19 June 2018

Water, Sanitation and Development

Author/Compiled by
Risch Tratschin (seecon international gmbh)

Introduction

Factsheet Block Body

Water is crucial for any form of development (SPUHLER 2008)

Water is crucial for any form of development. Source: SPUHLER (2008)


The Millennium Development Goal 7 stipulates to improve environmental sustainability by integrating sustainable development in country policies, by reducing the biodiversity loss, by halving the proportion of people without access to safe water and sanitation and by improving lives of at least 100 million slum dwellers (UN 2010).

Expanding access to domestic water supply and sanitation services will bring the international community closer to meeting a number of other MDGs – in fact, for many of the targets, it is difficult to imagine how significant progress can be made without first ensuring that poor households have a safe, reliable water supply and adequate sanitation facilities. Meeting the target on access to water and sanitation is particularly vital in terms of the poverty, gender, and health goals, and also has a significant impact on other Goals (UNMP-TWS 2005). According to UNDP, overall human development is more closely linked to access to water and sanitation than any other development driver, including spending on health or education, and access to energy services (UNDP 2010). 

Impact of sustainable sanitation and water management and IWRM

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(Adapted from UNMP-TWS 2005)

Improved access to water and sanitation and Integrated Water Resources Management (IWRM) have various impacts on social and economic development of millions of people. Here are some key development issues which are affected by improved access to water and sanitation, and by IWRM:

Poverty

  • Household livelihood security depends on the health of its members, hence adults who are ill themselves or who must care for sick children are less productive.
  • Illnesses caused by unsafe drinking water and inadequate sanitation generate health costs that can claim a large share of poor households’ income.
  • Time spent collecting water cannot be used for other livelihood activities.
  • IWRM can improve allocation (agriculture, industry, households) and reduce vulnerability to water-related hazards.

Hunger

  • Healthy people are better able to absorb the nutrients in food than those suffering from water-related diseases, particularly worms, which rob their hosts of calories.
  • Water is a direct input to irrigation for expanded grain production. Reliable water sources (IWRM) support subsistence agriculture, home gardens, livestock, and tree crops and thus higher nutritional standards.

Primary education

  • Relieve girls from water-fetching duties, allowing them to attend school.
  • Having separate sanitation facilities for girls in schools increases their school attendance, especially after menarche.
  • Reducing illness related to water and sanitation, including injuries from water-carrying, improves school attendance, especially for girls.

Gender equality (see gender factsheet)

  • Water sources and sanitation facilities closer to home put women and girls at less risk for sexual harassment and assault while gathering water and searching for privacy.
  • Community-based organisations for water supply and sanitation can improve social capital of women.
  • Reduced time, health, and care-giving burdens from improved water services give women more time for productive endeavours, adult education, empowerment activities, and leisure.

Child mortality

  • Higher rates of child survival are a precursor to the demographic transition to lower fertility rates; having fewer children reduces women’s domestic responsibilities.
  • Sanitation and safe water in health care facilities help ensure clean delivery and reduce neonatal deaths.
  • Improved sanitation, safe drinking water sources, and greater quantities of domestic water for washing reduce infant and child morbidity and mortality.
  • Mothers with improved water supply and sanitation services are better able to care for their children, both because they have fewer illnesses and because they devote less time to water-fetching and seeking privacy for defecation.

Maternal mortality

  • Accessible sources of water reduce labour burdens and health problems resulting from water portage, reducing maternal mortality risks.
  • Improved health and nutrition reduce susceptibility to anaemia and other conditions that affect maternal mortality.

Major diseases (see health factsheet)

  • Safe drinking water and basic sanitation help prevent water-related diseases, including diarrhoeal diseases, schistosomiasis, filariasis, trachoma, and helminthes. 1.6 million deaths per year are attributed to unsafe water, poor sanitation, and lack of hygiene.
  • Improved water supply reduces diarrhoea morbidity by 21%; improved sanitation reduces diarrhoea morbidity by 37.5%; hand washing can reduce the number of diarrhoeal cases by up to 35%; additional improvements in drinking water quality, such as point of use disinfection, would reduce diarrhoeal episodes by 45%.
  • Improved water management (IWRM) in human settlements reduces transmission risks of such mosquito-borne illness as malaria and dengue fever.

