Liquid Magic: How Universal Access to Clean Water Will Lead to Poverty Eradication in SubSaharan Africa

Senior Independent Project

Megan Grace Landau

Spring 2012

Abstract
My paper is about the water crisis and its implications on poverty eradication in subSaharan Africa. I chose this topic because I believe each and every person deserves a life that is
free of poverty; a life that allows and enables him or her to realize their full potential as human
beings. Clean water is a crucial foundation for human development, yet for a large section of
humanity, access to it is not in place. Almost one billion people worldwide lack access to clean
water, but this headline number only captures one dimension of the problem. It is my hope that
this paper puts a face on those sub-Saharan Africans who suffer from ill health, gender
inequalities and restricted opportunities in education and the economy because of the water
crisis. I trust that within a generation, the worldwide water crisis can be consigned to history.
I relied heavily on the United Nations Development Programs Human Development
Report 2006, Beyond Scarcity: Power, Poverty and the Global Water Crisis. The United
Nations Millennium Development Goals Report 2011 was also very helpful throughout the
entire process. I interviewed Bobby Bailey, Erin Swanson and John Sauer, who each work for
organizations that promote the use of water projects in an effort to reduce poverty.
In this paper, I will argue that no other single intervention is more likely to have a
significant impact on poverty in sub-Saharan Africa than the provision of safe water. First, I will
discuss the state of poverty in SSA and the increasing global awareness of the water crisis. I will
describe the health implications of a lack of adequate WASH, and the time poverty experienced
by the women and children who must collect water each day. Then, I will describe the impact of
education on sustainability, the empowerment of women, the health of children, and the success
of the economy. I will conclude with a look into the future of the water crisis.

Landau 3

Now, I am beautiful, exclaimed Helen Apio, with a glowing smile and fresh flowers in
her hair. She was speaking to Becky Straw, the Water Project Manager for charity: water, a
non-profit organization that brings clean and safe drinking water to people in developing nations.
Hope and happiness rocked Helens village in the rural countryside of Northern Uganda as the
local women cheered and danced exuberantly. They were celebrating the opportunities that came
with the new water well built in their village. The women used to spend most of their time
walking a mile and a half, four to five times a day, as they carried two five-gallon Jerry Cans1 to
the nearest water point. There, they had to wait in line, sometimes for hours, for contaminated
water. However, since the materialization of the new well, Helens life has been transformed. I
am happy now, Helen beamed, I have time to eat, my children can go to school. And I can
even work in my garden, take a shower and then come back for more water if I want! I am
bathing so well.2 Because of its new water well, Helens village is prospering after centuries of
poverty. In Helens village, and sub-Saharan Africa as a whole, water changes everything.

Jerry Can: A flat-sided can for storing or transporting liquids, used especially for motor fuels and having a capacity between of 20 and 23 liters.
Jerry Cans are used in developing nations to carry water back and forth from water sources to schools, homes and villages. When full with water,
a 20 liter Jerry can weights 44 pounds.
2
Becky Straw, Will the Beautiful Women of the World Please Stand Up, 8 Nov. 2011, <charitywater.org>. See Appendix A.

Landau 4
Human progress depends on access to clean water and the ability of societies to harness
the potential of water as a productive resource. 3 Throughout history, initiatives in water,
sanitation and hygiene (WASH) reform have been the catalysts for economic growth and human
development. In fact, the water and sanitation crisis facing the people of the developing world
today has parallels with an earlier period in the history of todays rich countries:
Few people in the industrial world reflect on the profound importance of
clean water and sanitation in shaping the history of their countries or their
life chances. Not too many generations ago the inhabitants of London,
New York and Paris were facing the same security threats as those of in
Lagos, Mumbai and Rio de Janeiro today. Water polluted with raw sewage
killed children, created health crises, undermined growth and kept people
in poverty. New technologies and finance made universal access to clean
water possible. But the crucial change was political At the start of the
21st century the world has the opportunity to unleash another leap forward
in human development. Within a generation the crisis in water and
sanitation could be consigned to history.4
For developing countries, it is becoming increasingly clear that the lack of access to
WASH facilities is truly a crisis. The United Nations Development Program (UNDP) proclaims,
The word crisis is sometimes overused in development. But when it comes to water, there is a
growing recognition that the world faces a crisis that, left unchecked, will derail progress
towards the Millennium Development Goals5 and hold back human development.6
Water flows through all aspects of human life.7 Access to it is a basic human necessity
and therefore a fundamental human right. Still, 884 million people worldwidethree times the
population of the United Statesdo not have access to clean water,8 and 2.6 billion people lack
access to adequate sanitation; a crisis that threatens life and destroys livelihoods on a devastating

Kevin Watkins, United Nations Development Program (UNDP), Human Development Report 2006; Beyond Scarcity: Power, Poverty and the
Global Water Crisis (New York: UNDP, 2006) v.
4
Watkins 28.
5
This is a concept that I will discuss more extensively in a later section.
6
Watkins v.
7
Watkins 20.
8
See Appendix B, Figures 2 and 3.

Landau 5
scale.9 The World Health Organization (WHO) deems twenty liters of water a day as the
minimum requirement per person for adequate drinking, sanitation, personal hygiene and
cooking. However, while the average American uses four hundred liters of water a day, the
average person in the developing world uses only ten liters. That is merely one half of a Jerry can
per day in the developing world, contrasted with two hundred Jerry cans per day in America.10 In
regard to this disparity, the organization Living Water International notes:
Unlike war and terrorism, the global water crisis does not make media
headlines, despite the fact that it claims more lives through disease than any
war claims through guns. Unlike natural disasters, it does not galvanize
concerted international action, despite the fact that more people die each year
from drinking dirty water than from the worlds hurricanes, floods, tsunamis
and earthquakes combined. This is a silent crisis experienced by the poor, and
tolerated by those with the resources, technology, and the political power to
end it. Yet this is a crisis that is holding back human progress, consigning
large segments of humanity to lives of poverty, vulnerability and insecurity.11
The water crisis is a crisis for the poor.!12 Worldwide, one in three people living on less
than one dollar a day lack access to clean water.13 This correlation is reflected in sub-Saharan
Africa (SSA), where fifty-one percent of the population lives on less than $1.25 a day, the
international poverty line,!14 and forty percent of the population15 lacks access to safe drinking
water.16 The water crisis implications on poverty are nothing but a downward spiral. It is a crisis
that is almost exclusively experienced by the poor, however, its implications make it impossible
to relieve oneself of poverty.

United Nations Department of Economic and Social Affairs (UN DESA), Millennium Development Goals Report 2011 (New York: United
Nations, 2011) 54.
10
What We Do, WaterAid, <wateraid.org>.
11
A Global Crisis, Living Water International, <water.cc>.
12
UN DESA, Poverty Eradication, 18 Nov. 2011 <social.un.org>. According to the United Nations Social Policy and Development Division,
poverty entails more than the lack of income and productive resources to ensure sustainable livelihoods. Its manifestations include hunger and
malnutrition, limited access to education and other basic services, social discrimination and exclusion as well as the lack of participation in
decision-making.
13
Watkins 7.
14
UN DESA, MDG Report 2011 6.
15
United States, Census Bureau, Monthly Population Estimates (Washington, D.C.: Census Bureau, 21 Dec. 2011) 1. 327 million people in SSA
lack access to clean water. Similarly, the population of America is currently estimated to be 307 million, according to the census bureau.
16
World Health Organization/UNICEF Joint Monitoring Program, Progress on Sanitation and Drinking Water: 2010 Update (New York:
UNICEF; Geneva: WHO, 2010) 7.

