19.11.2003 www.idrc.ca
ORGANIZACION DE ESTADOS AMERICANOSTaller Preparatorio No 3
“GESTIÓN INTEGRADA DE RECURSOS HIDRÍCOS”
Dra Sofialeticia Morales
Senior Advisor Millennium Development Goals and Health TargetPan American Health Organization
June 19-21
www.idrc.ca
PAHO organized the First Meeting of Ministers of Health and Environment in Washington, D.C. and the ministers signed the the Pan American Charter in Health and Human Sustainable Development in 1995
In 2002 under the umbrella of the III Summit of the Americas the Second Meeting of Ministers of Health and Environment took place in Canada
In 2005, under the umbrella of the IV Summit of the Americas the Third Meeting of Ministers of Health and Environment took place in in Mar del Plata, Argentina, with a clear commitment to the MDGs
The Summit of the AmericasThe Summit of the Americas
PAHO 2006
www.idrc.ca
Why are the MDGsimportant?
Commitment to Action
HEALTH’S IMPORTANCE GIVES IT A KEY ROLE IN DEVELOPMENT
QUATIFIABLE AND AMBITIOUSGOALS AND INDICATORS TO MEASURE ADVANCMENT AND DEMAND PROGRESS
BY DIFFERENTIATING BETWEEN THE AVAILABLE AND THE NECESSARY IT IS POSSIBLE TO CALCULATE ACHIEVEMENT COSTS A GLOBAL PARTNERSHIP FOR DEVELOPMENT THAT EMPHASIZES THAT GLOBAL SECURITY AND PROSPERITY ARE RELIANT ON A MORE EQUITABLE WORLD.
THE HIGHEST LEVEL OF POLITICAL CONSENSUS ON THE MEASURES TO COMBAT POVERTY
MILLENNIUN DEVELOPMENT GOALS
www.idrc.ca
The region is on track to meet the targets for:Reducing hungerReducing undernutrition among childrenReducing infant mortalityAccess to drinking waterGender equity in education
The region has not made enough progress towards the targets concerning:
Extreme poverty (adverse pattern: countries with higher poverty rates have advanced less)Maternal mortalityUniversal primary educationAccess to sanitationEnvironmental sustainability
OVERVIEW OF PROGRESS TOWARDS THE GOAL
The Millennium Development Goals A Latin American and Caribbean PerspectiveUnited Nations/ECLAC
www.idrc.ca
HIV/AIDSODM 6
HIV/AIDSODM 6
MDGs Synergy
Indivisible package
Nutrition
ODM 1
Nutrition
ODM 1
Water and SanitationODM 7
Water and SanitationODM 7
GenderODM 3
Child and maternal mortality ODM 4 and 5
EducationODM 2
EducationODM 2
Water and Sanitation
www.idrc.ca
MDGs Synergy for Health TargetsMDGs Synergy for Health Targets
The Social and Economic Determinants of Health
The Environmental Determinants of Health
The New Global Determinants
The Human Right Perspective of Health
The Social Cohesion
The Health targets as a powerful poverty reduction strategyThe need to work with all with an inter-sectorialapproach
PAHO 2006
www.idrc.ca
HPR
PH
PHCSOC PRO
INTSEC
COMPART
ODM
Potable Water
Sanitation
Disposal of Excretes
Environment
Community Participation
Housing
The Millennium Development Goals and the integrated approach for Health and Environment
The Millennium Development Goals and the integrated approach for Health and Environment
PAHO 2006
www.idrc.ca
STAGESSTAGESInequality: A Cornerstone of the MDG
16.922.7
25.233.3
37.053.8
21.722.9
42.432.3
7.516.0
17.912.3
14.21.9
4.3
18.6
100.0 80.0 60.0 40.0 20.0 0.0
-212-111
34
0 10 20 30 40 50 60 70 80 90 100
ARG
VEN
COL
PRY
BOL
HND
PER
SLV
NIC
GTM
CRI
PAN
ECU
MEX
BRA
URY
CHL
LAC
Progreso desde 1990Pobreza extrema en 2004
Water Poverty and malnutritionGoal 1: Reduce PovertyGoal 1: Reduce Poverty
www.idrc.ca
WORLD REGIONS: GINI COEFFICIENT, 1997-2002(Concentration of per capita income, by deciles)
Source: World Bank, World Development Indicators [on line] (http://www.worldbank.org/data/).