Environmental sustainability

  • Adequate treatment and disposal of excreta and wastewater contributes to better ecosystem management and less pressure on freshwater resources.
  • Improved sanitation reduces flows of human excreta into waterways, helping to protect human and environmental health.
  • Inadequate access to safe water and inadequate access to sanitation and other infrastructure are two of the five defining characteristics of a slum.

Economic benefits of improved access to water and sanitation

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Improving water supply and sanitation services can have substantial economic benefit: the WHO estimated some years ago that each $1 invested would yield an economic return of between $3 and $34, depending on the region (HUTTON / HALLER 2004). The UNDP estimated recently that an investment in water supply yields an average economic return of $4.4 to $1 and investment in sanitation a return of $9.1 to $1 (UNDP 2010).

The health-related costs avoided would reach $7.3 billion per year, and the annual global value of adult working days gained because of less illness would rise to almost $750 million. Better services resulting from the relocation of a well or borehole to a site closer to user communities, the installation of piped water supply in houses, and latrines closer to home yield significant time savings. The annual value of these time savings would amount to $64 billion if the target is met (HUTTON / HALLER 2004).

As an example, the World Bank’s Water and Sanitation Program estimated that inadequate sanitation caused India economic losses equivalent to 6.4% of India’s GDP in 2006 at US$53.8 billion. The report indicates that premature mortality and other health-related impacts of inadequate sanitation were the most costly with 72% of total impacts, followed by productive time lost to access sanitation facilities or sites for defecation with 20%, and drinking water-related impacts with 7.8% (WSP 2010).

Conclusion

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MDG 7, which demands environmental sustainability, is considered to be a key goal and a prerequisite for overall MDG achievement. Hence it is not an isolated goal in itself, but instead forms an integral goal for all the MDGs. The provision of safe water and basic sanitation and also improved IWRM can have various, significant impacts on hunger alleviation, health, education or environmental conditions.

But still MDG 7 is displaying insignificant progress because of lacking internalisation of environmental components in socio-economic development. This is needed to protect valuable ecosystem services, such as biodiversity, fish habitats and pollination. Such services can determine the long-term capacity of human societies to buffer or absorb sudden environmental shocks, such as droughts and floods. And there is a growing realisation that huge challenges, such as eradicating hunger, will have to be achieved through environmentally sustainable solutions (SEI 2005).

Library References

Evaluation of the Costs and Benefits of Water and Sanitation Improvements at the Global Level

The aim of this study was to estimate the economic costs and benefits of a range of selected interventions to improve water and sanitation services, with results presented for 17 WHO sub-regions and at the global level. The results show that all water and sanitation improvements were found to be cost-beneficial, and this applied to all world regions. The main

HUTTON, G. HALLER, L. (2004): Evaluation of the Costs and Benefits of Water and Sanitation Improvements at the Global Level. Geneva: World Health Organisation (WHO) URL [Accessed: 01.11.2012]

Linking Poverty Reduction and Water Management

This paper analyses how water management can contribute to reduce poverty and makes policy recommendations. Contains a detailed assessment of water’s potential contribution to all of the seven MDGs - not just that one which explicitly refers to water.

POVERTY-ENVIRONMENT PARTNERSHIP (PEP) (2006): Linking Poverty Reduction and Water Management. New York: United Nations Development Programme / Stockholm: Stockholm Environment Institute URL [Accessed: 07.06.2011]

Sustainable Pathways to Attain the Millennium Development Goals: Assessing the Key Role of Water, Energy and Sanitation

This report highlights the importance of the environment in achieving all MDGs. It focuses on three core aspects of goal fulfilment, namely freshwater to eradicate hunger and sustain ecosystems, energy and sanitation for poverty alleviation, health improvements and environmental sustainability.

SEI (2005): Sustainable Pathways to Attain the Millennium Development Goals: Assessing the Key Role of Water, Energy and Sanitation. Stockholm: Stockholm Environmental Institute URL [Accessed: 30.03.2011]

Health, Dignity and Development: What Will it Take?

