1.Human DevelopmentReport 2006Beyond scarcity:Power, poverty and the global water crisisPublished for theUnited NationsDevelopmentProgramme(UNDP)

2. Copyright 2006by the United Nations Development Programme1 UN Plaza, New York, New York, 10017, USAAll rights reserved. No part of this publication may be reproduced, stored in aretrieval system or transmitted, in any form or by any means, electronic, mechanical,photocopying, recording or otherwise, without prior permission.ISBN 0-230-50058-7Palgrave MacmillanHoundmills, Basingstoke, Hampshire RG21 6XS and175 Fifth Avenue, New York, NY 10010Companies and representatives throughout the worldPalgrave Macmillan is the global academic imprint of the Palgrave Macmillan division ofSt. Martins Press LLC and of Palgrave Macmillan Ltd.Macmillan is a registered trademark in the United States, United Kingdom, and other countries.Palgrave is a registered trademark in the European Union and other countries.9 8 7 6 5 4 3 2 1Printed by Hoechstetter Printing Co. on chlorine-free paper with vegetable inks and theuse of environmentally compatible technology.Cover and layout design: Grundy & Northedge Information Designers, LondonMaps and graphics: Philippe Rekacewicz, Narest, NorwayTechnical editing, layout and production management: Communications DevelopmentIncorporated, Washington, D.C.Editors: Bruce Ross-Larson, Meta de Coquereaumont and Christopher TrottFor a list of any errors or omissions found subsequent to printing, please visit ourwebsite at http://hdr.undp.org 3. Team for the preparation ofHuman Development Report 2006Director and lead authorKevin WatkinsResearch, writing and statistics Statistical adviser: Tom GriffinLiliana Carvajal, Daniel Coppard, RicardoProduction management and translationFuentes, Arunabha Ghosh, Chiara coordination: Carlotta Aiello andGiamberardini, Claes Johansson (ActingMarta JaksonaChief of Statistics), Papa Seck, Cecilia UgazEditors: Bruce Ross-Larson, Meta de(Senior Policy Advisor) and Shahin Yaqub. Coquereaumont and Christopher Trott Cover and layout design: Peter Grundy andTilly Northedge Maps and graphics: Philippe RekacewiczThe Human Development Report Office (HDRO)The Human Development Report is the product of a collective effort. Members of the NationalHuman Development Report (NHDR) team provide detailed comments and advice throughoutthe research process. They also link the Report to a global HDR network in developing countries.The NHDR team, led by Sarah Burd-Sharps (Deputy Director), comprises Amie Gaye, SharmilaKurukulasuriya, Hanna Schmitt and Timothy Scott. The HDRO administrative team makes theoffice function and includes Oscar Bernal, Mamaye Gebretsadik, Melissa Hernandez, Fe Juarez andMary Ann Mwangi. Operations are managed by Sarantuya Mend. HDROs outreach and advocacyprogramme is managed by Marisol Sanjines. 4. ForewordHuman development is first and foremost about allowing people to lead a life thatthey value and enabling them to realize their potential as human beings. The nor-mative framework for human development is today reflected in the broad vision setout in the Millennium Development Goals, the internationally agreed set of time-bound goals for reducing extreme poverty, extending gender equality and advancingopportunities for health and education. Progress towards these objectives provides abenchmark for assessing the international communitys resolve in translating com-mitments into action. More than that, it is a condition for building shared prosperityand collective security in our increasingly interdependent world.This years Human Development Report looks atpeople are denied the right to clean water andan issue that profoundly influences human poten- 2.6 billion people lack access to adequate sanita-tial and progress towards the Millennium Devel-tion. These headline numbers capture only oneopment Goals. Throughout history human prog- dimension of the problem. Every year some 1.8ress has depended on access to clean water and onmillion children die as a result of diarrhoea andthe ability of societies to harness the potential of other diseases caused by unclean water and poorwater as a productive resource. Water for life insanitation. At the start of the 21st century un-the household and water for livelihoods throughclean water is the worlds second biggest killer ofproduction are two of the foundations for humanchildren. Every day millions of women and youngdevelopment. Yet for a large section of humanity girls collect water for their familiesa ritual thatthese foundations are not in place.reinforces gender inequalities in employment and The word crisis is sometimes overused in de-education. Meanwhile, the ill health associatedvelopment. But when it comes to water, there is awith deficits in water and sanitation underminesgrowing recognition that the world faces a crisisproductivity and economic growth, reinforcingthat, left unchecked, will derail progress towards the deep inequalities that characterize currentthe Millennium Development Goals and holdpatterns of globalization and trapping vulnerableback human development. For some, the global households in cycles of poverty.water crisis is about absolute shortages of physi-As this Report shows, the sources of the prob-cal supply. This Report rejects this view. It argues lem vary by country, but several themes emerge.that the roots of the crisis in water can be tracedFirst, few countries treat water and sanitation as ato poverty, inequality and unequal power rela- political priority, as witnessed by limited budget al-tionships, as well as flawed water managementlocations. Second, some of the worlds poorest peo-policies that exacerbate scarcity. ple are paying some of the worlds highest prices for Access to water for life is a basic human needwater, reflecting the limited coverage of water utili-and a fundamental human right. Yet in our in-ties in the slums and informal settlements wherecreasingly prosperous world, more than 1 billion poor people live. Third, the international com-Hum a n De v e l opme n T Re p oR T 2006 5. munity has failed to prioritize water and sanita- ingand it has the potential in many countries tion in the partnerships for development that haveto roll back human development gains achieved coalesced around the Millennium Development over generations. Reduced water supplies in Goals. Underlying each of these problems is the areas already marked by chronic water stress, fact that the people suffering the most from themore extreme weather patterns and the melt- water and sanitation crisispoor people in generaling of glaciers are part of the looming challenge. and poor women in particularoften lack the po- Multilateral action to mitigate climate change by litical voice needed to assert their claims to water. reducing carbon emissions is one leg of the publicThese and other issues are carefully exam- policy response for meeting that challenge. The ined in the Report. The challenges it sets out areother is a far stronger focus on supporting adap- daunting. But the authors do not offer a coun-tation strategies. sel of despair. As the evidence makes clear, thisIt is already clear that competition for water is a battle that we can win. Many countries havewill intensify in the decades ahead. Population made extraordinary progress in providing cleangrowth, urbanization, industrial development and water and sanitation. Across the developing the needs of agriculture are driving up demand for world people living in slums and rural villages a finite resource. Meanwhile, the recognition is are providing leadership by example, mobiliz- growing that the needs of the environment must ing resources and displaying energy and innova- also be factored in to future water use patterns. tion in tackling their problems. At the start ofTwo obvious dangers emerge. First, as national the 21st century we have the finance, technologycompetition for water intensifies, people with and capacity to consign the water and sanita- the weakest rightssmall farmers and women tion crisis to history just as surely as todays rich among themwill see their entitlements to water countries did a century ago. What has been lack-eroded by more powerful constituencies. Second, ing is a concerted drive to extend access to waterwater is the ultimate fugitive resource, traversing and sanitation for all through well designed andborders through rivers, lakes and aquifersa fact properly financed national plans, backed by a that points to the potential for cross-border ten- global plan of action to galvanize political will sions in water-stressed regions. Both dangers can and mobilize resources. be addressed and averted through public policiesWater for livelihoods poses a different setand international cooperationbut the warning of challenges. The world is not running out ofsigns are clearly visible on both fronts. water, but many millions of its most vulnerableThis Report, a product of research and anal- people live in areas subject to mounting waterysis by international experts and staff across the stress. Some 1.4 billion people live in river basinsUN system, is intended to stimulate debate and in which water use exceeds recharge rates. Thedialogue around a set of issues that will have a symptoms of overuse are disturbingly clear: riv-profound bearing on progress towards achiev- ers are drying up, groundwater tables are falling ing the Millennium Development Goals and and water-based ecosystems are being rapidly de-human development. graded. Put bluntly, the world is running down one of its most precious natural resources and run- ning up an unsustainable ecological debt that will be inherited by future generations.Far more also needs to be done in the face of the threats to human development posed by cli-Kemal Dervi mate change. As the Report stresses, this is not aAdministrator future threat. Global warming is already happen-United Nations Development Programme The analysis and policy recommendations of this Report do not necessarily reflect the views of the United Nations Develop- ment Programme, its Executive Board or its Member States. The Report is an independent publication commissioned by UNDP. It is the fruit of a collaborative effort by a team of eminent consultants and advisers and the Human Development Report team. Kevin Watkins, Director of the Human Development Report Office, led the effort. i Human De velopmen T RepoR T 2006 6. AcknowledgementsThis Report could not have been prepared without the generous contribution ofmany individuals and organizations. The authors wish to acknowledge their specialdebt to Amartya Sen, whose work has shaped the evolution of the Human Develop-ment Report over the years. Kemal Dervi, the Administrator of the United NationsDevelopment Programme (UNDP), has provided consistent support and encour-agement. His personal commitment is deeply appreciated. Errors of commission andomission are the sole responsibility of the authors.Contributors Tigrek, Leopoldo Tornarolli, Cecilia Tor-Background studies, papers and notes weretajada, Hkan Tropp, Erika Weinthal, Daleprepared on a wide range of thematic issuesWhittington and Aaron T. Wolf.relating to the Report. Contributors were: Several