Africans Deserve Access to Clean Water and Sanitation as a Public Health Priority

By: Moses Odey, B.A. Philosophy. Freelance Health Writer and Datelinehealth Africa (DLHA) Volunteer, with medical review and editorial support from the DLHA Team.

 

Access to clean water and sanitation is a public health priority in Africa

 

Highlights

• Millions of Africans do not have access to clean water and sanitation, causing disease, child deaths, poverty, and slowing development.

• In 2020, 42 countries still practiced open defecation, and only 7 are on track to end it by 2030.

• The gaps are wide between cities and villages, between regions, and between rich and poor. Cities have made some progress, but rural areas are still greatly lacking.

• Several factors ranging from poor infrastructure to environmental and political issues contribute to the persistent lack of clean water and sanitation across the continent. 

• Factors such as inadequate infrastructure, rapid urbanisation, and financial constraints serve as challenges in achieving access to clean water and sanitation in Africa. 

• Addressing the challenges of poor access to clean water and sanitation in Africa requires strong political will to improve infrastructure, strengthen governance, and raise public awareness for health behaviour change.

 

Introduction 

Access to clean water and adequate sanitation is not just a basic human need, it is a human right. Yet, millions of Africans continue to live without these essential services, facing daily challenges that compromise their health, dignity, and opportunities for development. 

The lack of clean water and sanitation contributes to the spread of diseases, limits educational and economic prospects, and reinforces cycles of poverty and inequality. 

Prioritizing access to clean water and sanitation across the continent is not only a moral and humanitarian imperative but also a crucial step toward sustainable development, public health, and social justice. Africans deserve access as a matter of dignity, equity, and the right to a healthy life.

This article explores the urgent need for access to clean water and sanitation across Africa, and discusses the key challenges contributing to water and sanitation inequities. It also offers strategic recommendations for ensuring sustainable and equitable access to clean water and sanitation for all Africans.

 

The State of Clean Water and Sanitation in Africa

Millions of Africans lack access to clean water and sanitation, a basic human right, leading to widespread disease, child mortality, and poverty, 

Despite global commitments to the United Nations Sustainable Development Goals (SDGs), to ensure availability and sustainable management of water and sanitation for all by 2030, progress has been slow. “Equitable access to drinking water, sanitation and hygiene is not only the foundation of health and development for children and communities. Water is life, water is development, water is peace,” said Marie-Pierre Poirier, UNICEF Regional Director for West and Central Africa. [1]

The 2022 WHO/UNICEF Joint Programme Monitoring (JPM) report on Water, Sanitation, and Hygiene, (WASH), in Africa asserts that between 2000 and 2020, 

• Africa’s population increased from 800 million to 1.3 billion people. 

• About 500 million (nearly 1 in 3) people gained access to basic drinking water.

• But 418 million people (1 in 3) still lack even a basic level of drinking water service

• 290 million (about 1 in 4) gained access to basic sanitation services.

• But 779 million (about 1 in 2) people still lack basic sanitation services (including 208 million who still practice open defecation) and 839 million still lack basic hygiene services. [1] 

• Among 42 countries with open defecation, in 2020, only 7 countries are currently on track to eliminate open defecation by 2030. [2] 

The Sustainable Development Goals of the United Nations General Assembly emphasize the need for global access to safe drinking and potable water. 

However, sub-Saharan Africa (SSA) bears significant risk, with a twofold rise in population and a limited availability of hygiene and sanitation facilities. [3]

In sub-Saharan Africa, merely 31% of the population had access to safe drinking water in 2022, compared to a global average of 73%. For safely managed sanitation services, the figure stands at 24% in the region, significantly lower than the global average of 57%. [4] 

In 2022, an estimated 2.2 billion people globally lacked potable water. Worsening indices are noted across African nations compared to other continents, with 24 African countries leading the first-twenty-five highest mortality rate attributed to exposure to unsafe WASH services. [3] 

Research has shown that achieving the Sustainable Development Goals (SDGs) success in Africa by 2030, would require:

• 12-fold increase in the current rate of progress on safely managed drinking water 

• 20-fold increase in current rate of progress on safely managed sanitation and 

• 42-fold increase in current rate of progress on basic hygiene services. [2] 

A 2024 survey indicates widespread dissatisfaction in governments’ efforts in providing water and sanitation services. 

About one in four citizens report that their household frequently went without enough clean water during the past year. Only minorities enjoy access to piped water and a sanitation system, with stark disadvantages among rural and poor populations. A growing majority give their government poor marks on their provision of water and sanitation services. [5]

Disparities in Regions 

Studies have shown that across 39 African countries, water supply is the fourth most important issue citizens want their governments to address, after unemployment, economic management, and health. 

It ranks as the top concern in Benin and Mozambique, second in Guinea, Niger, Congo-Brazzaville, Tanzania, Togo, Ethiopia, Namibia, and third in Côte d’Ivoire and Uganda. 

The issue is especially pressing for rural and poor populations, who face the greatest challenges in accessing clean water and sanitation. [5] 

The disparities are however stark between urban and rural areas, between sub-national regions and between the richest and the poorest. 

