Mid-Decade Evaluation of Water Supply and Sanitation in Latin America and the Caribbean  /  Washington, D.C., 1997

By:  Pan American Health Organization /  World Health Organization   /  Division of Health and Environment

Executive Summary

The 1990 World Summit for Children adopted the World Declaration on the Survival, Protection and Development of Children, and endorsed the Plan of Action which established goals and targets to be reached by 1995 and 2000, to better the health conditions of women and children. The Heads of States inter-alia called for the universal coverage of water supply and the elimination of excreta in a sanitary manner by the year 2000.

This Declaration, coming at the completion of the international Drinking Water and Sanitation Decade (1981-1990), is particularly significant in this Region, considering that after nearly 90 years, cholera reappeared in the Region of the Americas in January 1991. The situation of drinking water supply and sanitation in Latin America and the Caribbean was evaluated in 1990 and established the coverage of these basic services at 790/o for water and 66% for sewage and excreta disposal.

Intermediate Targets for 1995

Taking into consideration the situation in the sector, the following Mid-Decade targets were proposed for water supply and sanitation for 1995.

In water supply, reduce by one fourth the difference between the population with water services and those without access to such facilities.

In sanitation, reduce by one sixth the difference between the population served and those unserved. Several lines of actions and strategies were recommended to attain these targets, including as priority, to extend coverage to marginal urban and rural areas.

Coverage of Service Reported in 1995

Tlie information provided by the countries put the 1995 coverage for the total of population with access to water supply by house connections and other acceptable means such as public standposts at reasonable distance at 73%. This information is based on reports provided by 23 countries in the Region, covering 98 % of the population of Latin America and the Caribbean.

The survey indicates that the development of water supply services in this Region has been much slower than expected and even declined as several countries have revised downward their level of coverage. More consideration was given to such factors as reliability of services and distances as countries began to look more closely at their water supply infrastructure in the advent of the cholera epidemic.

Several countries substantially reduced their coverage figures for urban water supply, including Brazil, Colombia, Ecuador, Haiti and Venezuela. Ecuador, and Venezuela also reduced their rural water coverage. An in depth evaluation is needed in these countries to analyze the fluctuations in the coverage of water supply in order to reach a conclusion. It is important to note that since Brazil represents such a large proportion of the region population, a drop in the coverage by that country will have a significant impact on the regional statistics.

While the reports of the above countries account for most of the drop in coverage reported, it is important to note that only Bolivia, the Dominican Republic and Mexico showed any significant increase in water supply coverage over 1990.

The Report shows that major disparities still exist between the countries as far as coverage is concerned. The information indicates that Haiti and Paraguay are still covering less than 40% of their population with access to a safe source of water.

Since the cholera epidemic in 1991 there has been considerable progress in the disinfection of water supply in Latin America and the Caribbean. However, the systematic disinfection of water continues to be a problem in the Region. The period 1990-95 also witnessed a considerable interest and increase in the use of technologies for the on-site generation of chlorine and other disinfectants for the improvement of water quality.

The survey, together with a previous study carried out in 1994 on the status of disinfection in Latin America and the Caribbean, put the percentage of population receiving disinfected water on a regular basis at 59%. lt was indicated that most people living in urban communities received water according to the WHODrinking Water Guidelines, while the people in rural communities did not. A strategic plan for water quality improvement for the countries has been discussed in a Regional Drinking Water Quality Conference in Lima, Peru in May 1996.

In the field of sanitation, at the end of the International Drinking Water Supply and Sanitation Decade, wastewater and excreta disposal facilities were extended to 66% of the population. By 1995 the total coverage increased to 69%. The urban services remain constant at 80%, however, rural services were extended to approximately 40% of the population.

One of the most critical sanitary problems in Latin America remains the lack of sewage treatment. Untreated and inadequately treated sewage contaminases surface and ground water. Previous estimates put at 10% the level of sewage that received treatment at 10% or less. The survey indicated that the mean for the percent of sewage collected that receives treatment is just above 10%.

Financing

Several estimates have been made on the resources needed and the cost of providing universal coverage of water and sanitation in the American Region. According to UNICEF, it will require 52.2 billion dollars between 1990 and 2000 to provide universal coverage in water and sanitation. In 1985, the Latin American Office of the World Bank estimated that it would require 92 billion dollars in investment in the sector to achieve universal coverage by the year 2000. The Regional Plan of Investment in Health and the Environment (PIAS) proposed by PAHO, following the reintroduction of cholera in the Region, estimated a total investment of 115 billion dollars in sanitary infrastructure between 1993 and 2004 to achieve universal coverage of water and sanitation.

The information provided by the countries is not sufficient to give an accurate account of the total investments in the sector during the period 1990-95. However, the preliminary indication is that the total investments in the sector for the period, does not nearly approximate the estimate requirement indicated above.

T'he largest total investments in the sector were reported by Argentina, Bolivia, Dominican Republic, Ecuador, Mexico and Peru, Brazil and Chile. A probable estimate of all investments in the sector would probably be around 12 billion dollars for the period 1990-1995.

