The WASH Performance Index Report

collage-989

highlights-1

  • The Water, Sanitation, and Hygiene (WASH) Performance Index is a comparison of country performance in realizing universal WASH. The WASH Performance Index assesses performance in the following components: water access, water equity, sanitation access, and sanitation equity.
  • The top five performing countries in the 2015 WASH Performance Index rankings are El Salvador, Niger, Egypt, Maldives, and Pakistan. The bottom five performers are the Dominican Republic, Gambia, Ghana, Samoa, and Timor-Leste.
  • Progress toward equity in sanitation is significantly associated with governance indicators including control of corruption, government effectiveness, regulatory quality, and rule of law. These results suggest the enabling environment for WASH contributes to progress in sanitation equity.
  • Water access performance among countries in Sub-Saharan Africa varies widely, despite their having the lowest water coverage in the world.
  • Among the world’s most populated countries, Pakistan, China, and Nigeria were top performers (ranked 5, 11, and 18 respectively). Russia, the Philippines and India were bottom performers (ranked 72, 83, and 92 respectively).
  • Despite the assumption that countries with higher GDP will perform better in improving access to water and sanitation, GDP was not significantly correlated with performance.
  • Among most top performing countries, neither water nor sanitation dominated the overall Index value, suggesting improvements in water or sanitation do not come at the expense of the other.

Authors
Ryan Cronk, Jeanne Luh, Benjamin Mason Meier, and Jamie Bartram

Reviewers
Robert Bain, Michael B. Fisher, Katie Hall, Kaida Liang, Darren Saywell, and Katherine F. Shields

Webcast
The Water Institute recorded a special webcast from the Gillings School of Global Public Health, launching the WASH Performance Index. The webcast featured special guest speakers Catarina de Albuquerque, a world-renowned international human rights lawyer and advocate and the vice chair of Sanitation and Water for All (SWA); and Ed Cain, Vice President of grant programs for the Conrad N. Hilton Foundation. To view the recorded webcast online, please visit http://bit.ly/1D5TAPG.

Acknowledgements
This report was sponsored by the Conrad N. Hilton Foundation.

We would like to thank a number of people for their valuable contribution to the development, coordination, and production of the WaSH Performance Index and this report: Catarina de Albuquerque, Pete Andrews, Robert Bain, Clarissa Brocklehurst, Edmund Cain, Elizabeth Christenson, Chris Dunston, Michael B. Fisher, Georgia Kayser, Peter Gleick, Katie Hall, Shaheen Kassim-Lakha, Pete Kolsky, Kaida Liang, Rolf Luyendijk, Ashley McKinney, Patrick Moriarty, Jan-Willem Rosenboom, Ron Ross, Darren Saywell, Katherine F. Shields, Heather Skilling, Marissa Streyle, and Yael Velleman.

© University of North Carolina at Chapel Hill.

Introduction

highlights-1

  • Water, sanitation and hygiene (WASH) are essential to human health and development, and water and sanitation are recognized as human rights.
  • Proposed global targets for the post-2015 Sustainable Development Goals (SDGs) call for universal access to WASH, and reducing inequalities in access.
  • The forthcoming SDGs provide potential for convergence of human development and human rights policy.
  • New instruments are necessary to monitor and evaluate country performance on WASH and to ensure progressive realization of the human right to water and sanitation.
  • The WASH Performance Index meets these needs by comparing country performance on increasing access and equity to best-in-class performance at different levels of water and sanitation coverage.
  • Performance represents progressive realization of human rights. The Index is one of the first quantitative measures of progressive realization of the human right to water and sanitation.
  • The Index provides insight based on already-available water and sanitation data. It is designed to accommodate new types of data relevant to the SDGs as they become available.

Water, sanitation and hygiene (WASH) are essential to human health and development [1]. Water and sanitation feature prominently in human development policy, most recently the Millennium Development Goals (MDGs) [2, 3]. Monitoring of WASH in the MDGs focused on coverage of water and sanitation in countries.

Water and sanitation are recognized as human rights. The principle of progressive realization of human rights requires that each government takes steps “to the maximum of its available resources, with a view to achieving progressively the full realization of the rights” [4]. The UN General Assembly’s 2010 Resolution on the Human Right to Water and Sanitation calls upon governments “to scale up efforts to provide safe, clean, accessible and affordable drinking water and sanitation for all” [4].

Deliberations are underway to develop targets and indicators for WASH as part of future Sustainable Development Goals (SDGs). The forthcoming SDGs provide potential for convergence of human development and human rights policy related to WASH. Proposals for targets and indicators for the SDGs call for expanded monitoring on hygiene, WASH in non-household settings (schools and health care facilities), universal access, and improvements in service levels [5].

Like the MDGs, proposed monitoring approaches to assess progress toward these targets and indicators focus on levels of coverage [5]. Important additional insights would be obtained by complementing coverage monitoring with performance and allow fair comparison of countries. There is a need for an instrument to measure country performance in improving access to and equity of WASH and measure progressive realization of the human rights to water and sanitation [6].

Our proposed solution is the WASH Performance Index. The Index compares country performance to best-in-class performance. It enables fair comparison of countries at different stages of WASH development by comparing progress made by countries at similar levels of water and sanitation coverage. The Index is designed such that it can be calculated with already-available data and could be refined in the future to account for new nationally representative data on hygiene, water safety, improvements in service levels, and WASH in non-household settings for which data collection initiatives are anticipated.

