Water sanitation hygiene

Philip D. O’Brien, Regional Director, UNICEF Regional Office, Geneva

Address to commemorate the World Water Day

Geneva, Switzerland, 20 March 2008
20 March 2008

Your Royal Highness, Prince Willem-Alexander, Mrs Margaret Chan, Mr Jon Lane, Ms Beate Willhem, Friends and colleagues

I would like to extend the greetings of our Executive Director Ms. Ann Veneman to you all, and pass on her best wishes on World Water Day, during this International Year of Sanitation. She and all of us at UNICEF are very pleased to co-host this important day with the World Health Organization and the Water Supply and Sanitation Collaborative Council. UNICEF has a strong interest in and commitment to hygiene and sanitation globally as it is vital for the health, social and economic development of children.

Why "Sanitation Matters" for children is obvious: some 2.6 billion people in the World live without access to proper toilet facilities among them some 980 million young people under 18's. 280 million children under five live in homes without access to basic sanitation. Half of the (120 million) children born in the developing world each year will be born into homes without basic sanitation. They will be born but they don’t all live. As His Royal Highness said, more than 5000 children under 5-years-old die each day from inadequate water sanitation-diarrhea related causes.

And this has a devastating impact on their lives:

While the correlation between Under-five mortality and sanitation coverage is abundantly clear --- the damage does not stop there. Diarrhea launches a cause and effect chain with tragic results, diarrhea is closely linked to under-nutrition, and under-nutrition is associated with more than half of all under-five deaths. Undernourished children, in turn, have compromised immune systems and are at a higher risk for developing pneumonia – a disease that kills more children than any other disease.

This chain reaction illustrates that sanitation and hygiene improvements are the bedrock for children’s health. Without them, the children are vulnerable to a host of fatal and debilitating diseases. Sanitation and hygiene are the foundations of preventive health as Margaret Chan has said.

But there is another side to all this;

A side that particularly affects girls and women - who in reality bear the true burden of the lack of access to improved hygiene and sanitation? Not just in terms of time and energy they expend daily caring for family members who have diarrhea or other diseases, but also the indignity and lack of privacy they suffer through not having basic sanitation facilities. Girls in particular suffer such indignities at schools where there are no separate toilets, and this lack of privacy often forces them to drop out of education, as they get older.

What Sandy Cairncross calls "Imprisonment by Daylight" is evocatively described by Hassina, a 10-year-old girl at Gewane Primary School in Ethiopia – "Toilets in our school and at home have made a big difference to my life. Before I hated using the old toilet at school or going to the field and I preferred to wait until evening time even if I had to go badly".

Our global commitment to keeping girls in school, to gender equity in education, (a goal that we are not meeting so far) is in part being under cut by the simple failure to have the right facilities in every school for every girl.

There is progress and there are solutions.

Great strides are being made in Asia and Africa in community based demand-led approaches for sanitation such as the Total sanitation approach in India or Community led total sanitation in Zambia. There, new demands are being catered for by a thriving sanitation industry led by innovative local sanitation entrepreneurs.

The Public Private Partnership for Hand washing and indeed UNICEF’s partnership with Unilever (Project Champion) are both undertaking innovative work in elation to hand washing behaviour change, which could really impact on the lives of children and their families.

To bring about transformations in sanitation and hygiene requires the cooperation from those whose life work is to stimulate demand: the marketers. One simple example: Hand washing, which effectively will reduce number of diarrhea cases by a third with a consequent impact on mortality, is vital in efforts to reach the Millennium Development Goals.

Combining the expertise and resources of the soap industry with the facilities and resources of governments, and the advocacy and outreach capacity of NGOS to promote hand washing with soap – these could be/would be enormous synergistic impact. Social marketing initiatives have proven to be successful in establishing the behavioral change in other health programming; change that so far has been difficult to achieve with conventional hygiene education programmes.

Moreover, let us not be stalled by cost considerations, spending money on sanitation is a good, if in the eyes of traditional economics, an unconventional, investment. Spend a $1 on sanitation, get a benefit of approximately $9, in saved health care costs, in increased educational attainment, and work productivity, though I am not sure anybody has been able to price the value of improved human dignity.


We need to accelerate our commitment and investments in hygiene and sanitation and take immediate action to increase access to improved services throughout the World. Today, just one day, gives us the chance to encourage that, and it is the day in which another 5000 needless, preventable deaths will take place. I hope when we acknowledge World Water day in 2009, that this figure will be significantly lower.

Children throughout the World like Hassina deserve nothing less. My kids always seem to manage to get in the last word, I have learned to yield it to them and it makes sense today to let it be Hassina who perhaps says it all for us:

"At first people did not want to talk about toilets and hygiene, they said it was embarrassing and that I shouldn’t be talking about it. But for me it is very important as it will protect my family and friends – so I kept talking and my parents listened to me and now we have a toilet at home".

Thank you!