Water & Sanitation/Hygiene Issues Specific To Underdeveloped & Developing Countries & Regions

Water and sanitation/hygiene issues can vary significantly between developed, and underdeveloped & developing parts of the world.

Three major issues that tend to be specific to underdeveloped or developing countries and regions include:

– (Lack of) Access to safely managed and clean drinking water

– (Lack of) Access to safely managed and basic sanitation and hygiene services

– Open defecation


In this guide, we outline some of the important information and considerations for each of these issues.

* Note – underdeveloped and developing regions can also be more vulnerable to water related natural disasters such as floods, but natural disasters are outside the scope of this guide.


Summary – Water & Sanitation/Hygiene Issues Specific To Underdeveloped Or Developing Countries & Regions

Some water issues are global.

These issues centre around having adequate supplies of water to meet demand (water stress or water scarcity), and adequate water quality

But, other water issues are specific to developing and underdeveloped regions of the world (which tend to be low and sometimes middle income areas and countries).

These include lack of access to clean and safe drinking water, and lack of access to basic sanitation and hygiene services (with open defecation sometimes being a side effect of this)

The impact of these issues is obvious – serious human health (inadequate water and sanitation is the leading cause of diarrhoea globally, just as one example), economic and social effects.

Young children in particular can be impacted by these issues

The main cause of these issues might be low income and poverty

In some cases, inadequate political or institutional investment in, and management of water and sanitation services and infrastructure may also play a role

The main solution might be that these regions, and in particular rural parts of these regions, need financial investment to help provide these basic services in the short term – external investment might make the most practical sense

Additionally, there would likely need to be focus on the proper political and private allocation of funds into infrastructure – corruption, mismanagement and improper spending of funds can be an issue in some places

In the long term, these regions need help developing economically so they can maintain and manage their own water and sanitation/hygiene services and infrastructure

Access to improved water sources increases with income (ourworldindata.org)

Similarly to improved water access, the provision of sanitation facilities tends to increase with income (ourworldindata.org)

Specific solutions to access drinking water might include adequate quality drinking water that comes from a protected source, and is delivered to where people live (so they don’t have to travel to collect their drinking water)

Specific solutions to access to basic sanitation and hygiene might include a protected toilet or latrine that prevents contact of excretion from human skin, disposal and waste collection and management services, feminine hygiene services, and taps and soap to wash hands


Other notes …

Sub-Saharan Africa, East Asia and The Pacific, & South Asia are some of the regions in the world with the most people who lack access to improved drinking water sources, or protected drinking water sources

Over 90% of people worldwide without access to improved sanitation facilities live in Asia, the Pacific or Sub-Saharan Africa

15 percent of the world’s population were still practicing open defecation, with rates being highest in South Asia (India in particular), and Sub Saharan Africa


Overall, stats show that over the last few decades, the % share of people affected by these issues is decreasing (which means the situation is improving) as the world population grows, but, the total number of people affected still totals in the millions and hundreds of millions – meaning, there’s still a lot that can be done to help these people.


Explaining The (Lack Of) Access To Safely Managed & Clean Drinking Water Issue

The Problem

People lack access to protected drinking water services that is safe to drink, and that is delivered to where they live

Beyond that, just because a water source has been improved, it doesn’t mean it is fully clean or safe to drink (so, quality of water, as well as access to that water, is a problem)


Where It Happens Most

Access [to clean drinking water] in 2015 remains lowest in Sub-Saharan Africa where rates typically range from 40 to 80 percent of households. 

The number of people in Sub-Saharan Africa without access to an improved water source has increased from 271 million in 2990, to 326 million in 2015. 

To put these numbers in context, almost half of people drinking water from unprotected sources worldwide live in sub-Saharan Africa, and eight in 10 live in rural areas.

East Asia and The Pacific make up 133 million, and South Asia also makes up 133 million. 