Gini coefficient (1997-2002)
(HIPC)(HIPC)
Median
Minimum
Maximum
75th percentile
25th percentile
Gin
i coe
ffici
ent,
1997
-200
2
OECD Eastern Europe and Central Asia
Latin America and the
Caribbean
Middle East and North
Africa
East Asia and the Pacific
South Asia
Sub-Saharan Africa
60
55
50
45
40
35
30
25
20
The Millennium Development Goals United Nations/ECLAC
www.idrc.ca
LATIN AMERICA: HOUSEHOLD SHARES OF TOTAL INCOME, BY INCOME QUINTILE, CIRCA 2002
ource: Economic Commission for Latin America and the Caribbean (ECLAC), on the basis of projections derived from household surveys in the relevant countries(urban areas).
0
10
20
30
40
50
60
70
Uru
guay
a/
Mex
ico
Ecua
dor a
/
Arge
ntin
a a/
Gua
tem
ala
Chi
le
Vene
zuel
a (B
oliv
aria
n R
epub
lic o
f)
Cos
ta R
ica
Per
u
El S
alva
dor
Para
guay
Hon
dura
s
Nic
arag
ua
Col
ombi
a a/
Pana
ma
Dom
inic
an R
ep.
Bra
zil
Bol
ivia
0
5
10
15
20
25
30
35
Poorest quintile Richest quintile Richest quintile/Poorest quintile
UNEQUAL INCOME DISTRIBUTION
The Millennium Development Goals United Nations/ECLAC
www.idrc.ca
Water and malnutrition
STAGESSTAGES
Water-sanitation and Well-Being: A Cornerstone of the MDG
Illnesses caused by unsafe drinkingIllnesses caused by unsafe drinking--water water and inadequate sanitation generate high and inadequate sanitation generate high health costs relative to income for the health costs relative to income for the poor. poor.
Healthy people are better able to absorb Healthy people are better able to absorb nutrients in food than those suffering from nutrients in food than those suffering from waterwater--related diseases, particularly related diseases, particularly helminthes infections, which rob their helminthes infections, which rob their hosts of calories. hosts of calories.
The time lost because of longThe time lost because of long--distance distance water collection and poor health water collection and poor health contributes to poverty and reduced food contributes to poverty and reduced food security.security.
www.idrc.ca
Malaria5%
MALNUTRICION AS A BASIC CAUSE OF DEATH
Malnutrition is a common cause of morbidity that is associated with higher rate of infection and sickness and increase death
Ballagio Child Survival Study Group. The Lancet, V. 361, June 28,2003, p.5
Malaria 5%Sarampión
7%
Diarrea19%
Infecciones respiratoriasagudas 19%
Perinatal18%
Otros32%
Mala nutrición53%
MALNUTRITON CONTRIBUTION TO THE MORTALITY RATE BY CAUSE OF DEATH IN
CHILDREN UNDER 5
0%
20%
40%
60%
80%
100%
Diarrea Malaria Neumonía Sarampión Todas lascausas
Proporción de muertes asociadas con desnutrición Todas las muertes
Caulfield y col. Am J Clin Nutr 2004; 80:193-8
www.idrc.ca
Water - Sanitation and malnutrition
STAGESSTAGES
Water- sanitation and Well-Being: A Cornerstone of the MDG
Water - Sanitation and Education
Goal 2: Universal Primary Education Goal 2: Universal Primary Education
www.idrc.ca
THE LINKAGES OF INEQUITYEducationLATIN AMERICA: PERSONS BETWEEN THE AGES OF 15 AND 19 WHO HAVE NOT COMPLETED THEIR PRIMARY EDUCATION (Circa 2002)
0.0
27.0
5.4
5.5
6.5
14.4
15.3
16.1
16.4
18.5
20.6
21.0
21.7
26.0
35.5
38.9
46.9
54.1
59.9
63.7
3.7
1.0
0.7
2.1
2.7
0.7
3.0
1.3
6.0
4.3
2.5
1.5
2.3
5.0
3.3
6.9
12.6
10.7
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0
Latin America b/
Argentina a/
Chile
Uruguay a/
Colombia
Ecuador
Mexico
Venezuela (Bolivarian Republic of)
Panama
Dominican Republic
Costa Rica
Peru
Brazil
Paraguay
Bolivia
El Salvador
Honduras
Nicaragua
Guatemala
Percentages
Quintile V (highest) Quintile I (lowest)
Boliv
ia
Bra
sil
Chi
le
Ecu
ador
Gua
tem
ala
Nic
arag
ua
Pan
amá
Par
agua
y
Per
ú
No originaria
Total
Originaria
0
10
20
30
40
50
60
Latin America, percentage of people from 15 to 19 years that have not managed to culminate the primary education according to ethnic or racial group. Year 2002
www.idrc.ca
Water and School Attendance
PAHO 2006
Improved health and reduced water carrying burdens improves school attendance as well as separate sanitation facilities for girls in schools.
