Water and sanitation infrastructure for health: The impact of foreign aid

Water and sanitation infrastructure for health: The impact of foreign aid

Globalization and Health 2010, 6:12 doi:10.1186/1744-8603-6-12

Publication date 29 July 2010

Full-text: http://www.globalizationandhealth.com/content/6/1/12

Background: The accessibility to improved water and sanitation has been understood as a crucial mechanism to save infants and children from the adverse health outcomes associated with diarrheal disease. This knowledge stimulated the worldwide donor community to develop a specific category of aid aimed at the water and sanitation sector. The actual impact of this assistance on increasing population access to improved water and sanitation and reducing child mortality has not been examined.

Methods: We performed a country-level analysis of the relationship between water and sanitation designated official development assistance (WSS-ODA) per capita, water and sanitation coverage, and infant and child mortality in low-income countries as defined by the World Bank. We focused our inquiry to aid effectiveness since the establishment of the Millennium Development Goals (MDGs).

Results: Access to improved water has consistently improved since 2002. Countries receiving the most WSS-ODA ranged from odds ratios of 4 to 18 times more likely than countries in the lowest tertile of assistance to achieve greater gains in population access to improved water supply. However, while there were modestly increased odds of sanitation access, these were largely non-significant. The countries with greatest gains in sanitation were 8-9 times more likely to have greater reductions in infant and child mortality.

Conclusions: Official development assistance is importantly impacting access to safe water, yet access to improved sanitation remains poor. This highlights the need for decision-makers to be more intentional with allocating WSS-ODA towards sanitation projects.

One response to “Water and sanitation infrastructure for health: The impact of foreign aid

  1. I commend the authors for carrying out this analysis and making it available in an open access journal. There are, as the authors point out, major (really major) caveats to the results observed in this ecological study. That said, I found it to be thought provoking, and, I have a few comments below:

    1. I don’t find the relationship between ODA and sanitation surprising. There are a number of countries that have opted for high-subsidy and high-tech sanitation solutions that are out of reach of those who need them the most. And, many of those same countries have not sufficiently addressed demand creation or affordability, which are key to achieving scale.

    2. The association between gains in sanitation coverage and reductions in infant mortality. The authors state, “higher levels of increase in sanitation and reductions in infant and child mortality, with adjusted odds ratios of 8 and 9 times for the highest compared to the lowest tertiles. They then go on to state, “And, yet, at least for donors that do provide disaggregated WSS-ODA data, only 30% of funding goes to sanitation and hygiene efforts.” One point that comes out here (besides the strong association of sanitation and infant and child mortality) is that more disaggregated information on where funding goes is needed.

    3. It would have been useful for the authors to attempt to come up with a variable (or variables) to characterize national water and sanitation policies for these 49 countries. It is well recognized that certain policies can speed or slow progress, especially in sanitation.

    4. The point made that more sub-national data are needed is a critical one.

    Finally, thanks to the authors for attempting to tease out the associations between ODA and water supply and sanitation coverage and infant and child mortality.

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