The WASH Performance Index answers two policy questions:

  • How quickly are countries improving access to improved water and sanitation relative to best-in-class performance; and
  • How quickly are countries improving equity in access to improved water and sanitation relative to best-in-class performance?

To answer the first question, we use the rate of change in coverage of improved water and sanitation. To answer the second, we use the rate of change of the gap in coverage of improved water and sanitation between rural and urban settings. To evaluate country progress, country rates of change are compared against best-in-class country performance at different levels of water and sanitation coverage.

This report describes the technical basis and rationale for the initial WASH Performance Index. It presents country performance and trends for the overall index and for each of its components –improving water access, water equity, sanitation access, and sanitation equity.

Methods

highlights-1

  • We consulted WASH stakeholders and experts to design the WASH Performance Index.
  • The Index assesses country performance in water access, water equity, sanitation access, and sanitation equity.
  • Country data compiled by the WHO/UNICEF Joint Monitoring Programme (JMP) were used to calculate rates of change for each component.
  • Frontier analysis was used to identify best-in-class performance at different levels of water and sanitation coverage.
  • The most recent rate of change from each country was compared to best-in-class performance among countries at similar levels of water and sanitation coverage to generate a benchmarked value, enabling fair comparison.
  • The index value is the sum of the component benchmarked values.
  • Country trends were calculated for each of the components.
  • We examined associations between component values and country characteristics (e.g. GDP per capita, percent urban, world region as defined by the World Bank) and governance indicators (e.g. government effectiveness, control of corruption, regulatory quality, rule of law).

Consultation
We consulted experts and stakeholders in designing the Index and incorporated feedback from a series of events: a think tank at the University of North Carolina at Chapel Hill (UNC) in March 2014, a workshop at the September 2014 Stockholm International Water Week, and a workshop at the October 2014 UNC Water and Health Conference. At the UNC think tank, nine participants representing WASH stakeholders from multilateral organizations, donors, NGOs and academia recommended that the Index should be simple for clarity of communication and focus on country-level water and sanitation coverage. In preliminary versions of the Index, we considered including input data, such as data on governance from sources such as the UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) report [7]. Think tank participants recommended separating these two types of data to enable comparison. In Stockholm over 30 WASH stakeholders and experts suggested the Index use already-available data and be able designed so as to be able to incorporate future data. At the UNC Water and Health Conference workshop, eight participants suggested the Index align with the indicators and data sources for the Sustainable Development Goals therefore making it ‘future proof’.

Index components
The WASH Performance Index is the sum of country performance values for the following components: water access, water equity, sanitation access, and sanitation equity. The access components use the rate of change of access to an improved water source or sanitation facility, where access is the proportion of the population using improved water or sanitation (i.e. coverage). The equity components use the rate of change of the gap in coverage between rural and urban settings. Countries have a decreasing gap between rural and urban coverage (i.e. increasing equity) or an increasing gap between rural and urban coverage (i.e. decreasing equity) (Figure 1).


Figure 1. Examples of increasing and decreasing equity in access to water and sanitation between rural and urban areas

Frontier Analysis
A country approaching 100% coverage can only improve water and sanitation slowly, while countries at intermediate levels of coverage can often increase coverage more rapidly. This is also seen with other technologies, such as the uptake of mobile phones [8]. When levels of coverage are compared with rates of change, we tend to see rates increasing at low levels of coverage, plateau at intermediate levels of coverage, and slow as they approach 100% coverage. This is illustrated in Figure 2, in which the best-performing countries represent a performance frontier at which best-in-class performance is demonstrated and against which countries at the same level of coverage can be compared.

Frontier analysis, a technique used to study efficiency or best-in-class performance, enables identification of top performing countries. It has been used to measure performance of “decision making units” such as schools, factories, and hospitals and has been applied to measure human rights realization [9, 10].

Methods-2-redo
Figure 2. Country performance on WASH using frontier analysis to describe the performance frontier at which best-in-class performance is achieved

Data sources
Data on improved water sources and improved sanitation facilities were obtained from the WHO/UNICEF Joint Monitoring Programme (JMP). The JMP, the agency charged with international monitoring of drinking water and sanitation, categorizes a drinking-water source as improved if “by nature of its construction or through active intervention, [it] is protected from outside contamination, in particular from contamination with faecal matter”. An “improved” sanitation facility is, “one that hygienically separates human excreta from human contact” [11].

National level data on the proportion of the population with access to improved water and sanitation (coverage points) were obtained from JMP Country Files. The JMP coverage points are compiled from nationally representative sources including Demographic and Health Surveys (DHS), Multiple Indicator Cluster Survey (MICS), World Health Surveys (WHS), and national censuses [12].

Calculation of rates of change
We calculated the line of best fit between each series of three consecutive coverage points for each country (i.e., a three-point moving average). Countries can have more than one rate if they have four or more coverage points – each corresponding to a different time in their development. When there were multiple coverage points from the same year for a country, data for that year were averaged to generate one coverage point. The country rate of change is the slope of the best-fit line. A three-point moving average was selected rather than the slope of all available coverage points to capture change in rate over time. The 2015 Index is based on the most recent three coverage points for each country. This process was performed for each of the components. Data from 212 countries and territories were reviewed from the latest JMP update in 2014 [13]. Country data were excluded if countries achieved 100% coverage or if there were insufficient coverage points (less than three). We were able to calculate rates for 138 countries for water access, 129 for water equity, 133 for sanitation access, and 126 for sanitation equity. An Index value was calculated for each country if values from all four components were available. We were able to calculate Index values for 117 countries.

