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Promoting global access to water and sanitation: A supply and demand perspective
Abstract
Almost 800 million people lack access to basic water supply, and almost 2000 million lack access to sanitation. Therefore, achieving universal access remains a crucial goal of the global development agenda. In order to shed light on whether international aid might help accomplish that goal, this study evaluates its impact in a sample of 121 developing countries during 1990–2015. A new approach is adopted in which aid affects access not only through provision of infrastructure (supply) but also through health education (demand). Additionally, the long-held concern about the persistence of impacts over time is addressed by estimating panel vector autoregressive models (PVAR). The results show that both supply- and demand-side interventions financed by aid can contribute to promoting access to water, but consistent long-term investments are needed.
... Almost 800 million people lack access to essential water supply and 2 billion people lack access to appropriate sanitation (Abellán & Alonso, 2022), while approximately one in four people globally lack consistent access to safe drinking water (UN, 2022;UNICEF, 2022). Although the number of people without safely managed services for drinking water decreased by 193 million between 2015 and 2020, it is estimated that 8 of 10 people who lack basic services reside in rural areas, and that attaining universal access will require a four times expansion of present levels of progress (WHO/UNICEF, 2021). ...
... What does the available evidence point us toward? When resources and capacity allow, integrated approaches between sectors (e.g., health and education) as well as multiple activity types (e.g., infrastructure and awareness raising) can be effective (Abellán & Alonso, 2022). Public-private partnerships can encourage entrepreneurial approaches to alleviate resource constraints (Opryszko et al., 2013). ...
Access to water has improved globally; however, nearly 800 million people continue to lack access, particularly in resource constrained contexts. Current efforts are not on track to meet the Sustainable Development Goals aim of safe and affordable drinking water for all. Innovative and contextualized solutions are required. This article describes a university-government collaboration in Ethiopia that addressed key data limitations, without which equity-based decision making was not possible. These efficient and cost-effective ways for obtaining and managing data support improved decision-making, and also identified avenues for improving water system governance through policy shifts and citizen participation.
... Water decontamination is a global challenge for water security (Abellán and Alonso, 2022). Surface water in intensive farming regions are prone to pesticides, posing a serious issue not only for human consumption of water and fish but also a threat to aquatic species (Zheng et al., 2016;Barizon et al., 2022). ...
The competition impact and feedstock type on the removal of water pesticides using biochar have not yet been sufficiently investigated. Therefore, here we investigated the potentiality of three different biochars (BCs) derived from rice husk (RHB), date pit (DPB), and sugarcane bagasse (SBB) biowastes for the simultaneous removal of ten pesticides from water in a competitive adsorption system. The BCs structural characterization and morphology were investigated by XRD, FTIR spectroscopy and SEM analysis. The potential adsorption mechanisms have been investigated using various isothermal and kinetic models. RHB showed the highest removal percentages (61% for atrazine/dimethoate and 97.6% for diuron/chlorfenvinphos) followed by DPB (56% for atrazine/dimethoate and 95.4% for diuron/chlorpyrifos) and then SBB (60.8% for atrazine/dimethoate and 90.8% for chlorpyrifos/malathion). The higher adsorption capacity of RHB and DPB than SBB can be due to their high total pore volume and specific surface area (SSA). Langmuir model described well the sorption data (R2 = 0.99). Adsorption equilibrium was achieved after 60 min for RHB, and 120 min for both DPB and SBB. The optimum adsorbent dose (g/L) was 10 for RHB and 4 for DPB and SBB. The removal efficiency of pesticides was enhanced by decreasing pH from 9 to 5 by RHB and to 3 by DPB and SBB. XRD and FTIR spectroscopy confirmed that BCs contain some active adsorption groups and metal oxides such as MgO, SiO, Al2O3, CaO, and TiO2 that can play an effective role in the pesticides sorption. BET-N2 adsorption analysis demonstrated that the BC pore size contributes significantly to pesticide adsorption. These findings indicate that RHB, DPB, and SBB have ability for adsorption of water pesticides even under acidic conditions. Therefore, the rice husk, date pit, and sugarcane bagasse biowastes could be pyrolyzed and reused as effective and low-cost sorbents for elimination of hazardous substances such as pesticides in the aqueous environments.
... Así, mientras que solo el 15% de la población urbana mundial carece de acceso a servicios de agua potable gestionados de forma segura, este porcentaje asciende al 47% entre la población rural (Gráfico 4). Para mejorar el acceso en estas áreas, no solo es importante abordar las desigualdades en la disponibilidad de infraestructuras, sino también incidir sobre los modelos de comportamiento de los usuarios, promoviendo la adopción de conductas higiénicas adecuadas a través de la educación (Aunger y Curtis, 2016;Abellán y Alonso, 2022). Esas tensiones generadas por el desigual acceso al agua pueden acrecentarse en el futuro, en zonas de creciente estrés hídrico, debido a los efectos del cambio climático. ...
El presente trabajo fue realizado a pedido del Ministerio de Medio Ambiente y Energía de la República de Costa Rica, en colaboración con el Banco Interamericano de Desarrollo (BID), con el objetivo de ofrecer un panorama aceptablemente comprehensivo de la financiación disponible para la agenda del agua y de las posibilidades que brinda la agenda de desarrollo para movilizar recursos a tal fin.
Este artículo presenta un análisis crítico de los métodos de evaluación de la eficacia de la ayuda para el desarrollo en el sector de la salud. La revisión de la investigación disponible revela que la gran incertidumbre existente respecto a la eficacia de la ayuda responde en buena medida a la indefinición de las cadenas causales objeto de evaluación. Para alcanzar conclusiones más precisas y fiables, se recomienda una evaluación desagregada y en contacto con las teorías del cambio diseñadas en las políticas de desarrollo.
