6 0.4 0.4 0.2 0.1 0.1 0.0 0.0

Western Pacific Region

2.0

New Zealand

Mortality rate (per 100 000 population)

12.4

*Information is not available for all countries in the Western Pacific Region. Due to the large population in China, the statistics from this country substantially affect the aggregated statistics for the Region. Source: WHO (2014a).

There is clear evidence that well-managed drinking-water and sanitation systems reduce considerably the risk of diarrhoeal diseases. Box 2 quantitatively demonstrates how the improvements in terms of quality of services lead to substantive reductions in risk.

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Effect of improvement in drinking-water supply and sanitation on diarrhoeal disease risk

The risk of diarrhoeal disease decreases as people in low- and middle-income countries use different levels of drinking-water and sanitation alternatives. For drinking-water, five levels were studied, namely: • Systematically managed piped drinking-water with continuity and good safety. • Basic piped drinking-water on premises (drinking-water piped into the household without certainty of its continuity and safety). • Other improved sources (public taps and standpipes, boreholes and tubewells, protected wells and springs, rainwater collection). • Unimproved: surface water (rivers, lakes), unprotected wells, springs, improved sources farther than a 30-minute round trip for collecting water. • Effective household drinking-water treatment and safe storage. One of the results of the study shows risk reduction attributed to moving from one drinking-water option to another, as seen in the following diagram. It is obvious that 45%

Unimproved source of drinking-water

a huge risk reduction occurs when moving from any option to well-managed piped drinking-water services. For sanitation, the following levels of sanitation options were studied: •

•

Community sanitation or sewer connections: those living in communities with access to a sewerage system or other systems removing excreta entirely from the community. Improved sanitation without sewer connections: those using improved onsite sanitation facilities (septic tank, ventilated improved latrine, pit latrine with slab, composting toilet). Unimproved sanitation (pit latrines without a slab or platform, hanging latrines, bucket latrines and open defecation).

The results of the study with regard to risk reduction attributed to moving from one sanitation option to another can be seen in the following diagram. It is obvious that huge health gains occur when moving from any option to a well-managed sanitation system.

HIGH 16%

11%

Improved sanitation without sewer connections

38%

14% Basic piped drinking- 28% water on premises

RISK TO HEALTH

Improved point source of drinkingwater

23%

HIGH

Unimproved sanitation

28%

69% 73%

Improved sanitation (including sewer connections)

RISK TO HEALTH

Box 2.

73% Piped drinkingwater, systematically managed

Drinking-water efficiently treated and safely stored in the household

Community sanitation or sewer connections LOW

LOW

Source: WHO (2014a).

Introduction

According to the commitments agreed globally concerning SDG 6, the aim is to achieve universal coverage by 2030 with safely managed drinking-water, sanitation and hygiene as indicated in Table 1. However, while such targets are not achieved, Box 3 proposes a few key interventions that would effectively accelerate health gains. Box 3. What can be done to accelerate health gains? Investing in safely managed drinking-water and sanitation infrastructure and services is the long-term solution to accrue a maximum of health benefits for the developing communities in the Western Pacific Region. WASH infrastructure is costly, and although it is fundamental to achieving a sustainable management of services, implementing the different phases of project development is a long-term endeavour. Under the current SDG 6 commitments, the ultimate aim of infrastructure project development is to achieve universal coverage with safely managed services by 2030. However, shorter-term solutions are available and should be promoted while the long-term infrastructure is not yet in place. Most of these interventions might be essential even when traditional infrastructure is already in place. They should include at least the following: •

•

For drinking-water, improved point sources availability and household water treatment and safe storage are fundamental. For sanitation, basic, sanitary, well-managed onsite facilities and promotion of hygiene behaviours, especially handwashing, are also fundamental. For both drinking-water and sanitation it is crucial to invest in the establishment and implementation of both water safety plans (WSPs) and sanitation safety plans (SSPs) as a condition to protect health and as a contribution to the process towards safe management of WASH systems. Improvement of WASH in schools and health settings can lead to substantial health gains.

It is advisable for these short-term interventions to be implemented without missing the perspective of broader sector plans, including adequate infrastructure, conducive to the sustainable attainment of the WASH SDG targets.

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

A girl washes her hands before lunch at a kindergarten. (Khánh Hòa Province, Viet Nam, 2015)

Essential statistics on drinkingwater, sanitation and hygiene

The statistics presented in this section are based on the latest estimates (2017) by the JMP. Statistics are presented for each country in the Western Pacific Region and are also presented as aggregated values for the Region and the PICs. Statistics for the different measures are not always available for all the countries. Therefore, where information on a particular country is not available, the name of the country is not included in the graphs. Similarly, aggregated values are calculated as weighted averages, taking the information available as the sample for the whole Region. Thus, the averages (population-weighted averages) refer to the countries for which information is available. The average values for the PICs do not include Australia and New Zealand as they are developed countries and their respective populations are disproportionately higher than those of many other PICs. The term â&#x20AC;&#x153;countries of the Western Pacific Regionâ&#x20AC;? refers to the Member States of the WHO Western Pacific Region. The list of all the countries is available in Annex 8.

2.1 Drinking-water 2.1.1 Using safely managed drinking-water facilities The WASH SDGs aim at achieving universal access to basic drinking-water services (SDG target 1.4) and universal access to safely managed drinking-water services (SDG target 6.1). Unfortunately, the number of countries (11 countries) for which estimates on safely managed services are available insufficiently representative of the whole Western Pacific Region (37 countries and territories). The same applies to the PICs, for which information is not sufficient to determine statistics on drinking-water safety as well as the other parameters indicative of safe management (drinking-water available when needed; accessible on the premises; free from contamination). Fig. 4 shows the statistics on safe management of drinking-water for the countries in the Region for which information is available. The majority of these countries report excellent performance; however, most are those at a higher level of development. Moreover, due to lack of information, statistics on safe management for these countries does not necessarily take into account all the elements considered as the basis for such a classification. There is a high probability that the situation depicted by the current JMP statistics will be less rosy in future assessments when all the components of

safely managed drinking-water for each country, as well as the statistics for all the Western Pacific countries are known. Fig. 4.

Proportion of population with access to safely managed drinking-water services and other supply alternatives in Western Pacific countries and areas, 2015 90 80 70 98

Republic of Korea

Japan

New Caledonia

Niue

100 Singapore

100 New Zealand

100

Macao SAR (China)

100

Hong Kong SAR (China)

30 20 24

Drinking-water coverage (%)

100

Safely managed

Basic, not safely managed

Limited

Unimproved

World

Cambodia

Northern Mariana Islands

Malaysia

Surface water

NOTE: Aggregated estimates on safely managed drinking-water services are not available for the countries of the Western Pacific Region and for the PICs. Source: country statistics from WHO and UNICEF (2017a).

2.1.2 Using basic drinking-water services Although statistics on safe management of drinking-water fall short of what would be needed to calculate regional estimates, information is available to determine statistics on access to basic drinking-water services. Basic drinking-water facilities are those described by the JMP as improved and requiring less than a 30-minute round trip to fetch water. Impressive progress was experienced in the Region with an increase of 15 percentage points in coverage with basic drinking-water services from 2000 to 2015 (Fig. 5). In 2015, 1.76 billion people in the Region (about 95% of the population) used improved sources of drinking-water that required no more than 30 minutes per round trip to collect drinking-water, and are thus considered as having access to basic drinkingwater services. The PICs, on the other hand, practically stagnated from 2000 to 2015 with regard to drinking-water supply coverage, with only half of the population using a basic drinking-water facility in 2015. It is important to mention that an undetermined proportion of the people served by basic facilities in the Region might be using drinking-water that is not safely managed.

Essential statistics on drinking-water, sanitation and hygiene

Proportion of the population in the Western Pacific Region and the PICs with access to different drinking-water options in 2000 and 2015, and comparison with the world aggregated statistics 100

13 1 29

Percentage (%)

Fig. 5.

50 40

2 6 4

4 12

20 10 0

2000 2015 Western Pacific Region Basic

2000 2015 Pacific island countries Limited Unimproved

2000

World

2015

Surface water

Source: country coverage statistics from WHO and UNICEF (2017a).

Despite such impressive progress, about 89 million people in the Region still use either unimproved water sources or surface water (rivers, lakes, etc.) or need to spend more than 30 minutes for a round trip to fetch water from an improved source (Fig. 6). Fig. 6.

900

700

600

500 844

50 40

400 300

30 20

200

100

Western Pacific Region Proportion of population with access to basic services

800

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

World Population without access to basic services (millions)

Population without access to basic drinkingwater services (millions)

100

Proportion of population with access to basic drinking-water services (%)

Source: country coverage statistics from WHO and UNICEF (2017a).

About three quarters of the Western Pacific countries have coverage with basic drinking-water services greater than 90% (Fig. 7). Despite such high coverage, about 89 million people do not have access to basic drinking-water. Fig. 7.

Proportion of populations in the Western Pacific countries using different types of drinking-water services, 2015

90 80 70 60 40

64 64

100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 99 99 99 99 99 98 96 96 96 94 91 91 91 88 83 80 78 75

30 20

Basic drinking-water coverage (%)

100

10 Australia Brunei Darussalam Hong Kong SAR (China) Macao SAR (China) Cook Islands French Polynesia Guam Nauru New Zealand Palau Republic of Korea Singapore Tokelau Tonga Wallis and Futuna Islands American Samoa Japan New Caledonia Northern Mariana Islands Tuvalu Niue China Malaysia Samoa Fiji Vanuatu Viet Nam Philippines Micronesia (Federated States of) Mongolia Lao People's Democratic Republic Marshall Islands Cambodia Kiribati Solomon Islands Papua New Guinea

Basic

Limited

Unimproved

Surface water

Source: country coverage statistics from WHO and UNICEF (2017a).

China, with a total population of 1.4 billion people, has ensured basic drinkingwater services for 96% of its citizens. Despite such a major achievement, about 58 million people are still unserved (Fig. 8). Together, Cambodia, Papua New Guinea, the Philippines and Viet Nam are home to about 27 million people who do not have access to these services and who are thus at higher risk of contracting water-related diseases. Fig. 8.

Population in the Western Pacific Region not using basic drinking-water, 2015 (population in millions) Philippines, 10 Viet Nam, 8 Papua New Guinea, 5 Cambodia, 4 Japan, 1 China, 58

Lao People's Democratic Republic, 1 Malaysia, 1 All other Western Pacific Region countries, 1

Source: country coverage statistics from WHO and UNICEF (2017a).

Essential statistics on drinking-water, sanitation and hygiene

2.1.3 Use of piped drinking-water systems Although three quarters of the population in the Western Pacific has access to drinkingwater piped into households, about one quarter (more than 460 million people) still need to fetch drinking-water from point sources (protected wells, protected springs, etc.) (Fig. 9). About 70% of the countries in this Region ensure the provision of drinkingwater piped into households to more than 50% of their respective populations. With regard to the PICs, only one third of the Regionâ&#x20AC;&#x2122;s population count on drinkingwater piped into their households. Fig. 9.

Proportion of populations in the Western Pacific Region using drinkingwater piped into their households, 2015

90 80 70 60

Piped

Hong Kong SAR (China) Macao SAR (China) French Polynesia New Zealand Palau Singapore American Samoa Brunei Darussalam Guam Tuvalu Wallis and Futuna Islands Japan New Caledonia Republic of Korea Northern Mariana Islands Malaysia Tokelau Tonga Australia Fiji Niue Samoa China Cook Islands Nauru Solomon Islands Philippines Lao People's Democratic Republic Viet Nam Kiribati Vanuatu Mongolia Cambodia Papua New Guinea Marshall Islands

Western Pacific Region Pacific island countries World

47 43 42 40 33 32 26 21 20 11

100 100 100 100 100 100 99 99 99 99 99 98 98 98 97 94 94 94 91 87 87 82 78 75 68

Drinking-water coverage (%)

100

Not piped

Notes: a. The average values for the Western Pacific Region include all the countries in the Region for which statistics are available. b. The average values for the PICs exclude Australia and New Zealand as they are developed countries and their respective populations are disproportionately higher than that of many other PICs. Source: country coverage statistics from WHO and UNICEF (2017a).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

2.2 Sanitation 2.2.1 Using safely managed sanitation facilities Safely managed sanitation facilities are improved facilities that are not shared with other households and where excreta are disposed of in situ or transported and treated off-site. The JMP calculates country estimates for safely managed sanitation when information on excreta management is available for at least 50% of the population using the dominant type of improved sanitation facility (sewer connections or on-site sanitation systems). Regional estimates – such as those used for the Western Pacific Region in this report – are made when such data are available for at least 30% of the regional population (WHO and UNICEF, 2017a). SDG target 6.2 is: “By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.” The indicators of this target (6.2.1) are the “percentage of population using safely managed sanitation services” and “access to handwashing facilities on premises.” Fig. 10 indicates the status of access to safely managed sanitation services in 2000 and 2015 for the Western Pacific Region and for the world. The JMP was unable to calculate aggregated estimates on safely managed sanitation for the PICs as the data available are insufficient to represent the whole group of countries.

Fig. 10.

Proportion of the population in the Western Pacific Region and the PICs with access to different sanitation options in 2000 and 2015, and comparison with the world aggregated statistics 100

Percentage (%)

80 70

5 29

40 30 20

57 33

10 0

60 50

2000 2015 Western Pacific Region Safely managed

2000

World

Basic, not safely managed

Unimproved

2015

Limited

Open defecation

Source: country coverage statistics from WHO and UNICEF (2017a).

Essential statistics on drinking-water, sanitation and hygiene

In 2015, only three fifths of the Western Pacific population had access to safely managed sanitation services. This means that nearly 790 million people in the Region do not have access to sustainably managed sanitation services. The number of people who frequently use unsanitary, unimproved sanitation options â&#x20AC;&#x201C; and who are thus exposed to serious health risks â&#x20AC;&#x201C; is equivalent to the entire population of Latin America. Fig. 11 indicates that very few countries generated sufficient information for the calculation of the proportion of people with access to safely managed sanitation services. As China is one of these countries, it was possible to calculate an average figure for the Western Pacific Region. Due to the relatively small sample representation, it is possible, however, that future WASH assessments might provide a different perspective as additional sanitation information is generated. Fig. 11.

Proportion of populations in the Western Pacific countries using safely managed sanitation and other types of sanitation options, 2015

100 90 80

74 Australia

New Zealand

100 Japan

100

Singapore

Sanitation coverage (%)

Safely managed

Basic, not safely managed

Limited

Source: country coverage statistics from WHO and UNICEF (2017a).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Unimproved

World

Western Pacific Region

Tuvalu

Hong Kong SAR (China)

Palau

China

Malaysia

Republic of Korea

Open defecation

2.2.2 Use of toilets flushing to sewers and wastewater treatment There is little information available in many Western Pacific countries to allow determination of the proportion of people using toilets flushing to sewers, and there is even less information on statistics showing the proportion of people producing wastewater treated by wastewater treatment plants (Fig. 12). Nearly 90% of the countries with more than 70% coverage with toilets flushing to sewers are among the wealthiest countries in the Region. Only three countries have over 70% of their wastewater treated by wastewater treatment plants that include secondary treatment or higher, or primary treatment with a long ocean outfall (Japan, Republic of Korea and Singapore). Fig. 12.

Proportion of people using toilets flushing to sewers and proportion of people generating wastewater treated by treatment plants, Western Pacific Region, 2015

100 90

Cambodia

Kiribati

Vanuatu

Niue

Papua New Guinea

Philippines

Lao People's Democratic Republic

Viet Nam

Samoa

Tonga

Nauru

Mongolia

American Samoa

French Polynesia

Malaysia

Northern Mariana Islands

China

Sewer connection

Marshall Islands

Palau

61 45

Guam

Japan

New Zealand

Australia

Hong Kong SAR (China)

Brunei Darussalam

Singapore

Tuvalu

Republic of Korea

30 20

100

Sanitation coverage (%)

Wastewater treated

Note: there is lack of information (expressed by the absence of bars on the graph above) to show statistics on treated wastewater for several countries in the Western Pacific Region. Source: country coverage statistics from WHO and UNICEF (2017a).

The three conditions to determine whether a sanitation facility is well-managed are the following: the excreta should be treated and disposed of in situ (well-managed on-site sanitation such as latrines), or it should be stored temporarily and then

Essential statistics on drinking-water, sanitation and hygiene

emptied, transported and treated off-site (septic tanks), or the wastewater should be transported through a sewerage system and then treated off-site (treatment plants). Fig. 13 shows the proportion of people in the Western Pacific Region using one of the three modalities above (sewer connections, septic tanks or latrines) and how the excreta are managed accordingly. The graph shows the proportion of population served with sewer connections and the proportion of people with their wastewater treated; the proportion of people with access to latrines and other on-site contained form of sanitation with the safe disposal in situ; and the proportion of people with access to septic tanks. Sound statistics about the safe emptying and treatment of sludge are not available. While in urban areas, sewer connections are the preferred form of sanitation, in rural areas, latrines and other types of on-site sanitation are predominant. Fig. 13.

Proportion of people in the Western Pacific Region with access to different types of technologies, total, rural, urban, 2015

Proportion of people served with different technologies (%)

100 90 80

60 50 40 30 20

33 24

20 10

9 8

10 9 9

0 Total

Rural

Urban

Western Pacific Region Sewer connections

Septic tanks

Wastewater treated

Emptied and treated (statistics not available for Western Pacific Region)

Latrines and other Disposed in situ

ÂŠ WEDC

Source: country coverage statistics from WHO and UNICEF (2017a).

Overhung latrine in Indonesia.

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

ÂŠ WHO / Jose Hueb

2.2.3 Using basic sanitation facilities

Public toilet in Fiji downtown.

More than 60% of the Western Pacific countries are reported to have coverage with basic sanitation services (improved sanitation facilities not shared between households) above 80% (Fig. 14). However, in six countries, open defecation is practised by over 10% of the overall population. In the Region as a whole, about one quarter of the population still does not have access to basic sanitation. Coverage with basic sanitation services in the Pacific is less than half that of the Western Pacific Region. Fig. 14.

