Extending the coverage and improving the quality of WSS is one of the most crucial challenges facing the international community. The provision of safe WSS is critical for achieving healthy societies, as “public health cannot advance without safe water” (UNECE-WHO/Europe, 2002). However, the actual impact of WSS on public health is mediated by other variables, among which hygiene education and people’s initiative in tackling the problems are paramount (Cairncross et. al, 1994; McGranahan et. al., 2001).
As demonstrated long-ago by White, Bradley, and White in their classic study of household water use in East Africa, increased volumes of water for domestic use do not necessarily translate into increased water use or improved health conditions (White et. al., 1972). This brings out the centrality of good governance and substantive citizenship in the management of WSS, as positive change in this field cannot be achieved without the active participation of the local communities.
The fact is that more than 5 million people still die each year from preventable water-related infections (European Commission, 2002b; WHO, 2003d), while millions are affected by long-term illnesses caused by the intake of health-threatening substances naturally present in water such as sulphates, arsenic, or manganese.
In particular, lack of or poor quality WSS have negative consequences on reproductive and child health, given that pregnant and lactating women and young children have higher-than average hydration requirements while they are among the most vulnerable sectors of the population, together with the terminally ill and the elderly (WHO, 2003). In this regard, it is estimated that preventable diarrhoeal diseases alone kill about 2 million people every year, most of whom are children under 5 years of age living in peri-urban and rural areas of LDCs under conditions of extreme poverty (WHO, 2003d).
Although, the impact of inadequate WSS is particularly acute in Asia, Africa and Latin America, the enlarged European Union is also affected with about 120 million people lacking access to safe and regular water supplies and 30 million cases of water-related preventable diseases recorded annually, though these figures are considered to be substantially underestimated (UNECE-WHO/Europe, 2002).
This situation has prompted a series of high-profile and far-reaching initiatives at the European level, which include the European Charter on Environment and Health (WHO-Europe, 1989), the Declaration on Action for Environment and Health in Europe (WHO-Europe, 1994), and the Protocol on Water and Health (UNECE-WHO/Europe, 1999). An assessment of the progress made so far and of the challenges ahead has been undergoing at the European level, a task that has taken special relevance in the face of imminent expansion of the European Union (UNECE-WHO/Europe, 2002; WHO-Europe, 2002; 2003; 2003b; 2003d).
At the global scale, the long-standing and increasing recognition of the urgent need for action has prompted renewed commitments from the international community. These include the decisions taken at the UN Millennium (UN, 2000) and Johannesburg (UN 2002) summits where it was agreed to reduce child mortality and halve the proportion of the world population without access to WSS by 2015 .
The European Commission has launched its Water Initiative in support of these policies (European Commission, 2002b), which is in line with the high priority given to water issues in European development and cooperation policy (European Commission, 2000, 2002c, 2003). Also, and in acknowledgement of the moral character of the task ahead, access to safe water services has been recently enshrined as a human right in the UN International Covenant on Economic, Social, and Cultural Rights (UN, 2002b; WHO 2003b).
More recently, at the 2003 G8 Summit, world leaders pledged their commitment to assist “as a priority, countries that make a political commitment to prioritise safe drinking water and basic sanitation as part of their strategy to promote sustainable development, including poverty eradication” (G8 Evian Summit, 2003).
However, despite these laudable formal commitments there is an increasing recognition that achieving the UN goals for water and sanitation may not be possible unless radical decisions are taken, both in developed and developing countries (NWCF, 2005). The simple fact that achieving the goals will require connecting around 200,000 and 400,000 people per day worldwide respectively for each of these services until 2015 (European Commission, 2003), is considered by some experts to be technically unfeasible.
Furthermore, the financial arrangements needed to double the investments flows into WSS as suggested by the Camdessus report to achieve the goals, would require very radical transformations worldwide in the governance of water resources and WSS (Camdessus, 2003).
One crucial problem here is that, even if the political will needed to meet the targets were there, achieving “good governance” and citizen participation requires a much more sophisticated understanding of the intertwining between the socio-political, cultural, and ecological dimensions involved in the organization and delivery of WSS in different countries.
Unfortunately, current mainstream water policies have so far failed to achieve good governance and promote the exercise of substantive citizenship rights, while ongoing research has identified worrying trends suggesting that the global institutions playing the key role in dictating public policies worldwide are very reluctant to accept criticism, to reassess their policy frameworks in the light of repeated failures, and continue to commit their efforts in the implementation of programmes that are largely blind to the needs, requirements, values, opinions, and preferences of people in developing countries, especially the most disadvantaged.
Although there is an increasing recognition that the mainstream policy models based on deregulation, liberalization, and privatization implemented since the 1980s have not enhanced good governance of essential services such as WSS and public health and have rather discouraged citizen involvement, developing and replicating suitable alternatives will require radical changes in the form that multilateral institutions, aid agencies, and other key power holders approach this matter (PRINWASS, 2004). At the centre of this challenge are the issues of governance and substantive citizenship that we propose to examine.