organizations generously sharedMartin Adams, Jos Albiac, Rajindra Ariya- their data and other research materials: Car-bandu, Jacob Assa, Karen Bakker, Bernard bon Dioxide Information and Analysis Center,Barraqu, James Bartram, Jeremy Berkoff, Caribbean Community Secretariat, Center forAnders Berntell, Helen Bryer, StephanieInternational Comparisons at the UniversityBuechler, Ximing Cai, Belinda Calaguas,of Pennsylvania, Development Initiatives, Eco-Lorenzo Cotula, Elizabeth Daley, Andre nomic and Social Commission for Asia and theDeGeorges, Malin Falkenmark, Matthew Pacific, Economic and Social Commission forGandy, Leonardo Gasparini, Toni German,Latin America and the Caribbean, EuropeanMicheal Grimm, Alejandro Guevara-Sangi-Commission, Food and Agriculture Organiza-ns, Laurence Haller, Ken Harttgen, Lotion, Institute of Development Studies, InternalHeller, Juan Emilio Hernndez Mazariegos,Displacement Monitoring Centre, InternationalCaroline Hunt, Guy Hutton, Anders Jger- Food Policy Research Institute, Internationalskog, Marion W. Jenkins, Stephan Klasen, Institute for Environment and Development,Michelle Kooy, Jakub Landovsky, Jan Lun- International Institute for Strategic Studies, In-dqvist, Boris Maran, Richard R. Marcus,ternational Labour Organization, InternationalErnst-Jan Martijn, Gordon McGranahan,Monetary Fund, International OrganizationLyla Mehta, Ruth Meinzen-Dick, Mark Mis- for Migration, International Telecommunica-selhorn, Erik Mostert, Synne Movik, Sobona tion Union, Inter-Parliamentary Union, JointMtisi, Arnold Michael Muller, Sunita Narain, United Nations Programme on HIV/AIDS,Alan Nicol, Tobias Pftze, David Phillips, Luxembourg Income Study, Office of theBrian Kevin Reilly, Claudia Ringler, Vicente United Nations High Commissioner for Refu-Snchez Mungua, Juan J. Snchez-Meza, gees, Organisation for Economic Co-operationDavid Sattherthwaite, Christopher Scott, and Development, Practical Action Consulting,Dajun Shen, Nur Endah Shofiani, Steven Sug-Stockholm International Peace Research Insti-den, Erik Swyngedouw, Oumar Sylla, Sahnaztute, Stockholm International Water Institute, Hum a n De v e l opme n T Re p oR T 2006 ii 7. United Nations Childrens Fund, United Batchelor, Sylvia Beales, Rosangela Berman Nations Conference on Trade and Develop- Bieler, sa Blomstrm, Rutgerd Boelens, Anne ment, United Nations Department of Eco-Bousquet, Benedito Braga, Marcia M. Brews- nomic and Social Affairs Statistics Division ter, Tony Burton, Eva Busza, Fernando Calde- and Population Division, United Nations De-ron, Ken Caplan, Markela Castro, Tarek Abou velopment Fund for Women, United Nations Chabake, Lekha Chakraborty, Mary Chamie, Educational, Scientific and Cultural Organi- Jacques Charmes, Declan Conway, Esteve zation Institute for Statistics, United NationsCorbera, Priti Darooka, Raj Kumar Daw, Par- Office on Drugs and Crime Treaty Section,tha Deb, Manuel Dengo, Catalina Devandas United Nations Office of Legal Affairs, Water- Aguilar, Philip Dobie, Moez Doraid, Kassym Aid, World Bank, World Health Organization,Duskayev, Arne Eide, Melissa Eisdell, Pauline World Intellectual Property Organization and Eizema, Elin Enge, Janique Etienne, Merle World Trade Organization.Douglas Faminow, Jean-Marc Faurs, KimberlyFisher, Richard Franceys, Sakiko Fukuda-Parr, Advisory Panel Ludmila Funso, Oscar Garcia, Maria Genina, The Report benefited greatly from intellectual Uladzimir Gerus, Peter Ghys, Donna L. Good- advice and guidance provided by an externalman, Maurizio Guadagni, Irene Guimares advisory panel of experts. The panel comprised Altafin, HRH Crown Prince Haakon, Brian Karen Assaf, Michel Camdessus, MargaretHammond, Bente Herstad, Hans Olav Ibrekk, Catley-Carlson, Leonid Dmitriev, Jan Eliasson, Artemy Izmestiev, Kareen Jabre, S. Janakara- David Grey, Wang Hao, Sylvy Jaglin, Sir Rich-jan, David Jones, Hazel Jones, Andrei Jouravlev, ard Jolly, Inge Kaul, Roberto Lenton, Bindesh- Tim Kasten, Ashfaq Khalfan, Nariman Kip- war Pathak, Grard Payen, Riccardo Petrella, shakbayev, Aloysius Kiribaki, Karoly Kovacs, Claudia W. Sadoff, Miguel Solanes, OlindaRadhika Lal, Jean Langers, Christopher Lang- Sousa, Sandra Suarez Perez, Anna Kajumuloton, Bruce Lankford, James Lenahan, Michael Tibaijuka, Klaus Toepfer, HRH Prince Wil-Lipton, Edilberto Loaiza, Mitchell Loeb, Jan lem-Alexander of the Netherlands, Ngaire Lundqvist, Nora Lustig, Rolf Luyendijk, How- Woods and Gordon Young. An advisory panelard Mann, Sebastien Martin, Wariara Mbu- on statistics made an invaluable contribution. gua, Charlotte McClain-Nhlapo, Patrick Mc- The panel members were Carla Abou-Zahr,Cully, David Molden, Daniel Mont, Federico Tony Atkinson, Hubert Escaith, Haishan Montero, Trevor Mulaudzi, Carlos Muoz, Te- Fu, Gareth Jones, Ian D. Macredie, Anna N. resa Munzi, Naison Mutizwa-Mangiza, Ngila Majelantle, John Male-Mukasa, Marion McE-Mwase, Rohini Nayyar, Gunhild Oerstavik, win, Saeed Ordoubadi, Francesca Perucci, Tim Siddiq Osmani, P. Sainath, Richard Palmer- Smeeding, Eric Swanson, Pervez Tahir and Mi- Jones, Eric Patrick, David Pearce, Agueda Perez, chael Ward. The team is grateful to Karen Fren-Chris Perry, Henrik Pilgaard, Will Prince, ken, Angela Me and David Pearce, the statisti- Shammy Puri, Eva Quintana Mourelle, Xavi cal peer reviewers who scrutinized the data in Ramos, Kalyan Ray, Chris Reij, Nils Rosemann, the Report and lent their statistical expertise. Shea Rutstein, Steven Sabey, Bharati Sadasi-vam, Zhanara Sagimbaeva, Julio Sanjines, Lisa ConsultationsSchipper, Janet Seeley, Sharda Sekaran, Yuriko Many individuals consulted during the prepara- Shoji, Yuriy Shokamanov, Vladimir Smakhtin, tion of the Report provided invaluable advice, David Smith, Petter Stlenheim, Ashok Subra- information and material. The Report teammanian, Morten Svelle, Michel Thieren, Hkan thanks Nigel Adderley, Wondu Alemayehu,Tropp, Tuong To Phuc, Vanessa Tobin, Kerry Serge Allegrezza, Juan Carlos Alurralde, PaulTurner, Sriti Vadera, Imraan Valodia, Henk Appasamy, Glauco Arbix, Togzhan Assan, van Norden, Veronique Verdeil, Sad Ould Kaisha Atakhanova, Dan Banik, Michelle Bar-A. Voffal, Charles Vorosmarty, Bill Walker, ron, Aparna Basnyat, Ivar A. Baste, CharlesTessa Wardlaw, Dominic Waughray, Siemon iii Human De velopmen T RepoR T 2006 8. Wezeman, Peter Whalley, Howard White, Flo-and presentation of the argument. Techni-rian Wieneke, Lars Wirkus, Albert M. Wright,cal and production editing was carried out byNancy Yanez Fuenzalida, Bulat Yessekin, Eliza-Meta de Coquereaumont, Elizabeth Collinsbeth Zaniewski and Windy Zhang. and Christopher Trott. Layout and proofread-ing were also done by Communications Devel-UNDP Readersopment Incorporated. The Report (includingA Readers Group, made up of colleagues in cover) was designed by GrundyNorthedgeUNDP, provided extremely useful comments, Information Designers. Maps and graphics forsuggestions and inputs during the writing of thethe Report were designed by Philippe Rekace-Report. The Report team is especially grateful to wicz, with the assistance of Laura Margueritte.Nada Al-Nashif, Amat Al Aleem Ali Alsoswa,The production, translation, distributionJohan Arvling, Walid Badawi, Michel Balima, and promotion of the Report benefited from theMohamed Bayoumi, Robert G. Bernardo, Ra-help and support of the UNDP Office of Com-zina Bilgrami, Aeneas C. Chuma, Niamh Col-munications: Niamh Collier-Smith, Maureenlier-Smith, Pedro Conceio, Philip Dobie,Lynch, David Morrison and William Orme.Jafet Enriquez, Sergio Feld, Emilie Filmer- Translations were reviewed by Yu Gao, Ce-Wilson, Bjoern Foerde, Edith Gassana, Prema cile Molinier, Vladimir Scherbov, Rosine SoriGera, Tegegnework Gettu, Rebeca Grynspan, Coulibaly, Mounir Tabet and Oscar Yujnovsky.Tim Hannan, Joakim Harlin, Gilbert FossounSusana Franco (who managed the project onHoungbo, Andrew Hudson, Ragnhild Imer-gender indicators) and Jonathan Morse madeslund, Abdoulie Janneh, Bruce Jenks, Gordon valuable contributions to the statistical team.Eric Johnson, Nanak Kakwani, Douglas Keh, The Report also benefited from the dedicatedRima Khalaf Hunaidi, Olav Kjorven, Elie work of interns: Paola Adriazola, Carolina Ara-Kodsi, Oksana Leshchenko, Carlos Linares, gon, Nurit Bodemann-Ostow, Torsten Henric-Metsi Makhetha, Lamin Manneh, Elena Marti-son-Bell, Roshni Menon, Sarai Nuez Ceronnez, Pratibha Mehta, Kalman Mizsei, Cielo Mo- and Min Zhang.rales, David Morrison, Abdoulaye Ndiaye, ShojiGloria Wightman and Juan Arbelaez of theNishimoto, Joseph Opio-Odongo, WilliamUN Office of Project Services provided criti-Orme, Hafiz Pasha, Stefano Pettinato, Gonzalo cal administrative support and managementPizarro, Martin Santiago, Susanne Schmidt,services.Guido Schmidt-Traub, Salil Shetty, MoustaphaSoumare, Juerg Staudenmann, Mounir Tabet,Sarah Timpson and Louisa Vinton.Editing, Production and TranslationThe Report benefited enormously from the ad-vice and contribution of the editorial team at Kevin WatkinsCommunications Development Incorporated. DirectorBruce Ross-Larson provided advice on structureHuman Development Report 2006 Hum a n De v e l opme n T Re p oR T 2006 ix 9. ContentsForewordvAcknowledgements viiOeriew Beyondscarcity:power,povertyandtheglobalwatercrisis 1Chapter1 Endingthecrisisinwaterandsanitation 25Lessons from history28How water insecurity decoupled economic growth and human development30The water-sanitation disconnectand delayed progress31Todays global crisis in water and sanitation 31Rich world, poor world31Wealth matters 35and sanitation lags behind water 36The data systematically underreport the scale of the deficit36The human development costs of the crisis 41Worsening income povertythe wealth effect of the crisis41Retarding improvements in child mortality ratesthe deadly link at birth42Spawning lifecycle disadvantages45Raising wider health costs45Hurting girls education47Exacerbating time-poverty and gender inequality 47Undermining human dignity 48The crisis hits the poor hardestby far 48The poor account for most of the deficit48The poor pay moreand more than they can afford 51The Millennium Development Goals and beyondgetting on track55A progress report on the Millennium Development Goal target 55Savings from meeting the Millennium Development Goal target 58Making progress a reality 59Recognizing the human right to water and sanitation 60Developing strong national strategies 61Increasing international aid for water and sanitation 66Building the global partnershipthe case for an international water and sanitation global action plan 70Chapter2 Waterforhumanconsumption 75Why the poor pay moreand get less water80 Improved and unimproved wateran illusory border between clean and dirty 80 x Human De velopmen T RepoR T 2006 10. Getting water from multiple providers 82Climbing the price ladder in urban slums83Why tariffs matter84Rural poorthe last in line 86Managing the network for efficiency and equity88Public providerskey to provision and financing 89Private providersbeyond concessions91Delivering the outcomesthe policies96Public financing and access for the urban poor97Regulation is critical 100Reaching the poor102International support for local financing105Chapter3 Thevastdeficitinsanitation 109The 2.6 billion people without sanitation112Who is where on the sanitation ladder? 