100

70 60

20 10

78 4 68

100 100 100 100 100 100 100 100 99 98 97 97 97 96 96 96 93 93 91 90 87 79 78 75 75 73 66 62 59 53 49 40 31

Sanitation coverage (%)

Basic

Limited

Unimproved

Western Pacific Region Pacific island countries World

Australia Japan New Caledonia New Zealand Palau Singapore Republic of Korea Malaysia Wallis and Futuna Islands Cook Islands French Polynesia Niue Samoa Brunei Darussalam Hong Kong SAR (China) Fiji Tonga Tokelau Tuvalu Guam Marshall Islands Northern Mariana Islands Viet Nam China Philippines Lao People's Democratic Republic Nauru American Samoa Mongolia Vanuatu Cambodia Kiribati Solomon Islands Papua New Guinea

Open defecation

Notes: a. The average values for the Western Pacific Region include all Western Pacific countries for which statistics are available. b. The average values for the Pacific exclude Australia and New Zealand as they are developed countries and their respective populations are disproportionately higher than that of many other Pacific countries. Source: country coverage statistics from WHO and UNICEF (2017a).

Essential statistics on drinking-water, sanitation and hygiene

The Western Pacific Region has not performed as well in providing basic sanitation to its citizens as it has performed in basic drinking-water services. One quarter of the population in China still does not have access to basic sanitation (Fig. 15). Because of China’s large population, the vast majority of unserved people live in this country (343 million people unserved). Cambodia, Papua New Guinea, the Philippines and Viet Nam are home to about 59 million people without access to these services. Fig. 15.

Population in the Western Pacific Region not using basic sanitation, 2015 (population in millions) Philippines, 25 Viet Nam, 20 Cambodia, 8 China, 343

Papua New Guinea, 6 Lao People's Democratic Republic, 2 Mongolia, 1 All other Western Pacific Region countries, 1

Source: country coverage statistics from WHO and UNICEF (2017a).

2.3 Hygiene

Despite the enormous health benefits of good hygiene behaviours, hygiene is frequently not a priority in many nations’ development process. The lack of proper hygiene has a particular impact on children, inhibiting their mental, physical and social development. The lack of proper sanitation in many schools in the Western Pacific countries has a considerable negative impact on education, particularly among

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases. Medical hygiene includes a specific set of practices associated with preservation of health – for example, environmental cleaning, sterilization of equipment, hand hygiene, water and sanitation, and safe disposal of medical waste (WHO Regional Office for the Western Pacific, 2013).

A child collecting water. (Manila, Philippines)

girls. A huge effort is needed from external support agencies, NGOs and especially governments, if the hygiene SDG target is to be achieved (Box 4). Box 4. What should be done to improve hygiene in the Western Pacific countries? The GLAAS 2017 survey identified crucial issues in effecting improvements in this area. They include the following: • the need for awareness creation among decision- and policy-makers at all levels; • formulation of a national hygiene promotion plan; • inclusion of hygiene promotion in school curricula; • hygiene monitoring and evaluation; • using different media nationwide; • local-level training; • increased investment; and • stakeholder participation in planning and implementing sanitation and hygiene programmes.

The new global SDG indicator for handwashing is the proportion of population with handwashing facilities with soap and water at home. Handwashing facilities can consist of a sink with tap water but can also include other devices that contain, transport or regulate the flow of water. Buckets with taps, tippy-taps and portable basins are all examples of handwashing facilities. Bar soap, liquid soap, powder detergent and soapy water all count as soap for monitoring purposes (WHO and UNICEF, 2017a).

Source: GLAAS 2017 survey questionnaires

Global Handwashing Day. (Viet Nam, 15 October 2010)

People living in households that have a handwashing facility with soap and water available on premises are counted as having basic facilities. Households that have a handwashing facility but lack water and/or soap are counted as having limited facilities. In some cultures, ash, soil, sand or other materials are used as handwashing agents, but these are less effective than soap and are therefore counted as limited handwashing facilities (WHO and UNICEF, 2017a). There is little evidence-based information on hygiene practises in the Western Pacific Region. The JMP provided consolidated statistics for only three countries: Cambodia,

Essential statistics on drinking-water, sanitation and hygiene

Mongolia and Viet Nam. The coverage with basic hygiene in these countries ranges from 66% in Cambodia to 86% in Viet Nam (Fig. 16). A standardization of household survey questions on hygiene has been agreed upon between the major international household survey institutions. For this reason, it is possible that far more information on this crucial issue will be available over the forthcoming years. Fig. 16.

Proportion of population in Cambodia, Mongolia and Viet Nam using basic and limited handwashing facilities in 2015 100 90

Hygiene coverage (%)

80 70

2 13

60 50 40 30

20 10 0

Cambodia

Mongolia

Viet Nam

No facility (no handwashing facility on premises) Limited (availability of a handwashing facility on premises without soap and water) Basic (availability of a handwashing facility on premises with soap and water) Source: country coverage statistics from WHO and UNICEF (2017a).

2.4 Implications of the SDG WASH targets on the Western Pacific Region 2.4.1 Drinking-water Unfortunately, there is little information on access to safely managed drinking-water services for the majority of the Western Pacific countries. Thus, it is not possible at this stage to establish a baseline and to evaluate the likelihood of such countries and the region as a whole to achieve SDG target 6.1. However, it is possible to determine statistics on access to basic drinking-water (SDG target 1.4) for most countries in the Region and therefore to calculate trends towards the 2030 target year. SDG target 1.4 aims at “achieving universal access to basic services” by 2030. It aims at ensuring that “all men and women, in particular the poor and vulnerable, have

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

equal rights to economic resources, as well as access to basic services…” For WASH, the indicator being measured is the proportion of population living in households with access to basic drinking-water, sanitation and hygiene (UN, 2016). If the trend from 2000 to 2015 continues to 2030, the Western Pacific Region as a whole is likely to achieve SDG target 1.4 (reaching universal coverage with basic drinking-water services); however, the PICs will fall short of more than 50 percentage points to achieve the target (Fig. 17). Fig. 17.

Change in the proportion of people with access to basic drinking-water services in the Western Pacific Region and the PICs between 2000 and 2015 and projection of change between 2015 and 2030 100

100 90 Wes

rn P

c acifi

Reg

ion

SDG target 1.4, SDG target 6.2

Drinking-water coverage (%)

80 70 60 50

Pacific island co

untries

40 30 20 10 0 2000

2015

2030 (Projected)

Year

Change in coverage with basic services 2000–2015 (Western Pacific Region) Change in coverage with basic services (2000–2015) (Pacific island countries) Projected change in coverage with basic services (2015–2030) (Western Pacific Region) Projected change in coverage with basic services (2015–2030) (Pacific island countries) Change in coverage with basic services to achieve the SDG 1 Target 1.4 (2015–2030) (Pacific island countries) Source: country statistics for 2000 and 2015 from WHO and UNICEF (2017a).

Essential statistics on drinking-water, sanitation and hygiene

Fig. 18 suggests that if the trend from 2000 to 2015 continues towards 2030, even if the Western Pacific Region as a whole achieves universal coverage, a few countries in the same Region will not. This apparent paradox is explained by the fact that the most populous countries will reach the target, whereas a few much less populous countries not achieving universal coverage will be weighted less when aggregating the regional statistics. Fig. 18.

Proportion of people with access to basic drinking-water in 2015 and projected coverage in 2030, Western Pacific Region, PICs and comparison with the world aggregated statistics

100

93 95

80 70

48 36

100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 99 99 99 99 99 98 96 96 96 94 91 91 91 88 83 80 78 75 64 64

20 0

2015

2030 (Projected – SDG target 1.4 achieved)

Western Pacific Region Pacific island countries World

10 Australia Brunei Darussalam Hong Kong SAR (China) Macao SAR (China) Cook Islands French Polynesia Guam Nauru New Zealand Palau Republic of Korea Singapore Tokelau Tonga Wallis and Futuna Islands American Samoa Japan New Caledonia Northern Mariana Islands Tuvalu Niue China Malaysia Samoa Fiji Philippines Vanuatu Viet Nam Micronesia (Federated States of) Mongolia Lao People's Democratic Republic Marshall Islands Cambodia Kiribati Solomon Islands Papua New Guinea

Drinking-water coverage (%)

2030 (Projected – SDG target 1.4 not achieved)

Members of Water Authority of Fiji (WAF) receive training during the Drinking Water Safety Plan Training of Trainers Workshop. (Wailoku Water Treatment Plant, Suva, Fiji)

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Source: country coverage statistics for 2015 from WHO and UNICEF (2017a).

ÂŠ UNICEF/Marc Overmars/2013

Trucking new rainwater harvesting tanks for households on Funafuti, Tuvalu as part of a drought resilience programme. (Funafuti, Tuvalu, 2013)

From 2000 to 2015, a total population of 414 million people gained access to basic drinking-water services in the Region, which represents a great effort towards universal coverage with this type of service (Fig. 19). The Region is expected to provide services to another 220 million people by 2030 to achieve SDG target 1.4. As indicated above, the coverage projections indicate that the target for the Western Pacific Region will be achieved. Population with access to basic drinking-water in 2000 and 2015 and projected coverage in 2030, Western Pacific Region and PICs

Population Western Pacific Region (millions)

2500

16.00 1978

2000 1500

1758

14.00 12.00 10.00

1344

1000 500

14.24 1978

4.47

5.63

8.00

6.96

6.00 4.00 2.00

Population using basic drinking-water services in 2000

Population using basic drinking-water services in 2015

Western Pacific Region

Population using basic drinking-water services in 2030

Population served in 2030 to achieve the SDG target 1.4

0.00

Population Pacific region (millions)

Fig. 19.

Pacific island countries

Source: country coverage statistics for 2015 from WHO and UNICEF (2017a).

This is not the case for the PICs, where only 1.16 million additional people were served from 2000 to 2015. The projection of the current trend to 2030 indicates that the projected population served will be about 7 million people as opposed to the 14 million required to achieve universal coverage.

Essential statistics on drinking-water, sanitation and hygiene

2.4.2 Sanitation If the sanitation coverage trends from 2000 to 2015 continue to 2030, SDG targets 6.2 (universal coverage with safely managed sanitation by 2030) and 1.4 (universal coverage with basic sanitation services by 2030) will not be met by the Western Pacific Region (Fig. 20). For safely managed sanitation services, the target will fall short of 18 percentage points, whereas for basic sanitation, the gap will be nine percentage points. Fig. 20.

100 90

91 78

Basic s

Sanitation coverage (%)

70 60

50 e Saf

40 30

ervice

SDG 6.2 and 1.4 targets

ly m

d age

ser

vice

20 10 0 2000

2015

Served with safely managed services

2030 (Projected)

Served with basic services Projected safely managed services Projected basic services Safely managed services trend to achieve the SDG target 6.2 Basic services trend to achieve the SDG target 1.4 Source: country coverage statistics for 2000 and 2015 from WHO and UNICEF (2017a).

For the PICs, information is not available to determine regional coverage statistics on safely managed sanitation services. Even looking into the much less demanding SDG target 1.4, if the current basic sanitation coverage trend continues to 2030, the PICs

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

are unlikely to achieve any of the sanitation targets. For example, they will fall short of SDG target 1.4 by 64 percentage points (Fig. 21).

Sanitation coverage (%)

Fig. 21.

Change in the proportion of people with access to basic sanitation services in the PICs between 2000 and 2015 and projection of change between 2015 and 2030 and trends required to achieve SDG 1.4 target 100

100

SDG target 1.4

80 60 40

20 0 2000

2015 Basic services Projected basic services

Year

2030 (Projected) Trend of basic services to achieve the SDG target 1.4

Source: country coverage statistics for 2000 and 2015 from WHO and UNICEF (2017a).

With regard to the few Western Pacific countries for which information was available for the determination of statistics on safely managed sanitation (Fig. 22), if the current trend continues to 2030, only three countries are likely to achieve universal coverage by 2030. They are Japan and Singapore (universal coverage already achieved) and Republic of Korea (current coverage at 98%). Even developed countries such as Australia and New Zealand seem not to be on track to achieve universal coverage with safely managed sanitation services by 2030.

2015

SDG target 6.2

90 82

World

Hong Kong SAR (China)

Palau

2030 (Projected â&#x20AC;&#x201C; SDG target 6.2 achieved)

Western Pacific Region

China

New Zealand

Malaysia

Republic of Korea

100

Singapore

100

Japan

Sanitation coverage (%)

100 90 80 70 60 50 40 30 20 10 0

Proportion of population with access to safely managed sanitation services in selected countries of the Western Pacific Region and projected coverage in 2030

Australia

Fig. 22.

2030 (Projected â&#x20AC;&#x201C; SDG target 6.2 not achieved)

Source: country coverage statistics for 2000 and 2015 from WHO and UNICEF (2017a).

Essential statistics on drinking-water, sanitation and hygiene

Even considering the much less demanding SDG target 1.4, which is to achieve universal coverage with basic sanitation services by 2030, the prospect for most countries is appalling (Fig. 23). From the 29 countries for which estimates are available, nearly three out of every five countries will not achieve the target if the current trend continues towards 2030. The Western Pacific Region as a whole is equally not on track to achieve SDG target 1.4, falling short by nine percentage points in 2030 to reach universal coverage. Fig. 23.

Proportion of population with access to basic sanitation services in selected countries of the Western Pacific Region and projected coverage in 2030

100

96 94 95

80 70

70 62

Pacific island countries

19 31

2015

World

Papua New Guinea

Kiribati

Solomon Islands

Vanuatu

Cambodia

Mongolia

American Samoa

Nauru

Lao People's Democratic Republic

China

2030 (Projected – SDG target 1.4 not achieved)

Philippines

Viet Nam

Northern Mariana Islands

Guam

Tonga

Fiji

Tokelau

Samoa

Hong Kong SAR (China)

Niue

French Polynesia

Singapore

Cook Islands

Republic of Korea

Palau

New Zealand

Malaysia

Japan

Australia

10 0

Western Pacific Region

42 78

100

54 100

SDG target 1.4

100

Sanitation coverage (%)

2030 (Projected – SDG target 1.4 achieved)

Source: country coverage statistics for 2000 and 2015 from WHO and UNICEF (2017a).

From 2000 to 2015, a total population of 348 million people gained access to basic sanitation services in the Region. In 2015, about one quarter of the population still did not have access to basic sanitation. The Region is expected to provide services to another 538 million people by 2030 to achieve SDG Girls’ and boys’ toilets in Malaita Province, Solomon Islands.

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

target 1.4, which is unlikely to occur if the current trend continues, as indicated in Fig. 24. For the PICs, the situation is far worse, where only 1.16 million additional people were served from 2000 to 2015. The projection of the current trend to 2030 indicates that the projected population served will be about 7 million people as opposed to the 14 million required to achieve universal coverage. Fig. 24.

Population with access to basic sanitation in 2000 and 2015 and projected coverage in 2030, Western Pacific Region and the PICs

Population (millions)

2500

16.00 1978

2000 1500

14.24

1615

1440

500

8.00

6.00

5.12

3.90

2.92

12.00 10.00

1092

1000

14.00

4.00 2.00

Population using basic sanitation services in 2030

Population using basic sanitation services in 2015

Population using basic sanitation services in 2000

Western Pacific Region

Population served in 2030 to achieve the SDG target 1.4

0.00

Pacific island countries

Source: country coverage statistics for 2000 and 2015 from WHO and UNICEF (2017a).

2.5 Inequalities in drinking-water supply, sanitation and hygiene 2.5.1 Drinking-water Progress has been made in the Western Pacific Region to reduce the disparity in coverage with basic drinking-water services between urban and rural populations. For the PICs, such a disparity is still very wide with the proportion of the rural population with basic drinking-water services less than half that of urban areas (Fig. 25). Fig. 25.

Proportion of urban and rural populations in the Western Pacific Region, PICs and the world using basic drinking-water services, 2015 96

Basic drinking-water coverage (%)

100 90 80 70 60 50 40 30 20 10 0

Western Pacific Region

Pacific island countries Urban Rural

World

Source: country coverage statistics from WHO and UNICEF (2017a).

Essential statistics on drinking-water, sanitation and hygiene

Fig. 26 shows basic drinking-water coverage for urban (top), rural (lower) and national (between urban and rural) populations through a vertical set of three dots for each country. Data from five countries out of the 21 for which information is available indicate disparity between urban and rural coverage of over 20 percentage points. Fig. 26.

100

Basic drinking-water coverage (%)

Proportion of urban, rural and national populations in the Western Pacific Region, PICs and the world using basic drinking-water services, 2015 100 96 96 98 90

100 99

99 97 94 100 100

100 100 99 90

97 84

96 99

94 80

30 29

20 10

Urban

Rural

World

Pacific island countries

Western Pacific Region

Vanuatu

Viet Nam

Tuvalu

Tonga

Solomon Islands

Samoa

Philippines

Papua New Guinea

Palau

New Zealand

Mongolia

Marshall Islands

Micronesia (Federated States of)

Malaysia

Kiribati

Lao People's Democratic Republic

Fiji

China

Cambodia

Australia

Brunei Darussalam

National

ÂŠ WHO/Yoshi Shimizu

Source: country coverage statistics from WHO and UNICEF (2017a).

Drinking water from a deep well at the site of the WHO Community Drowning Prevention Project. (Davao del Norte, Philippines, 2016)

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

ÂŠ UNICEF/Marc Overmars/2013

Innovative approaches are being introduced on Tanna using hydraulic ram pumps to lift water from valleys up to the villages. (Tanna, Vanuatu, 2013)

Fig. 27 shows basic drinking-water coverage for each wealth quintile in four countries of the Western Pacific Region. Each country is represented by a vertical set of five dots arranged according to average coverage for that country. The vertical spread of the dots shows the extent to which coverage varies between the richest and the poorest quintiles in each country. The differing patterns of dots also highlight variations in the relative gaps between the richest, rich, middle, poor and poorest quintiles. The gap between the richest and poorest quintiles is an important measure of inequality. Inequalities in basic drinking-water appear greater in Cambodia than in Viet Nam. Unfortunately, the available data do not allow for an analysis for the Region as a whole. Fig. 27.

Use of basic drinking-water facilities in selected countries by wealth quintile in 2015

Drinking-water coverage (%)

100

89 84

81 74 68 61

80 60

96 92

100

98 96 91 80

40 20

Poorest

Poor

Middle

Rich

Viet Nam

Philippines

Cambodia

Mongolia

Richest

Source: country coverage statistics from WHO and UNICEF (2017a).

Essential statistics on drinking-water, sanitation and hygiene

2.5.2 Sanitation There is significant disparity between urban and rural sanitation coverage in the Western Pacific Region (Fig. 28). While about two in every three urban residents has access to safely managed sanitation services, only two in every five rural residents enjoy this type of service. Proportion of urban and rural populations in the Western Pacific Region and the world using safely managed sanitation services, 2015

Safely-managed sanitation coverage (%)

Fig. 28.