Calculating the performance frontier and identifying best-in-class performance
We conducted frontier analysis using the FEAR software package in R version i386 3.1.1 [14]. We followed frontier analysis best practice and used the software to identify outliers which were removed when defining the performance frontier [15, 16]. The software used the rates of change from all countries to identify performance frontier points, each representing best-in-class performance.

We used Microsoft Excel® to generate a straight line between the performance frontier points to define best-in-class performance values at any level of coverage. Since countries can no longer improve once they reach 100% coverage or achieve equity, the line defining the performance frontier ended at 100% coverage and 0% rate of change.

Rates of change from years that coincided with or followed within three years of a country’s involvement in an armed conflict (with more than 1000 deaths) were not used in defining the performance frontier. To identify conflict states, we consulted the UCDP/PRIO Armed Conflict Dataset [17]. Conflict states were not assigned a rank for these years, but for reference, they were compared against best-in-class performance. Conflict states are denoted at the bottom of the ranking lists and in the annex (overall index and for each component) with asterisks.

Comparing best-in-class performance between countries
To generate a value for each component that enables country comparison we used the following equation:

Country component value = (country rate) ÷ (best in class performance rate)

This compares country rates to best-in-class performance and generates a value between -1 and 1, enabling fair comparison between countries. Values between 0 and 1 represent progress while values between 0 and -1 represent regression. Values of 1 lie along the performance frontier, reflecting best-in-class performance. Outliers were manually assigned a value of either 1 or -1. We repeated this process for each country and each of the components.

The most recent country component values were used in calculating the 2015 WASH Performance Index.

Trends in performance
While we report the most recent component values for each country, these values change over time. Trends in these values show whether country performance is improving or deteriorating. To examine trends in performance, we calculated the slope of all available values from each country for each component. For all countries where slopes could be calculated, we created three equal groups: either improving, unchanged, or deteriorating. Countries with only one value for any given component were not categorized (listed as “N/A” in tables). Countries with values that tracked along the performance frontier for all available values (i.e. maintaining best-in-class performance over time) were not categorized. Trends were further grouped based on their most recent component value in the 2015 Index. Countries with positive values in the 2015 index (with values between 0 and 1) were grouped and countries with negative values (with values between -1 and 0) were grouped. Trends should be interpreted alongside component values because, for example, a country might have a positive trend but negative component value or vice versa.

Assembling the Index
We followed index best practice and considered each component of the WaSH Performance Index as an equal-weighted value since we have no justification to weight any component more than another [18]. We use the latest country values for each component for the overall Index. For each country, the WaSH Performance Index is the sum of best-in-class performance for water access, water equity, sanitation access, and sanitation equity. Countries without all four components were not ranked.

Correlation between components and country indicators
We assessed correlations between component values and country indicators to explore potential underlying drivers of performance (Table 1). Country characteristics and governance indicators, representing the enabling environment, from publicly available data sets were used [19, 20]. The enabling environment is “a favorable culture of internal coordination and communication; policy and institutional behavior that guides behavior of water and sanitation service providers with clear and enforceable service standards, and resources to provide effective water and sanitation services” [21].

We used the latest available data for each indicator. To assess correlation between components and country indicators, we conducted univariable linear regression analyses for each of the components.

Table 1. Country characteristic and governance indicators

INDICATOR INDICATOR DESCRIPTION
Source: World Development Indicators (2013) [19]
Gross domestic product (GDP) per capita (in 2013 USD) GDP per capita reflects the amount of resources available for investment (in 2013 United States Dollars).
Gross National Income (GNI) per capita GNI is defined as “the sum of value added by all producers who are residents in a nation, plus any product taxes (minus subsidies) not included in output, plus income received from abroad such as employee compensation and property income.”
Under-five mortality rate Under-5 mortality rate is defined as “the probability per 1,000 that a newborn baby will die before reaching age five.”
Primary education Primary education is defined as the number of primary education years completed by the population.
Urban population (% of total) “Urban population refers to people living in urban areas as defined by national statistical offices. It is calculated using World Bank population estimates and urban ratios from the United Nations World Urbanization Prospects.”
World region World region as classified by the World Bank. Regions are Africa, East Asia and Pacific, Europe and Central Asia, Latin America and Caribbean, Middle East and North Africa, and South Asia.
World Bank income classification Classification defined by GNI per capita in 2013. Classifications are: Low-income (less than $1,045), middle-income ($1,045 to 12,746), and high-income ($12,746 or more). Lower-middle-income and upper-middle income economies are separated at a GNI per capita of $4,125.
Source: Worldwide Governance Indicators (2014) [20]
Control of corruption Control of corruption “captures perceptions of the extent to which public power is exercised for private gain, including both petty and grand forms of corruption, as well as capture of the state by elites and private interests.”
Voice and accountability Voice and accountability “captures perceptions of the extent to which a country’s citizens are able to participate in selecting their government, as well as freedom of expression, freedom of association, and a free media.”
Political stability and absence of violence Political stability and absence of violence “measures perceptions of the likelihood of political instability and/or politically motivated violence, including terrorism.”
Governance effectiveness Government Effectiveness (GE) reflects government commitment and effectiveness in implementing programs.
Regulatory quality Regulatory quality “captures perceptions of the ability of the government to formulate and implement sound policies and regulations that permit and promote private sector development.”
Rule of law Rule of law “captures perceptions of the extent to which agents have confidence in and abide by the rules of society, and in particular the quality of contract enforcement, property rights, the police, and the courts, as well as the likelihood of crime and violence.”

