India: Big push for small cities

By Prakhar Jain (email) and Aditya Bhol

The run-up to elect a new government brought sanitation to the fore of public conversation in India. Last month, Prime Minister Modi declared sanitation as a national priority, announcing ‘Swachh Bharat Abhiyan’, a sanitation programme dedicated to creating clean India by 2019 as a tribute to Mahatma Gandhi’s 150th birth anniversary. Whether or not this plan succeeds may depend on whether it is simply a repackaged programme such as the ‘Nirmal Bharat Abhiyan’ that was focused entirely on building toilets in rural India, or a renewed commitment to improve sanitation in both the rural and urban areas.  As India urbanizes, demand for effective and sustainable sanitation services will increase. India, with 11% of the world’s urban population currently, accounts for 46% of global urban open defecation [i]. While other developing countries like China, Vietnam, and Peru have already achieved open defecation free (ODF) status in urban areas, India still lags behind. The situation is particularly abysmal in small cities (population below a million) where close to 17% of the population defecates in the open as compared to 4% in large cities (population greater than a million) [ii]. The 2011 national census has shown that these small cities represent more than 91% of total urban open defecation in the country. If we are to catch up, the key is to immediately turn our attention towards small and medium-sized cities.

WSP – 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), a global partnership administered by the World Bank.

The study analyzed 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.

The report indicates that premature mortality and other health-relatedimpacts of inadequate sanitation, were the most costly at US$38.5 billion, 71.6 percent of total impacts, followed by productive time lost to access sanitation facilities or sites for defecation at US$10.7 billion, 20 percent, and drinking water-related impacts at US$4.2 billion, 7.8 percent.

India: inadequate sanitation costs the equivalent of 6.4 percent of GDP

Inadequate sanitation costs India US$ 53.8 billion, which is equivalent to 6.4 percent of India’s GDP in 2006, according to a new report [1] from the Water and Sanitation Program (WSP).

The study analyzed 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.

The report indicates that premature mortality and other health-related impacts of inadequate sanitation, were the most costly at US$ 38.5 billion, 71.6 percent of total impacts, followed by productive time lost to access sanitation facilities or sites for defecation at US$ 10.7 billion, 20 percent, and drinking water-related impacts at US$ 4.2 billion, 7.8 percent.

“The cost is more than I expected,” UNICEF’s water, sanitation and hygiene chief Clarissa Brocklehurst said in an interview with news site Bloomberg. “Yet, if you know the scale of open defecation in India, it’s not all that surprising.”

How valuable are environmental health interventions? : evaluation of water and sanitation programmes in India

Researchers have used an improved evaluation method to better calculate economic benefits of a rural water supply and sanitation programme in India. This was achieved by getting comprehensive pre-intervention baseline data from treatment and control villages, and including the costs of medical bills, lost income and and water treatment.

Pattanayak, S.K … [et al] (2010). How valuable are environmental health interventions? : evaluation of water and sanitation programmes in India. Bulletin of the World Health Organization ; vol. 88, no. p. 535-542. doi: 10.2471/BLT.09.066050

Abstract

Objective

To evaluate and quantify the economic benefits attributable to improvements in water supply and sanitation in rural India.

Methods

We combined propensity-score “pre-matching” and rich pre–post panel data on 9500 households in 242 villages located in four geographically different districts to estimate the economic benefits of a large-scale community demand-driven water supply programme in Maharashtra, India. We calculated coping costs and cost of illness by adding across several elements of coping and illness and then estimated causal impacts using a difference-in-difference strategy on the pre-matched sample. The pre–post design allowed us to use a difference-in-difference estimator to measure “treatment effect” by comparing treatment and control villages during both periods. We compared average household costs with respect to out-of-pocket medical expenses, patients’ lost income, caregiving costs, time spent on collecting water, time spent on sanitation, and water treatment costs due to filtration, boiling, chemical use and storage.

Findings

Three years after programme initiation, the number of households using piped water and private pit latrines had increased by 10% on average, but no changes in hygiene-related behaviour had occurred. The behavioural changes observed suggest that the average household in a programme community could save as much as 7 United States dollars per month (or 5% of monthly household cash expenditures) in coping costs, but would not reduce illness costs. Poorer, socially marginalized households benefited more, in alignment with programme objectives.

