785 million people across the globe still do not have access to safe drinking water. Even worse, two billion people lack access to basic sanitation, and 673 million people still practice open defecation. Living without these essential services negatively affects health, education, dignity, and means of living. The seventh South Asian Conference on Sanitation (SACOSAN-VII 2018) Declaration has acknowledged that rapid urbanization and growing inequalities in access to WASH especially around geographical areas, vulnerable groups and income levels, present challenges in sanitation and hygiene service provision in South Asia. It also recognized the progress made towards reducing open defecation in the region and growing attention given towards building sustainable and safely managed sanitation systems, calling for a renewed commitment of the countries to align their national and sub-national policies/strategies with safely managed sanitation services and hygiene as outlined in the Sustainable Development Goals (SDGs). Despite the progress, 558 million people in the region still practice open defecation and about 177,000 children die of diarrhea each year.
This crisis in water and sanitation has predominately been a concern for the poor, excluded, women, children, elderly and disabled. Although there has been considerable improvement since SACOSAN-I (2003), the crisis still exists in South Asia with many critical areas that require urgent attention. It seems that the countries in the region will have to work hard to achieve the SDG targets by 2030. While it is encouraging that water supply coverage in Nepal has risen from 46% in 1990 to 88% in 2018, only 25% of the available systems are estimated to be fully functional. Over 40% of the country’s population still needs to be served to meet the SDG target of providing piped water supply to 90% of the households by 2030. Furthermore, the national target of basic water supply coverage of 99% by 2030 cannot be met unless the non-functional schemes are repaired and rehabilitated.
Sanitation coverage has grown significantly from 6% in 1990 to the current level of over 99%. On 30 September 2019, the Government of Nepal declared the country ‘open defecation free’ (ODF) after self-declaration by all 753 local units from the 77 districts and is rapidly scaling-up access to safely managed sanitation services as the next priority. However, the stories of some locals and experts on the ground provide a much grimmer picture of sanitation coverage than that is nationally reported. Despite the government’s claim, many districts, mainly in the Tarai region, are still struggling to live up to the ODF status. Even major cities like Kathmandu have failed to control open defecation. Many people continue to defecate in the open, either because they have not built toilets in their homes due to financial issues, landlessness, or underlying social/cultural issues. One of the reasons why the government continues to struggle for sustainable sanitation services and hygiene has been the historic policy bias towards water supply. Sanitation and hygiene generally received a lower priority compared to water supply despite its central role in determining public health. Sanitation programs started being implemented together with drinking water programs as late as 1990. Only since the International Year of Sanitation in 2008 that the government started allocating a separate budget for sanitation. The annual budget for sanitation saw an increase of 12.4 fold from NPR 410 million in 2009/10 to NPR 5,100 million in 2018/19. However, there is still a funding gap of NPR 30,000 million (approx. US$ 280 million) to meet the current needs in the water, sanitation, and hygiene (WASH) sector. Hence, it is challenging for Nepal to meet the SDG target of providing improved sanitation facilities to 95% households by 2030.
Due to a lack of awareness on the use of safe water, proper use of sanitation facilities, and good hygiene practices, many people across the country live in poor hygiene conditions. Although the simple act of handwashing at critical times can reduce the number of diarrhea cases by 35%, data from 2013 show that only 12% Nepalese people wash their hands with soap before eating food, and over 50% of the population do not wash hands with soap water after using the toilet. Hygiene promotion has often been overshadowed by technology-driven water and sanitation interventions and in the health sector, there is often a greater focus on curative approaches rather than preventative approaches.
The progress in the WASH sector is not as expected because resources are duplicated, approaches not uniform, accountability mechanisms weak, and service delivery capacity lacking. Although various government policies and strategies are in place, many fail to be implemented. The service provided often miss vulnerable groups such as women, children, socially excluded, people with disabilities, the elderly, those living with chronic illness, those living in remote communities, and those under extreme poverty. A lack of sufficient knowledge has also made it difficult for people to assert their rights effectively and raise voices for sustainable WASH services with the government. Inter-sectoral coordination between the WASH, health, and education is equally lagging.
Furthermore, the recent political and administrative reforms, and changing donor policies, priorities, and financing modalities have brought challenges to raise funds for the WASH initiatives in the country. As the operating space and funding available for WASH continue to shrink globally, there will be fewer and fewer resources available in the future, reducing funds for many international organizations and affecting the internal funding scenario as well. For instance, DFID’s strategic shift towards governance, security, health, and climate change and disaster, focusing on sector-wide approaches as directed by its Operational Plan 2011-2016, significantly affected the country’s WASH sector funding during the first half of the 2010s. With these challenges, the question is whether Nepal will be able to meet the SDG targets on water, sanitation, and hygiene by 2030.