Sunday, December 9, 2007

Untold Stories

Even in the under-reported water and sanitation sector, we are constantly bombarded by stories and reports about what doesn’t work, what hasn’t worked, how we are failing as a planet to meet the water and sanitation MDGs. So in a belated Happy Thanksgiving post, I offer a couple of stories and snaps that show the progress the sector is making in small but meaningful ways:

There is a child in school in Niger because she doesn’t have diarrhea thanks to an extraordinarily simple bucket half full of clean water and a little sliver of soap that she and her family use to wash their hands every day.

A woman’s hands in Guatemala are no longer calloused because her village recently acquired a borehole with a handpump. The story – more of a human dignity story than a water story - involves her coming up with gratitude to the project leader and insisting that he feel how soft her hands were. (Thanks to Gil Garcetti for the great photo.)

There is a village in Tibet that is 100% free of open defecation because of some bold little kids running around sticking ‘poo flags’ in each pile, with the names of their shamed depositors written on those flags.

There is a woman in Senegal who no longer has to wait until nightfall for cultural reasons to defecate, because her family invested $4 in a household pit latrine. I couldn’t find a picture of ‘less severe constipation’ or ‘fewer liver problems’ to post, but you get the point.


Sunday, December 2, 2007

Vaccinations vs. safe drinking water and sanitation

An interesting article in The Lancet late last year didn’t receive the attention that it – or at least one sentence in it – merits.

I’d like to change that with the help of my now six readers:In Vol. 368, Issue 9543 (Oct 7 – 13, 2006) The Lancet published an editorial to coincide approximately with the release of the UNDP 2006 Human Development Report “Beyond scarcity: Power, poverty and the global water crisis”.

The Lancet piece dealt with the primacy of water and sanitation in global development, and drew attention to the likelihood that the world will fail to meet the MDG on sanitation. It also highlighted the regional disparities which are masked by global progress on the water MDG (viz. progress in India and China masking a lack of such progress in subSaharan Africa). Also of note in the one page editorial was the continued/continuing lack of prioritization of water and sanitation in budgets throughout the developing world.

The sentence at the heart of the argument I want to make on this blog is:
"It is dangerously short sighted to pour immense time and resources into vaccinating children only for them to die a few years later from diarrhoeal illnesses."
I don’t care if the solution to the global safe drinking water and sanitation problem is not a “traditional” health intervention like passing out antiretrovirals or vaccinations. There is clearly not a silver bullet, or even a silver shotgun solution to the water challenge – each situation (unfortunately) requires its own unique solution. Those solutions involve fewer traditional health interventions, and more engineering and infrastructure projects, more behavioral change and education programs (think massive handwashing campaigns for women and kids like this one).

Public health officials in any country, state, province or elsewhere should support and lobby for these non-health initiatives to provide safe water and sanitation, as should the international donor community:

a) they save lives and livelihoods, and

b) less water-related mortality and morbidity frees up hospital beds, staff and other health care resources for those more traditional health interventions. A person sick from preventable waterborne diarrheal disease is occupying a hospital bed whose purpose would be better served by hosting an HIV or TB or malaria patient (plus that girl suffering from diarrhea would be better off in school thank you very much).

Health systems are burdened beyond capacity in many areas already – advocates for public health, water and sanitation throughout the developing and developed world should focus more cogently on preventing preventable illness.

Wednesday, November 28, 2007

Donde esta el baño?

What is the first thing you learn in any foreign language, other than perhaps the name of the most popular intoxicating beverage in the country (e.g. cerveza, vino, slivovitza)? It is:

"Where is the bathroom?"

If that isn't the best way to communicate the primacy of sanitation I don't know what is. Brilliant (thanks David!)

OK - now imagine that the answer, in whatever language, is "We don't have one, or any paper, or any water." NOW what would you like to be able to say in that foreign language? You will find those phrases here.

I should change the name of this blog to Blogging on Sanitation the way recent events have been going...

Monday, November 19, 2007

Beat the Rush

One of the things that keeps me awake at night is that the global safe drinking water and sanitation sector can't compete with Heifer International during the holiday buying frenzy and the end-of-year search for tax breaks. Buying two shares of a pig or a flock of chicks strikes me as more fun than buying a toilet or a pump.

But WaterAid comes close:

How about a puppet show for hygiene promotion for 31 quid, or a soap-making business for 100?

One of the keys to attracting more financial and political support for the water is telling the right stories to the right people, and making it fun. Go WaterAid.

World Dunny Day! Cheers!

I imagine that all six of my readers already know that it is World Toilet Day today, but just in case one of you out there just woke up, Happy World Toilet Day! Or as the Aussies say World Dunny Day.

To the 2.6 billion without such amenities, hold on, I'll be right out.

Sunday, November 18, 2007

A Good Scratch

I made the mistake recently of asking a British friend of mine “What are the first three things you do in the morning?” His reply: “Well, I finish me gin from the night before, I smoke a ciggy, and I have a good scratch.”

I suspect that safe, clean water will be more important for those of us with less vigorous mornings.

Imagine your morning without water. Imagine your bathroom trip, your shower, your coffee/tea, imagine brushing your teeth without water. If you woke up and realized your home didn’t have safe water, what would your first three actions that morning look like? Forget the first three things – what is the first ONE thing you would do?

Water is vital not only to our morning rituals in the developed world; water is life in its barest essence. Water is security, human security.

Without water, women and families in Africa, Asia, Latin and Central America and elsewhere spend significant parts of their days NOT learning, NOT working, NOT being productive members of society, NOT watching their children play. We in the States are increasingly aware of this challenge abroad – throughout the developing world – and are increasingly active on behalf of the issue. Yet effectively tackling the global safe drinking water and sanitation problem is not as easy as driving to the local soup kitchen and ladling soup to homeless people on Thanksgiving - which reminds me - do that too. Ensuring that poor communities in Africa, Asia and elsewhere have safe water and sanitation is tough work – and requires money, political support, thoughtfulness, and patience. And of that list the most important may well be thoughtfulness.

The recent announcement of the Howard G. Buffett Foundation’s commitment to the sector - called the Global Water Initiative - is an important one, and one which displays many of the best – or at least emerging practices in the sector. It is also an announcement which merits MUCH more attention in the media than it received. John Sauer nailed it in The Huffington Post, trying valiantly to get this announcement the coverage it deserves.

$150m is important. Having a name like Buffett associated with its support for the global safe drinking water and sanitation sector is important in that it minimizes the risk of the next philanthropist getting on board. The focus on both water and sanitation is important. However, arguably more important are the Global Water Initiative's (GWI) efforts to streamline and decentralize decisionmaking throughout the entire process. Long before the formal launch GWI was consulting with a select group of several of the finest implementing organizations on the planet. Long before the launch the GWI was looking at ways not simply to build more systems but to catalyze systemic change in the world's most vulnerable communities. Long before its launch GWI was looking at ways not to measure quarterly or even annual results, but looking at what it could achieve over a ten year period and beyond. And long before its launch GWI was streamlining the process of distributing these grants and the process of receiving these grants in-country, so the focus could be on making the work itself as sustainable, as holistic and as inclusive as possible.

