Access to clean water and basic sanitation is essential for human health and socioeconomic development; lack of clean water and basic sanitation increases the prevalence of disease, malnutrition, and gender disparities. Every day, millions of people around the world consume drinking water from sources such as rivers and ponds and use either no or unhygienic sanitation facilities. In passing the Act and making access to safe water and sanitation for developing countries a specific policy objective of U.S. foreign assistance programs, Congress emphasized the importance, and raised the profile, of the need for improving access in many countries. The Act supports activities that (1) expand affordable and equitable access to safe water and sanitation for underserved populations; (2) support the design, construction, maintenance, upkeep, repair, and operation of water delivery and sanitation systems; (3) improve the safety and reliability of water supplies, such as through environmental management; and (4) improve the capacity of recipient governments and local communities, such as through capacity-building programs for improved water resource management. In addition, the importance of access to water was recognized in September 2000 with the ratification of the United Nations (UN) Millennium Declaration, whereby many countries and leading development institutions agreed to work toward meeting the needs of the world’s poorest people. Among the declaration’s eight Millennium Development Goals is that of halving, by 2015, the proportion of people lacking sustainable access to safe drinking water from 1990 levels. In 2002, the UN recognized the importance of sanitation with a declaration that included the goal of halving, by 2015, the proportion of people without access to basic sanitation, also from 1990 levels. A recent African Development Bank study found that, at current rates of progress, these targets for access to water and sanitation in sub-Saharan Africa will not be met until 2040 and 2076, respectively. U.S. government water- and sanitation-related activities are funded mainly through USAID and the Millennium Challenge Corporation. USAID obligates funding for water and sanitation activities primarily in three water sectors: WASH, water resources management, and water productivity. While the majority of USAID WASH activities are funded through accounts such as Development Assistance, Economic Support Fund, and Global Health and Child Survival, USAID also implements some water- and sanitation-related activities under the International Disaster Assistance and Title II Food for Peace accounts. USAID categorizes its WASH activities into two broad types of interventions: 1. direct service delivery, such as providing community stand pipes for household water and building latrines, and 2. institutional, policy, and behavioral interventions, such as improving operations of drinking-water service utilities and improving household- and community-level hygiene. USAID identifies accomplishments for its water and sanitation activities as providing either access to an improved source or improved access. Access to an improved source of safe water generally refers to first-time access to a source of uncontaminated water, while access to improved sanitation generally refers to first-time access to a simple pit latrine, septic system, or similar type of improved sanitary facility. Improved access to safe water generally refers to improvement of existing access to safe water, resulting in access to an increased amount or better quality of water. Improved access to sanitation generally refers to improvement of an existing sanitation facility, such as construction of a wastewater treatment plant for a public sewer system that had no existing treatment plant. In fiscal years 2008 and 2009, Congress directly linked the annual appropriations directives to the Act, requiring USAID to obligate at least $300 million for such activities, with the additional requirement that no less than $125 million of the $300 million appropriations directives be obligated in sub-Saharan Africa. USAID interprets the directives as allowing obligations for most USAID WASH sector activities and for some water resources management and water productivity sector activities to be attributed to meet the directives’ requirements. However, the language of the directives, and USAID’s interpretation of the directives, changed from fiscal year 2008 to fiscal year 2009. Fiscal year 2008. USAID interpreted the fiscal year 2008 appropriations directive as allowing attribution of an obligation for an activity in the water resources management or water productivity sector only if the activity had an explicit linkage to a WASH sector outcome. USAID further interpreted the fiscal year 2008 directive as allowing partial attribution in an amount proportional to an activity’s direct linkage to WASH outcomes. For example, if a USAID mission made obligations to construct a school, including installing a public water tap and latrines, the mission could reasonably argue that the funding for the water tap and latrines was attributable to the appropriations directive even if other aspects of the school’s construction were not. Fiscal year 2009. USAID interpreted the fiscal year 2009 directive as allowing attribution of an obligation for an activity in the water resources management or water productivity sector without a direct linkage to WASH outcomes. Figure 1 illustrates the attribution of USAID funding for water and sanitation activities to meet the annual appropriations directives for fiscal years 2008 and 2009. U.S. Agency for International Development (USAID) In fiscal years 2006 through 2009, about 45 percent of reported beneficiaries of USAID water and sanitation assistance—almost 11 million of the more than 24 million beneficiaries worldwide—were in the agency’s Middle East and North Africa region (see fig. 4). Most reported beneficiaries of USAID sanitation activities in this period also were in the Middle East and North Africa region (see fig. 5). USAID reported nearly 6 million beneficiaries in this region—about 53 percent of the more than 10 million total reported beneficiaries of the agency’s sanitation activities worldwide. The numbers of beneficiaries of USAID water and sanitation activities reported for fiscal years 2006 through 2009 fluctuated