– OurWorldInData.org


The Causes

Poverty and low income

Inadequate protected drinking water infrastructure, or no infrastructure at all

Inadequate political and institutional management of water services

Being in a rural area as opposed to an urban area

Water pollution and contamination


The Effects

Diseases and human health problems

Malnutrition, [and in the case of contaminated water] higher rates of transmission of infectious diseases like diarrhoea, cholera, dysentery, typhoid, and polio (OurWorldInData.org)


Death & higher mortality rates

Particularly with children. The WHO estimates that in 2015, the deaths of 361,000 children under 5-years-old could have been avoided by addressing water and sanitation risk factors (WHO/OurWorldInData.org). Contaminated drinking water is estimated to cause 502 000 diarrhoeal deaths each year (WHO.int)


More public health problems and investment

Water related problems lead to public health problems that have to be addressed

Slower economic growth, increased poverty, and more socio economic decline – water is used for almost everything in society and the economy, so, when there is a lack of access, work and other areas of the economy and society suffer. Women and children in particular spend 258 million hours every day worldwide collecting water. This is time spent not working, caring for family members or attending school (Water.org)


Decreased safety

Where people have to walk long distances to get their water. Women and children especially are at risk


Decreased education rates

If children have to spend time walking to obtain water from a water source far away from their home


Other socio economic effects



Overall, access to improved water sources is increasing across the world.


Per OurWorldInData.org:

Access to improved water sources is increasing across the world overall, rising from 76 percent of the global population in 1990 to 91 percent in 2015.

The share of rural households with improved water sources was lower than the total population in 2015, with 85 percent access. 

Globally 97 percent of urban households had improved water access, with most nations now having close to 100 percent penetration.


Per WHO.int, in 2018:

In 2015, 71% of the global population (5.2 billion people) used a safely managed drinking-water service – that is, one located on premises, available when needed, and free from contamination.

89% of the global population (6.5 billion people) used at least a basic service. A basic service is an improved drinking-water source within a round trip of 30 minutes to collect water.

844 million people lack even a basic drinking-water service, including 159 million people who are dependent on surface water.

Globally, at least 2 billion people use a drinking water source contaminated with faeces.

In low- and middle-income countries, 38% of health care facilities lack an improved water source, 19% do not have improved sanitation, and 35% lack water and soap for handwashing.


Also per WHO.int:

1.3 billion people with basic services, meaning an improved water source located within a round trip of 30 minutes

263 million people with limited services, or an improved water source requiring more than 30 minutes to collect water

423 million people taking water from unprotected wells and springs

159 million people collecting untreated surface water from lakes, ponds, rivers and streams.


Per WHO/UNICEF, via the theguardian.com. In 2015:

663 million people – one in 10 – still drank water from unprotected sources (a protected source protects against contamination, whereas an unprotected one doesn’t).

In 41 countries, a fifth of people drink water from a source that is not protected from contamination

In most countries, the majority of people spend less than 30 minutes collecting water, or have a piped supply within their home. But in some regions, especially sub-Saharan Africa, many people spend more than 30 minutes – and some more than an hour – on each trip to collect water. This burden still falls mainly on women and girls – they are responsible for this task in eight in 10 households that don’t have a piped supply.

Mongolia is the only country where men and boys have primary responsibility for collecting water

In many parts of the world, water isn’t available all day everyday. In some provinces of South Africa, water supply in 60% of households has been interrupted for two days or more. In South Africa in 2014, a fifth of households with municipal piped water had interruptions that lasted for more than two days. This was three times higher in some regions of the country. Few countries have water available continuously, but in many parts of the world a less than 24-hour supply is still considered sufficient. Countries use a wide range of different measures to assess availability and these must match up so that comparisons of service levels can be made across countries and over time.

The cost of drinking water and sanitation is different in different countries – In Tanzania, 10% of the population spend more than 5% of their expenditure on drinking water


How To Address (Lack Of) Access To Safely Managed & Clean Drinking Water

Financial investment in drinking water infrastructure for extraction, treatment and purification, transport and delivery in regions with the the highest rates of lack of access to safely managed and clean drinking water

Ensure water is continuously tested and monitored to ensure it’s safe to drink and that the quality of the water meets safe water guidelines and regulations

Address other contributing factors such as reducing poverty, reducing water pollution and contamination 

Ensure clean drinking water can be accessed all day, and not just intermittently or only for a limited number of hours in the day

Ensure drinking water is affordable for all individuals


Can aim for all regions throughout the world to have improved drinking water sources:

“An improved drinking water source includes piped water on premises (piped household water connection located inside the user’s dwelling, plot or yard), and other improved drinking water sources (public taps or standpipes, tube wells or boreholes, protected dug wells, protected springs, and rainwater collection).

