By: Katherine Edelen on August 31, 2015 Water and sanitation are two sides of the same development coin. In development and UN speak, they are rarely discussed separately. These days, the UN simply uses the acronym WASH (Water, Sanitation and Hygiene) when referring to this issue. But even though they are not disaggregated as separate issues in official circles these days, that was not always the case. When the Millennium Development Goals were created in 2000, there were two separate targets for water and sanitation. And as a result, progress toward these goals was highly uneven. While the goal of halving the portion of those was without access to safe drinking water was met in 2010, boasting 91% improved global water source coverage, the MDG sanitation target will not be attained until 2026 based on projections, making it one of the worst executed MDG agenda items. But more importantly, the gains have largely been unequal, with urban areas far outperforming rural areas and the least developed countries lagging behind other developing nations, translating to the poorest and most marginalized still going without access. Lack of proper sanitation and access to clean drinking water remains to be a lethal and poverty-inducing circumstance, responsible for 80% of deaths in the developing world and more than 4 billion cases of diarrhea worldwide. Of the 3.8 billion cases that do not result in death, many will suffer from extreme dehydration, reducing retention of micronutrients necessary for healthy childhood development and cognitive function. The interruption of cognitive function severely disrupts an individual’s ability to learn and focus, limiting the impacts of educational interventions. This is but one example of how gains in water and sanitation can magnify and compound the dividends of other development agendas, suggesting the foundational importance of addressing global water and sanitation needs. The past two decades have seen vast improvements in the area of water and sanitation, with nearly 2.1 billion people gaining access to improved sanitation facilities and 2.6 billion now using improved drinking water source since 1990, with the greatest gains made in Eastern Asia. These gains have largely come from a global recognition of how sustainable access to water and sanitation drastically improve health, education, security, dignity, and aid in reducing poverty. However, contaminated water and unsanitary conditions continue to threaten human security and development, and governments’ and donors’ interventions have left stark inequalities. Unwillingness to prioritize the poor in water and sanitation interventions has resulted in uneven and unjust results. Eight out of ten people still lacking access to safe drinking water live in rural areas. And unlike their more affluent counterparts, the least developed countries did not achieve the sanitation goal, with only 27% of their population having access to improved basic sanitation services since 1990. The situation is much more dire in states fragile and conflict-riddled states, where just over a quarter of these countries will attain the safe drinking water MDG. Failure to target investment towards those that need it most stems from misallocation of aid resources due to political interests and a dearth of information needed to make plans and decisions. Currently, USAID water and sanitation expenditure does not reflect global priorities of aiding the most vulnerable, with $74 million of its WASH budget going to countries with more than 80% water and sanitation coverage and only $51 million going to countries with less than 20% access. In other words, most of the funding is not going to the places that need it the most. Yet progress has been made. At the end of last year, Congress unanimously passed and President Obama signed into law H.R. 2901 Senator Paul Simon Water for the World Act of 2014. The bill seeks to improve USAID’s focus on, and accountability to, the poorest of the poor and the countries and communities suffering most from water-related diseases. Not only does it codify and elevate water leadership roles in USAID and the State Department, but it also sets criteria and deadlines for the development of a comprehensive and coordinated strategy that transparently justifies prioritization, resource allocation, and program development of water and sanitation interventions. These are the types of reforms that will go a long way in addressing the huge imbalances in water and sanitation aid distribution and perhaps enhance our ability as a global community to achieve the next set of Sustainable Development Goals over the next 15 years. But this will require the U.S. and other donor countries to prioritize the development and implementation of these type of aid reforms that look to prioritize the least developed, most marginalized, poorest, and those most estranged to the political process, and that will take political will.