Health through integrated water resources management

What is IWRM?

IWRM is the process of promoting the coordinated development and management of water, land and related resources, in order to maximize the resultant economic and social welfare in an equitable manner without compromising the sustainability of vital ecosystems.

Support to overall achievement of the MDGs

A basin-wide approach to water resources development and management has immediate repercussions for the MDG targets relating to

• the reduction of poverty and hunger (through the development of irrigated agriculture and the provision of access to safe drinking water),
• the promotion of gender equality and the empowerment of women (through changes in the gender roles in the management of land and water resources),
• the reduction of child mortality (through its positive impact on risk levels for water associated diseases),
• combating key communicable diseases, in particular malaria (through improved water management and reduction of mosquito breeding places), and
• better access to safe drinking water (through a better allocation of water to different user groups).

IWRM, Health and Disease

A number of health issues stand out as fundamentally linked to this goal and target.

• The nutritional status of communities can benefit significantly from the integrated management of water resources, since this will enhance the productive capacity of agricultural systems. Subsistence agriculture will thus produce food more reliably and in greater variety, while cash crop agriculture will produce higher value crops that will provide communities the means to buy food that is quantitatively and qualitatively better.
• The risk factors of water-associated ill health can be distinguished as those related to access to safe drinking water (diarrhoeal diseases, helminth infections, other water-borne diseases and
• Those related to the aquatic ecosystem that sustains insect vectors of diseases (malaria, schistosomiasis, lymphatic filariasis and a number of arboviral diseases).
• Considerable disease burdens can be attributed to current practice of water resources development and management, which therefore, for their health implications alone, often cannot be characterized as sustainable.

What's needed to reach the goal?

Future challenges to ensure a distinct health profile in IWRM efforts include the pressure in some parts of the world to accelerate water resources development in the face of growing scarcity of good quality water (with a resulting downgrading of health issues as externalities), and the fragmentation in governance systems (both horizontal between public sectors and vertical as a result of the process of decentralization) which will make the required intersectoral collaboration more difficult. It is therefore essential that health issues are embedded in the national policies and programmes for IWRM. Ministries of health will need strengthening to allow them to fulfil a powerful role in this connection.

The health significance of reaching the goal

Countries adopting the IWRM approaches in their national water resources policies and strategies will lay the foundation for a number of health gains, that will differ depending on the current conditions of water associated diseases and the types of water use that will be pursued through IWRM. In countries where rural malnutrition is a critical public health problem, IWRM will contribute to food security and to the possibility of more diverse diets. The development of irrigation schemes, the construction of dams and other hydraulic infrastructure development done within an IWRM context will allow for maximum health protection and promotion measures. Issues of water quality and their impact on communicable and non-communicable diseases are optimally addressed under IWRM principles. And in areas prone to floods, IWRM will facilitate better options to protect local communities from the hazards.

WHO efforts

The efforts of the World Health Organization through its Water, Sanitation and Health programme at HQ, regional and country offices include two strategic components:

• building national capacities in health impact assessment of water resources development and
• promotion of best practice in water management to protect and promote health.

For the first component the Organization offers a comprehensive capacity building package targeted at policy formulation, institution strengthening and skills development. For the second component the Organization is in the process of preparing best practice guidance, standards and norms that can be applied in the context of IWRM.