100 90 80 70 60 50 40 30 20 10 0

69 43

Western Pacific Region

World

Urban

Rural

Source: country coverage statistics from WHO and UNICEF (2017a).

Fig. 29 shows basic sanitation coverage for urban (top), rural (lower) and national (between urban and rural). A total of seven countries out of the 19 for which information is available show a disparity between urban and rural coverage of over 20 percentage points. Fig. 29. 100 90

Proportion of urban, rural and national populations in the Western Pacific Region, the PICs and the world using basic sanitation services, 2015 96

100

96 93

97 88 86 95

100 100

96 79

Sanitation coverage (%)

80 70

66 61

92 91

63 50

24 18

Urban

National

Source: country coverage statistics from WHO and UNICEF (2017a).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Rural

World

Western Pacific Region Pacific island countries

Viet Nam

Vanuatu

Tuvalu

Tonga

Solomon Islands

Samoa

Philippines

Papua New Guinea

Palau

New Zealand

Mongolia

Malaysia

Marshall Islands

Kiribati

Lao People's Democratic Republic

Fiji

China

Cambodia

Brunei Darussalam

From 2000 to 2015, the urban population in the Western Pacific Region served with safely managed sanitation almost quadrupled, with more than 500 million people gaining access to these services during this period of time (Fig. 30). In rural areas, the numbers of unserved remained practically unchanged, even considering that the rural population decreased by 200 million in the Region over this period of time. Fig. 30.

Population with and without access to safely managed sanitation services in urban and rural areas, Western Pacific Region and the world, 2000 and 2015

4000 3500

Population (millions)

3000

2250

2500 2215

2000

2472

1898

1500 1000 500 0

330 484

735

209

2000

1714 686

2015

Western Pacific Region - Urban

457

299

325

2000

2015

Western Pacific Region - Urban

957

2000

800

2015

World Urban

2000

1171

2015

World Rural

Population without access to safely managed services Population with access to safely managed services

ÂŠ WHO

Source: country statistics from WHO and UNICEF (2017a).

Mother and child in Hue, Viet Nam.

Essential statistics on drinking-water, sanitation and hygiene

ÂŠ WHO/Yoshi Shimizu

Access to water from the deep well. (Laguna, Philippines, 2016)

Overall status of the WASH sector

This section takes into account mainly the findings of the GLAAS 2016/2017 survey conducted in selected countries of the Western Pacific Region. Information was obtained from other relevant sources as well, as indicated directly on the respective texts.

3.1 Human right to drinking-water and sanitation In November 2002, the UN Committee on Economic, Social and Cultural Rights adopted General Comment No. 15 on the right to water. Article I.1 states that â&#x20AC;&#x153;The human right to water is indispensable for leading a life in human dignity. It is a prerequisite for the realization of other human rights.â&#x20AC;? General Comment No. 15 also defined the right to water as the right of everyone to sufficient, safe, acceptable and physically accessible and affordable water for personal and domestic uses (UN, 2002). On 28 July 2010, through Resolution 64/292, the United Nations General Assembly explicitly recognized the human right to water and sanitation and acknowledged that clean drinking-water and sanitation are essential to the realization of all human rights. The Resolution calls upon Member States and international organizations to provide financial resources, help capacity-building and technology transfer to help countries, in particular developing countries, to provide safe, clean, accessible and affordable drinking-water and sanitation for all (UN, 2010). The GLAAS survey 2016/2017 asked the participating countries if their constitution or other legislation recognizes water and sanitation as human rights. A total of five out of the 13 respondent countries in the Western Pacific Region indicated that human rights to water and sanitation were unequivocally recognized in their legal and institutional frameworks. The GLAAS 2012 survey revealed that while countries have cited the recognition of these rights as a major accomplishment, translation of these stated rights into concrete or explicit equity and nondiscrimination provisions and pro-poor policies and strategies appears to be in its early stages. Box 5 suggests a set of actions to strengthen the human right to WASH at the country level.

Box 5. Suggested actions to advance the human right agenda on water and sanitation •

•

Governments that have recognized the rights to water and sanitation through international treaties and/or national legislation are expected to establish a strategy or plan of action to ensure that the rights are realized. Governments need to take the lead, with the support of all relevant stakeholders, in taking concrete steps to progressively realize universal access to safe drinking-water and sanitation. Governments should develop and implement strategies to prioritize provision of services to those without access to WASH services – often poor, vulnerable and marginalized groups. Governments should adopt the necessary measures towards the full realization of the rights to water and sanitation. This includes the development of citizen complaint mechanisms and the possibility to judicially claim these rights are in place.

Source: adapted from WHO (2012).

3.2 National sector organization 3.2.1 Policies and strategies High-level political commitment represents the umbrella encompassing all efforts to accelerate and sustain the attainment of universal coverage with safely managed drinking-water, sanitation and hygiene. Successful implementation of this commitment requires a steady focus on the water and sanitation priorities, adequate allocation of resources and the establishment of a regular and transparent monitoring framework to ensure that all stakeholders can be held accountable against their agreed commitments, roles and responsibilities. Such responsibilities include enforcing relevant legal frameworks, ensuring effective regulatory mechanisms, maintaining and strengthening institutional arrangements and applying up-to-date technical knowledge through best practice. They all depend, ultimately, on political resolve to give balanced support to all essential elements (WHO, 2012). To the question: “Do national policies and implementation plans exist, and to what is the level of implementation?”, all Western Pacific countries that responded to the 2016/2017 GLAAS questionnaire reported a high level of political commitment to safe drinking-water provision and adequate sanitation. The identified actions required in the Region to improve the level of formulation and implementation of WASH policies and strategies are summarized in Box 6. It is generally agreed within the sector that public and private partnerships are fundamental to accelerate investments and improve the management of projects and services. It is also clear that the private involvement in the sanitation sector must be organized through sound regulatory frameworks and good controlling mechanisms. Private WASH sector involvement can range from the management of complex systems in total or just in part (e.g. maintenance of facilities, operation and maintenance of

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

water and wastewater treatment plants, etc.) to the management or implementation of small-scale projects in peri-urban or rural areas. Another crucial issue is the decentralization of services. In most Western Pacific countries, responsibilities for drinking-water and sanitation services are devolved to the local level. When decentralization is effective, it ensures that services are appropriate for local needs, that operation and maintenance requirements are met and that facilities created are sustained over time. This does not imply that these services can operate without any support from higher levels. Effective decentralization requires adequate technical, financial and human resources support to local authorities. The principle of subsidiarity applies: the initiative to seek support should come from the local level whenever the challenges faced cannot be solved with the technical, financial and human resources locally available. Conversely, the higher levels should be prepared to respond to any requests of support from local authorities. Independent regulation and quality control are functions performed at a higher level. Box 6. What needs to be done on country policies and strategies? As reported in the GLAAS 2017 report, there is a good level of political commitment to WASH in the Western Pacific Region. However, several actions are required to bring all countries to the same level with this regard. The following actions should be considered: • Reduce the fragmentation of government agencies responsible for drinking-water, sanitation and hygiene to avoid uncoordinated action and often gaps and overlapping of policy and regulation. • Organize discussion on the appropriate WASH framework, including a possible decentralization of WASH services where needed. • Promote the need for an overall national WASH framework to guide the different agencies in formulating their specific policies and strategies. • Define the lead institutions for WASH and especially for rural sanitation and hygiene. • Prepare strategic sector plans on how to achieve the WASH SDGs. • Define the level of involvement of the private sector in WASH development. • Identify ways to make the WASH sector attractive to the private sector through promotion of and facilitating public–private partnerships. • Establish regulatory, controlling and management mechanisms to ensure that public– private partnerships are successfully implemented. Source: adapted from WHO (2017b).

As shown in Annex 5.1, nine countries out of 13 have developed clear procedures in laws or policies for participation by service users and communities in sanitation planning programmes. Policy development and implementation were better for drinking-water, with 10 countries out of 13 that have developed a policy for both urban and rural areas. Different high-level regional initiatives occurred in East Asia to address the deficiencies and needs of the WASH sector, such as the Thematic Working Group on Water, Sanitation and Hygiene (see Box 7).

Overall status of the WASH sector

Box 7. The Thematic Working Group on Water, Sanitation and Hygiene1 The Thematic Working Group on Water, Sanitation and Hygiene (TWG WSH) is one of the seven inter-country thematic working groups established by the First Regional Forum on Environment and Health in Southeast and East Asian Countries on 9 August 2007, Bangkok, Thailand (see WHO and UNEP, 2007). The membership of the TWG WSH is composed of 14 countries: Brunei Darussalam, Cambodia, China, Indonesia, Japan, Lao People’s Democratic Republic, Malaysia, Mongolia, Myanmar, Philippines, Republic of Korea, Singapore, Thailand and Viet Nam. The TWG WSH is coordinated by a chairperson from one of the country’s institutions, appointed at each of its meetings and supported by WHO and the United Nations Environment Programme. The current chair is the Department of Health, Philippines. At each TWG WSH meeting, the activities performed by the Group are reviewed and a three-year work plan is revised and updated. Several meaningful activities were performed either by the countries individually or as a regional effort within the framework of this initiative. Examples of such achievements include the following: • A conceptual document on functions of health authorities in WASH was produced with a strong emphasis on advocacy and policy development aimed at environmental and social determinants of health, and founded on knowledge derived from research and analyses. • Health authorities collaborated with national water associations to conduct training, initiate demonstration projects, and develop national policies on safe drinking-water in urban systems in China, Cambodia, the Lao People’s Democratic Republic, the Philippines and Viet Nam. • Through the TWG WSH, WSPs were promoted as practical risk management tools to protect the quality of drinking-water. • The Philippines Department of Health led the planning and organization of the Second East Asia Ministerial Conference on Sanitation and Hygiene in 2010, wherein 13 Southeast and East Asian countries pledged to meet the MDG target for sanitation, adopt sustainable sanitation and hygiene policies, and facilitate regional collaboration for training and sharing of information. • WHO, in collaboration with the United Nations Children’s Fund (UNICEF) and with financial support from the United States Agency for International Development (USAID), supported intersectoral activities in the Philippines and Viet Nam aimed at strengthening national sector monitoring systems and harmonizing national methodologies with international best practises.

A special concern exists in the Region concerning sanitation due to its low coverage compared to the case for drinking-water. Because such a concern exists, the recurrent East Asia Ministerial Conference on Sanitation and Hygiene (EASAN) was launched in 2007 and since then three major conferences have been organized in the Region (see Box 8). Based on the unpublished discussion document prepared by the WHO Regional Office for the Western Pacific for the Fourth Meeting of the Thematic Working Group on Water, Sanitation and Hygiene, Manila, 26–27 November 2015.

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Box 8. East Asia Ministerial Conferences on Sanitation and Hygiene (EASAN) The First East Asia Ministerial Conference on Sanitation and Hygiene (EASAN 1), held in Beppu, Japan from 30 November to 1 December 2007, was attended by 135 participants, including high-level delegates from 13 countries (Cambodia, China, Indonesia, Lao People’s Democratic Republic, Mongolia, Myanmar, Philippines, Timor-Leste and Viet Nam; in addition, official delegations participated from several countries that had already achieved high rates of access to improved sanitation, namely Brunei Darussalam, Malaysia, Singapore and Thailand). Other attendees included officials from the Government of Japan and civil society and representatives from the Republic of Korea. Representatives of the major external support agencies, NGOs, resource people, and members of the media and private sector professionals also attended. This important meeting established a regional platform for cooperation in sanitation. Two subsequent conferences were organized in Manila, Philippines in 2010 (EASAN 2) and in Indonesia in 2012 (EASAN 3). The EASAN conferences generated tremendous interest among WASH stakeholders in East Asia due to both the precariousness of the sanitation status in this Region and the need to act effectively and vigorously to advance the sanitation agenda, especially in countries where sanitation coverage lags considerably behind drinking-water supply development. From meetings and studies undertaken at different occasions, it became clear that the following issues should be addressed if the sanitation agenda was to be properly tackled: • What are the approaches and technologies to be emphasized for the achievement of universal sanitation coverage? • Should we promote the adoption of sewerage systems and professional management, including public–private partnerships for sanitation in urban settings? Otherwise, what should be the approach for urban areas? • What should be the approaches for sanitation development in peri-urban and rural areas? • How should we deal with the problem of fragmentation and compartmentalization of sanitation sector institutions? • How can we improve the effectiveness of operation and maintenance of sanitation systems? • What should be done to improve human resources in the Region at all levels, including government-employed managers, technicians, labourers and staff from contractors? • How can we improve sanitation and hygiene in schools and health-care establishments? • How can sanitation development be financed? Source: WHO Regional Office for the Western Pacific (2013).

3.2.2 Planning and coordination An enabling environment for progress in drinking-water, sanitation and hygiene must support the translation of policies into action. Important factors include leadership, coordination, local capacity, effective monitoring and encouragement of broad participation to ensure WASH sector development. Coordination can be challenging in the common scenario where responsibilities for different aspects of WASH are

Overall status of the WASH sector

fragmented over a number of government agencies that devote only a small share of their overall resources to this area. Where overall responsibility is unclear, accountability for performance is typically weak. Agencies may not necessarily be held accountable, and it may be difficult to secure adequate financial and human resources to address issues that are perceived to be of lesser priority or even marginal in a specific institutional context, even though they may be essential components of the overall sanitation and drinking-water framework (WHO, 2012). The previous GLAAS surveys demonstrated that the WASH sector is becoming more coherent, with an increasing level of concern for sanitation, and that progress is being made on commitment through the setting of targets, progressively adopting WASH policies and improving coordination, including by engaging more stakeholders in planning. However, there are still difficulties in successfully implementing policies, developing effective and coherent planning and monitoring systems, and effectively supporting the local level in the delivery of services. While lead agencies have been identified in many countries, there is a general understanding that poor coordination still exists among implementing agencies, particularly when it comes to sanitation. In many countries, government coordination structures have been established at the national level, but this process of tightening coordination still needs to trickle down to provincial and local levels, although admittedly, the barriers to coordination may be lower at those levels. Box 9 suggests key actions to improve sector planning and coordination.

Box 9. Key action on sector planning and coordination at the country level Better planning and sound coordinating mechanisms for WASH development remain a major need in several Western Pacific countries. To achieve this, the following actions are envisaged: • Create the appropriate framework for coordination among government agencies, the private sector and NGOs for agreement on objectives and the development of common policies and strategies. • Expand and strengthen multisectoral collaboration. • Coordinate government agencies and external support agencies in preparing national instruments, frameworks and protocols in the field of WASH. • Promote integration of WASH with other sectors and respond to emerging issues such as climate change and WASH and the impact of water scarcity on public health. • Promote and develop or update and disseminate – through intrasectoral coordination and cooperation – health-based norms, standards, guidelines and best practices, particularly for drinking-water safety, recreational water quality, sanitation safety, safe wastewater use, WASH in schools and health facilities, and WASH monitoring. • Deﬁne clearly the WASH roles for each government institution and other stakeholder groups.

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

3.2.3 Sector assessments and monitoring The systematic performance of periodic reviews to monitor and evaluate the performance of sanitation and drinking-water uptake and services is increasingly used by countries as a basis for planning. Sector-wide reviews that are led and owned by the national government and involve all major stakeholders are key to improving WASH coordination and planning (WHO, 2010). Sector assessments, monitoring and evaluation programmes generate the following outcomes (WHO Regional Office for the Western Pacific and UNICEF/EAPRO, 2008): To provide quantitative information: zz A well-organized body of information about the current status of the sector. zz An understanding of the financial status of the sector and trends in investment and financing over the past. zz A mapping of institutional roles and responsibilities. zz Information about the current costs of service delivery for the different target groups. To provide qualitative information: zz An assessment of the attitudes of decision-makers in the sector and of national priorities more broadly concerning the sector. zz An understanding of the processes decision-makers and planners must go through to achieve change and progress for the sector. zz An assessment of “how we are doing” or of performance across the sector. zz An understanding of overall indicators, which could be used to assess the sector. To generate analytical outputs: zz Identification of weaknesses and critical bottlenecks that act as constraints on the sector and on efficiency. zz Financial analysis that improves understanding of the real costs of implementing recommended actions versus the “doing nothing” option. zz Improving the understanding of impacts on the health of a country population, including a risk analysis if recommendations are not followed. To make recommendations and proposals: zz Provide recommendations and proposals for sector improvement targeted to different population groups. zz Present different investment and financing scenarios and the strategic actions needed for sector improvement or reform. zz Generate specific planning for meeting national targets.

Overall status of the WASH sector

For advocacy and political lobbying: Advocate for sector reform and improvement. zz Increase national awareness and focus on sanitation issues and hygiene promotion, as well as issues around water supply. zz Generate interest and political visibility by going through a process of engagement with key national-level actors. zz

About 54% of the Western Pacific countries that participated in the 2016/2017 GLAAS survey indicated that they conducted at least one sector review over the last five years. Half of the countries indicated that they systematically use the data generated by such assessments for policy-making on drinking-water. Only three out of 13 countries indicated that they use sanitation data systematically for policy-making from such assessments. These figures indicate at least two different realities. First, a significant number of countries do not conduct WASH sector assessments systematically. The absence or insufficiency of data for policy- and decision-making leads to inadequate planning and budgeting and ultimately to gaps in service delivery. Secondly, it appears that even in countries where sector assessments are conducted, the information generated is not used systematically for decision- and policy-making. This may be caused by a careless dissemination of information or by the lack of confidence in the data generated.

ÂŠ UNICEF/Marc Overmars/2014

Despite the above outcomes of the GLAAS 2016/2017 survey, about 60% of the participating countries reported that they track progress of WASH development among the poor both in urban and rural areas.

Health clinics in Kiribatiâ&#x20AC;&#x2122;s Outer Islands face challenges in providing safe water and adequate sanitation for their patients. (North Tarawa, Kiribati, 2014)

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Planning processes could be dramatically improved if they could respond to data made available through management information systems. In this regard, WASH service delivery could undoubtedly benefit from a strengthened “whole-of-system” approach, which would entail inclusion of WASH in core government systems for planning and resource allocation (Box 10). Box 10. •

• • •

•

• •

What needs to be done in monitoring and evaluation?