widely (see table 1). USAID officials identified two key reasons for the yearly fluctuations in the reported beneficiaries: a revision of the indicators used to report results, and the approach used in reporting on projects with multiyear time frames. Revised indicators. A change in the indicators used to report beneficiaries of USAID water and sanitation activities resulted in substantial differences in the numbers of water beneficiaries reported for fiscal years 2006 and 2007, according to State and USAID officials. For fiscal year 2006, as for prior years, USAID reported the numbers of people gaining first-time access, as defined in the UN Millennium Development Goal, to an existing drinking water source or sanitation facility as well as those gaining improved access. For fiscal year 2007, USAID reported only the numbers of people gaining first-time access to an improved source of drinking water, such as a protected water well, and numbers of people gaining first-time access to an improved sanitation facility, such as a latrine. According to USAID and State officials, the indicator used for 2007 can be a more challenging target to meet in generating numbers of beneficiaries. According to USAID officials, the decrease in water beneficiaries reported for fiscal year 2007 that resulted from the change in the reporting indicator does not fully reflect the agency’s overall accomplishments. Multiyear project time frames. Results for some major water and sanitation project activities, such as water and wastewater treatment facility construction, are reported only when the facilities become operational—often several years after the projects are initiated—causing sudden increases in reported beneficiaries. For example, according to USAID officials, the Jordan mission reported beneficiaries of a major water treatment plant after its completion in 2008, although planning and construction of the plant had begun several years previously. USAID obligations for WASH activities rose from $265 million in fiscal year 2006 to $482 million in fiscal year 2009—an increase of nearly 82 percent (see fig. 6). According to State’s June 2008 annual report to Congress, the increased obligations for WASH activities reflect the growing U.S. commitment to reduce water-related diseases and to increase access to safe drinking water and sanitation in countries with critical needs. State’s June 2008 report also notes that in some instances, the increased obligations for WASH activities resulted in decreased emphasis on activities in other critical development sectors, including water resources management and water productivity. In fiscal years 2006 through 2009, USAID obligated a combined total of 89 percent, on average, of annual WASH funding in three of its regions—the Middle East and North Africa, sub-Saharan Africa, and Asia and the Pacific—and obligations for WASH activities in these regions increased overall. In Europe and Eurasia and in Latin America and the Caribbean, USAID’s other two regions, the agency obligated a combined total of 7 percent, on average, of its annual WASH funding, and obligations decreased overall. Middle East and North Africa. Obligations increased by about 200 percent, from $59 million in fiscal year 2006 to $177 million in fiscal year 2009. During the 4-year period, both total obligations and the percentage of increase were higher than in USAID’s other regions. Sub-Saharan Africa. Obligations increased by nearly 104 percent, from $81 million in fiscal year 2006 to $165 million in fiscal year 2009. Asia and the Pacific. Obligations increased by about 197 percent, from $36 million in fiscal year 2006 to $107 million in fiscal year 2009. Europe and Eurasia. Obligations decreased by approximately 71 percent, from about $7 million in fiscal year 2006 to about $2 million in fiscal year 2009. Latin America and the Caribbean. Obligations decreased by approximately 2 percent, from about $13.7 million in fiscal year 2006 to about $13.5 million in fiscal year 2009. Figure 7 shows USAID obligations for WASH activities in the five USAID regions in fiscal years 2006 through 2009. (App. III provides information on USAID water and sanitation obligations, as well as UN-reported access to improved water and sanitation, by country.) In fiscal years 2008 and 2009, the amounts of obligated funds that USAID attributed to meet the annual appropriations directives for water and sanitation activities pursuant to the Act exceeded the minimum amounts required in the directives. To meet the annual directive to obligate not less than $300 million for WASH activities worldwide, USAID attributed about $337 million in fiscal year 2008 and about $495 million in fiscal year 2009. Those amounts included about $136 million in fiscal year 2008 and about $153 million in fiscal year 2009 for sub-Saharan Africa, which USAID attributed to meet the annual directive to obligate not less than $125 million for projects in sub-Saharan Africa. Figure 8 shows amounts that USAID attributed in fiscal year 2009 to meet the directive to obligate not less than $300 million for WASH activities globally. (5.0%) (80.5%) Water supply, sanitation, and hygiene (WASH) Of the approximately $495 million of fiscal year 2009 obligations that USAID attributed to meet the overall annual appropriations directive for WASH activities, about $397 million (80 percent) was obligated in the 31 countries designated as high priority. About $36 million (7 percent) was obligated in 26 countries not designated as high priority, and another $61 million (12 percent) was obligated for USAID regional activities and other programs. Five high-priority countries—the West Bank and Gaza, Jordan, Pakistan, Sudan, and Afghanistan—received obligations totaling about $269 million (54 percent). (See fig. 9.) According to State and USAID officials, USAID obligated substantial amounts for water and sanitation activities in these five countries because of the countries’ strategic importance in relation to U.S. foreign policy and because of the relatively high amounts of overall foreign assistance funding allocated to these countries. About half of the USAID missions that we contacted reported implementing different types of WASH activities following the passage of the Act and related annual appropriations directives. In our structured interviews with officials at 15 missions