How do you help improve living conditions in areas that are short of water? Where do you start? Eleanor Hazell explains the principles behind WaterAid, a UK charity dedicated to exactly this

Water is essential to life on earth. You begin to feel thirsty after losing 1% of bodily fluids and risk death if you lose 10%.1 Demand for water is increasing rapidly because of population growth, industrialisation, irrigation for agriculture, urbanisation, and better living standards. It is estimated that by 2025, two thirds of the world's population will live in conditions of water shortage, and like so many other impacts of development, access is unequal. (See also p 94.)

Life and death

The results are deadly. Each year 2.2 million people, most of them children, die from diseases associated with lack of access to safe drinking water, inadequate sanitation, and poor hygiene. Even if not fatal, water related diseases have an enormous effect on health and wellbeing. Millions of working days are lost each year through illness, children are prevented from attending school, development in later life may be affected, and precious income is spent on medicines and health care. A recent study in Karachi, Pakistan, found that poor people living in areas without sanitation or hygiene education spend six times more on medical care than people living in areas with sanitation, who had a basic knowledge of household hygiene.1 The cost of lack of access to fresh water and sanitation is crippling the economies of some of the poorest countries in the world.

Prevention is best

It is clear that water related diseases and lack of access to fresh water, sanitation, and hygiene education are linked. Preventive measures should tackle all three.

Research over the past 10 years shows that improved water quality reduces childhood diarrhoea by 15-20%, but better hygiene through hand washing and safe food handling reduces diarrhoea by 35% and safe disposal of children's faeces leads to a reduction of nearly 40%.2

If this isn't enough to convince you that these are issues that affect you as future healthcare professionals, perhaps this fact will: the World Health Organization estimates that half the world's hospital beds are occupied by patients with waterborne diseases.3

Action

What can be done about this? How can people make a real difference to these problems? The UK charity WaterAid was set up in 1981 and is dedicated to helping the world's poorest people to access freshwater, sanitation, and hygiene education.

Beneficiaries can best describe the work we do. What follows is the account of 25 year old Fatima Omar. Fatima lives with her husband and six children in Biarro Sanjala, Niassa district, Mozambique. With WaterAid's help she built a well in her garden, where she can collect safe clean water whenever she needs.

"Before we had the well I used to collect my water from the swamp. It was very bad. We used to get many diseases like diarrhoea. In the wet season, water would flow into the swamp from the village, taking all the dirt and rubbish with it and it was filthy.

Children learning with pictures - hygine education and sanitation are as important as safe water to help people escape the spiral of poverty

"Then in the dry season there would be very little water and we would have to dig out holes at the bottom of the mud. This was very hard work; it was tiring and I used to get back problems too. Then two years ago we dug our well in our yard. But it was still unprotected and so the water was still dirty and we still had stomach problems.

"Now that we have this well the water is much cleaner and we don't have stomach problems any more. Now we don't have any problems we no longer have to drink dirty water and when it rains no dirty water enters the well."

Clean water has brought many other benefits: "Before I would have to go and work in the field then come back and still have to go and collect water for my family. This meant I could only make food much later. Now the water is very close to my house and I can always cook early. Before the children had to go and collect water early in the morning if they wanted to wash before going to school. Now they can wash quickly. They always go to school on time now. Their health is much better now too. It is a good well."

Fatima collects water from the well

Impact beyond health

A report looking at WaterAid projects in Ethiopia, Ghana, India, and Tanzania showed impacts on people's lives far beyond health improvements and reduction in time spent collecting water. With more time and less disease, people can work more. Impacts included improvements in household income levels and livelihood security; increased school attendance; better child care and teacher enrolment; social and cultural benefits such as reduced stress levels; increased status and self esteem; better family and community relations, and increased ability to observe religious rites and customs. Communities have been able to achieve a better quality of life and escape the spiral of poverty.4

Sustainable in the long term

WaterAid works with some of the poorest people in 15 countries in Africa and Asia. Communities are helped to plan, construct, manage, and maintain their own projects, using locally available materials and low cost technology. Communities contribute what they can afford--money or labour--and rightly feel proud when a scheme is completed. A sense of ownership, together with proper training, ensures that projects will be looked after in future and guarantees their long term sustainability.

"We look after the well and maintain it," explains Fatima, "If the rope breaks we buy a new rope, we buy new buckets if we need to. We keep the well clean and we keep the bucket inside the well."

WaterAid works through local partner organisations that have a wealth of local knowledge and skills. WaterAid supports these partners and encourages them to grow into independent organisations. Felicicao dos Santos Calisto, director of the partner organisation that helped Fatima construct her new well, explained, "I like our partnership because it works both ways. WaterAid helps us with our institutional development and helps us fund projects. This shows how a good partnership can work. On equal levels."

Hygiene

An equally important part of WaterAid is promoting safe hygiene practises. Access to safe water and sanitation will have only a limited impact on health unless combined with changes in behaviour. Cultures, lifestyles and resources vary in the countries in which WaterAid works and no one set of hygiene rules can be prescribed for everyone. WaterAid works with community members to identify problems and solutions appropriate for them. Hygiene messages are conveyed through drawings, plays, puppet shows, and other creative medium in a lively fun way. Often children are the first to pick up hygiene messages and change their behaviour; adults may be reluctant to alter habits ingrained over the course of a lifetime. WaterAid's "child to child" campaign recognises that children are often responsible for the care of younger siblings and teaches them to become health educators for their family, friends and ultimately the whole community.

Influencing policy

WaterAid uses its experience, good practice, and research to influence other organisations and governments about policy issues. WaterAid uses its authoritative voice to support campaigns, build networks, and develop alliances with other international bodies. The UK government acknowledged WaterAid's contribution towards achieving water and sanitation targets at the Johannesburg World Summit on Sustainable Development. Advocacy can have a key role in helping more poor people gain access to water and sanitation that WaterAid and all of its partners could possibly reach.

1. Hinrichsen D, Robey B, and Upadhyay UD. Solutions for a water-short world. Baltimore: Johns Hopkins School of Public Health, 1997. (Population reports, series M, No 14.) www.jhuccp.org/pr/m14edsum.shtml (accessed 12 Mar 2003).
2. WaterAid. Water for life. London: WaterAid, 2002. www.wateraid.org.uk (accessed 12 Mar 2003).
3. WHO/UNICEF. Global water supply and sanitation assessment. Geneva: WHO/UNICEF, 2000.
4. WaterAid. Looking back: the long-term impacts of water and sanitation projects. London: WaterAid, 2001.