"Despite an increase in coverage, the number of people that require access to sanitation and hygiene, for instance, are still the highest in Africa, if not the world," said Kebede Faris, water and sanitation expert for the World Bank's Ethiopia office. "As a result, a significant number of Ethiopians are still facing WASH [water, sanitation and hygiene]-related health problems and also losing their lives."
A recently released study by the UN Children's Fund (UNICEF) shows that some 271,000 Ethiopian children under the age of five died in 2010 alone, with pneumonia and diarrhoea causing more than one-third of those deaths.
The authors said "basic steps" such as hand-washing with soap, expanding access to safe drinking water and sanitation, along with providing other medical services, could have saved their lives. The problem remains: "An overwhelming majority, nine households in every 10, does not treat their drinking water," leaving them susceptible to various health problems.
Ethiopia is seeking to meet the UN Millennium Development Goals' targets on water, sanitation and hygiene through itsUniversal Access Plan II, which seeks to provide 98.5 percent of the population with access to safe water along with 100 percent access to sanitation by 2015.
Nationally, the proportion of Ethiopian households with access to an improved source of drinking water - categorized as a public tap or stand pipe, borehole, a protected well, spring water and rainwater - has reached 54 percent, according to theDemographic Health Survey 2011. However, there are significant disparities between urban households, where 95 percent of people have access to an improved source of drinking water, and rural areas where just 42 percent access safe drinking water.
Like access to water services, government data shows a wide gap in access to sanitation between urban and rural households. According to the country's Growth and Transformation Plan 2010, the national coverage of sanitation stands at 60 percent, with rural coverage at 56 percent, compared to 88 percent for urban households.
"Building latrines is not enough. A systematic approach that focuses on quality or building to minimum standards, maintenance and use are equally important," said the World Bank’s Kebede, adding that there was a need "to invest now to save more future lives and impairments of many kinds".
Other water-borne diseases are also common as a result of poor water and sanitation. "With more than 65 million people living in the trachoma endemic parts of rural Ethiopia, we need to reach out to more people and fast, with proper sanitation and hygiene practices, as most of the cases are happening in areas where water supply and sanitary conditions are poor," said Menebere Alemeu, country representative for NGO International Trachoma Initiative.
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The government has expressed its ambition to achieve the set targets. "Our eyes are on our own Growth and Transformation Plan targets, but globally we are also committed to achieving the MDGs [UN Millennium Development Goals]," said Minister of Health Tedros Adhanom.
Finding the money
However, the government's budgetary allocation to the water sector has been decreasing over the years, "declining almost by half - from 4 percent in 2006 to 2.5 percent in 2010", according to international NGO WaterAid. The inadequate budget for the water sector and the growing cost of establishing water and sanitation services could also see the country pay more for services, according to another recent study by the Ministry of Finance and the UN.
"The budget is calculated based on the current and future cost investment this sector requires and we are on [the] right track of securing the financing," said Yohannes Gebremedhin an official with the Ministry of Water and Energy. “We are now working on issues related to sustainability of the systems we set up with communities," he said, adding that this would cut down on the costs of repairing systems.
Recent updates to Ethiopia's universal water access plan and a new hygiene and sanitation Strategic Action Plan suggest that the cost of meeting the national WASH targets is now closer to US$2.4 billion, with $1.75 billion dedicated solely to the rural water supply.
"With this plan…we need to work on innovative, cost-effective sector-wide approaches along with securing the necessary budget on time so as to meet the target set," said Daniel Gelan, UNICEF's WASH expert. "We, along with the government, are working strongly to find the budget sources and are doing well so far."