Valuing Water, Valuing Livelihoods - Softcover

World Health Organization

Softcover

ISBN 10: 9241564288 ISBN 13: 9789241564281

Publisher: World Health Organization, 2012

Synopsis

This book gives decision makers, health professionals and analysts a comprehensive view of the arguments and challenges associated with establishing the value of drinking-water interventions. The experts who have contributed to this publication provide guidance on assessing the benefits from improving access to safe drinking water and from reducing the burden of water-related diseases. They show how to compare the value of these benefits to the costs of the interventions, with special reference to small-scale drinking water systems.

About this title

About the Author

World Health Organization is a Specialized Agency of the United Nations, charged to act as the world's directing and coordinating authority on questions of human health. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries, and monitoring and assessing health trends.

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Valuing Water, Valuing Livelihoods

Guidance on Social Cost-benefit Analysis of Drinking-water Interventions, with special reference to Small Community Water Supplies

By John Cameron, Paul Hunter, Paul Jagals, Katherine Pond

IWA Publishing

Copyright © 2011 World Health Organization
All rights reserved.

ISBN: 978-92-4-156428-1

Contents

Foreword, vii, 
Acknowledgements, ix, 
Introduction, xi, 
1. Background Katherine Pond, Stephen Pedley and Chris Edwards, 1, 
2. The practice of economic assessment of small-scale drinking-water interventions John Cameron and Paul Jagals, 15, 
3. Economic assessments of improvements in drinking-water supply – the global evidence Chris Edwards and John Cameron, 39, 
4. Current situation in access to drinking-water Katherine Pond and Stephen Pedley, 55, 
5. Defining the current situation – epidemiology Paul R Hunter and Helen Risebro, 75, 
6. Defining the current situation – observing livelihoods John Cameron, 101, 
7. Interventions for water provision Stephen Pedley, Katherine Pond and Eadaoin Joyce, 121, 
8. Estimating the costs of small-scale water-supply interventions Paul Jagals and Luuk Rietveld, 149, 
9. Estimating health impacts of interventions with a focus on small-scale drinking-water interventions Helen Risebro and Paul R. Hunter, 167, 
10. Cost-effectiveness analysis in practice Chris Edwards, 181, 
11. Social cost-benefit analysis – principles John Cameron, 199, 
12. Social cost-benefit analysis – summarizing the available global evidence on drinking-water interventions Chris Edwards, 217, 
Index, 239, 

CHAPTER 1

Background

Katherine Pond, Stephen Pedley and Chris Edwards

Socioeconomic development is clearly linked to access to safe drinking-water. Recognition of this link is not new. Yet, for the majority of the world's population, lack of access to safe drinking-water continues to be a concern in their daily existence. The International Decade for Action: Water for Life (2005–2015) (United Nations General Assembly, 2003) reminds us of the slow progress made over the last century and a half towards what must be the most basic of basic needs in providing a decent quality of life for all globally. As long ago as 1850, the Shattuck report recognized the economic consequences of inadequate water and sanitation:

"We believe that the conditions of perfect health, either public or personal, are seldom or never attained, though attainable; that the average length of human life may be very much extended, and its physical power greatly augmented; that in every year, within this commonwealth, thousands of lives are lost which might have been saved; that tens of thousands of cases of sickness occur, which might have been prevented; that a vast amount of unnecessarily impaired health, and physical disability exists among those not actually confined by sickness; that these preventable evils require an enormous expenditure and loss of money, and impose upon the people unnumbered and immeasurable calamities, pecuniary, social, physical, mental and moral, which might be avoided; that means exist, within our reach, for their mitigation or removal; and that measures for prevention will effect infinitely more, than remedies for the cure of disease." (Shattuck, 1850)

Since the publication of the Shattuck report, a wealth of evidence has accumulated to show that, where communities lack basic sanitation and use vulnerable and contaminated water, the provision of improved water and sanitation generally leads to a significant reduction in premature mortality and morbidity from water-related infectious disease. But there are other important benefits, sometimes forgotten, that are more difficult to quantify, such as security, privacy and dignity, as well as time saved accessing water. For the purposes of this book, we assume that appropriate technologies exist to achieve these benefits anywhere in the world. Our central concern here is to develop a framework for assessing the socioeconomic value of interventions improving access to safe drinking-water. We focus especially on small systems serving people who would otherwise be difficult to reach. Such people are often missed by large-scale schemes.

Access to safe drinking-water is one of the Millennium Development Goals (MDGs) agreed upon by the world's leaders at the United Nations Millennium Summit in 2000 (see Box 1.1).

The MDG drinking-water target is to halve by 2015 the proportion of people without sustainable access to safe drinking-water. But this is not the first time that the international community has set ambitious targets. In the early 1980s governments enthusiastically embraced the goal of Water and Sanitation for All by 1990 (United Nations, 1977). At the start of the 1990s, the same goal was restated. In 2004, however, the same number of people lacked access to an improved drinking-water source as in 1990, and these 1.1 billion people included 13 million in developed regions (WHO/UNICEF, 2006).