I myself would have chosen fewer countries to minimize dissipation of effort, and to make it more likely that this initiative will produce meaningful successes at scale - the sort of successes that generate headlines like "Every School in Guatemala Now Has Access to Safe Drinking Water" and "Every HIV/AIDS Clinic in Uganda Now Has Private Sanitation Facilities." It is money, it is political support, it is lots and lots of technical know-how and elbow grease that will push this sector onward. However, it is thoughtful initiatives like the Global Water Initiative that are likely to demonstrate not the gravity of the water problem or quick technical fixes, but how solvable the problem is if approached thoughtfully.

Sunday, November 11, 2007

International Year of Poo

Hooleintelligence has it right - I have been delayed in my posting due to my being a little too excited about the upcoming International Year of Sanitation. I'm not so sure that getting all worked up about another UN Year for something is advisable, but at least I am not alone:

World Toilet Association General Assembly - tickets still available. Seriously. Go. (Seoul, Nov. 21 - 25)

'Mr. Toilet' builds commode-shaped house

World Toilet Summit in Delhi - Check out my friend Dave Praeger's updates from the World Toilet Summit here. Poop humor just never gets old.

So how can we determine whether we are making progress with the global sanitation challenge? How about when news about sanitation shows up in mainstream media and not in the "Offbeat News" or "News of the Absurd."

And now the underlying harsh reality of this post: what kills and sickens more people, water or inadequate sanitation? A recent UNICEF report answers that clearly:

Reduction in diarrhoeal diseases morbidity resulting from improvements in drinking water and sanitation services:

  • 25% from improved drinking water
  • 32% from improved sanitation
  • 45% from improved hygiene (viz. handwashing)
  • 39% from household water treatment

Yes, we need all three. But we need an invigorated response to the global sanitation challenge. But Blogging on doesn't have the cachet that toilets deserve.

Tuesday, October 9, 2007

October 11 - Art Opening and Reception, Washington DC

Less blogging today, more partying. Carl Ganter is a rock star of the safe water sector. No one tells a story like this guy - check out

Please join the Woodrow Wilson Center’s Environmental Change and Security Program and Mexico Institute for the opening of:

Water Stories: A Focus on Mexico

Thursday, October 11, 2007

Art Opening and Reception
5:00 p.m. - 7:00 p.m.

Comments by Circle of Blue director J. Carl Ganter at 5:30 p.m.

Fourth Floor Atrium
Woodrow Wilson International Center for Scholars
1300 Pennsylvania Avenue, NW
Washington, DC

Please RSVP to

More than 1 billion people lack access to potable water and more than 2.6 billion do not have adequate sanitation. The Woodrow Wilson Center’s new photography exhibit, “Water Stories: A Focus on Mexico,” in collaboration with Circle of Blue, offers a vivid glimpse of the lives that lie behind these statistics. Circle of Blue director J. Carl Ganter chronicles water and sanitation challenges facing families in the Iztapalapa region of Mexico City. World Press-winning photographer Brent Stirton documents how water shapes everyday life in the Tehuacán Valley southeast of Mexico City, as residents struggle to obtain enough clean water to meet their basic needs. In Mexico, as with many other places around the world, the quest for water consumes time, energy, and valuable resources. Understanding this human struggle is one step toward ameliorating the global water crisis. In conjunction with the photography exhibit, the Woodrow Wilson Center is launching a new publication, entitled Water Stories: Expanding Opportunities in Small-Scale Water and Sanitation Projects, that features photographs taken by J. Carl Ganter. For more information please visit

This exhibition and the Navigating Peace Initiative are made possible by the generous support from the Carnegie Corporation of New York. Circle of Blue’s Mexico coverage, Tehuacán: Diving Destiny, was made possible with generous support from the Ford Foundation. Additional support from FEMSA and the Woodrow Wilson Center’s Mexico Institute.Location: Woodrow Wilson Center at the Ronald Reagan Building, 1300 Pennsylvania Ave., NW (“Federal Triangle” stop on Blue/Orange Line), Fourth Floor Atrium. A map to the Center is available at Note: Due to heightened security, entrance to the building will be restricted and photo identification is required. Please allow additional time to pass through security.

Thursday, October 4, 2007

And a belated Happy Birthday to the Great Soul

“A small body of determined spirits fired by an unquenchable faith in their mission can alter the course of history.”


And to honor one of Mahatma Gandhi's greatest quotes (even if two days after his 138th birthday), I shall extol the virtues of two Indian organizations which seem to be living up to Gandhi's ideal. The leaders of these organizations are certainly determined, their work is vital to man and beast, their faith in their mission unalterable, and I can only hope they will change the course of history.

Tarun Bharat Sangh deals in community-based water systems in India. Those systems are based on millennia-old rainwater capture technologies. That captured monsoon water, which would otherwise flow directly into the sea for the most part adding little value along its way, now replenishes groundwater tables, provides drinking water for people and animals, and irrigates cropland.

TBS' founder Rajendra Singh is who I want to be when I grow up.

SCRIA does related work in arid and semi-arid regions of Rajasthan, northern India, led by their Director Sunder Lal. Their most interesting work is detailed here.

The work of both organizations is replete with best practices regarding community involvement and ownership, gender inclusiveness, decentralized planning, long term planning and budgetary cycles, and a holistic approach which incorporates the needs both of homo sapiens and the rest of the ecosphere simply by better utilizing the water resources already available to that part of India.

Give them many rupees.

Thursday, September 27, 2007

Turning Coffee into Water

Thanks to a wee bit of lobbying (it was actually a very easy sell), the Clinton Global Initiative organized a breakfast/coffee table discussion on Safe Drinking Water which I had the pleasure of moderating today.

As I was tasked with reporting back to the appropriate authorities at CGI, my careful note-taking has revealed some compelling ideas from the table:

1) First of all, the suggestion was made to encourage the Clinton Global Initiative to better prioritize the global safe drinking water, sanitation and hygiene issue throughout all of the tracks (Global Health, Poverty Alleviation, Education and Energy/Climate Change for 2007 - tbd for 2008). Water is everywhere, but is rarely addressed directly and specifically (with an increasing number of exceptions like P&G’s PUR commitment, WaterHealth International’s commitment with Dow). The availability of water and sanitation will make all other sustainable development efforts, regardless of who funds them, more successful initially and more sustainable over the long run.

2) There needs to an increased advocacy effort to raise awareness of safe drinking water and sanitation as a major public health challenge, both in the developed and developing world. In particular, this awareness-raising needs to focus on the solutions to water and sanitation challenges, not just attest to the gravity of the problem. One participant focused specifically on ways to broadcast the water, sanitation and health message throughout the developing world, and getting those governments to better prioritize the issue in their own budgets. One useful precedent is the International Network to Promote Household Water Treatment and Safe Storage. Use such a tool to raise public awareness of the safe water issue throughout the world, use it to educate policymakers, use it to urge corporations, civic organizations, faith communities and private givers to focus on the opportunity to address the cause of development challenges, not just on the symptoms.