National monitoring and evaluation systems should be in a position to provide support to programming and project planning and implementation based on reliable and accessible data. Monitoring systems should reduce the current gaps in data collection, availability, quality and use of data for informed decision-making. Monitoring and evaluation systems should track the quality and performance of services, as well as financial and human resources. Improvements to monitoring systems are urgently needed for strengthening of efforts to improve access and reduce inequalities among the most disadvantaged population groups. Monitor, research and report reliable and credible WASH data to inform policies and programmes, including on WASH risk factors and burden of disease, as well as progress towards SDG 6 targets. Explore mechanisms for interaction with major monitoring initiatives such as the JMP, GLAAS and TrackFin. Taking into account the ambitious SDG WASH targets, monitoring and evaluation mechanisms should be considered as a priority as they are fundamental for proper orientation of resources in the WASH sector.

Source: based on WHO (2014b).

3.3 Human resources Planning, building and managing drinking-water and sanitation systems require a diverse range of people with a variety of training, experience and skills, including managers, planners, engineers, laboratory technicians, microbiologists, masons, plumbers and hygiene promoters. The WASH sector normally involves a broad range of government bodies as well as parastatal authorities and nongovernmental entities, including the private sector and civil society institutions that are directly involved in planning, design and implementation. The human resources available to ensure that adequate sanitation and drinking-water services are delivered and sustained are therefore an aggregate of the human resource capacity of all these different institutions. Coordination among the different organizations is essential when it comes to overall human resource planning for WASH. The health sector plays a vital role in promoting sanitation and hygiene in many countries, as well as in monitoring the safety of drinking-water supplied to users. In addition, the education and health sectors need to ensure that drinking-water and sanitation facilities are provided and maintained in their schools, clinics and hospitals (WHO, 2014b).

Overall status of the WASH sector

It is a daunting task to determine the role of each organization and to map the human resource capacity and requirements to deliver the respective services accordingly. For many countries in the Western Pacific Region, it has been suggested that the achievement of their mission is critically hampered by a lack of adequate human resources. The human resources section of the GLAAS 2016/2017 is only available in the long version of the GLAAS questionnaire. As most of the Western Pacific countries chose to work with the short version, the subsequent sections refer to previous GLAAS surveys.

3.3.1 Sufficiency of staffing Previous GLAAS surveys point to a massive gap in available drinking-water, sanitation and hygiene staff, often in the very countries that are most seriously not on track in achieving universal coverage with these services. It is well known that it is often difficult to attract skilled personnel to work in the WASH agencies and retain them in their job as there is much competition with other sectors.

3.3.2 Incentives and continuing education Previous GLAAS surveys (e.g. WHO, 2012) reported that there were insufficient incentives for drinking-water, sanitation and hygiene staff. Motivation can be strengthened in a number of ways, including creating opportunities for staff to develop their skills and increase their experience. Although many countries report that suitable in-country education and training institutions do exist, they also report that there are insufficient courses available to meet the needs of the existing staff. Mapping of training institutions that offer appropriate courses would be an important first step in strengthening human resource capacity across the Region. The possible role of national institutions for public administration and management needs to be explored, as these usually provide training for civil servants irrespective of the sector in which they work, thereby contributing to overcoming the fragmentation of the human resource base and of the institutional environment in which people operate.

3.3.3 Constraints to human resources development The following constraints were identified by the countries participating in the GLAAS survey 2016/2017 (not all constraints are common to all countries): zz insufficient budget to hire and retain staff; zz lack of human resources planning; zz political interference in recruiting WASH personnel favouring people without the required competence; zz limited numbers of institutions providing specific training on different WASH issues, with most staff learning by doing; zz limited number of WASH professionals available both in the private and public sectors;

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

low salary, little motivation and lack of incentives; limited availability of technical, managerial and administrative information; high personnel turnover; difficulty in recruiting professionals to work in rural areas because of limited career development opportunities and low benefits; public institutions rarely dismiss their personnel even when they lack capacity and are not motivated; and generally, the sanitation sub-sector does not attract talented individuals as sanitation jobs are often viewed as unimportant within the institution’s hierarchy.

zz zz zz zz

In the PICs, the geographical distribution of the country’s population in many islands makes it difficult to hire and retain the required skilled WASH staff.

3.3.4 Human resources planning Many WASH agencies developed their human resource strategies – including the definition of the adequate numbers and qualification of staff – according to different requirements (management, technical, labour), career development planning, training, etc. The lack of clear human resource strategies, including specific policies for human resource management, are obstacles to attracting and retaining qualified personnel for the WASH sector (WHO, 2012). Box 11 suggests actions to be taken for human resources development in the WASH sector at country level. Box 11. •

• • •

• •

•

What needs to be done for effective human resources development in the WASH sector?

Make a realistic assessment of staff needs in the WASH sector. Such an assessment should identify the staff needs at different levels, such as senior officers, supervising staff, technical staff and operators at each institution having sector responsibilities. Promote the need for sufficient budgets to hire and retain sufficient quantities of competent staff. Conduct human resources planning taking into account the needs of the different WASH agencies at national and local levels. Formulate career development plans, indicating the staff’s development goals for the year, the means to achieve those development goals and indicators to measure progress. In certain situations, these achievements can be linked to performance agreements, thereby encouraging staff to make progress on their own professional development. Develop sound training programmes based on assessment of needs at all levels. Promote and support the improvement and capacity-building of training centres and other learning institutions to make them realistically supportive of WASH staff development initiatives. Devise approaches and incentives to make the WASH sector attractive to WASH staff, especially those dealing with sanitation and in places away from larger cities (e.g. rural areas, small islands, etc.).

Source: interpreted from responses to past GLAAS surveys questionnaires.

Overall status of the WASH sector

3.4 Gender issues The GLAAS survey 2012 indicated that women are a clear minority in the WASH sector, with women making up just a fraction of the professional/managerial staff in WASH agencies in the Western Pacific Region. This section outlines essential elements that WASH stakeholders should take into account in the WASH programme cycle in order to enhance a gender-responsive approach to maximize the health benefits of access to WASH services. Such elements are:2 Policy issues: A gender policy articulates goals and the required action to achieve such goals. It forms the documented basis for strategy development and resource allocation. Operational aspects of gender responses: Institutions engaged in WASH operations, such as NGOs, utilities, donor agencies and local government bodies, need to adopt institutional policies and strategies that address gender issues. Sector agencies such as ministries, utilities or NGOs, seeking to practise gender mainstreaming as an enhancement to service quality, can ensure that the work environment is conducive to all individuals and that women in particular are not subject to discrimination. Gender responses to monitoring and evaluation: A crucial aspect of effective gender mainstreaming is a monitoring system to record, analyse and document input, output, process and impact indicators in a sex-disaggregated way. When data collection is disaggregated by sex, it is possible to assess the different positive or negative impacts of a programme on women and men, young and old, rich and poor, and make informed decisions on programming in the future. Gender responses to citizenâ&#x20AC;&#x2122;s voices: Women and marginalized citizens should be heard by providers of services to ensure that their concerns are taken up seriously in the project planning and WASH services implementation, as well as in services management. Service agencies should create the channels for effective citizen engagement and receive citizen input to shape their programmes or services. Tools that help increase the ability of men and women to exercise their rights and responsibilities are useful for empowerment and in highlighting and redressing gender issues during key phases of the project cycle. Gender responses to behaviour change: Women play a central role in upholding hygiene standards in the home. The habit of washing hands with soap at critical times (after defecation, before handling food, before cooking, before eating, etc.) reduces diarrhoeal incidence significantly. Diarrhoea remains one of the main threats to childrenâ&#x20AC;&#x2122;s health and well-being in developing countries. The WASH project cycle should include a gender component aimed at promotion of handwashing with soap 2

Based on WSP (2010).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

as an important element conducive to hygiene behaviour change and sanitation uptake efforts. Box 12.

What needs to be done to address WASH gender issues at the country level?

It is important to create an enabling environment to ensure that the gender perspective is successfully incorporated into the WASH agenda. Governments need to have a clear commitment to both incorporate drinking-water and sanitation programmes explicitly into their national development strategies, and to ensure that a gender perspective is mainstreamed into this agenda. Some essential national actions include the following: Mobilize resources to improve access to safe water and sanitation: • Facilitate access to grants or credit on concessionary terms for women’s groups for installation and maintenance of adequate drinking-water supply and sanitation facilities. • Allocate resources to civil society organizations and small-scale providers of water and sanitation services, particularly those that include women as full partners. • Provide micro-credit and creative alternative financing mechanisms to gendersensitive organizations for improving or building community-based water and sanitation services. Strengthen legislation and facilitate access to land and water for productive uses: • Recognize women’s important role in agriculture, livestock and fisheries, assist them in gaining access to water for productive uses and accord women equal rights to land tenure. • Support and promote equitable land and tenure arrangements that enable female producers to become decision-makers and owners. • Improve women’s productivity in using water for agriculture and small business through training, market linkages and access to information. Promote access to sanitation: • Ensure that the overall national sanitation framework is gender-sensitive. • Earmark funds for hygiene education in school curricula and separate sanitation facilities for boys and girls. • Commission research to identify, through gender analysis, where social and economic groups are chronically excluded from access to sanitation. Develop capacity and encourage participation: • Introduce affirmative action programmes for training women in technical and managerial careers in the water and sanitation sector. • Ensure that a minimum percentage of women participate in decision-making from the ministerial down to village levels. • Provide assistance to facilitate research into gender considerations in water resource management. • Allocate funds to the capacity development of women and girls. • Encourage both women and men to participate in businesses involved in water resource management and sanitation schemes. Source: UN-Water (2006).

Overall status of the WASH sector

3.5 Financing 3.5.1 Sources of funding and expenditures Both government budget and expenditure trends can be indicators of priorities in national policy and action. The 2016/2017 GLAAS country survey requested the most recent annual line ministry budgets for WASH to determine the level of public funds being allocated to WASH. Fig. 31 indicates the government budget for selected countries in the Western Pacific Region. The values presented are not comparable between countries in the Region due to the large disparity in population size. The countries shown in Fig. 31 provided WASH-specific budgets for government ministries and/or institutions, or provided an aggregated national budget for WASH services. Fig. 31.

Reported annual government WASH budgets in the Western Pacific Region, most recent fiscal year (2015â&#x20AC;&#x201C;2017) 53 794

10 000 1000

291

237

210

155

100

10 2

Vanuatu

Tonga

Solomon Islands

Cambodia

Lao People's Democratic Republic

Fiji

Philippines

Malaysia

Mongolia

1 China

Budget (US$ millions)

100 000

Source: data from WHO (2017b).

If the government WASH budgets are applied in proportion to their respective populations, the above picture changes considerably (see Fig. 32). It is clear that some countries are making a huge investment effort towards increasing the level of

174

Source: data from WHO (2017b).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Vanuatu

Lao People's Democratic Republic

Philippines

Cambodia

Malaysia

China

Mongolia

Solomon Islands

Tonga

200 180 160 140 120 100 80 60 40 20 0

Reported annual government WASH budgets per capita in the Western Pacific Region, most recent fiscal year (2015â&#x20AC;&#x201C;2017)

Fiji

US$

Fig. 32

WASH coverage for their citizens as compared to the world average (about US$Â 19 per capita). The level of budgets indicated in Figs. 31 and 32 do not necessarily reflect the total level of WASH investments in these countries. Additional investment sources might include those from the private sector, NGOs and the users themselves, which are not captured in these statistics. On the other hand, it is well known that sanitation is frequently underfunded as compared to drinking-water. However, the information collected thus far does not allow for the presentation of separate budgets for drinking-water supply and sanitation to compare and underscore the disparity in budget allocations. According to previous GLAAS surveys, where a majority of the country population uses services from traditional infrastructure such as piped water from centralized treatment plants and sewerage systems, most of the WASH financing comes from tariffs. In the Western Pacific Region, most of the financial inputs to the WASH sector come from government sources (see Annex 5.13). Lack of data is an impediment to financial planning and performance tracking. For WASH investment planning, data needed to estimate future needs and resources can include information such as: coverage levels and targets, predicted population growth, an up-to-date inventory of assets and their current condition, cost and performance data, availability of external funds, domestic budget execution performance, and estimated trends in demand for services. About one quarter of the Western Pacific Region countries that participated in the GLAAS 2016/2017 survey indicated that data are available, analysed and used for decisions regarding resource allocation for sanitation and drinking-water. Only one participating country indicated that there is a government-defined financing plan/budget for the WASH sector that is published and agreed on. About 25% of the countries indicated that expenditure reports are publicly available and easily accessible, and allow comparison of committed funds to expenditures.

3.5.2 O&M costs and systemâ&#x20AC;&#x2122;s efficiency The providers of WASH services must reach a balance between new investment to provide service to the unserved and recurrent expenditure to sustain existing infrastructure. There is a need to meet the costs for staffing, electricity, parts and supplies to operate and ensure the continuous functioning of existing systems and assets. Household user fees and tariffs are applied to cover some or all of the operating and capital costs for service provision. However, household tariffs do not fully recover the costs of service in a majority of the respondent countries, and in many cases, the operational financing gap is covered through government subsidies. About 46% of the Western Pacific Region countries reported that they cover over 80% of the urban drinking-water operations and maintenance (O&M) costs whereas for rural drinking-water this percentage is only 15%. With regard to urban sanitation, 38% of the countries cover over 80% of the O&M costs whereas for rural sanitation this percentage is only 23%. Although government subsidies might exist for WASH systems where full cost recovery is not practised, in many cases the systems are poorly

Overall status of the WASH sector

operated and maintained and thus function inefficiently or even stop functioning much earlier than foreseen in the project cycle. Despite policies and regulations to fully cover O&M costs in some countries, many service providers and communities continue to struggle to balance the recovery of costs and affordable tariffs for services (WHO, 2017a). Cost recovery in water supply and sanitation services means that the total revenue to the service provider at least equals the cost of supply. A stable revenue stream helps prevent cash flow or financing difficulties for the utility. At least three types of cost recovery are relevant to this analysis: (a) operational cost recovery means that the revenues are at least equal to the operating expenses of providing a service; (b) full service cost recovery means that capital maintenance expenditure and costs of capital are also recovered; and (c) full environmental cost recovery includes the external costs of a service, including any environmental damage (WSP, 2011). Box 13 offers relevant suggestions to improve the efficiency and recovery of capital costs and O&M costs of the WASH services.

Box 13. • • • •

• • • •

What needs to be done to address O&M costs and efficiency?

Establish policies and regulations to fully cover O&M costs and establish a sustainable balance between the recovery of costs and affordable tariffs for services. Define approaches and mechanisms to recover the capital costs and the O&M costs of WASH services. Develop awareness mechanisms to target the problem of low cost recovery, especially in rural areas, and in poor communities. Use national or local government financial mechanisms to subsidize insufficient cost recovery until adequate mechanisms are established for full cost recovery through users of services. Conduct tariff reviews regularly by service providers or by a regulatory authority to achieve full cost recovery where possible. Conduct WASH assessments to identify possible weaknesses with regard to the delivery of services by service providers. Determine the levels of the different components of non-revenue water. Establish programmes for reduction of non-revenue water to acceptable levels.

Source: based on WHO (2017b).

3.5.3 External support Most of the development aid for the countries in the Western Pacific Region is directed to activities related to policy-making, strategy development, coordination mechanisms, decentralization, capacity development and tariff setting. Most of the Western Pacific countries reported a very modest contribution from external aid as compared to the overall national disbursements for WASH (see Annex 5.13).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

General comments from external support agencies related to obstacles in improving the efficient and timely use of domestic capital financing allocated for WASH were expressed in past GLAAS surveys (e.g. WHO, 2010; WHO, 2017b). Such obstacles to progress in alignment, harmonization and coordination are grouped into two categories: obstacles at the country level, and obstacles among donor relationships.

ÂŠ WHO/ Yoshi Shimizu

The obstacles at the country level included the following factors: zz poor governance; zz weakness in water and sanitation policies or strategies; zz lack of credible national plans; zz delays in procurement due to complex procedures, length of procurement process, extended negotiations (which cause late release of funds and limited time to spend within financial year for which funds have been allocated); zz delayed or incomplete release of funds from the national finance ministry; zz administrative/funding release procedures too lengthy or too complex (e.g. project proposal requirements); zz lack of administrative/financial/technical resource capacity for advanced planning, and to design and manage projects; zz lack of private sector/companies, equipment and qualified personnel in the market; zz project delays due to logistical challenges in remote areas; zz land tenure compensation and land ownership issues (e.g. in Papua New Guinea); and zz securing clearances, licenses and permits from partner institutions (e.g. environmental impact).

Women washing clothes outside. (Vanuatu, 2016) Overall status of the WASH sector

The identiﬁed obstacles among donor relationships included: poor targeting of international resources; zz lack of transparency in partner structures and procedures; zz lack of full acceptance of principles of best practices by development partners; zz high transaction costs to harmonize between donors before beneﬁts are realized; and zz lack of prioritization of sanitation and drinking-water. zz

The provision of sustainable WASH services to all, including vulnerable populations, is a major facet of the WASH SDGs. Providing universal access under the SDGs may require not only additional financing, but an improvement in the use of financial resources as well as the optimization of existing WASH systems. Box 14 suggests key issues to be addressed to tackle crucial financial issues, taking into account the huge challenge of attaining the SDG WASH targets: Box 14. •

• • •

•

• •

What can be done to increase the financial feasibility of attaining the WASH SDG targets?

Promote cost recovery in WASH services, ensuring ideally that the total revenue to the service provider at least equals the costs associated with the provision of such services, taking into account the users’ affordability and their willingness to pay. Use national or local government revenues to subsidize insufficient cost recovery as a transition to full cost recovery, especially in rural and peri-urban areas. Review and adjust regularly the WASH tariffs to ensure the resources required to meet the O&M and capital costs. Reduce non-revenue water to help increase utility efficiency and allow more funds to be made available for maintenance and further investment, as well as reduce the strain on scarce water resources*. Improve the efficiency of service providers. Efficiency can be improved through programmes such as: structured asset management, which highlights preventive maintenance and leads to lower operating costs; resource recovery programmes that reclaim heat or power, or produce a new revenue stream (e.g. reclaimed solids); or staff training to build capacity and improve systems and procedures. Improve the absorption of domestic and external capital commitments. Use alternative sources of financing such as public–private partnerships, use of grants from external support agencies, soften lending agreements, etc.

