The quest for universal access to water and sanitation began with the United Nations Water and Sanitation decade from 1980 to 1990.  At the beginning of the decade, 56 percent of the world’s population (1.826 billion people) lacked access to safe water and 54 percent (1.734 billion) lacked access to sanitation (see note one). While substantial gains were made throughout the decade, and access to safe water extended to 80 percent of the world, sanitation lagged behind, reaching only 60 percent. Challenges threatening the realization of universal access to water and sanitation became evident: steady population growth, financial and administrative constraints, and poorly maintained hardware investments, which resulted in premature disrepair and disuse of pumps and toilets. 

At the close of the decade, the policy and programming of the water, sanitation, and hygiene (WASH) sector began to incorporate lessons learned from the prior ten years.  In a 1992 assessment, Sandy Cairncross, a public health engineer, epidemiologist and professor at the London School of Tropical Medicine and Hygiene, commented on this transition:

The principal challenges of the next decade will not be technological questions—the hardware of water supplies and sanitation—but the software issues: How are water and sanitation programs to be organized and financed?  How can people be trained, organized and motivated to install, use, and maintain the facilities?  How can institutions develop the sector further and make improvements more sustainable?  These are the questions for the 1990s.

As a result, the policy pendulum swung toward community-managed infrastructure.  With the belief that community-designed and managed water systems would be more sustainable, international development agencies shifted partnerships from local government departments to non-government organizations that supported, organized, and trained rural communities.  Communities were no longer viewed as “beneficiaries”, but rather owners of infrastructure.  Accordingly, the design and distribution of simple-to-use and easy-to-maintain infrastructure grew in importance as rural communities became the primary managers of their systems. 

Additionally, these changes fostered a dialogue on the relative merits of increasing water quantity versus improving its quality, leading to a series of studies on measurable health impacts of water supply advancements.  Donors and policy makers realized that safe water supplies would have to be combined with sanitation and hygiene to reduce parasitic infections, diarrhea and dysentery, and eye and skin diseases.

When the Millennium Development Goals (MDGs) were announced in 2000, they incorporated fundamental lessons learned from prior decades.  Goal 7, to ensure environmental sustainability, set a target to halve the proportion of people without access to an improved drinking-water source or sanitation facility by 2015.  It acknowledged the importance of water quantity and quality, stressing the integration of sanitation into program mandates to achieve desired health outcomes.  Investments in water and sanitation made sound economic sense; benefits could lead to economic returns averaging two to seven percent of national GDP. 

Progress toward meeting the MDGs is measured through national, regional and global surveys compiled by the Joint Monitoring Program (JMP), a program created by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF).  The JMP defines an improved drinking-water source as “by nature of its construction or through active intervention, protected from outside contamination, in particular from contamination with fecal matter,” and an improved sanitation facility as “one that hygienically separates human excreta from human contact."

By these definitions, the MDG goal of halving the percentage of people without access to an “improved source of water” was achieved in 2010. Over 2 billion people gained access to “improved water sources and 1.8 billion gained access to improved sanitation”. These were remarkable achievements for the water sector. Unfortunately, the sanitation target is proving more difficult to meet, and the goal of halving the percentage of people without sanitation will not be met by 2015. 

Furthermore, both sustainability and the integration of sanitation and hygiene, two important challenges of the first water decade– remained unresolved.  When assessed for long-term financial sustainability, it was recognized that, despite gains from 2000 to 2010, routine maintenance and infrastructure replacement had failed to be addressed.  Instead of shifting focus to sustainability, donors continued to finance capital investments.  Despite lessons to the contrary from the first water decade, an expectation that aid-recipients would cover operating and maintenance costs persisted. As governments decentralized, they delegated responsibilities to local and regional governments, which were often unable to levy the taxes or collect fees sufficient to cover routine operations and maintenance. Likewise, rural communities held responsible for their own infrastructure proved unwilling or unable to finance long-term maintenance, repair, and replacement. Increasing sanitation coverage was met with similar challenges. Despite millions of dollars spent to create demand for sanitation—incorporating both behavior change interventions and encouragement of sanitation businesses—large parts of Africa and South Asia will not meet the MDGs before 2026.

Consultations on the post-2015 WASH agenda began in 2011, and important policy goals were identified. Universal priorities for the next iteration of the MDGs were developed and recommended by WHO and UNICEF. These included the elimination of open defecation, universal access to safe drinking water and sanitation facilities, provision of proper sanitation and hygiene services in schools and health centers, sustainability of services, and increased equality of access.   

New challenges are on the horizon making it even harder to meet these new and ambitious targets.  Rapid urbanization, for example, presents an immediate challenge, as existing infrastructure is unable to meet growing population needs. More urban poor lack services than ever before. Infrastructure challenges come in the context of deep and widening income disparities both within urban areas and between urban and rural populations. While services may improve for those who can pay, a growing number of poor in urban slums or secondary towns have seen little to no progress. Continued urbanization will challenge governments to find and implement innovative pro-poor service delivery models. 

The global focus on improved access to important services, which began in 1980, evolved over thirty years to become more data-driven, specific, and pro-poor. The WASH sector has learned invaluable policy lessons, which are reflected in the recommendations for the post-2015 goals.  International goals and targets establish universal visions, meant to inspire action. To achieve the change they espouse, such goals will require strong local institutions that can resolve long-standing challenges in service delivery: transparent accountability mechanisms, rigorous monitoring, and accounting for long-term costs. New technologies and solutions to reduce water and energy waste must be explored and scaled. Likewise, national training programs for engineers, financial planners, community health workers, and other professionals will be critical to overcome current human resource deficits. If international goals are partnered with intelligent implementation strategies, the elusive quest for universal water and sanitation access may become a reality. 

Note One: The number of people un-served by improved sanitation in urban areas grew by 183 million between 1990 and 2010, and those using unimproved water sources grew by 21 million.  Data from UNICEF and WHO (2012) Progress on Drinking Water and Sanitation 2012 Update.

Cairncross, Sandy. “Sanitation and Water Supply: Practical Lessons from the Decade.”  Water and Sanitation Discussion paper Series Paper no. 9 (1992). 

Carter, R, S.F. Tyrell and P. Howsam. “Lessons Learned from the UN Water Decade.” Water and Environment Journal 7:6 (1993): 646-650.

UN Department of Public Information. “We Can End Poverty Millennium Development Goals and Beyond 2015.” 2013.

UN Water, n.d. “Access to Sanitation.” Accessed February 25, 2014.

WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. “Global Water Supply and Sanitation Assessment 2000 Report.” 2000.

WHO/UNICEF Joint Monitoring Program (JMP) for Water Supply and Sanitation. “Introduction.” Accessed February 3, 2014.