The sustainable development goals (SDGs) are now upon us. An initial reaction might be ‘too little time, too much to do’. This is, of course, somewhat dangerous as it might lead some professionals, some ministries, and some governments, to decide that nothing (or, at best, not much) can be done − after all, progress towards the sanitation target of the Millennium Development Goals (MDGs) was weak or very weak in many developing countries (Luh & Bartram 2016). However, we, as WASH professionals, cannot think like this and we have to face the enormity of the SDG challenges head-on. And enormous these challenges most certainly are. SDG #6 is all-water embracing (United Nations General Assembly 2015a, 2015b). It includes, for example, affordable safely-managed water and sanitation, and hygiene (notably facilities for handwashing with soap, menstrual hygiene management (MHM), and food hygiene), for all − and ‘all’ really does mean ‘all’. We therefore have to include the disabled, the elderly, slum dwellers, indigenous peoples and nomads, the homeless including street children and pavement dwellers, and refugees, prisoners and detainees. We also have to address the hygienic disposal of young-child faeces.

Water quality has to be improved by reducing pollution, halving the proportion of untreated wastewater, and substantially increasing recycling and safe reuse. This is going to be more than a little difficult, as currently around 1.5 billion (billion = 109) people who are served by sewers do not have any wastewater treatment (Baum et al. 2013); in total some 80% of all wastewater is untreated (Corcoran et al. 2010). Next is water-use efficiency and reducing the number of people suffering from water scarcity. This will also be difficult: currently some 4 billion people live under conditions of severe water scarcity for at least 1 month of the year, and 500 million face severe water scarcity throughout the year (Mekonnen & Hoekstra 2016). Furthermore, we have to implement integrated water resources management at all levels.

We have to do all the above by 2030. WASH professionals are clearly involved with all these aspects of SDG #6, although individually we may struggle with some of them − for example, how many male WASH engineers fully understand MHM?

Finally, there is ‘protecting and restoring water-related ecosystems, including mountains, forests, wetlands, rivers, aquifers and lakes’ − to be achieved by 2020 (yes, 2020).

A measure of ‘healthy scepticism’ is surely in order, if only to bring home the sheer enormity of our WASH-related challenges. For example, 2.4 billion people were without improved (now ‘basic’) sanitation in 2015 (World Health Organization/United Nations Children's Fund [WHO/UNICEF] 2015). Add in 1 billion (population growth 2016 − 2030) and that's 3.4 billion requiring ‘safely-managed’ sanitation by 2030. This equals around 600,000 people needing safely-managed sanitation per day during 2016 − 2030. The enormity of this task can be judged by our achievement of some 200,000 per day during 1991 − 2015 (WHO/UNICEF 2015). So we have to work three times harder to reach the SDG sanitation target.

Now consider the large number of deaths due to using unsafe water sources, unsafe sanitation, and no handwashing with soap (Table 1). SDG #6 really means we have to reduce these deaths in low- and middle-income countries to the number in high-income countries. This is going to be really difficult, especially in low-income countries. They went from 175 WASH-related deaths per 100,000 population (all ages, both sexes) to 58 per 100,000 in the 23-year period 1990 − 2013, a reduction of 67% (Institute of Health Metrics and Evaluation [IHME] 2016). This was clearly a really fantastic achievement. But do we honestly think they can go from 58 WASH-related deaths per 100,000 population to ∼1 per 100,000, a reduction of 98%, by 2030? I don't think so, but reducing WASH-related deaths is clearly most important to us as WASH professionals, so we should support low-income countries as they seek to reduce these deaths. They may not reach 1 WASH-related death per 100,000, but we can at least anticipate some really good progress.

Table 1

Deaths due to using unsafe water sources, unsafe sanitation, and no handwashing with soap (unsafe WASH) for both sexes and all ages in World Bank country-income groups in 2013 (IHME 2016)

Country-income groupNumber of unsafe-WASH deathsNumber of unsafe-WASH deaths per 100,000 populationNumber of unsafe-WASH deaths as percentage of all deaths
Low-income 492,000 58 7.1 
Lower middle-income 820,000 32 4.2 
Upper middle-income 75,000 0.5 
High-income 9,500 0.7 0.1 
Country-income groupNumber of unsafe-WASH deathsNumber of unsafe-WASH deaths per 100,000 populationNumber of unsafe-WASH deaths as percentage of all deaths
Low-income 492,000 58 7.1 
Lower middle-income 820,000 32 4.2 
Upper middle-income 75,000 0.5 
High-income 9,500 0.7 0.1 

However, this is not the end of the story. Good WASH is needed to support good nutritional outcomes (WHO/UNICEF/United States Agency for International Development [USAID] 2015) (see ‘stunting’ − low height-for-age − below), and to reduce neonatal, infant and under-5 mortality. It is needed in all schools and in all health-care facilities (with separate facilities for boys and girls, and men and women). It is also needed to support safe birth deliveries, especially home births with traditional birth attendants; this is to reduce the large number of deaths due to neonatal sepsis (there were 364,000 such deaths in 2013, a figure essentially unchanged since 1990 (IHME 2016)).