Landau 6
In SSA, access to WASH is a necessary precursor to all other forms of development.
Without sustainable access to these amenities, time spent on water collection and the health
implications of water-related illnesses keep Africans of all ages and genders from earning an
education. Education, along with water, represents opportunity: it empowers people with the
knowledge, skills and confidence they need to shape a better future.17 In 2008, only sixty
percent of sub-Saharan Africans had access to an improved water source.18 To meet the global
poverty eradication goals and to consign sub-Saharan African poverty to history, one hundred
percent of the people living in SSA need access to a safe and sustainable water source.
In this paper, I will argue that no other single intervention is more likely to have a
significant impact on poverty in sub-Saharan Africa than the provision of safe water. First, I will
discuss the state of poverty in SSA and the increasing global awareness of the water crisis. I will
describe the health implications of a lack of adequate WASH, and the time poverty experienced
by the women and children who must collect water each day. Then, I will describe the impact of
education on sustainability, the empowerment of women, the health of children, and the success
of the economy. I will conclude with a look into the future of the water crisis.
Background of Poverty in Sub-Saharan Africa
Before exploring the current state of poverty in SSA, it is important to understand the
regions fundamental causes for poverty. Africa is the second largest continent in both area and
population and SSA is divided into forty-nine independent countries.19 About two-thirds of all
Africans live in rural areas, where they make a living growing crops or raising livestock.20 In
many parts of rural Africa, the people live much as their ancestors did hundreds of years ago.
17

United Nations Educational, Scientific and Cultural Organization (UNESCO), Education Counts: Towards the Millennium Development
Goals (Paris: UNESCO, 2010).
18
UN DESA, MDG Report 2011 54.
19
Bureau of African Affairs, Countries and Other Areas, US Department of State, 20. Nov 2011, <state.gov>. See Appendix C.
20
Menghestab Haile, Weather Patterns, Food Security and Humanitarian Response in sub-Saharan Africa, Philosophical Transactions:
Biological Sciences, 29 Nov. 2005: 2169. In 2001, the total population of sub-Saharan Africa was estimated at 667 million with 436 rural, of
which 92% (400 million) are agricultural.

Landau 7
The problems associated with the water crisis are most severe in rural areas, primarily because
living beyond formal networks, rural communities typically manage their own water systems
without help from the government.21 For dispersed rural populations, delivering WASH services
is more difficult and often more costly than for urban populations. In these areas, political factors
come into play: people in rural communities typically have a far weaker voice in government
policies than their urban counterparts.22
The legacy of European colonialism looms over Africa as the root of many of the
continents current problems. Ethnic rivalries and territorial disputes that developed among
nations in the postcolonial period continue threaten the stability of SSA, and problems such as
overpopulation, poverty, famine, and disease remain challenges for sub-Saharan African
countries.23 Since 1980, no less than twenty-eight sub-Saharan African countries have been at
war, most being internal battles for power and wealth within states.24 In addition, many African
countries have been plagued by climate-related constraints, such as droughts, for a large portion
of their history.25 These droughts have serious impacts on the water crisis, at worst causing
famine and associated social disintegration.26
In SSA, the number of people living at the $1.25 a day poverty rate has increased
significantly since 1981. In absolute terms, the number of poor people has nearly doubled, from
200 million in 1981 to 390 million today. This leaves fifty-one percent of SSA in a state of
extreme poverty.27

21

Watkins 10.
Watkins 53.
23
Africa, World Book Encyclopedia, 2001 ed.
24
Richard Dowden, Africa: Altered States, Ordinary Miracles (New York: PublicAffairs, 2009) 2-3.
25
Michael H. Glantz and Richard W. Katz, Drought as a Constraint in sub-Saharan Africa, AMBIO: A Journal of the Human Environment,
2005: 334.
26
Charlotte Benson and Edward Clay, The World Bank, The Impact of Drought on sub-Saharan African Economies: A Preliminary Examination
(Washington, D.C.: The World Bank, 1998) 1.
27
World Bank Updates Poverty Estimates for the Developing World, The World Bank, 19 Nov. 2011, <econ.worldbank.org>.
22

Landau 8
United Nations Millennium Development Goals
At the 2000 United Nations (UN) Millennium Summit, the UN set eight Millennium
Development Goals (MDGs) with a target to end global poverty by 2015.28 The goals represent
human needs and basic rights that every individual around the world should be able to enjoy
freedom from extreme poverty and hunger; quality education, productive and decent
employment, good health and shelter; the right of women to give birth without risking their lives;
and a world where environmental sustainability is a priority, and women and men live in
equality. The UN affirms, meeting the goals is everyones business, because achieving the
goals will put us on a fast track to a world that is more stable, more just, and more secure.29
One target of the seventh MDG, target 7.C, strives to halve, by 2015, the proportion of
the population without sustainable access to safe drinking water and sanitation.30 Although
access to safe water only specifically falls under Goal Seven, water management is essential to
meeting each of the eight MDGs.31 Improved access to water and sanitation reduces poverty both
directly and indirectly. Therefore, poverty reduction strategies must include effective water and
sanitation interventions if they are to achieve long-term success.32
Health, Sanitation and Hygiene
The health implications from a lack of adequate WASH keep sub-Saharan Africans from
receiving a quality education and earning a suitable income.33 Consequently, many are prevented
from being relieved of poverty. According to the World Bank, eighty-eight percent of all
diseases are caused by unsafe drinking water, inadequate sanitation and poor hygiene; and at any
given time, patients suffering water-related diseases occupy half of the developing worlds
28

See Appendix D.
UN DESA, MDG Report 2011 3.
UN DESA, MDG Report 2011 53.
31
Poverty-Environment Partnership, Linking Poverty Reduction and Water Management, (Geneva: WHO, 17 Mar. 2006) 9.
32
Water, Sanitation and Poverty Reduction, (London: WaterAid, 2001) 2.
33
See Appendix E.
29
30

Landau 9
hospital beds. Children are the most severely affected by unsafe water, as water-related diseases
are the second biggest killer of children worldwide.34 In 2001, The Water Supply and Sanitation
Collaborative Council (WSSCC) found that a child dies every twenty seconds from a waterrelated disease. 35
Initiatives in WASH are vital to meeting four of the MDGs,36 and especially important to
Goal Fourto reduce by two-thirds the under-five mortality rate. In an effort to put the
magnitude of adequate WASH into perspective, the UNDP compares the substance to
immunizations: Clean water and sanitation are among the most powerful preventative
medicines for reducing child mortality. They are to diarrhea what immunization is to killer
diseases such as measles or polio: a mechanism for reducing risk and averting death.37
Adequate sanitation has the potential to produce cumulative benefits in public health,
employment and economic growth.38 According to the UNDP, Toilets may be an unlikely
catalyst for human progressbut the evidence that they are is overwhelming.39 Improved
sanitation is defined as access to a facility that ensures hygienic separation of human excreta
from human contactbasically, access to a toilet. Worldwide, two in five people do not have the
security and dignity of a hygienic latrine or toilet, 40 even though access to such a facility reduces
death rates by forty percent.41 This lack of hygienic separation is such a significant problem
primarily because, as the United Nations Childrens Fund (UNICEF) reports, One gram of feces
can contain ten million viruses, one million bacteria, one thousands parasite cysts and one

34

Rachel Oliver, All About: Water and Health, CNN, 18 Dec. 2007: 1.
Sanitation is Vital for Health, Water Supply and Sanitation Collaborative Council, <wsscc.org>.
36
Goal 4: Reduce by two thirds the under-five mortality rate. Goal 5: Improve maternal health. Goal 6: Combat HIV/AIDS, malaria and other
diseases. Goal 7.C: Reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation.
37
Watkins 43.
38
See Appendix F.
39
Watkins 120.
40
WHO/UNICEF, Progress on Drinking Water and Sanitation, 2010 Update 2.
41
Integrated Projects, WaterAid, <wateraid.org>.
35