Background
In order to protect public health during the outbreaks of infectious diseases including the pandemic COVID-19, provision of Water, Sanitation, and Hygiene (WASH) services is important. The challenges of inaccessible WASH services along with the pandemic COVID-19 in low-income countries can lead to a devastating problem.
Method
A systematic search of published articles was identified using PubMed, Web of Science, and Google Scholar, on relevant studies of COVID-19 and WASH services. Published articles were identified using abstracts and titles of the articles, followed by assessed for eligibility, and screening of the full text reports of relevant studies.
Results
Electronic database search identified 798 articles from which 28 full text articles were included in the systematic review. A lack of access to WASH services in households, schools, health care facilities, and other public spaces were the main identified COVID-19 related public health risks. A lack of adequate data and financial shortages were the challenges for mitigating the problems of COVI-19 and WASH services.
Conclusion
This systematical review identified the impacts and challenges of COVID-19 in the provision of WASH services. The results implied that COVID-19 has significant impacts on WASH services that can affect the health of the public. Therefore, strengthening and ensuring access to WASH services are important for preventing COVID-19 and realizing human rights. Community engagement also can be used to support for prevention and control of COVID-19. Countries need to be expand their investment in WASH services as an important mechanism for mitigating COVID-19.
Background: Significant developmental challenges in low-resource settings limit access to sustainable water, sanitation, and hygiene (WASH). However, in addition to reducing human agency and dignity, gendered WASH inequities can also increase disease burden among women and girls. In this systematic review, a range of challenges experienced by women relating to inadequate WASH resources are described and their intersection with health are explored. We further assess the effectiveness of interventions in alleviating inequalities related to the Sustainable Development Goals (SDGs) three (health), five (gender), and six (water). Methods: We searched the MEDLINE database to identify research articles related to water (i.e., WASH), gender, and sustainability. An analysis of both observational and interventional studies was undertaken. For each study, content analysis was performed to identify the relevant WASH, gender, and health related outcomes, and the main conclusions of the study. Results: Key themes from our search included that women and girls face barriers toward accessing basic sanitation and hygiene resources, including a lack of secure and private sanitation and of Menstrual Hygiene Management (MHM) resources. In total, 71% of identified studies reported a health outcome, suggesting an intersection of water and gender with health. Half of the research studies that included a health component reflected on the relationship between WASH, gender, and infantile diseases, including under-5 mortality, waterborne parasites, and stunting. In addition, we found that women and girls, as a result of their role as water purveyors, were at risk of exposure to contaminated water and of sustaining musculoskeletal trauma. A limited number of studies directly compared gender differences in accessing WASH resources, and an even smaller fraction (N = 5, 8.5%) reported sex-disaggregated outcomes. Educational, infrastructural, and programmatic interventions showed promise in reducing WASH and health outcomes. Indeed, infrastructural WASH interventions can be successful if long-term maintenance is ensured.
Conclusions: Significant WASH inequities in women and girls further manifest as health burdens, providing strong evidence that the water-gender-nexus intersects with health. Thus, addressing gender and water inequities holds the potential to alleviate disease burden and have a significant impact on achieving the SDGs, including SDG three, five, and six.
Cholera is a severe diarrhoeal disease affecting vulnerable communities. A long-term solution to cholera transmission is improved access to and uptake of water, sanitation and hygiene (WASH). Climate change threatens WASH. A systematic review and meta-analysis determined five overarching WASH factors incorporating 17 specific WASH factors associated with cholera transmission, focussing upon community cases. Eight WASH factors showed lower odds and six showed higher odds for cholera transmission. These results were combined with findings in the climate change and WASH literature, to propose a health impact pathway illustrating potential routes through which climate change dynamics (e.g. drought, flooding) impact on WASH and cholera transmission. A causal process diagram visualising links between climate change dynamics, WASH factors, and cholera transmission was developed. Climate change dynamics can potentially affect multiple WASH factors (e.g. drought-induced reductions in handwashing and rainwater use). Multiple climate change dynamics can influence WASH factors (e.g. flooding and sea-level rise affect piped water usage). The influence of climate change dynamics on WASH factors can be negative or positive for cholera transmission (e.g. drought could increase pathogen desiccation but reduce rainwater harvesting). Identifying risk pathways helps policymakers focus on cholera risk mitigation, now and in the future.
This paper develops a simple econometric strategy to operationalise the United Nations Children’s Fund’s (UNICEF’s) conceptual framework for nutrition. It estimates the extent to which child stunting correlates with investments in water, sanitation, and hygiene (WASH) across population groups (poor and nonpoor) and residence (urban and rural). Moving away from estimating single intervention marginal returns, the empirical framework of intervention packages is tested in Tunisia, a country with notable but uneven progress in reducing stunting. A successful nutritional strategy will thereby require mapping the distinctive intervention packages by residence and socio-economic status, away from universal policies, that more strongly correlate with reduction in stunting.
Physical height is an important measure of human capital. However, differences in average height across developing countries are poorly explained by economic differences. Children in India are shorter than poorer children in Africa, a widely studied puzzle called “the Asian enigma.” This paper proposes and quantitatively investigates the hypothesis that differences in sanitation — and especially in the population density of open defecation — can statistically account for an important component of the Asian enigma, India's gap relative to sub-Saharan Africa. The paper's main result computes a demographic projection of the increase in the average height of Indian children, if they were counterfactually exposed to sub-Saharan African sanitation, using a non-parametric reweighting method. India's projected increase in mean height is at least as large as the gap. The analysis also critically reviews evidence from recent estimates in the literature. Two possible mechanisms are effects on children and on their mothers.