in countries where USAID made obligations for WASH activities in fiscal year 2009, 7 missions reported having changed the types of activities they implemented. For example: USAID mission officials in Sudan reported that they began implementing new WASH activities after being directed by USAID headquarters, soon after the Act was passed, to increase obligations for WASH activities. According to these officials, beginning in fiscal year 2008, the mission began activities such as installing community water taps and providing hygiene and water purification training within their long-term development portfolio while concurrently decreasing obligations for shorter-term water and sanitation activities supported by disaster- and emergency-related funding. USAID mission officials in Kenya reported that after the passage of the Act, USAID headquarters directed the mission to obligate approximately $4 million for activities that could be attributed to meet the appropriations directive in fiscal year 2006. The officials said that although the mission had not previously implemented such activities, it quickly developed and began implementing activities such as constructing public water taps and latrines in urban areas and building sand dams to improve water access in rural areas. USAID Kenya officials also noted that some obligations that are currently attributed to meet the minimum amounts required by Congress in the appropriations directive were previously used for other mission activities, such as promoting economic growth. The other seven missions that responded to our structured interviews reported that the passage of the Act and related annual appropriations directives had had little or no effect on the types or numbers of their activities but had affected the way they reported the results of their activities. For example: USAID officials in Jordan reported that the mission began categorizing the results of long-standing activities differently, so that obligations could be attributed to meet the annual appropriations directives. According to the officials, the mission has continued implementing the same general types and numbers of activities—such as the construction of large-scale water- treatment facilities for urban populations in Amman and Aqaba—that it implemented prior to passage of the Act. USAID officials in Ecuador reported that the mission recategorized existing activities so that obligations for these activities could be attributed to the appropriations directives. According to the officials, the mission recategorized municipal development activities—including constructing potable water systems in small cities and building household sanitation facilities in rural areas—that the mission had been implementing for more than a decade as part of a program to assist local governments in improving infrastructure. In a strategic framework developed jointly with USAID, and in its annual reports to Congress on U.S. water and sanitation assistance, State has presented a broad strategy for furthering the U.S. foreign assistance objective of providing affordable and equitable access to safe water and sanitation in developing countries, as required by the Act. In June 2008, State announced a joint State-USAID strategic framework for water and sanitation that, according to State and USAID officials, represents the current U.S. water and sanitation strategy. Among other things, the framework highlighted five WASH activity areas for focusing U.S. investments: strengthening capacity and sustainability of small-scale service providers; improving the operating environment, operations and financial sustainability of certain utilities; mobilizing capital for infrastructure development; improving household- and community-level hygiene and sanitation; and integrating water supply and sanitation with humanitarian and disaster- related assistance. In announcing the strategic framework, State noted that the U.S. strategy fully embraced the priorities and guiding initiatives of the Act, represented the overarching strategic framework for U.S. water sector efforts, and included the guiding principles for strategic action in the water sector. The framework also includes discussions of other strategy-related issues. For example, the framework describes the need to balance U.S. country-level water-sector programs within the context of the overall U.S. assistance portfolio in the country and notes the importance of having good information for monitoring and evaluation of strategic plans. Before and after the issuance of the joint strategic framework in 2008, State’s annual reports to Congress presented various water- and sanitation-related goals and objectives but noted that the development of a U.S. water and sanitation strategy is ongoing. For example, the June 2006 report outlined three objectives for overall U.S. water and sanitation assistance: increase access to, and effective use of, safe water and sanitation; improve water resources management and water productivity; and improve water security by strengthening cooperation on shared waters. However, State noted in the report that the information did not represent a final statement of the U.S. water and sanitation strategy but, instead, represented the beginning of a long-term process to develop and implement a strategy. Since 2006, State’s annual reports to Congress have regularly described various modifications to the stated objectives for water and sanitation, noting that the modifications were intended to build on the existing strategy. For example, in issuing the joint strategic framework in 2008, State noted that the framework was to be considered a work in progress rather than a final strategy and, in its 2009 report, State acknowledged that it was continuing to build on the existing strategy. State has not developed specific and measurable goals, benchmarks, and timetables to assess its progress. Moreover, State has not developed an estimate of funding needed for the United States to achieve its overall foreign assistance policy objective. State’s annual reports to Congress in fiscal years 2006 through 2009 do not include performance measures, and the reports acknowledge that the development of performance measures for U.S. water and sanitation assistance is still in progress. For example: Fiscal year 2006. In June 2006, State reported that it planned