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One good decision at the Earth Summit: to improve sanitation
Despite disappointments for environmentalists, the Johannesburg Summit on Sustainable Development (26 August4 September) did achieve one encouraging result for health. A clause in the internationally agreed conclusions calls for the "halving of the proportion of people without access to basic sanitation" by 2015.
Johannesburg set few definite targets, and most that were set aren't new they simply repeat a small proportion of the impressive targets agreed by the 189 member states of the UN at the Millennium Summit in September 2000. But Johannesburg's clause on sanitation is a genuine addition, and so deserves some attention.
Richard Helmer, Director of WHO's Department of Protection of the Human Environment, told the Bulletin: "It was very important. In the Millennium Development Goals (MDGs) sanitation was explicitly excluded. We only had water supply; sanitation was only mentioned obliquely under habitat that 100 million urban dwellers were to get better conditions, and things like that. The US didn't like it. They said it made an unnecessary commitment that we could not keep."
But now there is a commitment to improved sanitation, in a clause added to the MDG, which says: "to halve, by the year 2015, the proportion of people who are unable to reach or to afford safe drinking-water".
And there is one further benefit: progress towards reaching the targets is not to be left to chance, but will be monitored by Mark Malloch Brown, head of the UN Development Programme, who was also appointed "scorekeeper" for the follow-up to the MDGs.
Malloch Brown told Geoffrey Lean, environment correspondent for The Independent newspaper in the UK, that he aimed to ensure that Johannesburg is not followed by a period of inaction as previous summits have been. Malloch Brown is due to report to the UN General Assembly in October on the efforts of 15 countries to attain the MDGs, and will now expand his work to monitor the progress of every country in the developing world every year. "This is going to be a revolution in implementing decisions" Malloch Brown told the The Independent.
Johannesburg Summit Secretary-General Nitin Desai informed delegates that the water and sanitation goals were backed up by announcements of concrete projects and partnerships with the US announcing an investment of US$ 970 million in water projects over the next three years, and the European Union announcing its commitment to partnerships to meet the new goals, primarily in Africa and Central Asia. The UN has received 21 other partnership initiatives in this area with at least US$ 20 million in extra resources, Desai said.
However a question mark may be raised over whether much of this will be new money, says Helmer. Issues are also raised by the involvement of the World Trade Organization, whose General Agreement on Trade in Services has opened the door for international private water companies to move in on water and sanitation in areas like Manila and Johannesburg itself, with controversial results. "American or European enterprises going out into the Third World to run the water for another city that doesn't sound right somehow," said Helmer. "They should privatize it locally on the spot."
According to Helmer, the responsibility for improvements to water supply and sanitation will really rest with the national governments and municipal authorities of affected areas. "They really have to make the investments and push the agenda themselves," Helmer told the Bulletin. "The external aid for investments in water supply and sanitation is always marginal only 5%. Not much more."
There have been extraordinary mismanagements and failings in this sector in developing countries, but there is pressure for improvement "because the water is getting shorter" said Helmer. "With the lack of sanitation, the watercourses in the cities and downstream get terribly polluted and are less fit for other uses ... We have many rivers with such high concentrations of organics and bacteria that they can't even be used for irrigation."
Nevertheless the world has seen a decrease in mortality from poor sanitation. "The situation has improved in some places, and with rapid oral rehydration therapy (ORT) you can avoid mortality from diarrhoea and cholera. But ORT doesn't prevent the next case. The prevalence of all the waterborne diseases is not going down," Helmer said. 
Robert Walgate, Bulletin