Evaluating the health impact of urban WASH programmes

Improving health is a key justification for WASH interventions…but evaluating health impacts is often viewed as too complex and costly.

This Discussion Paper, a WSUP/SHARE collaboration, argues for more widespread evaluation of the health impacts of WASH interventions: not with the aim of demonstrating that WASH can improve health (we know it can), but rather with the aim of assessing the impact of particular interventions.

We suggest that more frequent evaluation could contribute to improved effectiveness, by encouraging investors and implementers to focus on impacts rather than outputs (such as number of toilets constructed). More widespread health impact evaluation would also enable more objective comparative assessment of the value-for-money of different types of urban WASH intervention. Further, we argue that health impact evaluation need not be as costly as is widely thought. We discuss available methods, and suggest that the most appropriate approach in urban WASH evaluation contexts will often be the before-after concurrent control (BAC) design.

This Discussion Paper is co-published by Water & Sanitation for the Urban Poor (WSUP) and the Sanitation and Hygiene Applied Research for Equity (SHARE) Research Consortium. It is presented at this stage as a basis for sector debate, and should not be considered a definitive statement of the views of these organisations.

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