Economic Assessment of Sanitation Interventions in Vietnam - WSP

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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
Economic Assessment of Sanitation Interventions in Vietnam | Local Benefits of Improved Sanitation and Hygienealthough indirect diseases through malnutrition, especiallyALRI, take a heavy toll. Malnutrition is considered as animportant disease related to sanitation and hygiene sincethere are nearly 1.8 million children under-five years sufferingfrom malnutrition. Although the prevalence of helminthsand scabies are not high compared to diarrhea andmalnutrition, these diseases are included because of theirobvious links to poor sanitation and hygiene.TABLE 15: REPORTED SANITATION AND HYGIENE-RELATED ILLNESS CASES AND DEATHS (2005)DiseaseTotal casesAnnual morbidityCases per personAnnual reported deaths 4Diarrheal diseases 964,420 0.0116028 42Urban 260,116Rural 704,304Helminths (worms) 1 24,545 0.0002953 -Urban 6,620Rural 17,925Trachoma 2 982,667 0.0118223 -Urban 192,780Rural 789,887Scabies 3 206,137 0.0024800 -Urban 55,598Rural 150,540Hepatitis A 7,834 0.0000942 -Urban 2,113Rural 5,721Malnutrition (under fives) 1,818,939 0.0218833 -Diseases associated with malnutrition(under fives)Urban 463,742Rural 1,355,197596,046 0.0071709 2,494ALRI (Pneumonia) 488,610 0.0058784 2,476Urban 163,201Rural 325,410Measles 8,160 0.0000982 -Urban 2,201Rural 5,959Malaria 99,276 0.0011944 18Urban 24,240Rural 75,0361Prevalence of helminths is sourced from the survey on soil-transmitted nematodes by the Institute of Malaria, Parasitology and Entomology/MOH,2006-2007.2Prevalence of trachoma is sourced from the survey on trachoma by the Department of Preventive Medicine/MOH, 2007.3Incidence of scabies is assumed to be 20% of reported skin disease as there is no specific information on scabies.Source: MOH (2007).4Note that these statistics from the national information system underestimate the number of deaths due to these causes.www.wsp.org33
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Economic Assessment of Sanitation I
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ForewordTarget 10 of the Millennium
Page 22 and 23: Glossary of TermsBenefit-cost ratio
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ReferencesAcharya A, Paunio MK and
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ANNEX 1: PROGRAM APPROACH ANALYSIST
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ANNEX TABLESANNEX A. STUDY METHODST
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