While urban centers have seen modest improvements, rural communities remain highly underserved. 

In urban areas, 2 out of 5 people lack safely managed drinking water, 2 out of 3 people lack safely managed sanitation, and half the population lacks basic hygiene services. 

In rural areas, 4 out of 5 people lack safely managed drinking water, 3 out of 4 people lack safely managed sanitation, and 7 out of 10 lack basic hygiene services. [1]  

Also, findings, based on 53,444 face-to-face interviews in 39 African countries, show that water supply and sanitation remain major challenges in most African countries, especially for rural populations and poor households. [6] 

African countries continue to lag behind, with millions lacking basic services. These disparities not only heighten health risks, including waterborne diseases, but also reinforce cycles of poverty, especially for women and children tasked with water collection. 

 

Causes of Poor Access 

1. Poor Infrastructure and Maintenance

There exist in most African countries, a lack of investment in water treatment plants, pipelines, and sewage systems which results in frequent breakdowns, water losses, and contamination. Giving rise to many rural communities relying on unsafe surface water sources.

2. Rapid Population Growth and Urbanisation

Africa is experiencing one of the fastest rates of population growth and urbanisation globally. Rapid urbanisation has led to the expansion of informal settlements that lack adequate water supply and sanitation facilities.

3. Political Instability and Poor Governance

• Political instability and poor governance which exists in some African countries hinder effective water and sanitation service provision.

• Weak institutional frameworks, lack of accountability, and mismanagement of resources contribute to failed projects and unsustainable systems.

4. Environmental and Climatic Factors

• Water scarcity is intensified by environmental degradation and climate change impacts. Many regions in Africa face increasing water stress due to variable rainfall patterns.

• Additionally, pollution of water bodies reduces the availability of clean water for domestic use. 

5. Economic Constraints

• Poverty remains a central barrier to improved water and sanitation infrastructure in many African countries. Inadequate investment from the private sector and international donors increase the funding gap. 

• The high cost of building and maintaining water infrastructure, especially in rural areas, prevents widespread service delivery.

6. Sociocultural Factors

• Cultural practices and social norms also influence access to water and sanitation. Water collection is traditionally the responsibility of women and children in some communities leading to gender disparities in access and decision-making. 

• Open defecation remains prevalent in some areas due to long-standing practices and a lack of awareness about the health risks associated with poor sanitation. 

 

Health Implications of Poor Access to Clean Water and Sanitation 

Poor access to clean water and sanitation in Africa leads to numerous health challenges which include:

Waterborne Diseases

• Poor sanitation is linked to transmission of diarrhoea diseases such as cholera and dysentery, as well as typhoid, intestinal worm infections and polio. It exacerbates stunting and contributes to the spread of antimicrobial resistance. [7]

• Cholera outbreaks are common in areas lacking adequate water treatment. 

• Protozoan infections like giardiasis, amoebiasis, and cryptosporidiosis also occur from consuming contaminated water. 

Parasitic Infections

• Schistosomiasis (bilharzia) is prevalent where people bathe or wash in infested freshwater.

• Although nearly eradicated, guinea worm disease historically affected communities dependent on unsafe drinking water sources.

Malnutrition and Stunted Growth

• Undernutrition is directly caused by inadequate food intake and disease, but is worsened by factors like food insecurity, poor child care, low maternal education, limited healthcare access, lack of clean water and sanitation, and poor hygiene. [8]

• Recurrent diarrhoea episodes impair nutrient absorption, contributing to malnutrition and stunted growth in children.

Health Risks to Women and Girls

Lack of clean, private toilets exposes women and girls to urinary tract infections, menstrual hygiene challenges, and increased risk of sexual violence when forced to use unsafe facilities. 

Increased Child and Maternal Mortality

• Poor sanitation in healthcare facilities increases the risk of infections during childbirth.

• Contaminated water consumption leads to high maternal and neonatal mortality rates.

Antimicrobial Resistance

Poor sanitation enables the spread of antibiotic-resistant bacteria in water supplies, posing broader public health risks.

 

What Challenges are there?

Africa faces major challenges in achieving safe water and sanitation. The following are some challenges involved in acquiring clean water and sanitation:

 1. Inadequate Infrastructure

• There exists in many African countries a considerable lack of physical infrastructure for water supply and sanitation. 

• Many countries lack sufficient pipelines, water treatment plants, boreholes, and sanitation facilities to serve their growing populations. 

• Where infrastructure exists, it is often poorly maintained, leading to leakages, contamination, and service breakdowns.

2. Rapid Urbanisation

• Africa is experiencing some of the fastest urbanisation rates globally.

• Many urban centers are expanding faster than the development of water and sanitation services can keep up.

• Informal settlements (slums) proliferate without access to piped water or sewage systems, leading to unsafe practices like open defecation and reliance on contaminated water sources.

• Urban water utilities are therefore overstretched, struggling to meet the demands of growing populations with limited resources.

3. Financial Constraints

• Many African countries face chronic underfunding of the water and sanitation sector.

• Investments required to build, operate, and maintain systems are substantial, yet public budgets are often insufficient, and private sector participation remains low due to perceived risks and low profitability.

