A SNAPSHOT OF 2015 UPDATE SANITATION AND HYGIENE IN EAST ASIA AND THE PACIFIC 2015 REGIONAL ANALYSIS AND UPDATE

A SNAPSHOT OF 2015 UPDATE SANITATION AND HYGIENE IN EAST ASIA AND THE PACIFIC 2015 REGIONAL ANALYSIS AND UPDATE

Overview The East Asia and Pacific Region has made gains over the last 25 years: Use of improved sanitation increased by 27 percentage points between 1990 and 2015, almost than double the rate of increase of the world as a whole 770 million more people in the region use improved sanitation in 2015 than in 1990, the majority of them in China, which has made very good progress Four % of the regional population, or 83 million people, practice open defecation However, significant challenges remain: Seven countries in the region made limited or moderate progress and did not meet the MDG sanitation target Five countries are still below 50% coverage levels (Cambodia, Kiribati, Papua New Guinea, Solomon Islands and Timor-Leste) 519 million people are still without access to improved sanitation Progress in the Pacific sub-region is stagnant: the proportion of people using improved sanitation has increased by just 2% in 25 years Outside of China, open defecation rates in the region are still high at 10% Coverage disparities are pronounced in the region, with improved sanitation coverage ranging from less than 40% of the population in some countries (Papua New Guinea, East Asia World Total and the Pacific Solomon Islands) to more than 90% in 9 countries (e.g., Fiji, Malaysia, Thailand and Tonga) Coverage is also highly inequitable within countries: richer households and urban dwellers are much more likely to use improved sanitation than poorer and rural households Handwashing with soap rates are lower in rural areas and much lower in poor households in some countries A new global analysis of access to sanitation in schools shows that the East Asia and Pacific region lags behind global averages, and that progress is slow Information about this Snapshot Regional and World Sanitation Coverage Trends This snapshot is produced by the UNICEF Regional Office for East Asia and the Pacific Unless otherwise indicated, data in this snapshot is from the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation 2015 dataset, the latest available (see page 13 for full citations and credits) The UNICEF East Asia and Pacific Region encompasses 27 countries; 12 in East Asia and 15 in the Pacific (*UNICEF regions differ slightly from JMP and MDG regions: see last page for listing) A Snapshot of Sanitation and Hygiene in East Asia and the Pacific 2015 Update 2

Progress and Challenges Six countries have significant open defecation problems Seven countries made only limited or moderate progress on the MDG target Sanitation MDG Gap in Countries with Limited or Moderate Progress Proportion of population practicing open defecation, 2015 and 2010, in the six EAP countries still above the Developing World average of 16% Sanitation coverage varies significantly from country to country Gap between 2015 coverage and sanitation target. Note that other countries missed the target but made good progress, including Cambodia, Philippines and Vanuatu. Region Improved sanitation coverage in East Asia and Pacific countries, 2015, national, per cent, with Region and World comparators A Snapshot of Sanitation and Hygiene in East Asia and the Pacific 2015 Update 3

Sanitation Inequities Urban-rural coverage gaps are shrinking in East Asia and the Pacific Despite progress there continues to be substantial disparity in some countries The rural-urban sanitation gap in the East Asia and Pacific Region has shrunk from 30 percentage points in 1990 (70% urban, 40% rural) to 22 points in 2015 (86% urban, 64% rural), smaller than the global gap of 31 points Fiji, Indonesia, Palau, and the Philippines have made the best progress reducing the urban-rural sanitation gap; however, the gap has actually increased substantially in Cambodia, from 19 percentage points in 2000 to 58 in 2015 The gap in the Pacific sub-region is very high (50 percentage points) and has hardly improved since 1990 (51 points). Urban Rural Urban-rural disparity varies significantly, and has increased in some countries Urban-rural gap, 2015 Gap increase since 1990 Improved sanitation: urban-rural range in East Asia and the Pacific Countries, 2015 (in Thailand, urban coverage at 90% is lower than rural coverage at 96%) plus gap increase since 1990 (red = greater gap in 2015 than in 1990) A Snapshot of Sanitation and Hygiene in East Asia and the Pacific 2015 Update 4

