Water, Sanitation and Hygiene Promotion

1

• Water, Sanitation and Hygiene Promotion
• A civil society submission to the
• Government of Bangladesh on
• National Strategy for Economic Growth, Poverty
  Reduction and Social Development
• (Poverty Reduction Strategy Paper)

2
What is a PRSP

• In September 1999 the World Bank and IMF
  developed a new framework for giving low interest
  loans and debt relief to 42 poorest countries in
  the world.
• This is conditional on countries developing a
  Poverty Reduction Strategy Paper (PRSP)
• PRSP is about prioritising budget allocation in
  order to achieve poverty reduction objectives.
• The PRSP is matched by national level medium term
  expenditure framework (MTEF). Gradually the MTEF
  and PRSP could be the basis for all donor
  assistance.

3

• WaterAid and Partners involvement in the process
• WAB and Partner NGOs consider access by the poor
  to affordable safe water supplies and environment
  sanitation as central to poverty reduction.
• The main objective of their engagement
• To ensure that access to safe water and
  environmental sanitation remain a priority in the
  PRSP.

4
Chapter structure of iPRSP

• "what the broad lessons are from the past
  development experience"
• "where we stand now in terms of poverty and
  social indicators"
• "what do the voices of the citizens suggest"
• "where we would like to go by the year 2015"
• "how we are going to reach the social targets"
• "what would be the macroeconomic framework for
  poverty reduction in the medium-term"
• "how do we know that we are reaching our
  targets"

5
The stated iPRSP goals

• Remove the ugly faces of poverty by eradicating
  hunger, chronic food insecurity, and extreme
  destitution
• Reduce the number of people living below the
  poverty line by 50 percent
• Attain universal primary education for all girls
  and boys of primary school age
• Eliminate gender disparity in primary and
  secondary education
• Reduce infant and under five mortality rates by
  65 percent, and eliminate gender disparity in
  child mortality

6

• Reduce the proportion of malnourished children
  under five by 50 percent and eliminate gender
  disparity in child malnutrition
• Reduce maternal mortality rate by 75 percent
• Ensure access of reproductive health services to
  all
• Reduce substantially, if not eliminate totally,
  social violence against the poor and the
  disadvantaged groups, especially violence against
  women and children
• Ensure comprehensive disaster risk management,
  environmental sustainability and mainstreaming of
  these concerns into the national development
  process.

7
5 strategic elements

• accelerating pro-poor economic growth
• fostering human development of the poor
• womens advancement and closing of gender gaps
• social protection
• participatory governance and enhancing
  non-material dimensions

8
Accelerating pro-poor economic growth
infrastructure development

• Improved and safe water supply and sanitation
  services will be emphasized for
• Reducing health costs
• Improving malnutrition
• Increasing productivity of labor
• Reducing time spent by women and children in
  water collection
• More productive use of time and resources by poor
  households

9
How will this happen?

• Following the National Water Supply and
  Sanitation Policy 1998, a development framework
  will be worked out to address the issues in a
  comprehensive manner.

10

• Impact
• Every day 20,000 metric tons of human excreta are
  deposited on public lands and waterways. This is
  one of the main causes of contamination surface
  water
• 125,000 children under five die each year from
  diarrhoeal disease, 342 children per day
• Diarrhoeal disease causes 5.75 million disability
  adjusted life years 61 of total DALYs.
• 5 billion taka (us 80 million) is spent every
  year for the treatment of hygiene related
  diseases
• Every child in Bangladesh suffers an average of
  three to five diarrhoeal attacks in each year,
  which is a major contributor to malnutrition
• Women and girls suffer the most from water,
  sanitation and hygiene deficiencies. A lack of
  privacy in sanitation increases the risks of
  urinary tract infection, reproductive health
  problems and physical attack.

11

• WaterAids participatory impact assessment,
  Looking Back, cites the following connections
  between water projects and different aspects of
  poverty
• Improvements in livelihoods and productive time
• Minimising the costs of healthcare due to
  significant reduction in diarrhoeal and other
  water-related diseases
• Reduction in infant and maternal mortality and
  morbidity
• Improved mental health
• Increased school attendance, especially for girls
• Improvements in the quality of family life
• Increased participation in social/community
  activities and observance of religious
  obligations
• Enhanced self-esteem of individuals and
  communities

12
Recommendations

• Special emphasis should be given to addressing
  water and sanitation and hygiene promotion in the
  Deprivations in Health section of the full
  PRSP. Improved water supply, sanitation
  services and hygiene practices need to be
  emphasised as a major element for the building of
  human capability in the full poverty reduction
  strategy for Bangladesh.

13

• To enable sustainable integrated community
  managed water supply and sanitation schemes to be
  realized, the empowerment of local government
  requires the decentralization and devolution of
  the roles and responsibilities.
• The approaches and outputs for the Water and
  Sanitation sector need to be revised from the
  hardware output approach to a people centered
  approach.

14

• Recommendation for an additional goal/target for
  the full PRSP
• Ensure access to safe water, proper sanitation
  (100) and hygiene practices by all by the year
  2015.

15

• The approaches required to ensure the maximize
  the impact and ensure the sustainability of the
  water and sanitation interventions under
  Infrastructure Development should be explicitly
  set out in the Fostering Human Development of
  the Poor route to poverty reduction with
  special emphasis on hygiene education.

16

• Include integrated water, sanitation and hygiene
  education in the essential health package.
• Water and Sanitation should be addressed as a
  separate sector under Infrastructure
  Development at Annex 6

17

• Give more emphasis to preventative health care
  approaches in the full PRSP.
• Provide the disease base data for mortality and
  morbidity which will help to understand the
  overall health situation and identify priority
  areas for intervention.

18

• Special effort is needed for awareness building
  on issues related to gender among all (men, women
  and children) for action towards transformation
  of the gender division of labour.

19

• Ideally, separate budget lines for water,
  sanitation and hygiene promotion
  activities/interventions will be explicitly
  stated in the Medium Term Expenditure Framework.
• Investments in water and sanitation should be
  considered as investments for the nation for
  building human capability to reduce the overall
  poverty of the country.

20

• A clear policy indication is needed for the urban
  poor, especially those living in urban slums, to
  provide them basic water and sanitation services.
  
• The main debate in Bangladesh about settlement
  is the tenure of slums people and access to basic
  services needs a policy direction for the poverty
  reduction of the urban poor.