The information provided by the financing agencies indicated that the two largest investment banks, the World Bank and the Inter-American Development Bank, invested a total of 4.27 billion dollars during the period 1991-95, including 1.58 billion dollars in Mexico.

The German Government (GTZ and KFW) reported spending 111.3 million dollars during the same period, and CIDA 11.2 million dollars in Central America. The Caribbean Development Bank reported spending 53.9 million dollars in water and sanitation projects in the Caribbean. Other agencies that provided investment in the sector include JICA, USAID, UNICEF and the European Community (EEC).

For the countries that provided complete information on sector investments, the mean ratio of external contribution to the total investments in the countries increased to 45% in comparison to 30% reported in the previous decade.

The investments in sewerage and sanitation continues to lag those in water supply. The available information indicate that the sewerage and sanitation investments approximate 50% of the water investments during the period.

Water Supply and Sanitation Sector

Constraints

The five most serious constraints identified by the countries in order of prioriry were: - the lack of government policy for the sector; the limitation in funding; the inappropriateness of the institutional framework; the inadequacy of the cost recovery systems; and the obsolescence of existing legislation.

Other constraints were the lack of trained professionals and technicians, logistics and the non involvement of communities.

lt is to be noted that lack of knowledge of water resources, and lack of appropriate technologies were not perceived as major constraints to sector development which largely remains a function of the institutional, legal and financing framework

Sector Modernization

From the end of the last decade, the countries have been engaged in a process of sector reform. These reforms were prompted by the lack of efficiency of the agencies in the sector. In fact, water agencies were highly subsidized by the central and local governments and served as a place of employment. one important aspect of this modernization of the sector has been a move towards decentralization, municipalization and towards increase participation of the private sector in the water sector through various forms.

The largest coverage of water supply by private organizations was reported by Argentina. Other countries like Bahamas, Brazil, Honduras, also reported limited coverage by private entities. In Chile, the Regional Water and Sanitation Companies have decentralized and are operating on a commercial basis. In Brazil, companies established in the States under the National Sanitation Plan have improved sanitation services. In Colombia, greater responsibility has been given to the municipalities for the development of infrastructures, including drinking water and sanitation. In the Caribbean, Trinidad and Tobago has recently privatizad the operation of the water and sewerage authority.

Despite all the changes and move toward decentralization and privatization, in order to achieve self sufficiency, inadequate institutional framework and lack of government policy, continues to be reported as the main constraint to sector development.

Conclusions and Recommendations

Considering the information provided by the countries in relation to the Mid-Decade survey, the following conclusions can be reached and recommendations made:

• The water supply and sanitation programs in Latin America and the Caribbean are not proceeding at a pace that could guarantee the achievement of the goals set for the year 2000 as indicated in the World Summit for Children. The available information indicates a drop in regional coverage, largely due to revision of data provided by Brazil. Several other countries have also indicated a lack of progress in the sector. A greater awareness from the countries about what constitutes safe water in view of the cholera epidemics may play a role in the revision of the data provided by the countries.

• The available financial information also indicate that the level of investment in the sector fell short of the proposed plans of investment geared at achieving significant increase or full coverage in these services. The lack of investment and the limitation in financing have been reported as a significant constraint in the sector.

• The sector problems remain basically organizational, legal and institutional as several countries reported lack of adequate institutional framework as the major constraint to sector development. Also inappropriate legal framework and the lack of well defined policies were cited as major constraints.

It is recommended that:

• Governments step up their efforts to achieve the goal of water and sanitation by the year 2000 as outlined in the World Summit for Children and in other fora, and the countries, in particular those that llave shown a drop or lack of progress in coverage, evaluate their internal situation in order to take corrective actions.

• Governments and financial  institutions make special efforts to increase resource mobilization and the means for financing water and sanitation projects.
  

• Ministries of Health take the leadership to ensure that water quality constitutes an integral component of the effort to provide the population of countries of Latin America and the Caribbean with adequate preventive health care; disinfection of drinking water to be promoted, in particular in rural areas and to high-risk populations.

• In the context of the Regional Plan for Investment in the Environment and Health, PAHO continue to support sector reform and modernization, including aspects of decentralization and participation of the private sector.
  
• PAHO continue to support sector modernization efforts which aim at decentralization of the management of water services and increased financial responsibility, and develop clear policy and operational guidelines for privatization and decentralization to assist countries in their sectoral reform.
  
• PAHO organize a Regional effort to follow up on Initiative 47 of the Santa Cruz Summit, promoting a Regional Plan for Drinking Water Quality at the highest political and technical levels.

Table of contents

1. Background

1.1 World Summit for Children

1.2 International Drinking Water Supply and Sanitation Decade

1.3 Declaration of Puerto Rico

1.4 International and Regional Conferences

1.5 Population

1.6 Intermediate Targets for 1995 for Water Supply and Sanitation

1.7 Water and Sanitation Monitoring

1.8 Cholera

2. Evaluation of Water Supply and Sanitation

2.1 Objectives and Methodology

2.2 Coverage of Water Supply

2.3 Drinking Water Quality

2.4 Water Sources and Usage

2.5 Sewage and Excreta Disposal

3.  Financing

4.  Water Supply and Sanitation Sector

4.1 Constraints

4.2 Sector Modernization

5. Conclusions and Recommendations

    Annexes

1. Background

1.1  World Summit for Children

The 1990 World Summit for Children adopted the World Declaration on the Survival, Protection and Development of Children, and endorsed the Plan of Action which established goals and targets to be reached by the years 1995 and 2000 to better the health conditions of women and children. These recommendations were endorsed at the highest levels of government.

