Economic Assessment of Sanitation Interventions in Vietnam - WSP

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Economic Assessment of Sanitation Interventions in Vietnam | Local Benefits of Improved Sanitation and HygieneTABLE 17: TREATMENT-SEEKING BEHAVIOR FOR SANITATION- AND HYGIENE-RELATED DISEASES (ALL AGES)% seeking treatment from:DiseasePublic provider Private clinicSelf-treatment No treatment TotalDiarrheal diseases 964,420 1,370,737 5,219,670 360,960 7,915,788Nationwide 3.0% 8.0% 66.0% 23.0% 100.0%Urban 2.0% 5.0% 70.0% 23.0% 100.0%Rural 5.0% 10.0% 50.0% 35.0% 100.0%Helminths 24,545 34,886 132,845 9,187 201,464Nationwide 2.0% 8.0% 70.0% 20.0% 100.0%Urban 1.0% 4.0% 80.0% 15.0% 100.0%Rural 5.0% 10.0% 60.0% 25.0% 100.0%Trachoma 982,667 - - - 982,667Nationwide 100.0% 0.0% 0.0% 0.0% 100.0%Urban 10.0% 0.0% 0.0% 0.0% 10.0%Rural 90.0% 0.0% 0.0% 0.0% 90.0%Scabies 206,137 292,985 1,115,665 77,152 1,691,939Nationwide 1.0% 4.0% 85.0% 10.0% 100.0%Urban 0.0% 2.0% 90.0% 8.0% 100.0%Rural 2.0% 5.0% 80.0% 13.0% 100.0%Hepatitis A 7,834 11,135 42,399 2,932 64,300Nationwide 10.0% 18.0% 55.0% 17.0% 100.0%Urban 20.0% 20.0% 55.0% 5.0% 100.0%Rural 10.0% 15.0% 50.0% 25.0% 100.0%Malnutrition 1,818,939 - - - 1,818,939Nationwide 10.0% 18.0% 55.0% 17.0% 100.0%Urban 20.0% 20.0% 55.0% 5.0% 100.0%Rural 10.0% 15.0% 50.0% 25.0% 100.0%ALRI (Pneumonia) 488,610 694,466 2,644,476 182,875 4,010,427Measles 8,160 11,598 44,164 3,054 66,976Malaria 99,276 141,102 537,305 37,157 814,840Source: ESI Phase 1 study, 2009; MOH, 2006.The estimated numbers of people of all ages in both urbanand rural areas seeking care from different providersfor diseases attributed to poor sanitation and hygiene arepresented in Table 18, Table 19 and Table 20.The unit costs for treatment of diarrheal disease are providedin Table 21, and broken down by healthcare provider.As indicated in Table 21, treatment costs include: (1) Directhealthcare expenses such as diagnostics and medical treatmentcosts; (2) Incidental expenses, i.e. non-health patientcosts, including transport, food, etc. For inpatient treatment,healthcare expenses also include inpatient stay.There are significant differences in the cost of diarrheatreatment between health providers and self-treatment, andbetween outpatient and inpatient care. The highest treatmentcosts associated with diarrhea are from inpatients atpublic health providers in rural areas (US$19.9 per person36Economic Assessment of Sanitation Interventions
Economic Assessment of Sanitation Interventions in Vietnam | Local Benefits of Improved Sanitation and HygieneTABLE 18: ESTIMATED NUMBERS OF CASES (ATTRIBUTED TO POOR SANITATION AND HYGIENE) SEEKING CARE FROMDIFFERENT PROVIDERS (ALL AGES)DiseaseAttribution toSanitationReportedcasesPublic sector% underreportedEstimatedactual casesPrivate clinic Self-treatment No treatmentDiarrheal diseases 88% 964,420 10% 1,060,862 1,206,249 4,593,310 317,645Helminths 100% 24,545 10% 27,000 34,886 132,845 9,187Trachoma 80% 982,667 10% 1,080,934 - - -Scabies 80% 206,137 10% 226,751 234,388 892,532 61,722Hepatitis A 60% 7,834 10% 8,617 6,681 25,440 1,759Malnutrition: 48% 1,818,939 10% 2,000,833 - - -ALRI 5% 784,792 10% 863,271 55,682 212,034 14,663Malaria 2% 110,032 10% 121,035 3,078 11,720 810Source: ESI Phase 1 study, 2009; MOH, 2006.TABLE 19: ESTIMATED NUMBERS OF CASES (ATTRIBUTED TO POOR SANITATION AND HYGIENE) PER PERSON PER YEAR (ALLAGES)Disease 0-4 Years 5-14 Years 15+ YearsDiarrheal disease 4.2 0.5 0.3Helminths 0.7 0.8 0.7Hepatitis A, E 0.001 0.0001 0.00002Scabies 0.03 0.003 0.001Trachoma 0.2 0.01 0.001Malnutrition 0.4 0.04 0.00Indirect: malaria 0.0003 0.002 0.0004Indirect: ALRI 0.04 0.01 0.001Total 5.5 1.4 1.0Source: ESI Phase 1 study, 2009; MOH, 2006.TABLE 20: ESTIMATED NUMBERS OF CASES (ATTRIBUTED TO POOR SANITATION AND HYGIENE) SEEKING CARE FROMDIFFERENT PROVIDERSRegionPercentage of population receiving medicalexamination and treatment over 12 monthsInpatienttreatmentOutpatienttreatmentSelf-treatment or notreatmentUrban 37.2% 7.4% 34.2% 58.4%Rural 33.4% 7.0% 29.9% 63.1%Total 34.3% 7.1% 30.9% 62.0%Source: VHLSS, 2004.per case). Self-treatment of patients at home in urban areasinvolves the lowest cost (US$3.3 per person per case).This is a main reason why the majority of patients selectself-treatment when they think the disease is not serious(see Table 18). A long queue of patients seeking diagnosisand treatment under the health assurance system is oftena major barrier to low-income patients and their relativesseeking treatment, while wealthier patients often prefer toshift to a more expensive, but more flexible ‘demand-driven’treatment option.www.wsp.org37
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Economic Assessment ofSanitation In
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Economic Assessment of Sanitation I
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ForewordTarget 10 of the Millennium
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Glossary of TermsBenefit-cost ratio
Page 24 and 25: AcknowledgmentsThe Economics of San
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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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