When I started writing about drinking water supply in low income countries (like India and Pakistan) I saw it primarily as an economic issue.  It was only when I read recent papers on stunting that I realized the catastrophic health and economic impacts of stunting caused by faecal contamination of drinking water supplies, now common in many parts of the world.

Stunting occurs when infants drink contaminated water causing repeated diarrhoea attacks which result in permanent damage to the intestines, restricting nutrient intake so affected children suffer from malnutrition even if they eat enough. Nearly half of all children in South Asia and other parts of the world are now affected.  So many piped water schemes provide contaminated water at the point of consumption.  The water pumped into the system may be safe to drink, but what goes into the mouth is not.

The only way to start fixing this problem is safe drinking water distribution. Obtaining and treating bulk supplies of safe drinking water is relatively inexpensive: even desalination costs only $0.50 per ton. While there are many water-scarce regions, in most there is still plenty to drink once treated.  The scarcity affects agriculture more than drinking.

Piped water supply utilities are failing in most low-income countries and few if any provide a 24/7 supply of safe water. For example, “good” utilities in South Asia provide intermittent water for 1-2 hours every 2^nd day: sewerage seeps in through leaks during the “off” time contaminating the network. Many leaks result from crude attempts by engineers to enforce revenue collection by temporarily disconnecting adjacent water and sewerage pipes to recalcitrant customers. Air trapped in pipes destroys meters. A downward spiral in service quality and revenue collection forces people to stand in line to bribe tanker drivers to refill contaminated domestic tanks. Water has to be filtered and sterilized to make it safe, or supplied in 20 liter bottles at $100-150/ton.

Low trust between consumers, utilities and government undermines attempts to improve service quality. Conventional water supply technologies require trust and collaboration between diverse social actors which is much more difficult than in high income countries so the problem persists.

And for the majority of people who have no piped water, the situation is even worse. When women carry and purify water their labour is unpaid but comes at a cost: more than $30/ton across South Asia using standard value of time models.

The consequences of drinking water safety failures affect everyone: the real cost of getting just enough can exceed 10% of family income. It helps to explain stubbornly persistent poverty, stunting and malnutrition from environmental enteropathy caused by fecal contamination. The economic and health catastrophe in low-income countries affects us all.

In the next post, I will describe why so many previous attempts to solve this problem have failed and how I came to see some elegant solutions.