113The water-sanitation-hygiene benefits loop 115Why does sanitation lag so far behind water? 118The national policy barrier118The behaviour barrier119The perception barrier 119The poverty barrier119The gender barrier 120The supply barrier 120Bringing sanitation for all within reach 120Action from below makes a difference 121Government leadership is vital 122The financing problem127Developing responsive markets127The way ahead128Chapter4 Waterscarcity,riskandvulnerability 131Rethinking scarcity in a water-stressed world134Understanding scarcity 134Breaching the limits of sustainable useproblems, policies and responses 138Augmenting supplyoptions and constraints148Regulating demand for a scarce resource152Dealing with risk, vulnerability and uncertainty 155The crucial role of infrastructure 155Global warmingthe predictable emergency 159The way ahead169Chapter5 Watercompetitioninagriculture 171Water and human developmentthe livelihood links 174 Agriculture under pressurethe emerging scenarios 175 Immovable objects and irresistible forces 177 Hum a n De v e l opme n T Re p oR T 2006 xi 11. Competition, rights and the scramble for water178The limits to private water markets 179The water rights agendamissing equity and empowerment181Customary and formal rightsevidence from Sub-Saharan Africa183Water rights shape entitlements 186Better governance in irrigation systems 187Reducing the risk of poverty188Financing with equity 189Empowermentthe missing link192Greater water productivity for the poor 195Water harvesting and micro-irrigation 195Low-technology solutions with high human development returns197The way ahead 199Chapter6 Managingtransboundarywaters 201Hydrological interdependence204Sharing the worlds water 205Following the river 206The costs of not cooperating209Transmitting tensions down the river209Shrinking lakes, drying rivers211The case for cooperation215The rules of the game 215On the river and beyond the river 218The state of cooperation221River basin cooperation for human development 224Basin-level cooperation 224Weak institutional structures for water management226Creating the conditions for cooperation 228Notes233Bibliographicnote 236Bibliography 238 Boxes Eight reasons for the world to act on water and sanitation links to the Millennium Development Goals 221.1 A great leapfrom water reform to sanitation reform in 19th century Great Britain 291.2 Breaking the links between race, disease and inequality in US cities321.3 The flying toilets of Kiberathe severe neglect of water and sanitation coverage in poor areas of Nairobi381.4 The water-sanitation gap in the Philippines 401.5 The health costs of the water and sanitation deficit461.6 South Africaacting on the right to water 642.1 The burden of history: many networks were not designed to reach the poor862.2 Water, gender and time-poverty872.3 Public services can workPorto Alegres Department of Water and Sewerage shows how90 xii Human De velopmen T RepoR T 2006 12. 2.4 What went wrong with concessions? Three failures and three lessons932.5 Pro-poor water pricing practices in Cte dIvoire 942.6 Water consumption subsidies in Chilegreater efficiency and equity982.7 Standpipesreaching the poor, but often at too high a price1002.8 Citizens report cardsvoice as agency for change 1012.9 Ghanas rural water supplya participative approach that works 103 2.10 Some for all, not all for some in Uganda 104 2.11 Empowering rural people in Moroccolocal demand leads to increased coverage1053.1 Disability and sanitation1143.2 Children as agents of change 1163.3 Action from belowthe Orangi Project 1213.4 Bangladeshs total sanitation campaign 1233.5 Sulabhbringing sanitation to the poor in India1243.6 Lesothoprogress in rural sanitation 1253.7 The condominial approach to sewerage systems in Brasiliapolitics and technology 1264.1 Chinamanaging a water crisis in a high growth economy 1424.2 Yemen under stress 1444.3 Groundwater mining subsidies in Mexico 1464.4 The real value of water-based ecosystems 1474.5 Increasing supply by reducing pollutionmarkets and technology 1484.6 Desalinizationand its limits1504.7 Integrated Water Resources Management1544.8 Droughts, floods and water insecurity in Kenya 1574.9 Melting water banksshrinking glaciers are changing water flows1665.1 Chilewater markets and reform in a high growth economy1795.2 Water trading in the western United States 1805.3 Water rights and redistribution in South Africa1825.4 Overlapping water rights and unequal exchange in the Philippines 1835.5 Fabrics versus farmers in West Java1845.6 Customary law and inequality in Senegal1855.7 Winners and losers from water policy reform on the Pangani River in Tanzania 1875.8Irrigation and water management in Central Asia1905.9Devolution of water governance in Andhra Pradesh 1936.1 Beyond the riverthe costs of noncooperation in Central Asia 2146.2 Water rights in the Occupied Palestinian Territories 2166.3 European experience with river basin management: the Rhine and the Danube Rivers 2196.4 River basin cooperation takes many forms 2256.5 Southern Africaregional integration through cooperation on international rivers 2276.6 Global Environment Facilitybuilding knowledge, capacity and institutions229 Tables1.1 The Millennium Development Goal target: past performance and future targets for water and sanitation562.1 Cebu, Philippines: patterns of water use among households not connected to the main water network812.2 Independent water providers: important but expensive actors in Latin American cities842.3 Private participation in water networks takes many forms... 914.1 Projected water use and diversions to nonagricultural sectors by region, 2000 and 2050 1394.2 Global warming thresholds and targets160Hum a n De v e l opme n T Re p oR T 2006 xiii 13. 5.1 Irrigation charges and value of production for selected irrigation schemes in Asia191 6.1 International basins link many countries206 6.2 Thirty-nine countries receive most of their water from outside their borders210 6.3 Countries are withdrawing water faster than it is replenished 210 6.4 Potential benefits in the Kagera subbasin 226Figures 1.1 Shrinking slowly: the global water and sanitation deficit33 1.2 Worlds apart: the global water gap 34 1.3 Many countries face a long climb to universal coverage 36 1.4 Incomes and outcomes in water and sanitation: wealth and performance often diverge 37 1.5 Diarrhoea: the second biggest killer of children 43 1.6 Clean water and toilets cut infant deaths43 1.7 Clean water reduces the risk of diarrhoea 44 1.8 and so does access to sanitation44 1.9 Poor people account for most of the water and sanitation deficit 481.10 The water divide 491.11 The great sanitation divide501.12 Poor people have lower sanitation coverage in Brazil 501.13 Paying the price for poverty: water takes a large share of household spendingfor the poorest 20%511.14 The costs of being beyond the utility521.15 Water prices: the poor pay more, the rich pay less 531.16 The water divide within countries: Kenya, Tanzania and Uganda531.17 The rural-urban divide: disparities in access to sanitation remain large 541.18 Some ethnic groups have much less access to water541.19 Regional divide: in Peru lower coverage in poorer provinces costs lives551.20 Some regions are off track for reaching the Millennium Development Goal targetfor water and sanitation 571.21 Water coverage is slipping with rapid urbanization in some countries 581.22 Water: a low priority in many budgets621.23 Public investment in water and sanitation is insufficient to meet the Millennium DevelopmentGoal target in many countries671.24 Donors vary widely in commitment, and financing is unpredictable 681.25 Some donors attach more priority to water and sanitation than do others69 2.1 Most households in Jakarta get their water from multiple sources 81 2.2 Public utilities provide the cheapest water83 2.3 Utility water prices usually rise with volume85 2.4 Where do the water subsidies go? 99 2.5 Lifeline tariffs work if connection rates are high 100 3.1 Climbing the sanitation ladder has financial as well as health implications113 3.2 The benefits of sanitation depend on household and community action115 3.3 In Viet Nam the poor are left far behind 119 3.4 Wealth gaps in sanitation in Cambodia120 3.5 Pro-poor growth in access to sanitation in Colombia and Morocco124 4.1 Water availability in decline136 4.2 Water stress is projected to accelerate in intensity in several regions136 4.3 Global water stress intensifying 137 4.4 Our wealthier, thirstier world 137 4.5 How the world uses its water 138 xi Human De velopmen T RepoR T 2006 14. 4.6 Agriculture is still the largest user of water 1384.7 Income variability trails rainfall variability in Ethiopia 1564.8 Large inequalities in risk mitigation capacity 1584.9 Our world will get much warmer in the next century 160 4.10 Our warming world: stabilization will require drastic emissions cuts 161 4.11 Declining aid flows to agriculture 1695.1 Access to irrigation water can reduce poverty and vulnerability1755.2 Sub-Saharan Africa has the smallest ratio of irrigated to rainfed agriculture1775.3 Asia accounts for more than half of global irrigated land1775.4 Irrigation is linked to lower poverty in many developing countries 1885.5 Agricultural productivity and equity are often closely related 1895.6 Heads you win, tails you lose on quantity 1895.7 and poverty is higher among tail-end farmers1895.8 Water harvesting in retreat in India 1966.1 Water conflict focuses on volumes, cooperation can be much broader 2216.2 Beyond quantitywater agreements cover many areas222 Maps4.1 Water overuse is damaging the environment in many major basins 1404.2 Climate change will cause a decline in water run-off for many regions1624.3 Climate change threatens to reduce cereal productivity across much of Sub-Saharan Africa 1644.4 Climate change will leave India with fewer rainy days1676.1 Africas rivers and lake basins cross many borders 2076.2 The Mekong binds livelihoods across borders2086.3 The vanishing Lake Chad2116.4 The shrinking Aral Sea: the environmental costs of cotton213 SpecialcontributionsFrontloading financing for meeting the Millennium Development Goalfor water and sanitation, Gordon Brown and Ngozi Okonjo-Iweala 72Access to safe water is a fundamental human need and a basic human right, Kofi Annan78Clean, accessible and affordable water is a human right and a foundationfor economic and social development, Luiz Incio Lula da Silva 79Water and sanitation: a daunting challenge, but one we can overcome, Jimmy Carter117Human development indicatorsThestateofhumandevelopment 263Readersguideandnotestotables274Monitoringhumandevelopment:enlargingpeopleschoices...1 Human development index283 1a Basic indicators for other UN member countries 2872 Human development index trends 2883 Human and income poverty: developing countries 2924 Human and income poverty: OECD countries, Central and Eastern Europe and the CIS 295Hum a n De v e l opme n T Re p oR T 2006 x 15. ...toleadalongandhealthylife...5 Demographic trends2976 Commitment to health: resources, access and services3017 