3) There is a bottleneck in delivering health-related products and services across the board. Think bednets, vaccines, pharmaceuticals. Also think safe drinking water, latrines, hygiene promotion programs. Although a debate emerged around the issue, the table’s thinking was that there is a reasonable amount of new, innovative and sustainable ideas in the water and health sector, and what is now needed are innovative ways of scaling those doable solutions up, out and over. One example was raised of using village health shops on a grand scale around the world to promote not just bars of soap but hygiene promotion messages. And the option of bolting on microfranchised water purification systems to such village health shops was discussed, as well as using these shops as a foundation from which to deliver social marketing techniques aimed at increasing the number of people with access to improved sanitation systems (e.g. pit latrines). And how about Trainers Without Borders to deal with some of the lack of institutional capacity to grow the sector?

4) Behind every commitment at CGI this year, and there have already been a LOT, there is an exceptional narrative story that if told eloquently and broadly will result not only in progress in the water sector, but additional such commitments at next year’s CGI.

More soon. However, a quick news flash: Bill Clinton announced in a press conference this morning that CGI intends to expand to Asia this year (they are shooting for a meeting in Hong Kong). One might consider lobbying CGI Hong Kong to make sure that the 700 million Indians without improved sanitation are represented, and that the 23% of Chinese (300 million!) without safe drinking water are well-represented in Hong Kong.

Wednesday, September 26, 2007

Clinton Global Initiative Part 2: Water!

Hot from the Press Office of the Clinton Foundation:

Opening Day of Third Annual CGI Brings Commitments in Every Focus Area Affecting Lives Around the Globe

One commitment caught my eye:

Procter & Gamble, working with partner organizations in the Children’s Safe Drinking Water program, will provide sachets to purify an estimated 2 billion liters of water. By using the easily accessible system, the program will help prevent 80 million days of diarrhea illness and save 10,000 lives by 2012. The $20 million project follows a 2006 commitment by P&G to work with partners to provide safe drinking water and hygiene education to 1 million children in Africa by 2009.

Great to see that first CGI commitment to water, building on P&G’s meeting its commitment from last year.

But wait…

The Dow Chemical Company will provide $30 million of loan guarantees to support the financing of up to 2,000 community water systems, serving 11 million people in India through WaterHealth International (WHI). For the past two years, WHI has provided sustainable, low cost community-based water systems to rural villages in India. WHI has installed 100 systems and partners with local NGOs to provide water and sanitation education. Dow’s commitment will help to extend WHI’s reach well beyond the current projections of 3,000 systems over the next five years.

And one more commitment to ponder:

Lalique will establish a fundraising campaign, BELIEVE, that will collect donations from a percentage of sales revenue taken from each brand’s exclusive products and services. Funds gathered from donations will be shared with an alliance of poverty alleviation charities that relieve the needs of people in developing countries. Lalique’s CEO, Guillaume Gauthereau, was inspired to make this commitment by remarks made at a CGI press conference in early 2007 where it was stated that $1 in the developing world is equivalent to $100 in developed economies. BELIEVE aims to raise $1 million to alleviate poverty.

Who wants to go see Monsieur Gauthereau and brief him on safe drinking water and sanitation, and its tremendous multiplier effect on sustainable development throughout the developing world?

I am surprised in this writing about how heavily weighted these commitments are toward the role the corporate sector plays in global development. Private foundations tomorrow perhaps.

And will tomorrow see a major CGI commitment to diarrhea? Sleepless night ahead…

Clinton Global Initiative Part 1: Water, water, nowhere

Sorry for the gap in posts – have been on the road a lot lately, including a couple of very interesting visits to water development groups in Guatemala – check out Agua del Pueblo here or google them to find out more about their work for those of you interested in Guatemala. They are primarily funded by a bilateral relationship with the Spanish government now, but looking to diversify and expand their work with water, sanitation and hygiene promotion.

I’m blogging today from right in the middle of the 2007 Clinton Global Initiative, waiting patiently for a direct mention of water, sanitation, hygiene, diarrhea, cholera, or anything… Throw me a bone people! There has been a great deal of optimistic, inspiring discussion in the plenary and breakouts so far from 52+ current and former heads of state and probably 1000 other people, representing 600+ commitments, tens of millions of lives impacted or saved, in over 100 countries.

Five significant commitments have been made public so far, the most interesting of which is the “Global Campaign to Reduce Maternal and Child Deaths in Poor Countries” launched by Norway’s Prime Minister Jens Stoltenberg with others.

Finally, a discussion early this afternoon in the Global Health session about Prime Minister Stoltenberg’s commitment elicited an interesting remark from CARE’s President and CEO Helene Gayle. She suggested that in order to meet the goals laid out by the Prime Minister, it is necessary to take a broader approach to child and maternal health, and focus on the causes of that mortality and morbidity – and she mentioned safe water and sanitation specifically.

More to come.

PS Off to question Jane Goodall about the nexus of biodiversity conservation (viz. great apes) and homo sapiens need for safe drinking water. See earlier related post here.

PPS Best quote ever: Development is about much more than safe water, but never about less.

Wednesday, September 5, 2007

Faecal Attraction Redux

Just when you thought it was safe to take the provenance of your drinking water and the disposal of your feces for granted, I give you:

Faecal Attraction: Political Economy of Defecation

This is worth three minutes of your time. Watch, then continue below...


Unfortunately this lack of knowledge is not unique to India - most of us in the West would be hard pressed to answer the same questions with any more eloquence.

Here are a couple of select Youtube comments so you don't have to read through them all:
  • Super! although it would be great if you also gave us the answers to the questions being asked...coz i don't know shit either(pun intended!)!
  • Hmmm
  • So...this wonderful video only offers the problem, not the solution. WHAT THE F___ IS THE SOLUTION? MAKE A VIDEO ABOUT THAT.
  • this is nice probably they should put this on tv

Agreed that it belongs on TV (a 30 minute documentary in prime time would be a good start).

Agreed that the video only offers education and awareness-raising. For some answers to these questions (at least in the US), I offer:

From the U.S. Environmental Protection Agency:

"Drinking water can come from either ground water sources (via wells) or surface water sources (such as rivers, lakes, and streams). Nationally, most water systems use a ground water source (80%), but most people (66%) are served by a water system that uses surface water. This is because large metropolitan areas tend to rely on surface water, whereas small and rural areas tend to rely on ground water. In addition, 10-20% of people have their own private well for drinking water. To find the source of your drinking water, check your annual water quality report or call your water supplier."

Also visit EPA's Local Drinking Water Information page.

Now, where does your poo go?

The Water Environment Federation is a leading source of water quality information. They deal with the least sexy thing that we all take for granted: pipes - to bring us clean water and to take dirty water far away and treat it. WEF's newest campaign is called "Water is Life, and Infrastructure Makes It Happen."

WEF's job is to take the mystery out of where your poo goes. Click here for a nice Flash diagram of wastewater treatment - believe it or not this stuff is reasonably entertaining.