The UN Millennium Project Task Force on Water and Sanitation published this extensive report in 2005 with two main aims: First, it highlights which specific policies and resources are needed to meet the MDGs and who needs to take reasonability for ensuring they are in place. And secondly, it identifies the specific policies and resources required to meet the MDGs as part of a larger UN Millennium Project. It also pinpoints actions required in other sectors, emphasising that advances in a number of other areas strongly affect the ability of countries to meet the MDG water and sanitation target (7c) and to optimise water use.

UN MILLENNIUM PROJECT TASK FORCE ON WATER AND SANITATION (UNMP-TWS) (2005): Health, Dignity and Development: What Will it Take?. London: United Nations Development Programme URL [Accessed: 28.03.2011]

The Economic Impacts of Inadequate Sanitation in India

Inadequate sanitation causes India considerable economic losses, equivalent to 6.4 percent of India’s GDP in 2006 at US$53.8 billion, according to The Economic Impacts of Inadequate Sanitation in India, a new report from the Water and Sanitation Program (WSP). The study analysed the evidence on the adverse economic impacts of inadequate sanitation, which include costs associated with death and disease, accessing and treating water, and losses in education, productivity, time, and tourism. The findings are based on 2006 figures, although a similar magnitude of losses is likely in later years.

WSP (n.y): The Economic Impacts of Inadequate Sanitation in India. New Delhi: Water and Sanitation Program (WSP), World Bank URL [Accessed: 29.03.2011]

Progress on Sanitation and Drinking-Water. 2010 Update

This well illustrated report describes the status and trends with respect to the use of safe drinking-water and basic sanitation, and progress made towards the MDG drinking-water and sanitation target. It presents some striking disparities: the gap between progress in providing access to drinking-water versus sanitation; the divide between urban and rural populations in terms of the services provided; differences in the way different regions are performing, bearing in mind that they started from different baselines; and disparities between different socioeconomic strata in society. Each JMP report assesses the situation and trends anew and so this JMP report supersedes previous reports (e.g. from 2004, 2006 and 2008).

WHO ; UNICEF (2010): Progress on Sanitation and Drinking-Water. 2010 Update. Geneva: World Health Organisation (WHO) / New York: UNICEF URL [Accessed: 16.05.2019]
Further Readings

SDG 6 along the water and nutrient cycles

This AGUASAN publication illustrates how the water and nutrient cycles can be used as a tool for creating a common understanding of a water and sanitation system and aligning it with SDG 6.

BROGAN, J., ERLMANN, T., MUELLER, K. and SOROKOVSKYI, V. (2017): SDG 6 along the water and nutrient cycles. Using the water and nutrient cycles as a tool for creating a common understanding of a water and sanitation system - including workshop material. Bern (Switzerland): AGUASAN and Swiss Agency for Development and Cooperation (SDC) URL [Accessed: 26.03.2019] PDF

The Post 2015 Water Thematic Consultation Report

This report is the result of a stakeholder consultation organised by the United Nations and partners to lay the groundwork for a new development agenda after 2015. The contributions are organised around three main topics: access to drinking water, sanitation and hygiene; water resources and wastewater management; and water quality improvements.

UN-WATER (2013): The Post 2015 Water Thematic Consultation Report. New York: United Nations Water (UN-Water) URL [Accessed: 26.08.2013]

Progress on Drinking Water and Sanitation

There are still 780 million people without access to an improved drinking water source. And even though 1.8 billion people have gained access to improved sanitation since 1990, the world remains off track for the sanitation target. It is essential to accelerate progress in the remaining time before the MDG deadline, and I commend those who are participating in the Sustainable Sanitation: Five Year Drive to 2015. This report outlines the challenges that remain. Some regions, particularly sub- Saharan Africa, are lagging behind. Many rural dwellers and the poor often miss out on improvements to drinking water and sanitation. And the burden of poor water supply falls most heavily on girls and women. Reducing these disparities must be a priority.