* The GLAAS 2016/2017 survey in the Western Pacific countries revealed that in Mongolia, Papua New Guinea and Solomon Islands, the average non-revenue water presented by the three largest drinking-water suppliers in these countries amounted to 63%, 33% and 17%, respectively. Source: WHO (2017b).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Â© WHO/Yoshi Shimizu

Woman fetching water in Tancari village. (Papua New Guinea, 2016)

Regional programmatic priorities

The main focus of the WHO Regional Office for the Western Pacific in support of the WASH agenda is to highlight the basic right of all citizens to health protection through access to safely managed drinking-water supply and sanitation, and good hygiene behaviours. The Regional Office has been a major partner to relevant multilateral and bilateral agencies in organizing crucial high-level events and has facilitated important related international commitments. The Regional Officeâ&#x20AC;&#x2122;s programmatic WASH priorities in the Region are outlined briefly in the subsequent sections of this document but this list is by no means exhaustive. Any new subject area may be added whenever there is a perception of any new important health hazard linked to WASH issues not already included in this list.

4.1 Drinking-water quality 4.1.1 Drinking-water quality guidelines The primary purpose of the WHO Guidelines for Drinking-water Quality (GDWQ) is the protection of public health. The GDWQ provide the WHO recommendations for managing the risk from hazards that may compromise the safety of drinking-water (WHO, 2017c). The overall objectives of the GDWQ are to: zz provide an authoritative basis for the effective consideration of public health in setting national or regional drinking-water policies and actions; zz provide a comprehensive preventive risk management framework for health protection, from catchment to consumer, that covers policy formulation and standard-setting, risk-based management approaches and surveillance; zz emphasize achievable practices and the formulation of sound regulations that are applicable to low-, middle- and high-income countries alike; zz summarize the health implications associated with contaminants in drinkingwater, and the role of risk assessment and risk management in disease prevention and control; zz summarize effective options for drinking-water management; and zz provide guidance on hazard identification and risk assessment.

Since 1995, the GDWQ have been kept up to date through a process of rolling revision, which leads to the regular publication of addenda that may add to or supersede information in previous editions, as well as expert reviews on key issues in preparation for revision of the Guidelines. The GDWQ describe reasonable minimum requirements of safe practice to protect the health of consumers and derive numerical “guideline values” for constituents of water or indicators of water quality. When defining mandatory limits, it is preferable to consider the Guidelines in the context of local or national environmental, social, economic and cultural conditions. The Guidelines should also be part of an overall health protection strategy that includes sanitation and other strategies, such as managing food contamination. This strategy would also normally be incorporated into a legislative and regulatory framework that adapts the Guidelines to address local requirements and circumstances. The approach followed in these Guidelines is intended to lead to national standards and regulations that can be readily implemented and enforced and are protective of public health, taking into account the local context. The nature and form of drinkingwater standards may vary among countries and regions. There is no single approach that is universally applicable. It is essential in the development and implementation of standards that the current or planned legislations relating to water, health and local government are taken into account, and that the capacity of regulators in the country is assessed. Approaches that may work in one country or region will not necessarily transfer to other countries or regions. It is essential for each country to review its needs and capacities in developing a regulatory framework. According to the GLAAS 2014 survey, about 60% of the respondent countries in the Western Pacific Region reported that urban drinking-water quality is normally tested against national standards. In rural areas, it was reported that 50% of the countries conduct such testing (WHO, 2014b). The basic and essential requirement to ensure the safety of drinking-water is the implementation of a “framework for safe drinking-water” based on the GDWQ. This framework provides a preventive, risk-based approach to managing water quality. Such a framework would normally be enshrined in national standards, regulations or guidelines, in conjunction with relevant policies and programmes. Box 15 includes the basic elements of such a framework.

Regional programmatic priorities

Box 15.

What can be done to implement the drinking-water quality framework in Western Pacific countries?

WHO proposed framework for safe drinking-water: 1. Establish national standards for drinking-water quality, taking into account the national health-based targets, the WHO GDWQ and local needs, priorities and capacities. 2. Implement WSPs to support effective management of the water supply systems comprising the following: • a system assessment – to understand the system sufficiently to identify threats to water safety, assess associated risks and address improvements to ensure that risks are adequately managed; • monitoring – ongoing monitoring by the water supplier and the surveillance agency to ensure that the system continues to operate as it should, consumers are satisfied and national standards are met; and • management and communication – develop management plans to guide actions to be taken in normal operation and incident conditions, and ensure that supporting activities such as operator training are undertaken. 3. Implement a system of independent surveillance that verifies that the WSP is effective and that national standards are being met. The framework for safe drinking-water should be regularly updated according to new international and national developments to incrementally improve water safety and to ultimately achieve long-term health-based targets. The link: http://apps.who.int/iris/bitstream/10665/254637/1/9789241549950-eng. pdf?ua=1 provides detailed information about the framework for safe drinking-water. Source: based on WHO (2017c).

4.1.2 Water safety plans (WSPs) WSPs ensure that drinking-water is safe by assessing and managing risks from catchment to consumer. In 2005, WHO and the Government of Australia established the Water Quality Partnership for Health (WQP). The WQP promoted the institutionalization of WSP implementation through the development and implementation of national policies and frameworks that defined roles and responsibilities in terms of establishing, monitoring and assessing the performance of WSPs. These regulatory mechanisms drive sustainable WSP implementation at scale and help ensure resources are available to support WSP training, implementation (e.g. infrastructure improvements identified through WSPs) and ongoing WSP auditing. Through a holistic and participatory approach, the WQP ensures that communities are empowered to own and lead processes to improve their access to safe drinking-water. The WHO GDWQ recommend WSPs – a proactive management approach encompassing the whole water supply chain, from catchment to consumer (WHO, 2017c).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

The WQP’s ultimate aim is to reduce the burden of water-related diseases and continuously improve drinking-water supplies. WSPs should be overseen by national regulatory authorities, backed by robust legal frameworks and adequate national budgets. WSPs produce, as a result, improvements in cost savings; better operational efficiency; reduction in non-revenue water; increased financial support from government, donors and development banks; improved drinking-water quality; better service delivery; and improved health. The global WQP achievements were assessed in 2017. The assessment demonstrated the following achievements in the Western Pacific Region (DFAT and WHO, 2017): High performance in delivery zz The WQP has supported the establishment of 356 WSPs – 174 in urban settings and 182 in rural communities. zz An estimated 50.7 million people now have access to safer drinking-water. zz The cost of implementing the WSPs is less than US$ 0.65 cents per person benefiting from such implementation (WHO Regional Office for the Western Pacific and DFAT, 2014). National ownership and institutionalization of WSP processes zz The WQP evolved from a WHO-led project to a national, multi-stakeholder drinking-water quality programme. zz Eight countries in the Western Pacific Region updated their national drinkingwater quality standards, based on the most recent WHO guidelines. zz In the Lao People’s Democratic Republic, Mongolia, the Philippines and Viet Nam, WSPs are legally required for drinking-water suppliers. zz In Cambodia, the Lao People’s Democratic Republic, Mongolia, the Philippines and Viet Nam, WSP teams are collaborating to improve WASH service delivery in health facilities and schools. zz WSPs are increasingly viewed as ideal adaptation tools to protect water resources from the impact of climate change. Increased national capacity (WHO Regional Office for the Western Pacific and DFAT, 2014): zz Since 2012, 65 WSP training sessions have supported 175 national WSP trainers, who have developed their skills and trained more than 2000 national professionals. zz Mongolia and the Philippines have established WSP national training centres. zz The Philippines is establishing a regional WSP training centre. zz WQP attracts investments. In 2014, the Ulaanbaatar City Council in Mongolia awarded over US$ 11 million for its three-year WSP investment plan. zz WQP has facilitated 30 national cooperation agreements with 18 development partners to promote WSPs, especially in rural areas. Although the WQP ended in mid-2017, governments of countries and areas in the WHO Western Pacific and South-East Asia Regions are keen to forge ahead in extending WSPs and linking them to their SDG commitment to provide safely managed

Regional programmatic priorities

Box 16.

What can be done to advance the WSP agenda in the Western Pacific Region?

In February 2017, the WHO Regional Office for the Western Pacific organized the meeting “The development of action plans for achieving and monitoring SDG WASH targets – lessons from accomplishments of the WHO/DFAT Water Quality Partnership” in Manila, Philippines. The meeting was attended by representatives from 12 countries of the Western Pacific Region and one from the South-East Asia Region. The following priority actions were identified by the participants: • Member States should continue the WSP programmes and strategies by leveraging the lessons learnt, identifying the gaps, actions and activities needed, technical and financial partners, and the cost of continuation. This should be the basis for future resource mobilization. • Member States should consider WSP surveillance as a key component of water quality monitoring. • Member States should formulate and implement strategies dealing with water availability and sanitation safety, as part of their WASH SDG strategies. • WHO is requested to support Member States in formulating the continuation strategies, and help them articulate their resource and knowledge gaps to build WASH SDG strategies. • WHO is requested to provide tools, guidance and advice on sanitation safety planning. • WHO is requested to seize the opportunity to fill gaps regionally in the SDGs in the area of WASH in health-care facilities to fulfil both universal health coverage and SDG requirements, and establish more robust indicators/surveillance for disaster risk reduction/climate change adaptation. • Conduct external impact assessments of established WSPs and undertake an independent external evaluation of the WQP. • Engage national health authorities in all WQP countries to strengthen collaboration with national associations of water-supply companies and agriculture, environment, construction, industry and education sectors; • Complete the national institutionalization process by setting up intersectoral frameworks to develop national drinking-water programmes, ideally under the leadership of a single agency, with a clear roadmap. • Improve capacity for WSP policy development and implementation through training, integrating equity dimensions in WSP processes. • Strengthen the development and implementation of mechanisms to enforce WSP regulation. • Member States should allocate financial resources to support WSPs. • Mobilize additional funds to ensure the sustainability of national drinking-water programmes beyond 2017. • Sustain and increase national WSP training capacity by strengthening national and regional training centres and setting up a pool of regional WSP trainers that will also serve as auditors and certifiers. • Build skills to carry out impact assessments and audit WSPs. • Consolidate and broaden cooperation with development partners at national, regional and global levels. • Collaborate with ministries of health and WHO teams to implement WSP principles, through an intersectoral approach, to reduce infection risks in health facilities, advance nutrition in schools and reduce water-related diseases in communities. • Develop an efficient communication strategy and disseminate materials to showcase the WSP’s achievements and potential for replication. Source: WHO Regional Office for the Western Pacific (2017b).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

drinking-water. A clear articulation of this link in national programmes and capturing it into viable and scalable strategies is the key to the sustainability and continuity of this project into national programmes. The relatively new SSPs, whose fundaments are similar to those of the WSPs, provide a framework to complete the barriers against most water-related diseases. Thus, there is a need to consider both WSPs and SSPs in countriesâ&#x20AC;&#x2122; legal, planning and management frameworks for achieving the WASH SDGs. Doing so, however, poses important technical and financial challenges to be addressed in due time (WHO Regional Office for the Western Pacific, 2017b). Box 16 suggests key actions at the country and international levels to continue the momentum established over many years to implement the concept and practice of WSPs in the Western Pacific Region.

4.1.3 Household water treatment and safe storage Household water treatment and safe storage (HWTS) is an important public health intervention to improve the quality of drinking-water and reduce waterborne diseases, particularly among those who rely on water from unimproved sources, and in some cases, unsafe or unreliable piped water supplies. Further, safe drinking-water is an immediate priority in most emergencies, and HWTS can be an effective emergency response intervention. However, achieving health gains associated with HWTS relies on two important factors â&#x20AC;&#x201C; HWTS technologies need to sufficiently reduce pathogens to protect health and also be used correctly and consistently by those who are exposed to contaminated water (WHO, 2016). HWTS is not a substitute for sustainable access to safe drinking-water, but does serve as an important interim measure for removing pathogens from drinking-water and reducing disease risk (UNICEF and WHO, 2015). The International Scheme to Evaluate Household Water Treatment Technologies (see Box 17) was established by WHO in 2014 to evaluate the microbial performance of HWTS technologies against WHO health-based criteria. The results of the Schemeâ&#x20AC;&#x2122;s evaluation are intended to guide HWTS product selection by Member States and WHO International Scheme to Evaluate Household Water Treatment Box 17. Technologies In 2014, WHO formally launched the International Scheme to Evaluate Household Water Treatment Technologies with a call for submissions for Round I of testing. The Scheme provides independent testing and advice on household water treatment performance based on WHO criteria. It aims to work with national governments in building the technical capacity of research and laboratory institutions for conducting complimentary assessments of household water treatment and, in general, applying the WHO Guidelines on Drinking-water Quality recommendations at the national level. For more information on the Scheme, and products that have been or are currently being tested, visit: http:// apps.who.int/iris/bitstream/10665/204284/1/9789241509947_eng.pdf. Source: WHO (2016).

Regional programmatic priorities

What can be done to advance the HWTS agenda in the Western Pacific Box 18. Region? The following are key generic steps towards the implementation of HWTS at the country level. Considering that different countries might be at different stages of development of HWTS, such recommendations need to be adapted to each situation. Detailed explanations on the various steps can be found in the publication, Sanitation and hygiene in East Asia: towards the targets of the Millennium Development Goals and beyond (WHO Regional Office for the Western Pacific, 2013). Create demand by: • identifying a target population that would benefit from HWTS and spend time understanding the overall context; • selecting an appropriate target population based on risk factors and practices; and • selecting a suitable and feasible HWTS option. Supplying requires providing products and services by taking the following steps: • Consult the list of products tested by WHO to determine if the product meets WHO standards. If it is not on the list, review microbiological data to better understand its performance. Methods and products may include filtration, chemical disinfection, disinfection with heat (boiling and pasteurization) and flocculation/disinfection. However, there can be great variability in products depending on the quality of manufacturing and parts, the design, and the way in which the product is intended to be used. In addition, a combination of these methods may be used to increase the efficacy of treatment. • Ensure that the chosen method/product is affordable and available. • Implementers need to set up a system to support households in the proper and consistent use of HWTS over the long term. Households need a contact point for followup service, purchase of replacement parts and queries. Monitoring: • Monitoring is essential for ongoing improvement of the implementation of programmes. It helps to create a feedback loop within a programme. It is particularly important for measuring the impact and success of a programme, especially if an organization wants to scale up its activities. • Monitoring includes the following elements: management; product quality; distribution systems; household education; performance and use of HWTS option; and impact. Human capacities required for implementation: • Developing people’s knowledge and skills is part of building the overall organizational capacity required for implementation. A variety of roles are needed to implement HWTS programmes, including the following: programme implementers, community health promoters, product manufacturers, trainers, and other stakeholders such as donors, governments, universities and educational institutions. • Use a capacity-building and competency validation process. Competency is a knowledge, skill or attitude that is a standardized requirement for somebody to properly perform a specific job or role. Validation is the process of checking people’s knowledge, skills and attitudes to confirm that they are competent in their role. Validators can be from within the implementing organization or from external training organizations. Programme financing: • Implementers need consistent and long-term funding to ensure that all of their programme activities are executed without disruption. • At least the following costs should be considered: programme planning and administration; promotion and education activities; product manufacturing and distribution; monitoring and evaluation. Source: adapted from WHO Regional Office for the Western Pacific (2013).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

procuring UN agencies. In this regard, the Scheme fills an important global and national need for independent health-based evaluation of HWTS, especially considering the large number of product manufacturers and product claims, and the limited capacity of low-income countries to conduct testing to verify these claims (WHO, 2016). In Round I, 10 products were evaluated, eight of which met at least minimum WHO health standards. The Round II report will be launched in 2018 and will detail results from 20 products. Product results can be found on the Scheme web page: http://www. who.int/water_sanitation_health/water-quality/household/list-of-products/en/. Plans are currently underway to simplify testing protocols to allow more laboratories to conduct testing and to capacitate low- and middle-income countries in evaluating and regulating HWTS alongside broader water quality surveillance and regulation efforts. Rosa and Clasen (2010) reported that from 67 countries where national household surveys provided data on household water treatment (HWT), an estimated 1.1 billion people globally (33% of households) reported treating water in the household, with the practice being particularly common in the Western Pacific (66.8%) and SouthEast Asia Regions (45.4%). Boiling is the most commonly used method (21% of study households). Filtration is fairly commonly reported in both regions. It was also found that household filters produced a statistically significant reduction in diarrhoeal disease, while chlorination and solar disinfection did not show a significant impact. It is speculated that this apparent lack of effect from household chlorination and solar disinfection may be due to a number of factors, such as incorrect or inconsistent use of the technology. It does not suggest that they are not effective at reducing microbial contamination, but that no additional health benefit can be ascribed to these technologies in the burden of disease calculations. Implementing a HWTS strategy at the country level should be done in close coordination with broader water safety improvements and specific health efforts targeting vulnerable groups, such as pregnant mothers or those living with HIV/AIDS. The process for addressing HWTS nationally includes the following steps: create demand for HWTS; supply the required HWTS products and services to meet the demand; monitor and ensure a continuous improvement of programme implementation. Box 18 presents more details about country-level strategies on HWTS.

4.2 WASH in schools The new JMP service ladders for WASH in schools enable countries to track progress towards SDG 6 Target 4.a, which aims at basic drinking-water, sanitation and hygiene in all schools (Table 5). In countries where basic services are not ambitious, a countrydefined advanced level may be appropriate based on the national context, priorities and resources. Criteria for an advanced level might include normative elements that are not captured by the basic indicator, such as the quality of drinking-water, ratios of pupils per toilet, or availability of menstrual hygiene management materials in bathrooms (WHO and UNICEF, 2017b).

Regional programmatic priorities

Table 5.

JMP service ladders to monitor WASH in schools

SERVICE LEVEL

DRINKING-WATER

SANITATION

HYGIENE

Advanced

To be defined at national level

Basic (SDG)

Drinking water from an improved source is available at the school

Improved facilities, which are single-sex and usable at the school

Handwashing facilities that have water and soap are available

There are improved facilities (flush/ pour flush toilets, pit latrine with slab, composting toilet), but not single-sex or not usable at time of survey

Handwashing facilities with water, but no soap

Limited

There is an improved source (piped, protected well/ spring, rainwater, packaged/ delivered water), but water is not available at time of survey No water source or unimproved source (unprotected well/ spring, surface water)

No toilets or latrines, or unimproved facilities (pit latrines without a slab or platform, hanging latrines, bucket latrines)

No handwashing facilities at the school or handwashing facilities with no water

No service

Source: WHO and UNICEF (2017b).

Although the JMP succeeded in obtaining survey information on WASH in schools in selected countries of the Western Pacific Region (Table 6), this information is clearly insufficient to use for a solid analysis representative of the whole Region. However, upon analysing the data available for a few countries, it is clear that considerable effort will be required if the Region wishes to achieve the correspondent SDG targets for drinking-water and sanitation. Even less information is available on hygiene practised in the schools in the Region. Table 6.