Be in the Know...Go With the Flow

So how do you solve the sanitation problem in many parts of the world? Here is a good start - from the most simple (latrines) to one of the seven wonders of the industrial world, London's sewage system.

And one of my perennial favorites: Sulabh International and their two-liter pour-flush latrines.

Monday, September 3, 2007

15,200 miles to go for safe drinking water

The New York Inquirer is duly impressed by several statistics associated with the Blue Planet Run: the 15,200 miles the BPR runners are putting in around the world to raise awareness of the global safe drinking water and sanitation challenge, over four continents and 95 days.

Even more meaningful statistics, however, compellingly link the issues of safe drinking water and human mobility:
  • Poor women in Africa and Asia walk an average of six kilometers a day to collect water.

  • Poor rural women in developing countries may spend eight hours a day collecting water, carrying up to 20 kilos of water on their heads each journey.
We have all seen and cooed at the glorious, romantic photographs of women in the developing world carrying those buckets of water on their heads with a baby strapped to their backs while dressed in colorful saris.

You think that’s romantic? You try it. A twenty liter bucket of water weighs 45 pounds, in some cases half the body weight of the woman carrying it. Add wild animals, snakes, and unduly interested men to the commute, and you’ve got a recipe for trouble.

The Blue Planet Run is performing admirably in raising ‘name recognition’ of the global health crisis of unsafe water and inadequate sanitation (which remains largely unreported in the U.S.) Name recognition will get an issue far, but not far enough (who hasn’t heard of Howard Dean?). It is up to everyone now to capitalize on the awareness that has been raised by the Blue Planet Run and move toward meaningful political and financial support:

  • How can we keep each of the actors who designed sneakers for the campaign engaged in the issue (Hilary Swank, Courteney Cox, Rosie O’Donnell, Lance Bass, Alan Cumming)? Thanks to the Blue Planet Run they are now aware of this issue, and likely interested in doing more.
  • How can we all encourage the New York Giants, also supporters of Blue Planet Run, to dedicate a day at the field to global safe water?
  • How can the Blue Planet Run Foundation best prepare for its 2009 round-the-world footrace, which is expected to travel through the southern hemisphere? What can the world community do now to encourage the governments in the countries through which the 2009 runners will travel to greet those runners with increased budgetary commitments to water and sanitation infrastructure, particularly in rural communities? How many of those countries will commit at that point to universal coverage of water and sanitation (such as we enjoy in the US, Europe and Japan)?

Thursday, August 30, 2007

Faecal Attraction

So I’m reading a book about poo, and its contribution to civilization. Somehow this got left out of my undergrad class on Western Civilization at Georgetown.

The book I reference is Poop Culture: How America Is Shaped By Its Grossest National Product. I haven’t reached the end yet, but I don’t expect any real surprises – I think I know how this one ends. It’s an awfully interesting read, with insights about poo that I hadn’t considered (or wanted to). We all would benefit by paying closer attention to this issue, and Poop Culture adds some interesting blue-sky approaches to human waste treatment that we should consider – e.g. converting it to energy.

Executives from the Water Environment Federation consistently and justifiably argue that what separates developed from developing countries is not human rights, respect for the environment, or Internet access but PIPES – unglamorous infrastructure. E.g. what happens to poo once it leaves the body?

My challenge is seeing that what happens to that poo around the world doesn’t result in unnecessary mortality and morbidity such as from diarrheal diseases. Over 2.6 billion around the world lack adequate sanitation facilities, or quite literally a place to go to the bathroom. This doesn’t mean that they are NOT going to the bathroom, but rather that 2.6 billion people do so in a way that often negatively impacts their health and the health of their neighbors, kids, passersby. Many organizations are struggling with a way to make this massive public health challenge more compelling. What would make it as cool to talk about poo/defecation/shit at cocktail parties as it is to talk about HIV/AIDS?

Dave Praeger’s book gives us a hint, or at least a lesson to be learned from history:
“By the end of the nineteenth century, state and social reformers in both England and America were working hard to spread the flush toilet across society and alleviate critical sanitary threats. Much of the strategy involved the state extending and maintaining modern sewer and water infrastructures, but reformers still needed to convince skeptics that the new bathroom technology was a boon and not a power-grab by the government. To overcome resistance in people who had been pooping in privies or chamber pots all their lives and were quite content with them, they associated health, happiness, refinement, and civilization with the flush toilet. The corollary of that, of course, was that people who didn’t use flush toilets were the opposite.”
This approach hits close to that of today’s social marketing experts, primus inter pares PSI. Social marketing is defined as “the systematic application of marketing alongside other concepts and techniques to achieve specific behavioral goals for a social good.” The bottom line is that 2.6 billion people need the health benefits associated with improved toilet facilities – the best way to make that happen may well NOT be preaching about those health benefits, but rather finding clever ways to make toilets/pit latrines more cosmopolitan, hip, cool, fun, refined, or alternatively to make it embarrassing to NOT have one.

So what can we learn from PSI’s approach and late nineteenth century America and England. Hopefully a lot – precisely zero people died from cholera in these two countries in 2007.

Wednesday, August 22, 2007

Comfortably Numb

Is there anybody in there?
Just nod if you can hear me.
Is there anyone home?

The world’s gravest public health crisis is unsafe drinking water and inadequate sanitation. Diseases related to this problem kill 5x more kids than HIV/AIDS, and twice as many as malaria. Four billion cases of debilitating diarrhea occur each year, and diarrheal diseases alone kill well over two million kids on an annual basis.

So, the good news: The world came together last week at the Stockholm International Water Institute’s World Water Week to discuss precisely this issue.

And the bad news: the three of you who read this blog are hearing more about World Water Week through this medium than most other people through what I'll humbly call more popular media.

Those mainstream media may well tackle water and climate change, ocean conservation, the bottled water industry, water as a human right, privatization and related issues. But they shy away from unsafe water as the gravest – and most solvable – global public health challenge. This was manifested by the paucity of coverage of World Water Week in at least the U.S. media. Neither The New York Times nor The Washington Post had even a poorly-turned phrase on World Water Week. The only Associated Press story picked up (according to a Google news search) in the U.S. media focused entirely on bio fuels, never even mentioning the severity of this global problem. (Way to go John Sauer at Water Advocates for tracking this.)

Solving the world’s drinking water and sanitation crisis is difficult – it is not a soundbite or silver bullet issue. As my cohort Dennis Warner of Catholic Relief Services says, it’s not rocket science – it’s harder than rocket science. How long did it take to train your kids to wash their hands after they use the bathroom? Do you wash your hands after each trip to the john even today? What’s our water infrastructure financing gap in the U.S. up to now?

But solving this problem is possible. How many English die of cholera in 2007? How many Japanese die of diarrhea? How many Americans have guinea worm, schistosomiasis or malaria?

The unsafe water issue will soon drive the international development agenda itself – it’s unfortunately a matter of time before the media are forced to come to terms with this global challenge whether they like it or not.