School children are especially prone to worm infections; improving sanitation and hygiene can prevent these infections.
The lack of appropriate facilities may discourage children from attendance.
When a school lacks access to basic sanitation facilities the students have poor hygiene habits.
www.idrc.ca
Water and Sanitation and malnutrition
Water and Sanitation and Education
Water and Sanitation and Equity
STAGESSTAGES
Water and Well-Being: A Cornerstone of the MDG
Goal 5: Promote gender equality Goal 5: Promote gender equality and empower womenand empower women
www.idrc.ca
Reduced time, health and careReduced time, health and care--giving giving burdens from improved water services burdens from improved water services give women more time for productive give women more time for productive endeavors, adult education and leisureendeavors, adult education and leisure
Increasing women’s roles in decision-making to match their responsibilities, and bringing about a more equitable division of labor help improve water supply, sanitation and hygiene.
Two thirds of the world's illiterate are female, and the rate of employment of women is only two thirds that of men.
water-related enterprises, such as agricultural development projects, have a far greater success rate when women are involved than when they are excluded.
PAHO 2006
Water and Gender Equity
www.idrc.ca
Water and malnutrition
Water and Education
Waterand Equity
Water and Infant and maternal mortality
STAGESSTAGES
Water and Well-Being: A Cornerstone of the MDG
Goal 4: Reduce child mortalityGoal 4: Reduce child mortality
www.idrc.ca
Water and Infant Mortality
:
➟
Improved sanitation and drinkingImproved sanitation and drinking--water water sources reduces infant and child sources reduces infant and child morbidity and mortality.morbidity and mortality.
Improved water and sanitation directly reduce the risks of illness and death for children. They also mean improved nutrition and food security, which reduce susceptibility to disease.
Economic growth is higher in countries with lower initial infant mortality rates.Four times more children die from diarrheal diseases as from HIV/AIDS.
