This year’s World Water Day of March 22, themed “water for all”, took place just five days after the third electoral debate that covered health issues. Thus it is timely to evaluate our task ahead on ensuring water is accessible and safe for all.
As we witnessed in the March 17 presidential debate, the discourse on health raised the question on balancing the quality of health services for all with the cumulative high costs borne by the nation. The answers of both vice-presidential candidates Ma’ruf Amin, running with President Joko “Jokowi” Widodo, and Sandiaga Uno, running with Prabowo Subianto, focused on more efficient governance of the healthcare system as well as disease prevention. Unfortunately, no one touched on the environmental factors that cause a large number of diseases of which the treatment is covered by our universal healthcare system.
Poor health is strongly associated with water pollution. The Global Burden of Diseases study in 2015 found that 1.8 million premature deaths across the world were related to water pollution. According to a study in Indonesia led by former health minister Nafsiah Mboi in 2016, skin and diarrheal diseases were significant causes of reduced life expectancy.
Diarrheal diseases are still prevalent among children living in poor environments in Indonesia according to other studies. Unimproved latrines and untreated drinking water are strongly associated with rural communities and urban slums. While only 6 percent of people in Jakarta lack access to proper sanitation, in rural Papua the number reaches 98 percent, as cited by the World Bank in 2016.
Stunting, an example used by Ma’ruf in the debate, has also been associated with inadequate sanitation and water supply. Consistent with the Lancet’s Commission on Pollution and Health finding in its 2018 report, pollution-related health problems disproportionately hit the poor and vulnerable, especially children affected by pollution before birth.
Improvements in the distribution of safe drinking water and sanitation have progressed slowly despite the economic growth in recent decades. Twenty-seven million people in Indonesia lack access to clean water and 51 million lack proper sanitation. Public Works and Housing Ministry reports state that progress has only reached 62 percent for proper sanitation projects and 72 percent for drinking water projects. This rate is slower than other infrastructure projects entrusted to the ministry. Achieving the target would cost the state Rp 275 trillion (US$19.38 billion).
Even when piped water is available, some surveys show worrying water quality. In Yogyakarta, two of three drinking water samples were contaminated with fecal bacteria. Pollution of shallow groundwater is reported in all large cities across Java, while in Jakarta one of two samples were contaminated by fecal coliform and 4 of 5 samples by E. coli.
The quality of our water sources needs immediate improvement. In 2017, the Environment and Forestry Ministry reported 52 percent of Indonesia’s monitored water was heavily polluted, a good improvement from the previous year’s 68 percent but still high. However, the 2017 data came from only 100 sampling points, mostly rivers.
The Environment and Forestry Ministry still fell short of its target of calculating the pollution load in 15 priority rivers. To date, only the load from 7 out of 15 rivers has been calculated, while systematic programs addressing pollution such as from industrial discharges remain unrealized. Some of these heavily polluted rivers are the only sources of water for the surrounding communities.
Studies have shown that sanitation and drinking water access should go hand in hand for better health protection.
Additionally, we can only provide safe water supply economically if water sources are of good quality, thus reducing treatment costs. Restoring the quality of our water sources is a matter of political commitment, which sadly was not highlighted, let alone specified, in all three debates.
The Lancet Commission on Pollution and Health has summarized the best practice for combating pollution, which is considerably cheaper than paying for its health impact. The health goals related to water must not be separated from environmental goals of improving the quality of our natural waters.
While improving sanitation and access to safe drinking water must continue, the next government might consider reviewing and expanding successful small facilities and focusing on the most vulnerable. Finally, a solid financial strategy to sustainably finance the work also needs to be determined, especially in this era of increasing water shortages.
Despite our progress, we still need to move toward the Sustainable Development Goals and do our homework around water issues before it gets worse and too costly to address. World Water Day is a reminder not to forget old, rustic, water pollution and sanitation issues. For the next presidential term, this uphill challenge will remain. (MQ)