I suggest instead that the 1.1 billion people without safe drinking water throughout the developing world need the U.S. and European media to lead the target. As the NYT looks to the FT for story ideas, and as the Economist looks to The New Yorker, one well-placed story on unsafe water as the world’s biggest cause of preventable infant/child mortality and morbidity will punch well above its weight (and win a Pulitzer or two, people).

Some get it: one particularly insightful, clever piece comes from Carl Ganter at the Pacific Institute’s Circle of Blue: Navigating the Mainstream: The Challenge of Making Water Issues Matter. Read it and visit Circle of Blue. Seriously.

Another: Gil Garcetti (yes, that Gil Garcetti) is now an amazing professional photographer covering the world’s water crisis. See his new book Water is Key.

Another: Matt Damon’s new movie Running the Sahara is scheduled for release this fall.

There are stories lined up - there are high profile testimonials lined up – there are convincing water experts lined up. If that’s not enough, there’s always the crushing grip of reason which is tightening. We need to act – there are billions of the world’s poorest waiting for their governments to properly prioritize this issue. There is an opportunity for the Western media to get out ahead of this issue and pull the world along.

Sunday, August 19, 2007

None of My Business

Typically, I try always to be open-minded - to walk a mile in the other guy’s shoes, even if it is just to be a mile away and have his shoes when the deal goes sour. However, there are some things to which I cannot possibly relate, and even trying to gets me in trouble. One of those things is the female menstrual cycle.

So I find myself today getting caught up on some reading, in particular a NY Times article from December 23, 2005 entitled “Another School Barrier for African Girls: No Toilet.” I made it about three sentences into the article when this phrase caught my eye: “the realities of menstruation in a school with no latrine, no water, no hope of privacy other than the shadow of a bush, and no girlfriends with whom to commiserate.”

I quickly stopped my halfhearted attempt to relate to this, and am now working on the more simple reality that this is a bad thing and needs fixing.

So… Although the article’s protagonist (Fatimah Bamun, pictured above) is in Ethiopia, this is a reality which unfortunately is not isolated to Ethiopia or even Africa. Fifty percent of the world’s schools do not have access to safe water and single-gender sanitation facilities, and those parts of the world with such luxuries are in the fortunate position of not having to relate to this reality.

In Guinea, enrollment rates for girls from 1997 to 2002 jumped 17 percent after improvements in school sanitation, according to a recent Unicef report. The dropout rate among girls fell by an even bigger percentage.

This post is not about water – it can’t be. This post is about water as a direct conduit to additional educational opportunities for girls, and as a less direct but perhaps more compelling conduit to corresponding increases in economic development and decreases of fecundity rates.

Water and sanitation are statistically validated as significant contributors to education, whether it’s the Education Millennium Development Goal or any other success metric. A recent WaterAid report quantifies the impact of safe water and sanitation on not just the quantity of education, but also on the:

  • quality of education - children suffering from diarrhea or thirst (or holding back until nightfall to urinate) cannot concentrate on their lessons, and

  • teachers - particularly female teachers who often suffer the same consequences as do their pupils. It is very difficult to recruit and retain qualified teachers where the schools don’t have water and sanitation.

I’d also suggest a quick glance at least at the summary of the Proceedings of the 2005 Water, Sanitation and Hygiene Education for Schools Roundtable Meeting which begins with this quote from former UN Secretary General Kofi Annan:

Water is intimately linked with education and gender equality. Girls who have to spend time gathering water for the family tend not to be in school. And where schools have sanitation, attendance is higher, especially for girls. Water is connected to health, since millions of children get sick and die every year from water-borne diseases and for lack of basic sanitation and hygiene.

I’m not asking readers to relate to this gruesome reality, or even to solve the world’s water problem. More pragmatically I am asking you to consider what it would take to catalyze a situation whereby each of the world’s schools achieves safe, affordable and sustainable access to safe drinking water and single sex sanitation facilities? How many schools are there, how many suffer from these shortages, and what would it take for every government in the developing world to meet its responsibility and fill that gap? Last and least, what could the international donor community do to jumpstart this sort of commitment to life and livelihood?

For example, there are 54,000 schools in South Africa. If 50% of those do not yet have water and sanitation that defines our universe as 27,000 schools. At a conservative (on the high side) $20,000 a pop for water, sanitation and hygiene promotion, that’s $540m. Couldn’t the international donor community come up with $54m to goose the GoSA to make that commitment? Then wouldn’t the governments of Zambia, Mozambique, Botswana and Namibia be embarrassed…

Sunday, August 12, 2007

I’ll be damned if I’m gonna pay to take a piss

Direct quote from a tourist during a recent trip to Paris: “I’ll be damned if I’m gonna pay half a euro to take a piss. I’m going to McDonald’s!”

So people have a difficult time paying to go to the bathroom in France. Not exactly a newsflash, and I think the same will be said once public toilets start becoming more prevalent in NYC. Tourists will still whistle nonchalantly through hotel lobbies to get away with doing their business for free.

In several woredas (districts) in Ethiopia, however, it’s now the hip thing to not only have your own pit latrine by your home, but to pay for the privilege. How did this happen, and in Ethiopia of all places, where the per capita GDP is $US1,000, and where only 6% (sic) of the population has access to improved sanitation facilities? What’s the secret?

Trachoma is the world’s leading cause of preventable blindness, and is caused by a lack of safe water and inadequate sanitation facilities. Transmission of trachoma can be decreased significantly by using improved sanitation facilities like pit latrines. The Carter Center’s Trachoma Control Program, in cooperation with the Ethiopian Ministry of Health, launched a program in 2002 to catalyze the building of 10,000 pit latrines to stem trachoma. If there is one global public health story over the past few years that deserves to be above the fold in every mainstream periodical, it is this one:

Pit Latrines for All Households: The experience of Hulet Eju Enessie Woreda, Amhara National Regional State, Northwest Ethiopia

The full report (in Amharic) is a bit of a read. The gist of this executive summary (in English) is this:

  • 89,000 pit latrines were built (the actual number is now 225,000)
  • Ethiopians have for the most part done this themselves
  • Most households paid nothing for their latrines; of those who paid anything, the median amount was USD$2.80.
  • The secret to success was not throwing money at the problem, or pushing some inappropriate top-down technology or infrastructure.

The secret to success is what the Carter Center calls "community mobilization, the presence of a strong political commitment among local leaders, and integration into the pre-existing community structures and practices." The latin taxonomic name for that is “Ethiopicae grandmae,” less technically “Ethiopian grandmothers,” or “informal village leaders.”

Pit latrines do not sell themselves in most cases, particularly in rural and peri-urban areas where the need to find an unspoiled place to leave a #2 is less urgent because there is simply more real estate. Latrines are frequently expensive to build and maintain, even if the local demand exists. It is often very difficult even to create that demand though, particularly in more rural communities, and difficult to ensure that those latrines are used for their intended purposes, not as homes or as cow-dung storage sheds.

