From poverty to power - Oxfam-Québec

FROM POVERTY TO POWERDespite some positive results, the dogmatic insistence of aiddonors that only privatisation will improve water provision (discussedin Part 5) has led to sharp price rises, excluding poor people andtriggering at least one ‘water war’ of protest, in Bolivia. The polariseddebate over privatisation has sidelined the more necessary discussionof how to ensure access for poor people and communities. Publicproviders, who still deliver over 90 per cent of water in developingcountries, include both dismal failures and outstanding success stories.Learning the lessons of good public sector reform is a vital part ofdelivering water to poor people.Sanitation is often given little attention in national debates, due toa taboo on public discussion of the topic, leading to less spending.In Malawi, for example, while government spending on health andeducation has grown as a share of GDP, spending on water andsanitation has declined. 41Like education and health care, water and sanitation services are afocus of grassroots activism, via self-help initiatives and efforts toconvince authorities to act. Some of the greatest progress has come inIndia and Pakistan, where slum dweller associations have helped tobring sanitation to millions of people. Success on water and sanitationin countries such as China, India, Lesotho, and Brazil show that one ofthe keys is developing demand for sanitation, rather than pursuing‘top down’ engineering solutions. Progress lies in the interactionbetween citizens’ movements and effective states.CONTROL OVER FERTILITYOne essential service is rarely considered vital by government plannersor economists, and is therefore most often overlooked: reproductiveand sexual health care. If women are to realise their full human rights,and nations are to ensure broader health and well-being, women mustbe able to decide what happens to their own bodies in terms of sexualityand child-bearing. Failure to provide reproductive and sexual healthcare, and to uphold women’s access to these services, accounts for nearlyone-fifth of illness and premature death, and one-third of the illnessand death of women of reproductive age. 42 Control over fertility, alongwith economic opportunity,women’s education,and changes in attitudesand beliefs, is central to ending discrimination against women.46