Adequate nutrition,
safe drinking water and adequate sanitation are vital for the
prevention of serious disease and the maintenance of good health
and high labour productivity. In most parts of the world, nutrition
has improved over the past 25 years, as reflected in declining
infant and child mortality rates and in declining percentages of
the total population suffering from undernutrition. But the
improvements in child nutritional status in the 1970s ceased, on
average, in the 1980s. Some 100 million children under the age of
five show protein energy malnutrition; more than 10 million suffer
from the severe form that is normally fatal if not treated. The
estimated number of people suffering from severe undernutrition,
with calorie intakes providing an energy level less than 1.2 times
the basal metabolic rate (BMR), increased from 320 million in 1980
to 348 million by 1984 in 89 developing countries (excluding
China). The number below 1.4 BMR increased from 475 to 512 million
(figure 12.3). (BMR = i.o is the energy needed under resting and
fasting conditions. It varies with body weight and sex.) The
proportion of the population that is undernourished fell in the
early 1980s in Asia, North Africa, and Central America, but there
was no overall improvement in South America. The proportion rose
sharply in sub- Saharan Africa, which has suffered long-term
declining food availability per capita and increased malnutrition,
due to economic stress and severe drought. Within regions, economic
stress in the 1980s has been strongly associated with malnutrition,
based on a recent survey of 33 countries (16 in Africa, 6 in Asia,
and in Latin America and the Caribbean).
Assuming that the
recent pattern of income distribution and food consumption relative
to per capita income continues, FAO estimates that the total number
of people suffering acute malnutrition will increase slightly to
353 million (in 89 developing countries) by the year 2010, and the
number below 1.4 BMR will increase to 532 million. To reduce these
numbers significantly, the system of income and food distribution
will need improvement in many countries, and food production will
need to accelerate.
Adequate nutrition
is but one facet of disease prevention and health maintenance. A
safe water supply and adequate sanitation are also necessary.
Percentages of the population that have access to safe drinking
water supply and adequate sanitation increased in many developing
countries from 1975 to 1985, although variations in national
interpretations of these concepts and changes in the number of
countries reporting on them to WHO limit the comparability of the
data, both between countries and over time. Of 89 countries
surveyed in 1985, 73 per cent of the urban population and 42 per
cent of the rural population had safe supplies of drinking water,
compared with 74 per cent of the urban population (in 76 countries)
and only 19 per cent of the rural population (in 69 countries)
in 1975-19.
Although the
percentage served did not increase much in the urban areas, the
number of people served increased greatly, along with the total
urban population. The percentage of urban populations with adequate
sanitation increased from 51 per cent in 60 countries in 1975 to 61
per cent in 65 countries in 1985. In rural areas, adequate
sanitation increased from 11 to 15 per cent over the 10-year
period.
In 1985, the only
groups of countries in which less than 74 per cent of the urban
population had safe drinking water were the least developed
countries (52 per cent) and Southeast Asia (49 per cent). In
contrast, less than 50 per cent of the rural population had safe
water in all of the developing regions, except Western Asia and the
Mediterranean. The percentage of the urban population with adequate
sanitation in 1985 was more diverse, although the only country
groups averaging less than 55 per cent were South Asia (34 per
cent) and the least developed countries (44 per cent). The rural
percentages were mostly between 15 and 35 per cent, but only 3 per
cent in South Asia.
With the slowdown in
economic growth in many developing countries in the 1980s, it has
become apparent that few of them have reached the ambitious target
of 100 per cent water supply and sanitation coverage originally set
for the end of 1990, as the goal of the International Drinking
Water Supply and Sanitation Decade (1981-1990). Based on the
cross-section relation between percentages served and per capita
GDP in 1985, and on the baseline projections of GDP growth for 1990
and the year 2000, relatively small increases from 1985 to 1990 and
the year 2000 will occur in the percentages of safe water and
adequate sanitation in most regions. Additional increases of a few
percentage points could be expected with higher total investment in
a scenario for more rapid economic growth. But large increases in
coverage would also require an increase in water supply and
sanitation as a share of total investment. It might also require
significant reductions in average unit costs, or increased efforts
to raise sufficient revenues from taxes and user charges to cover
the costs of construction, operation and maintenance.
Meeting the goal of
100 per cent coverage is a serious challenge. Although countries
with average tariffs equal to or higher than costs of production
have seen significant progress, the poorer regions, including
Africa and the least developed countries have not. For most regions
the most serious constraints on meeting the goal have been funding
limitations and inadequate cost recovery frameworks, insufficient
trained personnel and unsatisfactory operation and
maintenance.
It was calculated in
the 1980s that if low-cost technologies are used, construction
costs for safe drinking water and adequate sanitation facilities
for 100 per cent of the population by the year 2000 could be less
than 1 per cent of annual GDP during the period from 1986 to the
year 2000 in most of the developing countries. The cost would be
higher, 1 to 2 per cent, in sub- Saharan Africa. These low-cost
technologies include public standpipes rather than individual house
connections for water supply, and non-water- borne sanitation
(dry-pit privies, night-soil collection, etc.). Water-borne sewage
systems for urban areas would cost considerably more to construct,
but might have lower costs for operation and
maintenance.