• Water and sanitation projects are often underfunded, delayed, or abandoned, leaving communities without access to safe services.

4. Poor Governance

• Governance issues, including weak institutions, lack of accountability, and corruption, undermine water and sanitation projects. 

• Funds earmarked for development are sometimes mismanaged or diverted.

• Policy incoherence and frequent changes in leadership further destabilize long-term planning and project continuity.

• In some African countries, water utilities suffer from political interference, leading to inefficient operations and inequitable service provision.

5. Environmental and Climate Challenges

• Africa is highly vulnerable to climate variability and change, which directly impacts water availability and quality. 

• Droughts, desertification, floods, and changing rainfall patterns affect surface and groundwater sources. Some regions experience prolonged droughts, while others face flooding that contaminates water supplies.

• Water scarcity intensifies competition for limited resources, and sanitation facilities are damaged or rendered unusable by floods.

6. Limited Technical Capacity

• In Africa, there exists a shortage of skilled professionals such as engineers, hydrologists, sanitation experts, planners and this affects the design, implementation, and maintenance of water and sanitation projects.

• Training institutions may be under-resourced, and brain drain further depletes the workforce.

• Projects are poorly designed, implemented, or left unmaintained, leading to short lifespans and unreliable services.

7. Inadequate Data and Monitoring

Reliable data on water resources, consumption patterns, and sanitation coverage are often lacking or outdated in many African countries. This hinders evidence-based planning, monitoring, and accountability. 

 

The Way Forward 

To achieve adequate access to clean water and sanitation in Africa, certain measures must be taken into consideration. They are:

 Increased Investment in Infrastructure

• Governments and development partners need to prioritize funding for building and maintaining water supply systems, sewage treatment plants, and rural boreholes.

• Public-private partnerships can help mobilize resources for large-scale projects. 

Decentralized and Community-Based Solutions

• Small-scale, local water systems (like wells, rainwater harvesting, and water kiosks) should be promoted in remote areas where centralized systems are impractical.

• Also empowering communities to manage their water resources fosters sustainability.

Use of Technology and Innovation

• Innovations like solar-powered water pumps, low-cost filtration systems, and smart water monitoring can expand access in low-income areas.

• Mobile technology can be used for reporting broken infrastructure or paying for water services.

Policy and Governance Reforms

• Transparent and accountable governance is critical to ensure funds are used effectively.

• Enforcing water and sanitation standards, and integrating water management in broader development policies, can strengthen impact.

Regional Cooperation and Knowledge Sharing

• Cross-border collaboration on water resources (like river basins) can prevent conflict and improve efficiency.

• Sharing best practices among African countries accelerates progress.

 

Conclusion 

Access to clean water and sanitation is not just a basic human need, it is a right that underpins health, dignity, and sustainable development in Africa. Prioritizing clean water and sanitation empowers communities, reduces preventable diseases, promotes economic productivity, and fosters social equity. For Africa to achieve its development goals and ensure the well-being of its people, urgent investments and policy commitments toward universal access must be made. It is not a privilege, but a necessity that every African deserves. 

 

References: 

1. UNICEF. Africa to drastically accelerate progress on water, sanitation and hygiene – report [Internet]. New York: United Nations Children’s Fund; 2022 March 20. [Accessed 2 May 2025]. Available from here. 

2. UNICEF. WHO/UNICEF JMP snapshot of progress on drinking water, sanitation and hygiene in Africa 2015-2020: Five years into the SDGs [Internet]. 2022 March 22. [Accessed 2 May 2025]. Available from here.

3. Okesanya OJ, Eshun G, Ukoaka BM, et al. Water, sanitation, and hygiene (WASH) practices in Africa: exploring the effects on public health and sustainable development plans. Trop Med Health. 2024;52(68). doi:10.1186/s41182-024-00614-3. Available from here.

4. Pandey K. Road to 2030: World, especially Africa, won’t achieve access to clean water, sanitation goal, says UN [Internet]. Down-To-Earth. 2023 July 7. [Accessed 2 May 2025]  Available from here.

5. Ben Saad MN, Ayana GW, Ssevume SM. Water and sanitation still major challenges in Africa, especially for rural and poor citizens. Afrobarometer Dispatch No. 784. 2024 Mar 22. [Acessed 3 May 2025]. Available from here.

6. World Water Day: Africans demand action from government as challenges with water supply and sanitation persist [Internet]. Afrobarometer 2024 Mar 19 [Accessed 3 May 2025]. Available from here.

7. World Health Organisation. Sanitation. [Internet]. Geneva: 2024 March 22. [Accessed 5 May 2025]. Available from here. 

8. Hutton G, and Chase C. Water Supply, Sanitation, and Hygiene. In: Mock CN, Nugent R, Kobusingye O, et al., editors. Injury Prevention and Environmental Health. 3^rd ed. Washington (DC): The International Bank for Reconstruction and Development/The World Bank; 2017 Oct 27. Chapter 9. doi: 10.1596/978-1-4648-0522-6_ch9. Available from here. 

 

Related: Seven Common Communicable Diseases in Africa: Causes and Control

 

 

Published: May 24, 2025

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