In the area of water and sanitation at The World Summit for Children, the Heads of States called for the universal coverage of water supply and the elimination of excreta in a sanitary manner by the year 2000. This commitment implies at the minimum easy access to a safe source, and water in sufficient quantity and quality in aecordance with local definitions and norms of health improvement by means of adequate environmental and sanitary conditions.

In the American Region, the extensive survey carried out at the completion of the International Drinking Water and Sanitation Decade (1981-1990) evaluated the situation of drinking water supply and sanitation in Latin America and the Caribbean and established the coverage of these basic services. The report indicated that by the end of 1988, an estimated 79% of the population had reasonable access to water supply by house connections or reasonable access to public sources. For the same period, 66% of the population was also reported to have access to a sanitary means of excreta disposal. This report also indicted a significant difference in the level of coverage between the urban and rural sectors as reflected below:

Table 1*

* The situation of Drinking Water Supply and Sanitation in the American Region at the End of the Decade 1981 -
   1990, PAHO Document 1990.

Notwithstanding the limited coverage in rural water supply and sanitation coverage, the report further recognized that:

• Coverage did not necessarily indicate adequacy of services in terms of quality and quantity. Problems such as intermittent supply and shortcomings in operation and maintenance may result in contamination of water supply.

• Monitoring and surveillance of drinking water quality was limited as well as the level of coverage of disinfection facilities.

• Discharges of untreated or inadequately treated wastewater remains a major threat of pollution to surface and ground water. In addition to biological contamination, the chemical contamination due to industrial wastes was a matter of concern.  

• Significant disparities exist between the level of coverage of the countries. Nine countries reported total population served by water supply either by house connections or easy access at 60% or less, and 10 countries with less than 60% coverage in sanitation, cither through sewerage connections or services though adequate private means of excreta disposal.  

• Several weaknesses in the water and sanitation sector were identified and are summarized in the Declaration of Puerto Rico.

The report of the evaluation of the International Drinking Water Supply and Sanitation Decade (19811990) was presentes to the XXXV Meeting of the Directing Council (1991) which, inter alia, requested the Director of the Pan American Health Organization to continue to give high priority to the promotion of the development and efficient management of basic water supply and sanitation services in the countries, with emphasis on urban and rural poor and high-risk groups, and to assist the countries in developing and maintaining national information systems to monitor and evaluate program progress as well as regional progress. The Council also requested the Director to develop actions which are complementary to water and sanitation programs and to increase their sanitary and health impact. These actions should include education and training programs, research, technology development, information exchange, and community participation.

  The Directing Council also urged the countries to renew their political commitment to the improvement of water supplies and sewage and excreta disposal services, improving water quality through the protection of water sources including the treatment of wastes that may affect them and improved management of water treatment and distribution systems; and to promote social mobilization in the water and sanitation sector, involving communities in planning, financing, and managing water and sanitation sei-vices.

1.3  Declaration of Puerto Rico  

The evaluation of the International Drinking Water and Sanitation Decade was presented to the Regional Conference on Water Supply and Sanitation held in San Juan, Puerto Rico in September 1990. The Conference analyzed in depth the situation of water supply and sanitation in the Region and the achievements of the Water Decade, and made severas recommendations which resulted in the Declaration of Puerto Rico. The Conference recognized several constraints which continued to plague the sector and needed to be addressed by policy makers and international agencies. Amongst the principal causes were: 

• The inadequacy of the sector's organization, in particular excessive division of responsibilities and duplication of functions, limited coordination and excessive centralization.
•  The difficulty to recover investment and to generate income through payment for services which results in administrative deficiencies.  
• The wasteful use and the prevalent culture which precludes awareness of the value of waterand the need to use it rationally and to pay a realistic price for the services.
• The human resources development and staff development were mentioned as areas for attention in the future.  
• The basis for any serious sector development remains the political commitment of the governments collectively and individually to improve the situation and allocate the necessary resources.

1.4  International and Regional Conferences

On the internacional scene, severas other recommendations have been made concerning the sector development during the 1990s. The most important are: 

• The New Delhi Statement which resulted from the worldwide evaluation of the International Drinking Water Decade recommended the provision of safe water in sufficient quantity and pro-per sanitation for all (by the year 2000).

• The international Conference on Water and Environment, Dublin, Ireland 1992 resulted in the Dublin Statement, which recognizes the basic right of all human beings to have access to sanitation at an abordable price, and that past failure to recognize the economic value of water, has led to wasteful and environmentally damaging uses of the resources. Managing water as an economic good was seen as an important way of achieving efficient and equitable use and encouraging conservation and protection of water resources.  

