Health, Dignity and Development; What Will it Take?

THIS IS ONE of 13 thematic volumes produced by the Millennium Project, along with a synthesis volume (Investing in Development – which is described in an earlier section) on how to achieve the Millennium Development Goals (MDGs). It presents various strategies and actions required to reach MDG target 10: “Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation”, and examines the requirements for water resources management and development in relation to all the MDGs. The first part of the report focuses on target 10 itself, beginning with an overview of the global discourse on water and sanitation, including the scale of need and the very large health burdens that arise from inadequacies in provision. It places the issue within the broader context of the MDGs, and takes a critical look at the global monitoring system currently in use for measuring progress towards the water and sanitation target. The report then examines access to water and sanitation services by region, and identifies those areas with greatest need. It discusses how needs differ across different contexts – for instance, in dispersed rural settlements, small towns, large villages and larger, dense urban settings. The report clearly distinguishes issues of water from those of sanitation, in order to highlight the distinctive characteristics that need to be addressed in order to accomplish target 10. Within this framework, discussion of the political, institutional, technical and financial constraints to expanding both water supply and sanitation services is presented. Turning to the challenge of meeting the sanitation target, the report explores the nature of demand for improved sanitation and calls for a reorientation of public institutions to achieve improved delivery. Part I concludes with a discussion of the technological options available for improving service delivery, and presents several cost-reduction strategies before looking at both global and national cost estimates and various financial strategies. Part II takes a broader look at water and its role in meeting all the MDGs. It emphasizes how water resources and development are intrinsically linked to poverty, hunger, environmental sustainability, health and gender equality. Stressing the need to capitalize on the momentum of the MDGs in reaching target 10, the report calls for increased investment and wider adoption of integrated water resource management. Recognizing the challenges to integrated water resource management, Part II concludes with a discussion of the conceptual framework and the institutional mechanisms required for monitoring water resources, and looks at the global support structures in place. Part III details the Task Force’s recommendations for making the goals achievable, and presents ten critical actions needed to meet the water and sanitation target. These recommendations and actions are synthesized into an operational plan presenting priority actions for a range of actors, including national governments, donor agencies, service providers, civil society, research organizations and the UN system itself.