to begin developing metrics for measuring progress and establishing time lines for completing programs and projects. Fiscal year 2007. State’s June 2007 report does not include metrics, time lines, or other performance measures. In the report, State notes that developing measurements for monitoring and assessing progress is particularly challenging in the water sector due to, among other things, questionable data quality and reliability as well as difficulty in correlating the outputs of specific activities with the results achieved at the local, regional, or national levels. Fiscal years 2008 and 2009. State’s reports in June 2008 and 2009 include descriptive information for some high-priority countries and geographic regions, and the 2009 report includes some quantitative performance measures for some countries. However, neither report contains comprehensive metrics, timelines, or other performance measures needed to assess overall progress. In addition, State has not developed an assessment of funding needed to achieve the U.S. water and sanitation objective, as required by the Act. Such an assessment would involve developing metrics (i.e., specific and measurable goals to be met within certain time frames) from which estimated funding levels could be determined. According to State officials, such country-level specific and measurable goals, timetables, and benchmarks for water and sanitation have been developed by USAID missions in some countries since 2009 and are currently being developed in other countries. State officials also noted that WASH obligations have exceeded the minimum required amounts in the annual appropriations directives for fiscal years 2008 and 2009 and that USAID water and sanitation activities implemented with these funds have continued to generate additional beneficiaries. However, State and USAID officials acknowledged that a comprehensive assessment of funding needed to achieve the U.S. objective cannot be developed without a quantifiable overall U.S. goal for WASH activities. As of September 2010, such a goal had not been specified. State’s annual reports to Congress in fiscal years 2008 and 2009 identify countries designated as high priority for water and sanitation assistance, as required by the Act. The 2008 report lists 36 countries designated as high priority for fiscal year 2008, and the 2009 report lists 31 countries designated as high priority for fiscal year 2009 (see fig. 10). In both years, nearly half of the countries identified as high priority were in USAID’s sub- Saharan Africa region; more than a quarter were in the Asia and the Pacific region; and one country, Haiti, was in the Latin America and the Caribbean region. The joint State-USAID strategic framework and State’s annual reports to Congress identify a number of factors, including the two criteria specified in the Act, that influenced the designations of high-priority countries for fiscal years 2008 and 2009. A country’s level and type of need for water and sanitation (specified in the Act) Conditions in the country that would support long-term sustainable results (specified in the Act) The U.S. comparative advantage, such as level of expertise, relative to that Opportunities to leverage U.S. foreign assistance through partnerships and similar mechanisms with other donors and partners Consistency with U.S. foreign policy priorities Compliance with statutory directives that affect foreign assistance According to the joint strategic framework and State’s annual reports, USAID missions generally consider all of these factors, in consultation with host governments, in planning for water and sanitation activities as part of the missions’ overall development portfolios. In turn, as noted in the framework and annual reports, and according to a key State official, State considers USAID missions’ water and sanitation plans in designating high-priority countries. The extent to which State considers USAID missions’ water and sanitation plans in designating high-priority countries is unclear. In addition, State’s designations are not clearly linked to verifiable analysis. Role of mission plans in State’s designation process is unclear. State officials said that they considered USAID mission plans in making high-priority designations. However, in our structured interviews with senior USAID officials at missions in 15 countries as well as our review of USAID mission plans, we found several missions where State’s designations did not reflect USAID mission planning for water and sanitation activities. For example, in Kosovo, which was designated as high-priority for fiscal year 2009, the mission’s plans did not include water and sanitation activities. In contrast, the missions’ plans in Ecuador and Egypt, which were not designated as high priority, included a significant number and range of such activities. For example, the Ecuador mission’s fiscal year 2009 plans included construction of drinking water supply and sanitation systems, protection of watersheds, and management of water resources. Similarly, for fiscal year 2009, the Egypt mission planned to invest in technology to supply water for Bedouin communities and to provide technical assistance to increase water use efficiency and productivity, among other things. High-priority designations are not clearly linked to verifiable analysis. The strategic framework and the annual reports do not include evidence of systematic or verifiable analysis that State conducted in examining underlying USAID missions’ plans for water and sanitation activities. In addition, the framework and reports do not specify the basis for State’s designations of high-priority countries. Although the strategic framework and annual reports emphasize that missions may consider a number of factors in planning and allocating resources for water and sanitation activities, the documents do not identify USAID missions’ processes for recording and quantifying the specific factors considered or the relative weights given these factors and do not identify State’s consideration of the factors. A State official acknowledged that State’s review of missions’ water and sanitation plans and activities generally are not based on systematic analysis. In addition, we found that average percentages of USAID mission budgets allocated for WASH activities did not reflect countries’ designations