Objectives:
Safe drinking water, sanitation and hygiene are protective against diarrhoeal disease; a leading cause of child mortality. The main objective was an updated assessment of the impact of unsafe water, sanitation and hygiene (WaSH) on childhood diarrhoeal disease.
Methods:
We undertook a systematic review of articles published between 1970 and February 2016. Study results were combined and analysed using meta-analysis and meta-regression.
Results:
A total of 135 studies met the inclusion criteria. Several water, sanitation and hygiene interventions were associated with lower risk of diarrhoeal morbidity. Point-of-use filter interventions with safe storage reduced diarrhoea risk by 61% (RR=0.39; 95% CI: 0.32, 0.48); piped water to premises of higher quality and continuous availability by 75% and 36% (RR=0.25 (0.09, 0.67) and 0.64 (0.42, 0.98)), respectively compared to a baseline of unimproved drinking water; sanitation interventions by 25% (RR=0.75 (0.63, 0.88)) with evidence for greater reductions when high sanitation coverage is reached; and interventions promoting handwashing with soap by 30% (RR=0.70 (0.64, 0.77)) versus no intervention. Results of the analysis of sanitation and hygiene interventions are sensitive to certain differences in study methods and conditions. Correcting for non-blinding would reduce the associations with diarrhoea to some extent.
Conclusions:
Though evidence is limited, results suggest that household connections of water supply and higher levels of community coverage for sanitation appear particularly impactful which is in line with targets of the Sustainable Development Goals. This article is protected by copyright. All rights reserved.
Funding of the public water supply in developing countries is often justified by the expectation that it significantly decreases the time spent on water collection, leading to increased labor force participation of women. We empirically test this hypothesis for rural Benin. Daily water collection times are reduced by 41 minutes but still take 2 hours after the installation of a public pump. Even though walking distances are reduced, women still spend a lot of time waiting at the water source, and not all women use the improved water source. Moreover, a reduction in time to fill one water container induces women to fill more containers per day. Time savings are rarely followed by an increase in the labor supply of women. The economic value of the annual time savings is 1%–2% of a rural households’ income.
Background:
Sanitation aims to sequester human feces and prevent exposure to fecal pathogens. More than 2.4 billion people worldwide lack access to improved sanitation facilities and almost one billion practice open defecation. We undertook systematic reviews and meta-analyses to compile the most recent evidence on the impact of sanitation on diarrhea, soil-transmitted helminth (STH) infections, trachoma, schistosomiasis, and nutritional status assessed using anthropometry.
Methods and findings:
We updated previously published reviews by following their search strategy and eligibility criteria. We searched from the previous review's end date to December 31, 2015. We conducted meta-analyses to estimate pooled measures of effect using random-effects models and conducted subgroup analyses to assess impact of different levels of sanitation services and to explore sources of heterogeneity. We assessed risk of bias and quality of the evidence from intervention studies using the Liverpool Quality Appraisal Tool (LQAT) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, respectively. A total of 171 studies met the review's inclusion criteria, including 64 studies not included in the previous reviews. Overall, the evidence suggests that sanitation is protective against diarrhea, active trachoma, some STH infections, schistosomiasis, and height-for-age, with no protective effect for other anthropometric outcomes. The evidence was generally of poor quality, heterogeneity was high, and GRADE scores ranged from very low to high.
Conclusions:
This review confirms positive impacts of sanitation on aspects of health. Evidence gaps remain and point to the need for research that rigorously describes sanitation implementation and type of sanitation interventions.
This Special Issue explores macroeconomic effects of aid from various perspectives through a blend of studies, both conceptual and empirical in nature. The overall aim is to enhance the understanding of the macroeconomic dimensions of aid in the policy and research communities, and to inspire further innovative work in this important area. This opening article provides a scene setting summary of five generations of aid research, with a particular focus on how the JDS has contributed to this literature, and ends with an overview of the papers included in this Issue.
This paper has four messages. First, a literature review shows that panel data models including lagged dependent variables lead to statistically significant, favourable results for at least one form of aid unless only commitment data are used. Second, in our own analysis, we find that growth rates or levels of aid per capita have statistically significant, favourable effects on growth rates rather than on levels of life expectancy and illiteracy. Third, for the growth rate of illiteracy, we find a strong role of polynomial distributed lags, helping to explain the great diversity of aid results found in the literature. Fourth, in simulations, both effects are small in terms of growth rates in the short run but cumulate over time to non-negligible amounts. Copyright © 2016 John Wiley & Sons, Ltd.
While many developing countries have made progress in human development, gender equality remains a challenge for most. This study uses data on bilateral official aid disbursements from the OECD Development Assistance Committee (OECD-DAC) to examine the impact of aid and its sectoral allocation on overall gender inequality as well as on gender inequality in health and education. We find that the impact of aid on gender inequality is dependent on initial human development and per capita income. However, increased aid to the health and education sectors appears to be effective in reducing maternal mortality and gender inequality in youth literacy regardless of initial conditions. © 2016 UNU-WIDER. Journal of International Development published by John Wiley & Sons, Ltd.
Background: Community-led total sanitation (CLTS) uses participatory approaches to mobilise communities to build their own toilets and stop open defecation. Our aim was to undertake the first randomised trial of CLTS to assess its effect on child health in Koulikoro, Mali.
