Millions of people in southern Africa still lack access to latrines and clean drinking water, says WaterAid.

The majority of southern Africans are living in an “unrelenting struggle against sanitation and water poverty,” according to a new report that accuses governments in the region of failing to prioritise their plight.

In From promise to reality, the international NGO WaterAid says southern African leaders have fallen behind on their promises to boost public spending on basic services, with the poorest and most vulnerable people hardest hit.

“There is a lot of economic growth in the region… but this is bypassing much of the population,” said John Garrett, senior policy analyst at WaterAid, contrasting the optimism over southern Africa’s economic prospects with the region’s lagging progress on clean water and sanitation targets.

An estimated 174 million people in southern Africa – almost two thirds of the total population – lack access to basic latrines, while more than 100 million go without clean drinking water. Some 120,000 children under the age of five die every year in the region from diarrhoea caused by unsafe water and sanitation.

WaterAid says progress in increasing access to services in southern Africa has been “stubbornly slow” since 1990. In some cases levels of access are “stalling or even falling”.

A major increase in resources is needed, particularly in rural areas, it says.

Garrett said sanitation and hygiene have been particularly neglected, with some governments casting these as private issues best left for households and families to address. Where money is available, it often appears to be directed primarily to urban centres at the expense of rural areas.

In 2008, African governments signed the eThekwini declaration committing to spend at least 0.5% of their GDP on sanitation and hygiene, and to put in place separate budget lines to improve accountability and help track progress.

WaterAid says no government in southern Africa has met the spending target.

The NGO’s report, which is based on case studies from Madagascar, Malawi, Mozambique, Swaziland, and Zambia, says increased revenue from natural resources should make it easier to fund basic services.

But governments do not always benefit enough from their natural resources and there is little transparency over how that money is spent, it says.

It points out that the Seychelles, for example, which has near universal access to water and sanitation, received 50 times as much aid per person as the Democratic Republic of the Congo, which is off-track for both targets and has almost 47 million people without basic sanitation.

The report says governments and aid donors should better prioritise how they spend their money on water and sanitation and commit to ambitious new goals for 2030.

As part of the agreement for what succeeds the millennium development goals (MDGs), which expire in 2015, countries should sign up to achieving universal access to basic drinking water, sanitation, and hygiene by 2030, the report says.

It also calls for a “major drive on affordable housing” across southern Africa and for governments to adopt comprehensive housing plans.

The world met the millennium development goal target to halve the proportion of people without access to improved water sources in 2010 – five years ahead of the 2015 deadline – though deep disparities remain.

In 2011, an estimated 768 million people remained without access to an improved source of drinking water – more than 40% live in sub-Saharan Africa.

Meanwhile, 2.5 billion people lack access to improved sanitation facilities worldwide.

Of the 15 countries in the Southern Africa Development Community, only seven are expected to meet the MDG target on clean drinking water.

Just three – Angola, Botswana, and the Seychelles – are on-track to meet the target to halve the proportion of people without access to basic sanitation by 2016.

This article origninally appeared on The guardian and can be viewed here http://www.theguardian.com/global-development/2014/mar/03/southern-africa-leaders-failing-prioritise-water-sanitation