Status of drinking-water and sanitation coverage in schools of selected Western Pacific countries (%) DRINKING-WATER

COUNTRY

Basic service

Limited service

SANITATION

No service

Basic service

Limited service

No service

–

China

–

Fiji

Lao People’s Democratic Republic

–

Papua New Guinea

Philippines

–

Cambodia

= Not available Source: WHO and UNICEF dataset.

Different initiatives have been launched by different institutions aimed at promoting and improving WASH in schools. The Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) Fit for School Programme, working in Cambodia, Indonesia, the Lao People’s Democratic Republic and the Philippines, together with their partners – Southeast Asian Ministers of Education Organization (SEAMEO), UNICEF and the Australian Department of Foreign Affairs and Trade (DFAT) – are now focusing on

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

the issue of sanitation in schools by building upon the experiences of the hygiene promotion interventions (Box 19). Box 19.

The Fit for School approach

The Fit for School (FIT) approach is based on four core principles: simplicity, sustainability, scalability and systems thinking. A school health programme and its interventions must be based on best possible evidence, should be cost-effective and simplified to facilitate implementation in the school context with little extra effort. To ensure sustainability, long-term allocation of government human and financial resources is crucial. A close partnership with the parents and local community is imperative in maximizing ownership and accountability. Capitalizing existing systems and resources are essential elements for scalability. The approach works through the education sector, especially on the sub-national level, in order to establish sustainable programme management and implementation within the local structures. Additional payments and monetary incentives are not part of the approach since this often leads to a collapse of activities as soon as the external funding ends. Aligned with these principles, the interventions comprise handwashing with soap and toothbrushing with fluoride toothpaste as daily group activities, complemented by biannual deworming. Institutionalizing these interventions addresses some of the most prevalent diseases among schoolchildren. To provide a healthy environment, schools need functional washing facilities and toilets. These basic school infrastructures are prerequisites for positive hygiene behaviour and address key determinants of health. Learn more about the Fit for School Programme: http://www.fitforschool.international/ fit-approach/fit-for-school-principles/

ÂŠ WHO/Yoshi Shimizu

Source: GIZ (2017).

Girl next to a water storage tank in Lata village. (Papua New Guinea, 2016) Regional programmatic priorities

GIZ and UNICEF also launched the Three Star Approach for WASH in Schools to improve the effectiveness of hygiene behaviour change programmes for children, complementing UNICEF’s broader child-friendly schools initiative and GIZ’s Fit for School approach, which promote safe, healthy and protective learning environments (Box 20). Box 20.

The Three Star Approach

The Three Star Approach for WASH in Schools is designed to improve the effectiveness of hygiene behaviour change programmes. The approach ensures that healthy habits are taught, practised and integrated into daily school routines. The Three Star Approach helps schools meet the essential criteria for a healthy and protective learning environment for children as part of UNICEF’s broader child-friendly schools initiative. It aims to address the bottlenecks that block the effectiveness and expansion of current WASH in Schools programmes. In the Three Star Approach, schools are encouraged to take simple, inexpensive steps outlined in a Field Guide. These steps are designed to ensure that all students wash their hands with soap, have access to drinking-water, and are provided with clean, gendersegregated toilets at school every day. Group activities drive this incremental approach, beginning with daily, supervised group handwashing sessions. Once minimum standards are achieved, schools can move from one to three stars by expanding hygiene promotion activities and improving infrastructure, especially for girls, and will ultimately achieve the national standards for WASH in Schools. The Three Star Approach involves changing the way WASH in Schools programming is perceived by schools, communities and decision-makers in government and support agencies. By prioritizing the most essential actions for achieving goals, the Three Star Approach helps schools focus on meeting children’s needs through key interventions. At the same time, it provides a clear pathway for all schools throughout a country to meet national standards, and for all children to have hygiene-promoting and healthy schools. It encourages local action and support from communities and does not depend on expensive hardware inputs from the education system or external support agencies. “Keep it simple, scalable and sustainable” is the guiding concept for interventions at all stages, so that the approach can be sustainably expanded country-wide at low cost. Learn more about the Three Star Approach: https://www.unicef.org/wash/schools/files/ UNICEF_Field_Guide-3_Star-Guide.pdf Source: GIZ and UNICEF (2013).

What needs to be done to improve WASH in schools? UNICEF (2012) proposes a set of essential steps in managing drinking-water, sanitation and hygiene standards in a given country (see Table 7). This proposition is generic and should not be used as a blueprint for all countries. It should be adapted according to the stage of development of the country’s education system and to the WASH status in schools in each country.

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Table 7.

What can be done at the national, district and local levels to improve drinking-water, sanitation and hygiene in schools? DISTRICT LEVEL (OR EQUIVALENT)

LOCAL LEVELS (SCHOOL AND COMMUNITY)

Review existing national policies and ensure a national policy framework supportive of improved conditions in schools.

Raise awareness of WASH in schools among key stakeholders at the district level.

Mobilize support from teachers, schoolchildren, families and other local stakeholders to achieve and sustain a healthy school environment.

Ensure that appropriate national bodies exist for setting and monitoring standards.

Ensure that an appropriate body or service exists at the district level for overseeing compliance with standards. Try to incorporate all entities and organizations working in the district on WASH in Schools.

Create an appropriate body to oversee the implementation of standards in the school.

Review national standards and add to them if needed. Establish an effective regulatory framework that encourages and supports compliance.

Ensure that district-level guidance and support for compliance reflects the national regulatory framework. Use appropriate guidelines where standards do not exist.

Define a set of targets, policies and procedures for implementing national standards and/or guidelines in a way that reflects local conditions. Define how targets, policies and procedures will be applied.

Provide expertise and resources for assessment and planning at the national level.

Provide expertise and resources for assessment and planning at the district level.

Assess existing conditions; consult local stakeholders, including staff and local community; and plan improvements and new developments.

Provide locally appropriate plans and specialist input for new structures and improvements to existing structures.

Plan improvements or new developments required, with specialist technical input if necessary.

Promote, provide and/or facilitate funding for national programmes.

Advocate for the allocation of funding for planned improvements and new developments.

Guarantee funding for planned improvements and new developments.

Monitor developments at the national level and promote consistent application of standards in all districts.

Ensure oversight of improvements and new developments to confirm the consistent application of appropriate standards in all schools.

Oversee implementation of planned improvements and new developments.

Ensure that WASH components are adequately reflected in the education management information system (EMIS) at the national level.

Monitor ongoing conditions in all schools and promote remedial action where required.

Monitor ongoing conditions and ensure remedial action where required.

Provide training and information materials appropriate to a range of school settings. Ensure appropriate curriculum for teacher training.

Provide appropriate training and information to teachers, school directors and extension agents.

Provide advice and training to staff, schoolchildren and parents.

NATIONAL LEVEL

Source: UNICEF (2012).

4.3 WASH in health-care facilities WASH in health-care facilities are fundamental for reducing health-careâ&#x20AC;&#x201C;related infections, increase trust and uptake of services, increase efficiency and decrease cost of service delivery. In low- and middle-income countries, WASH facilities in many health-care facilities are absent. Data from 54 countries, representing 66Â 101 facilities worldwide, show that 38% of health-care facilities do not have an improved water source, 19% do not have improved sanitation and 35% do not have water and soap for handwashing. This lack of adequate facilities compromises the ability to provide safe and quality care and places both those providing and those seeking care at considerable and preventable risk (WHO and UNICEF, 2017a). In Cambodia, WHO indicated that although 91% of the health facilities counted on

Regional programmatic priorities

improved drinking-water systems, only 39% counted on sanitation facilities and only 15% had basic hygiene facilities (WHO, 2017b). The WHO/UNICEF global action plan that was launched in 2015 aims at ensuring that all health-care facilities in all settings have adequate and safely managed drinkingwater, sanitation and hygiene services by 2030. To realize this aim, global task teams composed of WASH and health professionals have been established to drive progress in five main areas: advocacy; leadership and policy; monitoring; evidence; and facility-based improvements. Within all streams of work there is a focus on national action and solutions, documenting lessons learnt, and working jointly with health sector colleagues to drive change in key areas such as quality universal health coverage; maternal, newborn and child health; infection prevention and control; and antimicrobial resistance (WHO and UNICEF, 2017c). The WASH FIT tool developed by WHO is a powerful instrument to improve WASH in health-care facilities (Box 21). Box 21.

The water and sanitation for health facility improvement tool (WASH FIT)

The WASH FIT is a practical guide providing a description of a risk-based, continuous improvement framework and associated tools for undertaking WASH improvements as part of wider quality improvements in health-care facilities. WASH FIT is an adaptation of the WSP approach, which is recommended in the WHO GDWQ as the most effective way of ensuring continuous provision of safe drinking-water. WASH FIT extends beyond water quality to address sanitation, hygiene, health-care waste and other aspects of environmental health and health-care facility management and staff empowerment. As such, it also draws upon WHO’s SSPs as well as WHO recommendations for infection prevention and control. The guide contains a number of ready-to-use tools to help implement WASH FIT and step-by-step instructions for each stage. The overall aim of using WASH FIT is to improve and sustainably maintain WASH services in health-care facilities. The tool has been implemented in over 10 countries and initial results indicate that it is most effective when done alongside broader national advocacy, systems change and monitoring efforts. A mobile version of the tool is available, as well as training modules. Learn more about the WASH FIT guide: http://apps.who.int/iris/bitstre am/10665/254910/1/9789241511698-eng.pdf?ua=1 WASH FIT mobile can be found here: https://washfit.org/#/ and training modules here: https://www.washinhcf.org/resources/training/ Source: WHO and UNICEF (2017d).

Unfortunately, information about the status of health-care facilities in the countries of the Western Pacific Region is badly missing. Considering the ambitious target set by SDG 6 of achieving universal WASH coverage in health-care facilities by 2030, there is a need to establish a baseline from which to measure progress. The JMP devised four service ladders for WASH in health-care facilities – water, sanitation, hand hygiene,

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

and health-care waste â&#x20AC;&#x201C; that each focus on conditions in the outpatient setting (Table 8). The indicators are universally applicable, but reporting will disaggregate among different types of health-care facilities. As with schools, in countries where basic services are already the norm, a country-defined advanced service level may be appropriate based on the national context, priorities and resources. Examples of requirements for an advanced level might include drinking-water quality, excreta management systems, or compliance with mandated cleaning routines (WHO and UNICEF, 2017a). Table 8.

Service ladders for monitoring WASH in health-care facilities DRINKING-WATER

SANITATION

HAND HYGIENE

ENVIRONMENTAL CLEANING

HEALTH-CARE WASTE

Advanced

To be defined at national level

Basic (SDG)

Water is available from an improved source located on premises.

Improved sanitation facilities are located on premises and usable, with at least one toilet designated for women/girls with facilities to manage menstrual hygiene needs, at least one toilet separated for staff, and at least one toilet meeting the needs of those with limited mobility.

Functional hand hygiene stations are available at points of care, and within 5 meters of toilets.

Basic standard written policies and protocols for cleaning available, and staff with cleaning responsibilities have all received training within the last 24 months.

Waste is safely segregated into at least three bins and sharps and infectious waste are treated and disposed of safely.

Limited

Water is available but from an improved source located offpremises; or an improved water source is on site but water is not available.

Improved sanitation facilities are present but are not usable or not on premises, or do not meet the needs of specific groups (staff, women/ girls, people with limited mobility).

Functional hand hygiene stations are available at either points of care or toilets, but not both.

Policies and protocols available for some but not all cleaning activities; or not all staff with cleaning responsibilities have received training within the last 24 months.

Waste is segregated but not disposed of safely, or bins are in place but not used effectively.

No service

Water is taken from unprotected dug wells or springs, or surface water sources; or there is no water source at the facility.

Toilet facilities are unimproved (pit latrines without a slab or platform, hanging latrines and bucket latrines), or there are no toilets or latrines at the facility.

No functional hand hygiene stations are available at either points of care or toilets.

No cleaning policies or protocols are available.

Waste is not segregated or safely treated and disposed of.

SERVICE LEVEL

Source: WHO and UNICEF (2017a).

Regional programmatic priorities

Achieving the target of universal coverage of health-care facilities with safely managed WASH services requires a huge effort. Such effort cannot even be determined quantitatively for the Western Pacific Region as there is a lack of information for generating baseline statistics on this issue. The SDG baseline report for WASH in health-care facilities will be published in Q3 2018 and efforts are being made to capture all the data that exist in the Region, as well as embed WASH in health-care facility indicators into existing health monitoring systems to better inform the status of coverage and intervention efforts. Box 22 makes an attempt to provide suggestions on the way forward for countries in the Region. Such suggestions cannot be applied to all countries in the Western Pacific Region as they are at different stages of development. Box 22. •

•

• • •

• •

What needs to be done to improve WASH in health-care facilities?

WASH leaders should work with health colleagues to understand the existing national policy, regulatory and health sector priorities and how to use existing health frameworks to bring attention to and improve WASH in health-care facilities. Advocacy should focus on drawing attention to the needs, informed by national and-or sub-national assessments, including immediate and longer-term WASH improvements. Human and financial resources should be increased at the facility level and advocate for WASH within existing health efforts, especially universal health coverage, infection prevention control, antimicrobial resistance and child and maternal health. The definition of WASH in health-care facilities in the Western Pacific Region should at least comply with the requirements suggested in WHO guidelines addressing availability of safe, sufficient drinking-water, adequate numbers of improved and safely managed facilities for men and women, safe hygiene practices (e.g. handwashing with soap), hygiene promotion to patients and caregivers, environmental cleaning procedures, and safe management and disposal of health-care waste. Countries should adopt minimum WASH standards and revise them as needed to reflect emerging technologies and practices. A core set of national indicators should be developed that takes into account international monitoring requirements. Facility assessment and risk management tools should be shared and updated recurrently. Further work is needed in developing and implementing risk-based improvement plans that prioritize and specify actions using the WASH FIT approach. Document regional and country examples of successful strategies and approaches for improving WASH in health-care facilities. Researchers in the Region should engage in dialogue, share tools and collaborate more with health-care institutions in studying the impact of improving WASH services as well as operational research and how to most effectively improve and sustain services.

Source: WHO and UNICEF (2015).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

4.4 WASH in climate change Climate change affects the social and environmental determinants of health – clean air, safe drinking-water and sanitation, sufficient food and secure shelter. Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths per year globally, just considering malnutrition, malaria, diarrhoea and heat stress. Areas with weak health systems, including insufficient and inadequate infrastructure, will be the least able to cope without assistance to prepare and respond. Reducing emissions of greenhouse gases through better transport, food and energy-use choices can result in improved health, particularly through reduced air pollution (WHO, 2017d).

The Western Pacific Region, which includes many low-lying PICs, is especially vulnerable to climate variability and change, and the impact is not limited to climate-sensitive diseases. Changes in climate are expected to affect a wide range of environmental and social determinants of health, with increased heatwaves, rising sea levels, increased number and severity of flooding events and other extreme weather events contributing to a series of challenges ranging from food security to a scarcity of drinking-water and increases in communicable and respiratory diseases (WHO Regional Office for the Western Pacific, 2015).

Cyclone Ian devastated houses and roof catchments and compromised the availability of adequate water supplies for the affected population. (Ha’apai, Tonga, 2014)

Regional programmatic priorities

Flooding in low-lying areas, Nadi river basin. (Viti Levu, Fiji, 2009)

The response to the consequences of climate change needs to be broad as it touches on a wide range of problems, each requiring specific action. For WASH, Box 23 makes an attempt to provide key directions.

Box 23.

What to do to face the challenges of WASH in climate change?

The Vision 2030 Study conducted by WHO and the Department for International Development (United Kingdom of Great Britain and Northern Ireland) (DFID) is focused on how and where climate changes anticipated in the medium term will affect the drinkingwater and sanitation situation; what can be done to optimize the technologies and systems that exist to maximize their resilience; and what needs to be done differently to ensure that the services of the future can cope with the impacts of climate change. The following are the main conclusions of this study, adapted to the situation in the Western Pacific Region: 1. Climate change is widely perceived as a threat rather than an opportunity. There may be signiﬁcant overall beneﬁts to health and development in adapting to climate change. • Efforts to adapt to climate change would create a stimulus to aim directly for higher levels of service for those currently unserved, without passing through the intermediate step of communal levels of services. • A focus on adaptation to climate change puts greater emphasis on the need to address water source sustainability from the outset of new programmes and not simply as an afterthought. • Concern about adapting to climate change creates stronger pressure to rationalize the choice of technologies to be used to deliver sustainable and effective services.

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

2. Major changes in policy and planning are needed if ongoing and future investments are not to be wasted. • Technologies capable of adapting to the range of climate scenarios need to be identified and prioritized. Some widely used technologies will be unsustainable in some areas. Human and institutional capacities and investments need to be redirected towards sustainable solutions. • Technologies, management and planning are needed that can be adapted to cope with multiple threats and not only climate change. • Reducing water use and better demand management will be critical where drinking-water systems involve piped water supply and waterborne sanitation, especially where rainfall declines. • Community-managed drinking-water sources and supplies fail early and are frequently contaminated. Climate change will aggravate this. 3. Potential adaptive capacity is high but rarely achieved. Resilience needs to be integrated into drinking-water and sanitation management to cope with present climate variability. It will be critical in controlling adverse impacts of future variability. • Urgent action is required to turn the potential adaptive capacity of many utilitymanaged water supplies to actual resilience to climate change. • Systematic assessments of the climate change resilience of all utilities and of rural water and sanitation programmes are needed. • Adaptations that are available need to be put in place in areas likely to face climate changes. 4. Although some of the climate trends at the regional level are uncertain, there is sufficient knowledge to inform urgent and prudent changes in policy and planning in most regions. • In Asia, drinking-water coverage is high, with much rural reliance on protected wells. Flooding and decreasing reliability of surface waters may become major challenges. 5. There are important gaps in our knowledge that already or soon will impede effective action. Targeted research is urgently needed to fill gaps in technology and basic information, to develop simple tools, and to provide regional information on climate change. • There are technology gaps – for example, in widely acceptable alternatives to sewerage for cities, and in the application of data capture and signaling to inform better monitoring. • There are significant gaps in basic information – for example, in understanding the water resource base, and on water demand from household-level access to drinking-water. • Simple tools are needed in various areas – for example, for rapid assessment of the vulnerability of water utilities to climate change. • There is a lack of detailed information on climate change at the regional level. The Vision 2030 study can be found here: http://www.who.int/water_sanitation_health/publications/9789241598422/en/ Sources: WHO and DFID (2009); WHO (2017e).