Methods: We did a cluster-randomised trial to assess a CLTS programme implemented by the Government of Mali. The study population included households in rural villages (clusters) from the Koulikoro district of Mali; every household had to have at least one child aged younger than 10 years. Villages were randomly assigned (1:1) with a computer-generated sequence by a study investigator to receive CLTS or no programme. Health outcomes included diarrhoea (primary outcome), height for age, weight for age, stunting, and underweight. Outcomes were measured 1·5 years after intervention delivery (2 years after enrolment) among children younger than 5 years. Participants were not masked to intervention assignment. The trial is registered with ClinicalTrials.gov, number NCT01900912.
Findings: We recruited participants between April 12, and June 23, 2011. We assigned 60 villages (2365 households) to receive the CLTS intervention and 61 villages (2167 households) to the control group. No differences were observed in terms of diarrhoeal prevalence among children in CLTS and control villages (706 [22%] of 3140 CLTS children vs 693 [24%] of 2872 control children; prevalence ratio [PR] 0·93, 95% CI 0·76–1·14). Access to private latrines was almost twice as high in intervention villages (1373 [65%] of 2120 vs 661 [35%] of 1911 households) and reported open defecation was reduced in female (198 [9%] of 2086 vs 608 [33%] of 1869 households) and in male (195 [10%] of 2004 vs 602 [33%] of 1813 households) adults. Children in CLTS villages were taller (0·18 increase in height-for-age Z score, 95% CI 0·03–0·32; 2415 children) and less likely to be stunted (35% vs 41%, PR 0·86, 95% CI 0·74–1·0) than children in control villages. 22% of children were underweight in CLTS compared with 26% in control villages (PR 0·88, 95% CI 0·71–1·08), and the difference in mean weight-for-age Z score was 0·09 (95% CI –0·04 to 0·22) between groups. In CLTS villages, younger children at enrolment (
Background and methods:
Cholera remains a significant threat to global public health with an estimated 100,000 deaths per year. Water, sanitation and hygiene (WASH) interventions are frequently employed to control outbreaks though evidence regarding their effectiveness is often missing. This paper presents a systematic literature review investigating the function, use and impact of WASH interventions implemented to control cholera.
Results:
The review yielded eighteen studies and of the five studies reporting on health impact, four reported outcomes associated with water treatment at the point of use, and one with the provision of improved water and sanitation infrastructure. Furthermore, whilst the reporting of function and use of interventions has become more common in recent publications, the quality of studies remains low. The majority of papers (>60%) described water quality interventions, with those at the water source focussing on ineffective chlorination of wells, and the remaining being applied at the point of use. Interventions such as filtration, solar disinfection and distribution of chlorine products were implemented but their limitations regarding the need for adherence and correct use were not fully considered. Hand washing and hygiene interventions address several transmission routes but only 22% of the studies attempted to evaluate them and mainly focussed on improving knowledge and uptake of messages but not necessarily translating this into safer practices. The use and maintenance of safe water storage containers was only evaluated once, under-estimating the considerable potential for contamination between collection and use. This problem was confirmed in another study evaluating methods of container disinfection. One study investigated uptake of household disinfection kits which were accepted by the target population. A single study in an endemic setting compared a combination of interventions to improve water and sanitation infrastructure, and the resulting reductions in cholera incidence.
Discussion and recommendations:
This review highlights a focus on particular routes of transmission, and the limited number of interventions tested during outbreaks. There is a distinct gap in knowledge of which interventions are most appropriate for a given context and as such a clear need for more robust impact studies evaluating a wider array of WASH interventions, in order to ensure effective cholera control and the best use of limited resources.
Infant mortality rate (IMR) is regarded as an important indicator of population health. IMR rates vary substantially with the highest found in sub-Saharan Africa (SSA) compared to the lowest in Europe. Identifying spatial disparities in IMR and quantifying attributable risk factors is essential for policymakers when tailoring time-appropriate interventions at a global, regional, and country level.
Data for 192 countries were extracted from the World Bank Development Indicator database for the period 1990–2011. Spatial clustering was used to identify significant higher-risk IMR countries. A robust ecological generalized linear negative binomial regression model was used to quantify risk factors and associated decomposition values (Shapley).
Significant reductions were observed in IMR for all of the World Health Organization regions for the period 1990–2011 except for SSA, which indicated a reversal of this trend in the 1990s due to HIV. Significant high-risk clustering of IMR is also indicated in SSA countries and parts of Asia. Maternal mortality (survival), lack of water and sanitation and female education were confirmed as prominent and high attributable risk factors for IMR. Distinct temporal changes in the attributability of these factors were observed, as well as significant heterogeneity with regards to the most attributable factor by region and country.
Our study suggests that maternal mortality is the most prominent attributable risk factor for infant mortality, followed by lack of access to sanitation, lack of access to water, and lower female education. Variation exists across regions and countries with regards to the most attributable factor. Our study also suggests significant underestimation of IMR in regions known for poorer data quality. The results will aid policymakers in re-tailoring time-appropriate interventions to more effectively reduce IMR in line with Millennium Development Goal 4.