Landau 10
hundred parasite eggs.42 Naturally, without sanitation facilities to safely contain and dispose of
human feces, the health of a community is put at severe risk.
The sanitation situation in SSA is particularly bleak. In 2008, only sixty-nine percent of
sub-Saharan Africans had secure access to an improved43 sanitation facility,44 and poor people
were over fifteen times more likely to practice open defecation than those who were better off.45
Mary Akinyi describes the sanitation conditions in the Mugomo-ini village where she lives in
Kiberia, Kenya:
The conditions here are terrible. You can see for yourself. There is sewage
everywhere. Some people have pit latrines, but they are shallow and they
overflow when it rains. Most people use buckets and plastic bags for
toiletsand the children use the streets and yards. Our children suffer all
the time from diarrhea and other diseases because it is so filthy.46
Teenage girls are the most heavily impacted by the deficit in sanitation due to the stigma
surrounding menstruation. In SSA, lack of access to sanitation becomes a central cultural and
human health issue, contributing to female illiteracy and low levels of education, in turn
creating to a cycle of poor health for women and their children.47 School attendance rates among
girls rise by eleven percent when private sanitation facilities are available at the school building,
enabling the girls to carry on with their education while they are menstruating. Often times,
parents withdraw their daughters from school when the school does not offer adequate sanitation
and separate toilets for girls due to concerns regarding security and privacy. In one estimate

42

International Year of Sanitation 2008: Overview, United Nations Childrens Fund (UNICEF), 2008, <sanitationyear2008.org>.
An improved facility refers to any sanitation facility that securely separates human excreta and human contact, such as a pit latrine or
standpipe.
44
UN DESA, MDG Goal Report 2011 55.
45
John Garret and Tom Slaymaker, Sub-Saharan Sanitation Targets Two Centuries Away, Epoch Times 29 Nov. 2011: 17.
46
Watkins 38.
47
United Nations University Institute for Water, Environment and Health, Sanitation as a Key to Global Health: Voices From the Field (Ontario:
United Nations University, 2010) 11.
43

Landau 11
made by the UNDP, about half of the girls in SSA who drop out of primary school do so because
of poor water and sanitation facilities.48
In order to ensure a lasting and sustainable impact, community education regarding
sanitation and hygiene must be integrated as a central focus of all water projects. Without
knowledge of proper sanitation and hygiene, an entire communitys supply of clean water can be
easily contaminated, because when clean water is brought to villages for the first time, citizens
do not know how to protect the cleanliness of the water or of themselves.49 For instance, if a
child goes to the bathroom and then dips his hands in a water source without washing them, he
contaminates all of the previously clean water. In addition, unhygienic handling of water during
transport or within the home can contaminate clean water, as hands are vehicles for transmitting
pathogens to food, water and mouths.50 Tragically, if current rates of progress continue, universal
access to sanitation in SSA will not be met for another two hundred years.51
Many of the diseases that plague sub-Saharan Africans are easily preventable, meaning
they can be prevented with steady access to clean water, effective sanitation and good hygiene.
In fact, approximately ten percent of the total global disease burden could be prevented by
improvements related to WASH.52
Worldwide, eighty-eight percent of all cases of diarrhea are attributable to unsafe and
inadequate WASH, and in Africa, diarrhea is the primary killer of children.53 The disease

48

Watkins 268.
B. Wisner and J. Adams, World Health Organization, Environmental Health in Emergencies and Disasters (Geneva: WHO, 2002) 124.
50
WHO/UNICEF Joint Monitoring Program, Progress on Drinking Water and Sanitation: Special Focus on Sanitation (New York: UNICEF,
Geneva: WHO 2008) 4.
51
Maroussia Klep, Political Motivation in sub-Saharan Africa Essential for Reaching Sanitation Millennium Development Goals, Media
Global News: The Developing World in Focus 29 Sept. 2011: 1.
52
Annette Pruss-stn, Bos, Gore and Bartram, Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and
Promote Health (Geneva: WHO, 2008) 7.
53
Garret and Slaymaker 4.
49

Landau 12
category diarrhea encompasses several more severe diseases, most notably cholera,54 typhoid
fever55 and bacillary dysentery. In addition, fifty percent of all malnutrition cases are associated
with repeated diarrhea as a result of unsafe WASH. 56
Parasitic worms also lead to many diseases in SSA, though basic sanitation alone reduces
the presence of these diseases by up to seventy-seven percent.57 Schistosomiasis58 is one of the
most brutal worms, along with bilharzias, guinea worm and hookworms.59
Water-washed diseases, perhaps the easiest disease category to prevent, are caused by a
water scarcity where people cannot wash themselves, their clothes or their homes regularly. The
most common water-washed diseases are trachoma,60 the leading cause of preventable blindness
in the developing world, and scabies.61 The prevention of these simply entails the ability to wash
regularly with soap.
Malaria is common in areas where much of the drinking water is stagnant.62 Enclosed and
stable water projects are necessary in sub-Saharan African communities in order to reduce the
use of stagnant water, subsequently reducing the prevalence of malaria.
Although neither HIV nor AIDS is caused by a lack of WASH, little or no access to safe,
clean water in a community often positively correlates with a high prevalence of both the virus

54

Eric Mintz and Richard Guerrant, A Lion in Our Village- The Unconscionable Tragedy of Cholera in Africa, The New England Journal of
Medicine, 12 March 2009: 1060. The cholera epidemic is often a fatal consequence of inadequate access to safe drinking water and sanitation,
and in 2008 alone, there were about 57,500 suspected cases of cholera in sub-Saharan Africa.
55
Samuel Kariuki, Typhoid Fever in sub-Saharan Africa: Challenges of Diagnosis and Management of Infections, The Journal of Infection in
Developing Countries: 1. 400,000 cases of typhoid occur annually in Africa, with school-age children, especially those from resource-poor
settings with inadequate WASH systems, disproportionately affected.
56
Pruss Ustun, Bos, Gore and Bartram 7. For more information about malnutrition, see Appendix G, Figure 1.
57
Facts and Figures, World Health Organization, <who.int>.
58
V.R. Southgate, D. Rollinson, L.A. Tchuem Tchuente and P. Hagan, Towards Control of Schistosomiasis in sub-Saharan Africa, Journal of
Helminthology, 22 Feb. 2007: Abstract. Approximately 80% of the 200 million people infected with schistosomiasis inhabit SSA, and the annual
mortality in SSA is estimated to be 280,000.
59
For more information about parasitic diseases, see Appendix G, Figure 2.
60
Watkins 46. In 2004, 1,380,000 people in sub-Saharan Africa were living with blinding trachoma. A greater number of people were living with
trachoma that had not yet caused blindness yet. For more information on trachoma, see Appendix H, Figure 1.
61
Water Washed Diseases, WaterAid, <wateraid.org>.
62
WHO, Malaria, <who.int>. According to the World Malaria Report 2010, there were 225 million cases of malaria and an estimated 781,000
deaths due to the disease in 2009. Most of these deaths occurred in Africa, where a child dies every forty-five seconds of malaria and the disease
accounts for approximately twenty percent of all childhood deaths.

Landau 13
and syndrome.63 Caring for individuals with HIV/AIDS requires close and sustainable access to
safe water, primarily because people with HIV can need over one hundred liters of water per day
to remain as healthy as possible.64
In SSA, good health is reliant upon adequate WASH; and all subsequent forms of
community developmentnamely education and time spent on productive workare reliant
upon good health. Without a healthy foundation, it is impossible that significant improvements in
poverty eradication will materialize.
Time Poverty
Becky Straw, who met with Helen Apio in her rural Ugandan village, reflects on a
recurring image she sees as the Water Project Manager of charity: water: I travel to some of
the most desperate places on earth in search of clean water. And while the landscape changes,
theres always one thing that remains the same: the women are always walking the women are
always carrying water. From the back of a truck in Uganda, she reports:
I watch women gather up their children and move to the edge of the road
to let us pass. Their feet are gnarled and calloused: a result of thousands of
miles walked barefoot over rocks and mud. With babies strapped to their
backs, their brightly colored skirts sway and their knees quiver and brace
under the weight of water and children. Most balance pails on their heads,
while some grip eighty pounds of water with sweaty palms, a bright
yellow five-gallon Jerry Can in each hand. Im in awe of how they
manage. But of course, they have no choice. The average woman in Africa
walks three miles every day for water. Often, its water from putrid rivers
or disease infested-swamps. Worldwide, women are more than twice as
likely as men to collect drinking water.65
Straws experiences reflect the conditions of time poverty and gender inequality in SSA.
In most of the region, the gender divisions of labor assign women responsibilities that men do
not share. The most obvious pattern in the division of labor is that women are mostly confined
63
64
65

Water and HIV/AIDS, Lifewater International, <lifewater.org>.

