One of the most quoted WASH statistics was recently “downgraded”. For every $1 invested in water and sanitation, not $8 but “only” $4 is returned in economic returns through increased productivity. This recalculation [1], says the World Health Organization, is mainly a result of higher investment cost estimates and the more complete inclusion of operation and maintenance (O&M) costs.
Providing a better insight into O&M costs has been one of the achievements of the WASHCost project of the IRC International Water and Sanitation Centre. WASHCost has published minimum benchmarks for costing sustainable basic WASH services in developing countries [2]. The project collected data from Burkina Faso, Ghana, Andhra Pradesh (India) and Mozambique.
The main message is that spending less than the minimum benchmarks will result in a higher risk of reduced service levels or long-term failure. NGOs claiming that “US$20 can provide clean water for one person for 20 years” have clearly forgotten to include annual recurrent costs for operation and maintenance, capital maintenance and direct support.
The real cost for 20 years of basic water supply from a borehole and handpump would be, per person, between US$ 20 and US$ 61 for construction plus US$ 3-6 every year to keep it working. In total for the 20 years this would amount to US$ 80 to US$ 181 per person.
Similarly, for the most basic sanitation service, a traditional pit latrine, the combined costs would be US$ 37 – 106 per person over 20 years.
Researchers at the University of California, Berkeley, have received a five-year, $10.9 million grant from the Bill & Melinda Gates Foundation to evaluate several interventions to combat diarrheal disease in developing countries.
Dr. Jack Colford
Dr. Jack Colford, professor of epidemiology at UC Berkeley’s School of Public Health, will coordinate the project, working with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) and Innovations for Poverty Action (IPA).
An estimated 2.2 million children under the age of 5 die from diarrhoeal diseases each year, according to the World Health Organization. Most of these diseases are thought to be preventable with improvements in sanitation, water quality and hygiene.
Due to the high cost of developing and maintaining large infrastructure projects, such as networked water, there is now a movement toward simpler, alternative methods to improve health in rural areas. However, there is almost no evidence that allows direct comparison of the health benefits or cost effectiveness of these simpler interventions, such as improved latrines, household water treatment and hand washing with soap.
The goal of the new project is to determine how sanitation interventions, delivered alone or as part of combined intervention packages, impact child health and well-being. In addition to improved sanitation, the intervention packages will include drinking water improvements and hand washing solutions. The results have the potential to influence how billions of dollars are directed towards long-term improvements in health and economic outcomes for millions of children each year, said Colford.
“Increasingly, foundations, governments, the World Bank and development agencies such as the MCC (Millennium Challenge Corporation) are demanding evidence of effectiveness when awarding development funds,” said Colford. “Right now, it is unknown whether single interventions are as cost effective as combinations of these interventions. This grant will fund the first large-scale, randomized impact evaluation designed to gather rigorous evidence about this question.”
The study will test the impact of these sanitation, water and hygiene interventions using a large-scale, randomized impact evaluation in Bangladesh and Kenya. These two countries are representative of the two regions that account for the majority of the world’s gastrointestinal disease burden: Southeast Asia and sub-Saharan Africa. The researchers expect to enroll a total of 23,000 children in the trials, which will be monitored by several institutional review boards.
Of the $10.9 million, about $7.9 million will be subcontracted out to the two field sites. Dr. Stephen Luby, head of the Programme on Infectious Diseases and Vaccine Sciences with ICDDR,B, and Michael Kremer, Ph.D., a research affiliate with IPA, will lead the trials in Bangladesh and Kenya, respectively. They will be joined by a team of experts from various disciplines, including public health, economics, behavioral change, nutrition, cognitive development and tropical enteropathy.
Despite the existence of inexpensive and efficient means of treatment, diarrhoea kills more children than AIDS, malaria and measles combined, according to a report issued today by UNICEF and the World Health Organization (WHO).
The report, titled Diarrhoea: Why Children Are Still Dying and What Can Be Done (PDF), includes information on the causes of diarrhoea, data on access to means of prevention and treatment, and a seven-point plan to reduce diarrhoea deaths. “It is a tragedy that diarrhoea, which is little more than an inconvenience in the developed world, kills an estimated 1.5 million children each year,” said UNICEF Executive Director, Ann M. Veneman.
“Inexpensive and effective treatments for diarrhoea exist, but in developing countries only 39 per cent of children with diarrhoea receive the recommended treatment.” Dr Margaret Chan, Director-General of WHO, said: “We know where children are dying of diarrhoea. We know what must be done to prevent those deaths. We must work with governments and partners to put this seven-point plan into action.” Diarrhoea is a common symptom of gastrointestinal infection, which can have a variety of sources.
However just a handful of organisms are responsible for most acute cases of diarrhoea and one, Rotavirus, is responsible for more than 40 per cent of all diarrhoea-related hospital admissions of children under five. A new vaccine for Rotavirus has been found to be safe and effective but is still largely unavailable in most developing countries. Though most episodes of childhood diarrhoea are mild, acute cases can lead to significant fluid loss and dehydration. This dehydration can lead to death unless fluids are quickly replaced. Oral rehydration therapy is the cornerstone of fluid replacement and the new low-osmolarity formula of oral rehydration salts (ORS) is a simple, inexpensive and life-saving remedy that prevents dehydration in children suffering diarrhoea.