Does foreign aid promote aggregate economic growth? In contrast to widespread perceptions, academic studies of this question have been rapidly converging towards a positive answer. We employ a simulation approach to (i) validate the coherence of recent empirics and (ii) calculate plausible ranges for the rate of return to aid. Our results highlight the long-run nature of aid investments and indicate the return to aid falls in ranges commonly accepted for public investments. We find no basis for the view that aid has a pernicious effect on productivity.
http://www.wider.unu.edu/publications/working-papers/2014/en_GB/wp2014-089/
Around half the rural population of the Mekong Delta lacks year round access to clean water and faces increasing domestic water contamination problems. In combination with inappropriate hygiene behaviour and poor sanitation this leads to high risk of water-related diseases. On the policy level, microcredit schemes have globally become a popular element in addressing such problems. The present paper analyses the contradictory results of such a microcredit programme for rural water supply and sanitation in the context of the rural Mekong Delta in Vietnam, through a qualitative study foremost based on semi-structured interviews in rural communes of Can Tho City. It is concluded that the programme has a positive effect with regard to the safer disposal of human excreta and the water quality in rivers and canals, but that the programme has only a marginal impact on poverty reduction as it reaches only better-off households already having access to clean water. The paper shows how the outcome of rural water supply and sanitation policies are strongly influenced by the local ecological, technological and social settings, in particular by the interests of involved stakeholders. The authors finally challenge the common assumption that water supply and sanitation should in all circumstances be integrated into the same policy.
The problem of inadequate access to water, sanitation and hygiene (WASH) in less-developed nations has received much attention over the last several decades (most recently in the Millennium Development Goals), largely because diseases associated with such conditions contribute substantially to mortality in poor countries. We present country-level projections for WASH coverage and for WASH-related mortality in developing regions over a long time horizon (1975-2050) and provide dynamic estimates of the economic value of potential reductions in this WASH-related mortality, which go beyond the static results found in previous work. Over the historical period leading up to the present, our analysis shows steady and substantial improvements in WASH coverage and declining mortality rates across many developing regions, namely East Asia and the Pacific, Latin America and the Caribbean, Eastern Europe and the Middle East. The economic value of potential health gains from eliminating mortality attributable to poor water and sanitation has decreased substantially, and in the future will therefore be modest in these regions. Where WASH-related deaths remain high (in parts of South Asia and much of Sub-Saharan Africa), if current trends continue, it will be several decades before economic development and investments in improved water and sanitation will result in the capture of these economic benefits. The fact that health losses will likely remain high in these two regions over the medium term suggests that accelerated efforts are needed to improve access to water and sanitation, though the costs and benefits of such efforts in specific locations should be carefully assessed.
Objective:
The willingness to pay (WTP) for the construction of bathrooms with a flush toilet was assessed in households in a rural community in northern Vietnam. We also examined the effects of socio-economic factors on the WTP.
Methods:
The contingent valuation method, an economic survey technique, was used. We used the iterative bidding game technique to elicit household WTP that involved a sequence of dichotomous choice questions followed by a final open-ended question. A total of 370 households that did not have toilets were selected for this study. Respondents to the questionnaire were the primary income earners and decision-makers of their respective household.
Results:
Of those responding to the questionnaire, 62.1 % reported being willing to pay for the construction of bathrooms with a flush toilet. The mean and median of maximum WTP amounts were Viet Nam Dong (VND) 15.6 million and VND 13.0 million, respectively (minimum VND 2.0 million; maximum VND 45.0 million). Significant correlates of the WTP rate were: (1) gender of the head of household, (2) age of the head of household, (3) economic status of household, (4) type of current toilet, (5) satisfaction with existing toilet, and (6) knowledge of health effects of poor sanitation. The significant determinants of WTP amount were (1) geographic location and (2) economic status of household.
Conclusion:
About two-third of the households in the study area were willing to pay for an improvement in their current sanitation arrangements. Both WTP rate and WP amount were strongly influenced by the economic status of the households and health knowledge of the study respondents.
Access to improved water supplies and sanitation generally reduces childhood diarrhea incidence. Using a cross-sectional stratified cluster sampling design, interviews were conducted among grade 4-6 primary schoolchildren from 10 primary schools in highland and lowland districts of Pursat Province, Cambodia, in both June (rainy season) and December (dry season) 2009 to determine the demographics and water sources/sanitation used. Parents also recorded any incidents of diarrhea in their children over those months. We explored the sociodemographic factors associated with use of improved water sources/sanitation, using mixed effect modelling. Participation was 84.7% (1,101/1,300). About half exclusively used improved water sources but less than 25% had access to improved sanitation during both seasons. Adjusting for clustering within households and within individuals over time, exclusive use of improved water sources and sanitation were associated with the following: dry season, more permanent housing type, family size < 8 members, and higher levels of education. Exclusive use of improved sanitation was associated with good hygiene practices and exclusive use of improved water sources was associated with male gender. Access to improved water sources and sanitation among rural Cambodian primary schoolchildren can be improved, particularly in those with lower socio-economic status. Programs to promote use of improved water sources/sanitation need to target less educated parents.
The accessibility to improved water and sanitation has been understood as a crucial mechanism to save infants and children from the adverse health outcomes associated with diarrheal disease. This knowledge stimulated the worldwide donor community to develop a specific category of aid aimed at the water and sanitation sector. The actual impact of this assistance on increasing population access to improved water and sanitation and reducing child mortality has not been examined.
We performed a country-level analysis of the relationship between water and sanitation designated official development assistance (WSS-ODA) per capita, water and sanitation coverage, and infant and child mortality in low-income countries as defined by the World Bank. We focused our inquiry to aid effectiveness since the establishment of the Millennium Development Goals (MDGs).
Access to improved water has consistently improved since 2002. Countries receiving the most WSS-ODA ranged from odds ratios of 4 to 18 times more likely than countries in the lowest tertile of assistance to achieve greater gains in population access to improved water supply. However, while there were modestly increased odds of sanitation access, these were largely non-significant. The countries with greatest gains in sanitation were 8-9 times more likely to have greater reductions in infant and child mortality.
