Prerpints.org logo
Preprint
Article

Who Is Being Left behind in Water Security towards the Achievement of the 2030 Agenda?

Altmetrics

Downloads

144

Views

63

Comments

0

supplementary.pdf (1018.71KB )

This version is not peer-reviewed

Submitted:

08 September 2023

Posted:

11 September 2023

You are already at the latest version

Alerts
Abstract
We investigate if anyone is being left behind in accessing safely managed drinking water (SM) in achieving the 2030 agenda. We use 23 countries grouped globally as critically insecure water (CIWC). The results indicate none of the CIWC had over 50% of the population accessing SM, N. America and Europe had highest percentages while Sub Saharan Africa had the least. People left behind are found in rural areas, in countries vulnerable to climate change because of poor governance, low-income, and women’s low education. Institutional quality, equity and equality should be improved in using resources critical to leaving no one behind.
Keywords: 
Subject: Environmental and Earth Sciences  -   Water Science and Technology

1. Introduction

UN Member States in 2015 adopted Sustainable Development Goals (SDGs) pledging to “leave no one behind” within and between nations, peoples and segments of society; endeavoring to reach the furthest behind first (UN 2015). The concept of leave no one behind (LNOB) implies no individual, group of people, country, or region should be left behind in the quest to achieve the SDGs. Out of the 17SDGs, this paper’s investigation is on SDG 6 whose task is to ensure availability and sustainable management of water and sanitation for all. We focus on target 6.1.1 “Proportion of population using safely managed drinking water services” (UNstats 2023).
The present study applies the UN- Water (2013) definition of water security as “The capacity of a population to safeguard sustainable access to adequate quantities of acceptable quality water for sustaining livelihoods, human well-being, and socio-economic development, for ensuring protection against water-borne pollution and water-related disasters, and for preserving ecosystems in a climate of peace and political stability”. The definition implies water security is attained if all people everywhere can access adequate good quality water to sustain good health, income and socio-economic development activities; and that used water is treated to prevent pollution and disease; and to boost resilience against floods and droughts; and good governance to resolve any disputes.
Water resources play a critical role because firstly, about 71% of the earth’s surface is covered by water, however only 0.5% of the total water found in rivers, lakes, streams, aquifers, rainfall and reservoirs can be usable by humans. Whereas a large portion of the rest of the water is salty and a small portion is frozen freshwater (Arora and Mishra 2022; Visbeck 2018). Secondly, on average, the adult human body contains approximately 67.85% of water distributed evenly to 70% of all major body organs (Munteau et al. 2021). Lastly, water sustains all life including humans, animals and plants, and of human development. However, water is affected by human activities including land use change and pollution that contribute to climate change effects that exacerbate floods and drought, and water related conflicts (Falkenmark 2020).
According to the Sustainable Development Goals Report (SDG 2022), as of 2020 the proportion of the global population with access to safely managed drinking water services was 74%, nonetheless, 2 billion people lacked access to these services. Whereas 1.2 billion lacked access to basic water services. The report predicts that at the present rate of progress by 2030, 81% will be covered globally and 1.6 billion will be left behind without access to safely managed drinking water services. To meet the target of LNOB by 2030, asks for fourfold increase in the present rate of progress. About 72% of the world’s population reside in water insecure countries, while 8% in critically water insecure countries (MacAlister et al. 2023). UNICEF (2021) reported that 1.42 billion people including 450 million children reside in regions exposed to high or extremely high water vulnerability. According to UN –Water (2023) report, water use is increasing yearly by about 1% globally since 40years ago, and this same rate is likely to remain through 2050 due to population growth, socio-economic development and changing consumption patterns. During 2000-2019 period, floods caused US$650billion in economic losses, affected 1.65 billion people contributing to over 100,000 deaths. At the same time, droughts influenced 1.43 billion people with economic losses of about US$130 billion. Floods and droughts comprise over 75% natural disasters (CRED/UNDRR 2020). In 2020, about 44% of domestic wastewater globally did not meet safety treatment requirements before being released into the environment (UN-Habitat/WHO 2021).
The achievement of water security (goal 6) is a determinant factor in meeting the targets of 2030 agenda in SDGs including poverty (1), zero hunger (2), health (3), education (4), gender (5), energy (7), work (8), inequality (10), communities (11), and peace and security goal 16 (UN-Water 2016; Adeel 2017). Furthermore, a study by Taka et al. (2021) assessed the synergies and trade-off of enhanced water security on meeting the targets of the 2030 agenda; and found that water security contributes positively to all the SDGs particularly good health and zero hunger.
No child should be left behind in accessing and completing education; access to basic water services in schools is indispensable. Unsafe drinking water largely contributes to diseases such as hepatitis, typhoid, cholera, dysentery, diarrhea, malaria, polio and trachoma (WHO 2022). About half a million deaths in low- and middle income countries are associated with diarrhea a majority of the victims being children under 5 (WHO 2019; Levallois and Villanueva 2019). Access to clean water nurtures good health and well-being and reduces waterborne diseases. Water security facilitates food production leading to food security and reduction of malnutrition. Water fosters socio-economic development through food production, food processing, transformation and preparation subsequently generating income, which in turn enables economic access to food. Whereas constraint access to safe drinking water and sanitation services compromises nutritional status via water-borne diseases and incurable intestinal infections (HLPE 2015; Miller et al 2021; Larson et al. 2020; Young et al. 2021). Schools characterized with unimproved water source, lack handwashing facilities, and have high person to person contact are risky environments for children and staff for they exacerbate susceptibility to environmental health hazards particularly waterborne diseases.
Poor health is a huge burden to children’s education; it contributes to absenteeism from school and poor school grade performance (Sharma and Adhikari 2022; UNICEF 2021). Unprotected water sources deliver unsafe water for it contains neurotoxins or other chemicals that tend to affect brain development from prenatal throughout childhood with severe irreversible consequences affecting motor function, learning, and behavior. Stunted neurodevelopment contributes to lower school grades leading to decreased lifetime earnings and increased crime (Silbergeld 2016; Bondy and Campell 2017). Another path where lack of safe water affects children’s health is by exacerbating malnutrition and stunting which also affects cognitive development. Water scarcity is known to cause children to be absent from school either because of water-borne diseases or to collect water; it triggers child labour, migration and conflicts (UNICEF 2021). Sufficient drinking water quantity boosts students’ education performance by the influence of hydration on attentiveness, focusing, and short-term memory (Chard et al. 2019; Hunter et al 2014).
Our aim is to investigate if anyone is being left behind in accessing safely managed drinking water services globally, across regions, nations and within countries in the quest to achieve the 2030 agenda. Given the important role health, nutrition and education plays in human development and their interlinkages with water security, comparisons will be done between the access of safely managed drinking water in schools (education), under-five mortality rates (health), and child nutrition status (zero hunger) across the globe, regions, countries and within countries to gauge who is being left behind.
Several studies including Correa-Porcel et al. (2021); Chen et al. (2019) and Morales-Garcia and Rubio 2023 among others have investigated water - energy- food nexus. To our knowledge, we are among the first to carry out a study on NOLB on water- health-food- education nexus in terms of the 2030 agenda. This paper will highlight on those left behind in accessing safely managed drinking water services to enable more knowledge exchange on this set of people who generally are deprived of other SDGs given that water security is interlinked to several SDGs. Thus, the paper contributes directly to the ongoing research on water security issues and indirectly to the SDGs linked to water issues. We are not simply identifying those left behind in accessing safely managed water, but are also indicating where they live and why they are being left behind. We thereby present a well-founded basis to enable policymakers to include it in the design and the implementation of the policies to resolve water security issues common to those furthest at the back.

