Better hygiene and access to drinkingwater and sanitation will accelerate progress toward twomillennium development goals (MDGs): 'reduce under-fivechild mortality rate by 2/3 between 1990 and 2015' and"by 2015 halve the proportion of people withoutsustainable access to safe drinking water and basicsanitation". Meeting the latter goal will requireinfrastructure investments of about US$23 billion per year,to improve water services for 1.5 billion more people(292,000 people per day) and access to safe sanitation for2.2 billion additional people (397,000 per day). Watersupply, sanitation, and hygiene are about more than health.Saved time, particularly for women and children, is a majorbenefit. Beneficiaries of water and sanitation projects inIndia reported these benefits: less tension/conflict inhomes and communities; community unity, self-esteem,women's empowerment (less harassment) and improvedschool attendance (Water Aid 2001). Improved hygiene (handwashing) and sanitation (latrines) have more impact thandrinking water quality on health outcomes, specificallyreductions in diarrhea, parasitic infections, morbidity andmortality, and increases in child growth (Esrey et al 1991;Hutley et al 1997). Most endemic diarrhea is notwater-borne, but transmitted from person to person by poorhygiene practices, so an increase in the quantity of waterhas a greater health impact than improved water qualitybecause it makes it possible (or at least more feasible) forpeople to adopt safe hygiene behaviors (Esrey et al 1996).
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