Water, sanitation and nutritional status3058 Inequalities in maternal and child health 3099 Leading global health crises and risks311 10 Survival: progress and setbacks 315...toacquireknowledge...11 Commitment to education: public spending 31912 Literacy and enrolment 32313 Technology: diffusion and creation 327...tohaveaccesstotheresourcesneededforadecentstandardofliving...14 Economic performance 33115 Inequality in income or expenditure33516 The structure of trade 33917 Rich country responsibilities: aid 34318 Flows of aid, private capital and debt 34419 Priorities in public spending34820 Unemployment in OECD countries 352...whilepreservingitforfuturegenerations...21 Energy and the environment 353...protectingpersonalsecurity...22 Refugees and armaments 35723 Victims of crime 361...andachievingequalityforallwomenandmen 24 Gender-related development index363 25 Gender empowerment measure367 26 Gender inequality in education371 27 Gender inequality in economic activity375 28 Gender, work and time allocation379 29 Womens political participation 380Humanandlabourrightsinstruments30 Status of major international human rights instruments 38431 Status of fundamental labour rights conventions388Technicalnote1393Technicalnote2400Technicalnote3402Definitionsofstatisticalterms404Statisticalreferences411Classificationofcountries 413Indextoindicators 417IndextoMillenniumDevelopmentGoalindicatorsintheindicatortables 421 xi Human De velopmen T RepoR T 2006 16. Oeriew Beyondscarcity Power,poertyandtheglobalwatercrisisThe global crisis in water The water is not good in this pond. We collect it because we have no alternative. All theconsigns large segmentsanimals drink from the pond as well as the community. Because of the water we are of humanity to lives of also getting different diseases.poverty, vulnerabilityZenebech Jemel, Chobare Meno, Ethiopia and insecurity Of course I wish I were in school. I want to learn to read and write. But how can I? My mother needs me to get water. Yeni Bazan, age 10, El Alto, Bolivia The conditions here are terrible. There is sewage everywhere. It pollutes our water. Most people use buckets and plastic bags for toilets. Our children suffer all the time from diar- rhoea and other diseases because it is so filthy. Mary Akinyi, Kibera, Nairobi, Kenya They [the factories] use so much water while we barely have enough for our basic needs, let alone to water our crops.Gopal Gujur, farmer, Rajasthan, India Four voices from four countries united by a sin-human progress, consigning large segments of gle theme: deprivation in access to water. That humanity to lives of poverty, vulnerability and deprivation can be measured by statistics, butinsecurity. This crisis claims more lives through behind the numbers are the human faces of the disease than any war claims through guns. It millions of people denied an opportunity to re- also reinforces the obscene inequalities in life alize their potential. Water, the stuff of life and a chances that divide rich and poor nations in basic human right, is at the heart of a daily crisisan increasingly prosperous and interconnected faced by countless millions of the worlds most world and that divide people within countries vulnerable peoplea crisis that threatens lifeon the basis of wealth, gender and other mark- and destroys livelihoods on a devastating scale.ers for disadvantage. Unlike wars and natural disasters, the Overcoming the crisis in water and sanita- global crisis in water does not make mediation is one of the great human development headlines. Nor does it galvanize concerted in-challenges of the early 21st century. Success in ternational action. Like hunger, deprivationaddressing that challenge through a concerted in access to water is a silent crisis experienced national and international response would act by the poor and tolerated by those with the re- as a catalyst for progress in public health, edu- sources, the technology and the political power cation and poverty reduction and as a source of to end it. Yet this is a crisis that is holding backeconomic dynamism. It would give a decisive Hum a n De v e l opme n T Re p oR T 2006 1 17. The scarcity at the heart impetus to the Millennium DevelopmentSome commentators trace the global chal-of the global water crisis is Goalsthe targets adopted by governments as lenge in water to a problem of scarcity. The spiritpart of a global partnership for poverty reduc- of Thomas Malthus, who in the 19th centuryrooted in power, povertytion. The business as usual alternative is to tol-disconcerted political leaders by predicting aand inequality, not inerate a level of avoidable suffering and loss offuture of food shortages, increasingly pervadesphysical availability human potential that all governments should international debates on water. With popula-regard as ethically indefensible and economi- tion rising and demands on the worlds watercally wasteful. expanding, so the argument runs, the futurepoints to a gloomy arithmetic of shortage.Water for life, water for livelihoods We reject this starting point. The availability ofwater is a concern for some countries. But theBy means of water, says the Koran, we give lifescarcity at the heart of the global water crisis isto everything. That simple teaching captures a rooted in power, poverty and inequality, not indeeper wisdom. People need water as surely as physical availability.they need oxygen: without it life could not exist. Nowhere is this more apparent than in theBut water also gives life in a far broader sense. area of water for life. Today, some 1.1 billionPeople need clean water and sanitation to sus-people in developing countries have inadequatetain their health and maintain their dignity. But access to water, and 2.6 billion lack basic sanita-beyond the household water also sustains eco- tion. Those twin deficits are rooted in institu-logical systems and provides an input into thetions and political choices, not in waters avail-production systems that maintain livelihoods. ability. Household water requirements representUltimately, human development is abouta tiny fraction of water use, usually less than 5%the realization of potential. It is about whatof the total, but there is tremendous inequalitypeople can do and what they can becometheirin access to clean water and to sanitation at acapabilitiesand about the freedom they havehousehold level. In high-income areas of citiesto exercise real choices in their lives. Water per- in Asia, Latin America and Sub-Saharan Africavades all aspects of human development. Whenpeople enjoy access to several hundred litres ofpeople are denied access to clean water at home water a day delivered into their homes at lowor when they lack access to water as a produc-prices by public utilities. Meanwhile, slumtive resource their choices and freedoms aredwellers and poor households in rural areas ofconstrained by ill health, poverty and vulner-the same countries have access to much less thanability. Water gives life to everything, includingthe 20 litres of water a day per person required tohuman development and human freedom.meet the most basic human needs. Women andIn this years Human Development Report young girls carry a double burden of disadvan-we look at two distinct themes in the globaltage, since they are the ones who sacrifice theirwater crisis. The first, explored in chapters 13,time and their education to collect water.is water for life. Delivering clean water, remov-Much the same applies to water for liveli-ing wastewater and providing sanitation are hoods. Across the world agriculture and in-three of the most basic foundations for human dustry are adjusting to tightening hydrologicalprogress. We look at the costs of not putting inconstraints. But while scarcity is a widespreadplace these foundations and set out some of the problem, it is not experienced by all. In water-strategies needed to bring universal access tostressed parts of India irrigation pumps extractwater and sanitation within reach. The second water from aquifers 24 hours a day for wealthytheme, water for livelihoods, is the subject of farmers, while neighbouring smallholders de-chapters 46. Here we focus on water as a pro-pend on the vagaries of rain. Here, too, the un-ductive resource shared within countries andderlying cause of scarcity in the large majority ofacross borders, highlighting the immense chal-cases is institutional and political, not a physicallenges now facing many governments to man-deficiency of supplies. In many countries scar-age water equitably and efficiently.city is the product of public policies that have 2 Human De velopmen T RepoR T 2006 18. encouraged overuse of water through subsidies and poor sanitation dwarf the casualties associ-There is more than enoughand underpricing. ated with violent conflict. No act of terrorism water in the world for There is more than enough water in the generates economic devastation on the scale ofdomestic purposes, forworld for domestic purposes, for agriculture andthe crisis in water and sanitation. Yet the issuefor industry. The problem is that some peoplebarely registers on the international agenda. agriculture and for industry.notably the poorare systematically excludedIt is not just the contrast with national secu- The problem is that somefrom access by their poverty, by their limitedrity imperatives that is striking. Today, interna-peoplenotably the poorlegal rights or by public policies that limit ac- tional action to tackle the crisis in HIV/AIDScess to the infrastructures that provide waterhas been institutionalized on the agenda of the are systematically excludedfor life and for livelihoods. In short, scarcity is Group of Eight countries. Threatened withmanufactured through political processes anda potential public health crisis in the form ofinstitutions that disadvantage the poor. When avian flu, the world mobilizes rapidly to drawit comes to clean water, the pattern in manyup a global plan of action. But the living realitycountries is that the poor get less, pay more and of the water and sanitation crisis elicits only thebear the brunt of the human development costs most minimal and fragmented response. Whyassociated with scarcity. is that? One plausible explanation is that, un-like HIV/AIDS and avian flu, the water andHuman security, citizenship and socialsanitation crisis poses the most immediatejustice and most direct threat to poor people in poorJust over a decade ago Human Developmentcountriesa constituency that lacks a voice inReport 1994 introduced the idea of human se-shaping national and international perceptionscurity to the wider debate on development. Theof human security.aim was to look beyond narrow perceptions ofApart from the highly visible destructivenational security, defined in terms of military impacts on people, water insecurity violatesthreats and the protection of strategic foreign some of the most basic principles of social jus-policy goals, and towards a vision of securitytice. Among them:rooted in the lives of people. Equal citizenship. Every person is entitled Water security is an integral part of this to an equal set of civil, political and socialbroader conception of human security. In