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The three legs?

Like the three legs of a stool or the three stones which support the cooking pot over the fire, we need three related things to reduce disease in our families

1997 Available in English, French, Spanish and Portuguese

Footsteps magazine issues on a wooden desk.

From: Water, sanitation and hygiene – Footsteps 30

Water, sanitation and hygiene must go hand in hand to achieve improvements in health

by Richard Franceys.

We all know that water is a wonderful gift. It falls as rain and collects in streams and rivers or under the ground. From there we can take it for drinking, for cooking, for bathing and for washing pots and pans and clothes.

We must have water for life. We all have some form of water supply already – if we didn’t we couldn’t live. But many of us would like to have a better quality water supply closer to home. This is what costs money.

For health!

To spend this money, government or aid projects need to prove that supplying clean water brings benefits which can be measured. The most obvious benefit is improved health. None of us want our children or weaker relatives to suffer from diarrhoeal diseases such as dysentery and cholera. The World Health Organisation tell us that over 3 million children die each year through diarrhoeal disease. But the significant reduction in disease that can result from improving the water supply only occurs when sanitation and hygiene education are also improved.

Like the three legs of a stool or the three stones which support the cooking pot over the fire, we need three related things to reduce disease in our families…

  • clean water supply
  • effective hygiene behaviour (particularly the use of soap and water for handwashing and clean containers for collecting and storing water)
  • safe disposal of human wastes (sanitation).

UNICEF has estimated that it is possible to reduce child deaths from diarrhoea by a quarter if all these three things are encouraged in a community. Improvements in sanitation and hygiene each contribute to about 35% of the reduction. Surprisingly, increasing water quantity contributes only 20% and ‘safe’ water quality contributes only 15% of the beneficial effect. In this edition of Footsteps we have articles about all of these ‘legs’.

Water supply

Having more water closer to home not only improves health but also reduces the long time spent by so many women and children in collecting water. One improvement is to build a water tank for use by homes, clinics or schools. Details are included in article 'Ferro cement tank' in this issue.

Hygiene behaviour

A latrine and hand pump project in Bangladesh spent nearly a quarter of its budget on hygiene education. This is very much more than most projects, which choose to put nearly all their resources into pipes and pumps. However, the result was that incidence of diarrhoea fell by a quarter and that the number of days on which the average child suffered from diarrhoea almost halved. We look at this very important and often over-looked subject on page 4. Water supply and sanitation on their own are not enough.


Having sanitation means being able to dispose of our human waste (urine and faeces) safely. For most people, this means having the most suitable form of pit latrine. We give the details you need to consider for different designs on pages 12–14. When they are built and used correctly, even the simplest pit latrines can give an excellent service.

Sewerage systems which pipe away all the waste are very, very expensive. The common pattern in many towns is for the government to provide sewerage only for the rich people and commercial users – and then fail to charge for the full cost ‘because it is for the public health’. The rich usually benefit from such systems at the expense of the poor.

Community involvement

In rural areas communities need to decide what they want and what they can afford. Government agencies and NGOs have to learn ways to support communities in their technical and financial decision making, not to do the job for them. Community organisations also have a very important part to play in the growing towns and cities. They can enable households to build their own latrines and can also lobby for community rights over piped water supply rather than getting involved in construction.

Why do we have to pay in urban areas?

In urban areas the best provider of water is usually a government agency. Traditionally these organisations give a second rate service (varying water quality at low pressure for a few hours per day) only to middle-income and rich areas. Many poor families have to be content with a third rate service through standpipes, if they are lucky. Others have ended up paying for their water through vendors – costing five times, ten times and even twenty times more in some cities than the amount a middle-income family pays for a private house connection.

This experience has taught us that water supply and sanitation is not something that we can leave to governments to provide through general taxation. In urban areas perhaps we should be starting campaigns through our churches and NGOs saying: ‘We want to pay for a good supply of water!’ At the same time we should insist that richer people must also pay their full amount. It is time for our water projects to stop subsidising the rich.

Finally – the dilemma

Our dilemma is that, to help the poorest, people must pay more for water supplies. Only then will poorer areas receive an improved supply instead of paying high prices to water vendors. Yes, water is a gift – but we all have to pay for the privilege of receiving it and disposing of it safely. And after getting this precious water – it is the way we use it which will make all the difference to our health.

Richard Franceys is a water engineer at the Water, Engineering and Development Centre (WEDC), Loughborough University, Leicestershire, LE11 3TU, UK.

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