Monday, January 11, 2016

Toilets Can Work: Short and Medium Run Health Impacts of Addressing Complementarities and Externalities in Water and Sanitation

Poor water quality and sanitation are leading causes of mortality and disease in developing countries. However, interventions providing toilets in rural areas have not substantially improved health, likely because of incomplete coverage and low usage. This paper estimates the impact of an integrated water and sanitation improvement program in rural India that provided household-level water connections, latrines, and bathing facilities to all households in approximately 100 villages. The estimates suggest that the intervention was effective, reducing treated diarrhea episodes by 30-50%. These results are evident in the short term and persist for 5 years or more. The annual cost is approximately US$60 per household.
75% of India’s surface water is polluted by human and agricultural waste and industrial effluents. Reports say lack of sanitation is the key reason for child malnutrition
... In India, open defecation is still practiced by 65% of the rural population and only 14% of the rural population have piped in water to the household (WHO-UNICEF 2014). By some estimates, lack of safe water, inadequate sanitation, and poor hygiene practices cause 1.1 million deaths from diarrhea each year, representing 1.5% of the global burden of disease (Prüss-Ustün et al. 2014).... Open defecation in India may be responsible for approximately 9% of total infant mortality, or 6.5 deaths per 1,000 infants per year (Geruso and Spears 2015).
Swachh Bharat proposes to provide toilets to all 110 million rural households that currently do not have one, at a cost of US$ 22.0 billion (Ministry of Rural Development 2014, Ministry of Drinking Water and Sanitation 2014)....
Reviews typically estimate that nearly 90% of deaths preventable by improvements to water,  sanitation and hygiene are in the fecal - oral  group (Prüss-Üstün et al. 2008).
The total cost of implementing RHEP in a typical village of 50 households was approximately US$60 per household per year, as compared to annual household consumption of approximately US$740. Of this $60 annual cost, we estimate that annual maintenance costs are about $11 with the annuitized value of the upfront capital cost accounting for the remainder.
The approximate construction cost per household is $440 with annual maintenance costs of roughly  $11. Assuming an interest rate of 10% per year and given the intended useful 20-year life of the tank and sanitary facilities, the equivalent annuity cost is approximately $58 per household per year. 

by Esther Duflo, Michael Greenstone, Raymond Guiteras and Thomas Clase
National Bureau of Economic Research (NBER)
NBER Working Paper No. 21521; Issued in September 2015

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