Sick water?

Regionally, there are large variations in progress towards this MDG. For sanitation, the regions of Africa south of the Sahara and southern Asia show the greatest disparity, with 330 mil- lion and 221 million people without access to basic sanitation, respectively. Not surprisingly, the regional variations in lack of access are proportionally mirrored in the diarrhoeal dis- ease data. Figure 16 presents the regional child mortality rates from diarrhoea for which lack of access to sanitation is the root-cause, modulated by regional differences in the capacity of health services. THE SANITATION LADDER In their efforts to monitor progress in achieving the MDG wa- ter and sanitation target, WHO and UNICEF designed the sani- tation ladder. The sanitation ladder reflects incremental prog- ress even in situations where it is not possible to achieve the full MDG target. Poverty is the overarching determinant, and the position of a community on the sanitation ladder therefore relates to that community’s capacity to deal with wastewater management as well. Not only do higher rungs on the ladder reflect a better sanitation starting point for effective wastewater management, but the corresponding improved socio-economic status will also permit a greater capacity to manage wastewater and invest in the necessary infrastructure.

Child mortality rates Percentage

40

Africa

Perinatal conditions Diarrhoeal diseases Respiratory diseases Malaria diseases Other causes

35

30

25

Eastern Mediterranean

20

South East Asia

15

Europe

Western Pacific

10

Americas

High income countries

5

0

Source: WHO, 2008.

Figure 16: Child mortality rates by cause and region, 2004. Source: WHO, 2008.

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