• The 1992 Rio Conference (Earth Summit 1992) resulted in the adoption of the Agenda 21, which devoted a significant chapter to the management of fresh water resources and presentes the most comprehensive set of recommendations for sustainable development of urban and rural water supply. These recommendations inter alia include protection and safeguard of environmental health through integrated management of water resources, institutional reform, community management and sound financing practices as guiding principles for development of water and sanitation services.  

• The Caribbean Cooperation of Health also established targets for complete coverage of water water in basic sanitation by 1995 for all Caribbean country members of CARICOM.

• The Declaration of Santa Cruz de la Síerra requested inter alia that the governments strengthen their programs to increase access to safe water and to fight the contamination of water resources and to assure that water supplies are safe and adequate.

1.5  Population 

The total population of Latin America and the Caribbean in 1995, was estimated at 473,718 million, which would indicate an increase of some 40 million persons over the 1990 population. The population projections for Latin America and the Caribbean are summarized below. 

Table 2 *

 * Statistical Yearbook for Latin America and the Caribbean, Edition 1994. CEPAL. 

Based on the above projections, an additional 80 million would need to be provided with water supply and sanitation between the years 1990 and 2000. This is to be added to the 89 million deficit already reported in the 1990 evaluation. 

The population estimated for 1995 and projections for the year 2000 of the individual countries are shown in Annex A.

1.6  Intermediate Targets for 1995 for Water Supply and Sanitation

After considering the level of coverage achieved by the countries at the end of the International Drinking Water and Sanitation Decade, UNICEF proposed the following intermediate targets for 1995, to cover the deficit observed and to meet the year 2000 goals. 

- Reduce by 25% the difference between the population with water services and those without access to such facilities. This
   would necessitate an annual increase of 1.5% for some countries with major needs. it was further estimated that to reach this
    target, some 68 million additional people will need to have access to water. 

- In sanitation, reduce by one sixth the difference between the population served and those unserved. This would imply an
   annual rate of 2% in all countries (or 66 million additional persons to be served) a line of actions and strategies were
   recommended to attain these targets among the most important were: 

• prioríty to extend coverage to marginal urban and rural areas;
• promote the use of low cost appropriate technologies;
• the reinforcement of community participation; and

• the promotion of the intervention of the governments and private sector in the financing an management of water and sanitation services.

lt was recognized that several countries, Bolivia, Dominican Republic, Haiti, Honduras, Nicaragua and Peru, would need to spend a considerable percentage of their gross national product to meet any significant goals in water and sanitation. 

Annex B shows the targets for urban and rural water supply and sanitation established by the respective countries of Latin America and the Caribbean, reported in relation with this survey. 

1.7  Water and Sanitation Monitoring

Recalling the recommendations of the Secretary General of the United Nations in his Report on the Achievements of the International Drinking Water and Sanitation Decade, with regard to the need to strengthen information systems on water and sanitation, the New Delhi Statement, the World Summit on Children as well as the Declaration of Puerto Rico, the countries were requested to develop more efficient and reliable information systems for the water and sanitation sector. To facilitate this task, the World Health Organization and UNICEF signed an Agreement for the joint Monitoring Program for Water Supply and Sanitation in 1990 to assist member countries to develop an information system that more aceurately estimates the coverage and quality of water services. This information system referred to as WASAMS, would be useful for identifying population at risk and for advocacy and planning of services for the unserved in particular. The stage of development of this system in the respective countries is covered in a separate report. 

The lack of a reliable information system at the national level, remains a critical problem for assessing the water and sanitation sector at the national level, as some countries have found it impossible to provide the information requested and that several of the questionnaires were also incomplete

1.8  Cholera

After nearly 90 years, cholera reappeared in the Region of the Americas in January 1991. The seventh pandemic of Vibrio cholera 01 biotype El Tor, began on the coast of Peru and subsequently spread inland to most countries of the Region. For the three year period 1991-1993, the countries and international agencies approached the cholera epidemic as an emergency. Intensified efforts in all aspeets of prevention and control were taken. The disease, which now appears to be endemic, caused significant economic costs to the already overburdened health systems of the countries of the Region. The countries and the international community will continue to be challenged to maintain preventive and control programs, and monitor and refine national policies. The following Table summarizes the number of cases and deaths due to cholera reported to the Pan American Health Organization. A total of over 1.3 million cases have been reported, resulting in more than 11,000 deaths.

Table 3 *

*  Cholera Situation in the Americas update No. 14. PAHO Internal Document. April 1996 

Since the outbreak of cholera in 1991, the countries and the international community have actively promoted the development and implementation of national plans for cholera prevention and control throughout the Region. The current epidemic has created an opportunity to increase the attention paid to the existing control of diarrheal disease programs and to expand significantly and strengthen the capabilities of countries in that respect. Annex C shows the accumulated cases of cholera and related deaths by country since 1991. 

The cholera epidemic has also helped to focus attention to the state of infrastructure development of the countries, in particular to potential improvements to community water supply, including disinfection of community and private water supply, in house disinfection, sanitation, and food hygiene as a logical extension of the cholera response.

2.  Evaluation of Water Supply and Sanitation 

2.1  Objectives and Methodology

This report, prepared by the Division of Health and Environment of the Pan American Health Organization, has put together the information available in the water and sanitation sector as of December 1995, representing the mid point of the Decade. This information was provided by the countries through a questionnaire sent at the beginning of 1996. The sources of information are indicated in Annex F. 