UNICEF ; WHO (2012): Progress on Drinking Water and Sanitation. Update 2012. New York/Geneva: United Nations International Children’s Emergency Fund (UNICEF)/World Health Organisation (WHO) URL [Accessed: 19.04.2012]

Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage

The present study aimed to estimate global, regional and country-level costs and benefits of drinking-water supply and sanitation interventions to meet the MDG target in 2015, and to attain universal coverage. This report updates previous economic analyses conducted by the World Health Organization, using new WSS coverage rates, costs of services, income levels and health indicators.

HUTTON, G. (2012): Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage. (= WHO/HSE/WSH , 1 / 12 ). Geneva: World Health Organization URL [Accessed: 01.11.2012]

Linking Poverty Reduction and Water Management

This paper analyses how water management can contribute to reduce poverty and makes policy recommendations. Contains a detailed assessment of water’s potential contribution to all of the seven MDGs - not just that one which explicitly refers to water.

POVERTY-ENVIRONMENT PARTNERSHIP (PEP) (2006): Linking Poverty Reduction and Water Management. New York: United Nations Development Programme / Stockholm: Stockholm Environment Institute URL [Accessed: 07.06.2011]

Sustainable Pathways to Attain the Millennium Development Goals: Assessing the Key Role of Water, Energy and Sanitation

This report highlights the importance of the environment in achieving all MDGs. It focuses on three core aspects of goal fulfilment, namely freshwater to eradicate hunger and sustain ecosystems, energy and sanitation for poverty alleviation, health improvements and environmental sustainability.

SEI (2005): Sustainable Pathways to Attain the Millennium Development Goals: Assessing the Key Role of Water, Energy and Sanitation. Stockholm: Stockholm Environmental Institute URL [Accessed: 30.03.2011]

Drinking Water: Equity, Safety and Sustainability

The report investigates access to and use of drinking water in greater detail than is possible in the regular JMP progress reports, and includes increased disaggregation of water service levels and analyses of trends across countries and regions. It focuses on the three key challenges of equity, safety and sustainability.

UNICEF ; WHO (2011): Drinking Water: Equity, Safety and Sustainability. New York and Geneva: United Nations Children's Fund (UNICEF) and World Health Organization (WHO) URL [Accessed: 13.05.2019]

The MDG Target on Water and Sanitation Reader. UN-Water Decade Programme on Advocacy and Communication (UNW-DPAC)

Compiled by the UN-Water Decade Programme on Advocacy and Communication (UNW-DPAC), this reader is intended for all those interested in getting familiar with issues related to the achievement of target 7c of the MDGs. It provides basic references for easy reading and some of the latest and most relevant United Nations publications on issues related to the accomplishment of the Millennium Development Goals (MDGs) as they relate to water and sanitation. Link is provided when the publication is available online.

UNW-DPAC (2010): The MDG Target on Water and Sanitation Reader. UN-Water Decade Programme on Advocacy and Communication (UNW-DPAC). Zaragoza: UN Office to Support the International Decade for Action ‘Water for Life’ 2005-2015 URL [Accessed: 31.03.2011]

Progress on Sanitation and Drinking-Water. 2010 Update

This well illustrated report describes the status and trends with respect to the use of safe drinking-water and basic sanitation, and progress made towards the MDG drinking-water and sanitation target. It presents some striking disparities: the gap between progress in providing access to drinking-water versus sanitation; the divide between urban and rural populations in terms of the services provided; differences in the way different regions are performing, bearing in mind that they started from different baselines; and disparities between different socioeconomic strata in society. Each JMP report assesses the situation and trends anew and so this JMP report supersedes previous reports (e.g. from 2004, 2006 and 2008).

WHO ; UNICEF (2010): Progress on Sanitation and Drinking-Water. 2010 Update. Geneva: World Health Organisation (WHO) / New York: UNICEF URL [Accessed: 16.05.2019]

Progress on Sanitation and Drinking-Water. 2013 Update

This well illustrated report describes the status and trends with respect to the use of safe drinking-water and basic sanitation, and progress made towards the MDG drinking-water and sanitation target. It presents some striking disparities: the gap between progress in providing access to drinking-water versus sanitation; the divide between urban and rural populations in terms of the services provided; differences in the way different regions are performing, bearing in mind that they started from different baselines; and disparities between different socioeconomic strata in society. Each JMP report assesses the situation and trends anew and so this JMP report supersedes previous reports