as high priority and that missions were often unaware of the designations. USAID missions’ allocations for WASH activities do not reflect high-priority designations. Among countries where funding attributable to the annual appropriations directives was obligated for water and sanitation assistance in fiscal year 2009, the average percentage of USAID mission budgets allocated for WASH activities in high-priority countries did not differ significantly from the average percentage allocated in non- high-priority countries. USAID missions in high-priority countries allocated an average of about 3.2 percent for WASH activities, while USAID missions in non-high-priority countries allocated an average of about 3.1 percent of their budgets for such activities. USAID missions are often unaware of high-priority designations. At missions in 11 of 13 high-priority countries where we conducted structured interviews, senior USAID officials were unaware of, and had not been consulted about, the country’s designation. Officials at USAID headquarters acknowledged that, although State coordinates and consults with USAID on a wide range of water- and sanitation-related issues at the headquarters levels, USAID missions may not be aware of the designation process. The designations of high-priority countries in State’s 2008 report are not consistently associated with data on need for water and sanitation. State’s 2008 and 2009 annual reports both note that to identify a country’s level of need for water and sanitation, among the other factors it considered in prioritizing water and sanitation assistance, USAID referred to 2008 data published jointly by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). However, the countries designated as high priority for fiscal year 2009 exclude 4 of the 10 countries that UN data show with greatest need for access to improved water sources, as well as 7 of the 10 countries that UN data show with greatest need for access to improved sanitation. Figure 11 shows the 10 countries that the UN ranked as having the greatest need for improved water and sanitation, respectively, including those countries designated as high priority in State’s 2008 report. Moreover, as shown in figure 12, a number of the 31 countries that State designated as high priority for fiscal year 2009 are not among those that 2008 UN data show as having the greatest need for water or sanitation. For example: In 5 of the 31 countries designated as high priority—Lebanon, Georgia, Armenia, Jordan, and the West Bank and Gaza—at least 89 percent of the population had access to both improved water and sanitation. In 12 of the 31 countries designated as high priority, at least 75 percent of the population had access to improved water, and in 24 of the countries, more than half of the population had such access. In 6 of the 31 high-priority countries, at least 75 percent of the population had access to improved sanitation, and in 11 of the countries, at least half the population had such access. In response to these observations, State officials said that a variety of issues are involved in considering level of need. For example, the officials stated that in Jordan, although a relatively high percentage of the population have access to safe water and improved sanitation, the use of surface and ground water for vital economic development, including agricultural purposes, has made water increasingly scarce—resulting in low per capita water availability. Likewise, in India, although a relatively large percentage of the population have access to safe water and improved sanitation, more than 100 million people lack such access. The Senator Paul Simon Water for the Poor Act of 2005 established the U.S. foreign assistance policy objective of providing access to safe water and sanitation in developing countries. Since fiscal year 2006, State has annually reported to Congress, as required by the Act, on USAID’s provision of water and sanitation assistance that has benefited millions in developing countries. Reflecting growing U.S. government attention to global water and sanitation needs, USAID obligations for WASH activities—totaling more than $1 billion in fiscal years 2006 through 2009— increased substantially, with the greatest increases in the agency’s North Africa and the Middle East, sub-Saharan Africa, and Asia and the Pacific regions. In addition, USAID obligations for certain water and sanitation activities exceeded the annual appropriations directive in fiscal year 2009 by a significant amount. However, although State has taken steps to develop the water and sanitation strategy required by the Act, the documents comprising the strategy—State’s annual reports to Congress and the 2008 joint State- USAID strategic framework—do not include specific and measurable goals, benchmarks, and timetables for U.S. water and sanitation assistance or an assessment of needed funding. As a result, it is difficult to assess the extent to which USAID’s reported accomplishments and funding levels further the U.S. foreign assistance policy objective. Additionally, because State’s fiscal year 2008 and 2009 reports to Congress on water and sanitation activities do not clearly identify the basis for its designations of high-priority countries, it is not possible to determine the extent to which the designations meet the criteria put forward in the Act. In particular, the reports do not clearly show the relation of State’s high- priority designations to USAID’s planned activities and reported funding. In addition, although the reports list factors such as a country’s level of need—one of the criteria specified in the Act—that may influence State’s high-priority designations, the reports do not identify the specific factors that influenced the designations for fiscal years 2008 and 2009 or identify an objective and verifiable process for weighing these factors. To enable State to fulfill requirements in the Senator Paul Simon Water for the Poor Act of 2005, we recommend that the Secretary of State, in consultation with the Administrator of USAID, take the following two actions: Ensure that the U.S. water and sanitation strategy addresses all components required by the Act, including specific and measurable goals, benchmarks, and timetables for achieving the U.S. foreign assistance objective of providing affordable and equitable access to