A guide on climate-resilient WSPs has been developed to support water suppliers and WSP teams to better understand climate change impacts on water supplies and to identify, assess and address climate change risks as part of water safety planning (WHO, 2017e). Potential improvements in the face of climate variability and change are also included in this guide, which can be found here: http://www.who.int/water_ sanitation_health/publications/climate-resilient-water-safety-plans/en/. Regional programmatic priorities

ÂŠ UNICEF/Marc Overmars/2013

Local dance and drama are used to communicate health and hygiene messages such as here for CLTS celebrations on North Tarawa. (Kiribati, 2013)

Bibliographic references Blencowe HL, Graham W (2010). Clean birth kits – potential to deliver? Evidence, experience estimated lives saved and cost. London: Save the Children and Immpact (https://www.healthynewbornnetwork.org/hnn-content/uploads/CBK_brief-LOWRES.pdf, accessed 15 February 2018). DFAT, WHO (2017). Water safety plans as normal practice: policy and institutional strengthening for WSP mainstreaming – final report for phase 3 (July 2012 – June 2017). Geneva: Australia Department of Foreign Affairs and Trade and WHO. GIZ (2017). Fit for school programme [website]. Manila: GIZ Fit for School Programme (http://www.fitforschool.international/, accessed 17 December 2017). GIZ, UNICEF (2013). Field guide: the three star approach for WASH in schools. New York: GIZ and UNICEF (https://www.unicef.org/wash/schools/files/UNICEF_Field_ Guide-3_Star-Guide.pdf, accessed 17 December 2017). Rosa G, Clasen T (2010). Estimating the scope of household water treatment in lowand medium-income countries. Am J Trop Med Hyg. 82(2):289–300. UN (2002). General Comment No. 15. The right to water. New York: UN (http://www. un.org/waterforlifedecade/human_right_to_water.shtml, accessed 15 October 2017). UN (2010). Resolution A/RES/64/292. New York: UN (http://www.un.org/ waterforlifedecade/human_right_to_water.shtml, accessed 15 October 2017). UN (2014). Millennium Summit [website]. New York: UN (http://www.un.org/ millenniumgoals/bkgd.shtml, accessed 5 August 2017). UN (2016). Report of the Inter-Agency and Expert Group on Sustainable Development Goal Indicators. New York: UN (https://unstats.un.org/unsd/statcom/47th-session/ documents/2016-2-IAEG-SDGs-E.pdf, accessed 10 December 2017). UNICEF (2012). Water, sanitation and hygiene in schools. New York: UNICEF (https:// www.unicef.org/publications/files/CFS_WASH_E_web.pdf, accessed 17 December 2017). UNICEF, WHO (2015). Progress on sanitation and drinking-water – 2015 update and MDG assessment. Geneva: WHO and UNICEF (https://washdata.org/sites/default/ files/documents/reports/2017-06/JMP-2015-Report.pdf, accessed 5 September 2017).

UN-Water (2006). Gender, water and sanitation: a policy brief. New York: UN (http://www.un.org/waterforlifedecade/pdf/un_water_policy_brief_2_gender.pdf, accessed 23 February 2017). WHO (2010). UN-Water Global Annual Assessment of Sanitation and Drinking-water: targeting resources for better results. Geneva: WHO (http://www.who.int/water_ sanitation_health/monitoring/investments/glaas-2009-2010-cycle/en/, accessed 24 October 2017). WHO (2012). UN-Water Global Analysis and Assessment of Sanitation and Drinkingwater: the challenge of extending and sustaining services. Geneva: WHO and UN-Water (http://www.who.int/water_sanitation_health/publications/glaas_report_2012/en/, accessed 24 October 2017). WHO (2014a). Preventing diarrhoea through better water, sanitation and hygiene: exposures and impacts in low- and middle-income countries. Geneva: WHO (http:// apps.who.int/iris/bitstream/10665/150112/1/9789241564823_eng.pdf, accessed 12 April 2017). WHO (2014b). UN-Water Global Analysis and Assessment of Sanitation and Drinking-water (GLAAS) 2014 report: investing in water: increasing access, reducing inequalities. Geneva: WHO and UN-Water (http://www.who.int/water_sanitation_ health/publications/glaas_report_2014/en/, accessed 12 January 2017). WHO (2016). Results of Round I of the WHO International Scheme to Evaluate Household Water Treatment Technologies. Geneva: WHO (http://apps.who.int/iris/ bitstream/10665/204284/1/9789241509947_eng.pdf, accessed 31 August 2017). WHO (2017a). UN-Water Global Analysis and Assessment of Sanitation and DrinkingWater (GLAAS) 2017 report: financing universal water, sanitation and hygiene under the Sustainable Development Goals. Geneva: WHO and UN-Water (http://www. who.int/water_sanitation_health/publications/glaas-report-2017/en/, accessed 24 October 2017). WHO (2017b). Achieving quality universal health coverage through better water, sanitation and hygiene services in health-care facilities â&#x20AC;&#x201C; a focus on Cambodia and Ethiopia. Geneva: WHO (http://www.who.int/water_sanitation_health/publications/ uhc-thru-better-wash.pdf, accessed 12 October 2017). WHO (2017c). Guidelines for drinking-water quality: fourth edition incorporating the first addendum. Geneva: WHO (http://apps.who.int/iris/bitstre am/10665/254637/1/9789241549950-eng.pdf, accessed 13 December 2017). WHO (2017d). Climate change and health [website]. Geneva: WHO (http://www.who. int/mediacentre/factsheets/fs266/en/, accessed 12 November 2017).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

WHO (2017e). Climate-resilient water safety plans: managing health risks associated with climate variability and change. Geneva: WHO (http://apps.who.int/iris/bitstre am/10665/258722/1/9789241512794-eng.pdf, accessed 16 February 2018). WHO, DFID (2009). Summary and policy implications Vision 2030: the resilience of water supply and sanitation in the face of climate change. Geneva: WHO and DFID (http://www.who.int/water_sanitation_health/publications/vision_2030_summary_ policy_implications.pdf, accessed 12 December 2017). WHO, UNEP (2007). Charter of the regional forum on environment and health Southeast and East Asian countries – framework for cooperation. Ministerial Regional Forum on Environment and Health in Southeast and East Asian Countries. Geneva: WHO and UNEP (http://www.wpro.who.int/rfeh/policy_documents/1_charter_ regional_forum.pdf, accessed 28 September 2017). WHO, UNICEF (2015). Water, sanitation and hygiene in health-care facilities – urgent needs and actions. Global meeting, 17–18 March 2015, Geneva, Switzerland. Geneva: WHO and UNICEF (https://www.washinhcf.org/fileadmin/user_upload/documents/ Montgomery-WASH-in-HCF-Opening.pdf, accessed 27 November 2017). WHO, UNICEF (2017a). Progress on drinking water, sanitation and hygiene: 2017 update and SDG baselines. Geneva: WHO and UNICEF (https://washdata.org/sites/ default/files/documents/reports/2018-01/JMP-2017-report-final.pdf, accessed 28 August 2017). WHO, UNICEF (2017b). WASH in the 2030 Agenda: new global indicators for drinking water, sanitation and hygiene. Geneva: WHO and UNICEF (https://washdata.org/ sites/default/files/documents/reports/2017-07/JMP-2017-WASH-in-the-2030agenda.pdf, accessed 16 August 2017). WHO, UNICEF (2017c). WASH in health-care facilities: global action to provide universal access by 2030 [website]. Geneva: WHO (https://www.washinhcf.org/ home/, accessed 18 December 2017). WHO, UNICEF (2017d). Water and Sanitation for Health Facility Improvement Tool (WASH FIT): a practical guide for improving quality of care through water, sanitation and hygiene in health care facilities. Geneva: WHO and UNICEF (http://apps.who.int/ iris/bitstream/10665/254910/1/9789241511698-eng.pdf, accessed 18 December 2017). WHO Regional Office for the Western Pacific (2013). Sanitation and hygiene in East Asia: towards the targets of the Millennium Development Goals and beyond. Manila: WHO Regional Office for the Western Pacific (http://www.wpro.who.int/ environmental_health/documents/docs/Sanitation_and_Hygiene_in_East_Asia. pdf, accessed 14 September 2017).

Bibliographic references

WHO Regional Office for the Western Pacific (2015). Climate change and health in the Western Pacific Region: synthesis of evidence, profiles of selected countries and policy direction. Manila: Regional Office for the Western Pacific (http://iris.wpro. who.int/bitstream/handle/10665.1/12401/9789290617372_eng.pdf, accessed 12 November 2017). WHO Regional Office for the Western Pacific (2017b). Meeting report: development of action plans for achieving and monitoring SDG WASH targets – lessons from accomplishments of the WHO/DFAT Water Quality Partnership, Manila, Philippines, 20–23 February 2017. Manila: Regional Office for the Western Pacific (http://apps. who.int/iris/bitstream/handle/10665/260155/RS-2017-GE-16-PHL-eng.pdf, accessed 6 May 2018). WHO Regional Office for the Western Pacific, DFAT (2014). Water Quality Partnership – Status December 2014. Manila: WHO Regional Office for the Western Pacific. WHO Regional Office for the Western Pacific, UNICEF/EAPRO (2008). Water supply and sanitation sector assessments: a guide for country-level action. Manila: WHO Regional Office for the Western Pacific and UNICEF (http://iris.wpro.who.int/ bitstream/handle/10665.1/5465/9789290614180_eng.pdf, accessed 6 May 2018). WSP (2010). Gender in water and sanitation. Nairobi: Water and Sanitation Program World Bank (https://www.wsp.org/sites/wsp.org/files/publications/WSP-genderwater-sanitation.pdf, accessed 19 February 2018). WSP (2011). Cost recovery in urban water services: select experiences in Indian cities. New Delhi, India: Water and Sanitation Program (https://www.wsp.org/sites/wsp. org/files/publications/WSP-Cost-Recovery-Urban-Water-Services.pdf, accessed 8 December 2017).

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Annexes Annex 1. Global, regional and national basic drinking-water coverage, 2000 and 2015

American Samoa (USA) Australia Brunei Darussalam Cambodia China

Surface water

Unimproved

Limited

Basic, not safely managed

Basic

Surface water

URBAN

Unimproved

Limited

Basic, not safely managed

Basic

Surface water

RURAL

Unimproved

Limited

Basic, not safely managed

Basic

% urban

Year

COUNTRY, AREA OR TERRITORY

Population (thousands)

NATIONAL

2000

2015

2000

19 107

87 100

0 100

2015

23 969

89 100

0 100

2000

331

100

2015

423

77 100

0 100

0 14

2000

12 198

2015

15 578

2000

1 269 975

2015

1 376 049

China, Hong Kong SAR

2000

6 784

100

2015

7 288

100 100

100

China, Macao SAR

2000

432

100 100

100

2015

588

100 100

100

2000

65 100

Cook Islands Fiji French Polynesia (France) Guam (USA) Japan Kiribati Lao People’s Democratic Republic Malaysia Marshall Islands Micronesia (Federated States of) Mongolia

2015

2000

811

75 100

0 0

2015

892

2000

237

56 100

2015

283

56 100

2000

155

2015

170

95 100

2000

125 715

2015

126 573

2000

2015

112

2000

5 343

2015

6 802

2000

23 421

2015

30 331

2 100

2000

2015

2000

107

2015

104

2000

2 397

2015

2 959

New Caledonia (France) New Zealand Niue Northern Mariana Islands (Commonweatlh of the) (USA) Palau Papua New Guinea Philippines Republic of Korea Samoa Singapore Solomon Islands Tokelau Tonga Tuvalu Vanuatu Viet Nam Wallis and Futuna (France) World Western Pacific Region Pacific island countries

Surface water

Unimproved

Limited

Basic, not safely managed

Basic

0 0

2015

100

2000

210

2015

263

2000

3 858

86 100

0 100

2015

4 529

86 100

0 100

2000

2015

2000

2015

0 100

2000

2015

87 100

2000

5 374

2015

7 619

2000

77 932

2015

100 699

2000

46 206

2015

50 293

82 100

2000

175

2015

193

2000

3 918

100 100

100

2015

5 604

100 100

100

2000

412

2015

584

2000

2015

0 100

2000

2015

106

24 100

0 100

2000

2015

0 100 100

2000

185

2015

265

2000

80 286

2015

93 448

2000

0 100

2015

2000

6 126 622

2015

7 349 472

2000

1 678 044

2015

1 847 250

2000

8 102

2015

10 834

Source: WHO and UNICEF (2017a).

Surface water

Unimproved

Limited 0

Surface water

100 100

Unimproved

Limited

100

Basic, not safely managed

Basic

URBAN

Basic, not safely managed

2000

RURAL

Basic

Nauru

% urban

Year

COUNTRY, AREA OR TERRITORY

Population (thousands)

NATIONAL

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Annex 2. Global, regional and national safely managed drinking-water coverage, 2000 and 2015 NATIONAL

RURAL

URBAN

American Samoa (USA) Australia Brunei Darussalam Cambodia

China China, Hong Kong SAR

Fiji French Polynesia (France) Guam (USA)

Japan

Kiribati Lao People’s Democratic Republic Malaysia

Nonpiped

Piped

Free from contamination

Available when needed

Accessible on premises

Safely managed

Nonpiped

Piped

Free from contamination

Available when needed

Accessible on premises

Safely managed

Nonpiped

Piped

Free from contamination

Available when needed

Accessible on premises

Safely managed

2000

2015

2000

19 107

100

2015

23 969

2000

331

100

2015

423

100

2000

12 198

2015

15 578

2000

1 269 975

2015

1 376 049

2000

6 784 100

2015

7 288 100 100 100

China, Macao 2000 SAR 2015 Cook Islands

% urban

Year

COUNTRY, AREA OR TERRITORY

Population (thousands)

Proportion of population using Proportion of population using Proportion of population using improved water supplies improved water supplies improved water supplies

100 100

432 100 100 100 100 100 100

100 100 100 100 100

588 100 100 100 100 100 100

100 100 100 100 100

2000

85 100

2015

87 100

2000

811

2015

892

2000

237

2015

283

100

2000

155

2015

170

100

2000

125 715

2015

126 573

2000

2015

112

2000

5 343

2015

6 802

2000

23 421

2015

30 331

Marshall Islands

2000

2015

Micronesia (Federated States of)

2000

107

2015

104

2000

2 397

2015

2 959

Mongolia

Nauru

2000

10 100

2015

10 100

Annexes

NATIONAL

RURAL

URBAN

New Zealand

Nonpiped

Piped

Free from contamination

Available when needed

Accessible on premises

Safely managed

Nonpiped

2015

263

2000

3 858

77 100

100

100 100

100

2015

4 529

86 100 100

100 100

100

100 100

100

2000

2015

Northern 2000 Mariana Islands (Commonwealth of 2015 the) (USA)

Niue

Palau Papua New Guinea Philippines Republic of Korea Samoa

Singapore Solomon Islands Tokelau

Tonga

Tuvalu

Vanuatu

Viet Nam Wallis and Futuna (France) World

2000

2015

100

95 100

100

2000

5 374

Pacific island countries

2015

7 619

2000

77 932

2015

100 699

2000

46 206

2015

50 293

2000

175

2015

193

100 100

2000

3 918 100 100 100

2015

5 604 100 100 100

100 100

2000

412

2015

584

100 100

2000

2015

2000

2015

106

2000

2015

2000

185

2015

265

50 100

2000

80 286

2015

93 448

2000

100

2015

2000 6 126 622

2015 7 349 472

2000 1 678 044

Western Pacific Region 2015 1 847 250 2000

8 102

2015

10 834

Source: WHO and UNICEF (2017a).