Conclusion

Given the renewed interest in water, sanitation and hygiene outcomes, evaluating the economic benefits of environmental interventions by means of causal research is important for understanding the true value of such interventions.

For more on WASH evaluation see:

Garandeau, R., Casella D. and Bostoen, K. (2009). Evaluating & improving the WASH sector : strengthening WASH governance, learning about complexity, assessing change. (Thematic overview paper series ; 23). The Hague, The Netherlands, IRC International Water and Sanitation Centre. Download here

Contact: Subhrendu K. Pattanayak, Duke University, USA, e-mail: subhrendu.pattanayak@duke.edu

Ghana – GH¢8.6m spent on sanitation-related diseases in Upper West

Sanitation-related diseases accounted for about GH¢8.6 million of money spent in the treatment of diseases reported to health facilities in the Upper West Region last year and thereby strained the finances of the various Mutual Health Insurance schemes.

Out of this amount about GH¢7,427,351 was spent on patients on admission while GH¢1,254,117 took care of out patients. These diseases are malaria, acute respiratory infections and diarrhoea.

Alhaji Abu Yahaya, Chairman of the Upper West Regional Health Committee who disclosed this at Wa on Saturday said during the period, 208,309 patients reported at these facilities with malaria while 29,494 patients and 10,537 patients suffered from acute respiratory infections and diarrhoea respectively.

Speaking when he presided at the closing session of a one-week course for Sanitation Guards drawn from the Wa Municipality, Wa East, Wa West and Sissala East Districts, he noted that these diseases were 90% preventable if the people changed their behaviour and attitude to sanitation.

He called on the government to invest heavily in sanitation in order to arrest the huge money that was constantly expended on medical care and the man-hours lost as a result of diseases that could be prevented.

Mr. Emmanuel Volsuri, Regional Operations Supervisor of Zoom Lion Ghana Limited said 90 Sanitation Guards had so far been trained in the region and provided with the necessary logistics and bicycles and uniform to enhance their work.

He said Zoom Lion organized the training programme to impart in the participants the relevant skills and knowledge to carry their duties effectively.

The Guards are expected to assist Environmental Health Officers in hygiene education and promotion, premise inspection, dissemination of sanitary information, supervision and monitoring of sanitation services.

The Upper West Regional Minister, Mahmud Khalid in a speech read on his behalf, said the Global economic recession enjoined all persons to be serious with sanitation to avert the channelling of resources to fight diseases that could be prevented.

He commended Zoom Lion for its contribution to solving environmental problems adding that, the nation’s objectives could only be achieved if the people had healthy bodies and minds.

Source – Ghana Business News

India – Failing to Control Open Defecation Blunts Nation’s Growth

India Failing to Control Open Defecation Blunts Nation’s Growth, By Jason Gale

March 4 (Bloomberg) — Until May 2007, Meera Devi rose before dawn each day and walked a half mile to a vegetable patch outside the village of Kachpura to find a secluded place.

Dodging leering men and stick-wielding farmers and avoiding spots that her neighbors had soiled, the mother of three pulled up her sari and defecated with the Taj Mahal in plain view.

With that act, she added to the estimated 100,000 tons of human excrement that Indians leave each day in fields of potatoes, carrots and spinach, on banks that line rivers used for drinking and bathing and along roads jammed with scooters, trucks and pedestrians. Devi looks back on her routine with pain and embarrassment.

“As a woman, I would have to check where the males were going to the toilet and then go in a different direction,” says Devi, 37, standing outside her one-room mud-brick home. “We used to avoid the daytimes, but if we were really pressured, we would have to go any time of the day, even if it was raining. During the harvest season, people would have sticks in the fields. If somebody had to go, people would beat them up or chase them.”

In the shadow of its new suburbs, torrid growth and 300- ­million-plus-strong middle class, India is struggling with a sanitation emergency. From the stream in Devi’s village to the nation’s holiest river, the Ganges, 75 percent of the country’s surface water is contaminated by human and agricultural waste and industrial effluent. Everyone in Indian cities is at risk of consuming human feces, if they’re not already, the Ministry of Urban Development concluded in September.