Future development of the Index
Data for other proposed SDG targets and indicators such as hygiene, improvements in service levels, water safety, and WaSH in non-household settings are not yet available. Such data will likely be collected and become available within five years [12, 22]. A minimum of three different years of data for these new aspects must be collected so that rates of change can be calculated for the WaSH Performance Index. Data for an indicator can only be included when they are available for a sufficient number of countries. Our initial choice of indicators was influenced by data availability in order to maximize the number of countries we were able to assess. We will also assess whether other indicators of equity, such as the relative levels of access among wealth quintiles, might be added to the Index.

We will update the index and rankings in response to new insights and as new data become available (e.g. from JMP). According to the 2014 JMP report, 106 data sets from 63 countries were added, indicating potential for meaningful updates in the WaSH Performance Index rankings [12].

Country performance in improving water access

highlights-1

  • Country rates of change (progression or regression, percent per year) in access to water were compared to the performance frontier (best-in-class performance) to generate a country value for performance in improving water access.
  • Despite persistently being the region with the lowest water coverage in the world, water access performance among countries in Sub-Saharan Africa varies widely, with both top and bottom performers in the region.
  • Country performance in improving water access is positively associated with the South Asia region, suggesting countries from this region have been performing better as compared to other regions.
  • Top performing countries in improving water access are El Salvador, Mali, Tajikistan, Nepal, Liberia, Nigeria, Sri Lanka, Lao PDR, Maldives, and Thailand.
  • Bottom performing countries are Namibia, Mauritania, the Dominican Republic, Costa Rica, North Korea, Belarus, Ghana, Jordan, the Solomon Islands, and Colombia.

Country rates of change (progression or regression, percent per year) in access to water were compared to the performance frontier (best-in-class performance) to generate a country value for performance in improving water access. Values for water access performance were calculated for 138 countries. Figure 3 summarizes the values.
WA-3-redo
Figure 3. Water access performance: component values by country

In contrast, Figure 4 shows water coverage. Despite persistently being the region with the lowest water coverage in the world, water access performance among countries in Sub-Saharan Africa varies widely, with both top and bottom performers. Identifying characteristics of top performing countries and learning from them may enable more rapid progress among countries. South East Asia has higher performance despite low coverage, while South America has higher coverage but lower performance.

WA-b
Figure 4. Global water coverage by country (percentage)

Figure 5 shows all the rates of change used in defining the performance frontier for water access. Points defining the performance frontier were: Ethiopia (1998), Cambodia (1998), Malawi (1997), Cambodia (2009), Namibia (2001), El Salvador (2007), Armenia (2005), Armenia (2008), and Belarus (2009). Figure 6 shows the latest rates of change from each country.


Figure 5. Performance frontier for water access based on rates of change from all countries and all times


Figure 6. Water access performance: 2015 values

Top and bottom performing countries
Top performing countries for water access performance are El Salvador, Mali, Tajikistan, Nepal, Liberia, Nigeria, Sri Lanka, Lao PDR, Maldives, and Thailand. Bottom performing countries are Namibia, Mauritania, the Dominican Republic, Costa Rica, North Korea, Belarus, Ghana, Jordan, the Solomon Islands, and Colombia.

Mali, a top performing country, has rapidly increased coverage. In 1987, coverage was 26%, passing 40% in the early 2000s and reaching 72% in 2010. Another example is Tajikistan. Despite stagnant coverage from 1999 (61%) to 2003 (62%), Tajikistan has increased access to improved water sources from 62% in 2003 to 77% in 2012.

In contrast, the Dominican Republic has experienced slippage in coverage. From 1996 to 2000, coverage was near 90%. Coverage fell to 85% in 2003 and 79% in both 2007 and 2010. Namibia is experiencing stagnation. While Namibia experienced a rapid increase in access from the early 1990s to the mid-2000s, with coverage increasing from 65% to nearly 90%, in more recent years slipped to 86% in 2004 and 2007 and further down to 82% in 2010.

Among the most populated countries in the world, Nigeria, Pakistan and Mexico were among top performers while India, Bangladesh, and Indonesia were among the bottom performers.

Alphabetical lists of countries with values for all components and trends are available in the Annex.

Correlations
Country performance in improving water access is significantly and positively associated with the South Asia region, suggesting countries from this region have been performing better as compared to other regions. Country performance in improving water access is negatively associated with GDP per capita, though the regression model suggests that changes in GDP are associated with little change in performance.

There were no other significant associations among country characteristics examined.

No governance indicators were associated with water access performance.

