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J Water Health 02 (2004) 157-169

The prominence of health in donor policy for water supply and sanitation: a review

Rebecca Clark and Stephen W. Gundry

International Development Centre, University of Oxford, Queen Elizabeth House, 21 St Giles, Oxford OX1 3LA, UK Tel.: +44 (0)1865 273639 Fax: +44 (0)1865 273607 E-mail: rebecca.clark@qeh.ox.ac.uk

Water and Environmental Management Research Centre, University of Bristol, 83 Woodland Road, Bristol BS8 1US, UK Tel.: +44 (0)117 954 5294 Fax: +44 (0)117 954 5389 E-mail: stephen.gundry@bristol.ac.uk

Improved water supply, sanitation and hygiene used in combination are effective at achieving better health for poor people in developing countries. However, donor policy has been dominated by interventions in water supply, at the expense of achieving the potential health benefits of improved sanitation and hygiene. Commitments recently made by the international community require greater emphasis on improved sanitation and hygiene and their impacts on health. This review assesses whether such a shift in emphasis is apparent in donor policy. It examines the prominence given to achieving better health in water supply and sanitation policies of three donors: the World Bank, the European Union and the Department for International Development of the British Government. It finds that health benefits are explicit and integral in recently updated policy documentation concerning water supply and sanitation. This has taken place in an environment focused on poverty reduction and demand-led, financially sustainable interventions. Mechanisms that have enabled donors to prioritise the health impacts in this environment are discussed, including adoption of an asset-based conceptualisation of poverty and a cross-sectoral approach.

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