WHO ; UNICEF (2013): Progress on Sanitation and Drinking-Water. 2013 Update. New York/Geneva: United Nations International Children’s Emergency Fund (UNICEF)/World Health Organisation (WHO) URL [Accessed: 21.08.2013]

Interventions to Improve Water Quality and Supply, Sanitation and Hygiene Practices, and Their Effects on the Nutritional Status of Children

Water, sanitation and hygiene interventions are frequently implemented to reduce infectious diseases, and may be linked to improved nutrition outcomes in children. The objective of this paper is to evaluate the effect of interventions to improve water quality and supply, provide adequate sanitation and promote handwashing with soap, on the nutritional status of children under the age of 18 years and to identify current research gaps.

DANGOUR, A.D. WATSON, L. CUMMING, O. BOISSON, S. CHE, Y. VELLEMAN, Y. CAVILL, S. ALLEN, E. UAUY, R. (2013): Interventions to Improve Water Quality and Supply, Sanitation and Hygiene Practices, and Their Effects on the Nutritional Status of Children. (= Cochrane Database of Systematic Reviews 2013 , 8 ). Chichester: John Wiley & Sons URL [Accessed: 05.09.2013]

How much International Variation in Child Height Can Sanitation Explain?

Physical height is an important economic variable reflecting health and human capital. Puzzlingly, however, differences in average height across developing countries are not well explained by differences in wealth. This paper provides the first documentation of a quantitatively important gradient between child height and sanitation that can statistically explain a large fraction of international height differences.

SPEARS, D. (2013): How much International Variation in Child Height Can Sanitation Explain?. (= Policy Research Working Paper , 6351 ). Washington: The World Bank Water and Sanitation Program (WSP) URL [Accessed: 23.09.2013]

Report of the Special Rapporteur on the Human Right to Safe Drinking Water and Sanitation, Catarina de Albuquerque

Focusing on sustainability in the realization the human rights to water and sanitation, the report examines how the rights to water and sanitation can and must be met for present and future generations. Using the human rights framework, the report analyses states’ common approaches to water and sanitation, particularly in adopting measures both during times of normalcy and during economic and financial crises, and shows how those approaches often fail to incorporate sustainability.

ALBUQUERQUE, C. (2013): Report of the Special Rapporteur on the Human Right to Safe Drinking Water and Sanitation, Catarina de Albuquerque. (=Report submitted to the General Assembly’s Human Rights Council, 24th session, July 11, 2013). Geneva: Office of the United Nations High Commissioner for Human Rights (OHCHR) URL [Accessed: 07.10.2013]

Human Resource Capacity Gaps in Water and Sanitation

This is the synthesis report of the Human Resource Capacity Assessments. In the water and sanitation sector, the human resource requirement to meet the water and sanitation targets has been relatively unknown in relation to the numbers of staff, qualifications and their practical experience. IWA developed an assessment method to collect data on human resource gaps (skills) and shortages (number of workers) at the national level in the water and sanitation sector. The assessment method was piloted in five countries in 2009, Mali, Zambia, South Africa, Bangladesh and Timor L’este and in phase 2 a more structured approach was used for 10 in-country assessments (Burkina Faso, Tanzania, Mozambique PNG, Sri Lanka, Lao PDR and Philippines, Niger, Senegal, and Ghana).

IWA (2013): Human Resource Capacity Gaps in Water and Sanitation. Main Findings and the Way Forward. London: International Water Association (IWA) URL [Accessed: 16.04.2019]

Interventions to Improve Water Quality for Preventing Diarrhoea

Diarrhoeal diseases are a leading cause of mortality and morbidity, especially among young children in developing countries. While many of the infectious agents associated with diarrhoeal disease are potentially waterborne, the evidence for reducing diarrhoea in settings where it is endemic by improving the microbiological quality of drinking water has been equivocal. The aim of the present study is to assess the effectiveness of interventions to improve water quality for preventing diarrhoea.

