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.)