Economic inequities are also significant in the region, with widening gaps Disparities in improved sanitation coverage between rich and poor households in rural areas are pronounced in the region (see four examples below) The gap between poorest and richest rural households is 70 per cent or more in some countries, including Indonesia and Lao PDR (shown below) Of even greater concern is the fact that the gaps between the poorest and richest households are getting wider in some countries, including in Indonesia and PDR Lao, and in Viet Nam and Cambodia (not shown): in these countries not enough progress has been made increasing sanitation usage among the poorest households Use of improved sanitation, rural, by household wealth quintile, per cent, in 1995 and 2012. Source: JMP analysis based on multiple MICS, DHS and other surveys, JMP Update Report 2015. A Snapshot of Sanitation and Hygiene in East Asia and the Pacific 2015 Update 5

Regional and country averages mask large disparities within countries These equity tree examples from Cambodia and Philippines illustrate the levels and types of disparities in sanitation, as compared to national, regional and global averages. Cambodia A tall equity tree, ranging from 5% to 100% coverage Philippines A smaller gap between the richest and poorest Use of Improved sanitation. Source: JMP 2015 (2012 estimates for wealth quintile data, 2015 for all other figures) A Snapshot of Sanitation and Hygiene in East Asia and the Pacific 2015 Update 6

Child Faeces Disposal Practices The safe disposal of child faeces is just as important as the disposal of adult faeces for the prevention of diarrhoea, however it is common in the region (and globally) for child faeces to be unsafely disposed of. Most households do not dispose child faeces safely In all regional countries with available data, child faeces are usually disposed of unsafely (left in the open, buried in the courtyard, or thrown in a ditch or drain) instead of safely (child uses toilet, or faeces disposed of in toilet/latrine). Sanitation coverage is lower among children than the population at large: Philippines example Only 16 percent of children under the age of three defecated or had their faeces put into an improved toilet or latrine, compared to 74 percent of the population at large using improved latrines/toilets. Wealth quintile variation: Cambodia example Richer households are much more likely to dispose of child faeces correctly, and not only because of the greater availability of toilets in these households (see below). Availability of toilets is not the only factor: Indonesia example As expected, households with improved sanitation facilities are more likely to dispose of child faeces correctly. However, even in households with improved toilets, child faeces are disposed of unsafely in many cases. The proportion of children aged under three with safe feces disposal reported in MICS and DHS surveys. Source: Management of Child Feces: Current Disposal Practices, June 2015, WSP and UNICEF. A Snapshot of Sanitation and Hygiene in East Asia and the Pacific 2015 Update 7

Handwashing with Soap and Water Handwashing with soap varies by country but is always more common in urban areas Handwashing with soap, per cent, using standardized MICS/DHS proxy indicator: Percentage of households where a place for handwashing was observed with soap and water. Source: latest DHS and MICS surveys. Handwashing with soap disparities by household wealth varies from country to country Handwashing with soap, per cent, using standardized MICS/DHS proxy indicator: Percentage of households where a place for handwashing was observed with soap and water. Source: latest DHS and MICS surveys. A Snapshot of Sanitation and Hygiene in East Asia and the Pacific 2015 Update 8

Sub-Regional Analysis Outside of China: Slower progress, High open defecation rates China accounts for 68 per cent of the population of the East Asia and Pacific region, and thus trends in China have a significant impact on WASH averages in the region as a whole When taken separately, certain key WASH indicators are quite different in the region outside of China than in China, notably in the area of rate of progress and open defecation The proportion of people practicing open defecation in the region outside of China is 10 per cent, just under the world average of 13 per cent (most of whom are in Indonesia, which has the second largest number of open defecators in the world: 52 million) Most new sanitation users since 1990 in the region are in China Outside of China, open defecation levels in the region are high Number of people who gained access to improved sanitation from 1990 to 2015, millions Population practicing open defecation in EAP not including China and in China, % and millions, 2015 Pacific Sub-Region: Low coverage, Slow progress, Off-track At 31 per cent, sanitation coverage in the Pacific sub-region (14 Small Island Nations and Papua New Guinea) is low, about the same as coverage in Sub Saharan Africa (30%) The situation is not improving: coverage increased by just two per cent in the sub-region from 1990 to 2015 Sanitation coverage, percent, 2015 in the Pacific sub-region, the EAP region and the world A Snapshot of Sanitation and Hygiene in East Asia and the Pacific 2015 Update 9