broadrights, including the means to exercise theseterms water security is about ensuring that every rights effectively. Water insecurity compro-person has reliable access to enough safe water mises these rights. A woman who spendsat an affordable price to lead a healthy, digni-long hours collecting water, or who suffersfied and productive life, while maintaining the from constant water-related illness, has lessecological systems that provide water and alsocapacity to participate in society, even if shedepend on water. When these conditions arecan participate in electing her government.not met, or when access to water is disrupted, The social minimum. All citizens shouldpeople face acute human security risks trans- have access to resources sufficient to meetmitted through poor health and the disruption their basic needs and live a dignified life.of livelihoods. Clean water is part of the social minimum, In the world of the early 21st century na- with 20 litres per person each day as thetional security concerns loom large on the in-minimum threshold requirement.ternational agenda. Violent conflict, concerns Equality of opportunity. Equality of op-over terrorist threats, the proliferation of nu-portunity, a key requirement for socialclear weapons and the growth of illicit trade justice, is diminished by water insecurity.in arms and drugs all pose acute challenges.Most people would accept that educationAgainst this backdrop it is easy to lose sightis integral to equality of opportunity. Forof some basic human security imperatives, in- example, children unable to attend schoolcluding those linked to water. The 1.8 millionwhen they are afflicted by constant boutschild deaths each year related to unclean water of sickness caused by unclean water do not, Hum a n De v e l opme n T Re p oR T 2006 3 19. Ensuring that every personin any meaningful sense, enjoy a right tohalving the proportion of world population has access to at least education. without sustainable access to safe drinking Fair distribution. All societies set limits towater and basic sanitationGoal 7, target 1020 litres of clean waterthe justifiable extent of inequality. Deep in- is a key target in its own right. But achievingeach day is a minimum equality in access to clean water in the homethat target is critical to the attainment of otherrequirement for respectingor productive water in the field does notgoals. Clean water and sanitation would savemeet the criterion for fair distribution, es-the lives of countless children, support progressthe human right to waterpecially when linked to high levels of avoid-in education and liberate people from the ill-able child death or poverty. nesses that keep them in poverty.The idea of water as a human right reflects The urgency of achieving the Millennium these underlying concerns. As the UN Secretary- Development Goal for water and sanitation General has put it, Access to safe water is a fun- cannot be overstated. Even if the targets are damental human need and, therefore, a basic achieved, there will still be more than 800 mil- human right. Upholding the human right tolion people without water and 1.8 billion people water is an end in itself and a means for givingwithout sanitation in 2015. Yet despite progress substance to the wider rights in the Universalthe world is falling short of what is needed, es- Declaration of Human Rights and other le- pecially in the poorest countries. Changing this gally binding instrumentsincluding the right picture will require sustained action over the to life, to education, to health and to adequatenext decade allied to a decisive break with the housing. Ensuring that every person has accesscurrent business as usual model. to at least 20 litres of clean water each day to The 2015 target date is important for practi- meet basic needs is a minimum requirement for cal and symbolic reasons. At a practical level it respecting the right to waterand a minimum reminds us that time is running outand that target for governments. the deadline for the investments and policiesHuman rights are not optional extras. Norneeded to deliver results is fast approaching. are they a voluntary legal provision to be em-Symbolically, 2015 matters in a deeper sense. braced or abandoned on the whim of individual The state of the world in that year will be a governments. They are binding obligations thatjudgement on the state of international cooper- reflect universal values and entail responsibili- ation today. It will hold up a mirror to the gen- ties on the part of governments. Yet the humaneration of political leaders that signed the Mil- right to water is violated with impunity on a lennium Development Goal pledge and deliver widespread and systematic basisand it is the the verdict on whether the pledge was honoured human rights of the poor that are subject to thein the breach or the observance. gravest abuse. Some time in 2015 another less important but no less symbolic event will take place. The Reaching the Millennium Development US National Aeronautics and Space Adminis- Goal target in 2015a test of humanitytration will launch the Jupiter Icy Moons Proj- There is now less than 10 years to go to the 2015 ect. Using technology now under development, target date for achieving the Millennium De-a spacecraft will be dispatched to orbit three velopment Goalsthe time-bound targets of of Jupiters moons to investigate the composi- the international community for reducing ex-tion of the vast saltwater lakes beneath their ice treme poverty and hunger, cutting child deaths, surfacesand to determine whether the condi- getting children an education and overcomingtions for life exist. The irony of humanity spend- gender inequalities. Progress in each of theseing billions of dollars in exploring the potential areas will be conditioned by how governmentsfor life on other planets would be powerful respond to the crisis in water. and tragicif at the same time we allow the The Millennium Development Goals pro- destruction of life and human capabilities on vide a benchmark for measuring progress to- planet Earth for want of far less demanding wards the human right to water. That is why technologies: the infrastructure to deliver clean 4 Human De velopmen T RepoR T 2006 20. water and sanitation to all. Providing a glass ofthe first third of the 20th century. In Great Not having access to waterclean water and a toilet may be challenging, but Britain the expansion of sanitation contributed and sanitation is a politeit is not rocket science.to a 15-year increase in life expectancy in the euphemism for a form of Mahatma Gandhi once commented thatfour decades after 1880.the difference between what we do and whatdeprivation that threatenswe are capable of doing would suffice to solve The fault line between sanitation life, destroys opportunity andmost of the worlds problems. That observationand water undermines human dignityhas a powerful resonance for the MillenniumIn rich countries clean water is now available atDevelopment Goals. The unprecedented com-the twist of a tap. Private and hygienic sanita-bination of resources and technology at our dis- tion is taken for granted. Concern over waterposal today makes the argument that the 2015 shortages may occasionally surface in sometargets are beyond our reach both intellectually countries. But that concern has to be placed inand morally indefensible. We should not be sat-perspective. Children in rich countries do notisfied with progress that falls short of the goals die for want of a glass of clean water. Young girlssetor with half measures that leave whole sec-are not kept home from school to make longtions of humanity behind.journeys to collect water from streams and riv- ers. And waterborne infectious disease is a sub-Water for lifethe global crisis in waterject for history books, not hospital wards andand sanitation morgues.Clean water and sanitation are among the most The contrast with poor countries is strik-powerful drivers for human development. They ing. While deprivation is unequally distributedextend opportunity, enhance dignity and help across regions, the facts of the global water cri-create a virtuous cycle of improving health andsis speak for themselves. Some 1.1 billion peoplerising wealth. in the developing world do not have access to a People living in rich countries today are minimal amount of clean water. Coverage ratesonly dimly aware of how clean water fostered are lowest in Sub-Saharan Africa, but most peo-social progress in their own countries. Just overple without clean water live in Asia. Deprivationa hundred years ago London, New York and in sanitation is even more widespread. SomeParis were centres of infectious disease, with 2.6 billion peoplehalf the developing worldsdiarrhoea, dysentery and typhoid fever under-populationdo not have access to basic sanita-mining public health. Child death rates were tion. And systemic data underreporting meansas high then as they are now in much of Sub- that these figures understate the problem.Saharan Africa. The rising wealth from indus- Not having access to water and sanita-trialization boosted income, but child mortal- tion is a polite euphemism for a form of depri-ity and life expectancy barely changed.vation that threatens life, destroys opportunity Sweeping reforms in water and sanitationand undermines human dignity. Being with-changed this picture. Clean water became the out access to water means that people resort tovehicle for a leap forward in human progress.ditches, rivers and lakes polluted with humanDriven by coalitions for social reform, by moral or animal excrement or used by animals. It alsoconcern and by economic self-interest, govern- means not having sufficient water to meet evenments placed water and sanitation at the centrethe most basic human needs.of a new social contract between states and citi- While basic needs vary, the minimumzens. Within a generation they put in place thethreshold is about 20 litres a day. Most of thefinance, technology and regulations needed to1.1 billion people categorized as lacking accessbring water and sanitation for all within reach. to clean water use about 5 litres a dayone- The new infrastructure broke the link be- tenth of the average daily amount used in richtween dirty water and infectious disease. By one countries to flush toilets. On average, people inestimate water purification explains almost half Europe use more than 200 litresin the Unitedthe mortality reduction in the United States inStates more than 400 litres. When a EuropeanHum a n De v e l opme n T Re p oR T 2006 5 21. Water and sanitation are person flushes a toilet or an American person Close to half of all people in developingamong the most powerfulshowers, he or she is using more water than iscountries suffering at any given time from a available to hundreds of millions of individu-health problem caused by water and sanita- preventive medicinesals living in urban slums or arid areas of the de-tion deficits.available to governments toveloping world. Dripping taps in rich countries Millions of women spending several hours areduce infectious disease. lose more water than is available each day to day collecting