The objective is to analyze the situation of the countries and to evaluate their progress in the accomplishment of the sector goals and to examine to what extent the constraints identified in previous reports are being addressed. 

The questionnaire entitled "Drinking Water Supply and Sanitation Sector Information Form" was sent in English and Spanish to 25 countries of Latin America and the Caribbean, which reports statistical information and is included in the PAHO data base. 23 Countries responded to the questionnaire. Information from the country reports presentes at the Water and Sanitation Monitoring System (WASAMS) Workshops carried out in 1995 in Central America, Andean and Southern Cone countries were used to complete the coverage data. information from the World Bank and the inter-American Development Bank was used to finish the often incomplete financial report provided by the countries 

This report combines the sector information, collected by PAHO with additional information obtained from other sources and other studies carried out in the countries, to provide the rapid evaluation of the sector by the end of 1995.

2.2  Coverage of Water Supply 

The information provided by the countries put the 1995 coverage for the total population with access to water supply by house connections, and other acceptable means such as public standposts, at a reasonable distance at 73%. This information is based on reports provided by 23 countries in the Region, covering over 98% of the population of Latin America and the Caribbean. Reasonable access to water supply is defined in an urban environment as the availability of water at a distance not farther than 200 meters from a house or to a public standpost. In rural areas, the definition is more flexible and may vary with the topography of the area.

 The survey indicates that the development of water supply services in this Region has been much slower than expected. Several countries have revised downward their level of coverage, giving more consideration to such factors as quality and reliability of services and distances to water sources as countries began to look more closely at their water supply infrastructure in the advent of the cholera epidemic. 

By 1988, the urban water supply services through house connections and public sources (access within 200 meters) was reported at 88%. In the rural sector 55% had water supply primarily through public sources. In 1995, urban coverage was reported as 84% and rural coverage at approximately 41%. Table 4 summarizes the level of population coverage in Latin America reported for 1988 and 1995. 

The 1995 survey reports a static situation with regard to water and sanitation services. The distribution of the WHO Drinking Water Quality Guidelines and the preparation of the Regional Drinking Water Quality Plan have helped focussed attention to aspects of quality and reliability of water supply in the Region. These activities, in addition to the outbreak of cholera, have made the potability and the quality of water important issues and concerns in the countries. 

Table 4

 *  PAHO Reports.

Several countries in 1995 (Brazil, Colombia, Haiti and Venezuela) reduced the coverage figures for urban water supply. Table 5 shows individual country's access to water supply in urban and rural arcas and the total coverage reported for 1995. 

Comparing the information reported at the end of the previous decade and 1995, Brazil reduced its coverage in urban water supply from 100% (1988) to 80% (1995) and their rural coverage from 86% (1988) to 28% (1995). Colombia also reduced their rural coverage from 87% (1988) to 32% and Ecuador from 47% (1988) to 10% (1995). Haiti also reported a drop from 55% in urban population served by the end of the decade to 38% in 1995. Venezuela reduced both their urban and rural coverage from 89% in 1990 to 79% in 1995. An in depth evaluation is needed in these countries to analyze the fluctuations in the coverage of water supply in order to reach a conclusion. It would also be important to establish a data base in these countries for monitoring the sector for the remainder of the Decade. However, it is important to note that since Brazil represents such a large proportion of the Region population, a drop in the coverage by that country, will have a significant impact on the regional statistics. 

While the above reports account for most of the drop in coverage reported, Bolivia, Dominican Republic, and Mexico reported significant increase in the water supply coverage over 1988. Bolivia reported a significant increase from 46% in 1988 to 70% in 1995, the Dominican Republic from 68% and 28% in 1988 for urban and rural water coverage to 88% and 55% respectively in 1995, and Mexico reported an increase from 80% and 41% coverage in urban and rural water supply to 83% and 57% respectively in 1995. Notwithstanding this reported increase, there are no sustained initiatives to promote the development of water and sanitation in the Region that are aimed at the achievement of the Mid-Decade targets and the goals of the year 2000. 

Table 6 shows a comparison between the total coverage reported in 1988 and 1995 and related changes by country. 

The report shows that major disparities still exist between the countries as far as coverage is concerned. Table 5 indicates that Haiti and Paraguay are still covering less than 40% of their population with access to a safe source of water and five other countries Guatemala, Ecuador, Nicaragua and Peru and now also Brazil are reporting a less than 70% total coverage. The total unserved population is estimated at 128.3 million. 

Even though the rural population in Latin America and the Caribbean remains fairly constant between 1990 and 1995, the coverage in rural water supply is still very low. Ten countries reported covering less than 40% of their rural population with water supply. Coverage figures for other countries not included in this survey is shown in Annex G. In comparison, information from the Environmental Protection Agency of the United States of America indicates that 250 million people (93%) are served by public water systems and 20 million (70%) by private systems. Canada also indicates that 99% of the population has safe water - 86 % by central systems and 13% by individual means.