Trends in performance
Table 2 shows the trend in country values for water access performance. The trends suggest countries with a positive value vary in whether they improved over time, with a roughly even number of countries improving, unchanged, or deteriorating. Conversely, the majority (60%) of countries with a negative 2015 value deteriorated over time. This suggests, for water access performance, that deterioration is a long-term phenomenon – meaning that countries with negative values continue to deteriorate over time.

Table 2. Trends in country values of water access performance
Water-Access-table-2-redo

Country performance in improving water equity

highlights-1

  • Country rates of change (progression or regression, percent per year) in equity of access to water were compared to the performance frontier (best-in-class performance) to generate a country value for performance in improving water equity. For the 2015 Index we used the gap in rural and urban coverage as our indicator of equity.
  • Country performance in improving water equity is not associated with GDP per capita while the gap in improved water coverage is associated. This suggests the Index enables fair comparison between countries at different levels of water coverage.
  • Top performing countries are Belarus, Sierra Leone, Liberia, Niger, Zimbabwe, El Salvador, Tanzania, Tajikistan, Mongolia, and Uruguay.
  • Bottom performing countries are Burkina Faso, Honduras, Namibia, Jordan, Kyrgyzstan, Mozambique, Gambia, Timor-Leste, Cape Verde, and Djibouti.
  • There were no associations between country performance in improving water equity and the country characteristics or governance indicators we explored.

Country rates of change (progression or regression, percent per year) in equity of access to water were compared to the performance frontier (best-in-class performance) to generate a country value for performance in improving water equity. For the 2015 Index, we used the gap in rural and urban coverage as our indicator of equity. Values for country performance in improving water equity were calculated for 129 countries. Figure 7 summarizes the values by country.

WE-a
Figure 7. Water equity performance: component values by country

Figure 8 shows all of the rates of change used in defining the performance frontier for water equity. Points defining the performance frontier were Ethiopia (2001), Mauritania (1995), Bolivia (2000), Uruguay (2007), and Belarus (2011). Figure 8 shows the latest rates of change from each country.


Figure 8. Performance frontier for water equity based on rates of change from all countries and all times

WE-9
Figure 9. Water equity performance: 2015 values

Top and bottom performing countries
Top performing countries for performance in improving water equity are Belarus, Sierra Leone, Liberia, Niger, Zimbabwe, El Salvador, Tanzania, Tajikistan, Mongolia, and Uruguay. Bottom performing countries are Burkina Faso, Honduras, Namibia, Costa Rica, Jordan, Kyrgyzstan, Mozambique, Gambia, Timor-Leste, Cape Verde, and Djibouti.

Among the most populated countries in the world, Pakistan, Nigeria, and China were among top performers while Bangladesh, Philippines, and Mexico were among the bottom performers.

Alphabetical lists of countries with values for all components and trends are available in the Annex.

Correlations
County performance in improving water equity is not significantly associated with any of the governance indicators or country characteristics, including GDP per capita (Figure 10). In contrast, there is a positive association between GDP per capita and the gap in coverage (Figure 11). This suggests the water equity performance is a fair comparison between countries at different levels of coverage.

WE-h
Figure 10. Water equity performance versus GDP per capita (log)

WE-j
Figure 11. Water coverage equity vs. GDP per capita (log)

Trends in performance
Table 3 shows the trend in country values for water equity performance. The trends suggest countries with a positive value are more likely to have improved over time (35%) rather than deteriorate. Conversely, 47% of countries with a negative value deteriorated over time rather than improved. This suggests, for water equity performance, that improvement and deterioration are long-term phenomena – suggesting that countries with positive values continue to improve over time while countries with negative values continue to deteriorate over time.

Table 3. Trends in country values of water equity performance


Country performance in improving sanitation access

highlights-1

  • Country rates of change (progression or regression, percent per year) in access to sanitation were compared to the performance frontier (best-in-class performance) to generate a country value for performance in improving sanitation access.
  • Country performance in sanitation access is significantly and positively associated with the South Asia region, suggesting countries from this region are performing better (progressing more rapidly).
  • Top performing countries are Jordan, Malawi, Egypt, Uzbekistan, South Africa, China, Tanzania, Jamaica, Nepal, and Sri Lanka.
  • Bottom performing countries are Ghana, Sierra Leone, Costa Rica, Timor-Leste, Vanuatu, Democratic Republic of the Congo, Belarus, Thailand, Samoa, and Estonia.

Country rates of change (progression or regression, percent per year) in access to sanitation were compared to the performance frontier (best-in-class performance) to generate a country value for performance in improving sanitation access. Values for sanitation access performance were calculated for 133 countries. Figure 12 summarizes the values.

SA-a
Figure 12. Sanitation access performance: component values by country

Figure 13 shows sanitation coverage by country. While coverage is low across much of Sub-Saharan Africa, sanitation access performance is often better depending on the country. Many countries in South East Asia and South America also have better performance than coverage.

SA-b
Figure 13. Global sanitation coverage by country (percentage)

Figure 14 shows all the rates of change used in defining the performance frontier for sanitation access. Points defining the performance frontier were Niger (1995), Cambodia (1996), Mozambique (2008), Rwanda (2002), Thailand (1990), Bosnia and Herzegovina (2007), Jordan (2006), Estonia (2006), and Estonia (2007). Figure 15 only shows the latest rates of change from each country.