– WorldBank, & UNICEF/WHO, via OurWorldInData.org


Can aim for all regions throughout the world to have safe water that meets a certain quality:

Some [water] sources protect against contamination, but it still might not be safe to drink the water.

To be considered “safe”, a source of drinking water must be free from pathogens and high levels of harmful substances. Globally, the main health concern is faecal contamination, which is identified by the presence of bacteria such as E.coli.

In many places, a water point is designed to protect against contamination, but the water from it might still have traces of E.coli – the groundwater may be contaminated by faulty latrines, or the containers people use to carry and store water may contain traces of the bacteria.

In Nepal, 91% of the population drink from an improved water source, but E.coli has still been detected.

[So, improved drinking water sources need to be monitored for quality and contamination/pollution too]

– WHO/UNICEF, via the theguardian.com


According to OurWorldInData.org:

Access to improved water sources generally increases with income of the country


Sometimes, there are emergency responses required in some countries such as Yemen, where conflict has contributed to water shortages. Organisations like UNICEF has help re-establish water reserves, along with helped in providing other emergency water and sanitation services (borgenproject.org)


Explaining The (Lack of) Access To Safely Managed & Basic Sanitation & Hygiene Services Issue

The Problem

A lack of access to improved sanitation conditions or facilities to dispose of human waste safely and hygienically


Unimproved sanitation facilities include flush or pour–flush to elsewhere, pit latrine without slab or open pit, bucket, hanging toilet or hanging latrine, or no facilities or bush or field.


Types Of Sanitation

According to Wikiprogress.org:

– Basic sanitation – refers to the management of human feces at the household level. Basic sanitation is the same as improved sanitation. This is facilities that ensure hygienic separation of human excreta from human contact. They include:

  • Flush or pour-flush toilet/latrine to a piped sewer system, a septic tank or a pit latrine.
  • Ventilated improved pit latrine.
  • Pit latrine with slab.
  • Composting toilet.

– On-site sanitation – the collection and treatment of waste is done where it is deposited. Examples are the use of pit latrines, septic tanks, and Imhoff tanks.


Where It Happens Most

From OurWorldInData.org: 

Of the total number of people without access to improved sanitation facilities by region, over 90 percent of those without access in 2015 resided in Asia, the Pacific or Sub-Saharan Africa.

The largest region share was from South Asia, accounting for 40 percent and nearly one billion without access. This was followed by Sub-Saharan Africa with nearly 30 percent (706 million), and East Asia & Pacific with around 22 percent (520 million).

There remains large inequalities in levels of access to improved sanitation across the countries in the world

In 2015, the total share of the population with access to improved sanitation across Europe, North America, North Africa and some of Latin America is typically greater than 90 percent (and in most cases between 99 and 100 percent).

Between 80 and 90 percent of households in Latin America and the Caribbean have improved sanitation.

Access is slightly lower across Central and East Asia, typically between 70 and 80 percent.

In South Asia, progress has been varied. Sri Lanka has achieved a 95 percent access rate; Pakistan and Bangladesh both have access of over 60 percent; whereas India lags behind in this regard with just under 40 percent.

Regionally, access is lowest in Sub-Saharan Africa where most countries have less than 40 percent access rates.

In South Sudan, only 6-7 percent of the population had improved sanitation in 2015.

Within each country, rural areas generally have less access to sanitation than urban areas


[Rural areas compared to urban areas tend to have a lower share of sanitation facilities]


The Causes

Poverty and low income

Inadequate sanitation and hygiene infrastructure and services, or no infrastructure and services at all

Inadequate political and institutional management of water services

Lack of access to basic water services (water is required for sanitation and hygiene services)

Being in a rural area as opposed to an urban area


The Effects

Human health problems – higher rates of the transmission of infectious diseases such as diarrhoea, cholera, dysentery, typhoid, and polio. This is particularly the case with contaminated water and when there is a lack of water for proper sanitation (OurWorldInData.org)

Death and higher mortality rates – particularly with children. The WHO estimates that in 2015, the deaths of 361,000 children under 5-years-old could have been avoided by addressing water and sanitation risk factors (WHO/OurWorldInData.org)

+ socio economic effects


Some more findings from OurWorldInData.org & WHO on the impacts are:

There are a number of important contributing factors to child mortality, including nutrition, healthcare and other living standards … But, in countries where open defecation is greater than 10 percent, typically more than 20 children per 1,000 die before their 5th birthday.