2. Data and methods

2.1. Data source

The study uses secondary data from numerous sources including Our World in Data, a data portal produced by the Oxford Martin Programme on Global Development at the University of Oxford, the data we have used from this source was originally sourced from WHO/UNICEF joint program. Moreover, we have directly used data from WHO/UNICEF. We have also used secondary data from World Bank governance indicators, and DHS datasets. These data sources gather data from internationally renowned sources including national statistical agencies, central banks, and custom services that have used household survey methods to collect data. They standardize the data to enable suggestive comparisons across countries.

2.2. Method

We follow MacAlister et al. (2023) a study that assessed global water security in 2023. 186 countries with sufficient data to access 10 components of water security were covered notwithstanding their size, population or geography. The 10 components of water are drinking water, sanitation, good health, water quality, water availability, water value, water governance, human safety, economic safety and water source stability. The components were assessed using the most recent national SDG indicator data (2020). Each water security component was evaluated and individual countries received a score ranging from 0-10. Country scores were compared globally, while overall national water security score was a result of the sum of the 10 components of a maximum score being 100. National scores were classified as water secure (75 and over), moderately secure (65-74), insecure (41-64) and critically insecure (40 or below). The present study uses 23 countries in the critically insecure group to represent nations left far behind in achieving the 2030 agenda of water security for all. The list of the names of the countries is found in Table 2.
WHO/UNICEF definitions across the drinking water ladder are as follows ‘Safely managed’ drinking water is an improved source located on premises, available at all times, and free from contamination. ‘Basic’ drinking water source’ is an improved source within 30 minutes round trip collection time. ‘Limited’ drinking water source is an improved source over 30minutes round trip collection time. ‘Unimproved’ drinking water source connotes water from unprotected dug well or unprotected spring against contamination. An improved water source implies access to piped water, tube wells, boreholes, protected dug wells, springs and rainwater collection. While ‘surface water’ is water directly from a river, dam, lake, pond stream and canal (Ritchie and Roser 2021).
Data on drinking water in schools is for 2021, and is derived from UNICEF/WHO, this data is worldwide, and countries whose schools have more than 99% access to basic water are not included. While some countries are not included because of missing data during the period in question. We use governance indicators to gauge the impact of institutional quality on water security and other variables of interest in the critical water insecure countries. The respective governance indicators are reported in the standard normal units ranging from -2.5 to 2.5, higher values connote better outcomes (Kaufmann et al.2010). Table on descriptive statistics is in Appendix 1, Table 1.

3. Results and discussions

3.1. Who is being left behind

We investigate who is being left behind in water security by examining the drinking water ladder in terms of percentages of the population accessing safely managed water (SM), basic water, limited water, unimproved water and surface water in critically water insecure countries (CWIC). In Table 1 out of the 22 CWIC, only six countries had information on the percentages of people that had access to safely managed and basic water in 2020. None of the countries had over 50% of the population accessing SM; Pakistan had the highest percentage (36) while Chad had the lowest percentage (5). Pakistan and Sierra Leone had over 50% of their populations with access to basic water, while Madagascar had the least percentage of the population accessing basic water (33). CWIC in 2020 with over 20% of the population grouped as limited access to water were South Sudan (37%), Yemen (29%), Somalia (28%), Ethiopia (27%), Sudan (27%), and Niger (22%). CWIC with over 20% unimproved water source are Chad (32%), Madagascar (32%), Niger (27%), Haiti (23%), Papua New Guinea (22%), and Solomon Islands (21%). In 2020, 30% of Papua New Guinea’s population used surface water, while in Madagascar, Sierra Leone, and in Liberia were 12% respectively. The rest of CWIC had below 10% of their populations using surface water.
In addition, Table 1 compares the percentages of the population with access to an improved water source (piped water, tube wells, boreholes, protected dug wells, springs and rainwater collection) in CWIC between 2000 and 2020. Table 1 shows all countries had positive percentage changes with the exception of Solomon Islands (-14%), Comoros (-12%), and South Sudan (-1%). The percentage of the Ethiopian population with access to improved water source was 19% in 2000, but has performed so well by increasing the population to 50% in 2020 a 174 percentage increase. Other countries with impressive performance are Afghanistan from 28% in 2000 to 76% in 2020 a 167 percentage change and Somalia from 24% in 2000 to 56% in 2020 a 139percentage change. In terms of the population having access to an improved water source Table 1 suggests that all the CWIC had over 50% of their populations using improved water source in 2020, with the exception of South Sudan (40%), Papua New Guinea (45%), Chad (46%) and Niger (47%).
Table 1. Percentage of people across drinking water ladder in critically insecure water countries.
Table 1. Percentage of people across drinking water ladder in critically insecure water countries.
SM Basic Limited Unimpr. Surface Water Water Absolu Relative
2020 2020 2020 2020 2020 2000 2020 change Change
Afghan 28 48 1 14 9 28 76 47 167
Chad 5 40 15 32 8 40 46 7 17
Comoro 90 80 2 -12
Djibouti 15 7 2 75 76 1 1
Eritrea 47 52 5 11
Ethiopi 12 37 27 19 5 19 50 32 174
Haiti 10 23 56 67 1 19
Liberia 9 3 12 62 75 14 22
Libya 0 84 100 16 19
Madag. 20 33 3 32 12 36 53 17 47
Micron. 85 88 3 4
Niger 22 27 4 37 47 2 27
Pakista 36 54 4 4 2 87 90 3 3
P.Guine 2 22 30 33 45 12 37
S. Leon 10 53 9 16 12 40 64 23 57
Sol. Islands 6 21 6 79 67 11 -14
Somalia 28 13 2 24 56 33 139
S. Suda 37 14 9 41 40 0 -1
Sri Lank 1 5 2 80 92 12 15
Sudan 27 4 9 43 60 17 39
Vanua. 1 0 8 82 91 9 11
Yemen 29 8 3 41 61 20 48
Note: Afghan- Afganistan, Ethiopi- Ethiopia, Madag- Madagascar, Micron- Micronesia, Pakista- Pakistan, P. Guine- Papua New Guinea, S. Leon- Sierra Leone, Sol. Islands- Solomon Islands, S. Suda- South Sudan, Sri Lank- Sri Lanka and Vanua- Vanuatu.

