A report from the WHO and UNICEF’S Joint Monitoring Programme for drinking water and sanitation (JMP) warns that far too few people are using improved sanitation and the number with access to clean drinking water has actually fallen.

The JMP report, titled 'Progress on drinking water and sanitation - special focus on sanitation', assesses for the first time global, regional and country progress using an innovative ‘ladder’ concept showing sanitation practices in greater detail so that experts can highlight trends.

The report found that the number undertaking the risky practice of open defecation dropped from 24% in 1990 to 18% in 2006.There are also disparities between rural and urban dwellers in particular - worldwide, there are four times as many rural dwellers without improved water sources compared to around 137 million urban dwellers.

Ann M Veneman, UNICEF’S executive director, warned: ‘At current trends, the world will fall short of the Millennium sanitation target by more than 700 million people. Without dramatic improvements, much will be lost.’

However, the report found that more and more people are using improved sanitation. One key aim is to highlight the risk of open defecation. Dr Margaret Chan, WHO’s director-general, said: ‘We have today a full menu of low-cost technical options for the provision of sanitation in most settings. More and more governments are determined to improve health by bringing water and sanitation to their poorest populations. If we want to break the stranglehold of poverty, and reap the multiple benefits for health, we must address water and sanitation.’

Many southern African countries have made real improvements in access to safe drinking water, the report says, and seven of the ten making the best progress - Burkina Faso, Namibia, Ghana, Malawi, Uganda, Mali and Djibouti - are on target to meet the MDG. Five countries not on track to meet the target but still making rapid progress are in sub-Saharan Africa - Benin, Cameroon, Comoros, Mali and Zambia.