Contaminated drinking water, poor sanitation facilities and open defecation contribute to the transmission of infectious diseases such as diarrhoea, cholera, dysentery, typhoid, and polio, and can also have severe impacts on malnutrition.

Stunting — determined as having a height which falls below the median height-for-age WHO Child Growth Standards — is a sign of chronic malnutrition … [but is also linked to poor sanitation and hygiene]


Other stats and findings on the effects of lack of sanitation according to Worldvision.com.au are:

Poor water and sanitation is the leading cause of diarrhoea, which is the second biggest cause of death among children under five, killing 760,000 each year 

Poor water and sanitation can severely erode health and wellbeing gains made by food and nutrition programs

Illness and time spent collecting water also reduces school attendance and adults’ capacity to work and earn income. A 2012 World Bank study of 18 African countries found they lose 1-2.5 percent of GDP – around US$5.5 billion – every year due to poor sanitation

272 school days are lost each year due to water related diseases

80% of childhood disease is related in some way to unsafe drinking water, inadequate hygiene and poor sanitation


And according to UN.org, Every 20 seconds a child dies as a result of poor sanitation.


Uniteforsight.org discusses a case study of lack of sanitation in Cape Town settlements 



In the last three decades (since 1990), 29 percent of the global population gained access to sanitation. But, in 2015, 2.39 billion still lack access to basic sanitation


From OurWorldInData.org (which has great charts and data on access to sanitation and open defecation + water access):

The total number of people without access to improved sanitation has remained almost constant from 1990 to 2015: in 1990 this figure was 2.49 billion, and in 2015 it reduced to 2.39 billion.

Total world population has of course grown in total though over this period

This means the % of the population without access has decreased (which is an improvement)

This population growth also means the total number with access has increased from 2.8 billion in 1990 to nearly 5 billion in 2015.

From 1990-2015, a share of 29 percent of the global population gained access to sanitation.

But, share of people gaining access to improved sanitation is growing at different rates in different countries and regions and better effort needs to be made that countries and areas lagging behind are helped out


In 2018, according to WHO.int:

In low- and middle-income countries, 19% do not have improved sanitation, and 35% lack water and soap for hand washing.


From Worldvision.com.au – 844 million people lack access to safe water, while 2.5 billion people live without improved sanitation.


WHO.int have a good fact sheet on access to sanitation and open defecation 


How To Address (A Lack Of) Access To Safely Managed & Basic Sanitation & Hygiene Services 

Potential ways to increase access to improved sanitation and decrease open defecation are:

– To develop, invest in and aid low income/low GDP countries economically so they can afford new water and sanitation facilities and infrastructure, and so they can maintain it.

This would involve improved sanitation services (including toilets and latrines for individual families, and eliminating shared toilets for families, feminine hygiene services, and the ability to wash and soap hands), as well as the ability to dispose of, treat, and manage human waste safely and effectively with sewage and waste services.

According to the United Nations World Health Organization (2014), every dollar invested in water and sanitation results in a $4.30 return in the form of reduced healthcare costs (Worldvision.com.au)

Place specific focus on rural areas who lag in both sanitation and open defecation rates


Worldbank.org says:

“Reaching the Sustainable Development Goal (SDG) of access to safely managed water and sanitation services by 2030 will require countries to spend $150 billion per year. A fourfold increase in water supply, sanitation, and hygiene (WASH) investments compared to what is spent today, this is out of reach for many countries, threatening progress on poverty eradication.”


An example of an organisation helping with the sanitation issue is UNICEF. UNICEF’s water, sanitation and hygiene (WASH) team works in over 100 countries worldwide to improve water and sanitation services, as well as basic hygiene practices.

In one year, UNICEF’s efforts provided nearly 14 million people with clean water and over 11 million with basic toilets.