This particular Carter Center program did not have the resources to build latrines themselves, but only to do the community mobilization and training. I spent several years in the late 1990s working for USAID and U.S. Department of State contractors on democracy and governance initiatives throughout Africa. Not infrequently I found that the fewer financial resources we had available for a project, the more successful it turned out to be. This was because less money led to non-financial commitment(s) being provided by local leaders, and by women’s groups in particular. Once those local commitments were made available, the sustainability of our work increased dramatically.

This Carter Center report indicates similar results from a similar approach. If Patty Stonesifer would come to me today with the “How would you spend $5b” question, my answer would be “Scale the sanitation work of both the Carter Center and Sulabh International by customizing their approaches for every country/community in the world, and blow the sanitation MDG out of the water.”

It is not cost-effective to vaccinate a newborn against polio or mumps if that child will die at three years old from a preventable waterborne disease like diarrhea or malaria or be forced into a life of leading a trachoma-blinded adult around for the rest of his/her life.

Using a pit latrine is freedom, comfort, and honour!” — Villager from Hulet Eju Enessie Woreda

Monday, August 6, 2007

Hearts and Minds

Rear Admiral William McRaven had an intriguing quote in The Economist on June 14, 2007:
American officials insist that AFRICOM will not be all about building bases and airstrips but will co-operate with development agencies, NGOs and diplomats to win African hearts and minds and so deny terrorists havens from which to operate. Rear Admiral William McRaven, head of the special forces now operating in the Sahara, says his men are much more likely to drill boreholes and build houses than to shoot at anyone. “I don't want a fragile state collapsing any more than Greenpeace or USAID does,” he says.
Rear Admiral McRaven is Special Operations component, SOCEUR (Special Operations Command, Europe). His comment comes in the broader context of The Economist article called Policing the undergoverned spaces.

This post is not to suggest that the U.S. will win the long war by drilling boreholes, nor is it to suggest that U.S. military forces, much less the Special Forces, should be taking care of the water needs of the developing world (in fact I argue against this). There is, however, a growing recognition that along with traditional military operations we should be pursuing less militaristic methods of winning hearts of minds, particularly in countries deemed most likely to become breeding grounds for terrorists. The provision of water and sanitation becomes a particularly salient intervention in this equation. The U.S. intelligence community has realized for some time that overlaying the map of water scarce countries with the map of countries deemed the biggest threats to U.S. national security gets an almost perfect match. Plus the USG gets the biggest bang for its development dollar (in both direct and indirect returns) by investing that dollar in relatively simple water and sanitation initiatives.

One good recent example where this all comes together is CSIS's recent post on Below the Surface: U.S. International Water Policy. Erik Peterson notes:
Targeting water would also yield other geopolitical dividends—including removing what is a serious obstacle to stability and security within states and reducing the possibility for conflict or tension between countries with shared water resources. Finally, water represents an avenue for the United States to demonstrate leadership in the world at a time when its image has eroded so considerably. In short, a water-centered set of policies could represent a remarkable opportunity for the United States to “do good” while “doing well” when it comes to pursuing its own interests in the world.
So maybe this post is about how to win the long war after all.

Friday, August 3, 2007

Since you asked...

This is what keeps me awake at night (or at home on a Friday evening):

No matter how much I do, or anyone I work with or consort with does, no matter how much the international donor community does to support safe drinking water and sanitation around the world, no matter if every international donor dollar is spent in exactly the right, highly coordinated way, all we can hope for is for all of those resources collectively to be the cherry on top of the cake, or at best a little gas to get the water development engine going.

Where's the real money? Approximately 70 cents of each dollar that is invested in water/sanitation/hygiene in the developing world comes from public sector finance in developing countries themselves - Ghanaian, Nicaraguan, Vietnamese, Indian taxpayer dollars/rupees/cedis etc. Ten percent give or take comes from the international donor community, with the rest coming from international and domestic private investments in water and sanitation infrastructure.

The end game - universal coverage of water and sanitation, like we enjoy in the States, Europe, Japan - must be played and won by the developing country governments themselves. They must do a much better job of prioritizing water/sanitation in their own budgets over the long run, and do a better job of prioritizing water in international aid requests in the short/medium term (e.g. Millennium Challenge Corporation compacts). [So shouldn't I/we be lobbying those governments instead of the donor community here? Now you try to get some sleep with that question hanging over your head...]

Government subsidies, tax incentives, and grants are all partial answers to how developing country governments should tackle this problem. There are also a number of regulatory paths to take, and I just read of a couple more today:

The Disease Control Priorities Project (DCPP) is an "ongoing effort to assess disease control priorities and produce evidence-based analysis and resource materials to inform health policymaking in developing countries." They recently published a very insightful piece on Water, Sanitation, and Hygiene: Simple, Effective Solutions Save Lives.

It's a clear, short (4pp!) paper detailing both the problem and at least hinting at some interesting partial solutions. One example: with respect to sanitation infrastructure (e.g. building pit latrines), government subsidies are often unruly, inequitable and highly politicized. The DCPP recommends a regulatory approach to address the challenge:

In Bobo Dioulasso, Burkina Faso, for example, the local administration withdrew land tenure rights from owners who did not build a latrine on their plot within a specified time. As a result, 90 percent of households now have their own latrine. Another effective regulation requires landlords to provide latrines for their tenants.
Yay. Another opportunity for developing country governments to more effectively encourage the construction of pit latrines is through what is commonly known as social marketing, much and well-practiced by Population Services International in the donor arena. Governments are encouraged by the DCPP to promote latrines by almost any means possible, as it is perhaps the most cost-effective way to ensure their construction. It is also likely to come out ahead in any cost-benefit analysis. Pit latrines do NOT sell themselves, so governments stepping in to make them more compelling one way or another is part of the solution. And the scale of the solution matches the scale of the problem and I get to go out on Friday nights...

I also have self-doubts about the fact that if only the world's agriculture were 10% more water efficient, there might not be a drinking water supply problem at all, so maybe I should be working on that issue?!? But that's for another post.

Wednesday, August 1, 2007

More Systems, or Systemic Change?

GLOBE-Net today published Life at the bottom of the pyramid: Are environmental technologies the way out?

They start with C.K. Prahalad's work on The Fortune at the Bottom of the Pyramid (those four billion people, each living on less than two bucks a day, together constitute a $5trillion consumer market, fyi). Then GLOBE-Net says that that market won't materialize, and those four billion people won't pull themselves out of poverty, unless and until their simple needs for human security are met - e.g. clean drinking water.

SO let's go whole hog and nail both the safe drinking water problem AND the economic development problem in one swoop. This relates to my earlier post about microfinance and water, but I want to elaborate on that. In many cases, sustainability happens where development and capitalism intersect. It is an under-recognized truth that this is also the case in many instances with respect to something as basic as safe drinking water.

Just because water has many more sociocultural externalities associated with it than does energy, for example, doesn't mean that people are not able and as importantly willing to pay for it.