3.2. Where are those left behind in water security found?

There is no disaggregated data of drinking water ladder (safely managed water (SM), basic water, limited water, unimproved water and surface water) showing geographical location of people in CWIC, therefore we use improved water source to locate people left behind in water security. Table 2 presents the percent of people using improved water services in rural areas as a percentage of the rural population and the percent of people using improved water services in urban areas as a percentage of the urban population in CWIC in 2020. Afghanistan had 100% of the urban population using improved water, while only 66% of the rural population used improved water source. Sri Lanka had 100% urban and 91% rural, while Vanuatu 100% urban and 88% rural, the respective countries’ percentages of populations had access to improved water source in 2020. All the CWIC countries had above 50% of the urban population with access to improved water source.
Out of the 19 countries that reported, to have above 50% of the urban population with access to improved water sources, nine of them reported to have below 50% of the rural population with access to improved water source. People left behind in accessing at least an improved water source are mostly found in the rural areas including South Sudan (34%), Somalia (37%), Madagascar (36%), Chad (38%), Niger (39%), Papua New Guinea (39%), Ethiopia (40%), Haiti (43%), and Djibouti (47%). These results are similar to Jami and Pizzi (2018) who found that eight out of ten people without access to improved water source live in rural areas, while nine out of ten people drinking surface water live in rural areas. While Adeyeye et al. (2020) reiterate that water supply in rural areas is negligible and inaccessible due its unaffordability, poor service by the formal water infrastructure since local municipalities have limited capacities and resources to maintain or repair when the water systems fail.
Table 2. Immunization, U5MR, access to water, food insecurity and governance indicators.
Table 2. Immunization, U5MR, access to water, food insecurity and governance indicators.
Year 2020 Water Food Under Govt. Polit. Regu. Rule Voice
Imm. U5MR Total Rural Urban Insec. nouri. Corru Effec. Stab. Qual. Law Acc.
Afgha 70 58 75 66 100 70 30 -1.5 -1.6 -2.7 -1.4 -1.8 -1.1
Chad 52 111 46 38 74 .. 33 -1.5 -1.2 -1.1 -1.3 -1.4 -1.4
Como 87 51 80 77 88 80 .. -1.2 -1.6 -0.3 -1.2 -1.3 -0.8
Djibou 70 56 76 47 84 49 14 -0.7 -0.7 -0.5 -0.8 -1.0 -1.4
Eritrea 95 39 .. .. .. .. .. -1.3 -1.6 -1.0 -2.1 -1.5 -2.1
Ethiop 71 49 50 40 84 56 25 -0.4 -0.6 -1.8 -1.0 -0.4 -1.0
Haiti 51 61 67 43 85 83 47 -1.3 -2.1 -1.0 -1.2 -1.0 -0.8
Liberi 65 78 75 64 86 81 38 -0.9 -1.4 -0.4 -1.0 -1.0 -0.1
Libya 73 11 100 .. .. 39 .. -1.6 -1.8 -2.5 -2.2 -1.9 -1.4
Mada 66 66 53 36 80 61 49 -1.0 -1.0 -0.5 -0.8 -0.9 -0.3
Micro 83 26 88 .. .. .. .. 0.9 0.2 1.1 -1.0 0.2 1.1
Niger 81 116 47 39 86 56 .. -0.6 -0.6 -1.7 -0.8 -0.6 -0.5
Pakist 77 66 90 89 93 33 17 -0.8 -0.5 -1.8 -0.7 -0.7 -0.9
P. Gui 39 44 45 39 86 .. 22 -0.6 -0.8 -0.7 -0.7 -0.7 0.0
S. Le 91 109 64 53 78 87 27 -0.4 -1.0 -0.3 -0.9 -0.8 -0.1
S. Isla 94 19 67 59 91 .. 18 0.1 -0.8 0.6 -0.8 0.0 0.6
Somal 42 115 56 37 79 77 53 -1.7 -2.1 -2.6 -1.9 -2.3 -1.8
S. Su 49 99 41 34 70 86 .. -1.9 -2.3 -2.2 -2.0 -1.9 -1.8
Sri La 96 7 92 91 100 10 3 -0.3 0.0 -0.1 -0.2 0.0 -0.1
St. Kit 99 15 .. .. .. 27 .. 0.4 0.7 0.9 0.5 0.5 0.8
Suda 90 57 60 53 74 51 13 -1.4 -1.5 -1.7 -1.6 -1.1 -1.4
Vanu 78 24 91 88 100 23 12 -0.1 -0.4 0.9 -0.4 0.3 0.6
Yeme 72 60 61 51 77 .. 41 -1.7 -2.3 -2.7 -1.8 -1.8 -1.8
Note: Afghan- Afganistan, Djibou- Djibouti, Ethiopi- Ethiopia, Madag- Madagascar, Micron- Micronesia, Pakista- Pakistan, P. Guine- Papua New Guinea, S. Leon- Sierra Leone, Sol. Islands- Solomon Islands, S. Suda- South Sudan, Sri Lank- Sri Lanka, St. Kit- st Kitts and Nevis, and Vanua- Vanuatu.
People being left behind in water security are most likely to be found in countries vulnerable to climate change for it affects water security through droughts and floods. A World Congress on disaster risk reduction (DRR) held in Sendai, Japan in 2015, came up with a framework called Sendai to enable countries to have good governance in handling DRR. Figure 1 in appendix 1 points to country scores in the adoption and implementation of the DRR strategies in line with the Sendai Framework. Figure 1 is a Pareto chart indicating individual country values in descending order. Countries to the right of the chart after the Pareto line intersects with Egypt, Kazakhstan and Namibia starting with Papua New Guinea have low scores in the adoption of DRR, the countries in question are about 50% of the countries in Figure 1 in appendix 1. Consequently, these countries have low human resilience and capacity building contributing to water insecurity, a study by Gheuens et al. (2019) had similar findings.
Comparisons of drinking water ladder across world regions: Table 3 indicates that North America and Europe are at the top with the highest percentages (90.1%) of the populations accessing safely managed water (SM) in 2000 and in 2020 had zero percent of the population using surface water. While Sub Saharan Africa (SSA) in 2000 had only 17.1% of population, using SM, and 18.7% using surface water, in 2020, the percent of the population using SM rose to 30 and surface water fell to 6.8%. The SSA region had the highest percent (15.6%) of the population using unimproved water in 2020; however was a significant improvement from 27.5% in 2000. Furthermore, SSA had the highest percent of the population with limited water access in both 2000 (9%) and in 2020 (12.9%).
In 2020, Table 3 indicates that people being left behind in water security globally are found in SSA, for it had the highest percentages of the population having limited drinking water, population using unimproved water source and surface water.
Comparisons across income levels in Table 3, shows that in 2020 the highest percentages of people being left behind in water security are found in low-income countries. In 2020, 97.6% of the population in high-income countries were using SM water sources, while in low-income countries was 28.8%. In the same period 0.1% of the population in high income countries had limited access to water, while in low income countries 17.8% of the population suffered from limited access to drinking water. In high-income countries 0.2% of the population used unimproved water source in 2020, while in the same period 17.1% of the population in low-income countries used unimproved water source. In 2020, the high-income countries had zero percent of the population using surface water for drinking, while in the same period 5.9% of the population in low-income countries used surface water for drinking purposes. Swe et al. (2021) and Hannah et al.( 2022) found that globally people lacking access to basic drinking water services are found in low and lower-middle- income countries particularly in South Asia, Southeast Asia and SSA.
Figure1 on disaggregated water security across regions and income groups in 2020 vividly confirms the discussions of Table 3.