safe water and sanitation in developing countries. Explain, in the mandated annual reports to Congress, the basis for designations of countries as high priority for water and sanitation assistance, including specific factors considered—in particular, the two criteria established by the Act—as well as any process used to weigh such factors. We sent a draft of this report to State and USAID for their review. Both provided written comments, which we reproduced in appendixes IV and V, respectively. State and USAID also provided technical comments that we incorporated as appropriate. In their written comments, State and USAID accepted our findings and State accepted our recommendations. Both State and USAID noted that they had begun to review their current efforts and to address the issues raised in our report. State observed that it and USAID designate as “priority” those countries where water or sanitation is a key component of the U.S. development strategy. State also noted that the designations are driven primarily by the significance of water or sanitation challenges to the country’s socioeconomic development and the likelihood that U.S. assistance can make a meaningful difference. Our report acknowledges that a number of factors are considered in the designations of high-priority countries. However, we maintain that the precise basis for such designations should be more transparent. As we agreed with your office, unless you publicly announce the contents of this report earlier, we plan no further distribution of it until 6 days from the date of this letter. At that time, we will send copies of this report to the Secretary of State; the Administrator, USAID; and interested congressional committees. In addition, the report will be available at no charge on the GAO Web site at http://www.gao.gov. If you or your staff have any questions about this report, please contact me at (202) 512-3149 or gootnickd@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. Individuals who made key contributions to this report are listed in appendix VI. We were asked to review efforts of the Department of State (State) and the U.S. Agency for International Development (USAID) to respond to requirements in the Senator Paul Simon Water for the Poor Act of 2005 (the Act). This report 1. describes USAID’s water and sanitation activities and reported 2. describes USAID obligations for water and sanitation activities in fiscal years 2006 through 2009, including obligations attributed to meet annual appropriations directives in fiscal years 2008 and 2009; 3. assesses State’s development of a U.S. water and sanitation strategy as required by the Act; and 4. examines State’s process for designating high-priority countries as required by the Act. As agreed with our congressional requesters, we focused our review on USAID funding and activities in the water supply, sanitation, and hygiene (WASH) sector and excluded assistance provided through the Millennium Challenge Corporation from the scope of our work. In addressing these objectives, we reviewed the Act and related appropriations directives, as well as State, USAID, and nongovernmental organization (NGO) reports (including State and USAID annual reports), documents, and data, and interviewed officials of these organizations in Washington, D.C. We met several times with officials at State and USAID to discuss their responsibilities, activities, progress, and challenges in implementing the Act. We also reviewed reports from the Congressional Research Service and the United Nations’ (UN) annual progress reports on the UN Millennium Development Goals. We reviewed reports from several NGOs and interest groups in Washington, D.C., including CARE USA, Center for Strategic and International Studies Global Strategy Institute, International Housing Coalition, Water Advocates, Woodrow Wilson International Center for Scholars, and World Wildlife Fund, among others. In addition, we reviewed and analyzed the authorizing legislation for the Act and congressional committee reports, as well as various USAID policy documents and implementing guidance. We selected 15 countries for our review, as part of a judgmental sample of countries where USAID had obligated funding for assistance associated with the Act. To objectively select the sample of countries, we analyzed various criteria and concluded that the following were most relevant: (1) levels of funding for WASH activities; (2) geographic dispersion among USAID’s five regions; and (3) magnitude of water- and sanitation-related needs according to UN Millennium Development Goal indicators. From September 2009 to February 2010, we visited 6 of the 15 countries— Ecuador, Ethiopia, Haiti, Jordan, Kenya, and Sudan—which represent three of USAID’s five regions. In each country we reviewed U.S.-funded water and sanitation project activities and priorities and interviewed USAID officials. Additionally, in Jordan, we met with government officials from the Ministry of Water and Irrigation, and in Sudan, we met with officials from the Ministry of Water Resources and Irrigation and the Southern Sudan Urban Water Corporation. We also interviewed USAID implementing partners in the 6 countries, including the International Organization for Migration and the Fund for the Protection of Water in Ecuador; Development Alternatives, Inc., Mercy Corps, and ECODIT, Inc., in Jordan; Winrock International and Louis Berger Group in Sudan; Water and Sanitation for the Urban Poor, the Aga Khan Foundation East Africa, the Adventist Development and Relief Agency, and CARE USA in Kenya; and CARE USA, the International Rescue Committee, Save the Children United States, and the Relief Society of Tigray in Ethiopia. We met briefly with officials of CHF International and the International Organization for Migration in Haiti but were unable to obtain detailed information owing to an earthquake on January 12, 2010, which coincided with our visit. In addition, we reviewed country- or region-specific information on water and sanitation activities for USAID missions in 9 of the 15 countries: Afghanistan, the Democratic Republic of the Congo, Egypt, India, Indonesia, Kosovo, Lebanon, Pakistan, and the West Bank and Gaza. We collected comparable information for these countries by conducting structured interviews with mission officials in each country via telephone or