Economic Drain

Illness, lost productivity and other consequences of fouled water and inadequate sewage treatment trimmed 1.4-7.2 percent from the gross domestic product of Cambodia, Indonesia, the Philippines and Vietnam in 2005, according to a study last year by the World Bank’s Water and Sanitation Program.

Sanitation and hygiene-related issues may have a similar if not greater impact on India’s $1.2 trillion economy, says Guy Hutton, a senior water and sanitation economist with the program in Phnom Penh, Cambodia. Snarled transportation and unreliable power further damp the nation’s growth. Companies that locate in India pay hardship wages and ensconce employees in self- sufficient compounds.

The toll on human health is grim. Every day, 1,000 children younger than 5 years old die in India from diarrhea, hepatitis- causing pathogens and other sanitation-related diseases, according to the United Nations Children’s Fund.

Read More – Bloomberg.com

Indonesia: Poor Sanitation Still Causes Heavy Health and Economic Losses

The economic costs of poor hygiene and sanitation in Indonesia reached an estimated US$6.3 billion, or 2.3 percent of GDP in 2006, according to a new report today released by the Water and Sanitation Program.

The study, Economics Impacts of Sanitation in Indonesia, finds that the lack of access to sanitation poses heavy financial and economic costs to the Indonesian economy, not only to individuals but also to the public and commercial sectors.

[..]

Poor sanitation, including poor hygiene, causes at least 120 million disease episodes and 50,000 premature deaths annually, the report says. The resulting economic impact is more than US$3.3 billion (IDR 29 trillion) per year. Poor sanitation also contributes significantly to water pollution-adding to the cost of safe water for households, and reducing the production of fish in rivers and lakes. The associated economic costs of polluted water attributed to poor sanitation exceed US$1.5 billion (IDR 13 trillion) per year.

Read more: WSP, 19 Aug 2008

Pakistan – Diarrhoeal diseases cost country

ISLAMABAD: The diarrhoeal diseases are costing Pakistan Rs 55 billion to Rs 84 billion annually, as 91 million population – 74 million in rural areas and 17 million in urban areas – lack access to improved sanitation in the country, said Caretaker Minister for Environment Syed Wajid Ali Bukhari on Tuesday.

He was addressing the inaugural ceremony of International Year of Sanitation (IYS 2008).

Bukhari said 1.5 million under-five children died every year in the world due to diarrhoea, of which 88 percent deaths were due to lack of sanitation and adequate water.

Read More – Daily Times

Philippines – Poor sanitation costs Pinoys P78B yearly

The World Bank on Wednesday said poor sanitation in the Philippines costs the government 77.8 billion a year. In its study “Economic Impacts of Sanitation in the Philippines”, the World Bank said poor sanitation also causes 31 premature deaths a day and reduces income from fishery, tourism and other sectors.

“Healthcare costs account for 71 percent of the total losses due to 38 million cases of diarrhea per year,” it added. For every dollar invested in improved sanitation, the World Health Organization had said, a country can reap up to $9 in benefits.

The World Bank study, which was also funded by the United States Agency for International Development (USAID), will be launched on February 18 in Mandaluyong City under the theme “Sanitasyon ang Solusyon” (Sanitation is the Solution). Expected to attend are the city’s Mayor Benjamin Abalos Jr., Health Secretary Francisco Duque, Environment Secretary Lito Atienza, Rep. Belma Cabilao of Zamboanga Sibugay and Miss Earth Philippines 2007 Jeanne Harn. Cabilao heads the House Committee on Ecology.

Read More – Manila Times, 15 Feb 2008

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Rodriguez UE, Jamora N, Hutton G. (2007). Economic impacts of sanitation in the Philippines. Washington, DC, USA, World Bank, Water and Sanitation Program.
A summary appeared in Economic impacts of sanitation in Southeast Asia

See also: East Asia: leaders vow to increase investments in sanitation and hygiene, Source Weekly, 21 Jan 2008