WaterAid, Web log post, <twitter.com>, 1 Dec. 2011. For more information about HIV/AIDS, see Appendix H, Figure 2.
Straw online. See Appendix I.

Landau 14
to unpaid domestic work and unpaid food production, whereas men dominate in cash crop
production and wage employment. 66 For the women of SSA, time spent collecting water
represents a heavy burden, accounting for an average of fifteen to seventeen hours per week in
rural areasabout twenty-six percent of a womens time.67 An average of forty billion hours a
year are spent collecting water in SSAequal to a years employment for the entire workforce
of France.68 The opportunity costs of water collection in SSA represent approximately two full
months of labor per person, accounting for a lesser amount of time spent on education, income
generation and leisure for women and children.
In its report entitled Gender, Time Use and Poverty in sub-Saharan Africa, the World
Bank attempted to define the term time poverty:
In broad terms, time poverty can be understood in the context of the
burden of competing claims on individuals time that reduce their ability
to make unconstrained choices on how they allocate their time, leading, in
many instances, to increased world intensity and to trade-offs among
various tasks The negative impact of these tradeoffs can be observed in
various dimensions of human poverty such as food security, child
nutrition, health and education.69
Although time poverty seems to only penalize women, it also deeply affects the
development and opportunities of children. This is because, throughout the developing world,
both men and women play multiple roles (productive, reproductive and community
management) in society.70 Yet while men are generally able to focus on a single productive role
at any given time, women play their roles simultaneously and must balance simultaneous
competing claims on limited time for each of them.71 Women, in turn, must bear the brunt of

66

Gender Terminology, USAID, <usaid.org>.

Womens Issues, WaterAid, <wateraid.org>.
68
Watkins 47. Women, Water.org, <water.org>. Worldwide, women spend two hundred million hours fetching water each day, greater than the
average number of hours that employees of WalMart, UPS, McDonalds, IBM, Target and Kroger work in one week, combined.
69
C. Mark Blackden and Quentin Wodon, The World Bank, Gender, Time Use and Poverty in sub-Saharan Africa (Washington, D.C.: The World
Bank, 2006) 16.
70
Blackden and Wodon 1.
71
Patricia Apps, Gender, Time Use and Models of the Household (Sydney: University of Sydney and IZA Bonn, June 2003) 1.
67

Landau 15
multiple domestic tasks at one time, the two most necessary and time-consuming tasks being
providing water and caring for children.72 Consequently, young children are brought along on
trips to collect water with their mothers, and often times, older children are sent to collect water
on their own so that their mothers can perform other domestic and income-generating work.73
The time spent collecting water keeps the children out of school, consequently refusing them
access to the most direct asset in poverty eradication, a quality education. After a water-well was
built in her village, Mzee Kityngile of the Songambele Village in Tanzania reported, It is now
difficult to find school-going children loitering around the village looking for water, which was
common in the past as everyone had to use extra hands to collect as much water as possible from
distant sources.74
The burden of time poverty on education is especially prevalent for girls, who are
assigned the task of water collection more frequently than males, because of deep gender
inequalities.75 The UNDPs Human Development Report 2006 explains:
The time burden of collecting and carrying water is one explanation for
the very large gender gaps in school attendance in many countries. In
Tanzania school attendance levels are twelve percent higher for girls in
homes fifteen minutes or less from a water source than in homes an hour
or more away. Attendance rates for boys are far less sensitive to distance
to water sources. For millions of poor households, there is a straight tradeoff between time spent in school and time spent collecting water.76
This explicit inequality consigns girls to a future of illiteracy and restricted choice.
When access to water and sanitation are secured in each rural sub-Saharan village,
womens time is freed up for income gathering work, looking after children and the elderly,

72

Blackden and Wodon 2.

Apps 32.
74
Water, Sanitation and Education, WaterAid, <wateraid.org>.
75
Apps 1.
76
Watkins 47.
73

Landau 16
earning an education, or simply relaxing; and childrenspecifically girlscan attend school
more consistently. Without these provisions in place, poverty eradication cannot materialize.77
Education
In the developing world, education represents opportunity. It empowers people of all ages
with the knowledge, skills and confidence they need to shape a better future in a smart and
sustainable fashion and helps people make decisions that meet the needs of the present without
compromising those of future generations. After examining its effects on each of the MDGs, it is
clear that education makes crucial impact on the eradication of poverty.78
Although the Universal Declaration of Human Rights holds that every child and adult is
entitled to an education,79 the school enrolment rates in African countries are among the lowest
in the world.80 In 2009, only seventy-six percent of primary-school aged children in SSA were
enrolled in school,81 accounting for forty-eight percent of the worldwide deficit in primary
education. 82 In the case of many rural African communities, education opportunities are
overwhelmingly affected by the availability of adequate WASH.83 In these communities, the
burdens of disease and time-poverty directly limit access to education. The alleviation of these
burdensas a result of sustainable access to WASH in each community and at each school
plays a direct role in the rise of attendance rates, and consequently, the drop in absenteeism and
dropout rates. 84 Since the achievement of each MDG positively correlates with a quality
education, it is critical that we invest in the development of quality systems for learning through

77

Womens Issues online.

Education Counts online.
79
The Universal Declaration of Human Rights, United Nations, <un.org>.
80
African Education Initiative, USAID, <usaid.org>.
81
UN DESA, MDG Goals Report 2011 17.
82
Education Counts online. Sixteen billion dollars a year in aid would send all children to school in low-income countries. This is about half of
the amount Americans spend on ice cream annually (thirty-one billion dollars).
83
UN DESA, MDG Goals Report 2011 18.
84
Poverty-Environment Partnership 24.
78

Landau 17
life if we are to meet the goals for poverty eradication.85 These systems must be developed with
WASH in mind, paying special attention to the implications of ill-health and time-poverty.
The education of children today dictates the success of sub-Saharan African communities
in the future, as it gives people the knowledge and skills they need to live better lives, boosts
productivity, and open doors to jobs and credit.86 According to the UN Educational, Scientific
and Cultural Organization (UNESCO), 171 million people could be lifted out of poverty if all
students in low-income countries left school with basic reading skillsequivalent to a twelve
percent cut in world poverty. By relieving children of poverty and teaching valuable skills,
schools act as assets to the community and catalysts for a better future.87 Fundamentally,
without success in meeting MDG Goal Two, to achieve universal primary education, it is
impossible to achieve Goal One, to eradicate global poverty and hunger; because an equal
access to education is the foundation for all other development goals.88
Universal access to education for children benefits both current and future generations.
After initiatives in poverty reduction strategies are taught in the classroom, children are
encouraged to teach their parents and peers what they have learned, consequently spreading the
lessons and initiatives throughout the entire community.89 In regards to this exponential reaction,
the UNDP refers to children as agents of change:
The classroom is one of the best places for effective positive changes in
hygiene. Teaching children hand washing and other good hygiene habits
protects their health and promotes transformations beyond school. In
Mozambique a national campaign trained children to teach other children
about hand washing and sanitation-related problems. In China and Nigeria
UNICEF-supported school-based hygiene projects report increases of 7580% in hand washing with soap.90
85

Education Counts online.

