5. Needed: A New Sanitary Revolution
The celebratory accounts of the 19th century sanitary revolution in Britain and elsewhere tend to gloss over the many obstacles and delays (see box below), and its dependence on the fruits of industrial progress and civic wealth. But its success over time left a legacy of assumptions about right solutions which, today, are inhibiting alternatives from emerging in very different environments. The sanitary reformers so elevated the role of engineering that issues of public health and disease control were removed from the province of individual action into the realm of public administration. This triumph characterised the subsequent history of water supply, sewerage and drainage not only in the industrialised countries but all over the world. The slogan of the Water Decade - "Water and Sanitation for All" - echoes the idea of a social right, justified on grounds of health and equity, to be provided principally at the public expense.
Investments needed for urban water supply and sanitation in developing countries The scale of investments needed to provide underserved populations with water and sanitation are variously estimated, depending on the cost of technology to be used and other variables. This 1991 World Bank estimate is based on the cost per person of $120 for water supply and $150 for sewerage (1985 dollars).
For the mega-city challenge of the developing world, particularly for their slum populations, the supremacy of public engineering works and the removal of responsible action from individuals and households is simply not going to work. In the social and economic context of most poor countries, this approach is suited only to city centres, industrial areas, and suburbs where urban life is moneyed and well-ordered. And even providing and maintaining highly engineered systems to these parts of town often extends the capacities of municipal utilities beyond their managerial limits. A World Bank review of 120 projects in the developing world found the water authorities performing well in only four countries. Examples of incompetence were legion. In Accra, Ghana, only 130 connections had been made to a system designed for 2,000. In Caracas, Venezuela, and in Mexico City, 30% of connections were unregistered.
Many of the problems faced by these bodies stem from the fact that water supply, drainage and sewerage has been vested in the hands of a public bureaucracy which is neither motivated nor empowered to function cost-effectively. Customers are inadequately billed and inadequately charged. Technology is usually imported and difficult and expensive to maintain. Both those from abroad who promote high-technology engineering schemes, and those who "purchase" them with foreign "aid" or subsidised loans, belong to establishments schooled to think in certain ways and dependent for personal or business reasons on large and remunerative contracts. In spite of widespread international recognition that poor countries' sanitary needs cannot be met in this way - financially, technologically, or managerially - 80% of investments in the sector are still allocated to high-cost systems.
From the perspective of the expanding urban slums, the provision of water supplies and sanitation by this type of technology and institution is not "Water and Sanitation for All" but "Water and Sanitation for an Elite Minority". If their technological and management regimes remain unaltered, the prospect that most existing municipal utilities can advance the urban water and sanitation frontier either conceptually or physically is dim. The same activist and argumentative vision which transformed sanitary fortunes in the past now needs to be harnessed to the demands of the Third World mega-city for the 21st century. The case for reform rests not only on the desirability of a healthy urban environment for city populations, but on the sustainability of supplies, and on human need and dignity. The reforms needed would benefit not only urban but rural populations, whose needs remain acute and should not in their turn be allowed to languish.
In the 19th century, serious effort to design appropriate systems, pass regulations, implement them, and find the resources locally and nationally for public health and sanitary care, only occurred in the wake of cholera. Will we again have to wait until cholera epidemics in Latin America and elsewhere strike terror into cities and continents? In many rapidly urbanising countries where life-threatening diarrhoeal disease is still endemic and erupts in periodic outbreaks, the urban sanitary crisis is a crisis simply waiting to happen.
The question is: can the crisis be avoided, and if so, how?
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