High-risk water and sanitation practices: evidence of underreporting from eight countries

Water and sanitation indicators in the erstwhile Millennium Development Goals (MDGs) failed to capture high-risk practices such as unimproved water consumption and open defecation undertaken on a regular basis. In conjunction with local partners, we used a mobile platform to implement representative randomized household surveys in eight countries across Asia and Africa (n=245,054) to quantify the presence and magnitude of such underreporting. Our study identified the use of high-risk practices as a regular option to be greater than their use as the main option. Across the study areas, this consistent underreporting amounted to 26 million (unimproved water) and 50 million (open defecation) people not being targeted for suitable policy interventions. A deeper analysis of Ghana shows poor and rural households are more likely to engage in high-risk practices. Current metrics inflate water and sanitation progress, and need to be adapted for the complex world we live in.