Education Counts online.
Water and Education, Lifewater International, <lifewater.org>.
88
Millennium Development Goals: Achieve Universal Primary Education, UNICEF, <unicef.org>.
89
Personal Hygiene and Sanitation Education, AMREF, June 2009, <amref.org>.
90
Watkins 116.
86
87

Landau 18

The most significant health-related implications on education is that people, primarily

children, are kept out of school due to the abundance of debilitating water-related diseases.91
Children are often too sick to attend school, and in many cases, embarrassing diarrhea92 keeps
them home. Additionally, it is not uncommon that schools must be suspended or closed due to
epidemics in the community. According to Lifewater International, frequent outbreaks of
waterborne diseases make a good education in rural areas nearly impossible. 93
When diseases do not keep children home from school, they can hinder the students
potential for academic success. It has been found that poor health directly reduces cognitive
potential and indirectly undermines school through attention deficits.94 Even when the children
who drink contaminated water avoid acute illness, they are likely to suffer impeded intellectual
development due to chronic diarrhea and parasites. 95 In a study called Disease and
Intelligence, The Economist reported:
There is, moreover, direct evidence that infections and parasites affect
cognition. Intestinal worms have been shown to do so on many occasions.
Malaria, too, is bad for the brain. A study of children in Kenya who
survived the cerebral version of the disease suggests that an eighth of them
suffer long-term cognitive damage. However, it is the various bugs that
cause diarrhea which are the biggest threat. Diarrhea strikes children hard.
It accounts for a sixth of infant deaths, and even in those it does not kill, it
prevents the absorption of food at a time when the brain is growing and
developing rapidly.96

91

Watkins 6.
Mintz, Guerrant 1062. Diarrheal diseases are a taboo subject in most sub-Saharan African villages. Since they are rarely spoken about, sufferers
do not know how to control or prevent the diseases. Similarly, before its reduction became an internationally prevalent issue, HIV/AIDS faced the
same taboo. To put an end to this taboo, President Yoweri Museveni of Uganda took an innovative and effective approach as he began to change
the public attitudes towards HIV in his country: he succeeded in reducing the rates of AIDS in Uganda when he re-characterized the disease as
similar to any other threat to the community. When a lion comes into your village, he said, you must raise the alarm loudly. Initiatives similar
to this one, with a focus on diarrhea in addition to HIV/AIDS, are imperative to the governance of all African nations if effective results are to be
seen in reducing death rates.
93
Water and Children, Lifewater International, <lifewater.org>.
94
Jeffrey Sachs, Macroeconomics and Health: Investing in Health for Economic Development (Geneva: World Health Organization, 20 Dec.
2011) 33.
95
Watkins 6.
96
Mens Sana In Corpore Sano: Parasites and Pathogens May Explain Why People in Some Parts of the World are Cleverer Than Those in
Others, The Economist, 1 June 2010, <economist.com>.
92

Landau 19
Health and education clearly have reciprocal benefits. When the people of SSA are
healthier, their attendance rates at school rise and the effectiveness of their education increases.
As their intellect grows, they gain the knowledge and skills necessary to keep themselves and
their children as healthy as possible in the future, in turn leading to even greater educational
opportunities and healthier lives.
Education reduces child mortality97 by teaching mothers who have children under the age
of five years old the benefits of and strategies to ensure good health for their children. In
developing countries, children of mothers with secondary education or higher are twice as likely
to survive beyond age five as those whose mothers have no education, and each extra year of a
mothers schooling reduces the probability of infant mortality by five to fifteen percent.98
In addition, education improves maternal health.99 With benefits that work in conjunction
with population control, empowerment through education is one of the strongest antidotes to
maternal risk. Women with higher levels of education are more likely to delay and space out
pregnancies, and to seek health care and support.100 Currently, one-quarter to one-half of girls in
developing countries have children before they are eighteen years old.101 Naturally, curbing this
number will increase education opportunities, empowerment, and health for the girls and for
their children. Therefore, including lessons regarding contraceptives and family planning into
educational curriculums is imperative.
With regards to water, it is important that sub-Saharan Africans are educated about the
benefits of ensuring environmental sustainability.102 The UNDP realizes, It is already clear that
competition for water will intensify in the decades ahead. Population growth, urbanization,
97

The lowering of child mortality rates in relation to poverty eradication is reflected in MDG Goal Four.
Education Counts online.
99
Improving maternal health in relation to poverty eradication is reflected in MDG Goal Five. Education Counts online. In Niger, women face
a one-in-seven chance of dying in childbirth. In rich countries, the odds average one-in-eight thousand.
100
Education Counts online.
101
Education Counts online.
102
Ensuring environmental sustainability in regards to poverty eradication is reflected in MDG Goal Seven.
98

Landau 20
industrial development and the needs of agriculture are driving up demand for a finite
resource.103 In rural villages of SSA, water availability has a profound affect on agricultural
productivity, and as the population continues to grow, the necessity for food will increase.104
Therefore, water must be treated as a precious natural resource, rather than an expendable
commodity.105 When clean water is properly conserved and sustained, the increased agricultural
yields that it generates will decrease malnourishment for sub-Saharan Africans as well as
increase household incomes, market activity, and overall community health. To meet these
benchmarks in the eradication of poverty, it is essential that communities be taught about
sustainable practices in conserving their water.106
The agricultural opportunities afforded by sustainable control of clean water sources will
not only aid in the economic advancement of rural sub-Saharan African villages; they will
empower women to be leaders in the economic and decision-making divisions of their
villages.107 Currently, women are doubly disadvantaged in irrigation systems. Lacking formal
rights to land in many countries, they are excluded from irrigation system management. At the
same time, informal inequalitiesincluding the household division of labor, norms on women
speaking in public and other factorsmilitate against women having a real voice in decisionmaking Change is possible, however.108 This change towards gender equality is rooted in the
ability of women to earn an income by producing crops, but a number of factors must be in place
in order for women to do so. Their own health must be ensured, as well as the health of their
children; their children must be cared for in school during working hours; clean water must be

103

Watkins vi.
Ester Boserup, The Conditions of Agricultural Growth: The Economies in Need of Agrarian Change Under Population Pressure (New
Brunswick: Transaction, 2005) viii.
105
Watkins 24.
106
Education Counts online.
107
Reyes Aterido, Thorsten Beck and Leonardo Iacovone, The World Bank, Gender and Finance in sub-Saharan Africa: Are Women
Disadvantaged?, (Washington, D.C.: World Bank, 1 Feb. 2011) 8.
108
Watkins 18.
104

Landau 21
present within a few miles of the village so that the women are not burdened by time poverty;
there must be enough water available for both men and women to use for irrigation; and the
women must be able to obtain an education regarding agricultural productivity. With each of
these elements in place, the economic outcomes of agricultural women are profound.109
In 2005, twenty-four hundred Sudanese farmers gained access to various tools to improve
their productivity, including small-scale irrigation systems, as a piece of a five-year Recovery
and Rehabilitation Program implemented across the country. Aisha Sharief, a woman who heads
a farm run by women in Arabaat, notes the continued benefits that the program has provided,
even six years later: Nowadays we have permanent irrigation and alternate crops like sorghum
and vegetables.110 She also grows tomatoes, okra and arugula, which are sold at markets in Port
Sudan, thirty kilometers away from her farm. In addition, Aisha is a member of an agriculturerealted business association, the first leadership position of her life.111 After Aishas community
was able to secure sustainable access to water, the villages women as well as the village as a
whole reaped benefits in several areas. With a more extensive array of crops grown on their
fields, the villages malnutrition is combated; by selling crops at a market, economic activity on
personal and community-wide levels is increased; and from leadership opportunities for women,
gender equality is improved. While theses widespread advantages of irrigation systems in
regards to health, the empowerment of women, and the economy are very apparent, it is
important to remember the underlying drive of each of these advantages: the ability of villages to
secure access to their water in a sustainable fashion, made possible by a solid education.112

109

Watkins 19.
More Water, Better Lives for Sudanese Farmers, UNDP News Center, 23 May 2011, <beta.undp.org>.
111
More Water, Better Lives for Sudanese Farmers online.
112
K. O. Oloruntegbe, et al., Rethinking Development and Sustainability of African Economy: The Roles of Science Education, African
Journal of Business Management, June 2010: 812-813.
110

Landau 22
Currently, across SSA, women are paid less for their work and have limited access to
positions of decision-making power; however, wages, agricultural income and productivityall
critical for reducing povertyare higher where women involved in agriculture receive a better
education. 113 This outcome is supported by the Human Capital Theory, which asserts,
Education creates skills that facilitate higher levels of productivity amongst those who possess
them in comparison with those who do not. Education, then, is costly but it brings associated
benefits which can be compared with its costs in much the same way as happens with any
investment project.114 This theory is demonstrated in Kenya, where if women farmers are given
the same level of education as their male partners, their yields for beans, maize and cowpeas
increase by up to twenty-two percent.115 It is clear that many aspects of poverty reduction
namely a sustainable water supply; the empowerment of women; the increase of economic
activity and personal income; greater health; and increased educational opportunitieswork in
conjunction with reciprocals benefits for one another. However, it is basic access to water that
fundamentally allows each of these individual aspects to thrive.
Additional empowerment for women is rooted in their reproductive choices, and it has
been found that when educated, women have greater control over these choices. According to the
World Bank and the University of Gottingen in Germany, an extra year of female schooling
reduces fertility rates by ten percent.116 In Mali specifically, women with a secondary education
or higher have an average of three children, while those with no education have an average of
seven children.117 In the fight to eradicate poverty and achieve universal access to WASH,

113

Education Counts online.

