Disparities in access: renewed focus on the underserved Rick Johnston, WHO UNC Water and Health, Chapel Hill 13 October, 2014
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
Metrics and visualization of inequality Status Gaps Ratios Complex measures Trends How status measures change over time 3
Progressive reduction of inequalities 1.6%/year 3.4%/year 4
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
GEOGRAPHIC INEQUALITIES 6
Regional gaps
Rural piped coverage (%) Urban-rural gaps (piped drinking-water on premises) 100 80 60 Average gap: 50 percentage points French Polynesia New Tuvalu Guam Niue Zealand New Caledonia Japan American Samoa NMI Samoa DPRK Cook Islands Korea 40 20 0 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 0 20 40 60 80 100 Urban piped coverage (%)
Urban-rural gaps are closing (improved drinking-water) 60 40 20 0 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 -20-40 7 countries Reducing coverage Reducing equality Djibouti Chad Niger Angola Guinea-Bissau Cambodia 15 countries Increasing coverage Reducing equality -20-10 0 10 20 30 40 50 60 Change in national drinking-water coverage (percentage points) 9
GROUP-BASED INEQUALITIES 10
Culture-specific Tend to be specific to local culture Religion Ethnicity (language) Caste Challenge of correlation with urban/rural, wealth 11
Religion in D.R. Congo 12
INDIVIDUAL INEQUALITIES 13
Wealth based disparities: quintile Poorest Poor INDONESIA - Rural sanitation coverage Evolution (1995-2010) by wealth quintiles Middle Rich Richest 56 53 50 38 48 28 41 19 16 24 22 9 8 5 21 12 26 11 7 20 16 11 27 10 13 22 18 23 26 8 18 16 35 27 6 26 53 3 51 78 Open defecation Unimproved facilities Shared facilities Improved facilities Rich-poor gap: 44%pt in 1995 to 67% pt in 2010
Typologies (1) 15
Typologies (2) 16
-20 0 20 40 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 -20-10 0 10 20 30 40 Change in coverage, 1995-2010 Improved Sanitation (Urban) 17
-40-20 0 20 40 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 -20-10 0 10 20 30 40 Change in coverage, 1995-2010 Improved Sanitation (Rural) Improved Sanitation (Urban) 18
Other individual stratifiers Age Sex Disability Education 19
Proportion defecating in the open (%) Education 80 70 60 50 Open defecation practices in Burkina Faso, Cambodia, India, Ethiopia and Nepal show disparities according to level of education 76 48 71 70 59 52 54 48 40 34 37 34 34 30 20 10 14 5 15 15 17 9 4 0 Burkina Faso Cambodia India Ethiopia Nepal No education, preschool Primary Secondary Higher 20
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
Limitations of household surveys Normally a single respondent Typically woman of child-bearing age Small sample size For (multiple) disaggregation 22
MULTIPLE DIMENSIONS 23
Multiple dimensions Victora, 2005 24
Averages mask huge disparities; 40% open defecation in Mozambique, but 96% among the rural poor
Conclusions Inequalities will be front and centre in post- 2015 monitoring New metrics and new methods will be needed Data should drive programmes and investments 26