A study by the African Development Bank (AfDB) concludes that improved sector coordination and capacity building at the local level are some of the key elements to increase efficiency in the water and sanitation sector.
The AfDB study  examines the trends in access to water and sanitation in sub-Saharan Africa using secondary data, desk research and field research conducted December 2008 and March 2009 in Burkina Faso, Kenya, Madagascar and Uganda. The case studies are based on primary data collected from Water and Finance Ministries, as well as from meetings and interviews with beneficiaries of AfDB-funded water and sanitation projects.
At the current pace, the study calculated that access-to-water target of the Millennium Development Goals (MDGs) will only be met in 2040, and the access-to sanitation target in 2076.
Between 2002 and 2007, aid allocation to water and sanitation projects increased from 0.9 percent of overall Official Development Assistance (USD 218 million) to 1.5 percent (USD 472 million). The AfDB loan and grant approvals in the water and sanitation sectors increased from UA 67 million (3.3 percent of total) in 2002 to UA 211 million (6.8 percent of total) in 2007. Over the same period, disbursements grew from UA 52 million to UA 109 million per year.
Country experiences indicate that the following elements are key to increasing efficiency in the water and sanitation sector:
- Improved sector coordination, with assignment of clear responsibility to one ministry accountable for progress in the achievement of water and sanitation targets;
- Increased integration between policy making, planning, budgeting and monitoring and evaluation;
- Increased focus on capacity building, especially at the local level, and for all stages of water and sanitation projects – from planning to procurement, to execution, monitoring and maintenance;
- Promotion of linkages among stakeholders, including government bodies and donors, and civil society organisations.
Experience further shows that countries that adopt well-designed water utility reforms are substantially improving access to services and making progress in financial capacity to sustain and expand the services.
Successful types of reforms include:
- The introduction of improved institutional frameworks, including the establishment of laws, rights, and licenses,
and the definition of clear responsibilities of different actors
- The introduction of mechanisms for effective participation of stakeholders, and knowledge and information systems;
- The development and management of an infrastructure for annual and multi-year flow regulation – for floods and droughts, for multi-purpose storage, and for water quality and source protection;
- The use of operating contracts between the utility and the public agency responsible for supervising water companies;
- The establishment of clear accountability systems and the introduction of performance incentives for employees;
- The introduction of improved commercial systems, including metering and metered billing;
- The introduction of explicit models for delivering services to poor consumers, accounting for service sustainability and integrating the specificities of the local context.
 Stampini, M., Salami, A. and Sullivan, C. (2009). Development aid and access to water and sanitation in sub-Saharan Africa. (Development research brief ; no. 9). Tunis, Tunisia, Development Research Department, African Development Bank. 4 p. Download full text [PDF file]