Zoe Oxaal, Education and Poverty: A Gender Analysis (Brighton: University of Sussex, 2007) 3.
115
Agnes Quisumbing, Ruth Meinzen-Dick, and Lisa Smith, Increasing the Effective Participation of Women in Food and Nutrition Security in
Africa (Washington, D.C.: International Food Policy Research Institute 2004) 4.
116
Dina Abu-Ghada and Stephan Klasen, The Economic and Human Development Costs of Missing the Millennium Development Goal on
Gender Equity (Washington, D.C.: World Bank, Gottingen: University of Gottingen, May 2004) 12.
117
Education Counts online.
114

Landau 23
population control118 is essential. Population growth means, any slippage from the Millennium
Development Goal target [to halve to proportion of the population without access to water and
sanitation] will leave the world standing still on water and sanitation coverage.119
Education touches all aspects of life and its gains are cumulative and long lasting.
However, without fundamental health and time, women and children cannot and do not earn a
proper level of schooling. In terms of poverty eradication in the rural villages of SSA, a lack of
education is the problem and sustainable access to clean water is the solution.
Conclusion
As the organizations charity: water and Living Water International drilled into the red
African dirt of an isolated rural community in Rwanda, a diverse and anxious crowd waited
excitedly for the first signs of clean water. Instantaneously, as water hit the spout of the newly
installed hand pump, the crowd rose in huge cheers of celebration. The children made a mad
dash for the water, drinking, bathing and basking in their refreshment. Like liquid magic, joy
swept the crowd.120
In recent years, the water crisis has come to the attention of the developed world as
numerous non-governmental organizations (NGOs) have placed universal access to adequate
WASH at the center of their poverty reduction strategies. With high standards for themselves,
these organizations are making a significant impact, typically utilizing focused projects just like
the one in Rwanda. Many of the NGOs struggle relentlessly to find a perfect balance between
immediate results and projects that are highly sustainable.121 However, their work, funded almost
entirely by public donations, simply cannot achieve the necessary results fast enough.

118

The specific ways in which population control leads to eradication of poverty are extensive as well as controversial, and therefore beyond the
scope of my paper.
119
Watkins 55.
120
Esther Havens and Taylor Walling, Rwanda: Meet Jean Bosco, charity: water, <charitywater.org>.
121
See Appendix J.

Landau 24
The water crisis is not a problem of scarcity. The problem is that some peoplenotably
the poorare systematically excluded from access by their poverty, by their limited legal rights
or by public policies that limit access to the infrastructures that provide water for livelihoods.122
In short, water scarcity is manufactured through political processes that disadvantage the poor.
In order to consign the crisis to history, African governments must see improved access
to WASH as the focal point of their national agendas. They must bring water and sanitation out
of the shadow and into the mainstream by giving a voice to the individualswomen, children,
teachers, and doctorswho are hit the hardest by the crisis.123 In doing so, it is necessary that
they remove the manufactured scarcity of water for the unseen and unheard rural populations
who currently suffer day-in and day-out.
The rest of the international order must not forget about the crisis, either. The ten billion
dollar price tag to achieve the MDG to ensure universal sustainable access to clean water seems
like a large sum, but put into context, it represents less than five days worth of global military
spending.124
In 2015, the US National Aeronautics and Space Administration (NASA) will launch the
Jupiter Icy Moons Project to determine whether the conditions for life exist on three of Jupiters
moons. In regards to this undertaking, the UNDP condemns:
The irony of humanity spending billions of dollars in exploring the
potential for life on other planets would be powerful and tragicif at
the same time we allow the destruction of life and human capabilities on
planet Earth for want of far less demanding technologies: the
infrastructure to deliver clean water and sanitation to all. Providing a glass
of clean water and a toilet may be challenging, but it is not rocket
science.125

122

Watkins 3.
Watkins 61.
124
Watkins 8.
125
Watkins 4.
123

Appendix A

Ugandan women waving from beside their new water well.

Source: Esther Havens, charitywater.org

Appendix B

Figure 1
Often times, sub-Saharan Africans must share their water sources with animals.
Source: charitywater.org

Figure 2
A woman in Ethiopia collects contaminated water.
Source: Water.org

Appendix C

The countries shaded in red account for the region of sub-Saharan Africa.
Source: b-slaglobal10.wikispaces.com

Appendix D
Millennium Development Goals
Goal 1: Eradicate extreme poverty and hunger
Target 1: Halve, between 1990 and 2015, the proportion of the people whose income is
less than $1 a day
Target 2: Halve, between 1990 and 2015, the proportion of people who suffer from
hunger
Goal 2: Achieve universal primary education
Target 3: Ensure that, by 2015, children everywhere, boys and girls alike, will be able to
complete a full course of primary schooling
Goal 3: Promote gender equality and empower women
Target 4: Eliminate gender disparity in primary and secondary education, preferable by
2005, and in all levels of education no later than 2015
Goal 4: Reduce child mortality
Target 5: Reduce by two-thirds, between 1990 and 2015, the maternal mortality ratio
Goal 5: Improve maternal health
Target 6: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio
Goal 6: Combat HIV/AIDS, malaria and other diseases
Target 7: Have halted by 2015 and begun to reduce the spread of HIV/AIDS
Target 8: Have halted by 2015 and begun to reverse the incidence of malaria and other
major diseases
Goal 7: Ensure environmental sustainability
Target 9: Integrate the principles of sustainable development into country policies and
programs and reverse the loss of environmental resources
Target 10: Halve, by 2015, the proportion of people without sustainable access to safe
drinking water and sanitation
Target 11: By 2020, to have achieved a significant improvement in the lives of at least
100 million slum dwellers
Goal 8: Develop a global partnership for development
Source: Human Development Report 2006, hdr.undp.org

Appendix E
From the Field: Health
I turn on the tap and mud comes out, reports Scott Harrison, founder of charity:
water. This is your water? he asks. Youve got to be kidding me. You must be.
Harrison is with Dominic Mosa in the laundry room of Mosas health clinic in rural
Kenya. The health clinic serves a population of about 30,000 people, however, its water
is piped up from a muddy river about half a mile away. Even though the clinic does its
best to provide good care and medications to its patients, the disease-ridden water
undermines them. When the water pump breaks, the clinic must force patients to bring
their own Jerry cans of water with them before they can receive treatment. Citizens
within a twenty-mile radius of Mosas clinic rely on its doctors and resources, but the
clinic lacks the most basic ingredient for good healthsafe water. Mosas clinic presents
a downward spiral people for in his communityespecially to the sixty percent who are
sick at any given time: they come to him with water-related illnesses, but his clinic does
not have the water-related resources to cure them.
Source: Scott Harrison, From the Field: Kenya, charitywater.org.