SA-14
Figure 14. Performance frontier for sanitation access performance based on rates of change from all countries and all times

SA-15
Figure 15. Sanitation access performance: 2015 values

Top and bottom performing countries
Top performing countries for sanitation access performance are Jordan, Malawi, Egypt, Uzbekistan, South Africa, China, Tanzania, Jamaica, Nepal, and Sri Lanka. Bottom performing countries are Ghana, Sierra Leone, Costa Rica, Timor-Leste, Vanuatu, Democratic Republic of the Congo, Belarus, Thailand, Samoa, and Estonia. Among the most populated countries in the world, China, Pakistan, and Bangladesh were among top performers while the Philippines, Nigeria, and Russia were among the bottom performers.
Alphabetical lists of countries with values for all components and trends are available in the Annex.

Alphabetical lists of countries with values for all components and trends are available in the Annex.

Correlations
Country performance in improving sanitation access is negatively associated with under-five mortality rate. Performance is also positively associated with the South Asia region, suggesting countries from this region have been performing better (progressing more rapidly) as compared to other regions.

Trends in performance
Table 4 shows the trend in country values for sanitation access performance. The trends suggest countries with a positive value are more likely to be improving over time (36%) rather than deteriorating. Conversely, the majority (54%) of countries with a negative value were deteriorating over time rather than improving. This suggests, for sanitation access performance, that improvement and deterioration are long-term phenomena.

Table 4. Trends in sanitation access performance

Country performance in improving sanitation equity

highlights-1

  • Country rates of change (progression or regression, percent per year) in equity of access to sanitation were compared to the performance frontier (best-in-class performance) to generate a country value for performance in improving sanitation equity. For the 2015 Index we used the gap in rural and urban coverage as our indicator of equity.
  • Country performance in improving sanitation equity was significantly positively associated with governance indicators including control of corruption, government effectiveness, regulatory quality, and rule of law. This suggests governance may be an underlying driver of country performance in improving sanitation equity.
  • Country performance in improving sanitation equity was significantly positively associated with the Middle East and North Africa region, suggesting countries from this region have better performance.
  • Top performing countries are Egypt, Niger, Estonia, Jordan, Ukraine, South Africa, Chile, Pakistan, Fiji, and Uzbekistan.
  • Bottom performing countries are Vanuatu, Botswana, Mauritania, Samoa, India, Belarus, Central African Republic, Burundi, Timor-Leste, and Tanzania.

Country rates of change (progression or regression, percent per year) in equity of access to sanitation were compared to the performance frontier (best-in-class performance) to generate a country value for performance in improving sanitation equity. For the 2015 Index we used the gap in rural and urban coverage as our indicator of equity. Values for sanitation equity performance were calculated for 126 countries. Figure 16 summarizes the values.

Figure 17 shows all the rates of change used in defining the performance frontier for sanitation equity which is also shown. Points defining the performance frontier were: Niger (2007), Malawi (2008), India (2000), Paraguay (1999), South Africa (2008), Mexico (2002), Bosnia and Herzegovina (2001), Egypt (2006), Estonia (2011), and Estonia (2009). Figure 18 only shows the latest rates of change from each country.

SE-a
Figure 16. Sanitation equity performance: component values by country

SE-17
Figure 17. Performance frontier for sanitation equity based on rates of change from all countries and all times

SE-18
Figure 18. Sanitation equity performance: 2015 values

Top and bottom performing countries
Top performing countries for sanitation equity performance are Egypt, Niger, Estonia, Jordan, Ukraine, South Africa, Chile, Pakistan, Fiji, Uzbekistan, and Palau. Bottom performing countries are Vanuatu, Botswana, Mauritania, Samoa, India, Belarus, Central African Republic, Burundi, Timor-Leste, and Tanzania. Among the most populated countries in the world, Pakistan, Nigeria, and Indonesia were among top performers while the Philippines, Brazil, and India were among the bottom performers.

Although India defined the performance frontier in 2000 (suggesting best-in-class performance), their most recent performance indicates that they are a bottom performing country despite the recent launch of the “Clean India Mission” by Prime Minister Modi. This demonstrates that performance can vary over time.

Alphabetical lists of countries with values for all components and trends are available in the Annex.

Correlations
Country performance in improving sanitation equity is associated with control of corruption, government effectiveness, regulatory quality, and rule of law. These results highlight the importance of governance and its role in establishing an enabling environment, and their contribution to progress in sanitation equity.

In terms of country characteristics, performance is positively associated with both GDP and GNI per capita and strongly negatively correlated with income group. Sanitation equity performance is significantly higher in the Middle East and North Africa region as compared to other regions. It is also significantly associated with countries that have a larger urban population.

Trends in performance
Table 5 shows the trend in country values for sanitation equity performance. The trends suggest countries with a positive value are more likely to be increasing over time (47%) rather than deteriorating. Conversely, 39% of countries with a negative value deteriorated over time rather than improving. This suggests improvement and deterioration are long-term phenomena.

Table 5. Trends in country values of sanitation equity performance
SE-table-5

Sanitation-equity-latest-6

Country comparison: the WaSH Performance Index rankings and trends

highlights-1

  • The WaSH Performance Index is the sum of country performance values in the following components: water access, water equity, sanitation access, and sanitation equity.
  • Among most top performing countries, neither water nor sanitation dominated the overall Index value, suggesting improvements in water and sanitation do not necessarily come at the expense of the other.
  • Among the most populated countries in the world, Pakistan, China, and Nigeria were top performers (ranked 5, 11, and 18 respectively). Conversely, Russia, the Philippines and India were bottom performers (ranked 72, 83, and 92 respectively).