Coverage (%) Average Sanitation Coverage (%) Sanitation in Schools Sanitation in schools is a cause for concern Average sanitation coverage in schools in the region is 8 percentage points lower than global averages Trends are flat: sanitation coverage has increased by just 2% in five years (from 2008 to 2013) There is significant disparity in coverage between and within countries Average sanitation coverage in schools (61%) is actually lower than coverage in households (67%) Evidence shows that poor school WASH coverage has a negative impact on education achievement, health outcomes and gender equality (see pg. 10 for sources on the evidence base for school WASH) Regional coverage and progress lags behind the global average 80 60 40 20 0 2008 2013 59 61 East Asia and Pacific Sanitation coverage in schools, average of 19 EAP countries vs. global average, 2008 and 2013. 63 Global 69 School sanitation is inadequate in many countries in the region 100 100 100 100 95 81 80 66 62 64 60 69 72 60 53 52 53 47 45 40 23 20 10 4 0 61 Percentage of schools with sanitation facilities, national and 19 country region average (no data for 8 countries), 2013. Data may or may not take into account criteria such as the ratio of students to toilets available, privacy, gender segregation and functionality, depending on the country. Source: figures on this page are from Advancing WASH in schools monitoring, 2015, UNICEF A Snapshot of Sanitation and Hygiene in East Asia and the Pacific 2015 Update 10

Sanitation Coverage in East Asia and the Pacific Improved sanitation coverage in East Asia and Pacific countries, 2015, national. Only countries in the UNICEF East Asia and Pacific region are shown. This map does not reflect a position by UNICEF on the legal status of any country or territory or the delimitation of any frontiers. Sources and Notes This document is the 2015 annual update of the original 2012 snapshot. Main sanitation dataset: from Progress on Drinking Water and Sanitation: 2015 Update (with supplemental data from wssinfo.org), from the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation Country-specific DHS data: from published Demographic and Household Surveys available at measuredhs.com, from USAID and national statistics bureaus. Country-specific MICS data: from published Multiple Indicator Cluster Surveys available at childinfo.org, from UNICEF, other UN agencies and national statistics bureaus School data from: Advancing WASH in schools monitoring, 2015, UNICEF For evidence on the benefits of WASH in Schools see: Jasper C., Le T.-T., Bartram J. (2012). Water and Sanitation in Schools: A Systematic Review of the Health and Educational Outcomes. International Journal of Environmental Research and Public Health. 9(8):2772-2787. UNICEF (2012). Raising even more clean hands: Advancing health, learning and equity through WASH in Schools. http://www.unicef.org/wash/schools/files/raising_even_more_clean_hands_web_17_october_2012(1).pdf Cover photo credits, clockwise from top left: UNICEF/Chin 11/Za Lyan, UNICEF Viet Nam/2014/Truong Viet Hung, UNICEF/2012/Dean, UNICEF Philippines/2014/Gray UNICEF does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Acknowledgements UNICEF thanks Greg Keast, who developed and produced this snapshot under the guidance of Chander Badloe, UNICEF East Asia and the Pacific. Thanks also to the reviewers and contributors to the snapshot series: Almud Weitz from the Water and Sanitation Program; James Wicken from WaterAid; Hilda Winartasaputra from Plan International; and Robert Bain, Ramesh Bhusal, Therese Dooley, Nguyen Thanh Hien, Libbet Horn-Phathanothai, Dara Johnston, Janine Kandel, Rolf Luyendijk, Nadarajah Moorthy, Henk van Norden, Marjolein Oijevaar, Marc Overmars and David Parker from UNICEF. UNICEF acknowledges the financial support from DFAT for making this 2015 update possible. A Snapshot of Sanitation and Hygiene in East Asia and the Pacific 2015 Update 11