Appendix F

This is an Arbaloo, one type of improved sanitation facility. Arborloos are a portable
latrine design where a shallow pit has a slab and structure over it. After a year, when the
pit has filled with waste and additional compost, the latrine can be relocated and a tree
planted above the well-fertilized pit.
Source: Water.org

Appendix G
Throughout the developing world, children are often observed to suffer from both
malnutrition and diarrhea. This is because an estimated fifty percent of malnutrition is
associated with repeated diarrhea or intestinal nematode infections as a result of unsafe
and insufficient WASH. According to the World Health Organization, one in four
children in SSA are affected by malnutrition due to unsafe water. These children have
skinny, spindly arms, yet fat bellies. This is because all of the food they eat sits in their
stomach, but because of diarrhea, when the food leaves, it leaves so quickly that the
intestines cannot pull the nutrients out of it. Therefore, all of the nutrients children eat
flow right out of their body, leaving them severely malnourished.
Figure 1
Malnutrition
Source: charitywater.org

Youll see a bunch of kids running around here with big sores on their feet. They come
from Jiggers, a worm that attaches itself to the skin, boroughs in the skin, and lays eggs.
If you dont dig them out, they develop into mature worms and go in deeper until finally,
you get these big sores and ulcers in your feet. Youll see them start on the toe and just
grow around the toe and then jump across to the next toe until finally the kids cant
hardly walk; and the Jiggers start on their knees and you can sometimes see scars and
sores on the kids knees because they havent been able to walk on their feet anymore and
theyve got to walk on their knees. If theyre not washed and cleaned, they get worse and
worse. The solution isnt real difficult: the kids need to be cleaning their feet every night
before they go to bed, and you know, it doesnt happen when theres not enough water,
even for cooking and washing. The feet dont get washed; theyre the last things that are
going to get washed.
Figure 2
Jim Hocking, founder of the organization Integrated Community Development
International, discusses the prevalence of a parasitic worm called Jiggers in the Central
African Republic.
Source: icdi.org

Appendix H
Trachoma is a contagious eye infection, referred to as a passport to poverty by the
UNDP. The trachoma infection causes a sticky eye discharge with soreness and swelling
of the eyelids. After repeated infections, scarring of the inner eyelids occurs which can
lead to thrichiasis, where the eyelashes turn inwards. These then rub on the eye, scarring
the cornea and causing blindness. As the disease progresses, people lose their ability to
work and receive an education, and they depend on care from family members. It can be
spread, especially among young children, by flies, fingers and clothing coming into
contact with infected eyes, thus spreading the infection to others peoples eyes. When
asked how trachoma affected her ability to work, a woman suffering the disease in SSA
replied: My lids are biting like a dog and scratching like a thorn. Can you stand on a
thorn? Imagine you have a thorn in your foot that you cant get outthen try talking of
work. Transmission can be reduced, and therefore the infection can be eliminated, by
improved facial cleanliness, fly control, and access to adequate and improved WASH
facilities.
Figure 1
Trachoma
Source: Human Development Report 2006, wateraid.org
Caring for individuals with HIV/AIDS requires access to safe water. HIV/AIDS patients
have compromised immune systems and are therefore more prone to common illnesses
and diseases, especially diarrhea and water-washed diseases, which are primarily caused
by unsafe water; and the patients are unable to walk to the long distances to obtain water,
which many of their prescribed medications require in order to be effective. It is
important to note that in general, WHO recommends a minimum intake of twenty liters
of water per person, per day, but people with HIV can need over one hundred liters a day
to remain as healthy as possible. At the community level, the fight against HIV/AIDS
must include clean water initiatives in order to prolong lives, improve health, and render
medications more effective.
Figure 2
HIV/AIDS
Source: lifewater.org

Appendix I

A balancing act: an Ethiopian woman balances a full 40-pound container of water on her
back as she prepares to tie her shawl for the journey home from a water source.
Source: Water.org

Appendix J
Question: Can you explain Water For Peoples strategy in focusing on sustainable, long-term
projects rather than the quick-solution, smaller-scale projects?
Answer: With Water For People, our mission has evolved. Were one of the organizations that
recognized early on in the game that the typical development model is really broken. We want to do
good, but were ultimately accountable to our donors, not our customers. This is a weird dynamic
that doesnt allow us to learn from our failures and mistakes. Were shifting to sustainability. Were
shifting our way of looking and monitoring/evaluating to a learning focus so we dont keep making
the same mistakes. The way our strategy is evolving, into the Everyone program, is really all about
systems. We need to ensure that the system works so that everyone gets water, but we cant be
directly involved in the process, because then the project wont be successful (because it wont be
sustainable). The ownership and accountability wont be in place. What were looking at is a way to
get African governments more engaged, private sectors more engaged, etc. What were doing is
working with a business development service providers, they then provide businesses that want to
expand their services into sanitation improvement. Were taking a very different approach than just
building a toilet were working with local banks, small businesses, local businesses, etc. Were
showing them different technologies they can use to reduce some of the barriers that are there for the
civil sector. Whats happening is that hopefully, the systems get built, but theyre all led and built up
locally. We only want to facilitate and help coordinate, a much different approach than direct
service. Hopefully, its a lot more sustainable. And hopefully scalable, businesses are trying to find
markets. Why does everyone have a cell phone? When I first saw a cell phone, it was bigger than
your Macbook! There were 100 in all of Rwanda. Now, 15 years later, there are cell phones for
everyone, even in Rwanda. Companies got in the market, they started making profits, and then
thought, We need to go and sell these phones to poor people. They werent fancy products, but
sooner or later, everyone had a cell phone. Businesses need to get growth. With water its a little
different, but I think we can find models that work quite similarly. A lot of other organizations are
not working like this. Its really interesting; people are going to move in this direction. Were still
very engaged in day to day activities, controlling relationship, hands on help, but there is no way that
this kind of model can scale. No one has the interest to go and scope out the ways to make that scale.
Source: Personal Interview, John Sauer, 22 Dec. 2011

Works Cited
Abu-Ghada, Dina, and Stephan Klasen. The Economic and Human Development Costs of
Missing the Millennium Development Goal on Gender Equity. Washington, D.C.: The
World Bank, 2004. Print.
African Education Initiative. United States Agency for International Development. United
States Government, n.d. Web. 25 Jan. 2012. <usaid.org>.
Apps, Patricia. Gender, Time Use and Models of the Household. Sydney: University of Sydney
and IZA Bonn, 2003. Print.
Benson, Charlotte, and Edward Clay. The Impact of Drought on sub-Saharan African
Economies: A Preliminary Examination. Washington, D.C.: World Bank Publications,
1998. Print.
Boserup, Ester. The Conditions of Agricultural Growth: The Economies in Need of Agrarian
Change Under Population Pressure. New Brunswick: Transaction, 2005. Print.
Charity: water. 2010 Annual Report. New York: Charity: water, 2010. Print.
Countries and Other Areas. Bureau of African Affairs. US Department of State, n.d. Web. 22
Jan. 2012. <state.gov>.
Diarrheal Diseases. WaterAid. N.p., 2012. Web. 25 Jan. 2012. <wateraid.org>.
Dowden, Richard. Africa: Altered States, Ordinary Miracles. New York: PublicAffairs, 2009. 23. Print.
Facts and Figures. Water, Sanitation and Health. World Health Organization, n.d. Web. 24
Jan. 2012. <who.int>.
Garret, John, and Tom Slaymaker. Sub-Saharan Sanitation Targets Two Centuries Away.
Epoch Times 29 Nov. 2011: 17. Print.