The WaSH Performance Index is the sum of country performance values in the following components: water access, water equity, sanitation access, and sanitation equity. Each of the components ranges from -1 to 1 meaning the overall WaSH index value can range from -4 to 4.

Figure 19 summarizes the values. The WaSH Performance Index was calculated for 117 countries (i.e. 117 countries had values for all four index components). Tables 6 and 7 list the countries with the top ten and bottom ten values. Values range from -1.34 to 2.6, which is much smaller than the range of possible values (-4 to 4).

Figure 19. WaSH Performance Index values by country

Top and bottom performing countries
The top ten and bottom ten countries are a surprising group. Low levels of coverage are often clustered in certain regions – for example, water access is low in sub-Saharan Africa while sanitation access is low in South and Southeast Asia. In contrast, performance values appear to be spread widely within regions. This suggests that country-specific factors, such as the enabling environment, may be driving performance and regions as a whole are not constrained to perform poorly.

Among countries with top ten values, two are low income, five are lower middle income and three are upper middle income. Among countries with bottom ten values, three are low income, five are lower middle income, and two are upper middle income. Top performing countries are located in all world regions with the most from South Asia (n = 4) and Sub-Saharan Africa (n = 2). Among bottom ten countries, three are from East Asia and the Pacific, and four are from Sub-Saharan Africa. A few countries are under-represented in the JMP data sets that we used, notably highly industrialized countries with very high coverage rates (as data may not be collected) and small island developing nations (as few have nationally representative household surveys).

Table 6. Top ten countries in the 2015 WaSH Performance Index

Table 7. Bottom ten countries in the 2015 WaSH Performance Index

Among the most populated countries in the world, Pakistan, China, and Nigeria were top performers (ranked 5, 11, and 18 respectively). Russia, the Philippines and India were bottom performers (ranked 72, 83, and 92 respectively).

Trends in performance
Tables 8 and 9 show the trend of components for the top ten and bottom ten countries. Six of the top ten have improving trends over time for all components. Conversely, seven of the bottom ten have an unchanged or deteriorating trend for all components. Tables 6 through 9 show that among most top performing countries, neither water nor sanitation components dominated the overall Index value, suggesting improvements in water and sanitation do not necessarily come at the expense of the other.

Table 8. Trend in performance among the top ten countries
Index-table

Table 9. Trend in performance among the bottom ten countries
Index-table-2


What does the WaSH Performance Index mean for
policy and practice?

highlights-1

  • The WASH Performance Index provides national policy makers with a new instrument to inform investment decisions and identify aspects of water and sanitation access and equity in need of targeted improvement.
  • The Index provides potential for convergence of human development and human rights policy in the Sustainable Development Goal period.
  • For the human rights community, the Index enables objective and comparable assessment of progressive realization.
  • The Index informs finance ministers, donors, practitioners, and investors on the types of investments to make – for example, in infrastructure, governance or both.
  • This first version of the Index shows its potential use for the WaSH sector by offering insights on country performance and identifying relationships between country performance and governance factors.
  • We will continue to update and refine the Index based on feedback from stakeholders to improve utility.

The WASH Performance Index generates further value from water and sanitation coverage data available from the JMP by assessing country rates of change in access and equity and benchmarking these rates to best-in-class performance. Countries at different levels of water and sanitation coverage are thereby compared fairly, which enables ranking of performance.

Our results indicate that, with few exceptions, there are no significant associations between most country characteristics, such as GDP per capita, and performance on water and sanitation access and equity. Thus even countries with limited resources can make great strides in both advancing water and sanitation and progressively realizing the human right to water and sanitation. It also suggests that the index is “fair,” in that it fairly compares countries across different levels of water and sanitation coverage.

There are associations between country performance in improving sanitation equity and governance factors, such as low corruption, government effectiveness, regulatory quality, and rule of law. These results suggest the importance of governance in establishing an enabling environment and accelerating achievement of equity.

The WaSH Performance Index has implications for policy, decision-making, advocacy, accountability, human rights, and WaSH investment targeting.

What the Index means for policy and decision-making

  • The Index enables evidence-based decision-making to identify country strengths and weaknesses with respect to performance on water and sanitation access and equity.
  • The WaSH Performance Index provides national policy makers with a new instrument to inform investment decisions and identify aspects of water and sanitation access and equity in need of targeted improvement.

What the Index means for advocacy, accountability, and human rights

  • The WaSH Performance Index addresses some of the norms of the human right to water and sanitation and it is one of the first instruments capable of quantitatively assessing progressive realization. Future versions of the Index will address additional human rights norms as more data become available.
  • The WaSH Performance Index fairly compares country performance, which enables countries at different levels of water and sanitation coverage to be compared and ranked. Rankings encourage healthy competition between countries and behavior change to drive improvements.
  • For the human rights community, the Index enables objective and comparable assessment of progressive realization.
  • The Index values should be useful for human rights treaty organizations that conduct country reviews.

