ECONOMIC BENEFITS FROM WATER, SANITATION AND HYGIENE PROMOTION

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ECONOMIC BENEFITS FROM WATER, SANITATION AND
HYGIENE PROMOTION

• Presentation at Annual Seminar for District
  Directors of Health Services, Uganda
• Jo Smet
• IRC International Water and Sanitation Centre
• Kampala, 25 May 2006

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Content overview

• Dar es Salaam, 1982
• Hygiene improvement framework
• Barriers of water/sanitation disease transmission
• Measuring cost effectiveness
• Effectiveness WASH interventions
• Cost benefit for water and sanitation
• Economic benefits WASH
• WASH and livelihoods
• Some cost effective WASH approaches

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Hygiene Improvement Framework
WSSSC, 2005
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Disease transmission and control
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Latrine as disease barrier
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Effects of different WASH interventions
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Example of overview of WASH impact studies
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Measuring effectiveness of WASH

• Cost effectiveness analysis show which
  interventions in a particular sector are most
  beneficial
• Disability-Adjusted Life Years (DALY) estimations
  widely used in health sector to determine cost
  effectiveness
• DALY method measures reduction in morbidity and
  mortality from specific intervention
• Effectiveness is expressed as amount spent (US)
  per case of illness averted, death averted and
  averted DALY
• Most WASH programmes do NOT measure cost
  effectiveness yet!
• The use of DALY for WASH is not recommended
  non-health benefits are NOT considered, and WASH
  has delayed effects

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WASH and DALY

• WHO data on the burden of disease shows that
  approximately 3.1 of deaths (1.7 million) and
  3.7 of
• disability-adjusted-life-years (DALYs) (54.2
  million) worldwide are attributable to unsafe
  water, sanitation
• and hygiene.
• In Africa 4 8 of all disease burden is
  attributable to unsafe WASH.
• Over 99.8 of all the deaths attributable to
  these factors occur in developing countries and
  90 are deaths of children

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DALY of Hygiene Promotion versus other health
interventions

• A recent report states
• adding hygiene promotion is particularly
  efficient and effective in reducing morbidity and
  mortality from child diarrhoea
• a 1996 study
• USD21 per DALY saved through Hygiene Promotion
• against USD 24 for oral rehydration therapy
• and USD15 35 for expanded immunization

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WASH generating economic benefits

• Each 1 invested in WASH would yield an economic
  return of between 3 and 34 (depending on
  region) (WHO)
• Households with improved WASH services suffer
  less morbidity and mortality from water- and
  sanitation-related diseases. Global figure 10
  reduction in diarrhoeal episodes. Health-related
  cost reduction 7.3 billion/year
• WASH services close to home significant time
  savings
• WASH at home and schools more educational
  opportunities for women and girls

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WASH generating economic benefits (more)

• WASH creates new economic, productive
  opportunities extra household income may result
  in better health
• Better WASH services may remove a barrier for
  tourism development

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The cost of inaction!

• Some examples only
• 1992 cholera outbreak in Peru due to poor
  sanitation and inadequate disinfection of
  drinking water.
• Loss 34 GNP due to drop in tourism and fish
  exports.
• Plus US 1 billion due to lost income and
  additional health costs this is 10x national
  budget on water supply and sanitation (WHO et al,
  2004)
• 2005 cholera outbreak in Iran.
• Government ban on growing and selling green
  vegetables cost local farmers at least US 55.5
  million (Source Weekly, 7 Sept 2005)
• Sewage-polluted seas
• health impact on bathers and shellfish eaters
  approx. US 12-24 billion/year (WHO et al, 2004)

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Cost-benefit ratios for water sanitation
investment

• Cost benefit ratios for water and sanitation
  investment in WHO sub-region 2 (AFR-E) for
  different interventions

Adapted from Hutton and Haller, 2004
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Types of interventions

• African countries with very high adult, high
  child mortality, .i.e.
• Botswana, Burundi, Central African Republic,
  Congo, Côte d'Ivoire, Democratic Republic of the
  Congo, Eritrea, Ethiopia, Kenya, Lesotho, Malawi,
  Mozambique, Namibia, Rwanda, South Africa,
  Swaziland, Uganda, United Republic of Tanzania,
  Zambia, Zimbabwe.
• Interventions
• ? Intervention 1- Millennium targets halving the
  proportion of people who do not have access to
  improved water sources by 2015, with priority
  given to those already with improved sanitation.
• ? Intervention 2 - Millennium targets with
  sanitation targets halving the proportion of
  people who do not have access to improved water
  sources and improved sanitation facilities, by
  2015.
• ? Intervention 3 - Access for all to improved
  water and improved sanitation.
• ? Intervention 4 - A minimum of water disinfected
  at the point of use for all, on top of improved
  water and sanitation services.
• ? Intervention 5- Access for all to a regulated
  piped water supply and sewage connection into
  their houses.

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Cost Benefit ratio for sanitation

• Cost-benefit ratio for sanitation using
  pessimistic and optimistic scenarios Adapted
  from ERM, 2005

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WASH and livelihoods cycles
Improved WASH conditions
Better health and physical fitness for work
Economic productivity enhanced
Upgrade of Immediate environment
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Direct and indirect economic benefits from
diarrhoeal disease reduction
Source Hutton and Haller, 2004, 17
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Sanitation and livelihoods potentials

• The potentials for improved Livelihoods through
  affordable, safe and sustainable sanitation
• ? Better health from safe disposal of pathogenic
  human waste
• ? Better crops from applying decomposed human
  waste rich in nutrients on fields
• ? Better nutritional status of family members
  from better harvests
• ? More income from excess harvest used for food
  and well-being
• ? Better harvest because less sick days and so
  more productive days
• ? Less expenditure on hospital/doctors visits
  and medicine
• Better education and career future because less
  sick days at school
• (Borba and Smet, forthcoming)

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EcoSan Human waste as a resource
Source Werner, 2003 (GTZ-EcoSan)
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ArborLoo and Manure use
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EcoSan-economic benefits

• Provision of valuable nutrients (N, P, K), mostly
  from urine (80 of nitrogen, 55 of phosphorus
  and 60 of potassium)
• for rural and urban agriculture, forestry and
  aquaculture
• many farmers can often not afford fertilisers
• availability of fertilisers at the local market
  is low, and
• world reserve of phosphorous appears to be
  diminishing (50 yrs)
• ? Through the use of human waste in agriculture
  farmers income increases and so the livelihood
  of poor people including their health
• ? Overcoming the high demand for water to flush
  human waste particularly important in areas with
  scarcity of water EcoSan may save 20-40 of the
  domestic water consumption
• ? Health cost reduction as less microbiological
  contamination of ground/surface waters, the
  sources for drinking water, and stop to the
  pollution of surface water causing eutrophication
  and nitrate poisoning of the groundwater.
• Biogas from human waste (and other waste sources)
  is cost-effective energy source

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Some cost effective approaches

• School sanitation and hygiene promotion
• Total sanitation approaches
• Ecological sanitation
• Household centred environmental sanitation
• See website Uganda WATSAN Resource Centre
  www.watsanuganda.watsan.net
• And IRC, WSP, WSSCC, WELL, etc.

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Conclusions

• WASH is a basic requirement for health (and well
  being)
• WASH interventions show high cost effectiveness
• WASH interventions are long-term investments
  managed by households and communities
• District health sector to find balance between
  curative and preventive health measures such as
  WASH also for reasons of cost-effectiveness