P
ost-apartheid South Africa can lay claim to having substantially increased
access to piped drinking water for all. Virtually all urban households and
most rural households now have access to piped drinking water, with
the remaining deprived communities located in more remote rural areas and
in urban informal settlements. While drinking water may not necessarily be safe
(or consistently available) in rural communities, there has been no recurrence of
waterborne epidemics on the scale of the cholera epidemic of 2000–2001. However,
child under-five diarrhoea case fatality rates indicate ongoing health issues in rural
communities deprived of water services.
Water-related health issues are emerging due to conditions of water stress and climate
change. Constraints on supply call for greater water re-use and better management
of treatment plants to ensure river health and safe drinking water. The process of
eutrophication is degrading water and habitat quality, and the results are difficult to
treat. With climate change, existing microbial diseases could become more prevalent
which is especially disturbing as water treatment plants are discharging insufficiently
treated effluent into rivers. Contamination of groundwater and surface water from
acid mine drainage requires specialised treatment. All of these factors indicate the
need for improved water and health management, with greater surveillance of water
quality and the delivery of universal water services to ensure health and prevent
disease outbreaks.
The water-related Sustainable Development Goals extend the range of commitment
beyond access to basic water services, and include improved water quality, enhanced
water use and re-use and better water-related ecosystems. These commitments will
demand a well-integrated approach and close public monitoring.