PAHO 2006
www.idrc.ca
Infant Mortality (per 1,000 born alive) and Access to Sanitation and Water Supply (% of population)
0
20
40
60
80
100
120
Infant Mortality 7 8 10 14 14 20 23 24 25 28 34 42 43 44 44 47 48 52 55 86
Access to water 100 100 91 91 100 89 79 65 84 75 83 73 77 55 53 69 67 62 66 39
Access to sanitation 100 100 94 93 94 94 69 84 93 83 72 90 70 58 68 85 79 76 74 26
CAN EUA CUB CHI COR URU VEN ARG PAN COL MEX DOR HON ECU ELS BRA GUT NIC PER HAI
Source: Regional Report on Assessment of Drinking Water and Sanitation 2000 in the Americasl PAHO 2006
www.idrc.ca
Life expectancy at birth Vs Potable Water
PAHO 2006
y = 0.1977x + 56.806R2 = 0.476
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
0 10 20 30 40 50 60 70 80 90 100
Cobertura de agua
Espe
ranz
a de
Vid
a (y
rs)
Source: Health Indicators from Peru, 2001, Ministry of Health and PAHO
www.idrc.ca
0
10
20
30
40
50
60
70
80
90
100
BOL GUA ECU HON PER VEN MEX
NacionalPoblación indígena
MortalidadMortalidad infantilinfantil a a nivelnivel nacionalnacional y en y en poblacionespoblacionesindindíígenasgenas de de papaíísesses seleccionadosseleccionados de de laslas AmAmééricasricas
MortalidadMortalidad InfantilInfantil porpor 1,000 1,000 nacidosnacidos vivosvivos
Fuente: OPS/OMS 2000
www.idrc.ca
Water and malnutrition
Water and Education
Water and Gender Equity
Water and Infant mortality
STAGESSTAGES
Water and Well-Being: A Cornerstone of the MDG
Goal 5: MaternalGoal 5: MaternalHealthHealth
0
10
20
30
40
50
60
AP IP 1W 2 4 W 1 11M
DevelopedDeveloping
Water and Maternal Health
Goal 5: MaternalGoal 5: MaternalHealthHealth
70% of maternal deaths
www.idrc.caPAHO 2006
Accessible sources of water reduce Accessible sources of water reduce labor burdens and health problems labor burdens and health problems resulting from water portage, reducing resulting from water portage, reducing maternal mortality risks.maternal mortality risks.
Safe drinkingSafe drinking--water and basic sanitation water and basic sanitation are needed in health care facilities to are needed in health care facilities to ensure basic hygiene practices ensure basic hygiene practices following delivery. following delivery.
The increased child survival rates will start a trend towards lower fertility rates. Few pregnancies per woman reduce maternal mortality risks.
Close by water and sanitation facilities also reduce the risk of sexual harassment, for women and girls in particular, when gathering water
Water and Maternal Health
www.idrc.ca
Mortalidad Materna x 100.000 NV y Parto Institucional, según Departamentos bajo
línea de Pobreza, Colombia
Chocó Cauca Nariño Valle delCauca
Bogotá, D.C.
NacionalPoblación bajo Línea de Pobreza %
Parto Institucional
Mortalidad Materna0
50
100
150
200
250
300
Población bajo Línea de Pobreza % Parto Institucional Mortalidad Materna
0
50
100
150
200
250
Bs AiresArgentina
San JuanFormosa
ChacoJujuy
Mortalidad materna en Argentina para provincias
seleccionadas
www.idrc.ca
Water and malnutrition
Water and Education
Water and Gender Equity
Water and Infant and Maternal Mortality
Water and HIV and Malaria
STAGESSTAGES
Water and sanitation: A Cornerstone of the MDG
Goal 6: Combat HIV/AIDS and other diseasesGoal 6: Combat HIV/AIDS and other diseases
www.idrc.ca
Water related disease
Safe drinkingSafe drinking--water and basic water and basic sanitation help prevent watersanitation help prevent water--related disease, including related disease, including diarrheas diseases, diarrheas diseases, schistosomiasisschistosomiasis, , filariasisfilariasis, , trachoma and helminthes. trachoma and helminthes.
The reliability of drinkingThe reliability of drinking--water water supplies and improved water supplies and improved water management in human management in human settlement areas reduce settlement areas reduce transmission risks of malaria transmission risks of malaria and dengue fever. and dengue fever.
Diarrhea kills more people worldwide even than HIV/AIDS, tuberculosis or malaria..
www.idrc.ca
Outbreak January 1991August 1991February 1992
March 1993
Cholera epidemic in the Americas
PAHO 2006
www.idrc.ca
Water disinfection in Latin America and the Caribbean: urban areas
100 % Disinfection
80-99 % Disinfection
50-79 % Disinfection
1-49 % Disinfection
0 % Disinfection
Without data
PAHO 2006
www.idrc.ca
Pacific
Ocean
Atlantic
OceanMexico
El Salvador
Peru
Chile
Brasil
Bolivia
Argentina2’000,000
?
20,000500,000
250,000
250,000
?Nicaragua?
