The impact of inadequate water and sanitation services falls primarily on the poor. Badly served by the formal sector, the poor make their own, often inadequate, arrangements to meet basic survival needs. Many fetch water from long distances or end up paying high prices to water vendors for very small quantities of water. The clear need for basic water and sanitation services for the poor assumes even greater significance when the linkages with other dimensions of poverty are considered. Water and sanitation related sicknesses put severe burdens on health services and keep children out of school.
Human waste poses a tremendous social cost through pollution of rivers and groundwater.
Despite significant investments made in the sector during recent decades by governments, non-governmental organizations, bilateral and multilateral agencies and the private sector, the outlook on access to safe and adequate supplies of water and environmentally sustainable sanitation remains grim. Coverage varies substantially by country, but well over a third of rural populations in most lower income countries lack access to safe water or sanitation. This is despite water being consistently identified as a basic need and a top priority by those who lack convenient or affordable access to it. National indicators on access to safe water and adequate sanitation are compiled by the United Nations and shown in Technical Note 1. Lack of access arises both from income shortages and the specific cultural, economic, regulatory and institutional environment prevailing at the country in question.