What the Index means for WASH investment targeting

  • The Index enables finance ministers, donors and investors to make decisions about WaSH investment targeting. Figure 20 illustrates how the component values could inform decision-making.
  • Lower-performing countries may represent opportunities for more active efforts to improve the enabling environment and reform programs to enhance performance and achieve more rapid progress on water and sanitation access and equity.
  • High-performing countries (countries with high component values) and low levels of water and sanitation coverage represent opportunities for investments in infrastructure programs to move toward universal access to water and sanitation.
  • Countries with high performance and intermediate coverage may focus their efforts on service quality improvements – for example, to piped water at home and toilets with piped sewer system.
  • Countries approaching 100% coverage may focus investments in upgrading services and targeting under-served populations.

Implication-b
Figure 20. Using the WaSH performance index as a decision tool: an example with sanitation access performance

Conclusion
The first version of the WaSH Performance Index shows its potential use for the WaSH sector by offering insights on country performance. The Index provides potential for convergence of human development and human rights policy related to WaSH in the Sustainable Development Goal period. It identifies relationships between country performance and underlying drivers, such as governance. We will continue to update and refine the Index based on stakeholder feedback to improve utility.

WaSH Performance Index and trends: alphabetical by country


References
1. Bartram, J. and S. Cairncross, Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med, 2010. 7(11): p. e1000367.
2. Bartram, J., et al., Global monitoring of water supply and sanitation: history, methods and future challenges. Int J Environ Res Public Health, 2014. 11(8): p. 8137-65.
3. Bradley, D.J. and J.K. Bartram, Domestic water and sanitation as water security: monitoring, concepts and strategy. Philos Trans A Math Phys Eng Sci, 2013. 371(2002): p. 20120420.
4. Gleick, P.H., The human right to water. Water policy, 1998. 1(5): p. 487-503.
5. United Nations, International covenant on economic, social and cultural rights. 1966, UN New York.
6. United Nations General Assembly, A/RES/64/292. July 2010.
7. Bain, R., et al., Global assessment of exposure to faecal contamination through drinking water based on a systematic review. Trop Med Int Health, 2014. 19(8): p. 917-27.
8. Bartram, J., et al., Lack of toilets and safe water in health-care facilities. Bulletin of the World Health Organization, 2015. 93(4): p. 210-210.
9. Cronk, R., T. Slaymaker, and J. Bartram, Monitoring drinking water, sanitation, and hygiene in non-household settings: Priorities for policy and practice. Int J Hyg Environ Health, 2015.
10. WHO/UNICEF, Proposal for consolidated drinking water, sanitation and hygiene targets, indicators and definitions. 2013: Geneva and New York.
11. World Health Organization and UNICEF, Water, sanitation and hygiene in health care facilities: status in low and middle income countries and way forward. 2015: Geneva, Switzerland.
12. Meier, B.M. Legal Accountability for Human Rights Implementation through United Nations Treaty Bodies: Examining Human Rights Treaty Monitoring for Water and Sanitation. in 142nd APHA Annual Meeting and Exposition (November 15-November 19, 2014). 2014. APHA.
13. Hannemyr, G., The Internet as hyperbole: A critical examination of adoption rates. Information Society, 2003. 19(2): p. 111-121.
14. Fukuda-Parr, S., T. Lawson-Remer, and S. Randolph, An Index of Economic and Social Rights Fulfillment: Concept and Methodology. Journal of Human Rights, 2009. 8(3): p. 195-221.
15. Luh, J., R. Baum, and J. Bartram, Equity in water and sanitation: developing an index to measure progressive realization of the human right. Int J Hyg Environ Health, 2013. 216(6): p. 662-71.
16. WHO/UNICEF. WHO/UNICEF Joint Monitoring Programme: defintions and methods. 2014; Available from: http://www.wssinfo.org/definitions-methods/.
17. WHO/UNICEF, Progress on Drinking Water and Sanitation: 2014 Update. 2014: Geneva, Switzerland and New York, NY, USA.
18. WHO/UNICEF Joint Monitoring Programme. Country Files. 2014; Available from: http://www.wssinfo.org/documents/?tx_displaycontroller%5Btype%5D=country_files.
19. Wilson, P.W., FEAR: A software package for frontier efficiency analysis with R. Socio-economic planning sciences, 2008. 42(4): p. 247-254.
20. Andrews, D.F. and D. Pregibon, Finding the outliers that matter. Journal of the Royal Statistical Society. Series B (Methodological), 1978: p. 85-93.
21. Wilson, P.W., Detecting outliers in deterministic nonparametric frontier models with multiple outputs. Journal of Business & Economic Statistics, 1993. 11(3): p. 319-323.
22. Gleditsch, N.P., et al., Armed conflict 1946-2001: A new dataset. Journal of Peace Research, 2002. 39(5): p. 615-637.
23. Nardo, M., et al., Handbook on constructing composite indicators: methodology and user guide. 2005, OECD publishing.
24. World Bank. World Development Indicators. 2013; Available from: http://info.worldbank.org/governance/wgi/index.aspx#home
25. World Bank. Worldwide Governance Indicators. 2014; Available from: http://info.worldbank.org/governance/wgi/index.aspx#home.
26. Amjad, U., et al., Rethinking Sustainability, Scalability, and Enabling Environment: A Framework for Their Implementation in Drinking Water Supply. Water, 2015.