Gender Terminology. United States Agency for International Development. United States
Government, n.d. Web. 25 Jan. 2012. <usaid.org>.
Glantz, M. H., and R. W. Katz. Drought as a Constraint in sub-Saharan Africa. Ambio: A
Journal of the Human Environment 14.6 (2005): 334. United States Department of
Agriculture, National Agricultural Library. Web. 22 Jan. 2012.
<openagricola.nal.usda.gov>.
Glantz, Michael H., and Richard W. Katz. Drought as a Constraint in sub-Saharan Africa.
Ambio: A Journal of the Human Environment 14.6 (2005): 334. Print.
A Global Crisis. Life Water International. N.p., n.d. Web. 22 Jan. 2012. <water.cc>.
Haile, Menghestab. Weather Patterns, Food Security and Humanitarian Response in subSaharan Africa. Philosophical Transactions: Biological Sciences 360.1463 (2005):
2169-2182. Print.
Heukelbach, Jorg, et al. Tungiasis: A Neglected Health Problem of Poor Communities.
Tropical Medicine and International Health 6.4 (2011): 1. Print.
Hocking, Jim. Disease and Sanitation in the Central African Republic. charity: water. Central
African Republic. 2010. YouTube. Web. 25 Jan. 2012. <youtube.com>.
Integrated Projects. WaterAid. N.p., n.d. Web. 24 Jan. 2012. <wateraid.org>.
International Year of Sanitation: 2008 Overview. United Nations Childrens Fund. United
Nations, 2008. Web. 24 Jan. 2012. <sanitationyear2008.org>.
Kariuki, Samuel. Typhoid Fever in sub-Saharan Africa: Challenges of Diagnosis and
Management of Infections. The Journal of INfection in Developing Countries 2.6
(2008): 1. Print.
Klep, Maroussia. Political Motivation in sub-Saharan Africa Essential for Reaching Sanitation

MDGs. Media Global News: The Developing World in Focus 29 Sept. 2011: 1. Media
Global News. Web. 24 Jan. 2012. <mediaglobal.org>.
Malaria. World Health Organization. N.p., n.d. Web. 24 Jan. 2012. <who.int>.
Mens Sana In Corpore Sano: Parasites and Pathogens May Explain Why People in Some Parts
of the World are Cleverer Than Those in Others. The Economist 1 June 2010: 1. The
Economist. Web. 24 Jan. 2012. <economist.com>.
Millennium Development Goals: Achieve Universal Primary Education. United Nations
Childrens Fund. United Nations, n.d. Web. 25 Jan. 2012. <unicef.org>.
Mintz, Eric, and Richard Guerrant. A Lion in Our Village- The Unconscionable Tragedy of
Cholera in Africa. The New England Journal of Medicine 360.11 (2009): 1060. Print.
More Water, Better Lives for Sudanese Farmers. United Nations Development Program News
Center. United Nations, 23 May 2011. Web. 25 Jan. 2012. <beta.undp.org>.
Oliver, Rachel. All About: Water and Health. CNN 18 Dec. 2007: 1. CNN. Web. 24 Jan. 2012.
<cnn.com>.
Oloruntegbe, K. O., et al. Rethinking Development and Sustainability of African Economy: The
Roles of Science Education. African Journal of Business Management 4.6 (2010): 812813. Print.
Oxaal, Zoe. Education and Poverty: A Gender Analysis. Brighton: University of Sussex, 2007.
Print.
Parasitic Diseases. WaterAid. N.p., n.d. Web. 24 Jan. 2012. <wateraid.org>.
Personal Hygiene and Sanitation Education. African Medical and Research Foundation. N.p.,
2012. Web. 25 Jan. 2012. <amref.org>.
Poverty-Environment Partnership. Linking Poverty Reduction and Water Management. Geneva:

World Health Organization, 2006. Print.

Poverty Eradication. Department of Economic and Social Affairs. United Nations, 18 Nov.
2011. Web. 22 Jan. 2012. <social.un.org>.
Prss-stn, Annette, et al. Safer Water, Better Health: Costs, Benefits and Sustainability of
Interventions to Protect and Promote Health. Geneva: World Health Organization, 2008.
Print.
Quisumbing, Agnes, Ruth Meinzen-Dick, and Lisa Smith. Increasing the Effective Participation
of Women in Food and Nutrition Security in Africa. Washington, D.C.: International
Food Policy Research Institute, 2004. Print.
Quisumbing, Agnes, Ruth Meinzen-Dick, and Lisa Smith. Increasing the Effective Participation
of Women in Food and Nutrition Security in Africa. Washington, D.C.: International
Food Policy Research Institute, 2004. Print.
Sachs, Jeffery. Macroeconomics and Health: Investing in Health for Economic Development.
Geneva: World Health Organization, 2011. Print.
Sanitation is Vital for Health. Water Supply and Sanitation Collaborative Council. United
Nations Office for Project Services, n.d. Web. 24 Jan. 2012. <wsscc.org>.
Southgate, V. R., et al. Towards Control of Schistosomiasis in sub-Saharan Africa. Journal of
Helminthology 79.3 (2007): Abstract. Print.
Straw, Becky. Will the Beautiful Women of the World Please Stand Up. Charity: Water. N.p.,
8 Nov. 2011. Web. 22 Jan. 2012. <charitywater.org>.
Swanson, Erin. Personal interview. 19 Dec. 2011.
United Nations. Sanitation as a Key to Global Health: Voices From the Field. Ontario: United
Nations University for Water, Environment and Health, 2010. Print.

- - -. Childrens Fund. UNICEF Innovation Initiative: Stagnant Water Develops Diseases.

Denmark: UNICEF, n.d. Print.
- - -. Department of Economic and Social Affairs. Millennium Development Goals Report 2011.
New York: United Nations, 2011. Print.
- - -. - - -. Resolution 62/205: Second United Nations Decade for the Eradication of Poverty.
New York: United Nations, 2008. Print.
- - -. Development Program. Human Development Report 2006; Beyond Scarcity: Power,
Poverty and the Global Water Crisis. By Kevin Watkins. New York: United Nations,
2006. Print.
- - -. Educational, Scientific and Cultural Organization. Education Counts: Towards the
Millennium Development Goals. Paris: United Nations, n.d. Print.
- - -. High Commissioner for Human Rights. The Universal Declaration of Human Rights. N.p.,
n.d. Web. 25 Jan. 2012. <un.org>.
United States. Cong. House Committee on Foreign Affairs. Water for the World Act 2012. 112th
Cong., 2nd sess. H. Res 3658. THOMAS. Lib. of Congress, 14 Dec. 2011. Web. 25 Jan.
2012. <thomas.loc.gov>.
- - -. National Institute of Health. Typhoid Fever in the United States. Washington, D.C.:
National Institute of Health, 2001. Print.
WaterAid. Water, Sanitation and Education. London: WaterAid, 2001. Print.
- - -. Water, Sanitation and Poverty Reduction. London: WaterAid, 2001. N. pag. Print.
Water and Children. Lifewater International. N.p., n.d. Web. 24 Jan. 2012. <lifewater.org>.
Water and Education. Lifewater International. N.p., n.d. Web. 25 Jan. 2012. <lifewater.org>.
Water and HIV/. Life Water International. N.p., n.d. Web. 24 Jan. 2012. <lifewater.org>.

Water Washed Diseases. WaterAid. N.p., n.d. Web. 24 Jan. 2012. <wateraid.org>.
What We Do. WaterAid. N.p., n.d. Web. 22 Jan. 2012. <wateraid.org>.
WHO/Joint Monitoring Program. Progress on Drinking Water and Sanitation: Special Focus on
Sanitation. Geneva/York: World Health Organization/UNICEF Joint Monitoring
Program, 2008. Print.
- - -. Progress on Sanitation and Drinking Water: 2010 Update. Geneva/York: World Health
Organization/Joint Monitoring Program, 2010. Print.
Women. Water.org. N.p., n.d. Web. 25 Jan. 2012. <water.org>.
Womens Issues. WaterAid. N.p., n.d. Web. 25 Jan. 2012. <wateraid.org>.
The World Bank. Gender and Finance in sub-Saharan Africa: Are Women Disadvantaged?
Washington, D.C.: The World Bank, 2011. Print.
- - -. Gender, Time Use and Poverty in sub-Saharan Africa. Washington, D.C.: The World Bank,
2006. Print.
World Bank Updates Poverty Estimates for the Developing World. Data and Research. The
World Bank, n.d. Web. 22 Jan. 2012. <econ.worldbank.org>.
World Book. Africa. World Book Encyclopedia. Chicago: World Book, Inc., 2001. 98-136.
Print.
World Health Organization. Environmental Health in Emergencies and Disasters. Geneva:
World Health Organization, 2003. Print.