In my previous life (or at least two years of it) as a banker, one of the first things that we would look for in evaluating a company was to what extent the current management was invested financially in the company. Were management's interests and the shareholders' interests aligned? There is little reason to throw this way of thinking out of the window even when dealing with people making less that two dollars a day. GLOBE-Net gets it about right when they write with respect to community-level water filtration businesses:
In some cases, microfinance [has] allowed local residents to become 'water entrepreneurs.' Many organizations have found that once time and money have been invested in a filter, it is more likely to be used properly and maintained over time.
Some examples:

Acumen Fund

WaterHealth International

BioSand Filters

Locally Manufactured Chlorine


There are under-recognized opportunities to make water, sanitation and even hygiene development work financially self-sustaining. If we can tell better stories about the above examples and many others, we stand a pretty good chance of not just building a few more systems but of catalyzing meaningful systemic change.

Sunday, July 29, 2007

Bush/Cheney and Global Public Health Challenges

Let's consider for a moment the article currently front and center on WaPo:

Bush Appointee Blocked Surgeon General's Draft

I don't yet have a copy of the report, but its draft includes the following:
"we cannot overstate . . . that problems in remote parts of the globe can no longer be ignored. Diseases that Americans once read about as affecting people in regions . . . most of us would never visit are now capable of reaching us directly. The hunger, disease, and death resulting from poor food and nutrition create social and political instability . . . and that instability may spread to other nations as people migrate to survive."
Yes. And without provoking a flame war by getting involved in the partisan debate associated with the release (or non-release) of this report, let me tie this article to the world's largest public challenge: unsafe water and inadequate sanitation. They are not only the world's largest public health challenges but also the most solvable.

Safe water is not gun control or abortion or Iraq. It is noncontroversial, and supported by all save a few rabid isolationists. So let's ask this White House to fully fund 2005's Senator Paul Simon Water for the Poor Act and include this request in their FY09 budget to Congress this fall. Further updates shortly on how the FY08 process is going, btw.

Saturday, July 28, 2007

Water, Education, and American Express: priorities...

Just this morning I received an email from an old (I should say long-time) friend of mine suggesting I vote for the DonorsChoose project for education at the Amex Members Project contest here:

Members Project

She positioned DonorsChoose as the "David" and the UNICEF Children's Safe Drinking Water Project as the "Goliath," as does a recent interesting NY Times article here. My response to her (and to the dozens of other friends she had included in her To: line (most always a bad idea) was that Yes, UNICEF is large, but the word"Goliath" unjustly positions the Amex contest as a David vs. Goliath battle which fails to account for the real beneficiaries of both projects: children who either die from unsafe water or do not receive an adequate education.

Unsafe water is the #1 killer of children throughout the developing world. Period. Bad water kills five times as many kids as HIV/AIDS, twice as many as malaria. Period. More germane to this conversation: Without safe water, girl children in particular will not have the opportunity to enroll in school (they spend their childhoods either sick and hauling 45 pound buckets of dirty water on their heads). If their schools do not have single-gender sanitation facilities, they will drop out of school once they start menstruating and lack privacy. Safe water is in many cases the single biggest determinant of whether or not a girl receives an education.

For more information on the water/education nexus:

Water and Sanitation: The Education Drain (WaterAid)

The Education Millennium Development Goal: What Water, Sanitation and Hygiene Can Do

Water, Sanitation and Hygiene Education for Schools - Oxford Roundtable Statement

UNESCO – Focusing Resources on Effective School Health

Sunday, July 22, 2007

Homo sapiens vs. "lower primates"

The Washington Post published a very interesting piece this weekend:

In an Eastern Congo Oasis, Blood Amid the Greenery
In Africa's Oldest National Park, Gorillas Are Being Killed and Their Guardians Are Endangered, Too

Plenty of justifiable disgust with poachers, and I agree with that. But poachers are the symptom of a much more grave problem, the insecurity of the local populations of homo sapiens.

As I commented on the WP site, "At the risk of starting a flame war, let me suggest that we see homo sapiens as part of the solution, not just part of the problem. The better off humans are in that part of the world, the less likely they are to threaten "lower" primates."

One of the most effective ways to enhance basic human security in many parts of sub-Saharan Africa is to see that the locals have sufficient access to safe drinking water and sanitation. As an example, see what Daryl Hannah is doing in Rwanda:

Daryl Hannah Turns It On for World Water Day

The more safe drinking water is available in human villages, the less frequently those humans need to encroach on gorilla habitat. The unfortunate reality is that when homo sapiens encounter other primates, homo sapiens typically win. We should do what we can to avoid those instances, as should the local and national government authorities in Rwanda, Uganda and elsewhere.

The one other thing I would add in this forum is that if human waste in the villages is treated properly (e.g. pit latrines), the more likely that the bodies of water supporting the gorilla habitats will remain at least relatively unspoiled, so it is important to not omit consideration of environmental sanitation as well.

Wednesday, July 18, 2007

And in the red corner - our next 2008 contender

Senator Sam Brownback, a longstanding friend of Africa and water, continued his committed leadership by speaking at a group of national water leaders organized by Water Advocates on World Water Day March 22, 2007. In a speech given at that meeting, Sen. Brownback stated that "[t]he global water crisis is currently one of the greatest public health issues, condemning billions of people to a perpetual struggle to survive at the subsistence level. It is unconscionable that in 2007 so many people are dying from waterborne diseases." Talk to me Senator - I need a subscription to that sort of thinking.

He continued with "the crisis is most prevalent in developing countries, especially in Sub-Saharan Africa and South Asia. Many women and young girls in rural areas in Sub-Saharan African and other parts of the world must walk miles every day to retrieve water for their families."

That's two 2008 contenders on board, 7 Democrats and 9 Republicans to go, I think.

Vote Early Vote Often

Get warmed up for November 4, 2008 by voting at:

American Express - Members Project

I suggest Children's Safe Drinking Water. It's a point-of-use water purification system from UNICEF et al.

Friday, July 13, 2007

Throw Money at It

The global safe drinking water, sanitation and hygiene crisis is one which can surely benefit from additional financial resources. There is little donor fatigue in this sector - there is simply a dearth of donors.

If the Wealth and Giving Forum last week in Greenbrier, West Virginia has its say that may soon be changing.

As Tom Watson reports in onPhilanthropy:

The gathering focused on issues surrounding water - from disease and poverty to environmental and security concerns - and participating families were asked a number of questions during a polling session about their attitudes toward philanthropy. Just half-way through the conference, they were asked whether they'd be more likely to give their resources to water-related issues; 80% answered affirmatively.

Of the high net worth individuals and foundations present, 80% are now more likely to give to water-related issues. I'll settle for that.

Unsafe water and inadequate sanitation, and the mortality (between 3-6 million people die each year from unsafe water) and the morbidity (each year there are over 4 billion serious cases of diarrhea) they cause, are not controversial issues. This is not gun control or immigration, and what is possible (and required) is a massive, nonpartisan response by both developing and developed countries. The scale of the solution must match the scale of the problem.

Wednesday, July 11, 2007

Where to Start in Africa?