How are we going to cope? My answer would be ‘not too well’. There are many reasons for this. One is WHO/UNICEF's decision to exclude any form of shared sanitation (Joint Monitoring Programme [JMP] 2015), although it did include it a year earlier (JMP 2014). How can we possibly get safely-managed sanitation to all households in the world's slums by 2030 if we cannot count on well-managed shared sanitation? This is a major constraint to achieving the SDG sanitation target, as the number of slum dwellers is currently over 881 million (the figure for 2014; UN-Habitat 2015). This represents a current need for ∼100 − 150 million safely-managed household sanitation units. Population growth will increase these numbers − but is there space for all these latrines in high-density slums? Clearly not (at least not for the vast majority of slum households), so safely-managed shared sanitation is the only realistic answer (Rheinländer et al. 2015). I think WHO and UNICEF need to revisit their decision to exclude safely-managed shared sanitation.

Then there's open defecation (OD): around 965 million people were ‘open defecators’ in 2015 (WHO/UNICEF 2015). Ending OD will require ∼120 − 160 million safely-managed household sanitation units; again population growth will escalate these numbers. To gain ‘open-defecation-free’ (ODF) status is not just a matter of latrine provision, it is sustained latrine use. The Indian Ministry of Drinking Water and Sanitation (MDWS 2015) defines ODF as:

‘the termination of faecal-oral transmission, defined by (a) no visible faeces found in the environment/village; and (b) every household as well as public/community institutions using safe technology option for disposal of faeces. ‘Safe technology option’ means no contamination of surface soil, ground water or surface water; excreta inaccessible to flies or animals; no handling of fresh excreta; and freedom from odour and unsightly condition.’

MDWS (2015) goes on to say that ‘since ODF is not a one-time process, at least two verifications may be carried out […] in order to ensure sustainability of ODF.’ All excellent, of course, but ODF is most unlikely to be achievable in India or in many other countries by 2030 (actually India wants to end OD by 2 October 2019, the 150th anniversary of Mahatma Gandhi's birth (Modi 2014)).

OD is very serious, because it is the main explanation for stunting and all its consequent health and socio-economic impairments (Spears 2013) − 159 million children under 5 years of age (25% of all children under 5) were stunted in 2014 (WHO/UNICEF/USAID 2015). Furthermore, OD exacerbates violence against women and girls: they are at high risk from severe physical violence, including murder, rape, stabbing, stoning, and other bodily harm, as they walk to and from a place of OD, especially at night (Gosling et al. 2015).

Ending OD is a really good aspiration. It may not be achieved by 2030, but my view is that governments and multilateral and bilateral agencies should embrace this target now (as India is doing, and as Bangladesh has already done (Bhattacharjee 2016)). I also believe that governments should provide safely-managed sanitation to open-defecators before it is provided to those currently with ‘unimproved’ sanitation.

SDG #10.2 is to ‘By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.’ This means, for example, ending discrimination against ‘manual scavengers’ (insanitary-latrine emptiers) in South Asia and their families (who are in India from the Scheduled Castes − Dalits, formerly called the ‘untouchables’). The International Dalit Solidarity Network (2016) estimates that around 1.3 million Dalits in India, mostly women, make their living through manual scavenging. They earn ∼1 rupee (1.5 US¢, 1.3 Euro¢, 1 UKp) per day and suffer unimaginable social discrimination and violence. Ending such discrimination against manual scavengers is clearly within the realm of WASH professionals, but it is a really difficult socio-political task. India has not successfully addressed this since independence in 1947, despite national legislation to end the practice of manual scavenging, the latest being The Prohibition of Employment as Manual Scavengers and Their Rehabilitation Act 2013 (Human Rights Watch 2014). Can it be done by 2030? I really hope so, but I suspect not.

A final point: do we really believe that we can ‘protect and restore water-related ecosystems, including mountains, forests, wetlands, rivers, aquifers and lakes’ by 2020 − in just 5 years? Even by 2030 this would be difficult, but by 2020? This target is, I think, purely aspirational − not a bad aspiration, of course, but nonetheless really no more than a dream. Take the Ganga, for instance: 40% of the population of India lives in its catchment, and it's grossly polluted (Rowlatt 2016). There's very little chance it can be cleaned up by 2020.

It's going to be a real nightmare. It will be much more work than the fifth mythological Labour of Hercules − cleansing the stables of King Augeas from 30 years of manure from over 1000 cattle in one day (Nabilou 2014). But we, as WASH professionals, simply have to get on with our SDG work, despite the ‘healthy scepticism’ that I have portrayed. We may not achieve our SDG targets completely, but, even so, we will have made real improvements to the lives of hundreds of millions of people. So, let's roll up our sleeves and get on with our work! And, if it lasts until 2050, so be it.

Duncan Mara

Institute for Public Health and Environmental

Engineering,

School of Civil Engineering, University of Leeds

Leeds LS2 9JT,

UK

E-mail: d.d.mara@leeds.ac.uk

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