3.3. Why are people left behind in water security?

In Table 2, the columns on governance indicators indicate that none of CWIC had positive governance indicators above one; the indicators range from -2.5 to 2.5 in ascending order with 2.5 being the best score. Governance effectiveness and regulatory quality capture water governance in terms of the ability of the government to formulate and implement effective policies and regulations, and implement them, and the credibility of the government’s commitment to its stated policies. We note that out of the 23 CWIC, only Micronesia (0.2), Sri Lanka (0.0) and St. Kitts and Nevis (0.7) had positive but insignificant governance effectiveness. Only St. Kitts and Nevis had a positive regulatory quality indicator of 0.5, the rest of the CWIC had negative indicators. These findings apply to the rest of the governance indicators including corruption, political stability, the rule of law, and voice and accountability. These results suggest people in CWIC are left behind in water security because of poor governance, the marginalized have no voice to participate in water security issues, the institutions are generally ineffective, unaccountable leading to inequitable, inadequate and unjust laws, policies, and budgets. Bayu et al (2020) and Jami and Pizzi (2018) concluded that faulty policies and institutions contribute to poor basic service provision including safe drinking water; the poor are affected the most for they cannot afford alternative solutions.
Our findings in Table 3 and Figure 1 indicated that in 2020 97.6% of the populations in high-income countries had access to SM while in low income countries was only 28.8%. This has intrigued us to probe wealth quintiles of CWIC, but due to missing data, Figure 2 portrays wealth quartiles in rural and urban areas of 13 countries out of the 23 countries. We find in Figure 2 a wide disparity between the 20% highest wealth quartile in urban and the highest 20% wealth quartile in rural areas. Countries with over 50% of the 20% of top wealth quartile include Afghanistan with 73% of the top wealth quartile in urban areas and 3% in the rural areas, Chad (81%, 2%), Ethiopia (62%, 5%), Madagascar (66%, 10%), Niger (86%, 5%), Papua New Guinea (71%, 14%) and Yemen (55%, 4%). These disparities partly explain why Table 2 depicts that urban areas have higher percentages of the population with access to improved water services than rural areas. Africa is largely rural this connotes a large percentage of the African population lacks access to improved water services given that majority of rural dwellers belong to the lowest 20% wealth quartile. The lowest 20% in rural Liberia is 39%, Sierra Leone is 34%, Haiti is 33%, and Eritrea is 31%. Swe et al. (2021) concur that reduction of poverty levels substantially increases the percentages of the people accessing basic water services.
Gender roles in developing countries assigns women as domestic water managers for drinking, cooking and hygiene purposes. Educated women are more aware of the benefits of accessing improved water sources and the consequences of drinking unimproved water. Furthermore, women are the main caregivers of family sick members, thus the educated women with awareness of waterborne diseases are most likely to avoid the use of unimproved water sources. Table 4 on female versus male education status in the context of urban versus rural in the CWIC indicates that in 2020 the 12 countries with data, six countries had over 50% women without education. The countries with lowest percentage of women without education were Madagascar (6% urban and 19% rural), and Haiti (6% urban, 20% rural). Percentages of women with secondary or high school education under 10 are found in rural areas including Afghanistan (5), Chad (8), Eritrea (4) and Niger (9). Table 4 suggests that lack of education or low levels of education is a contributing factor for leaving people behind in water security. Adil et al (2021) and Thai and Guevara (2019) found that the more educated people are, the more likely that they will access improved water source as compared to those with low education or illiterate.
World Bank classifies fragile and conflict affected countries as those with high levels of institutional and social fragility, and countries affected by violent conflict. We note in Table 3 that fragile and conflict countries in 2020 had only 42.5% of their population using SM, while 11% used unimproved water and 5.4% used water surface. Thus, a nation’s fragility or conflict prone are determinant factors in meeting water security.

3.4. Which countries are being left behind in accessing water in schools?

Table 5 depicts pre-primary schools with unimproved, limited or basic water services in percentages globally in 2020, countries are disaggregated in quartiles, countries with over 99% of the population accessing basic water services are excluded, other countries are not included because of missing data, this explanation applies to tables 6 and 7. Countries with over 50% of pre-primary schools using unimproved water sources are Equatorial Guinea (75%), Vanuatu (65%), Eritrea (59%), and Papua New Guinea (58%). While countries with less than 50% of pre-primary schools with access to basic water sources include Tanzania (49%), Burundi (48%), Papua New Guinea (34%), and Solomon Islands (26%).
Table 6 on primary schools has more data on water as compared to Table 5 on pre-primary schools. Moreover, the number of countries with over 50% of primary schools with basic water services are 47 as compare to 12 countries, which had over 50% of pre-primary schools with basic water services. Countries with over 50% primary schools using unimproved water sources include Niger (83%), Central African Republic (81%), Ethiopia (80%), Equatorial Guinea (74%), Chad (70%), Madagascar (63%), Guinea (63%), Democratic Republic of Congo (58%), Cote d’Ivoire (56%), Vanuatu (51%) and Burundi (50%).
Table 7 depicts secondary or high school water services, countries with less than 50% of their schools without basic water services are Syria (49%), Nigeria (49%), Niger (48%), Philippines (46%), Burkina Faso (46%), Panama (41%), and Ethiopia (22%). While countries with over 50% of their secondary or high schools using unimproved water sources include Madagascar (74%), Haiti (63%), Vanuatu (58%), Central African Republic (58%) and Chad (50%).

3.5. Where are those schools left behind located and why are they left behind?

Figure 3 answers this question by disaggregating access to drinking water in schools by income levels and geographical location in 2021. Figure 3 indicates that in high-income countries a 100% primary and secondary schools have access to basic water services. Whereas in upper middle income countries 98% of secondary schools and 96% of primary schools have access to basic water services. Lower middle-income countries have 75% of secondary schools with access to basic water, while for primary schools is 63%. Urban areas’ schools with access to basic services are 71%, while rural areas\ schools are 65%. As concerns low-income countries, 39% pre-primary, 45% of the primary schools and 47% of secondary schools have basic water services. The disparity between rural and urban schools’ access to basic water services in low-income countries is unacceptably high (18%:85%). Figure 3 indicates that schools left behind in water security are found in rural areas, and in low income countries the reasons for being left behind are numerous as already discussed in the preceding texts including poverty (wealth quartiles), poor water governance, female’s low education levels in rural areas.

3.6. Lack of improved water source affects health, and food security.

Figure 4 depicts the impact of water security on health (U5MR), CWIC with low percentages of their populations with access to an improved water sources have the highest numbers of under-five child mortality rates. As the improved water line graph rises, the U5MR line graph falls, the lines intersect at Liberia and then water line graph keeps rising reaching its maximum (100%) at Libya with U5MR of 11 for every 1,000 live births. Gaffan et al. (2013) found that children living in households with unimproved water services, their probability of dying before age 5 was higher than that of children living in households using basic water services.
Figure 5 portrays the impact of improved water sources on food insecurity; countries with low percentages of population with access to improved water sources mostly have high percentages of food insecure people. While countries with high percentages of the population with access to improved water sources have low percentages of food insecurity, the movements of the two line graphs point to the important role water plays in nutritional status. Linderthof et al. (2021) reported that water quality affects food security, for example irrigation with polluted water; and people accessing unimproved water for food preparation compromise with food security.
Other factors that complement water security in health and nutritional status are wealth quartiles and geographical location. Table 8 depicts the comparisons of child health and nutrition status across income quartiles, and urban versus rural areas. Apparently, the 13 CWIC with data on the variables of interest do not show much difference between diarrhea in rural and urban areas. Whereas there notable differences in percentages of stunted children between urban and rural areas, with rural areas having higher percentages, for instance Yemen has the highest percentage of stunted children, the urban percentages are 34 compared to the rural that are 51. Rural areas are characterized by low percentages of the population accessing improved water sources, high levels of poverty, low levels of female education. A combination of these factors exacerbate poor child health and nutritional status in rural areas.