Population exposure to environmental arsenic
in Latin America
PAHO 2006
www.idrc.ca
Water and malnutrition
Water and Education
Water and Equity
Water and Maternal Mortality
Water and Malaria, VIH
STAGESSTAGES
Water and sanitation: A Cornerstone of the MDG
Access and Quality of Water
Goal 7: Ensure environmental sustainabilityGoal 7: Ensure environmental sustainability
www.idrc.ca
120 million people without
120 million people without
access to health services due
access to health services due
to economic reasons
to economic reasons
Social exclusion in health and environment in the Latin America and the Caribbean
Social exclusion in health and environment in the Latin America and the Caribbean
76.5 million people without access
to safe drinking water and basic
sanitation
PAHO 2006
103.5 million people without
access to basic sanitation107 million people without
access to health services due to
geographic reasons
www.idrc.ca
Water and Environmental sustainabilityWater and Environmental sustainabilityAdequate treatment and disposal of Adequate treatment and disposal of wastewater contributes to better wastewater contributes to better ecosystem conservation and less ecosystem conservation and less pressure on scarce freshwater pressure on scarce freshwater resources. Careful use of water resources. Careful use of water resources prevents contamination of resources prevents contamination of groundwater and helps minimize the cost groundwater and helps minimize the cost of water treatment. of water treatment.
Improved water management, including pollution control and water conservation, is key to environmental sustainability and ecosystem integrity.
Well-managed ecosystems more than pay for themselves, providing goods like fish and crops, and services like flood control and water purification. Yet
Developing countries are losing 4–8% of their GDP through environmental degradation
www.idrc.caSource: The Millennium Development Goals, a Latin America and Caribbean Perspective
Access to Urban Population
Access to rural population
www.idrc.ca
Water and sanitation observed and projected
PAHO 2006
www.idrc.ca
A vicious circle that we need to changeA vicious circle that we need to change
1817
16
15
14
13
1211 10 9
8
7
6
5
4
321
povertypoverty
SINERGY
Sanitation related sicknesses, affect development and
increase the need to medical expenditures
Lack of clean water and sanitation affect everyone’s health
Continued exposure to solid waste and
wastewater leads to chronic illnesses and
premature deaths
Effect on child development have an negative impact on
education, diminish the potential for a productive
life and national development.
Reduced productivity potential holds back
development and holds another generation in poverty
Poor people live shorter unhealthier lives
Sicker, less educated, poorer and hopeless citizens, living in an increasingly polluted
environment, are more likely to accelerate
environmental degradation
More poverty leads to more pollution
www.idrc.ca
Sustainable Development
The principles of sustainable development have
human health at their core. Improved health from
better quality water, access to sanitation and
improved hygiene will lead to reduction of human
suffering, increased productive capacities, a
better quality of life and life expectancy, and will
also reduce health care costs.
PAHO 2006
www.idrc.ca
If no action is taken to improve access to drinking water and sanitation…
Source: MDGs for Water <http://www.pacinst.org/press_center/the_worlds_water_2004-2005/Gleick-CHAPTER01.pdf >
PAHO 2006
www.idrc.ca
If Access to Water and Sanitation Improve…
Source: MDGs for Water <http://www.pacinst.org/press_center/the_worlds_water_2004-2005/Gleick-CHAPTER01.pdf >
PAHO 2006
www.idrc.ca
Water and malnutrition
Water and Education
Water and Equity
Water and Infant and Maternal Mortality
Water and Malaria, VIH
STAGESSTAGES
Water and sanitation: A Cornerstone of the MDG
Access and Quality of Water
Goal 8: Partnership for DevelopmentGoal 8: Partnership for Development
Partnernship for Development
www.idrc.ca
GoalGoal 8: 8: DevelopDevelop partnershippartnership forfor developmentdevelopment
THE CONTRIBUTION OF WATER AND SANITATIONTHE CONTRIBUTION OF WATER AND SANITATION
Achieving the MDG on drinking water supply coverage will represent a major expenditure in all countries, requiring between US$10 billion and US$30 billion a year on top of the amount already being spent. Many developing countries now spend more on debt service than on social services,
PAHO 2006
www.idrc.ca
A Formidable Task
The investment that will be needed in the water sector to meet the internationally agreed targets for poverty reduction is massive.
