DAR ES SALAAM, February 13, 2023—The completion of the new water supply scheme in Igamba village in Songwe district in southwestern Tanzania in December 2020, couldn’t have been more timely for 65 year old Matilda Kashilila. At the time, she was struggling with constant chest pains, even after completing her long course of tuberculosis treatment.
Tunu Peter, a nurse at Nsimbo Dispensary in Katavi region, washes her hands. This is one of the few dispensaries that has gained access to improved water supply and sanitation facilities.
Photo: ONA Stories/ World Bank
Publication Highlights
- Tanzania has made progress in access to water supply, sanitation, and hygiene services, but more can be done to meet targets set by the UN’s Sustainable Development Goals.
- Resourcing and implementing the Water Sector Development Program will reduce economic losses from inadequate access to WASH by $1.9 billion per year by 2030.
- Achieving universal access to water supply and sanitation services would create an estimated 24,000 skilled jobs, on top of jobs created by initial construction-related work.
I used to sell food, and some people said I must have got the disease from smoke from firewood while cooking. So I had to stop that business and open up a shop instead. I live with three young grandchildren and despite my health condition, I had to wake up each day at 5:00 a.m. to get water and have them ready for school by 7:00 a.m.
The water scheme was finished just as Mama Kashilila’s local savings society was disbursing its proceeds among members, and she immediately decided to use hers to connect her house to the water supply. “I am happy to be able to go through my days without chest pains or worrying about water,” she said. “Now, I can also water my vegetable garden.”
Since its Water Sector Development Program (WSDP) got underway in 2006, Tanzania has made significant progress improving the access of thousands of citizens like Mama Kashilila to water, sanitation, and hygiene (WASH) services. Against a backdrop of low coverage and slow progress in the sector during the Millennium Development Goals era, which ended in 2015, the country has renewed its commitment to expanding access for its population by fully adopting the ambitious Sustainable Development Goal (SDG) sector targets, which the UN has set for 2030.
The National Panel Survey (NPS) 2020/2021, released in January 2023, shows that since the NPS 2014/2015, four in every 10 households have gained access to improved sanitation (up from two-and-half households), and half the population now has access to clean water in the rainy season and two-thirds during the dry seasons.
However, more than 9% of Tanzania’s population of about 63.5 million continues to practice open defecation, which brings serious health risks, while rural areas generally lag urban centers in all dimensions of access to WASH services.
Reflecting on the importance of the progress made, as well as remaining gaps, the authors of the 18th Tanzania Economic Update Clean Water, Bright Future: The Transformative Impact of Investing in WASH, just published by the World Bank, argue the country stands to gain much more by pushing to deliver the goals of its third, by far most ambitious WSDP phase (WSDP-3, 2022–2026), whose financing requirements are estimated at $6.5 billion.
“The devastating consequences of inadequate access, versus the benefits gained, make such an investment highly cost-effective,” said Nathan Belete, the World Bank’s Country Director in Tanzania. “Achieving WASH goals can support the jobs agenda while mitigating the adverse effects poor water and sanitation have on workforce productivity. And they’re crucial for Tanzania to achieve its objectives for inclusive growth and property reduction.”
The WSDP-3, and its precedent, the WSDP-2, placed an emphasis on the critical role of behavior change and improving operations and maintenance to install better WASH services and sustain them.
Newly constructed toilets at the Mlowo dispensary in Songwe region.
Photo: Photo: ONA Stories/ World Bank
Better water and sanitation bring better health
This approach is built on learning from the challenges encountered in the first phase of the project, which include weak sector coordination (across and between institutions and donors), low budget allocation and low levels of execution, a narrow focus on capital expenditure (rather than on operations and maintenance), gaps in capacity at national and local levels, and weak monitoring and evaluation systems.
The report’s authors urge the Tanzanian authorities to embrace improved WASH as a pre-condition—and not only a result—of development, and to urgently resource the implementation of the WSDP-3, arguing this will reduce economic losses faced by Tanzania from inadequate WASH services by $1.9 billion per year by 2030. Within five years, these savings would enable the government to generate benefits equal to its initial investment of $4.1 billion.
“Expressed differently, providing near universal WASH access, through WSDP-3, would cost the government just $16 per capita per year, which is less than half the $38 per capita that inadequate WASH services cost Tanzania each year,” said Ruth Kennedy-Walker, World Bank Senior Water Supply and Sanitation Specialist.
Based on a global analysis conducted by the International Water Association, universal access to adequate water supply and sanitation services could also create an estimated 24,000 skilled jobs, in addition to the jobs created during initial, construction-related work. Many of these jobs would be professional and permanent positions, necessary for the operations and maintenance of WASH infrastructure and services. The jobs would, in turn, contribute to the livelihood of millions of people.
Only 61% of households in Tanzania currently have access to a basic water-supply, 32% have access to basic sanitation, and 48% have access to basic hygiene, according to SDG definitions. Tanzania has had to contend with death and disease as immediate consequences of this , with the burden falling heaviest on women, children, and the poor and vulnerable. The estimated 31,000 deaths each year due to inadequate WASH services are over 10% of preventable deaths in Tanzania, and cost the economy more than $2.4 billion each year in excess medical costs and lost productivity.
Some costs, however, are less obvious than others: The report discusses how inadequate sanitation greatly increases the rate of hospital-acquired infections, which in turn discourage patients from seeking care and result in increased morbidity and mortality from other causes.
WASH deficiencies also reduce the effectiveness of investments in education, as diseases and other health conditions result in cognitive deficits among children that permanently impair their capacity to learn. Tanzanian schoolchildren lose an estimated 33 million school days a year to illness—or 3 days per child—of which WASH-related diseases are a key cause. Menstruating girls often miss school or dropout completely due to lack of WASH access. Many children who are physically present in school suffer from WASH-related sickness and hunger, which undermine their ability to learn.
Each year, at least six million working days are lost, while the time required to reach distant water and sanitation facilities costs adults another 1.1 billion hours, for a total of over $1.4 billion in foregone income each year, or 1.9% of GDP. Lost labor hours and diminished productivity continually impinge on the government’s efforts to attract investment, encourage entrepreneurship, and raise living standards.
To achieve—and sustain—universal WASH access in Tanzania, the report recommends a combination of policy measures, institutional capacity building, and new financial arrangements at the national, subnational, and community levels. These actions are key:
- By recognizing the cross-cutting impact of WASH on the government’s larger policy agenda, policymakers across sectors can advocate for WASH investment and develop collaborative solutions to address their shared challenges.
- Multisectoral strategic planning beyond the WSDP-3 horizon must account for population growth, urbanization, and climate change.
- Robust data-collection will be necessary to gauge progress and inform future policies.
- A strong regulatory framework, well-designed incentives for private-sector participation/financing, sound management across the investment cycle, and reliable mechanisms for ensuring financial transparency and accountability will be crucial.