4. Conclusion

This paper embarked on the investigation of SDG 6 whose task is to ensure availability and sustainable management of water and sanitation for all by 2030. We focused on target 6.1.1 “Proportion of population using safely managed drinking water services”. We aimed at examining if anyone is being left behind in accessing safely managed drinking water services globally, across regions, nations and within countries in the quest to achieve the 2030 agenda. We followed MacAlister et al. (2023) who assessed global water security with the help of 10 components of water security including drinking water, sanitation, good health, water quality, water availability, water value, water governance, human safety, economic safety and water source stability. Country scores were compared globally, countries were grouped based on their aggregate score from the water security component. This study uses the 23 countries grouped as critically insecure water countries (CIWC) to determine who is being left behind in achieving the 2030 agenda of water security for all.
Results of the drinking water ladder in terms of percentages of the population accessing safely managed water (SM), indicate that none of the countries with data had over 50% of the population accessing SM. Thus, CWIC are the ones being left behind in water security, however these countries are doing better in improved water source but not in SM, for in 2020 all the CWIC had over 50% of their populations using improved water source with the exception of South Sudan, Papua New Guinea, Chad and Niger. It is notable that in 2020 countries like Papua New Guinea’s, Madagascar, Sierra Leone, and Liberia had over 10% of the population using surface water. North America and Europe are at the top with the highest percentages of the populations accessing SM in 2020 and had zero percent of the population using surface water. While Sub Saharan Africa in the same period had the least percentages of the population using SM, and the highest percentages of the population using surface water.
People left behind in accessing at least an improved water source are mostly found in the rural areas of South Sudan, Somalia, Madagascar, Chad, Niger, Papua New Guinea, Ethiopia, Haiti, and Djibouti. People being left behind in water security are most likely to be found in countries vulnerable to climate change for it affects water security through droughts and floods, particularly in those countries with low scores in the adoption and implementation of the DRR strategies in line with the Sendai Framework.
People are left behind in water security because of poor governance, for none of the CWIC had positive significant governance indicators. The governments of CIWC are mostly unable to formulate and implement effective policies and regulations, and are not credible in their commitment to the policies they make. Income levels are a determinant factor in accessing SM, for we find that in 2020 nearly all the populations in high-income countries had access to SM while in low-income countries a minimal percentage of the population had access to SM. Furthermore, the wide disparity between the 20% highest wealth quartile in urban and the highest 20% wealth quartile in rural areas contribute to high percentages of urban populations and very low percentages of rural populations using SM. SSA being largely rural implies a large percentage of the African population lacks access to improved water services given that majority of rural dwellers belong to the lowest 20% wealth quartile. Women’s low education levels is another factor contributing to why CIWC are being left behind in water security, since women are managers of water in most families in developing countries. Educated women are more aware of the benefits of accessing improved water sources and the consequences of drinking unimproved water. High percentages of uneducated women are found in rural areas of Afghanistan, Chad, Eritrea and Niger. Fragile and conflict countries had low percentages of their populations using SM thus, a nation’s fragility or conflict are determinant factors in meeting water security.
Pre-primary schools were found to lag behind primary and secondary or high schools in accessing basic water services. Countries with less than 50% of pre-primary schools with access to basic water sources include Tanzania, Burundi , Papua New Guinea, and Solomon Islands. Countries with over 50% primary schools using unimproved water sources include Niger, Central African Republic, Ethiopia, Equatorial Guinea, Chad, Madagascar, Guinea, Democratic Republic of Congo, Cote d’Ivoire, Vanuatu and Burundi. Countries with less than 50% of their secondary or high schools without access to basic water services are Syria, Nigeria, Niger, Philippines, Burkina Faso, Panama, and Ethiopia. While countries with over 50% of their secondary or high schools using unimproved water sources include Madagascar, Haiti, Vanuatu, Central African Republic and Chad. Low-income levels and geographical location (urban/rural) are among the key factors explaining why some schools lack access to basic water services.
CWIC with low percentages of their populations with access to an improved water sources have the highest numbers of under-five child mortality rates. Countries with low percentages of population with access to improved water sources mostly have high percentages of food insecure people. Rural areas are characterized by low percentages of the population accessing improved water sources, high levels of poverty, and low levels of female education. A combination of these factors exacerbate poor child health and nutritional status in rural areas.

Appendix 1

Table A1. Descriptive statistics.
Table A1. Descriptive statistics.
Average Stdev.err
Lowest20% Urban 3.54 3.14
Rural 28.00 4.99
Highest 20% Urban 57.20 17.22
Rural 5.52 4.34
Women No education Urban 25.25 17.06
Rural 51.69 23.01
Men No education Urban 12.22 9.16
Rural 28.74 15.46
Women Primary Urban 6.49 3.04
Rural 6.11 3.47
Men Primary Urban 6.39 3.46
Rural 8.67 3.53
Women Secondary/high school Urban 51.53 16.14
Rural 20.21 13.39
Men Secondary/high school Urban 67.82 10.39
Rural 38.54 9.16
Diarrhea 18.00 7.47
Immunization, DPT (% of children ages 12-23 months) 73.52 17.70
Mortality rate, under-5 (per 1,000 live births) 58.04 33.82
People using improved water services (% of pop.) 67.89 17.79
People using improved water services, rural (% of rural pop.) 54.95 19.17
People using improved water services, urban (% of urban pop.) 84.98 8.79
Prevalence of food insecurity in the population (%) 56.98 24.15
Prevalence of stunting (% of children under 5) 33.40 7.99
Prevalence of undernourishment (% of population) 27.59 14.84
Preprints 84620 g0a1
Figure A1. Disaggregated water security across regions and income groups in 2020.
Figure A1. Disaggregated water security across regions and income groups in 2020.
Preprints 84620 g0a1
Preprints 84620 g0a2
Figure A2. Comparison of wealth quartile of CWIC across rural and urban areas.
Figure A2. Comparison of wealth quartile of CWIC across rural and urban areas.
Preprints 84620 g0a2