Table 6
Comparison Between 1988 and 1995
Water Supply Coverage

The cholera epidemic that struck the Region in 1991 provided a reason for evaluating the safety of drinking water and improving its quality mostly through disinfection. An important element which impacted water quality was the publication of the English and Spanish revised edition of the WHO Guidelines for Drinking Water Quality which was extensively distributed and discussed in the Region. Theses guidelines were discussed in several national and subregional meetings such as those which took place in Trinidad in 1994 for the Caribbean, Mexico in 1995 for Central America and at the Regional Meeting in Lima, Peru in 1996. 

Since the cholera epidemic in 1991 there has been considerable progress in the disinfection of water supply in Latin America and the Caribbean. However, the systematic disinfection of water continues to be a problem in the Region. The scarcity of chlorine due to logistical problems, lack of funds and improper operation and maintenance, has led to several episodes where there was no water disinfection in small towns in particular. The period 1990-95 also witnessed a considerable interest and increase in the use of technologies for the on-site generation of chlorine and other disinfectants for the improvement of water quality. 

The survey, together with a previous study carried out in 1994 on the status of disinfection in Latin America and the Caribbean, put the percentage of population receiving disinfected water on a regular basis at 59%, Figure 1, shows the percentage of population in each country who receives disinfected water on a regular basis. When the information is broken down by urban and rural, a completely different picture emerges. Five countries, including Brazil, which is the largest country in the Region, reported less than 10% of their rural water supply population covered with disinfected water supply and four more countries less than 50% of the population, were served by disinfected water supply. The level of population who receives disinfected water in urban and rural areas is shown in Table 7. Available information indicates that Mexico has been able to increase coverage of chlorinated water from 35 million people in 1991 to approximately 68 million people in 1994. Figures 2 and 3 show the percentage of countries in relation to the level of disinfection coverage in urban and rural areas respectively. 

The Project on Training and Social Mobilization for the Prevention and Control of Cholera in Latin America, sponsored by GTZ, has been under active implementation since 1993 and provided the opportunity to nine countries (Bolivia, Colombia, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and Peru), to develop the framework for introducing and testing technologies of on site production of disinfectants and the use of disinfectant solutions such as sodium hypochlorite. The Italian Government provided funds for similar projects in Bolivia, Colombia, Dominican Republic and Nicaragua. Bolivia and Colombia in particular, have been very successful in experimenting with disinfection at the household level as an effective measure for cholera and diarrheal diseases control. 

With regard to the population that received water that meets the WHO Drinking Water Guidelines, it was reported that most people living in urban communities received water according to WHO Guidelines, while the people in rural communities did not. There was a strong correlation between population that received disinfected water and those receiving water according to the guidelines. It is to be noted however, that the population covered with adequate monitoring and surveillance is very limited, even in urban areas and practically non existent in rural areas. The population who receives water according to the WHO Guidelines and covered with water monitoring is also shown in Table 7.

It is important to note some specific water quality problems in the country that warrant some attention: 

• Argentina: There are certain areas in the country where the only water source is groundwater which contains high levels of sodium, fluorides and arsenic. 
• Bahamas: The main problem is sodium chloride resulting from salt water intrusion. Also an excessive quantity of private systems make water quality control difficult.
• Bolivia: Even though there are water quality norms in existence, there is no agency responsable to enforce them.
• Ecuador: In reality, there is no state or private organizations which dedicates itself to this activity
• Guatemala: It is estimated that 83% of the water supply in urban areas has contamination problems and that in the rural water supply the quality of water is inadequate.
• Haiti: Water is contaminated by inefficient excreta disposal
• Mexico: The principal water quality problems relate to the bacteriological quality and the presence of toxic materials.
• Paraguay: Most of the water sources are of good quality except for excess iron in some zones due to soil characteristics.
• Trinidad: The health agency program is generally weak. Control over plumbing activities is limited.

The Division of Health and Environment of PAHO has been working in various areas to improve the drinking water quality for human consumption in the Region in particular: 

• Dissemination and promotion of the use of the revised edition of the WHO Guidelines for Drinking Water Quality: including the organization of regional workshops to introduce the WHO Guidelines.  

• Provision of technical support to national drinking water quality improvement programs; in the development and use of efficient and effective technology for disinfection.

Table 7

•  Technical support of programs for the monitoring of surface water, the control of toxic substances in surface water and the prevention of groundwater contamination as well as protection of water sources has been provided through such programs as GEMS Water and the the program for the control of toxic substances in water.
  

•   Guidance on policies regarding the disinfection of water such as the recent Symposium "Balancing the Microbial and Chemical Risks in Drinking Water Disinfection," held in connection with the AIDIS Congress in Argentina, which was aimed at helping the countries establish sound priorities in their drinking water quality control programs in view of the concerns of disinfection by-products. 

A plan to organize and implement a concerted and coordinated initiative to help the countries obtain the goal of providing safe drinking water for all people in the Region is being prepared. This initiative is expressed in terms of a strategic plan for water quality improvement for the countries and was discussed in the Regional Drinking Water Quality Conference in Lima, Peru in May 1996.

