Disparities in access: renewed focus on the underserved. Rick Johnston, WHO UNC Water and Health, Chapel Hill 13 October, 2014

Transcription

1 Disparities in access: renewed focus on the underserved Rick Johnston, WHO UNC Water and Health, Chapel Hill 13 October, 2014

2 Sector proposal for post-2015 targets By 2030: to eliminate open defecation; to achieve universal access to basic drinking water, sanitation and hygiene for households, schools and health facilities; to halve the proportion of the population without access at home to safely managed drinking water and sanitation services; and to progressively eliminate inequalities in access. 2

3 Metrics and visualization of inequality Status Gaps Ratios Complex measures Trends How status measures change over time 3

4 Progressive reduction of inequalities 1.6%/year 3.4%/year 4

5 Stratifiers of inequalities of access Geographic Urban/rural; regions; formal/informal urban remote/accessible Group-based Religion; ethnicity; caste Individual-based Wealth; education ; sex; age; disability 5

6 GEOGRAPHIC INEQUALITIES 6

7 Regional gaps

8 Rural piped coverage (%) Urban-rural gaps (piped drinking-water on premises) Average gap: 50 percentage points French Polynesia New Tuvalu Guam Niue Zealand New Caledonia Japan American Samoa NMI Samoa DPRK Cook Islands Korea Marshall Islands Bhutan China Fiji Micronesia Thailand Philippines Sri Lanka Nepal Vanuatu Solomon Islands Timor-Leste Indonesia Viet Nam Kiribati India Lao Myanmar Mongolia PNG Cambodia Maldives Bangladesh Urban piped coverage (%)

9 Urban-rural gaps are closing (improved drinking-water) Reducing coverage Increasing equality 7 countries Dominican Republic Yemen Sudan Algeria Uzbekistan Chile Iraq World India Namibia China Cameroon Sierra Leone Ghana Swaziland Viet Nam Ethiopia Myanmar Uganda Burkina Faso Increasing coverage Increasing equality Malawi 87 countries Paraguay Mali countries Reducing coverage Reducing equality Djibouti Chad Niger Angola Guinea-Bissau Cambodia 15 countries Increasing coverage Reducing equality Change in national drinking-water coverage (percentage points) 9

10 GROUP-BASED INEQUALITIES 10

11 Culture-specific Tend to be specific to local culture Religion Ethnicity (language) Caste Challenge of correlation with urban/rural, wealth 11

12 Religion in D.R. Congo 12

13 INDIVIDUAL INEQUALITIES 13

14 Wealth based disparities: quintile Poorest Poor INDONESIA - Rural sanitation coverage Evolution ( ) by wealth quintiles Middle Rich Richest Open defecation Unimproved facilities Shared facilities Improved facilities Rich-poor gap: 44%pt in 1995 to 67% pt in 2010

15 Typologies (1) 15

16 Typologies (2) 16

17 Wealth quintile gaps are closing in urban areas Decreased coverage Increased equality Thailand South Africa Nigeria Paraguay Yemen Increased coverage Increased equality Cambodia Comoros India Ethiopia Senegal Angola Lao PDR Decreased coverage Decreased equality Increased coverage Decreased equality Change in coverage, Improved Sanitation (Urban) 17

18 Wealth quintile gaps are closing in urban more than in rural areas Decreased coverage Increased equality Congo Comoros Nigeria Decreased coverage Decreased equality Increased coverage Increased equality Thailand Yemen Egypt Lesotho South Africa Paraguay Thailand Nigeria Brazil Moldova MexicoCambodia Philippines Peru India Ethiopia Angola Morocco Ethiopia Senegal Lao PDR Viet Nam India Cambodia Indonesia Yemen Paraguay Pakistan Nepal Senegal Lao PDR Increased coverage Decreased equality Change in coverage, Improved Sanitation (Rural) Improved Sanitation (Urban) 18

19 Other individual stratifiers Age Sex Disability Education 19

20 Proportion defecating in the open (%) Education Open defecation practices in Burkina Faso, Cambodia, India, Ethiopia and Nepal show disparities according to level of education Burkina Faso Cambodia India Ethiopia Nepal No education, preschool Primary Secondary Higher 20

21 Disability 100% 87% 87% 87% 85% 80% 60% 68% 59% 56% 65% 40% 41% 35% 20% 16% 9% 0% Burkina Faso India Pakistan Sanitation: Not disabled Sanitation: Disabled Water: Not disabled Water: Disabled 21

22 Limitations of household surveys Normally a single respondent Typically woman of child-bearing age Small sample size For (multiple) disaggregation 22

23 MULTIPLE DIMENSIONS 23

24 Multiple dimensions Victora,

25 Averages mask huge disparities; 40% open defecation in Mozambique, but 96% among the rural poor

26 Conclusions Inequalities will be front and centre in post monitoring New metrics and new methods will be needed Data should drive programmes and investments 26