References

  1. Adeel, Z. A renewed focus on water security within the 2030 agenda for sustainable development. Sustain Sci 2017, 12, 891–894. [Google Scholar] [CrossRef]
  2. Adeyeye, K.; Gibberd, J.; Chakwizira, J. Water Marginality in Rural and Peri-urban Communities. Journal of Cleaner Production 2020, 273, 122594. [Google Scholar] [CrossRef]
  3. Adil, S.; Nadeem, M.; Malik, I. Exploring the Important Determinants of Access to Safe Drinking Water and Improved Sanitation in Punjab, Pakistan. Water Policy 2021, 23, 970–984. [Google Scholar] [CrossRef]
  4. Arora, N.K.; Mishra, I. Sustainable development goal 6: Global Water Security. Environmental Sustainability 2022, 5, 271–275. [Google Scholar] [CrossRef]
  5. Bayu, T.; Kim, H.; Oki, T. Water Governance Contribution to Water and Sanitation Access Equality in Developing Countries. Water Resources Research 2020, 56, e2019WR025330. [Google Scholar] [CrossRef]
  6. Bondy, S.C.; Campell, A. Water quality and Brain function. In Int J Environ Res Public Health; 2017; Volume 15. [Google Scholar] [CrossRef] [PubMed]
  7. Chard, A.N.; Trinies, V.; Edmonds, C.J.; Sogore, A.; Freeman, M.C. The impact of water consumption on hydration and cognition among schoolchildren: methods and resuts from a crossover trial in rural Mali. PLoS One 2019, 17, e0210568. [Google Scholar] [CrossRef]
  8. CRED/UNDRR (Centre for Research on the Epidemiology of Disasters/United Nations Office for Disaster Risk Reduction). 2020. Human cost of disasters: An overview of the last 20 years, 2000-2019. www.undrr.org/publication/human-cost-disasters-overview-last-20-years-2000-2019.
  9. Correa-Porcel, V.; Piedra-Munoz, L.; Galdeano-Gomez, E. Water –Energy-Food Nexus in the Agri-Food Sector: Research trends and innovating practices. In Int. J Environ Res Public Health; PMC8701236: PMCID, 2021; Volume 18. [Google Scholar] [CrossRef] [PubMed]
  10. Chen, D.; Zhang, P.; Luo, Z.; Zhang, D.; Bi, B.; Cao, X. Recent progress on the water- energy-food nexus using bibliometric analysis. Current Science 2019, 117, 577–586. [Google Scholar] [CrossRef]
  11. Falkenmark, M. Water resilience and human life support- global outlook for the next century. International Journal of Water Resources Development 2020, 36, 377–396. [Google Scholar] [CrossRef]
  12. Gaffan, N.; Kpozehouen, A.; Degbey, C.; Ahanhanzo, Y.G.; Paraiso, M.N. Effects of Household Access to Water, Sanitation, and Hygiene Services on Uncer-five Mortality in Sub-Saharan Africa. Frontiers in Public Health 2023, 11, 1136299. [Google Scholar] [CrossRef]
  13. Gheuens, J.; Nagabhatis, N.; Perera, E.D.P. Disaster- Risk, Water Security Challenges and Strategies in Small Island Developing States (SIDS). Water 2019, 11, 637. [Google Scholar] [CrossRef]
  14. Hannah, E.; O’Hare, B.; Lopez, M.; Hall, S. Achieving Basic Rights in Health-care Facilities in Low-Income Countries. The Lancet Global Health 2022, 10, e1243. [Google Scholar] [CrossRef] [PubMed]
  15. Hunter, P.R.; Risebro, H.; Yen;, M.; et al. Impact of the provision of safe drinking water on school absence rates in Cambodia: A quasi- experimental study. PLos One 2014. [Google Scholar] [CrossRef]
  16. HLPE. 2015. Water for food security and nutrition. A report by the High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security, Rome 2015.
  17. Jami, N.-N.; Pizzi, E. Governance and Water Progress for the Rural Poor. Global Governance 2018, 24, 575–93. [Google Scholar]
  18. Kaufmann, D.; Kraay, A.; Mastruzzi, M. 2010. The Worldwide Governance Indicators: Methodology and Analytical Issues. https://info.worldbank.org/governance/wgi/pdf/WGI.pdf.
  19. Larson, N.; Laska, M.N.; Neumark-Sztainer, D. Food insecurity, diet quality, home food availability, and health risk behaviors among emerging adults: findings from EAT 2010-2018 study. AM J Public Health 2020, 110, 1422–1428. [Google Scholar] [CrossRef] [PubMed]
  20. Levallois, P.; Villanueva, C.M. Drinking water quality and human health: An editorial. Int. J Environ Res Public Health 2019, 16, 631. [Google Scholar] [CrossRef] [PubMed]
  21. Linderthof, V. T. de Lange; Stign, R. The Dilenmas of Water Quality and Food Security Interactions in Low and Middle Income Countries. Frontiers in Water 2021, 3. [Google Scholar] [CrossRef]
  22. MacAlister, C.; Baggio, G.; Perera, D.; Qadir, M.; Taking, L.; Smakhtin, V. 2023. Global Water Security 2023 Assessment. United Nations, University Institute for water, environment and helath, Hamilton, Canada.
  23. Miller, J.D.; Workman, C.L.; Panchang, S.V.; Sneegas, G.; Adams, E.A.; Young, S.L.; Thompson, A.L. Water security and nutrition: current knowledge and research opportunities. Adv Nutr 2021, 12, 2525–2539. [Google Scholar] [CrossRef]
  24. Morales-Garcia, M.; Rubio, M.A.G. Sustainability of an economy from the water-energy-food nexus perspective. Environ Dev Sustain 2023. [Google Scholar] [CrossRef]
  25. Munteau, C.; Teoibas, D.; Iordache, L.; Balaurea, M.; Blendea, C. Water intake meets the Water from inside the human body- physiological, cultural, and health perspectives- Synthetic and Systematic literature review. Balneo and PRM Research Journal 2021, 12, 209. [Google Scholar]
  26. Our World in Data https://ourworldindata.org/.
  27. Ritchie, H.; Roser, M. 2021. “Clean Water and Sanitation”. Published online at OurWorldIndata.org. Retrieved from: 'https://ourworldindata.org/clean-water-sanitation'.
  28. SDGs. 2022. The sustainable development goals report 2022. https://unstats.un.org/sdgs/report/2022/The-Sustainable-Development-Goals-Report-2022.pdf.
  29. Sharma M.K., Adhikari R. Effect of School Water, Sanitation, and Hygiene on Health Status Among Basic Level Students’ in Nepal. Environmental Health Insights 2022, 2022, 16. [Google Scholar] [CrossRef]
  30. Silbergeld, E.K. Drinking water and the developing Brain. Cerebrum 1;2016:cer-09-16. [PubMed]
  31. Swe, K.T.; Rahman, M.M.; Rahman, M.S.; Teng, Y.; Abe, S.K.; Hashizume, M.; Shibuya, K. Impact of Poverty Reduction on Access to Water and Sanitation in Low- and Lower-Middle-Income Countries: Country Specific Bayesian Projections to 2030. Tropical Medicine &International Health 2021, 26, 760–774. [Google Scholar]
  32. Taka, M.; Ahopelto, L.; Fallon, A.; Heino, M.; Kallio, M.; Kinnunen, P.; Niva, V.; Varis, O. The potential of water security in leveraging Agenda 2030. One Earth 2021, 4, 258–268. [Google Scholar] [CrossRef]