CLASEN, T.F. ; ROBERTS, I.G. ; RABIE, T. ; SCHMIDT, W.P. ; CAIRNCROSS, S. (2009): Interventions to Improve Water Quality for Preventing Diarrhoea. In: The Cochrane Library: URL [Accessed: 30.09.2013]

Sanitation and Hygiene in Africa: Where do we Stand?

This book takes stock of progress made by African countries through the AfricaSan process since 2008 and the progress needed to meet the MDG on sanitation by 2015 and beyond. It addresses priorities which have been identified by African countries as the key elements which need to be addressed in order to accelerate progress.This book is essential reading for government staff from Ministries responsible for sanitation, sector stakeholders working in NGOs, CSOs and agencies with a focus on sanitation and hygiene and water and Sanitation specialists. It is also suitable for Masters courses in water and sanitation and for researchers and the donor community.

CROSS, P. COOMBES, Y. (2013): Sanitation and Hygiene in Africa: Where do we Stand?. Analysis from the AfricaSan Conference, Kigali, Rwanda. London: International Water Association (IWA) Publishing URL [Accessed: 01.11.2013]

Hygiene Intervention Reduces Contamination of Weaning Food in Bangladesh

This study was conducted to measure the impact of a hygiene intervention on the contamination of weaning food in Bangladesh.

ISLAM, M.S. ; MAHMUD, Z.H. ; GOPE, P.S. ; ZAMAN, R.U. ; HOSSAIN, Z. ; ISLAM, M.S. ; MONDAL, D. ; SHARKER, M.A.Y. ; ISLAM, K. ; JAHAN, H. ; BHUIYA, A. ; ENDTZ, H.P. ; CRAVIOTO, A. ; CURTIS, V. ; TOUR, O. ; CAIRNCROSS, S. (2013): Hygiene Intervention Reduces Contamination of Weaning Food in Bangladesh. In: Tropical Medicine and International Health: Volume 18 , 250-258. URL [Accessed: 25.11.2013]

Sustainability and CLTS: Taking Stock

Sustainability is without doubt one of the most burning subject matters that subsumes many of the issues that we are seeing in CLTS and wider WASH practice. There have been several useful studies on sustainability that have highlighted some of the different aspects as well as the complexities involved. However, it is unclear how much of the learning from these studies has been built into current and future programming and practice. Based on existing research and our own understanding, this issue of Frontiers of CLTS is an attempt at an up to date synthesis of where we are at the beginning of 2015. In the issue, we identify some priority areas for learning: How to phase in sanitation marketing; Post-ODF engagement of government, NGOS, donors and others; How to ensure equity and inclusion; How to transform social norms; Monitoring, learning, changing

CAVILL, S. CHAMBERS, R. VERNON, N. (2015): Sustainability and CLTS: Taking Stock. (= Frontiers of CLTS: Innovations and Insights , 4 ). Brighton: Institute of Development Studies URL [Accessed: 18.06.2019]
Case Studies

The Economic Impacts of Inadequate Sanitation in India

Inadequate sanitation causes India considerable economic losses, equivalent to 6.4 percent of India’s GDP in 2006 at US$53.8 billion, according to The Economic Impacts of Inadequate Sanitation in India, a new report from the Water and Sanitation Program (WSP). The study analysed the evidence on the adverse economic impacts of inadequate sanitation, which include costs associated with death and disease, accessing and treating water, and losses in education, productivity, time, and tourism. The findings are based on 2006 figures, although a similar magnitude of losses is likely in later years.

WSP (n.y): The Economic Impacts of Inadequate Sanitation in India. New Delhi: Water and Sanitation Program (WSP), World Bank URL [Accessed: 29.03.2011]

Cluster-Randomised Controlled Trials of Individual and Combined Water, Sanitation, Hygiene and Nutritional Interventions in Rural Bangladesh and Kenya

Water quality, sanitation, handwashing and nutritional interventions can independently reduce enteric infections and growth faltering. There is little evidence that directly compares the effects of these individual and combined interventions on diarrhoea and growth when delivered to infants and young children. The objective of the WASH Benefits study is to help fill this knowledge gap.