Development assistance has a substantial role to play by helping to build the capacity of national institutions, and, in poorer countries, providing leverage for other forms of finance and bridging the funding gap.
PAHO 2006
www.idrc.ca
World Health Organization Involvement
The WHO's strategic focus contributing to the world efforts towards the achievement of the water and sanitation target deals with a range of interventions from promotion and advocacy at all levels to country operations targeting the poor and underserved based on a strong and authoritative set of norms and best-practice tools. WHO's programmatic areas of emphasis works with partners and include:
Global monitoring of the water supply and sanitation sector through the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), which is the United Nations System instrument used to measure progress at country, regional and global levels in achieving the MDG water and sanitation target;
PAHO 2006
www.idrc.ca
Action Plans for PAHO and the Inter-American Association of Sanitary Engineering
and Environmental Sciences
Encourage the exchange of appropriate technologies and practices leading to collaborations Synergy
Work on the new “Water for the Poor Act” Platform
Improve the quality of life in the Americas through programs and services that promote:
sound environmental practicespoliciesmanagementeducation
sound environmental practicespoliciesmanagementeducation
PAHO 2006
www.idrc.ca
The safe water and wastewater inequity situation in the Region requires priority attention.The principal challenge is to establish alliances that will sum technical and financial resources. Improving access to safe water and sanitation in rural and poor urban areas will contribute to environmental sustainability and ecological balance.WHO & PAHO are committed to support the enhancement of Environmental Public Health in developing countries by forming alliances with OAS, the PNUMA, WB, IDB and other international organization
The safe water and wastewater inequity situation in the Region requires priority attention.The principal challenge is to establish alliances that will sum technical and financial resources. Improving access to safe water and sanitation in rural and poor urban areas will contribute to environmental sustainability and ecological balance.WHO & PAHO are committed to support the enhancement of Environmental Public Health in developing countries by forming alliances with OAS, the PNUMA, WB, IDB and other international organization
Framework for PartnershipsFramework for Partnerships
PAHO 2006
www.idrc.ca
Work with the more vulnerable communities
Empower communities
Inter-agency cooperation OAS-PAHO -WB
5. Learned lessons, follow-up and pilot project
A PROPOSAL FOR ACTIONA PROPOSAL FOR ACTION
A Cornerstone of the MDG1
Pov
erty
&
Hun
ger
2 U
nive
rsal
E
duca
tion
MILLENNIUM DEVELOPMENT GOALS
Faces & Places: Empowering Vulnerable Municipalities
1 Poverty & H
unger
1 P
over
ty &
H
unge
r
2 U
nive
rsal
E
duca
tion
3 G
ende
r E
qual
ity
4 C
hild
M
orta
lity
6 C
omba
t H
IV/A
IDS
, M
alar
ia &
oth
er
dise
ases
7 E
nsur
e E
nvir
onm
enta
l S
usta
inab
ility
8 G
loba
l P
artn
ersh
ip f
or
Dev
elop
men
t
5 M
ater
nal
Hea
lth
Commit Ministers of Health and Environment with the water
commisions
www.idrc.ca
EMPOWERING VULNERABLE COMMUNITIES: AS AN EXAMPLE Cotacachi In Ecuador
Con el compromiso y la participación comunitaria
Desde la cosmovisión indígena
Trabajando sobre los determinantes
Con una visión interdisciplinaria más alláde los compartimentos estancos de los sectores centrado en reducir la pobreza y mejorar las condiciones de vida.
Con un Plan de Acción que surgió de la misma comunidad
Llevado a cabo por los mismos actores ( la comunidad ) que se comprometieron al cambio.
Centrados en los Objetivos de Desarrollo del Milenio (objetivos, metas e indicadores claros en un tiempo preciso)
Criterios de gestión
www.idrc.ca
PAHO in the 21st Century
PAHO in the 21st Century
...improving health in the [email protected]
one team, one goalone team, one goal
PAHO 2006
