Introduction

1.1 Objectives of the paper

It is the objective of this paper to reflect on the progress being made in the sanitation sector and to examine what possible pathways exist to introduce sustainability in the United Nations Millennium Development Goal (MDG) process also showing that the target for sanitation ahs an impact on all the MDGs. The paper reviews the regional differences in some of the common health indicators such as diarrhoea mortality and DALYs in relation to inadequate hygiene and sanitation. It reviews the criteria surrounding the introduction of sustainable sanitation based in part on the work of the Sustainable Sanitation Alliance, what technical options exist in order to introduce more sustainable measures, what the costs can be compared to conventional approaches and what the potential impact of safe reuse of human excreta can have in agriculture, nutrition and food security. It reviews the WHO guidelines on safe reuse of human excreta and greywater in agriculture and also reviews a selection of sanitation planning tools. Finally it summarises what additional steps and pathways including financing and institutional arrangements that are needed in order to build in greater resilience and sustenance into the sanitation sector.

1.2. The MDG on water and sanitation

In 2000, the UN resolved to tackle the Millennium Development Goals or MDGs as they are commonly known. The MDGs are all-encompassing providing clear targets by 2015 to significantly reduce poverty, hunger, illiteracy, gender inequality, child mortality, disease and to ensure environmental sustainability and promote global partnership including open trade and financing. What the world didn't notice back in 2000 was that water supply and sanitation services had not been included as one of the environmental targets. And it was not until 2002 at the UN World Summit on Sustainable Development (WSSD) with the guidance of the WSSCC (Water Supply and Sanitation Collaborative Council) in Johannesburg that a target for these was adopted (MDG 7, Target 10). It turns out that sanitation is by far the largest of all the MDG targets affecting about 40% of the global population and possibly the biggest challenge since the sector has been so neglected and is riddled with development obstacles. It remains probably the largest killer of children and is still not a high priority among governments (WaterAid, 2008a).

World leaders came together in 2005 under the auspices of the 2005 World Summit at United Nations Headquarters to reiterate the MDGs as expressed in the Millennium Declaration and reaffirm their commitment to work towards achieving them, and also to assess the extent to which progress has been made since 2000. Likewise, on September 25, 2008 the UN High-Level Event on the MDGs took place to identify gaps and determine how to accelerate progress toward the MDGs. The Human Development Report (HDR) of 2006 (UNDP, 2006) provided a status report on the water and sanitation Target 10 of MDG 7, providing further necessary focus. These reviews have all concluded that the target for water supply is achievable but that for sanitation will not be met by 2015.

When it comes to the implementation of all the MDGs, the world seems to have forgotten the element of sustainability and what was resolved at the UNCED in Rio de Janeiro, Brazil, in 1992 and the WSSD in Johannesburg, South Africa, in 2002 (WSSD, 2002). Sustainability is absent from the MDG resolution of 2000 and the HDR of 2006. Neither does the JMP (Joint Monitoring Plan of WHO/UNICEF) include sustainability criteria in its definition of improved water supply and sanitation. The core of MDG 7 Target 10 is being tackled mainly using, for the most part, conventional approaches that lack technical innovation and social, economic and environmental sustainability (SEI, 2005). It is the objective of this paper to introduce such criteria and place it within a context of policy, planning and capacity development.

It is also high time for more comprehensive measurement tools in order to assess successes and failures within the sanitation sector. The global monitoring data on coverage have created a simplified division into "haves" and "have-nots" (Bartram, 2008). It is therefore a step in the right direction as is now the case in the latest JMP report of 2008 (WHO/UNICEF, 2008a) to monitor all forms of sanitation coverage, may it be sharing of communal latrines, unimproved, improved latrines or open defecation. The next step would be to provide some measures of installation longevity, functionality and sustainability.

Sanitation is a neglected and disjoint sector that in general is not properly understood nor prioritized by governments around the world. In addition it is not something that is well integrated into development programmes and tends not to be considered as a central concern for human well-being. Somehow it is "taken care of" in all sorts of ways from open defecation, to shared communal latrines, to waterborne household sewerage and centralized treatment systems. But in a way all of these are similar in that little or nor communication occurs between the stakeholders and the authorities. In many ways this is the "last chapter in human development" and there is much to be done (Rosemarin, 2007).

1.3. The International Year of Sanitation 2008

Perhaps because of the acknowledgement of the importance of sanitation and the staggering figure of those lacking basic sanitation, the UN declared 2008 the International Year of Sanitation to draw attention to the sanitation crisis and accelerate progress towards the sanitation target. Present global water and sanitation coverage figures clearly show that despite international commitment, enormous investment and concerted efforts to halve, by 2015, the proportion of people without sustainable access to safe drinking water and improved sanitation, there is still so much to be done to achieve timely success. The MDG sanitation target is an overarching one because of the importance of water and sanitation development as an instrument for sustainable development, economic growth, and poverty reduction. This makes MDG 7 crucial for the achievement of all the other MDGs (Table 1).

WHO/UNICEF (2008a) reported that in 2006, 884 million people in the world lacked access to improved water supply and 2.5 billion people lacked access to proper sanitation, with the great majority residing in the developing world. Only about one person in three in sub-Saharan Africa and South Asia has access to improved sanitation (UNDP, 2006). Furthermore, Black and Fawcett (2008) report that over 40% of people in the developing world still depend on a bucket, a bush, the banks of a stream, a back street or some other sheltered place for their several daily excretions. One in four people in Africa i.e. about 234 million...