William Easterly had an insightful piece "What Bono doesn't say about Africa" in the LA Times on July 6 which included:

...the typical African is a long way from being a starving, AIDS-stricken refugee at the mercy of child soldiers. The reality is that many more Africans need latrines than need Western peacekeepers — but that doesn't play so well on TV.
Couldn't agree more. The opportunities for education, health, poverty alleviation and real economic development which accrue to an individual who has a place to go to the bathroom are worth contemplating. Also worth contemplating, considering the overall pessimism regarding the potential of sub-Saharan Africa to reach the Millennium Development Goals, is the contribution that the provision of safe drinking water and improved sanitation (viz. latrines) makes to each of the other Millennium Development Goals. Much research exists to quantify the positive impact that safe drinking water and improved sanitation have on the MDGs on maternal and child health, education, poverty alleviation, gender equality and environmental sustainability. Some of the most clear findings on this are here.

Sunday, July 8, 2007

The Greatest Story Ever Untold - the Impending Eradication of Dracunculiasis

Smallpox was declared eradicated in 1980, making it the first infectious disease to be wiped off the face of the planet. This is an amazing accomplishment for humanity, and deserves an appearance on the silver screen - anyone want to write the script? Start by talking to D.A. Henderson.

An equally dramatic but under-reported story is the impending eradication of Guinea worm, a parasitic disease directly related to unsafe drinking water and inadequate sanitation. The Guinea worm is a particularly unpleasant critter, with a nine month+ lifecycle that makes it difficult to control much less eradicate.

Eradication protocol differs from that of smallpox in that eradicating Guinea worm relies not on a vaccine but on simple, life-saving water and sanitation infrastructure and hygiene promotion activities: drilling boreholes, purifying surface water, and teaching people (primarily villagers in rural communities in nine African countries) not to enter bodies of water when they are infectious.

The Carter Center and others expect to completely eradicate this parasite by 2009. Succeeding in this will be a testament not to the Carter Center's good works per se but to the ability of the poorest communities in the world to solve their own public health challenges with minimum inputs from the international donor community. It will be a testament to the importance of basic water and sanitation as a foundation for overcoming all public health-related challenges and meeting the Millennium Development Goals. Its success will also give the polio eradication initiative of Rotary International a nice kick in the pants.

John Edwards first of 2008 U.S. field to tackle safe drinking water

Democrat John Edwards recently became the first (of many - stay tuned for reports on Brownback, Obama and others) of the 2008 U.S. presidential contenders to thoughtfully tackle the global safe drinking water and sanitation issue.

His campaign website includes the following commitment:

"Invest in Clean Water: The World Health Organization has found that every $1 invested in clean water yields an economic return of $8. Edwards will double the U.S. investment in clean water. He will also convene an international summit of government, businesses, and non-profits to agree on necessary investments to make water safe worldwide by 2015."

The return on that one dollar investment may be even higher in many instances as reported here. These are both direct financial returns to individuals, families and communities, as well as significant time savings and healthcare cost savings.

For a broader look at the 2008 field and what the candidates are doing to prioritize solutions to global health challenges and extreme poverty, check out One Vote '08.

Tuesday, June 26, 2007

What's next for Muhammad Yunus?

What do you give a guy who has won the Nobel Peace Prize? How about suggesting he try to win another?

Now he looks pretty pleased in the snap here - and he deserves all the kudos that are his due. But what would it take to get Muhammad Yunus and other microfinance institutions to keep at it - and make small loans available to entrepreneurs throughout the developing world who want to launch socially beneficial businesses in the water and sanitation sector?

$20 puts a woman in the handmade soap-making business. Wrap the bars of soap in hygiene promotion messages, and you've got a job with enormous social benefits. Throw in a local language cartoon like Bazooka Joe and you'll have kids begging to wash their hands - think Scooby Doo toothpaste.

$100 would allow a village to buy a few bags of cement, a shovel, and a mold for a cement pit latrine slab. Add a few donor dollars as a social marketing grant to kickstart the latrine business (this things rarely sell themselves), and you have a job with enormous social benefits. When the villager can no longer keep up with growing demand in his village - inshallah - he franchises the model, expands the business, and expands its social benefits.

$3,000 - $10,000+ provides an entrepreneur the opportunity to launch a water pumping business or water purification business. Depending on local externalities, this could involve a borehole and an electric pump. This could involve arsenic removal technology, UV water purification, protecting a spring, rainwater catchment and myriad other options.

What I'm asking for is not a revolution. We didn't need a revolution to kill smallpox. We won't need a revolution to kill polio, Guinea worm or even malaria. What we need is a little creativity. We need to take what we already know how to do with microfinance for betel nut juice sellers, bricklayers, bicycle repairmen and so on and reapply and customize those skills and financial models to the water sector.

Saturday, June 23, 2007

Tony Blair and Safe Water

What the global safe drinking water issue lacks is sex appeal. To remedy this I give you:

Tony Blair

Matthew Yglesias: "What Blair needs to do is find himself a nice, fairly uncontroversial issue to work on. HIV/AIDS is always a solid choice, but I think Bill Clinton's cornered that market. Access to safe drinking water would probably be a good idea."

Good idea indeed.

Diarrhea: the unloved red-headed stepchild of the global health debate

We all know that 1.1 billion people do not have access to safe drinking water around the world, primarily in rural communities. We all know that 2.6 billion people do not have adequate sanitation facilities. So let’s jump right into this discussion of issues related to the global safe drinking water crisis with a shout out to what is arguably the world’s largest, most solvable but least compelling public health challenge: diarrhea. For reasons which remain obscure to me, diarrhea remains under-discussed at dinner parties and cocktail hours. But so was HIV/AIDS until a few years ago, and diarrhea also kills millions of people (mostly children) in a very unappetizing fashion.

2008 is the International Year of Sanitation. Will this accomplish anything other than give me the opportunity to say the “S” word in public at the Blue Salon last weekend? Will it result in anything consequential being done by developing or developed countries to tackle this issue?

I am humbled and inspired by Dr. Larry Brilliant’s recent words about diarrhea. In February 2007 he stated “We need to reduce population growth…And the best way to control population is through increasing child survival (and) educating girls…” He continued: “It is counter-intuitive, but eradicating smallpox and vaccine-preventable disease, stopping diarrheal diseases and malaria are the best family planning programs yet devised. With fewer childhood deaths, you get lower fertility rates.” Diarrhea kills five times as many children as does HIV/AIDS, twice as many as malaria, four times as many as measles. And those are just mortality statistics.

How about diarrhea-related morbidity? You can’t compete with the negative health, social and economic impacts of 4 billion cases of diarrhea each year. This isn’t the sort of diarrhea where you spend the evening on the couch getting caught up on Netflix and eating Pedialyte ice pops to rehydrate – all within paces of a bathroom with a nice flushing john. This is the sort of diarrhea which keeps children from school, which keeps adults from working or farming, which prohibits communities and nations from pulling themselves up to the next rung of the economic development ladder. And kills two million kids each year.

Diarrhea is not just treatable, it is preventable. It is preventable through the provision of safe drinking water, adequate sanitation and hygiene education throughout the developing world. So what’s the best way for the international community to invest its limited donor financial commitments? Where’s the best return for governments in the developing world to invest their healthcare resources?