The situation for drinking water appears better than that for sanitation. Although around 13% of the world's population (884 million people) lives in households where water is collected from distant, unprotected sources, 54% (3.6 billion) receives piped water at home. However, many piped water systems in developing and middle income countries work for only a few hours per day and/or are unsafe. In larger Asian cities, for example, more than one in five water supplies fails to meet national water quality standards. Reliable safe water at home prevents not only diarrhoea but guinea worm, waterborne arsenicosis, and waterborne outbreaks of diseases such as typhoid, cholera, and cryptosporidiosis.
Much of the impact of water supply on health is mediated through increased use of water in hygiene. For example, hand washing with soap reduces the risk of endemic diarrhoea, and of respiratory and skin infections, while face washing prevents trachoma and other eye infections. A recent systematic review of the literature confirmed that hygiene, particularly hand washing at delivery and postpartum, also helps to reduce neonatal mortality. It might be argued that water supplies also make flush toilets feasible, but this does not necessarily add to their health benefits, as we have seen no credible evidence that the health benefits of sanitation cannot be achieved by dry latrines, if they are properly built and maintained.
Privatisation is being promoted as a solution to the current dire state of services; evidence shows, however, that this is not a panacea, especially where expectations of African governments and the private sector incentives do not align. In order for the continent to achieve its economic potential, increase growth, and progress from being an exporter of raw materials to a producer of finished goods, service delivery must improve.