A long way to go - Estimates of combined water, sanitation and hygiene coverage for 25 sub-Saharan African countries.
BACKGROUND
Water, sanitation and hygiene (WASH) are essential for a healthy and dignified life. International targets to reduce inadequate WASH coverage were set under the Millennium Development Goals (MDGs, 1990-2015) and now the Sustainable Development Goals (SDGs, 2016-2030). The MDGs called for halving the proportion of the population without access to adequate water and sanitation, whereas the SDGs call for universal access, require the progressive reduction of inequalities, and include hygiene in addition to water and sanitation. Estimating access to complete WASH coverage provides a baseline for monitoring during the SDG period. Sub-Saharan Africa (SSA) has among the lowest rates of WASH coverage globally.


METHODS
The most recent available Demographic Household Survey (DHS) or Multiple Indicator Cluster Survey (MICS) data for 25 countries in SSA were analysed to estimate national and regional coverage for combined water and sanitation (a combined MDG indicator for 'improved' access) and combined water with collection time within 30 minutes plus sanitation and hygiene (a combined SDG indicator for 'basic' access). Coverage rates were estimated separately for urban and rural populations and for wealth quintiles. Frequency ratios and percentage point differences for urban and rural coverage were calculated to give both relative and absolute measures of urban-rural inequality. Wealth inequalities were assessed by visual examination of coverage across wealth quintiles in urban and rural populations and by calculating concentration indices as standard measures of relative wealth related inequality that give an indication of how unevenly a health indicator is distributed across the wealth distribution.


RESULTS
Combined MDG coverage in SSA was 20%, and combined basic SDG coverage was 4%; an estimated 921 million people lacked basic SDG coverage. Relative measures of inequality were higher for combined basic SDG coverage than combined MDG coverage, but absolute inequality was lower. Rural combined basic SDG coverage was close to zero in many countries.


CONCLUSIONS
Our estimates help to quantify the scale of progress required to achieve universal WASH access in low-income countries, as envisaged under the water and sanitation SDG. Monitoring and reporting changes in the proportion of the national population with access to water, sanitation and hygiene may be useful in focusing WASH policy and investments towards the areas of greatest need.
London School of Hygiene and Tropical Medicine, Department of Disease Control, Faculty of Infectious and Tropical Diseases, London, United Kingdom.
Rachel
http://orcid.org/0000-0002-5929-3616
R
Roche
Division of Data, Research and Policy, UNICEF, New York, New York, United States of America.
Robert
R
Bain
London School of Hygiene and Tropical Medicine, Department of Disease Control, Faculty of Infectious and Tropical Diseases, London, United Kingdom.
Oliver
O
Cumming
D017954:Africa South of the Sahara / Q000453:epidemiology; D003247:Conservation of Natural Resources / Q000706:statistics & numerical data / Q000639:trends; D003710:Demography; D005191:Family Characteristics; D006291:Health Policy / Q000639:trends; D006801:Humans; D006920:Hygiene / Q000592:standards; D009937:Organizational Objectives; D011203:Poverty / Q000706:statistics & numerical data / Q000639:trends; D012424:Rural Population / Q000706:statistics & numerical data; D012499:Sanitation / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D012959:Socioeconomic Factors; D013223:Statistics as Topic; D018505:Waste Management / Q000379:methods / Q000592:standards; D014881:Water Supply / Q000592:standards / Q000706:statistics & numerical data