– UNICEF.org 


An aim for areas with a lack of adequate sanitation and hygiene services is to provide improved sanitation.

An improved sanitation facility is defined as a facility that:

“… hygienically separates human excreta from human contact. They include flush/pour flush (to piped sewer system, septic tank, pit latrine), ventilated improved pit (VIP) latrine, pit latrine with slab, and composting toilet.”

Improved sanitation facilities range from simple but protected pit latrines to flush toilets with a sewage connection. To be effective, facilities must be correctly constructed and properly maintained.

– WorldBank & WHO/UNICEF, via OurWorldInData.org


The word ‘sanitation’ also refers to the maintenance of hygienic conditions, through services such as garbage collection and wastewater disposal. 

– Wikiprogress.org


Explaining The Open Defecation Issue

The Problem

Defecating in the open – in places such as fields, forests, beaches, open bodies of water, and so on. 


Where It Happens Most

According to UN.org, in 2011, 1.04 billion people still practiced open defecation. 


From OurWorldInData.org:

In 2015, 15 percent of the world’s population were still practicing open defecation, presenting a reduction of approximately half since 1990

Prevalence was highest in South Asia where the average share is 36 percent. India in particular still has high rates, with nearly 45 percent still using open defecation.

In Sub-Saharan Africa, this rate was 23 percent. However, some countries in particular — such as Niger, Chad, South Sudan and Eritrea — still have a prevalence between 60-80 percent.

[Open defecation is mainly a rural issues] … Open defecation in urban areas is typically below 20 percent of the population. For rural populations, however, the share of the population practicing open defecation can range from less than 20 percent to almost 90 percent. 


The Causes

Lack of access to basic waste disposal facilities and systems like toilets.


The Effects

In particular with open defecation, this can increase the rate of pathogens, toxins, nitrates and phosphates in the environment and harm the natural environment and ecosystem



The number of people practicing open defecation fell from 20 percent in 2000 to 12 percent in 2015

– wikipedia.org


How To Address Open Defecation

The solution is the same as the other issues – there needs to be a provision of improved sanitation and hygiene services

Low income regions need external financing to do this in the short term, and in the long term, need assistance growing their economies and income to be able to manage services and infrastructure themselves




1. Hannah Ritchie and Max Roser (2018) – “Water Access, Resources & Sanitation”. Published online at OurWorldInData.org.Retrieved from: ‘https://ourworldindata.org/water-access-resources-sanitation’ [Online Resource]

2. http://www.who.int/en/news-room/fact-sheets/detail/drinking-water

3. https://water.org/our-impact/water-crisis/

4. http://www.who.int/news-room/detail/12-07-2017-2-1-billion-people-lack-safe-drinking-water-at-home-more-than-twice-as-many-lack-safe-sanitation

5. https://data.unicef.org/topic/water-and-sanitation/drinking-water/

6. https://www.theguardian.com/news/datablog/2009/mar/03/access-water

7. https://www.theguardian.com/global-development-professionals-network/2017/mar/17/access-to-drinking-water-world-six-infographics

8. https://thewaterproject.org/water-scarcity/water_stats

9. https://washdata.org/

10. https://washdata.org/sites/default/files/documents/reports/2018-01/JMP-2017-report-final.pdf

11. https://ourworldindata.org/sanitation

12. https://ourworldindata.org/water-access

13. https://www.worldvision.com.au/global-issues/work-we-do/water-sanitation

14. http://wikiprogress.org/articles/health/access-to-sanitation/

15. http://www.un.org/waterforlifedecade/sanitation.shtml

16. http://www.who.int/topics/sanitation/en/

17. https://www.worldbank.org/en/news/press-release/2017/08/28/millions-around-the-world-held-back-by-poor-sanitation-and-lack-of-access-to-clean-water

18. https://www.unicef.org/wash/

19. http://www.who.int/en/news-room/fact-sheets/detail/sanitation

20. http://www.uniteforsight.org/urban-health/module4#_ftn2

21. https://en.wikipedia.org/wiki/Open_defecation#Prevalence_and_trends

22. https://en.wikipedia.org/wiki/Water_issues_in_developing_countries

23. https://borgenproject.org/most-water-scarce-countries/

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