The new WHO report shows that, while progress has been made, 2.5 billion people around the world still do not have access to improved sanitation.
The UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) report - which is published every 2 years - shows that 2.3 billion people around the world gained access to improved drinking water between 1990 and 2012.
Deaths among children due to diarrheal diseases - which are strongly associated with inadequate sanitation and hygiene and poor drinking water - have also fallen over the last 20 years from 1.5 million in 1990 to just over 600,000 in 2012.
On a further positive note, the World Health Organization (WHO) report shows that international aid for water, sanitation and hygiene (WASH) is rising: between 2010 and 2012, it went up by 30% - from $8.3 billion to $10.9 billion.
However, it also says that much remains to be done - particularly to reduce inequalities - and quantifies the huge scale of the global challenge:
- 2.5 billion people still do not have access to improved sanitation
- 1 billion people practice open defecation
- 748 million people have no access to an improved drinking water supply.
Hundreds of millions of people do not have clean water for washing hands
Moreover, says the WHO report, hundreds of millions of people still do not have clean water for washing their hands - just overcoming this would have a huge effect on reducing spread of diarrheal disease, the second leading cause of death among children under 5.
Poor sanitation and hygiene can increase the spread of diseases like intestinal worms, blinding trachoma and schistosomiasis, which affect people in the developing world.
The report also notes that:
"Neglect of WASH, and the ensuing poor conditions and practices in communities and institutional settings like schools and especially health facilities, have exacerbated the current West African Ebola crisis."
Using survey data from 94 countries and 23 external support organizations, the report presents a comprehensive analysis of the national and global challenges concerning WASH provision.
It shows that the universal human right to drinking water and sanitation is enshrined in the national legislation of two thirds of the countries surveyed. Also, 80% of them say they have policies in place for drinking water and sanitation, and more than 75% have policies for hygiene.
By access to "improved" drinking water, the report means having a source of water that is protected from external contamination - particularly fecal contamination. Examples include piped water into the home, plot or yard; protected spring; and a public tap or standpipe.
"Improved" sanitation facility is one that hygienically separates human excreta from human contact.
Serious funding gaps in rural areas and inequalities in provision
President John Agyekum Kufuor, chair of Sanitation and Water for All - a partnership of governments, donors, civil society and multilateral organizations - says:
"The report guides governments in knowing where progress in WASH is being made and where more resources need to be allocated."
The report says while international funding for WASH has increased, it is not enough to meet the needs; 80% of countries reported they do not have enough funds to meet their targets for drinking water and sanitation.
The report highlights the serious funding gap in rural areas and the inequalities of provision. For instance, most of the financing of sanitation continues to benefit those living in urban communities - whereas the vast majority who lack access live in rural areas. Spend on sanitation provision in rural areas, it notes, amounts to less than 10% of total WASH financing.
There also appears to be a mismatch between political support for universal access to water and sanitation and what happens at planning and implementation level. Less than one third of the countries surveyed have fully implemented, funded and regularly reviewed WASH plans, says the WHO report.
Countries also need to increase their monitoring of WASH - many reported gaps in their data gathering frameworks. This results in incomplete and fragmented data, which leads to weak analysis.
Another of the key challenges the report highlights is ensuring the provision of water and sanitation services in schools, health clinics and institutional settings.
Providing WASH services in schools ensures children stay and learn lifelong hygiene habits. WASH provision in health centers are not only essential to prevent disease outbreaks, they ensure patients get the privacy and safety they need, especially women giving birth.
Yet, says the report, less than 30% of countries surveyed have national WASH plans for schools, health facilities and other institutional settings that were being fully implemented, funded and regularly reviewed.
In August 2014, Medical News Today reported a study that highlighted the challenges that India faces in seeking to improve child health by increasing access to sanitation.