Economic Assessment of Sanitation Interventions in Vietnam - WSP

IV.Local Benefits of Improved Sanitationand Hygiene32This chapter discusses the following local impacts of improvedsanitation and hygiene:• Health (section 4.1)• Water (section 4.2)• Access time (section 4.3)• Intangibles (section 4.4)• External environment (section 4.5)• Reuse (section 4.6)• Summary of local benefits (section 4.7)4.1 HEALTHOne of the major arguments commonly used in favor ofimproving sanitation is a reduction in disease incidence,and the various associated health-related benefits. There aremany diseases associated with poor sanitation and hygienepractices, including diarrhea, dysentery, cholera, salmonellosis,shigellosis, typhoid fever, hepatitis A, trachoma, andsome parasitic diseases (ascariasis, trichuriasis, hookworm,schistosomiasis) (see Annex Table A6). Disease and povertyare linked in a vicious circle, and hence disease reductioncan lift populations out of poverty, or prevent them fromfalling into poverty. Less disease means less treatment seekingcosts and a gain in healthy time, leading to more timefor productive or leisure activities, which have a direct welfareimpact. When productive time gained leads to a netincrease in economic activity, it can contribute to economicgrowth and poverty reduction. Disease reduction also leadsto savings for society, such as health care and other statebenefits for chronic sufferers.ESI study, phase 1 (WSP, 2009) reported the estimatedcases and deaths per year from selected diseases attributedto poor sanitation in Vietnam. It showed that, of the diseaseattributed to poor sanitation, diarrhea has the highestnumber of cases at 7.05 million per year. Diarrhea is alsothe main cause of death from poor sanitation and hygiene,accounting for around 4,600 deaths per year in Vietnam.Malnutrition-related diseases, in particular acute lowerrespiratory infection (ALRI), account for an estimated1,500 deaths per year attributed to poor sanitation, followedby malaria with 600 deaths per year. In 2004, theWorld Health Organization estimated that diarrheal diseaseaccounted for 12% of overall deaths of 0-14 year olds inVietnam, and 50% of infectious and parasitic diseases. Thenumber of deaths from diarrhea exceeded the number ofdeaths from intentional and unintentional injuries, includingroad traffic accidents.Diseases such as scabies, helminths and hepatitis A appearto account for only a small proportion of the total diseaseburden. There are no reported cases in official statistics ofmortality from these diseases. Collectively, they account foronly about 5.4% of the number of cases. However, theircollective influence on the quality of life cannot be ignored.The prevalence of trachoma is still high as it is endemic inVietnam. Treatment is sought for only a small fraction ofcases, so healthcare costs would be much higher if all suffererssought formal health care for every incidence of disease.4.1.1 DISEASE BURDEN OF POOR SANITATIONAND HYGIENETable 15 presents the data available from the national healthinformation system in Vietnam on the number of cases anddeaths resulting from key sanitation and hygiene-relateddiseases. Although these data are not representative of thetotal disease burden at national level due to underreporting,they do provide an indication of which diseases are of mostsignificance nationally, and aid the selection of diseases toinclude in this present study.Table 15 shows that there were 964,420 cases of diarrhealdiseases in 2005. The actual number of cases is expectedto be many times higher, as concluded in the ESI phase 1study (WSP, 2009). Diarrhea is also reported as the majordirect cause of death due to poor sanitation and hygiene,Economic Assessment of Sanitation Interventions