  33. Thai, N.V.; Guevara, J.R. Women and Water Management. A Policy Assessment- A Case Study in Giang Province, Mekong Delta, Vietnam. Asia- Pacific Journal of Rural Development 2019, 29, 77–97. [Google Scholar] [CrossRef]
  34. UNICEF; WHO. 2022. Progress on Drinking Water, Sanitation and Hygiene in Schools: 2000-2021 data Update.
  35. UNICEF. 2021. Reimagining WASH Water security for all. https://www.unicef.org/reports/reimagining-wash-water-security-for-all.
  36. United Nations. Resolution adopted by the General Assembly on 25 September 2015, Transforming our world: the 2030 Agenda for Sustainable Development (A/RES/70/1. 2015. [Google Scholar]
  37. UN Water. UN World water development report 2023. Partnerships and cooperation for water. Facts, figures and action examples. https://unesdoc.unesco.org/ark:/48223/pf0000384659. 2023. [Google Scholar]
  38. UN-Water. 2016. Water and sanitation interlinkages across the 2030 Agenda for Sustainable Development https://www.unwater.org/sites/default/files/app/uploads/2016/08/Water-and-Sanitation-Interlinkages.pdf.
  39. UN-Water. What is water security? https://www.unwater.org/sites/default/files/app/uploads/2017/05/unwater_poster_Oct2013.pdf. 2013. [Google Scholar]
  40. UN-Habitat/WHO (United Nations Human Settlements Programme/ World Health Organization). 2021. Progress on wastewater treatment- Global status and acceleration Needs for SDG Indicator 6.3.1. Geneva, UN-Habitat/WHO. www.unwater.org/app/uploads/2021/09/SDG6_Indicator_Report_631_Progress-on-Wastewater-Treatment_2021_EN.pdf.
  41. UNstats. Global indicator framework for the sustainable development goals and targets of the 2030 Agenda for sustainable development. Retrieved 26th April 2023 at https://unstats.un.org/sdgs/indicators/GlobalIndicator.EN.pdf. 2023. [Google Scholar]
  42. Visbeck, M. Ocean science research is key for a sustainable future. Nat Commun 2018, 9, 690. [Google Scholar] [CrossRef] [PubMed]
  43. World Bank https://info.worldbank.org/governance/wgi/.
  44. WHO. Drinking water. https://www.who.int/news-room/fact-sheets/detail/drinking-water. 2022. [Google Scholar]
  45. WHO. Household water treatment and safe storage. World Health Organization. https://www.who.int/teams/environment-climate-change-and-health/water-sanitation-and-health/water-safety-and-quality/household-water-treatment-and-safe-storage. 2019. [Google Scholar]
  46. Young, S.L.; Frongillo, E.A.; Jamaluddine;, Z.; et al. Perspective: The importance of water security for ensuring food security, good nutrition, and well-being. Advances in Nutrition 2021, 12, 1058–1073. [Google Scholar] [CrossRef] [PubMed]
Preprints 84620 g001
Figure 1. Disaggregated water security across regions and income groups in 2020.
Figure 1. Disaggregated water security across regions and income groups in 2020.
Preprints 84620 g001
Preprints 84620 g002
Figure 2. Comparison of wealth quartile of CWIC across rural and urban areas.
Figure 2. Comparison of wealth quartile of CWIC across rural and urban areas.
Preprints 84620 g002
Preprints 84620 g003
Figure 3. Disaggregated access to drinking water by income to schools and geographic location in 2021.
Figure 3. Disaggregated access to drinking water by income to schools and geographic location in 2021.
Preprints 84620 g003
Preprints 84620 g004
Figure 4. Water security affects health (U5MR).
Figure 4. Water security affects health (U5MR).
Preprints 84620 g004
Preprints 84620 g005
Figure 5. Water security affects food insecurity.
Figure 5. Water security affects food insecurity.
Preprints 84620 g005
Table 3. Comparison of drinking water ladder across world regions and between time-period.
Table 3. Comparison of drinking water ladder across world regions and between time-period.
2000 2020 2000 2020 2000 2020 2000 2020 2000 2020
Entity wat_s wat_bas wat_li wat_u wat_s
Regions
Cent. & S. Asia 46.1 62.4 36.2 28.9 3.4 4.1 11.9 3.7 2.5 0.9
E. and SE Asia 1.0 0.9 14.3 4.2 3.3 0.6
L. Ame & Car 71.7 75.4 18.8 22.0 0.9 0.4 5.9 1.4 2.7 0.9
N.Amer& Euro 90.1 95.6 8.5 3.6 0.3 0.4 1.1 0.4 0.1 0.0
Sub-Sah Africa 17.1 30.0 27.8 34.6 9.0 12.9 27.5 15.6 18.7 6.8
W Asia & NAfri 67.9 78.7 15.9 13.3 4.6 5.6 9.3 1.3 2.3 1.1
World 61.7 74.3 20.0 15.8 2.5 3.6 11.8 4.7 4.1 1.6
Income levels
Lower-mid inc. 43.1 58.1 34.1 29.9 4.3 4.6 13.1 5.1 5.4 2.3
Low income 18.8 28.8 22.7 30.4 10.1 17.8 31.4 17.1 17.1 5.9
Upper-mid. Inc 68.8 76.8 15.7 18.6 0.8 0.8 12.1 3.3 2.6 0.5
High income 95.2 97.6 3.7 2.2 0.1 0.1 1.0 0.2 0.1 0.0
Least D C 25.0 37.1 25.7 29.7 8.8 13.4 26.0 14.0 14.6 5.9
Other
Fragile 37.5 42.5 23.4 31.7 6.8 9.4 19.1 11.0 13.2 5.4
L.locked Dev. C. 26.1 35.5 25.7 32.3 8.1 15.0 25.3 13.1 14.8 4.2
First, Second Third, Fourth, Fifth, Sixth- First is the best performer, while sixth is the worst performer. Note: wat_s is water safely managed; wat_bas_ is basic water; wat_li is limited water; wat_unimp is unimproved water source; and wat_s is surface water. Cent. & S.Asia- Central and South Asia, E. and SE Asia- East and South East Asia, L. Ame &Car- Latin America and the Caribbean, N. Amer &Euro – North America and Europe, W Asia &NAfri – West Asia and North Africa. Lower-mid inc- Lower Middle income countries, Upper-mid. Inc- Upper middle-income countries. Least DC- Least developed countries. L. locked Dev. C.- Land locked developing countries.
Table 4. Female vs. male education status in the context of urban vs. rural in the critical water insecure countries.
Table 4. Female vs. male education status in the context of urban vs. rural in the critical water insecure countries.
Wom. Men Wom. Men Wom. Men
no ed. no ed. Pri. Pri. Sec/hi Sec/hi
Urban Rural Urban Rural Urban Rural Urban Rural Urban Rural Urban Rural
Afgha 67 89 31 56 3 2 7 6 20 5 46 27
Chad 42 69 20 43 7 4 4 8 37 8 63 26
Como 19 37 11 19 5 7 8 12 67 41 69 49
Eritre 23 71 4 1 41 4
Ethiop 25 48 9 5 34 10
Haiti 6 20 3 13 8 10 6 8 72 43 80 49
Liberi 21 47 7 22 3 4 1 5 61 21 76 45
Mada 6 19 5 16 6 9 5 7 71 33 72 35
Niger 33 75 8 5 47 9
Pakist 28 62 14 33 12 11 11 13 56 22 68 45
P. Gui 7 25 4 14 11 11 12 14 52 23 60 31
S. Leo 28 61 15 42 3 4 4 4 62 23 75 41
Table 5. Pre-primary schools with unimproved, limited or basic water services in percentages.
Table 5. Pre-primary schools with unimproved, limited or basic water services in percentages.