2.4  Water Sources and Usage

An attempt was made to analyze the consumption of water in the countries. The survey indicates that water consumption in urban areas varies from a low estimate 100 liters per capita per day in Uruguay to above 600 liters per capita per day in Panama. On the average the water consumption is approximately 200 liters per capita per day in the urban areas. In the rural areas water consumption was reported from a low of 40 1/c/d in Nicaragua to 200 1/c/d in Argentina. The rural average water use is estimated between 80 and 90 liters per capita per day. 

Surface water continues to be a major source of drinking water for large urban communities as the rapid growth in urbanization in Latin America considerably increases water demand. At the same time, the increase in pollution of rivers and lakes affects the quality of water sources. The data indicates that countries with large metropolitan areas rely heavily on surface water. Argentina, Ecuador, Uruguay and Venezuela obtain most of their water from surface sources. Bahamas, Paraguay and Suriname rely almost exclusively on groundwater for urban water sources. Groundwater is also the preferred source of supply for rural water supply in almost every country. Conservation of urban and rural watershed and protection of ground and surface water sources remain priority for all countries in the Region. 

Table 8 shows the estimated per capita water consumption of urban and rural areas and the percentage of population supplied from ground and surface water for the countries.

Table 8
Per Capita Consumption and Source of Water Supply

 2.5 Sewage and Excreta Disposal 

At the end of the international Drinking Water Supply and Sanitation Decade, wastewater and excreta disposal facilities were extended to 66% of the population of the Region. This figure represented an increase over 7% of the 1980's coverage. The extension of urban services only kept up with the population growth increasing only from 78 to 80%. The rural coverage increase during the same period from 22% to 32% respectively. By comparison, in 1995 the total coverage increased to 69%. The urban services remain constant at 80%, however, the rural services were extended to approximately 40% of the population. This information is reflected in Table 9. 

Table 9
Sewage and Excreta Disposal Coverage

 The data further indicated that in the urban areas only 52% of the population is connected to municipal sewage collection services. The remaining is served by individual systems, such as septic tanks, cespools and pit latrines. For the most part, disposal in rural areas is done by individual systems, mainly latrines and in limited cases septic tanks and seepage fields. Because of the high cost of sewage collectors, appropriate technologies, which combine septic tank systems and small diameter sewers have bcen successfully applied in severas countries such as Brazil. On site waste disposal technologies are also being applied in most suburban environments of Latin America. 

Table 10 shows the level of coverage for sewage collection and excreta disposal by country and for urban and rural areas. Table 11 shows the comparison between the coverage in sewage and excreta disposal reported in 1995 and 1988. 

The unmet needs of wastewater and excreta disposal in Latin America and the Caribbean were estimated in 1988 at 162 million people lacking adequate means of disposal, 73 million in the urban areas and 89 million in rural areas. By the end of 1995 and based on the figures provided by the countries, the total unmet needs would be 145 million, 67 million in urban areas and 78 million in rural areas. 

For the most part, the lack of infrastructure for water supply and sanitation services was blamed for the resurgence of cholera in Latin America. One of the most critical sanitary problems in Latin America remaind the lack of sewage treatment. Untreated and inadequately treated sewage contaminated surface and groundwater. The contamination of groundwater by nitrate has caused a large number of water producing wells to be abandoned.  

Previous estimates put the level of sewage collected that reccived treatment at 10% or less. The survey indicated that the mean for the percent of sewage collected that received treatment is just above 100/o, Argentina is reporting treating 10% of its sewage while Colombia reports only 5%. Brazil estimates its coverage in sewage treatment at 20% and Mexico at 13%. This information is shown in Table 12. The water pollution problems in Latin America have been well documented and there is no evidence as far as the data shows of any substantive effort to change the situation. Some of the main efforts of the countries are worth mentioning.

Buenos Aires metropolitan area has constructed 20 waste treatment plants and is in the process of building 15 more. 

Mexico has built 16 treatment plants to control the discharge of wastewater into the Lerma-Santiago River basin. 

The Consultative Meeting on Excreta and Wastewater Disposal in Latin America and the Caribbean in 1991 identified the following critical issues for the subsector which are still to be addressed seriously. 

• Political support. One of the most critical aspects of the problem is the low level of political su-pport on the part of governments and relevant national sector institutions due to several factors such as a lack of environmental policies. This has led to a general absence of awareness on the part of the population. With the increased resultant pollution and their effect on water quality, in particular the deterioration of water source, the need for integrated water resources management and waste treatment and disposal will become a major issue in Latin America.

• Financing of wastewater facilities. Many problems were identified in that respect involving both the internacional financing agencies and the governments, including the lack of capacity of national institutions and the need to change the methodologies and criteria used for financing wastewater facilities by the internacional financing agencies. 

• Other main issues identified were the inadequacy and nonexistence of enviromental policies and institutional deficiencias and the need for developing and applying appropriate technological and engineering standards for waste disposal. 

In contrast, 75% of homes in the United States are served by centralized collection systems, and most of the remaining 25% are served by septic tank and soil absorption systems. Canada indicates that 95% of its population is provided with adequate wastewater facilities. 75% of these systems are central and 25% are individual. 5% of the central systems discharge wastewater without adequate treatment. 

A new initiative to concentrate on the waste treatment needs of the Region through cooperation between the countries and the international financing agencies was recommended. This initative would emphasize the development of projects for collection and treatment of wastewater and the control of water pollution. 