water. more than 1 billion people. Lifecycles of disadvantage affecting mil-Investment in this area is to Not having access to sanitation means that lions of people, with illness and lost educa-killer diseases like diarrhoea people are forced to defecate in fields, ditchestional opportunities in childhood leadingwhat immunization is toand buckets. The flying toilets of Kibera,to poverty in adulthood. a slum in Nairobi, Kenya, highlight what it To these human costs can be added the measlesa life-savermeans to be without sanitation. Lacking access massive economic waste associated with the to toilets, people defecate into plastic bags that water and sanitation deficit. Measuring these they throw onto the streets. The absence of toi- costs is inherently difficult. However, new re- lets poses particularly severe public health and search undertaken for this years Human Devel- security problems for women and young girls. opment Report highlights the very large losses In sanitation as in water, gender inequality sustained in some of the worlds poorest coun- structures the human costs of disadvantage.tries. The research captures the costs associatedAccess to water and sanitation reinforces with health spending, productivity losses and some long-standing human development les-labour diversions. sons. On average, coverage rates in both areasLosses are greatest in some of the poorest rise with income: increasing wealth tends to countries. Sub-Saharan Africa loses about 5% bring with it improved access to water and of GDP, or some $28.4 billion annually, a fig- sanitation. But there are very large variationsure that exceeds total aid flows and debt relief to around the average. Some countriessuch as the region in 2003. In one crucial respect these Bangladesh and Thailand in sanitation, and Sri aggregate economic costs obscure the real im- Lanka and Viet Nam in waterdo far betterpact of the water and sanitation deficit. Most than would be expected solely on the basis ofof the losses are sustained by households below income. Otherssuch as India and Mexico forthe poverty line, retarding the efforts of poor sanitationdo far worse. The lesson: incomepeople to produce their way out of poverty. matters, but public policy shapes the conversionOn any measure of efficiency, investments in of income into human development.water and sanitation have the potential to gen-erate a high return. Every $1 spent in the sector The human development costs creates on average another $8 in costs averted immenseand productivity gained. Beyond this static Deprivation in water and sanitation produces gain, improved access to water and sanitation multiplier effects. The ledger includes the fol- has the potential to generate long-run dynamic lowing costs for human development:effects that will boost economic efficiency. Some 1.8 million child deaths each year as aWhether measured against the benchmarkresult of diarrhoea4,900 deaths each day of human suffering, economic waste or extremeor an under-five population equivalent in sizepoverty, the water and sanitation deficit inflicts ato that for London and New York combined. terrifying toll. The flip-side is the potential for re-Together, unclean water and poor sanitation ducing that deficit as a means for human progress.are the worlds second biggest killer of chil-Water and sanitation are among the most power-dren. Deaths from diarrhoea in 2004 wereful preventive medicines available to governmentssome six times greater than the average an- to reduce infectious disease. Investment in thisnual deaths in armed conflict for the 1990s.area is to killer diseases like diarrhoea what im- The loss of 443 million school days each munization is to measlesa life-saver. Researchyear from water-related illness.for this Report shows that access to safe water 6Human De velopmen T RepoR T 2006 22. reduces child death rates by more than 20% in Prognosis for meeting the MillenniumAlmost two in three peopleCameroon and Uganda. In Egypt and Peru theDevelopment Goal target lacking access to clean waterpresence of a flush toilet in the house reduces the The Millennium Development Goals are not theand more than 660 millionrisk of infant death by more than 30%.first set of ambitious targets embraced by govern-ments. Water and sanitation for all within apeople without sanitationA crisis above all for the poor decade was among the impressive set of targetslive on less than $2 a dayThe crisis in water and sanitation isabove adopted following high-level conferences in thealla crisis for the poor. Almost two in three1970s and the 1980s. Performance fell far short ofpeople lacking access to clean water survive on the promise. Will it be different this time round?less than $2 a day, with one in three living onIn aggregate the world is on track for theless than $1 a day. More than 660 million peopletarget for water largely because of strong prog-without sanitation live on less than $2 a day, andress in China and India, but only two regionsmore than 385 million on less than $1 a day.are on track for sanitation (East Asia and Latin These facts have important public policy America). Large regional and national varia-implications. They point clearly towards thetions are masked by the global picture.limited capacity of unserved populations to fi- On current trends Sub-Saharan Africa willnance improved access through private spend- reach the water target in 2040 and the sani-ing. While the private sector may have a role to tation target in 2076. For sanitation Southplay in delivery, public financing holds the key Asia is 4 years off track, and for water theto overcoming deficits in water and sanitation.Arab States are 27 years off track. The distribution of access to adequate water Measured on a country by country basis, theand sanitation in many countries mirrors the water target will be missed by 234 milliondistribution of wealth. Access to piped waterpeople, with 55 countries off track.into the household averages about 85% for the The sanitation target will be missed by 430wealthiest 20% of the population, compared million people, with 74 countries off track.with 25% for the poorest 20%. Inequality ex- For Sub-Saharan Africa to get on track,tends beyond access. The perverse principle that connection rates for water will have to riseapplies across much of the developing world is from 10 million a year in the past decade tothat the poorest people not only get access to 23 million a year in the next decade. Southless water, and to less clean water, but they also Asias rate of sanitation provision will havepay some of the worlds highest prices:to rise from 25 million people a year to 43 People living in the slums of Jakarta, Indo- million a year. nesia; Manila, the Philippines; and Nairobi,The Millennium Development Goals Kenya, pay 510 times more for water per should be seen as a minimum threshold of pro- unit than those in high-income areas ofvision not as a ceiling. Even if they are achieved, their own citiesand more than consum- there will still be a large global deficit. What is ers pay in London or New York. worrying about the current global trajectory is High-income households use far more water that the world is on course to finish below the than poor households. In Dar es Salam, Tan-floor defined by the Millennium Development zania, and Mumbai, India, per capita water Goal promise. use is 15 times higher in high-income sub- urbs linked to the utility than in slum areas. Closing the gaps between current trends Inequitable water pricing has perverse conse- and targets quences for household poverty. The poorest Changing this picture is not just the right thing 20% of households in El Salvador, Jamaicato do, but also the sensible thing to do. It is the and Nicaragua spend on average more than right thing to do because water and sanitation 10% of their household income on water. In are basic human rightsand no government the United Kingdom a 3% threshold is seenshould be willing to turn a blind eye to the as an indicator of hardship. current level of human rights violation or the Hum a n De v e l opme n T Re p oR T 2006 7 23. What is needed in theassociated loss of human potential. And it is Since the mid-1990s there has been a prolifera-decade ahead is a concertedthe sensible thing to do because access to watertion of international conferences dealing with and sanitation equips people to get themselveswater, along with a proliferation of high-levelinternational drive starting out of poverty and to contribute to nationalinternational partnerships. Meanwhile, therewith nationally ownedprosperity. are 23 UN agencies dealing with water andstrategies, but incorporating Quantifying the potential gains for humansanitation. development from progress in water and sanita-So many conferences, so much activitya global action plan tion is difficult. But best estimates suggest thatand so little progress. Looking back over the the benefits heavily outweigh the costs. The ad-past decade, it is difficult to avoid the conclu- ditional costs of achieving the Millennium De-sion that water and sanitation have suffered velopment Goal on the basis of the lowest-cost, from an excess of words and a deficit of action. sustainable technology option amount to about What is needed in the decade ahead is a con- $10 billion a year. Closing the gap between cur-certed international drive starting with na- rent trends and target trends for achieving the tionally owned strategies, but incorporating Millennium Development Goal for water and a global action plan. There are no ready-made sanitation would result in: blueprints for reform, but four foundations are Some 203,000 fewer child deaths in 2015 crucial for success.and more than 1 million childrens lives Make water a human rightand mean it.saved over the next decade.All governments should go beyond vague An additional 272 million days gained inconstitutional principles to enshrine theschool attendance as a result of reduced epi-human right to water in enabling legisla-sodes of diarrhoea alone.tion. To have real meaning, the human Total economic benefits of about $38 bil- right has to correspond to an entitlement tolion annually. The benefits for Sub-Saharana secure, accessible and affordable supply ofAfricaabout $15 billionwould represent water. The appropriate entitlement will vary60% of its 2003 aid flows. Gains for South by country and household circumstance.Asia would represent almost $6 billion.But at a minimum it implies a target of atCan the world afford to meet the costs ofleast 20 litres of clean water a day for every accelerated progress towards water and sani-citizenand at no cost for those too poor tation provision? The more appropriate ques-to pay. Clear benchmarks should be set for tion is: can the world afford not to make the progressing towards the target, with na- investments?tional and local governments and water pro-The $10 billion price tag for the Millen-viders held accountable for progress. While nium Development Goal seems a large sumprivate providers have a role to play in water but it has to be put in context. It represents less delivery, extending the human right to than five days worth of global military