Sanitation Coverage Data Country estimates by type of sanitation practice, 1990, 2015 Country Cambodia China Cook Islands DPR Korea Fiji Indonesia Kiribati Lao PDR Malaysia Marshall Islands Micronesia Mongolia Myanmar Nauru Niue Palau Papua New Guinea Philippines Samoa Solomon Islands Thailand Timor-Leste Tokelau Tonga Tuvalu Vanuatu Viet Nam Region Year Total Population (x 1,000) Improved Shared Urban Rural National Other Unimproved Open Defecation Improved Shared Other Unimproved Open Defecation Improved Shared Other Unimproved 1990 9,057 19 3 13 65 0 0 6 94 3 0 8 89 2015 15,677 88 12 0 0 30 7 3 60 42 8 3 47 1990 1,165,429 68 5 24 3 40 2 49 9 48 3 42 7 2015 1,401,587 87 6 7 0 64 3 31 2 76 5 18 1 1990 18 - - - - - - - - - - - - 2015 21 - - - - - - - - 98-1 1 1990 20,194 - - - - - - - - - - - - 2015 25,155 88 6 6 0 73 3 24 0 82 5 13 0 1990 728 85 4 10 1 37 2 53 8 57 3 35 5 2015 893 93 5 2 0 88 5 7 0 91 5 4 0 1990 178,633 61 8 12 19 24 6 21 49 35 7 18 40 2015 255,709 72 10 5 13 47 12 12 29 61 11 8 20 1990 71 43 9 4 44 20 2 14 64 28 5 10 57 2015 106 51 11 18 20 31 3 17 49 40 7 17 36 1990 4,245 - - - - - - - - - - - - 2015 7,020 94 4 1 1 56 2 5 37 71 3 3 23 1990 18,211 90 4 5 1 83 4 5 8 86 4 6 4 2015 30,651 96 4 0 0 96 4 0 0 96 4 0 0 1990 47 77 11 10 2 41 9 29 21 65 10 17 8 2015 59 84 12 2 2 56 13 10 21 77 12 4 7 1990 96 49-46 5 9-80 11 19-72 9 2015 104 85-10 5 49-40 11 57-33 10 1990 2,184 65 31 3 1 - - - - - - - - 2015 2,923 66 32 1 1 43 30 0 27 60 31 0 9 1990 42,123 - - - - - - - - - - - - 2015 54,164 84 13 2 1 77 11 6 6 80 12 4 4 1990 9 66 31 2 1 NA NA NA NA 66 31 2 1 2015 11 66 31 0 3 NA NA NA NA 66 31 0 3 1990 2 - - - - - - - - - - - - 2015 1 - - - - - - - - 100-0 0 1990 15 63-37 - 8-92 - 46-54 - 2015 21 100-0 0 100-0 0 100-0 0 1990 4,158 62 10 25 3 13 3 66 18 20 4 60 16 2015 7,632 56 9 31 4 13 3 71 13 19 3 67 11 1990 61,949 69 17 7 7 46 12 19 23 57 14 14 15 2015 101,803 78 19 0 3 71 18 1 10 74 18 1 7 1990 163 94 5 1 0 92 6 2 0 93 6 1 0 2015 193 93 5 2 0 91 6 3 0 91 6 3 0 1990 312 - - - - - - - - - - - - 2015 584 81-10 9 15-19 66 30-16 54 1990 56,583 89 10 0 1 86 4 0 10 87 5 0 8 2015 67,401 90 10 0 0 96 4 0 0 93 7 0 0 1990 751 - - - - - - - - - - - - 2015 1,173 69 17 7 7 27 6 31 36 41 9 24 26 1990 2 NA NA NA NA - - - - 45 2 53-2015 1 NA NA NA NA - - - - 90 5 5-1990 95 97 1 2-94 1 5-94 1 5-2015 106 98 1 1-89 1 10-91 1 8-1990 9 75 8 15 2 71 4 18 7 73 6 16 5 2015 10 86 9 3 2 - - - - - - - - 1990 147 - - - - - - - - - - - - 2015 264 65 33 1 1 55 15 28 2 58 20 20 2 1990 68,910 65 4 7 24 29 2 26 43 36 2 23 39 2015 93,387 94 5 1 0 70 4 25 1 78 5 16 1 1990 1,634,142 70 6 19 5 40 3 41 16 49 4 34 13 2015 2,066,655 86 7 5 2 64 6 24 6 76 6 14 4 Open Defecation Source: Source: Progress on Drinking Water and Sanitation: 2015 Update (with supplemental data from wssinfo.org), from the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation UNICEF East Asia and Pacific Regional Office (EAPRO) September 2015 19 Phra Atit Road, Bangkok, 10200 Thailand Website: Email: Twitter: http://www.unicef.org/eapro/ asiapacificinfo@unicef.org twitter.com/unicefasiapac A Snapshot of Sanitation and Hygiene in East Asia and the Pacific 2015 Update 12