Water for people.pdf - WHO Thailand Digital Repository

1 2 0 / C H A L L E N G E S T O L I F E A N D W E L L - B E I N GBasic Needs and the Right to Healthreduction associated with different interventions was presented inthe paragraph on ‘the burden disease concept’. The incrementalanalysis of non-health benefits addressed three issues: the avoideddirect expenditures due to a reduced diarrhoeal disease burden,both for the collective health sector and at the household level, theavoided days lost, whether affecting formal or informal employment,other productive activities or school attendance, and reducedopportunity costs related to the location of water supply andsanitation facilities.Preliminary results of this modelling study present thefollowing picture.■ In absolute terms, the first interventions at a global cost ofUS$12.6 billion, with a global gain of 30.2 million DALYs avoided.■ Disinfection at point-of-use through chlorine treatment and safestorage vessels combined with limited hygiene education wouldresult in 122.2 million DALYs avoided at a relatively lowincremental cost (total cost US$11.4 billion).■ Disinfection at point-of-use proved consistently to be the mostcost-effective intervention across all subregions and would beclassified as very cost-effective in all areas where it was evaluated.■ Interventions targeted at key behaviours such as improving handwashing would also provide a highly cost-effective way ofachieving substantial health gains.■ In many developing countries, these cost-effectiveness datawarrant a policy shift, towards better household water qualitymanagement (together with improved individual hygiene) tocomplement the continued expansion of coverage and upgradingof services, with a greater emphasis on achieving health gainsassociated with access to drinking water at the household level.As a reticulated water supply piped into individual homes remainsa long-term aim for most developing countries, a focus on lowcostsolutions with a great impact on health per unit ofinvestment is desirable.Health Sector Issues Associatedwith WaterFrom basic needs to human rightsSince the 1970s, the basic needs concept has been a dominatingelement in the development debate. It comes as no surprise thatwater was first among the issues addressed in the efforts to meetbasic needs and to support a decent minimum standard of living andan acceptable level of human livelihood. The Mar del PlataConference in 1977 focused almost exclusively on the drinking watersupply and sanitation needs of the poor and vulnerable. Thisresulted in the designation of the period from 1981 to 1990 as theInternational Drinking Water Supply and Sanitation Decade (IDWSSD).The focus of this period certainly resulted in the mobilization ofconsiderable additional resources. It also facilitated the accelerateddevelopment of a more functional policy framework for drinkingwater supply and sanitation in many countries, and supportedinstitutional strengthening and the establishment of arrangementsbetween institutions formerly working without proper coordination.Great progress was made, certainly more than would ever have beenachieved had the 1980s not been designated as IDWSSD. In thecase of provision of safe drinking water, substantial progress wasmade towards the goal of universal coverage. Provision of access tosanitation, however, only managed to keep pace with populationgrowth and started trailing access to safe drinking water in anincreasingly disproportionate way.At the beginning of the 1990s, the concept of water as a basicneed became more differentiated. Sustainable development hadappeared on the scene (WCED, 1987) and water was among thenatural resources that needed to be used wisely to serve the needsof the present generation without jeopardizing the needs of futuregenerations. Poverty and excessive consumption patterns wereidentified as the key driving forces behind an unsustainable use ofnatural resources. Poverty was also increasingly recognized as thekey driving force for ill-health, in a vicious circle where ill-health ledto a further deepening of poverty at the household and communitylevel. The concept of sustainable livelihoods became complementaryto that of basic needs. It translated into issues such as the judiciousstewardship of water resources as well as personal hygiene andwater security at the household level.In the basic needs approach it had always been taken forgranted that the promotion and protection of human health was theimplicit goal of the provision of safe water and adequate sanitation.The results of the IDWSSD and the new concept of sustainablelivelihoods raised new questions about the nature and scope of thelinks between water and health. As Integrated Water ResourcesManagement (IWRM) entered the development arena after the UN