e-mail. However, because we judgmentally selected the sample of USAID missions for the structured interviews, our findings from these interviews cannot be generalized to all USAID missions. To describe funding obligations and reported beneficiaries, we reviewed numerous data sources. To review funding obligations for water and sanitation and compare these data with country statistics, we collected and examined data on obligations from State’s annual reports to Congress and from data provided by USAID. We collected and examined USAID mission budget data published in annual State Foreign Operations Congressional Budget Justifications to determine the percentage of each mission’s budget that was allocated to WASH activities. We also collected country-specific World Bank population data, to calculate the amount of WASH obligations in each country on a per-capita basis. To review and describe reported beneficiaries, we analyzed country-specific data published by the UN World Health Organization and the UN Children’s Fund (WHO/UNICEF) Joint Monitoring Programme for Water Supply and Sanitation on (1) the proportion of the population with access to an improved source of drinking water and (2) the proportion of the population with access to an improved sanitation facility. We did not conduct an independent data reliability assessment of the data published in the UN report. However, because both State and USAID use these UN- published data and, according to State and USAID officials, these data are sufficiently reliable for use in their reports, we determined the data from these sources to be sufficiently reliable for the purposes of this report. We conducted this performance audit from August 2009 through September 2010 in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings and conclusions based on our work objectives. During our visits to six countries in three of USAID’s five regions, we observed USAID water and sanitation activities such as hygiene education for children and construction of latrines for individual households, community water supply systems, and urban wastewater treatment systems. Figure 13 shows the six countries we visited. Figures 14 through 19 present observations from our site visits. We visited Ecuador and Haiti in the Latin America and the Caribbean region; Jordan in the Middle East and North Africa region; and Ethiopia, Kenya, and Sudan in the sub-Saharan Africa region. We chose these 6 countries, among the 15 selected for our review, because they met our criteria (see app. I) and represented three of five—that is, the majority—of USAID-defined regions. Ethiopia. We visited the Tigray region in northern Ethiopia where USAID’s activities included constructing borehole wells and water taps and teaching basic hand-washing and hygiene techniques in rural communities. Residents of several communities in this region told us that, in addition to improving the quantity and quality of water supplies, the wells and taps had improved the lives of women and girls, who are typically responsible for obtaining water for their families. The residents noted that, because women and girls no longer have to walk for several hours each day—sometimes as far as 4 or 5 miles each way—to obtain water, they are less susceptible to injury from carrying water over rugged terrain, are less vulnerable to attacks in insecure areas, and have more time and energy to attend school. The photos below show a community water tap and a woman demonstrating hand-washing techniques taught by an Ethiopian nongovernmental organization that had received USAID funding. Jordan. We visited a wastewater treatment facility under construction in northern Jordan and sites with household water cisterns on the outskirts of Amman. According to USAID officials, the recycled wastewater from the treatment facility in northern Jordan would be used for agricultural irrigation, thus increasing the availability of potable water for household needs. This project highlights USAID’s focus on water conservation in an arid region. At another site, a municipality had installed water meters to track usage and improve water use collection fees. In addition, we visited other sites where homeowners had received water cisterns as part of rainwater catchment systems for household use. The beneficiaries told us that, because local aquifers are being depleted rapidly due to population increases, the water cisterns have become increasingly important for providing household water. The photos below show a water meter for an urban household and a family’s water cistern funded by USAID. Kenya. We visited several sites in Kenya where USAID is conducting a wide variety of water and sanitation activities. In Kibera, an urban slum near Nairobi—the second largest slum in Africa—USAID funds have been used to install community water taps and public shower and latrine facilities. In contrast, we visited a sparsely populated area in the arid Mwingi District, east of the capital Nairobi, where USAID funds have been used to construct basic sand dams in river beds. The sand dam captures rainwater and reduces the rate at which rainfall runs off, thereby raising the water table and increasing water availability for households and livestock during several months of the dry season. The photos below show a water tap in Kibera and a sand dam in Mwingi District, Kenya. Sudan. In southern Sudan, we visited several types of water and sanitation activities in the city of Juba. At one of the sites, a facility for loading treated water onto tanker trucks was under construction. According to USAID officials, when this facility becomes operational, tanker trucks will deliver clean water to residents instead of the raw, contaminated river water that tanker trucks currently deliver. At another site, we observed a staff member of a USAID-funded NGO demonstrate proper hygiene and water-purification techniques to women and children at a neighborhood meeting. Several of the women who live in the neighborhood told us that their health and the health of their children had significantly improved since they began applying the techniques that were demonstrated. USAID/Sudan officials confirmed that improvements had been achieved. The photos below show a water-loading station under construction and an instructor demonstrating water purification techniques. Proportion of population with