Some 88 percent of diarrhoeal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. As of 2006, an estimated 2.5 billion people around the world were not using adequate sanitation facilities, and about 1 in 4 people in developing countries practiced open defecation. Access to clean water and good hygiene practices are extremely effective in preventing childhood diarrhoea. Hand washing with soap has been shown to reduce the incidence of diarrhoeal disease by over 40 per cent, making it one of the most cost-effective interventions for reducing child deaths caused by this neglected killer.
October 15 is annual Global Handwashing Day when millions of children and adults in over 80 countries will take part in activities to highlight this key intervention. The overall health and nutrition of children is also critical to their susceptibility to diarrhoea and the damage it can cause. Undernourished children are at higher risk of suffering more frequent, severe and prolonged episodes of diarrhoea, and repeated bouts of diarrhoea also place children at greater risk of worsening nutritional status.
The seven point plan to save the lives of children stricken by diarrhoea includes two treatment and five prevention elements.
The two treatment elements are:
fluid replacement to prevent dehydration; and
zinc treatments, which decrease the severity and duration of the attack.
The five prevention elements are:
immunization against rotavirus and measles;
early and exclusive breastfeeding and vitamin A supplementation;
handwashing with soap;
improved water supply quantity and quality; and
promoting community-wide sanitation.
Campaigns targeting childhood diarrhoea in the 1970s and 1980s achieved success by educating caregivers and scaling up oral rehydration therapy to prevent dehydration. The campaigns delivered promising results but following that success, focus shifted to other health problems. There is now an urgent need to shift attention and resources back to treating and preventing diarrhoea.
Johansson, E.M. … [et al.] (2009). Diarrhoea : why children are still dying and what can be done. New York, NY, USA, UNICEF and Geneva, Switzerland, World Health Organization. v, 58 p. ISBN 978-92-806-4462-3 (UNICEF). ISBN 978-92-4-159841-5 (WHO). Full report
There is also an online version of the report on 7pointplan.org
Face masks and clean hands may be key to preventing the influenza virus from spreading among family members, according to a study published online on 4 August 2009 in the Annals of Internal Medicine. The study, of 259 Hong Kong households, found that when family members wore face masks and minded their hand hygiene, the odds of catching the flu from an ill relative dropped by two-thirds. The key was to start taking the two measures within 36 hours of the stricken family member’s first symptoms.
The findings point to simple, inexpensive ways to curb flu transmission during both regular influenza season and during pandemics like the current swine flu (H1N1) outbreak.
Hand hygiene interventions consisted of the supply of liquid soap with instructions to wash hands after bathroom use, sneezing or coughing, and a alcohol-based hand rub, to be used whenever coming home and immediately after touching any potentially virus-contaminated surface.
The fact that hand-washing appeared effective, showed that the flu can spread via direct contact and, more indirectly, by touching virus-contaminated household objects like door handles, light switches and TV remotes.
The study was funded by the U.S. Centers for Disease Control and Prevention (CDC).
Earlier in 2009, the swine flu headlines had brought attention to the importance of handwashing. In May, the respected Wall Street Journal (WSJ) published an article on handwashing, complete with an instructional video. The “WSJ” handwashing technique does require a lot of water though, making it less suitable for developing countries.
While Americans may consider flush-and-forget-it indoor plumbing to be the pinnacle of sanitary science, the lowly latrine could be a far better solution for many parts of the developing world, say researchers at Michigan Technological University.
Associate Professor David Watkins, Professor James Mihelcic and PhD student Lauren Fry of the University’s Sustainable Futures Institute analyzed worldwide barriers to sanitation. Diseases such as dysentery attack millions of people every year, often fatally, largely as a result of poor sanitation. In particular, the researchers found that a scarcity of clean drinking water is not as big an issue as one might expect.
In fact, installing water-guzzling appliances such as toilets can actually promote unsanitary conditions when the effluent is discharged untreated into once-clean rivers and streams. A properly built latrine, on the other hand, keeps sewage safely separate from drinking water.
“Our challenge has been to look at what interventions make the most difference,” Watkins said. Their findings show that small changes can be more important in preserving health than big engineering projects, a fact that Watkins, an engineer, relates with some consternation. “As engineers, we like to build stuff. But handwashing is really important, too,” he said. “Even a simple thing like not dipping your hand into the water pot can make a big difference.”
Improved sanitation is considered equally important for public health as is access to improved drinking water. However, the world has been slower to meet the challenge of sanitation provision for the world’s poor. We analyze previously cited barriers to sanitation coverage including inadequate investment, poor or nonexistent policies, governance, too few resources, gender disparities, and water availability. Analysis includes investigation of correlation between indicators of the mentioned barriers and sanitation coverage, correlations among the indicators themselves, and a geospatial assessment of the potential impacts of sanitation technology on global water resources under six scenarios of sanitation technology choice. The challenges studied were found to be significant barriers to sanitation coverage, but water availability was not a primary obstacle at a global scale. Analysis at a 0.5° grid scale shows, however, that water availability is an important barrier to as many as 46 million people, depending on the sanitation technology selected. The majority of these people are urban dwellers in countries where water quality is already poor and may be further degraded by sewering vast populations. Water quality is especially important because this vulnerable population primarily resides in locations that depend on environmental income associated with fish consumption.