ARNOLD, B.F. ; NULL, C. ; LUBY, S. ; UNICOMB, L. ; STEWART, C. ; DEWEY, K. ; AHMED, T. ; ASHRAF, S. ; CHRISTENSEN, G. ; CLASEN, T. ; DENTZ, H.N. ; FERNALD, L.C.H. ; HAQUE, R. ; HUBBARD, A. ; KARIGER, P. ; LEONTSINI, E. ; LIN, A. ; NJENGA, S.M. ; PICKERING, A.J. ; RAM, P.K. ; TOFAIL, F. ; WINCH, P. ; COLFORD, J.M. (2013): Cluster-Randomised Controlled Trials of Individual and Combined Water, Sanitation, Hygiene and Nutritional Interventions in Rural Bangladesh and Kenya. The WASH Benefits Study Design Rationale. In: BMJ Open.: URL [Accessed: 09.06.2018] PDF

Open Defecation and Childhood Stunting in India

Poor sanitation remains a major public health concern linked to several important health outcomes; emerging evidence indicates a link to childhood stunting. In India over half of the population defecates in the open; the prevalence of stunting remains very high. Recently published data on levels of stunting in 112 districts of India provide an opportunity to explore the relationship between levels of open defecation and stunting within this population.

SPEARS, D. ; GHOSH, A. ; CUMMING, O. (2013): Open Defecation and Childhood Stunting in India. An Ecological Analysis of New Data from 112 Districts. In: PLOS ONE: Volume 9 URL [Accessed: 10.06.2018] PDF

Growing Taller Among Toilets

Child height is an important indicator of human capital and human development. Recent medical evidence suggests that exposure to poor sanitation - and speci cally to widespread open defecation - can pose a critical threat to child growth. This paper identi es an effect of open defecation on child height from within-province changes in the local area open defecation to which children are exposed.

KOV, P. SMETS, S. SPEARS, D. VYAS, S. (2013): Growing Taller Among Toilets. Evidence from Changes in Sanitation and Child Height in Cambodia, 2005-2010. Amston: Research Institute for Compassionate Economics (RICE) URL [Accessed: 23.09.2013]

Village Sanitation and Children's Human Capital

Open defecation is exceptionally widespread in India, a country with puzzlingly high rates of child stunting. This paper reports a randomized controlled trial of a village-level sanitation program implemented in one district by the government of Maharashtra. The program caused a large but plausible average increase in child height, which is an important marker of human capital. The results demonstrate sanitation externalities: an effect even on children in households that did not adopt latrines.

HAMMER, J. SPEARS, D. (2013): Village Sanitation and Children's Human Capital. Evidence from a Randomized Experiment by the Maharashtra Government. (= Policy Research Working Paper , 6580 ). Washington: The World Bank Water and Sanitation Program (WSP) URL [Accessed: 01.10.2013]
Awareness Raising Material

Driving Development By Investing In Water And Sanitation. Five Facts Support the Argument

This short pamphlets presents five key facts highlighting the importance of water for development, amongst them increasing economic productivity, reducing hunger and illness, and benefits for the environment.

SIWI (2005): Driving Development By Investing In Water And Sanitation. Five Facts Support the Argument. Stockholm: SIWI URL [Accessed: 24.08.2011]

What's a Toilet Worth?

This graphic shows the costs of inadequate sanitation and economic benefits that could result from improved sanitation.

THE WORLD BANK ; WSP (2013): What's a Toilet Worth?. Lack of Access to Sanitation Costs the World US$260 Billion Yearly. Washington: The World Bank, Water and Sanitation Program (wsp) URL [Accessed: 09.09.2013]

Integrating Water, Sanitation and Hygiene into Nutrition Programming

Diarrhea, pneumonia, and birth complications are the top three killers of children under age 5 worldwide. Diarrhea is also a leading cause of undernutrition in this age group, and one-third to one-half of all child mortality cases are linked to undernutrition. If mothers and other caregivers used basic hygiene practices and had better access to safe water and adequate sanitation this could greatly reduce under-5 deaths and improve child nutrition.

USAID ; WASH PLUS (2013): Integrating Water, Sanitation and Hygiene into Nutrition Programming. Washington: United States Agency for International Development (USAID), WASHplus URL [Accessed: 23.09.2013]

Alternative Versions to