The 2008 WHO/UNICEF JMP report gave some good news, however. For the first time since reporting began, the estimated number of people without access to improved drinking-water sources had dropped below one billion (WHO/UNICEF, 2008). More than half of the global population now benefits from piped water reaching their homes, and the numbers using unimproved water supplies are going down. The 2010 WHO/UNICEF JMP report showed this trend for drinking-water to be consolidating.

If progress in achieving access to drinking-water between 2006 and 2015 continues at the same rate as between 1990 and 2008, the global target of halving the proportion without access will be achieved (and actually surpassed) for the developing countries as a whole (Table 1.1). However, two points need to be noted. First, this will still leave some 700 million people without access. Second, the rate of improvement needs to be increased for some developing regions to achieve their 2015 targets. Otherwise these regions (including, most notably, sub-Saharan Africa) will fail to reach the 2015 targets. Over the next decade the population of developing countries is forecast to increase by 830 million, with sub-Saharan Africa accounting for a quarter of the increase and South Asia for another third. Taking into account this population growth, at least an additional 900 million people need access to water by 2015, otherwise these regions will fail to reach the 2015 targets (UNDP, 2006).

Access to safe drinking-water is an essential element of sustainable development, and it is central to the goal of poverty reduction. A recent WHO report (Hutton & Haller, 2004) shows that the total cost of providing safe water varies considerably depending upon the size and location of the target population. In order to achieve the most basic target of halving the proportion of people without sustainable access to an improved water supply by 2015, it has been estimated that developing countries need to spend US$ 42 billion on new coverage (Hutton & Bartram, 2008). The cost of maintaining existing services is estimated to total an additional one billion US dollars for water supply (Hutton & Bartram, 2008).

A significant challenge to water analysts, including public health engineers, physicians, technicians and economists, is to advise policy-makers on interventions to improve access to safe drinking-water that also produce total benefits greater than total costs. Social cost-benefit analysis, which builds on cost-effectiveness analysis, is a tool to aid this decision-making process. Social cost-benefit analysis is applicable even to small-scale water supplies.

SAFE DRINKING-WATER AS A HUMAN RIGHT

An objection often raised to using economic assessment in decision-making on whether or not to invest in expanding access to safe drinking-water is that a given minimum quantity and quality of drinking-water should be provided as a human right. If this is the case, then surely we do not need to show that drinking-water improvements up to that standard are economically justified by giving a positive rate of return.

As the UNDP Human Development Report of 2006 puts it: "ultimately, the case for public action in water and sanitation is rooted in human rights and moral imperatives" (UNDP, 2006, page 42). Article 12 of the International Covenant on Economic, Social and Cultural Rights recognizes "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health" (The Office of the United Nations High Commissioner for Human Rights, 1976). Article 24 of the Convention on the Rights of the Child (Office of the United Nations High Commissioner for Human Rights, 1976) ensures that children are entitled to the enjoyment of the highest attainable standards of health, which requires State Parties to take appropriate measures to combat disease and malnutrition, including within the framework of primary health care (which includes the provision of safe drinking-water).

In 2002, the United Nations Committee on Economic, Social and Cultural Rights, adopted a General Comment on the right to health (United nations Economic and Social Council, 2002). This includes access to safe drinking-water. Regardless of available resources, all States Parties are obliged to ensure that the minimum essential level of rights is achieved, and there is a constant and continuing duty for States to move towards the full realization of a right. This includes ensuring that people have access to enough water to prevent dehydration and disease. The constitutions of more than 90 countries include a reference to the right to water, although such constitutional provision has not been backed by a coherent strategy for extending access to water (UNDP, 2006). Recently, the United Nations General Assembly adopted Resolution 64/292 confirming that safe and clean drinking-water and sanitation is a human right essential to the full enjoyment of life and all other human rights. Subsequently, the United Nations Human Rights Council affirmed, in its Resolution A/HCR/RES/15/9, that the right to water and sanitation is derived from the right to an adequate standard of living and inextricably related to the right to the highest attainable standard of physical and mental health, as well as the right to life and human dignity (Office of the United Nations High Commissioner for Human Rights, 2010).

When a service or capability is defined as a human right, two problems remain: first, the scope of the human right has to be defined; and second, the human right has to be enforced.

Consider the scope of the right to water. How do we define a minimum standard for water access? Should it be defined in terms of the daily quantity (say, number of litres) to which a household has access? If so, what is that daily amount? What quality standards should this water meet? And what do we mean by acceptable access? Does it mean in the house? Or does it mean within 200 metres from the house? Or within one kilometre from the house?

WHO (2003) defines "no access" as circumstances when it is necessary to travel more than one kilometre or for more than 30 minutes to make a round trip to collect less than 5 litres of water per capita per day. Basic access is considered to be achieved where up to 20 litres per capita per day is available within one kilometre or 30 minutes round trip. Intermediate access is where water is provided on-plot through at least one tap (yard level) and it is possible to collect approximately 50 litres of water per capita per day. Optimal access is a supply of water through multiple taps within the house allowing an average of 100–200 litres per capita per day. Monitoring the supply of water is, however, a problem: "what emerges from research across a large group of countries is that patterns of water use are far more complex and dynamic than the static picture presented in global reporting systems" (UNDP, 2006).

