Skip to main content
NCBI home page
Bulletin of the World Health Organization logoLink to Bulletin of the World Health Organization
. 1998;76(6):617–631.

A reassessment of the cost-effectiveness of water and sanitation interventions in programmes for controlling childhood diarrhoea.

R C Varley 1, J Tarvid 1, D N Chao 1
PMCID: PMC2312499  PMID: 10191558

Abstract

Cost-effectiveness analysis indicates that some water supply and sanitation (WSS) interventions are highly cost-effective for the control of diarrhoea among under-5-year-olds, on a par with oral rehydration therapy. These are relatively inexpensive "software-related" interventions such as hygiene education, social marketing of good hygiene practices, regulation of drinking-water, and monitoring of water quality. Such interventions are needed to ensure that the potentially positive health impacts of WSS infrastructure are fully realized in practice. The perception that WSS programmes are not a cost-effective use of health sector resources has arisen from three factors: an assumption that all WSS interventions involve construction of physical infrastructure, a misperception of the health sector's role in WSS programmes, and a misunderstanding of the scope of cost-effectiveness analysis. WSS infrastructure ("hardware") is generally built and operated by public works agencies and financed by construction grants, operational subsidies, user fees and property taxes. Health sector agencies should provide "software" such as project design, hygiene education, and water quality regulation. Cost-effectiveness analysis should measure the incremental health impacts attributable to health sector investments, using the actual call on health sector resources as the measure of cost. The cost-effectiveness of a set of hardware and software combinations is estimated, using US$ per case averted, US$ per death averted, and US$ per disability-adjusted life year (DALY) saved.

Full text

PDF
617

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bern C., Martines J., de Zoysa I., Glass R. I. The magnitude of the global problem of diarrhoeal disease: a ten-year update. Bull World Health Organ. 1992;70(6):705–714. [PMC free article] [PubMed] [Google Scholar]
  2. Bobadilla J. L., Cowley P., Musgrove P., Saxenian H. Design, content and financing of an essential national package of health services. Bull World Health Organ. 1994;72(4):653–662. [PMC free article] [PubMed] [Google Scholar]
  3. Briscoe J. Water supply and health in developing countries: selective primary health care revisited. Am J Public Health. 1984 Sep;74(9):1009–1013. doi: 10.2105/ajph.74.9.1009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Esrey S. A., Feachem R. G., Hughes J. M. Interventions for the control of diarrhoeal diseases among young children: improving water supplies and excreta disposal facilities. Bull World Health Organ. 1985;63(4):757–772. [PMC free article] [PubMed] [Google Scholar]
  5. Gutiérrez G., Tapia-Conyer R., Guiscafré H., Reyes H., Martínez H., Kumate J. Impact of oral rehydration and selected public health interventions on reduction of mortality from childhood diarrhoeal diseases in Mexico. Bull World Health Organ. 1996;74(2):189–197. [PMC free article] [PubMed] [Google Scholar]
  6. Haggerty P. A., Muladi K., Kirkwood B. R., Ashworth A., Manunebo M. Community-based hygiene education to reduce diarrhoeal disease in rural Zaire: impact of the intervention on diarrhoeal morbidity. Int J Epidemiol. 1994 Oct;23(5):1050–1059. doi: 10.1093/ije/23.5.1050. [DOI] [PubMed] [Google Scholar]
  7. Henry F. J., Huttly S. R., Patwary Y., Aziz K. M. Environmental sanitation, food and water contamination and diarrhoea in rural Bangladesh. Epidemiol Infect. 1990 Apr;104(2):253–259. doi: 10.1017/s0950268800059422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Huttly S. R., Morris S. S., Pisani V. Prevention of diarrhoea in young children in developing countries. Bull World Health Organ. 1997;75(2):163–174. [PMC free article] [PubMed] [Google Scholar]
  9. Murray C. J., Govindaraj R., Musgrove P. National health expenditures: a global analysis. Bull World Health Organ. 1994;72(4):623–637. [PMC free article] [PubMed] [Google Scholar]
  10. Murray C. J., Kreuser J., Whang W. Cost-effectiveness analysis and policy choices: investing in health systems. Bull World Health Organ. 1994;72(4):663–674. [PMC free article] [PubMed] [Google Scholar]
  11. Murray C. J., Lopez A. D., Jamison D. T. The global burden of disease in 1990: summary results, sensitivity analysis and future directions. Bull World Health Organ. 1994;72(3):495–509. [PMC free article] [PubMed] [Google Scholar]
  12. Murray C. J. Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ. 1994;72(3):429–445. [PMC free article] [PubMed] [Google Scholar]
  13. Stanton B. F., Clemens J. D. An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. II. A randomized trial to assess the impact of the intervention on hygienic behaviors and rates of diarrhea. Am J Epidemiol. 1987 Feb;125(2):292–301. doi: 10.1093/oxfordjournals.aje.a114529. [DOI] [PubMed] [Google Scholar]
  14. Walsh J. A., Warren K. S. Selective primary health care: an interim strategy for disease control in developing countries. N Engl J Med. 1979 Nov 1;301(18):967–974. doi: 10.1056/NEJM197911013011804. [DOI] [PubMed] [Google Scholar]

Articles from Bulletin of the World Health Organization are provided here courtesy of World Health Organization

RESOURCES