Water, Sanitation and Hygiene Promotion A civil society submission to the Government of Bangladesh on

1. Water, Sanitation and Hygiene Promotion A civil society submission to the Government of Bangladesh on National Strategy for Economic Growth, Poverty Reduction and Social Development (Poverty Reduction Strategy Paper)

2. What is a PRSP • In September 1999 the World Bank and IMF developed a new framework for giving low interest loans and debt relief to 42 poorest countries in the world. • This is conditional on countries developing a Poverty Reduction Strategy Paper (PRSP) • PRSP is about prioritising budget allocation in order to achieve poverty reduction objectives. • The PRSP is matched by national level medium term expenditure framework (MTEF). Gradually the MTEF and PRSP could be the basis for all donor assistance.

3. WaterAid and Partners involvement in the process • WAB and Partner NGOs consider access by the poor to affordable safe water supplies and environment sanitation as central to poverty reduction. The main objective of their engagement • To ensure that access to safe water and environmental sanitation remain a priority in the PRSP.

4. Chapter structure of iPRSP • "what the broad lessons are from the past development experience" • "where we stand now in terms of poverty and social indicators" • "what do the voices of the citizens suggest" • "where we would like to go by the year 2015" • "how we are going to reach the social targets" • "what would be the macroeconomic framework for poverty reduction in the medium-term" • "how do we know that we are reaching our targets"

5. The stated iPRSP goals • Remove the ‘ugly faces’ of poverty by eradicating hunger, chronic food insecurity, and extreme destitution; • Reduce the number of people living below the poverty line by 50 percent; • Attain universal primary education for all girls and boys of primary school age; • Eliminate gender disparity in primary and secondary education; • Reduce infant and under five mortality rates by 65 percent, and eliminate gender disparity in child mortality;

6. Reduce the proportion of malnourished children under five by 50 percent and eliminate gender disparity in child malnutrition; • Reduce maternal mortality rate by 75 percent; • Ensure access of reproductive health services to all; • Reduce substantially, if not eliminate totally, social violence against the poor and the disadvantaged groups, especially violence against women and children; • Ensure comprehensive disaster risk management, environmental sustainability and mainstreaming of these concerns into the national development process.

7. 5 strategic elements • accelerating pro-poor economic growth • fostering human development of the poor • women’s advancement and closing of gender gaps • social protection • participatory governance and enhancing non-material dimensions

8. Accelerating pro-poor economic growth – infrastructure development Improved and safe water supply and sanitation services will be emphasized for • Reducing health costs • Improving malnutrition • Increasing productivity of labor • Reducing time spent by women and children in water collection • More productive use of time and resources by poor households

9. How will this happen? Following the National Water Supply and Sanitation Policy 1998, a development framework will be worked out to address the issues in a comprehensive manner.

10. Impact • Every day 20,000 metric tons of human excreta are deposited on public lands and waterways. This is one of the main causes of contamination surface water • 125,000 children under five die each year from diarrhoeal disease, 342 children per day • Diarrhoeal disease causes 5.75 million disability adjusted life years – 61% of total DALYs. • 5 billion taka (us$ 80 million) is spent every year for the treatment of hygiene related diseases • Every child in Bangladesh suffers an average of three to five diarrhoeal attacks in each year, which is a major contributor to malnutrition • Women and girls suffer the most from water, sanitation and hygiene deficiencies. A lack of privacy in sanitation increases the risks of urinary tract infection, reproductive health problems and physical attack.

11. WaterAid’s participatory impact assessment, Looking Back, cites the following connections between water projects and different aspects of poverty: • Improvements in livelihoods and productive time • Minimising the costs of healthcare due to significant reduction in diarrhoeal and other water-related diseases • Reduction in infant and maternal mortality and morbidity • Improved mental health • Increased school attendance, especially for girls • Improvements in the quality of family life • Increased participation in social/community activities and observance of religious obligations • Enhanced self-esteem of individuals and communities

12. Recommendations: • Special emphasis should be given to addressing water and sanitation and hygiene promotion in the ‘Deprivations in Health’ section of the full PRSP. Improved water supply, sanitation services and hygiene practices need to be emphasised as a major element for the building of human capability in the full poverty reduction strategy for Bangladesh.

13. To enable sustainable integrated community managed water supply and sanitation schemes to be realized, the empowerment of local government requires the decentralization and devolution of the roles and responsibilities. • The approaches and outputs for the Water and Sanitation sector need to be revised from the hardware output approach to a people centered approach.

14. Recommendation for an additional goal/target for the full PRSP: Ensure access to safe water, proper sanitation (100%) and hygiene practices by all by the year 2015.

15. The approaches required to ensure the maximize the impact and ensure the sustainability of the water and sanitation interventions under ‘Infrastructure Development’ should be explicitly set out in the ‘Fostering Human Development of the Poor ‘ route to poverty reduction with special emphasis on hygiene education.

16. Include integrated water, sanitation and hygiene education in the essential health package. • Water and Sanitation should be addressed as a separate sector under ‘Infrastructure Development’ at Annex 6

17. Give more emphasis to preventative health care approaches in the full PRSP. Provide the disease base data for mortality and morbidity which will help to understand the overall health situation and identify priority areas for intervention.

18. Special effort is needed for awareness building on issues related to gender among all (men, women and children) for action towards transformation of the gender division of labour.

19. Ideally, separate budget lines for water, sanitation and hygiene promotion activities/interventions will be explicitly stated in the Medium Term Expenditure Framework. Investments in water and sanitation should be considered as investments for the nation for building human capability to reduce the overall poverty of the country.

20. A clear policy indication is needed for the urban poor, especially those living in urban slums, to provide them basic water and sanitation services. The main debate in Bangladesh about settlement is the tenure of slums people and access to basic services needs a policy direction for the poverty reduction of the urban poor.