Regionally, there are large variations in progress towards this MDG. For sanitation, the regions of Africa south of the Sahara and southern Asia show the greatest disparity, with 330 mil- lion and 221 million people without access to basic sanitation, respectively. Not surprisingly, the regional variations in lack of access are proportionally mirrored in the diarrhoeal dis- ease data. Figure 16 presents the regional child mortality rates from diarrhoea for which lack of access to sanitation is the root-cause, modulated by regional differences in the capacity of health services.

THE SANITATION LADDER

In their efforts to monitor progress in achieving the MDG wa- ter and sanitation target, WHO and UNICEF designed the sani- tation ladder. The sanitation ladder reflects incremental prog- ress even in situations where it is not possible to achieve the full MDG target. Poverty is the overarching determinant, and the position of a community on the sanitation ladder therefore relates to that community’s capacity to deal with wastewater management as well. Not only do higher rungs on the ladder reflect a better sanitation starting point for effective wastewater management, but the corresponding improved socio-economic status will also permit a greater capacity to manage wastewater and invest in the necessary infrastructure.

42

Child mortality rates Percentage

10 15 20 25 30 35 40

0 5

Perinatal conditions Diarrhoeal diseases Respiratory diseases

Malaria diseases Other causes

Africa

Mediterranean

South East Asia

Europe

Western Pacific

Americas

income countries

Source: WHO, 2008.

Figure 16: Child mortality rates by cause and region, 2004. Source: WHO, 2008.

High

Eastern