According to the Joint Monitoring Programme report, Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment, released today by the UN Children’s Fund (UNICEF) and the World Health Organization (WHO), one in every three, or 2.4 billion people on the planet, are still without sanitation facilities – including 946 million people who defecate in the open.

“Until everyone has access to adequate sanitation facilities, the quality of water supplies will be undermined and too many people will continue to die from waterborne and water-related diseases,” Dr. Maria Neira, Director of the WHO Department of Public Health, Environmental and Social Determinants of Health said in a joint press release.

Access to adequate water, sanitation and hygiene is critical in the prevention and care of 16 of the 17 ‘neglected tropical diseases’ (NTDs), including trachoma, soil-transmitted helminths (intestinal worms) and schistosomiasis. NTDs affect more than 1.5 billion people in 149 countries, causing blindness, disfigurement, permanent disability and death.

And the practice of open defecation is linked to a higher risk of stunting – or chronic malnutrition – which affects 161 million children worldwide, leaving them with irreversible physical and cognitive damage, according to WHO.

Plans for the proposed new sustainable development goals (SDGs) to be set by the UN General Assembly in September 2015 include a target to eliminate open defecation by 2030. This would require a doubling of current rates of reduction, especially in South Asia and sub-Saharan Africa, WHO and UNICEF say.

Sanjay Wijesekera, head of UNICEF’s global water, sanitation and hygiene programmes, said what the data really show is the need to focus on inequalities as the only way to achieve sustainable progress.”

In other words, “the global model so far has been that the wealthiest move ahead first, and only when they have access do the poorest start catching up. If we are to reach universal access to sanitation by 2030, we need to ensure the poorest start making progress right away,” Mr. Wijesekera said.

Access to improved drinking water sources has been a major achievement for countries and the international community.

With some 2.6 billion people having gained access since 1990, 91 per cent of the global population now have improved drinking water – and the number is still growing. In sub-Saharan Africa, for example, 427 million people have gained access – an average of 47,000 people per day every day for 25 years, according the a press release on the report.

On the other hand, the progress on sanitation has been hampered by inadequate investments in behaviour change campaigns, lack of affordable products for the poor and social norms which accept or even encourage open defecation.

Although some 2.1 billion people have gained access to improved sanitation since 1990, the world has missed the MDG target by nearly 700 million people. Today, only 68 per cent of the world’s population uses an improved sanitation facility – 9 percentage points below the MDG target of 77 per cent.

WHO and UNICEF say it is vitally important to learn from the uneven progress of the 1990-2015 period to ensure that the new development agenda closes the inequality gaps and achieves universal access to water and sanitation.