Official development assistance is importantly impacting access to safe water, yet access to improved sanitation remains poor. This highlights the need for decision-makers to be more intentional with allocating WSS-ODA towards sanitation projects.
Controversy over the aggregate impact of foreign aid has focused on reduced form estimates of the aid-growth link. The causal chain, through which aid affects developmental outcomes including growth, has received much less attention. We address this gap by: (i) specifying a structural model of the main relationships; (ii) estimating the impact of aid on a range of final and intermediate outcomes; and (iii) quantifying a simplied representation of the full structural form, where aid impacts on growth through key intermediate outcomes. A coherent picture emerges: aid stimulates growth and reduces poverty through physical capital investment and improvements in health.
The connections between gender and water, sanitation, and hygiene (WASH) are profound, and the sector is beginning to explore the integration of gender-transformative principles into WASH programming and research. Gender-transformative approaches challenge inequalities and move beyond an instrumentalist approach to gender in development interventions. Through a critical review of academic empirical studies, this paper explores the last decade of WASH-gender literature (2008–2018). Trends were visualised using an alluvial diagram. The reviewed literature was underpinned by a diversity of disciplines, yet was dominated by women-focused, water-focused studies. Although the studies addressed many important gender considerations, few studies engaged with transformational aspects of gender equality. The majority of the studies were based in rural sub-Saharan Africa and South Asia, indicating opportunity to explore contextual dynamics in other areas of the global south. Lastly, the studies primarily focus on women of productive age; only a few studies touched on gender dynamics relevant for a diversity of women, and men and boys were mostly absent. Insights from this analysis can inform future studies at the intersection of WASH and gender. Researchers and practitioners are encouraged to include a diversity of voices, reflect on the strengths and limitations of research disciplines, and incorporate gender-transformative concepts.
Inadequate access to sanitation remains a persistent issue in sub-Saharan African countries , affecting children, women, and workers. We employ dynamic panel estimation to uncover the empirical relationship between institutions and access to sanitation in sub-Sahara Africa. We find that control of corruption, regulatory quality, and voice and accountability increase access to sanitation. Moreover, a dichotomy exists between rural and urban areas in that efficient corruption control, rule of law, and government effectiveness facilitate access to sanitation in rural areas. However, only voice and accountability matter in urban areas. These findings generate important policy implications in achieving universal access to improved sanitation.
This study attempts to measure how the effectiveness of aid to the drinking water sector is mediated by state capacity. I use panel data on a sample of 87 aid-receiving countries, with the Bureaucratic Quality Index as a measure of state capacity. Employing random effects, fixed effects, and system GMM techniques, the study empirically and robustly finds that state capacity does not have a significant positive mediating impact on aid effectiveness in increasing access to improved water sources. I also find that the mediating impact of state capacity is contingent on the level of democracy in aid-receiving countries.
Household water management is often women's responsibility, as related to the gendered nature of household roles. Ethnographic data suggest that household water insecurity could increase women's exposure to emotional and physical forms of intimate partner violence (IPV), as punishments for failures to complete socially expected household tasks that rely on water (like cooking and cleaning) and the generally elevated emotional state of household members dealing with resource scarcity. Here, we test the associations between sub-optimal household water access and women's exposure to IPV, using the nationally-representative data from Nepal Demographic and Health Survey, 2016. Drawing upon the intra-household bargaining model as the theoretical framework, we run instrumental variable probit regression, to test the association between household water access and prevalence of IPV against women. After controlling for other known covariates of IPV such as women's empowerment and education, the findings substantiate that worse household water access consistently elevates women's exposures to all forms of IPV. This suggests that improvements in household water access may have additional ramifications for reducing women's risk of IPV, beyond currently recognized socioeconomic benefits. While both household water access and IPV have known health consequences, linking them provides another pathway through which water could affect women's health.
In this paper, we investigate the impact of access to drinking water sources and sanitation facilities on the incidence of diarrheal diseases among children below 5 years of age in Ethiopia using the propensity score matching technique with a polychotomous treatment variable. We find that among the water sources traditionally considered as improved, only water piped into dwelling, yard or plot leads to a large percentage point reduction in diarrhea incidence. The other water sources, generally believed as clean, are not effective in reducing diarrhea even compared with some of the unimproved water sources. We also find that some unimproved water sources and sanitation facilities are less inferior than they are believed to be. These results suggest that the traditional way of categorizing different types of improved and unimproved water sources and sanitation facilities into a dichotomous variable, “improved” or “unimproved”, could be misleading as it masks the heterogeneous effects of the water sources and the sanitation facilities.
Handpumps are heavily relied upon for drinking water in rural areas of low- and middle-income countries, but their operation and maintenance remain problematic. This review presents updated and expanded handpump functionality estimates for 47 countries in sub-Saharan Africa and the Asia-Pacific region. Our results suggest that approximately one in four handpumps in sub-Saharan Africa are non-functional at any point in time, which in 2015 was roughly equivalent to 175,000 inoperative water points. Functionality statistics for Asia-Pacific countries vary widely, but data gaps preclude a robust region-wide estimate. In spite of data inconsistencies and imperfections, the results illustrate the persistent and widespread nature of rural water supply sustainability concerns.
