Susan Davis

This first guest blog was inspired by a conversation over a beer at the Brickstore Pub in Decatur, Georgia.  I got to know the author, Stephanie Ogden, when she was a Fellow for Water For People. She currently works for the Emory Center for Global Safe Water and She currently works for the Emory Center for Global Safe Water, Children Without Worms, and the International Trachoma Initiative, helping to increase coordination between the Water, Sanitation, and Hygiene and Neglected Tropical Diseases sectors. She has also worked with UNICEF. Opinions are her own. 

Q. Why were you in Uzbekistan & Kyrgyzstan?
Steph: I was working on a joint project between UNICEF and Emory University’s Center for Global Safe Water, trying to understand how to measure whether water, sanitation, and hygiene (WASH) access in schools is equitable for all school aged children.

Central Asia is a really interesting region at the intersection of China, Russia, and the Middle East, and it’s not one that we typically hear much about, other than its proximity to Afghanistan. But since the Soviet Union’s collapse in 1991, economic transition within the region has been challenging, and it’s interesting to see how those challenges have affected the water and sanitation sector.

Q. According to the Joint Monitoring Program (JMP), water & sanitation coverage (people who have access) is near 100%; why is UNICEF working there?  Are these considered developing countries?

Steph: Both Kyrgyzstan and Uzbekistan are low-income countries. To put it into perspective, Uzbekistan’s GDP per capita is similar to that of Vietnam and Nicaragua, and Kyrgyzstan’s is lower, similar to Cameroon and Nigeria. But they present a very different image of a developing country than say,sub-Saharan Africa, and there’s a very different set of development challenges for communities in these regions. Because of the past Soviet influence, there’s a ton of large-scale infrastructure in Central Asia: huge buildings, and expansive centralized water, heating and electricity infrastructure. We tend to think of developing countries as places where this type of infrastructure doesn’t exist, at least not in rural areas.You’re right that water and sanitation coverage statistics for Uzbekistan and Kyrgyzstan are high according to the JMP and other sources. However, actual, functional coverage is not only much less than statistics suggest, but may continue to decrease. The statistics say that about 98% of households in both countries have access to a latrine or toilet, and more than 85% reportedly have access to piped water. But what I saw over and over again is that there is clearly no monitoring to validate these statistics once they’re gathered. It’s widely acknowledged in Kyrgyzstan, for example, that water supply and sewage systems are deteriorating. Water pipes exist, but there isn’t necessarily water in them, and latrines aren’t necessarily functional or safe.

Q. Tell me about the water situation there.  Is it different in rural areas
compared to cities?
Steph: Water supply systems during the Soviet era were remarkably expansive and reached into the rural areas. Service delivery was centralized, heavily subsidized, and free to the public. But because the Central Asian countries are struggling to rebuild their economies since the collapse of the Soviet Union, they haven’t had the money to invest in maintenance and repair of those systems for two decades. Those systems are starting to crumble, and in many areas, they no longer work, or work only minimally – delivering only occasionally, and wasting water in a water scarce region along the way.

There is greater coverage in urban areas, but in many ways, because of the Soviet legacy, the disparity of water coverage in between rural and urban areas is much less than in regions like sub-Saharan Africa and South-east Asia.

Q. What’s going on with sanitation/toilets?  Is it particularly worse in schools? 

Steph: Funding toilets / sanitation systems isn’t any more attractive to governments and donors in Central Asia than it is in the rest of the world, and complete lack of investment has caused the failure of Soviet-designed sewage systems in many areas of Uzbekistan and Kyrgyzstan. In Kyrgyzstan, I saw dozens of schools that had once had water flush toilets connected to centralized sewage systems. But those systems haven’t worked in 10 years or more, and the schools have reverted to the use of pit latrines. Pit latrines are a fine way to approach sanitation when they’re well maintained, but most school latrines I saw in Kyrgyzstan are in such deplorable condition that they are public health hazards. There aren’t sufficient services or funds for pit emptying, and school latrines aren’t cleaned regularly.

Q. What do you think needs to be done about this?  Who should do it?
Steph: I think we need to have more nuanced ways to define and measure “access”. It’s valuable to know that infrastructure (e.g., pipes and taps, or toilets) exists, but infrastructure shouldn’t count as access if families aren’t using it, or aren’t able to use it. If we knew about the presence and functionality of infrastructure, as well as where and when families are actually accessing water and toilets, governments, development organizations, and communities could more efficiently target efforts to improve access.

I also think we also need to focus on the end goal, instead of the infrastructure. The link between sanitation and reduction of disease is proven.  But are we really achieving health goals if a latrine is in place, but is so dirty that no one uses it, or someone risks her health by using it?

We need to invest in maintenance and repair of existing infrastructure, and help create mechanisms at the community level for operation and maintenance, as well as cleanliness of public facilities, particularly in schools and hospitals.  Schools can take responsibility for water, toilets, and handwashing in schools, and education programs via the government or development organizations should consider water, toilets, and handwashing as essential elements.

Q. What would you tell donors based on your experience in Central Asia?
Steph: One of the biggest barriers to WASH access in many areas isn’t the lack of infrastructure, but the lack of investment in and planning for maintenance and repair. The 2010 Global Annual Assessment of  Sanitation and Drinking Water (GLAAS) found that only 13% of total donor funds for water and sanitation are used to support maintenance and repair of systems. There’s a huge bias towards funding the construction of new infrastructure to provide “new” access. Then development organizations get to count new beneficiaries and subtract them from the global total population still without access. That’s an incredibly sexy prospect. Helping communities to maintain and repair systems they already have isn’t considered as sexy. But it’s the only way to ensure that those systems continue to work for generations into the future, and ensure that communities continue to have access after development organizations have left the picture and patted themselves on the back.

More importantly, what all of this means is that what is happening in Central Asia is bound to happen elsewhere. All of those systems that have been built in Africa, in Latin America, in South and East Asia (and even the United States) are going to suffer the same disrepair if no attention is paid to operation and maintenance.

So I would tell donors, let’s redefine what’s sexy; prolonging services is just as valuable, and a way of achieving the same goals as creating new services. To that end, donors and development organizations should:

• Incorporate investment from the very beginning of programs in building local capacity to ensure that systems large and small are maintained long-term
• Encourage and enable local mechanisms for maintenance
• Contribute a larger percentage of the global pool of funds or finance to repair of major components of existing systems
• Investing more in monitoring existing systems (and learning from the results)

[For more information on costs of water & sanitation interventions over time, see WASHCost Project website.]