In many cases, the lack of basic services comes down to government's poor management of money.
The South African Human Rights Commission (SAHRC) has described the lack of access to clean water and adequate sanitation in the country as a potential "national crisis".
A report by the organisation found that, as far as the provision of water is concerned, 38% of South Africa's municipalities are at a high risk of crisis and 9% are already in crisis, putting their inhabitants at risk of contracting disease.
In the Madibeng local municipality, for example, diarrhoea is recurrent, especially among children, because neither the water supplied erratically by the municipality nor the water delivered by trucks is of an adequate standard.
In January, four people died in the Madibeng townships of Damonsville and Mothutlung during clashes with the police following protests over the supply of water in January.
This week was marked by fresh protests over sanitation and water in areas such as Mbombela, Bushbuckridge, Tshwete and Pienaar.
A department of water affairs report published in 2012 said that access to sanitation is increasing at a rate of 300 000 households a year but "the sanitation sector is faced with ongoing growth of formal and informal settlements, particularly in urban areas, due to rural-urban migration, population growth and the influx of foreign nationals".
But the increased provision of sanitation has been slow in the past two years "as there has been a lack of co-ordination between different departments and tiers of government," the SAHRC head of research, Karam Jeet Singh, said this week.
"The provision of basic services is a local government competency, happening in communities with no tax base. In many cases, local government has no resources to provide these resources.
"Sometimes local authorities get bulk grants from the government but they just don't know how to spend and they misallocate the funds, which is a polite way of saying there's corruption."
Singh said that water and sanitation must be one of the government's top five priorities because the right to them is linked to other rights.
"Improper toilets become a safety issue, especially for women.
"In schools with no proper toilets, it becomes an issue about the rights to education. If government were to prioritise it, there could be a co-ordinated response from the top.
"By no means are we saying it is a simple issue. The issue of new informal settlements is real but it can't be removed from other issues. It needs to be reprioritised so that it can be dealt with in a co-ordinated fashion," Singh said.
It is estimated that, at 2011's prices, about R45-billion was required to provide basic services and upgrade existing infrastructure, but the total grant to municipalities in the 2011-2012 financial year was R41-billion.
But the municipalities are also unable to spend their infrastructure grants.
Sabelo Mthantatho, a senior researcher of the Financial and Fiscal Commission, said that a lack of capacity and a failure to follow procurement regulations, which often led to service providers not delivering services of an acceptable standard, were largely responsible for underspending.
"Take the rural household infrastructure grant, for example, where conventional sanitation methods can't be used. That fund has experienced significant underspending since it was introduced in the 2010-2011 financial year."
Only 66.7% of that year's R100-million allocation was spent and, in the following financial year, only 72.8% of the R258-million allocation was spent. There was significant spending between February and March 2011 (R52-million), which raised the suspicion of "fiscal dumping".
"If a new grant is in the system," Mthantatho said, "you find that the beneficiaries are not aware or not sure how to use it, which is usually a lack of capacity."
The report also found the implementation of government's programmes for the very poor to be lacking.
"The issue there is that there are low levels of literacy – people don't know their rights – so you won't get the required levels of registration," Singh said. "If we got the required levels of response from the department of social development then people would know how to use it."
According to data from the web-based data and intelligence service Municipal IQ, over the past 10 years, North West has accounted for 10% of all protests, with 42% of them related to water.
Kevin Allan, the managing director of Municipal IQ, said this week that painting a picture of broad failure in municipal delivery was an overstatement and that delivery has generally improved.
"In metros, delivery is broadly very good, notwithstanding significant population growth.
"The problem is with smaller municipalities and a number of delinquent municipalities. In these, capacity is poor – they can't spend their money and thus can't deliver.
"Also, we can't generalise about protests and nondelivery. While protests are often because of poor delivery, in metros, which experience many protests, delivery is good and protests rather reflect frustration in pockets of poverty, which are often on the periphery of municipalities and where people feel deprived relative to neighbouring, more established suburbs, wards or communities."
Waste not: Adequate sanitation and clean water are basic rights. Photo:David Harrison
What price economic growth without water?
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.
International nongovernmental organisation WaterAid said in its report, From Promise to Reality, that 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 Garratt, 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, and more than 100-million go without clean drinking water. About 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.
Garratt 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 track progress.
WaterAid said 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, said 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 said. – Claire Provost © Guardian News & Media 2014