Numerous studies have sought to empirically test the effectiveness of foreign aid as a tool for international development, with often inconsistent or contradictory results. New sources of disaggregated aid data now allow researchers to test the impact of individual sectors of aid on sector-specific outcomes. The paper investigates the effectiveness of foreign aid in the water, sanitation, and hygiene (WaSH) sector and seeks to identify constraints on WaSH aid effectiveness in recipient countries. Multilevel latent growth, dynamic panel, and instrumental variable regression models were estimated on a panel dataset comprising 125 recipient countries over 20 years. WaSH aid was consistently associated with improved health outcomes in middle-income countries; no effect on those outcomes was observed in low-income countries. Potential constraints on the effectiveness of WaSH aid – including political, economic, institutional, and technical constraints – were examined using subgroup analysis. The effectiveness of WaSH aid was found to have been constrained by government ineffectiveness and regulatory quality in recipient countries. Countries with large rural populations also appear to have benefitted less from WaSH aid than more urbanized recipient countries.
Panel vector autoregression (VAR) models have been increasingly used in applied research. While programs specifically designed to fit time-series VAR models are often included as standard features in most statistical packages, panel VAR model estimation and inference are often implemented with general-use routines that require some programming dexterity. In this article, we briefly discuss model selection, estimation, and inference of homogeneous panel VAR models in a generalized method of moments framework, and we present a set of programs to conveniently execute them. We illustrate the pvar package of programs by using standard Stata datasets.
The Sustainable Development target of ensuring access to water and sanitation for all by 2030 has far-reaching implications for the achievement of the other SDGs. However, achieving this target remains a major challenge for sub-Saharan Africa, and the ability of governments in the region to expand access is constrained by limited financial resources. This paper investigates whether targeting foreign aid to the water and sanitation sector can help achieve the goal of expanding access to water and sanitation services in sub-Saharan Africa. The analysis is based on panel data estimation techniques controlling for country-specific effects and potential endogeneity of regressors. The econometric results suggest that increased aid targeted to the supply of water and sanitation is associated with increased access to these services, although the relationship is non-linear. The evidence in this study makes an important contribution to the scholarly debate on aid effectiveness. It also has important practical implications for aid policy: specifically, it suggests that in addition to scaling up aid disbursements to sub-Saharan African countries, donors need to increase aid allocation to water and sanitation as well as other areas where the region lags behind. There is also a need to identify structural constraints that may limit access to water and sanitation, and utilize foreign aid so as to alleviate these constraints.
The lack of access to safe water and adequate sanitation has implications for the psychosocial wellbeing of individuals and households. To review the literature on psychosocial impacts, we completed a scoping review of the published literature using Medline, Embase, and Scopus. Fifteen studies met the inclusion criteria and were reviewed in detail. Of the included studies, six were conducted in India, one in Nepal, one in Mexico, one in Bolivia, two in Ethiopia, one in Zimbabwe, one in South Africa, and two in Kenya. Four interrelated groups of stressors emerged from the review: physical stressors, financial stressors, social stressors, and stressors related to (perceived) inequities. Further, gender differences were observed, with women carrying a disproportionate psychosocial burden. We argue that failure to incorporate psychosocial stressors when estimating the burden or benefits of safe water and sanitation may mask an important driver of health and well-being for many households in low- and middle-income countries. We propose further research on water-related stressors with particular attention to unique cultural norms around water and sanitation, short and long term psychosocial outcomes, and individual and collective coping strategies. These may help practitioners better understand cumulative impacts and mechanisms for addressing water and sanitation challenges.
A voluminous academic literature exists on the effectiveness of foreign aid in general. However, relatively less work has been done on the impact of sector-specific foreign aid. This paper focuses on the impact of aid disbursements on outcomes in the Water Supply and Sanitation (WSS) Sector. Despite the considerable increase in aid flows to the WSS sector over the last few years, it is only recently that the literature has started to focus on assessing aid effectiveness in this sector. We contribute to the growing interest in sector-specific aid effectiveness literature by conducting an empirical analysis for a large panel of countries to assess the effectiveness of aid disbursements on improved access to WSS facilities. Our empirical results suggest that aid disbursements produce a strong, positive, and significant effect on improved access to WSS, and our results are robust to multiple specifications and estimation procedures. We also find strong evidence of non-linearities governing the relationship between aid flows and outcomes, in that aid disbursements are effective only in lower middle-income-countries rather than low-income-countries or upper middle-income countries. These results tend to suggest that a country needs to meet a certain development or income threshold before aid can prove to be effective and that aid flows tend to have diminishing returns. Finally, we also find that aid disbursements produce favorable effects in enhancing access to WSS facilities in rural as opposed to urban areas.
Recent research yields widely divergent estimates of the cross‐country relationship between foreign aid receipts and economic growth. We re‐analyse data from the three most influential published aid–growth studies, strictly conserving their regression specifications, with sensible assumptions about the timing of aid effects and without questionable instruments. All three research designs show that increases in aid have been followed on average by increases in investment and growth. The most plausible explanation is that aid causes some degree of growth in recipient countries, although the magnitude of this relationship is modest, varies greatly across recipients and diminishes at high levels of aid.
The health benefits are usually considered to be the most significant impacts of sanitation, but other factors are also important. This literature review examines both published and grey literature on the non-health impacts of sanitation. The main sections of this report summarize the social impacts of sanitation on women, adolescent girls, children, the disabled and the environment. Safe, private sanitation facilities can help women and girls to be secure and healthy, can encourage girls' attendance in school past puberty, can help preserve the dignity of disabled people and can improve the environment.
The allocation of a government budget between a public good and transfers is modeled under different systems of government.
The relatively even distribution of political power among groups in a democracy favors spending on nonexclusive public goods.
The more concentrated pattern of political power in a dictatorship favors spending on transfers targeted to powerful groups.
The hypothesis on public good provision is examined using cross-country data on public good provision and empirical indicators
of political regime. Dictatorial governments are found to provide public schooling, roads, safe water, public sanitation,
and pollution control at levels far below democracies.
