Water, health and a rapidly urbanising Africa

As a continent, Africa is rapidly urbanizing and urban areas are expected to experience a growth rate of 3.9% through to 2050 (Bahri et al, 2016). Much of this growth is projected to occur in smaller towns with limited infrastructure and therefore new water supplies will be required (Bahri et al, 2016; South African Cities Network, 2014). Densification and increasing populations in existing suburbs, as well as changing lifestyles, have led to increased water consumption (Popkin, 2006).  More prevalent impervious landscapes magnify runoff, increasing stormwater flows and flooding in urban areas (Roberts, 2010).

In South Africa, urban growth has resulted in growing housing and service backlogs (Fatti and Patel, 2013; Muller, 2007). In 1994, housing backlogs were estimated to be 1.5 million, in 2011, 1.9 million and by 2017, these were estimated to be 2.3million (Wilkinson, 2014; Msindo, 2018). In 2017, Statistics South Africa estimated that 13.6% of households in South Africa lived in informal dwellings (Statistics South Africa, 2017). A significant proportion of households (11%) did not have a water supply on their premises (Statistics South Africa, 2017). There are also sanitation backlogs with 18% of households in South Africa in 2017 deemed to have substandard toilet facilities such as chemical toilets, pit latrines without vents, or bucket or ecological sanitation (Statistics South Africa, 2017).

Existing ageing water infrastructure has not always been maintained adequately leading to significant losses through leakage (South African Cities Network, 2014; SAICE 2011; Wensley and Mackintosh, 2015; Bahri et al, 2016).

An adequate supply of clean water is essential for health and productivity. Education performance and learner health in schools have been linked to the quality of water and sanitation (Jasper et al, 2012; Cheng and Hong, 2004). Similarly, Haines et al (2000) show that poor water supplies result in inadequate hydration, reduced mental capacity and urinary tract infections. Increased absenteeism and illnesses have also been associated with a lack of water for handwashing (Freeman et al, 2012).

Unsafe water and hygiene have been identified as a leading cause of morbidity in South Africa (National Planning Commission, 2011; the Lancet, 2009). Risks are particularly high for under-5-year-olds where 9.3% of deaths are attributed to unsafe water, sanitation and hygiene (Lewin et al, 2007).

Universal reliable water supplies are, therefore, a focus of United Nations’ Sustainable Development Goals (SDGs) and South Africa’s National Development Plan (NDP).