Piped

Free from contamination

Nonpiped

Available when needed

Piped

Accessible on premises

Safely managed 86

Accessible on premises

Safely managed

210

Free from contamination

2000

Available when needed

New Caledonia (France)

% urban

Year

COUNTRY, AREA OR TERRITORY

Population (thousands)

Proportion of population using Proportion of population using Proportion of population using improved water supplies improved water supplies improved water supplies

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Annex 3. Global, regional and national basic sanitation coverage, 2000 and 2015

Australia Brunei Darussalam Cambodia

China China, Hong Kong SAR China, Macao SAR Cook Islands

Fiji French Polynesia (France) Guam (USA)

Japan

Kiribati Lao People’s Democratic Republic Malaysia

Marshall Islands Micronesia (Federated States of) Mongolia

Nauru New Caledonia (France)

Basic, not safely managed

Limited

Unimproved

Open defecation

Basic

Basic, not safely managed

Limited

Unimproved

Open defecation

% urban

Open defecation

Unimproved

Limited

Basic

Population (thousands)

Basic

URBAN

2000

Year American Samoa (USA)

RURAL

2015

COUNTRY, AREA OR TERRITORY

Basic, not safely managed

NATIONAL

2000

19 107

100

2015

23 969

100

2000

331

2015

423

2000

12 198

2015

15 578

2000

1 269 975

2015

1 376 049

2000

6 784

100

2015

7 288

100

2000

432

100

2015

588

100

2000

2015

2000

811

2015

892

2000

237

2015

283

2000

155

2015

170

2000

125 715

100

2015

126 573

100

2000

2015

112

2000

5 343

2015

6 802

2000

23 421

2015

30 331

100

2000

2015

2000

107

2015

104

2000

2 397

2015

2 959

2000

100

2015

100

2000

2015

263

100

Annexes

New Zealand

Niue Northern Mariana Islands (Commonwealth of the) (USA) Palau Papua New Guinea Philippines

Republic of Korea

Samoa

Singapore

Solomon Islands

Tokelau

Tonga

Tuvalu

Vanuatu

Viet Nam Wallis and Futuna (France) World

Open defecation

Unimproved

Limited

Basic, not safely managed

Basic

Open defecation

Unimproved

Limited

Basic, not safely managed

Basic

URBAN

2000

3 858

100

2015

4 529

100

2000

100

2015

2000

2015

2000

2015

100

2000

5 374

2015

7 619

2000

77 932

2015

100 699

2000

46 206

100

2015

50 293

100

2000

175

2015

193

2000

3 918

100

2015

5 604

100

2000

412

2015

584

2000

2015

2000

2015

106

2000

2015

2000

185

2015

265

2000

80 286

2015

93 448

2000

2015

2000 6 126 622

2015 7 349 472

Western Pacific Region

2000 1 678 044

2015 1 847 250

Pacific island countries

2000

8 102

2015

10 834

Source: WHO and UNICEF (2017a)

Open defecation

RURAL

Unimproved

Limited

Basic, not safely managed

Basic

% urban

Year

COUNTRY, AREA OR TERRITORY

Population (thousands)

NATIONAL

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Annex 4. Global, regional and national safely managed sanitation coverage, 2000 and 2015 NATIONAL

RURAL

URBAN

American Samoa (USA) Australia Brunei Darussalam Cambodia

China China, Hong Kong SAR China, Macao SAR Cook Islands

Fiji French Polynesia (France) Guam (USA)

Japan

Sewer connections

Septic tanks

Latrines and other

Wastewater treated

Emptied and treated

Disposed in situ

Safely managed

Sewer connections

Septic tanks

Latrines and other

Wastewater treated

Emptied and treated

Disposed in situ

Safely managed

Sewer connections

Septic tanks

Latrines and other

Wastewater treated

Emptied and treated

Disposed in situ

Safely managed

% urban

Year

COUNTRY, AREA OR TERRITORY

Population (thousands)

Proportion of population using Proportion of population using Proportion of population using improved sanitation facilities improved sanitation facilities improved sanitation facilities (excluding shared) (excluding shared) (excluding shared)

2000

16 27 20

2015

7 25 31

2000

19 107

0 60 12

2015

23 969

0 68 12

2000

331

2015

423

2000

12 198

1 19 29

2015

15 578

0 38 11

0 36

0 44 44

2000 1 269 975

29 19

0 10 21

7 32 30 28

3 33 10

9 26

0 24

3 74

2015 1 376 049

60 20

0 40 30

0 45 42 34

8 52

9 73

0 65 12

1 74

2000

6 784

100

0 15

2015

7 288

100

0 14

2000

432

100

2015

588

100

2000

2015

2000

811

2015

892

2000

237

2 77 20

2015

283

0 80 17

2000

155

0 24 65

2015

170

2000

125 715

1 23 66

1 37 61 22 18 61

2015

126 573

93 100

0 22 78

4 18 78

2000

1 20 10

0 16

2 25 16

2015

112

8 22 10

7 20

8 25 16

2000

5 343

2015

6 802

38 33

43 17

32 58

2000

23 421

78 49

0 29 31 35 31

11 55 27 12

41 17 39 42

2015

30 331

82 49

0 33 29 36 35

11 60 27 12

41 18 39 42

Marshall Islands

2000

2015

15 28 44

Micronesia (Federated States of)

2000

107

2015

104

2000

2 397

0 15

0 27

2015

2 959

0 13

0 18

2000

100

30 20 16

2015

100

30 20 16

Kiribati Lao People’s Democratic Republic Malaysia

Mongolia

Nauru

29 36

9 25 60

Annexes

NATIONAL

RURAL

URBAN

Safely managed

Disposed in situ

Emptied and treated

Wastewater treated

Latrines and other

Septic tanks

Sewer connections

Safely managed

Disposed in situ

Emptied and treated

Wastewater treated

Latrines and other

Septic tanks

Sewer connections

Safely managed

Disposed in situ

Emptied and treated

Wastewater treated

Latrines and other

Septic tanks

Sewer connections

% urban

Year

COUNTRY, AREA OR TERRITORY

Population (thousands)

7 12 81

6 12 82

0 38 36

1 37 41

New Caledonia 2000 (France) 2015

263

2000

3 858

75 10

0 66

2015

4 529

0 67

2000

15 78

2015

12 78

Northern Mar- 2000 iana Islands (Commonwealth of the) 2015 (USA)

New Zealand

Niue

Palau Papua New Guinea Philippines Republic of Korea Samoa

Singapore Solomon Islands Tokelau

2000

17 17

0 34 51

0 55 12 12 12

0 24 68

2015

20 20

0 39 61

0 88 12 16 16

0 32 68

2000

5 374

2 12

0 11

11 14 21 20

2015

7 619

2 12

0 11

11 14 21 20

2000

77 932

10 54

19 39

2015

100 699

6 67

7 63

2000

46 206

86 13

0 73

0 26 74

2015

50 293

0 97

0 69

5 72

2000

175

15 83

17 82

9 90

2015

193

10 87

10 86

7 91

2000

3 918

100 100

0 100

100

0 100

2015

5 604

100 100

0 100

100

0 100

2000

412

10 11

15 47

2015

584

19 13

29 47

2000

2015

100

2000

9 80

9 77

9 90

2015

106

14 80

16 77

7 90

2000

2015

0 10

8 73 14 14

0 13 15 63

4 81

2000

185

32 14

6 46

2015

265

30 16

6 46

2000

80 286

34 18

27 52

2015

93 448

13 64

20 51

0 88

2000

2015

2000 6 126 622

18 15 12 32 24 19

5 20 11

8 34

2015 7 349 472

26 17 15 36 35 28

7 26 16

9 43

43 10 14 59

Western Pacific Region

2000 1 678 044

33 18

15 21 11 33 30 26

5 32 11 10 30

2015 1 847 250

57 20

38 24 10 44 42 33

8 44 10

9 69

60 10

Pacific island countries

2000

8 102

4 15 14

1 15

12 13 36 26

2015

10 834

3 16 13

1 16

11 15 36 25

Tonga

Tuvalu

Vanuatu

Viet Nam Wallis and Futuna (France) World

Source: WHO and UNICEF (2017a).

0 97

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

9 13 58

5 12 66 9 69

Annex 5. Selected tables derived from the 2016/2017 GLAAS survey in the Western Pacific Region Annex 5.1. Countries of the Western Pacific Region with clearly defined procedures in laws or policies for participation by service users and communities in planning programmes, and level of participation

Sanitation

Level of participation

Procedures exist

Level of participation

Procedures exist

Level of participation

Procedures exist

Level of participation

National

Procedures exist

National

Level of participation

Rural

Procedures exist

Urban

Water resources planning and management

Level of participation

Rural

Hygiene promotion

Procedures exist

Urban

Drinking-water supply

Cambodia

0.5

China

0.5

Fiji

Lao People’s Democratic Republic

0.5

Malaysia

0.5

Micronesia (Federated States of)

0.5

Mongolia

0.5

Papua New Guinea

Philippines

0.5

Solomon Islands

0.5

Tonga

0.5

Vanuatu

Country

Procedures exist Legend

0 0.5

Level of participation

Yes

0.5

High Moderate Low

Annexes

People living with disabilities

Women

Populations living in slums or informal settlements

Populations with high burden of disease

Indigenous populations

Cambodia

Populations living in remote or hard-to-reach areas

Country

Poor populations

Annex 5.2. Policies and plans having specific measures to reach vulnerable groups

China

Fiji

Lao People’s Democratic Republic

Malaysia

Micronesia (Federated States of)

Mongolia

Papua New Guinea

Philippines

Solomon Islands

Tonga

Vanuatu

Viet Nam Legend

Yes

Annex 5.3. Tracking progress among vulnerable groups Sanitation

Drinking-water

Poor populations

Cambodia

China

Country

Fiji

Lao People’s Democratic Republic

Malaysia

Micronesia (Federated States of)

Mongolia

Papua New Guinea

Philippines

Solomon Islands

Tonga

Vanuatu

Viet Nam

Yes

Legend

0 1

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Annex 5.4. Specific measures in the financing plan to target resources to vulnerable populations

Populations living in remote or hard-to-reach areas

People living with disabilities

Women

Populations living in slums or informal settlements

Populations with high burden of disease

Indigenous populations

Poor populations

Populations living in remote or hard-to-reach areas

People living with disabilities

Women

Populations living in slums or informal settlements

Populations with high burden of disease

Indigenous populations

Drinking-water

Poor populations

Sanitation

0.5

China

Fiji

0.5

Mongolia

0.5

Papua New Guinea

0.5

Country

Cambodia

Lao People’s Democratic Republic Malaysia Micronesia (Federated States of)

Philippines

0.5

Solomon Islands

0.5

Tonga

0.5

Vanuatu

Viet Nam

1 Legend

0.5 0

Yes and measures are applied Yes, but measures are not applied consistently No

Annexes

Annex 5.5. Data availability for decision-making Most recent Joint Sector Review

Data availability for decision-making

Fiji Lao People’s Democratic Republic Malaysia Micronesia (Federated States of)

Status and quality of service delivery

Resource allocation

0.5

2015

National standards

2012

China

Policy and strategy

Cambodia

Status and quality of service delivery

Year

Country

Drinking-water

Resource allocation

Sanitation Policy and strategy

National

0.5

2015

0.5

Mongolia

2014

0.5

Papua New Guinea

2011

0.5

Philippines

2015

0.5

Solomon Islands Tonga

2016

0.5

Vanuatu

Viet Nam

2015

0.5

1 Legend

0.5 0.5

0.5

Data available, analysed, and used for a majority of decisions

0.5

Data available but not sufficiently used for decision-making

Only limited data collected and limited availability

Annex 5.6. Existence and level of implementation of a government-defined financing plan/budget for the WASH sector which is published and agreed Country

Sanitation

Hygiene

Rural

Urban

Rural

National

0.5

Lao People’s Democratic Republic

0.5

Malaysia

0.5

Mongolia

0.5

Papua New Guinea

0.5

Philippines

0.5

Cambodia China Fiji

Micronesia (Federated States of)

Solomon Islands Tonga Vanuatu

Viet Nam

0.5

1 Legend

0.5 0

Drinking-water

Urban

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Agreed and consistently followed Agreed but not sufficiently implemented No agreed financing plan/budget or in development

Annex 5.7. Expenditure reports are publicly available and easily accessible, and allow comparison of committed funds to expenditures Sanitation

Country

Drinking-water

Urban

Rural

Urban

Rural

Fiji

Lao People’s Democratic Republic

Cambodia China

Malaysia Micronesia (Federated States of) Mongolia Papua New Guinea Philippines Solomon Islands Tonga Vanuatu Viet Nam

0.5

0.5 0

0.5

0.5 1

Legend

0.5

Government, ODA, and non-ODA expenditure reports are available Some reports available Expenditure reports are not available

Annex 5.8. Operating and basic maintenance costs are covered by tariffs Country

Sanitation

Drinking-water

Urban

Rural

Urban

0.5

Cambodia

China

Fiji

Rural 0.5 0.5

Lao People’s Democratic Republic

Malaysia

0.5

Micronesia (Federated States of)

0.5

Mongolia

Papua New Guinea

Philippines Solomon Islands Tonga

0.5

Vanuatu

Viet Nam

1 Legend

0.5 0

Covers over 80% of costs Covers between 50% and 80% of costs Covers less than 50% of costs

Annexes

Annex 5.9. Absorption of external funds (% of official donor capital commitments utilized [three-year average]) Country

Sanitation

Drinking-water

Urban

Rural

Urban

Rural

Cambodia

China

Fiji

Lao People’s Democratic Republic

Micronesia (Federated States of)

Mongolia

Philippines

Solomon Islands

Tonga

Vanuatu

0.5

Viet Nam

Over 75%

Malaysia

Papua New Guinea

Legend

0.5

Between 50% and 75%

Less than 50%

Annex 5.10. Absorption of domestic funds (% of domestic commitments utilized [three-year average]) Country

Sanitation Urban

Rural

Urban

Rural

Cambodia

China

Fiji

Lao People’s Democratic Republic

0.5

Malaysia

Micronesia (Federated States of)

Mongolia

0.5

Papua New Guinea

0.5

Philippines

Solomon Islands

Tonga

Vanuatu

0.5

Viet Nam

Over 75%

Legend

0.5 0

Drinking-water

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Between 50% and 75% Less than 50%

Annex 5.11. Sufficiency of financing to reach national targets Country

Sanitation

Drinking-water

Urban

Rural

Urban

Rural

0.5

Fiji

Lao People’s Democratic Republic

Cambodia China

Malaysia

0.5

Mongolia

0.5

Papua New Guinea

Philippines

0.5

Solomon Islands

Tonga

Vanuatu

Viet Nam

0.5

Micronesia (Federated States of)

1 Legend

0.5

More than 75% of what is needed

0.5

Between 50 to 75% of what is needed

Less than 50% of needs

Annex 5.12. Government WASH budget (US$ millions, constant 2014 US$) National

Country

Year

Budget

Cambodia

2016

China

2016

53 794

Fiji

2017

155

Lao People’s Democratic Republic

2015

Malaysia

2016

291

2015

237

Philippines

2016

210

Solomon Islands

2017

Tonga

2016

Micronesia (Federated States of) Mongolia Papua New Guinea

Vanuatu Viet Nam

2016

Annexes

Annex 5.13. Annual WASH expenditure (US$ millions, constant 2014 US$) Country

National

By source of funding

Year

Expenditure

Households

Government

External

Repayable

Cambodia

2016

180

176

China

2016

3 836

Fiji

2017*

164

155

Lao People’s Democratic Republic

2015

Malaysia

Micronesia (Federated States of)

Mongolia

2015

298

237

Papua New Guinea

2013

276

Philippines

2015

Solomon Islands

2017*

Tonga

Vanuatu

2016

0.1

Viet Nam

2015

1 690

209

303

1 040

* Data for financial year 2016–2017.

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Annex 6. Glossary of selected terms used in this report Basic drinking-water: drinking-water from an improved source, provided collection time is not more than 30 minutes for a round trip, including queuing. Basic, not safely managed drinking-water: drinking-water from an improved source, provided collection time is not more than 30 minutes for a round trip, including queuing, that is not located on premises or available when needed or free from faecal and priority chemical contamination. Basic sanitation: improved sanitation facilities that are not shared with other households. Basic, not safely managed sanitation: improved sanitation facilities that are not shared with other households and where excreta are not safely disposed of in situ or transported and treated offsite. Improved drinking-water: improved sources include piped water, boreholes or tubewells, protected dug wells, protected springs, rainwater, and packaged or delivered water. Improved sanitation: improved sanitation facilities include flush/pour flush to piped sewerage systems, septic tanks or pit latrines; ventilated improved pit latrines, composting toilets or pit latrines with slabs. Limited drinking-water: drinking-water from an improved source for which collection time exceeds 30 minutes for a round trip, including queuing. Limited sanitation: use of improved facilities shared between two or more households. Open defecation: disposal of human faeces in fields, forests, bushes, open bodies of water, beaches or other open spaces, or with solid waste. Safely managed drinking-water: drinking-water from an improved source, provided collection time is not more than 30 minutes for a round trip, including queuing, that is located on premises, available when needed and free from faecal and priority chemical contamination. A safely managed drinking-water service is a basic drinkingwater service that is safely managed. Safely managed sanitation: use of improved facilities that are not shared with other households and where excreta are safely disposed of in situ or transported and treated offsite. A safely managed sanitation service is a basic sanitation service that is safely managed.

Annexes

Septic tank: a tank used to detain domestic wastes to allow the settling of solids prior to distribution to a leach field for soil absorption. Septic tanks are used when a sewer line is not available to carry them to a treatment plant. A settling tank in which settled sludge is in immediate contact with sewage flowing through the tank, and wherein solids are decomposed by anaerobic bacterial action. Sewage: mixture of human excreta and water used to flush the excreta from the toilet and through the pipes; may also contain water used for domestic purposes. Sewer: a system of underground pipes that collect and deliver wastewater to treatment facilities or directly to any receiving body of water, including rivers, lakes, canals, etc. Sewerage: a complete system of piping, pumps, basins, tanks, unit processes and infrastructure for the collection, transporting, treating and discharging of wastewater. Surface water: the water from sources open to the atmosphere, such as rivers, lakes and reservoirs. Unimproved drinking-water: drinking-water from an unprotected dug well or unprotected spring. Unimproved sanitation: use of pit latrines without a slab or platform, hanging latrines or bucket latrines. Wastewater: liquid waste discharged from homes, commercial premises and similar sources to individual disposal systems or to municipal sewer pipes, and which contains mainly human excreta and used water. When produced mainly by household and commercial activities, it is called domestic or municipal wastewater or domestic sewage. In this context, domestic sewage does not contain industrial effluents at levels that could pose threats to the functioning of the sewerage system, treatment plant, public health or the environment.

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION

Annex 7. Sustainable Development Goals SDG 1:

End poverty in all its forms everywhere.

SDG 2:

End hunger, achieve food security and improved nutrition and promote sustainable agriculture.

SDG 3:

Ensure healthy lives and promote well-being for all at all ages.

SDG 4:

Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.

SDG 5:

Achieve gender equality and empower all women and girls.

SDG 6:

Ensure availability and sustainable management of water and sanitation for all.

SDG 7:

Ensure access to affordable, reliable, sustainable and modern energy for all.

SDG 8:

Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all.

SDG 9: Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation. SDG 10: Reduce inequality within and among countries. SDG 11: Make cities and human settlements inclusive, safe, resilient and sustainable. SDG 12: Ensure sustainable consumption and production patterns. SDG 13: Take urgent action to combat climate change and its impacts. SDG 14: Conserve and sustainably use the oceans, seas and marine resources for sustainable development. SDG 15: Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss. SDG 16: Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels. SDG 17: Strengthen the means of implementation and revitalize the Global Partnership for Sustainable Development.

Annexes

Annex 8. Regional groupings considered in this report Countries and areas in the Western Pacific Region: American Samoa (USA), Australia, Brunei Darussalam, Cambodia, China, Hong Kong SAR (China), Macao SAR (China), Cook Islands, Fiji, French Polynesia (France), Guam (USA), Japan, Kiribati, Lao Peopleâ&#x20AC;&#x2122;s Democratic Republic, Malaysia, Marshall Islands, Micronesia (Federated States of), Mongolia, Nauru, New Caledonia (France), New Zealand, Niue, Northern Mariana Islands (Commonwealth of the) (USA), Palau, Papua New Guinea, Philippines, Pitcairn Islands (UK), Republic of Korea, Samoa, Singapore, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, Viet Nam, Wallis and Futuna (France). Pacific island countries: American Samoa (USA), Cook Islands, Fiji, French Polynesia (France), Guam (USA), Kiribati, Marshall Islands, Micronesia (Federated States of), Nauru, New Caledonia (France), Niue, Northern Mariana Islands (Commonwealth of the) (USA), Palau, Papua New Guinea, Pitcairn Islands (UK), Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu, Vanuatu, Wallis and Futuna (France).

100

DRINKING-WATER, SANITATION AND HYGIENE IN THE WESTERN PACIFIC REGION