A substantial portion of the world's population does not have ready access to safe water. Moreover, obtaining water may involve great expense of time and energy for those who have no water sources in or near home. From an historical perspective, with the invention of piped water, fetching water has only recently become largely irrelevant in many locales. In addition, in most instances, wells and clean surface water were so close by that fetching was not considered a problem. However, population growth, weather fluctuations and social upheavals have made the daily chore of carrying water highly problematic and a public health problem of great magnitude for many, especially women, in the poor regions and classes of the world. In this paper, we consider gender differences in water carrying and summarize data about water access and carrying from 44 countries that participated in the Multiple Indicator Cluster Survey (MICS) program. Women and children are the most common water carriers, and they spend considerable time (many trips take more than an hour) supplying water to their households. Time is but one measure of the cost of fetching water; caloric expenditures, particularly during droughts, and other measures that affect health and quality of life must be considered. The full costs of fetching water must be considered when measuring progress toward two Millennium Development Goals--increasing access to safe drinking water and seeking an end to poverty.
Effective allocation of investments is crucial to achieve the Water and Sanitation target of the Millennium Development Goals (MDG). The present paper exposes the main results of a detailed study made about the Official Development Assistance (ODA) and the international private investment in the water sector from 1995 to 2004. Public available data sets from the Development Assistance Committee (DAC), the World Bank, and from the Human Development Reports (population and water and sanitation access’ figures) have been collected in a specific database. ODA programmes have been analyzed individually, in order to separate water and sanitation subsectors, since DAC reporting system does not make it directly. The study includes a comparative analysis of public and private international investment; it analyzes the coherence, both geographical and sub sectorial of aid allocation, as well as the terms and conditions of the ODA delivered. Special focus was made on the sanitation subsector. Finally it assesses private participation success in the sector and evaluates cross cutting issues in ODA water programmes. Results of ODA’s analysis show how far donors lag behind their own commitments both in terms of quantity and quality of aid. Data show big geographical inequalities, comparing the share of aid received by regions related to the number of people without access living there. Regardless extremely low coverage in sanitation, donors are not really committed to improve it. Results from international private participation in water and sanitation projects show a little contribution to the achievement of the MDG, as well as a decrease tendency in participation. Complementarities between private and public sector were not significant, if MDG are to be achieved. As a main conclusion of the analysis, we can affirm that there is room for improvements in the water sector’s aid. A global coordination mechanism among donors is needed to ensure more efficient sector’s resources allocation; at the same time, donors should fulfil their own recommendations on terms and conditions of aid. International water and sanitation funds should add on existing national funds in order to effectively increase sector investment. Consideration of private sector’s investments could improve ODA’s allocations. The tiny amount of ODA resources dedicated to sanitation represents a huge contradiction with actual needs. Postprint (published version)
The expected increase in aid to Africa will put a big challenge for public service delivery. This paper provides an analysis
of the effects of the volume and volatility of aid on education, health, water and sanitation outcomes, taking also into account
the institutions related to public service delivery, including freedom of press, corruption, and decentralization, using a
simultaneous equation model. Overall the share of Official Development Assistance (ODA) that is provided for education and
health seems to have a positive impact on outcomes in these sectors, whereas total aid seems to be negatively associated.
Aid volatility is associated with better outcomes in sanitation, water, and infant mortality, contrary to expectations.
Many studies have reported the results of interventions to reduce illness through improvements in drinking water, sanitation facilities, and hygiene practices in less developed countries. There has, however, been no formal systematic review and meta-analysis comparing the evidence of the relative effectiveness of these interventions. We developed a comprehensive search strategy designed to identify all peer-reviewed articles, in any language, that presented water, sanitation, or hygiene interventions. We examined only those articles with specific measurement of diarrhoea morbidity as a health outcome in non-outbreak conditions. We screened the titles and, where necessary, the abstracts of 2120 publications. 46 studies were judged to contain relevant evidence and were reviewed in detail. Data were extracted from these studies and pooled by meta-analysis to provide summary estimates of the effectiveness of each type of intervention. All of the interventions studied were found to reduce significantly the risks of diarrhoeal illness. Most of the interventions had a similar degree of impact on diarrhoeal illness, with the relative risk estimates from the overall meta-analyses ranging between 0.63 and 0.75. The results generally agree with those from previous reviews, but water quality interventions (point-of-use water treatment) were found to be more effective than previously thought, and multiple interventions (consisting of combined water, sanitation, and hygiene measures) were not more effective than interventions with a single focus. There is some evidence of publication bias in the findings from the hygiene and water treatment interventions.
Universal access to drinking water: the role of aid
- Bain
Eficacia agregada de la ayuda: incidencia sobre el crecimiento del receptor
- Alonso
J.A. Alonso, Eficacia agregada de la ayuda: incidencia sobre el crecimiento del receptor, Rev. Evaluación Programas Políticas Públicas 3 (2014) 154-188.
What explains the rural-urban gap in infant mortality: household or community characteristics?
- van de Poel
E. van de Poel, O. O'Donnell, E. van Doorslaer, What explains the rural-urban gap in infant mortality: household or community characteristics? Demography 46
(4) (2009) 827-850, https://doi.org/10.1353/dem.0.0074.
Universal access to drinking water: the role of aid
- R Bain
- R Luyendijk
- J Bartram
R. Bain, R. Luyendijk, J. Bartram, Universal access to drinking water: the role of aid, in: WIDER Working Papers 2013/88, UNU-WIDER, Helsinki, 2013.