access to improved sanitation Percentages of countries’ populations with access to an improved source of drinking water and improved sanitation facilities are according to 2008 data from the UN World Health Organization and the UN Children’s Fund (WHO/UNICEF) Joint Monitoring Programme for Water Supply and Sanitation. OES = Bureau of Oceans, Environment, and Science, Department of State Because of rounding, small amounts of WASH obligations per capita in some countries appear as $0.00. These countries are Tajikistan ($0.005); India ($0.004); Niger ($0.003); Azerbaijan ($0.001); and Russia ($0.001)because (1) it is the only State-designated high-priority country where USAID made no obligations in any of the three water sectors and (2) UN data on access to water and sanitation for Kosovo were not available. Although designated as high priority for fiscal years 2008 and 2009, Kosovo is not shown because USAID obligated no funds for water or sanitation assistance in Kosovo in those years. Countries are listed in descending order according to the amount of USAID obligations for WASH activities. Includes the following USAID bureaus and missions: Asia Middle East Regional Bureau, Regional Development Mission-Asia, Africa Regional Bureau, East Africa Regional Bureau, Southern Africa Regional Bureau, West Africa Regional Bureau, Africa Office of Development Partners, Caribbean Regional Bureau, Middle East Regional Bureau. Includes Bureau for Democracy, Conflict and Humanitarian Assistance; Bureau for Economic Growth, Agriculture and Trade; Bureau for Global Health; and Office of Development Partners. In addition to the contact named above, Leslie Holen (Assistant Director), Reid Lowe, Justin Mausel, and George Taylor made key contributions to this report. Elizabeth Curda, Mark Dowling, Etana Finkler, Joel Grossman, Jacqueline Nowicki, and Jena Sinkfield provided technical support.

Summary: The Senator Paul Simon Water for the Poor Act of 2005 (the Act) made access to safe water and sanitation for developing countries a U.S. foreign assistance policy objective. The United States provides such assistance mainly through the U.S. Agency for International Development (USAID). The Act requires the Secretary of State to develop a water and sanitation assistance strategy with the Administrator of USAID; designate high-priority countries for assistance; and report annually to Congress on, among other things, implementation of the strategy and progress toward the U.S. policy objective. As requested, in this report GAO (1) describes USAID's accomplishments; (2) describes USAID's obligations of funds for water and sanitation assistance in fiscal years 2006-2009; (3) assesses the Department of State's (State) development of a U.S. water and sanitation strategy; and (4) examines State's designation of high-priority countries. GAO reviewed State and USAID documents and data and obtained the views of State and USAID officials in Washington, D.C., and 15 countries. State reported that USAID provided a wide range of water and sanitation activities in 2006 through 2009, such as installing community water taps, building latrines, and constructing major water treatment plants. Nearly 11 million of more than 24 million reported water beneficiaries and nearly 6 million of more than 10 million reported sanitation beneficiaries were in USAID's Middle East and North Africa region. USAID obligations of funds for water supply, sanitation, and hygiene (WASH) activities increased by approximately 82 percent from fiscal year 2006 to 2009, with the majority of funding supporting WASH activities in three USAID regions--sub-Saharan Africa, the Middle East and North Africa, and Asia and the Pacific. In fiscal years 2008 and 2009, about $337 million and $495 million, respectively, of USAID obligations for water and sanitation activities was attributed to meet annual congressional appropriations directives that no less than $300 million be obligated for those years. In fiscal year 2009, about 80 percent of the attributed funds were obligated in countries that State designated as high priority. State has taken steps to develop a water and sanitation strategy. In 2008, State and USAID issued a joint strategic framework that, according to State, largely comprises the broad current U.S. strategy. State also identified its annual water and sanitation reports to Congress in 2006 through 2009 as containing elements of this strategy. However, the strategic framework and annual reports do not include specific and measurable goals, benchmarks, and timetables, which the Act requires and which are needed to measure progress toward achieving the overall U.S. foreign assistance policy objective. Further, State has not provided an assessment--also required by the Act--of funding needed to achieve such goals, benchmarks, and timetables. In fiscal year 2008, State began to designate countries as high priority for water and sanitation assistance, designating 36 countries in 2008 and 31 countries in 2009. Nearly half of these countries were in sub-Saharan Africa and more than a quarter were in Asia and the Pacific. State said that in making the designations, it considered USAID mission plans for water and sanitation activities. In addition, State's annual reports to Congress identify factors that are reflected in the high-priority designations, including two criteria specified by the Act: need for improved access to water and sanitation and the existence of conditions that would support long-term sustainable results. Additional factors reflected in the designations include consistency with U.S. foreign policy priorities and compliance with statutory directives. However, GAO found that State's high-priority designations excluded several countries where USAID had provided water and sanitation assistance and included one country where USAID had not provided such assistance. Moreover, the designations for fiscal years 2008 and 2009 are not linked to verifiable analysis. As a result, the basis for State's designations of high-priority countries is unclear. GAO recommends that State (1) ensure that the strategy for U.S. water and sanitation assistance addresses all requirements, including goals and benchmarks, and (2) clearly identify, in its mandated reports, the basis for its designations of high-priority countries. State accepted GAO's recommendations.