To recapitulate: General Comment 15 on the right to water, adopted in November 2002 by the Committee on Economic, Social and Cultural Rights, sets the criteria for the full enjoyment of the right to water. Yet in 2008 about one in seven of the world's population was denied this basic need. Could the situation be improved by enforcing the human right? The answer is probably no because enforcement of the right to water would not appear to be a feasible option. For example, an attempt in South Africa in 2000 to enforce a right to adequate housing failed, with the Constitutional Court stating that the enforcement of any rights specified in the Constitution depends on the availability of resources. Yet, the right to water and sanitation as now adopted by UN Member States will be a powerful legal instrument to enhance the drive towards the goal of universal coverage, applying the principle of progressive realization.

This means that even if we can agree on a definition of adequacy for access to safe drinking-water, a case needs to be made for expanding sustainable access as compared with competing claims for other poverty reduction measures. That is, the question that will be asked is: does the expansion of access to safe drinking-water have a higher claim on resources than investments in other areas of development? There is, in short, a need for economic assessment of improvements in drinking-water supply.

HOW LACK OF ACCESS TO SAFE DRINKING-WATER AFFECTS WELL-BEING

Unsafe water and sanitation, including lack of hygiene, account for almost one tenth of the global burden of disease (Fewtrell et al., 2007). The use of disability-adjusted life years (DALYs) to measure burden of disease is explained in Chapter 10 of this book. Children under the age of 5 years are particularly susceptible to waterborne disease and suffer the most severe consequences. Other most vulnerable groups include the elderly and pregnant women.

Many life-threatening diarrhoeal diseases are waterborne, so that improving water quality in terms of microbiological contamination is one of the most important contributions of improved water supply to public health. Waterborne and other water-related diseases consist mainly of infectious diarrhoea, typhoid, cholera, salmonellosis, shigellosis, amoebiasis, and other protozoan and viral intestinal infections. Some pathogens causing these diseases are transmitted by water, although other forms of transmission do occur such as person-to-person contact, animal-to-human contact, transmission through food and aerosols, and by contact with fomites (Hunter, 1998). In addition to the dangers posed by pathogenic microorganisms, chemicals such as nitrates, fluoride or arsenic in water can have toxic effects. People who consume water contaminated with these chemicals may not immediately display symptoms of disease, but the long-term effects on their health can be extremely severe, as shown by the example of arsenic poisoning in Bangladesh (Smith, Lingas & Rahman, 2000). In addition, Santaniello-Newton & Hunter (2000) propose a category of diseases that are spread by the daily migration of people to collect water, such as meningococcal disease ("water-carrying disease"). Various non-infectious disorders of the musculoskeletal system resulting from the prolonged carrying of heavy weights, especially during childhood, should also be considered.

A number of studies from low-income countries have indicated that improved access to water – and the resulting increases in the quantity of water or time used for hygiene – are the determining factors of health benefits, rather than improvements in water quality (Curtis & Cairncross, 2003). Providing water security can play a wider role in poverty reduction and improving livelihoods, by reducing uncertainty and releasing resources that can be used to decrease vulnerability. It has been noted that improved domestic water supplies and improved local institutions can enhance food security, strengthen local organizations and build cooperation between people (Soussan, 2003). A water source may be very close to a village but may be of poor quality or only seasonally accessible. In order to reach a source of good quality it may be necessary to travel a considerable distance, thus resulting in less time for other activities (in other words, opportunity costs). In fact, it has been demonstrated that the biggest benefit, in terms of both water and sanitation, is time-saving through better access (Hutton et al., 2007).

In addition to the health benefits and the saving of time and energy, providing safe water can also have an influence on school enrolment and attendance. In many cultures, this particularly affects young school-age girls because, for many poor families, the economic value of a girl's work at home exceeds the perceived returns from schooling. On a wider scale, however, the education of girls is widely attested to lead to a fall in fertility rates and in the next generation's mortality and morbidity rates (World Bank, 2006). Clearly, improvements in water supply increase well-being. But are they a good investment?

This book shows how to assess whether improvements in access to safe drinking-water are a good investment. There are two forms of economic assessment that can be used to do this: cost–effectiveness analysis and social cost–benefit analysis.

(Continues...)

Excerpted from Valuing Water, Valuing Livelihoods by John Cameron, Paul Hunter, Paul Jagals, Katherine Pond. Copyright © 2011 World Health Organization. Excerpted by permission of IWA Publishing.
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Edition details

• Publisher: World Health Organization
• Publication date: 2012
• Language: English
• ISBN 10: 9241564288
• ISBN 13: 9789241564281
• Binding: Paperback
• Edition number: 1
• Number of pages: 288