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Water is at the core of sustainable development and is critical for socio-economic development, energy and food production, healthy ecosystems and for human survival itself (UN 2017). Therefore ensuring the sustainable provision of equitable access to sufficiently good quality water for people, productivity, and the environment is a necessary condition for ending poverty and hunger and achieving all the other ambitious goals being proposed for the post-2015 sustainable development agenda (UN 2015). This section of the report would give a brief overview of the global and local situation of the disease burden associated with lack of access to clean water while also highlighting on the policy stance in addressing the water and sanitation situation.
Globally, it is estimated that about 2.1 billion people are without access to clean water and about 4.4 billion people are without access to good quality sanitation (UN report). According to WHO/UNICEF Joint monitoring programme for water supply and sanitation, at least 1.8billion people worldwide are estimated to drink water that is not protected against contamination from feces. The most prevalent diseases attributable to exposure to poor water and sanitation conditions include diarrhea, cholera, trachoma, typhoid fever, and schistosomiasis. About 1.7 billion cases of childhood diarrhoeal are reported every year and diarrhoeal is estimated to be the second leading cause of under 5 mortality and each year it results to around 525 000 deaths of children under 5 (WHO 2017). In 2016 alone, there were about 132,121 reported cases of cholera and 2420 deaths. A large percentage of this mortality and morbidity are avoidable. In its 2013 reports on water security, the United Nations identified the following as target policies to address the leading water situation and they include: Good water governance through well-designed and empowered institutions with supporting legislative and policy instruments, promoting Innovative financial mechanisms through a supportive policy environment Identifying existing capacities, as well as gaps, in order to properly address the water security challenge and global water agenda (UN water security report).
At the bottom of the ladder in the poor water and sanitation situation are populations in low and middle-income countries. A United Nations report in 2015 estimated that in Sub-Saharan Africa about 40% of the 783 million people are without access to an improved source of drinking water and only a startling 30% of the population has access to good quality sanitation a 4% increase in coverage from 1990. This is a serious concern because of the associated massive health burden as many people who lack basic sanitation engage in unsanitary activities like open defecation, solid waste disposal, and wastewater disposal. Some parts of South Africa has been mired with the water crisis. This has given rise to issues around water quality and also water quantity. In 2016, it was estimated that about 7.87% of total deaths in Sub-Saharan Africa was attributable to the diarrhoeal disease. In South Africa, the figure was between 1.51 to 3.46%. These figures are excluding deaths resulting from other water and sanitation-related causes and goes to show that more work still needs to be done to actualize the SDG goal number 6 on water and sanitation. In 1996, South Africa Launched it is National sanitation policy and this was followed by the white paper on National water policy launched in 1997 (DWAF, 1997). Though these policy stances appear robust in a paper, there exists a gap between the formulation and the implementation process.
This review however aims to understand the burden of avoidable mortality and morbidity associated with lack of access to clean water and sanitation in rural South Africa (Mpumalanga district) and equally to identify new and existing policies both local and global that would help mitigate the current situation and help bridge the gap that exists between water and sanitation policy formulation and implementation. This work is aimed to contribute to the overall VAPAR project being undertaken by the Agincourt/MRC and its INDEPTH network collaboration. This topic was identified as important by the community participants involved in this project. It is expected that the findings would be relevant to the department of health, the policymakers and the government of South Africa and other major stakeholders in South Africans public health and development sector.
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