spend- water is an obligation of governments. ing and less than half what rich countries spend Draw up national strategies for water and each year on mineral water. This is a small price sanitation. All governments should prepare to pay for an investment that can save millions national plans for accelerating progress in of young lives, unlock wasted education poten-water and sanitation, with ambitious targets tial, free people from diseases that rob them ofbacked by financing and clear strategies for their health and generate an economic returnovercoming inequalities. Water and, even that will boost prosperity. more so, sanitation are the poor cousins of poverty reduction planning. They suffer Four foundations for successfrom chronic underfinancing, with public If high-level international conferences, en-spending typically less than 0.5% of GDP. couraging statements and bold targets could Life-saving investments in water and sani- deliver clean water and basic sanitation, the tation are dwarfed by military spending. global crisis would have been resolved long ago.In Ethiopia the military budget is 10 times 8Human De velopmen T RepoR T 2006 24. the water and sanitation budgetin Paki- owned and nationally led strategies, provid- Poor people get lessstan, 47 times. Governments should aim ing predictable, long-term support. There is access to clean waterat a minimum of 1% of GDP for water andalso scope for supporting the efforts of localand pay more for itsanitation spending. Tackling inequal- governments and municipal utilities to raiseity will require a commitment to financ- money on local capital markets.ing strategiesincluding fiscal transfers, Develop a global action plan. Internationalcross-subsidies and other measuresthatefforts to accelerate progress in water andbring affordable water and sanitation to the sanitation have been fragmented and inef-poor. National strategies should incorporate fective, with a surfeit of high-level confer-benchmarks for enhanced equity including:ences and a chronic absence of practicalMillennium Development Goals. Sup-action. In contrast to the strength of the plementing the 2015 target of halving international response for HIV/AIDS and the proportion of people without access education, water and sanitation have not to water and sanitation with policies tofigured prominently on the global develop- halve the gap in coverage ratios betweenment agenda. Having pledged a global ac- rich and poor.tion plan two years ago, the Group of EightPoverty Reduction Strategy Papers.countries have not set water and sanitation Making water and sanitation key priori- as a priority. The development of a global ac- ties, with clear goals and targets linked tion plan to mobilize aid financing, support to medium-term financing provisions.developing country governments in draw-Water providers. Ensuring that utilities, ing on local capital markets and enhance public and private, along with munici-capacity-building could act as a focal point pal bodies, include clear benchmarksfor public advocacy and political efforts in for equity, with associated penalties for water and sanitation. noncompliance. Support national plans with internationalProviding water for lifeaid. For many of the poorest countries de-velopment assistance is critical. Progress inThe human right to water, declares thewater and sanitation requires large upfrontUnited Nations Committee on Economic,investments with long payback periods. Social and Cultural Rights, entitles everyoneConstraints on government revenue limitto sufficient, safe, acceptable, physically acces-the financing capacity of many of the poor-sible and affordable water for personal and do-est countries, while cost-recovery potential mestic use. These five core attributes representis limited by high levels of poverty. Most do- the foundations for water security. Yet they arenors recognize the importance of water and widely violated.sanitation. However, development assistanceWhy is it that poor people get less access tohas fallen in real terms over the past decade, clean water and pay more for it? In urban areasand few donors see the sector as a priority: the cheapest, most reliable source of water isthe sector now accounts for less than 5% usually the utility that maintains the network.of development assistance. Aid flows willPoor households are less likely to be connectedneed to roughly double to bring the Millen-to the networkand more likely to get theirnium Development Goal within reach, ris- water from a variety of unimproved sources.ing by $3.6$4 billion annually. InnovativeIn Dar es Salaam, Tanzania, or Ouagadougou,financing strategies such as those providedBurkina Faso, fewer than 30% of householdsfor under the International Finance Facil- are connected.ity are essential to provide upfront financ- When households are not connected,ing to avert the impending shortfall against they have limited options. Either they col-the Millennium Development Goal target.lect water from untreated sources or a publicDonors should act in support of nationally source, or they purchase water from a range of Hum a n De v e l opme n T Re p oR T 2006 9 25. The criterion for assessing intermediaries, including standpipe operators, The key role of public providers policy should not be public water vendors and tanker truck operators. TheIn recent years international debate on the debate on water privatization has tended tohuman right to water has been dominated by or private but performance or overlook the fact that the vast majority of thepolarized exchanges over the appropriate roles nonperformance for the poor poor are already purchasing their water in pri-of the private and public sectors. Important vate markets. These markets deliver water of issues have been raisedbut the dialogue has variable quality at high prices. generated more heat than light. Some privatization programmes have pro- High prices for the poor duced positive results. But the overall record is Distance from the utility inflates prices. Asnot encouraging. From Argentina to Bolivia, water passes through intermediaries and each and from the Philippines to the United States, adds transport and marketing costs, prices are the conviction that the private sector offers a ratcheted up. Poor people living in slums oftenmagic bullet for unleashing the equity and ef- pay 510 times more per litre of water thanficiency needed to accelerate progress towards wealthy people living in the same city.water for all has proven to be misplaced. WhileUtility pricing policies add to the problems. these past failures of water concessions do not Most utilities now implement rising block tar- provide evidence that the private sector has no iff systems. These aim to combine equity withrole to play, they do point to the need for greater efficiency by raising the price with the volumecaution, regulation and a commitment to equity of water used. In practice, the effect is often to in public-private partnerships. lock the poorest households into the higher tar-Two specific aspects of water provision iff bands. The reason: the intermediaries servingin countries with low coverage rates caution poor households are buying water in bulk at theagainst an undue reliance on the private sector. highest rate. In Dakar poor households using First, the water sector has many of the character- standpipes pay more than three times the price istics of a natural monopoly. In the absence of a paid by households connected to the utility. strong regulatory capacity to protect the publicIf utility prices are so much cheaper, whyinterest through the rules on pricing and invest- do poor households not connect to the utility? ment, there are dangers of monopolistic abuse. Often because they are unable to afford the con- Second, in countries with high levels of poverty nection fee: even in the poorest countries thisamong unserved populations, public finance is can exceed $100. In Manila the cost of connect-a requirement for extended access regardless of ing to the utility represents about three monthswhether the provider is public or private. income for the poorest 20% of households, ris-The debate on privatization has sometimes ing to six months in urban Kenya. Location is diverted attention from the pressing issue of another barrier to entry. In many cities utilities public utility reform. Public providers domi- refuse to connect households lacking formalnate water provision, accounting for more than property titles, thereby excluding some of the 90% of the water delivered through networks poorest households.in developing countries. Many publicly ownedRural households face distinct problems.utilities are failing the poor, combining inef- Living beyond formal networks, rural commu-ficiency and unaccountability in management nities typically manage their own water systems, with inequity in financing and pricing. But though government agencies are involved in ser-some public utilitiesPorto Alegre in Brazil vice provision. Most agencies have operated on is an outstanding examplehave succeeded in a command and control model, often supply- making water affordable and accessible to all. ing inappropriate technologies to inappropriate There are now real opportunities to learn locations with little consultation. The result has from failures and build on successes. The crite- been a combination of underfinancing and low rion for assessing policy should not be public or coverage, with rural women bearing the costs byprivate but performance or nonperformance for collecting water from distant sources. the poor. 10 Human De velopmen T RepoR T 2006 26. Some countries have registered rapid prog- More broadly, it is important that govern-Progress depends onress in water provision. From Colombia to Sen-ments extend the regulatory remit beyond for-setting attainable targetsegal and South Africa innovative strategies havemal network providers to the informal mar- in national plans thatbeen developed for extending access to poor kets that poor people use. Regulation does nothouseholds in urban areas. While rural popula-mean curtailing the activities of private provid-are backed by financingtions continue to lag behind urban populationsers serving the poor. But it does mean working provisions and strategiesglobally, countries as diverse as Morocco and with these providers to ensure adherence to for overcoming inequalityUganda have sustained rapid increases in cover- rules on equitable pricing and water quality.age. What are the keys to success? Sustainable and equitable cost-recovery ispart of any reform programme. In many casesPolitical leadership and attainable targets there are strong grounds for increasing watermake the difference prices to more realistic levels and for improvingAs emphasized throughout this Report, there the efficiency of water management: in manyare no ready-made solutions. Policies that pro- countries water losses are too high and revenueduce positive outcomes for the poor in one set- collection is too low to finance a viable system.ting can fail in another. However, some broadWhat is sustainable and equitable varieslessons emerge from the success stories. The first, across countries. In many