No water service or unimproved Limited water services Basic water
E. Guinea 75 Guinea 33 Cambodia <1 Ecuador 91
Vanuatu 65 Burkina F. 29 Sierra L. <1 Fiji 90
Eritrea 59 Indonesia 27 Solomon Islands 30 Ghana 79
P.N. Guinea 58 Brazil 21 Mexico 29 Peru 76
C.A.R 49 Gabon 17 Gabon 24 Uzbekistan 76
Burundi 49 Senegal 16 Uzbekistan 16 Indonesia 70
D. R. Congo 44 Peru 14 Tanzania 14 Romania 67
Solomon Island 43 S. Sudan 11 Ghana 12 Cambodia 62
Côte d’Ivoire 42 Mexico 10 Peru 10 Mexico 61
Sierra Leone 41 Ghana 9 Papua New Guinea 8 Gabon 59
Chad 41 Uzbekistan 8 Fiji 4 Sierra Leone 58
Lebanon 40 Ecuador 7 Burundi 3 Lebanon 57
Cameroon 39 Fiji 6 Lebanon 3 Tanzania 49
S.T.Principe 39 El Salvador 6 Ecuador 3 Burundi 48
Gambia 38 Costa Rica 2 Indonesia 2 P N. Guinea 34
Cambodia 38 Iraq 2 Solom Islan 26
Tanzania 37
Note: First quartile; Second quartile; Third quartile; and Fourth quartile.
Table 6. Primary schools with unimproved, limited or basic water services in percentages.
Table 6. Primary schools with unimproved, limited or basic water services in percentages.
Basic water services or improved Limited water services No water service or unimproved
Armenia 99 Rwanda 59 Syria 48 Niger 83 Algeria 15
Tonga 98 Gabon 59 Benin 39 C.A R. 81 Cambodia 14
Viet Nam 96 Afghanistan 58 Philippines 29 Ethiopia 80 Tunisia 13
Malaysia 95 Lao P.D Republic 56 Zimbabwe 29 Equatorial Guinea 74 Gambia 13
British V.Is 94 Albania 56 Mali 28 Chad 70 Fiji 12
Jamaica 93 Congo 54 India 26 Madagascar 63 Costa Rica 11
Uzbekistan 90 Sierra Leone 52 Solomon Islands 25 Guinea 63 Ghana 11
Malawi 87 South Sudan 51 Tuvalu 25 D.R. Congo 58 Zimbabwe 11
Fiji 87 Mauritania 51 Mongolia 24 Côte d’Ivoire 56 Ecuador 10
Costa Rica 86 Tanzania 50 Uganda 23 Vanuatu 51 S.T. Principe 10
Algeria 85 Syria 49 Nigeria 23 Burundi 50 Djibouti 9
Palau 84 P.N.Guinea 46 Tanzania 22 Haiti 48 Malawi 7
Cambodia 83 Philippines 45 Sudan 20 P. N. Guinea 48 India 7
Sri Lanka 82 Burundi 45 Cameroon 20 Sierra Leone 47 Bangladesh 6
Ecuador 82 Liberia 44 Afganstan 17 Nigeria 46 Uganda 4
El Salvador 80 Sudan 43 El Salvador 16 Somalia 46 El Salvador 4
Bangladesh 80 Solomon Islands 43 Bangladesh 15 Cameroon 43 Mongolia 3
Zambia 78 Benin 43 Gabon 14 South Sudan 40 Ukraine 3
Ghana 78 Nepal 39 Ghana 12 Lebanon 37 Syria 2
Peru 77 Guinea 37 Lao P. Republic 11 Pakistan 37 Mali 2
Honduras 76 Cameroon 37 South Sudan 9 Sudan 36
Morocco 75 Madagascar 37 Indonesia 8 Eritrea 35
Tuvalu 75 Togo 33 Ecuador 8 Burkina Faso 33
Myanmar 74 Nigeria 31 Peru 7 Lao P.D. Republic 33
Uganda 73 Chad 30 P. N.Guinea 6 Solomon Islands 32
Mongolia 73 Panama 27 British Virgin Islands 6 Tanzania 28
Indonesia 72 C.A.R 16 Ethiopia 6 Gabon 27
Timor-Lest 71 Ethiopia 15 Burundi 6 Philippines 26
Mali 70 Malawi 6 Afgansta 25
Marshall Is. 68 Burkina Faso 5 Senegal 21
Kiribati 67 Malaysia 5 Indonesia 20
India 67 Cambodia 4 Iraq 19
Romania 64 Zambia 3 Benin 19
Pakistan 63 Lebanon 3 Zambia 18
Burkina F. 62 Costa Rica 3 Eswatini 17
Zimbabwe 60 C.A.R 3 Brazil 16
Lebanon 60 Fiji 2 Peru 15
Note: First quartile; Second quartile; Third quartile; and Fourth quartile.
Table 7. Secondary/ high schools with unimproved, limited or basic water services in percentages.
Table 7. Secondary/ high schools with unimproved, limited or basic water services in percentages.
Basic services or improved & available Limited water services No water services or unimproved
Malaysia 99 Mongolia 73 Syria 49 Madagascar 74 Eswatini 10
Saint Vincent 99 Albania 73 Burundi 39 Haiti 63 Brazil 9
Tonga 99 Honduras 71 Ethiopia 31 Vanuatu 58 Burundi 9
Grenada 99 Tanzania 70 Gabon 29 Mauritania 58 Iraq 9
Jamaica 97 Sierra Leone 66 Philippines 28 C. A. R. 58 Fiji 8
Armenia 97 P. New Guinea 65 Zimbabwe 26 Chad 50 Djibouti 7
Bangladesh 95 Liberia 65 Mongolia 25 E. Guinea 49 India 6
Palau 95 Zimbabwe 63 Tuvalu 24 Ethiopia 47 Ghana 6
Morocco 94 Timor-Leste 62 Papua New Guinea 23 Niger 45 Costa Rica 5
Ecuador 93 Lebanon 61 Solomon Islands 21 Burkina Faso 39 Zambia 5
Algeria 92 Solomon Islands 59 Nigeria 19 Somalia 37 S.T.Principe 5
Fiji 90 Marshall Islands 57 Costa Rica 19 Lebanon 37 Ecuador 4
Uzbekistan 89 Gabon 57 India 19 Sierra Leone 34 Malawi 4
British Virgin Islands 88 Togo 54 Tanzania 19 Nigeria 32 El Salvador 4
Sri Lanka 87 Burundi 52 Burkina Faso 15 Philippines 25 Ukraine 3
Kiribati 86 Syrian 49 Ghana 15 Liberia 24 Senegal 2
Pakistan 85 Nigeria 49 Malawi 14 Solomon Islands 20 Syria 2
Romania 85 Niger 48 El Salvador 12 Eritrea 20 Mongolia 1
El Salvador 84 Philippines 46 Peru 12 Cambodia 17 Algeria 1
Cambodia 82 Burkina Faso 46 Indonesia 11 Benin 16
Malawi 82 Panama 41 Liberia 11 Pakistan 15
Myanmar 82 Ethiopia 22 Niger 7 Guinea 14
Ghana 79 Algeria 7 Gabon 14
Rwanda 77 Bangladesh 5 Indonesia 14
Nepal 76 Ecuador 3 Côte d’Ivoire 14
Tuvalu 76 Jamaica 3 South Sudan 13
Costa Rica 76 Lebanon 3 Peru 13
India 75 Fiji 2 Gambia 12
Afghanistan 75 Grenada 1 Tanzania 12
Peru 75 Saint Vincent 1 Zimbabwe 12
Indonesia 75 Malaysia 1 P. New Guinea 12
Note: First quartile; Second quartile; Third quartile; and Fourth quartile.
Table 8. Comparison of child health and nutrition status across wealth quartiles, and urban vs. rural areas.
Table 8. Comparison of child health and nutrition status across wealth quartiles, and urban vs. rural areas.
L20% H20% Diarrhea Stunted Wasted
Country Urban Rural Urban Rural Urban Rural Urban Rural Urban Rural
Afghan 3 26 73 3 32 28
Chad 7 24 81 2 23 22 32 42 13 13
Comoros 9 25 34 14 16 17 25 32 12 11
Eritrea 1 32 52 0 11 15 32 49 10 17
Ethiopia 8 25 62 5 26 40 5 8
Haiti 0 33 43 5 23 21 18 24 5 3
Liberia 6 39 34 2 14 17 25 35 3 3
Mada 7 23 66 10 10 9 36 41 8 8
Niger 0 25 86 5
Pakistan 3 30 42 7 19 19 31 41 7 7
P. Guine 1 22 71 14 22 13
S. Leone 1 34 46 2 7 7 25 32 6 5
Yemen 1 28 55 4 28 32 34 51 14 17
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
Copyright: This open access article is published under a Creative Commons CC BY 4.0 license, which permit the free download, distribution, and reuse, provided that the author and preprint are cited in any reuse.
Prerpints.org logo

Preprints.org is a free preprint server supported by MDPI in Basel, Switzerland.

facebook logotwitter logolinkedin logo
MDPI Initiatives
Important Links
Subscribe

Disclaimer

Terms of Use

Privacy Policy

© 2024 MDPI (Basel, Switzerland) unless otherwise stated