Greater participation of professional organizations and pressure groups was seen as an essential element to support the development of appropriate environmental policies and to address environmental issues related to waste treatment and water pollution. The strengthening of environmental education programs to promote community awareness and participation was also recommended to improve sector policies.

 Table 11
Comparison Between 1998 and 1995
Sewage and Excreta Disposal Coverage

*Insufficient data.

Table 12
Percentage Of Sewage Treated
Before Discharge

* P = Primary Treatment
   S = Secondary Treatment
   O = Others

** R = River
     L = Lake
     S = Sea

Greater participation of professional organizations and pressure groups was seen as an essential element to support the development of appropriate environmental policies and to address environmental issues related to waste treatment and water pollution. The strengthening of environmental education programs to promote community awareness and participation was also recommended to improve sector policies.

In the financial analysis of wastewater and excreta disposal projects there is a need to consider the benefits of the prevention of diseases and epidemics such as cholera, and the cost reduction of developing water sources due to the elimination of pollution. lt was suggested that a tax on sectors such as tourism, agriculture and industry could help defray the expenses of providing adequate collection and treatment of waste and to support environmental control in the Region. 

It was strongly recommended that the international financing institutions consider a more integrated approach for projects, in particular, that water supply projects not be financed unless there is a concomitant commitment to the disposal of wastewater. The development of integrated and well coordinated water resources management programs that would give consideration to the health, environmental and economic aspects was recommended as the proper strategy for the Region. 

An increase in the level of research on the use of appropriate technologies to provide low cost solutions to the collection, treatment and disposal of wastewater was also recommended.

3. Financing

Several estimates have been made on the resources needed and the cost of providing universal coverage of water and sanitation in the American Region. According to UNICEF, it will require 52.2 billion dollars between 1990 and 2000 to provide universal coverage in water and sanitation. This sum does not take into account the rate of inflation during the period and the cost of operation and maintenance of facilities. 

In 1985, the Latin American Office of the World Bank estimated that it would require 92 billion dollars in investment in the sector to achieve universal coverage by the year 2000. This figure included cost of training of personnel and sector organization. This inversion plan also suggested that Bolivia, Dominican Republic, Haiti, Honduras, Nicaragua and Peru, would need to invest about 1% of the gross domestic product to that sector. 

The Regional Plan of Investment in Health and the Environment (PIAS) proposed by PAHO, following the reintroduction of cholera in the Region, estimated a total investment of 115 billion dollars in sanitary infrastructure between 1993 and 2004 to achieve universal coverage of water and sanitation. It was proposed that the bulk of the financing (70%) come from national investments and the balance (300%), would come from external investments. 

The information provided by the countries is not sufficient to give an accurate account of the total investments in the sector during the period 1990-95. However, the preliminary indication is that the total investments in the sector for the period, does not nearly approximate the estimate requirement to meet the Mid-Decade targets and for the goal of universal coverage by the year 2000 or 2003 as indicated in the Regional Plan of investment and other estimates. 

The principal total investments in the sector were reported by Argentina 800 million dollars, Bolivia 271 million dollars, Dominican Republic 787 million dollars, Ecuador 542 million dollars, El Salvador 140 million dollars, Mexico 1,928 million dollars, Nicaragua 111 million dollars and Peru 955 million dollars. In addition, information provided by Brazil and Chile indicated externas investments of 3.9 billion and 229 million dollars respectively. A probable estimate of all investments in the sector would probably be around 12 billion dollars for the period 1990-1995. 

The information provided by the financing agencies indicated that the two largest investment banks, the World Bank and the Inter-American Development Bank, invested a total of 4.27 billion dollars during the period 1991-95, including 1.58 billion dollars in Mexico. The German Government (GTZ and KFW) reported spending 111.3 million dollars during the same period, and CIDA 11.2 million dollars in Central America. The Caribbean Development Bank reported spending 53.9 million dollars in water and sanitation projects in the Caribbean. This would indicate a sum of 4.5 billion dollars invested in the sector for the period under review. Other agencies that provided investment in the sector include JICA, USAID, UNICEF and the European Community (EEC). 

Details of the individual country investments are shown in Table 13. Investments in Latin America and the Caribbean by the World Bank and the Inter-American Development Bank are shown in Table 14, investments by GTZ and KFW in Table 15, by CIDA in Table 16 and the Caribbean Development Bank Table 17.

For the countries that provided complete information on sector investments it is interesting to note an increase in the ratio of external contribution to the total investments in the country. These figures vary from 21% in Panama to 97% in Haiti, with an average of approximately 45% in comparison to 30% reported in the previous decade. 

The investments in sewerage and sanitation continues to lag those in water supply. The available information indicate that the sewerage and sanitation investments approximate 50% of the water investments during the period. 

Table 18 shows the projected investments by the countries for the period 1996-2000. Information on water and sewage cost and tariff are shown in Annex E and F. 

Table 13
Investments In Water Supply And Sanitation During
The Period 1990 - 1995 (Millions US$)

Table 14
Investments In Water Supply And Sanitation
In Latin America By Major Lending Agencies
(Millions US$)