low-income countriesand perhaps the most important, is that political the scope for cost-recovery is limited by pov-leadership matters. The second is that progress erty and low average incomes. Public spendingdepends on setting attainable targets in national backed by aid is critical. Middle-income coun-plans that are backed by financing provisions tries have more scope for equitable cost-recoveryand strategies for overcoming inequality. if governments put in place mechanisms to limit This does not mean uncritical support forthe financial burden on poor households.blanket subsidies. Well designed subsidies inMiddle-income and some low-income coun-Chile, Colombia and South Africa do reach tries also have the potential to draw more onthe poorand do make a difference. But in local capital markets. This is an area in whichmany cases subsidies ostensibly designed to international support can make a differenceenhance equity in utility pricing provide large through credit guarantees and other mecha-transfers to the wealthy, with few benefits for nisms that reduce interest rates and market per-poor households that are not connected to utili-ceptions of risk.ties. Similarly, in much of Sub-Saharan Africa Building on the national and global plan-higher income households with connections ning framework set out in chapter 1, core strate-to utilities derive the greatest gains from water gies for overcoming national inequalities in ac-sold at prices far below the level needed to covercess to water include:operations and maintenance costs. Setting clear targets for reducing inequal- ity as part of the national poverty reductionRegulation and sustainable cost-recovery strategy and Millennium Developmentare vital to equity and efficiency Goal reporting system, including halvingBecause water networks are natural monopo- disparities in coverage between rich andlies, regulation needs to ensure that providerspoor.meet standards for efficiency and equityin ef- Establishing lifeline tariffs that provide suf-fect, protecting the interests of the user. Strong,ficient water for basic needs free of charge orindependent regulatory bodies have been dif- at affordable rates, as in South Africa.ficult to establish in many developing coun- Ensuring that no household has to spendtries, leading to political interference and non-more than 3% of its income to meet itsaccountability. But efforts to build regulationwater needs.through dialogue between utility providers and Targeting subsidies for connections andcitizens have yielded some major advancesas water use to poor households, as developedin Hyderabad, India. in Chile and Colombia.Hum a n De v e l opme n T Re p oR T 2006 11 27. Even more than water, Increasing investments in standpipe provi-Why the deficit is so large sanitation suffers from asion as a transitional strategy to make clean,If sanitation is so critical to social and economicaffordable water available to the poor. progress, why is the deficit so largeand why combination of institutional Enacting legislation that empowers people is the world off track for achieving the Millen- fragmentation, weakto hold providers to account. nium Development Goal target? Many factorsnational planning and Incorporating into public-private partner-contribute.ship contracts clear benchmarks for equity The first is political leadership or, rather, low political status in the extension of affordable access to poor its absence. Public policies on sanitation arehouseholds. as relevant to the state of a nation as economic Developing regulatory systems that are ef-management, defence or trade, yet sanitation isfective and politically independent, with accorded second or third order priority. Evena remit that stretches from the utility net-more than water, sanitation suffers from a com-work to informal providers. bination of institutional fragmentation, weaknational planning and low political status.Closing the vast deficit in sanitation Poverty is another barrier to progress: thepoorest households often lack the financingThe sewer is the conscience of the city, wrotecapacity to purchase sanitation facilities. ButVictor Hugo in Les Miserables. He was describ-other factors also constrain progress, includ-ing 19th century Paris, but the state of sanita-ing household demand and gender inequality.tion remains a powerful indicator of the state of Women tend to attach more importance to san-human development in any community. itation than do men, but female priorities carryAlmost half the developing world lacks ac-less weight in household budgeting.cess to sanitation. Many more lack access togood quality sanitation. The deficit is widelyHow community-governmentdistributed. Coverage rates are shockingly lowpartnerships can helpin many of the worlds very poorest countries:The daunting scale of the sanitation deficitonly about 1 person in 3 in Sub-Saharan Af- and the slow progress in closing that deficitrica and South Asia has accessin Ethiopia theare seen by some as evidence that the Millen-figure falls to about 1 in 7. And coverage ratesnium Development Goal target is now unat-understate the problem, especially in countries tainable. The concern is justified, but the con-at higher incomes. In Jakarta and Manila oldclusion is flawed. There are many examples ofsewerage systems have been overwhelmed by a rapid progress in sanitation, some driven fromcombination of rapid urbanization and chronic below by local communities and some led byunderinvestment, leading to the rapid spreadgovernments:of pit latrines. These latrines now contaminate In India and Pakistan slum dweller asso-groundwater and empty into rivers, pollutingciations have collaborated to bring sanita-water sources and jeopardizing public health. tion to millions of people, using the powerAccess to sanitation bestows benefits atof communities to mobilize resources. Themany levels. Cross-country studies show thatNational Slum Dwellers Federation in Indiathe method of disposing of excreta is one ofand the Orangi Pilot Project in Pakistan,the strongest determinants of child survival: among many other community organiza-the transition from unimproved to improvedtions, have shown what is possible throughsanitation reduces overall child mortality by practical action.about a third. Improved sanitation also brings The Total Sanitation Campaign in Bangla-advantages for public health, livelihoods and desh has been scaled up from a community-dignityadvantages that extend beyond house-based project to a national programme thatholds to entire communities. Toilets may seem is achieving rapid increases in access to sani-an unlikely catalyst for human progressbut tation. Cambodia, China, India and Zam-the evidence is overwhelming. bia have also adopted it. 12 Human De velopmen T RepoR T 2006 28. Government programmes in Colombia,In sanitation the taboo remains resolutely Community-led initiatives areLesotho, Morocco and Thailand have ex-intact. This helps to explain why the subject does important, but they are notpanded access to sanitation across all wealth not receive high-level political leadership, and it a substitute for governmentgroups. West Bengal in India has also seldom figures in election campaigns or publicachieved extraordinary progress.debate. One of the reasons that the stigma has actionand private financing In Brazil the condominial approach to sew-been so slow to dissolve is that the crisis in sani- by poor households is not aerage has reduced costs and brought sanita- tation, unlike the crisis in HIV/AIDS, is more substitute for public financetion to millions of peopleand it is nowdiscriminating: it is overwhelmingly a crisis forbeing adopted elsewhere.the poor, not the wealthy. Tackling the crisis and service provisionEach of these success stories has different will require more awareness of the scale of theroots. Widely divergent public policies havecosts generated by the deficit in sanitation, asbeen developed to respond to local problems.well as a wider recognition that sanitation is aBut in each case the emphasis has been on de- basic right.veloping demand for sanitation, rather than Among the key policy challenges inapplying top-down supply-side models of pro-sanitation:vision. Community initiative and involvement Developing national and local political in-have been critical. But equally critical has been stitutions that reflect the importance ofthe interaction between government agencies sanitation to social and economic progress.and local communities. Building on community-level initiativesLocal solutions to local problems may bethrough government interventions aimedthe starting point for change. But it is up to gov- at scaling up best practice.ernments to create the conditions for resolving Investing in demand-led approachesnational problems through the mobilization of through which service providers respondfinance and the creation of conditions for mar- to the needs of communities, with womenkets to deliver appropriate technologies at anhaving a voice in shaping priorities.affordable price. Community-led initiatives are Extending financial support to the poorestimportanteven critical. However, they are nothouseholds to ensure that sanitation is ana substitute for government action. And private affordable option.financing by poor households is not a substitutefor public finance and service provision. Managing water scarcity, risk andvulnerabilityOvercoming the stigma of human wasteOne of the most important lessons from theIn the early 21st century debates on water in-sanitation success stories is that rapid progress creasingly reflect a Malthusian diagnosis ofis possible. With support from aid donors, even the problem. Dire warnings have been postedthe poorest countries have the capacity to mobi-pointing to the gloomy arithmetic of risinglize the resources to achieve change. Perhaps the population and declining water availability. Isbiggest obstacle can be summarized in a singlethe world running out of water?word: stigma. Not in any meaningful sense. But water There are some uncomfortable parallels be- insecurity does pose a threat to human devel-tween sanitation and HIV/AIDS. Until fairly opment for a largeand growingsection ofrecently the cultural and social taboos sur-humanity. Competition, environmental stressrounding HIV/AIDS impeded development ofand unpredictability of access to water as a pro-effective national and international responses, ductive resource are powerful drivers of waterat enormous human cost. That taboo has been insecurity for a large proportion of the globalweakening, partly because of the scale of the population.destructionbut also because HIV/AIDS af- Viewed at a global level, there is moreflicts all members of society without regard forthan enough water to go around and meet alldistinctions based on wealth. of humanitys needs. So why is water scarcityHum a n De v e l opme n T Re p oR T 2006 13 29. Scarcity has been induceda problem? Partly because water, like wealth,systems that fail to measure the depletion ofby policy failureswhenis unequally distributed between and withinscarce and precious natural capitaland it raises countries. It does not help water-stressed coun- important ques