Working Paper: NBER ID: w12987
Authors: Alix Peterson Zwane; Michael Kremer
Abstract: The Millennium Development Goals call for reducing by half the proportion of people without sustainable access to safe drinking water. This goal was adopted in large part because clean water was seen as critical to fighting diarrheal disease, which kills 2 million children annually. There is compelling evidence that provision of piped water and sanitation can substantially reduce child mortality. However, in dispersed rural settlements, providing complete piped water and sanitation infrastructure to households is expensive. Many poor countries have therefore focused instead on providing community-level water infrastructure, such as wells. Various traditional child health interventions have been shown to be effective in fighting diarrhea. Among environmental interventions, handwashing and point-of-use water treatment both reduce diarrhea, although more needs to be learned about ways to encourage households to take up these behavior changes. In contrast, there is little evidence that providing community-level rural water infrastructure substantially reduces diarrheal disease or that this infrastructure can be effectively maintained. Investments in communal water infrastructure short of piped water may serve other needs and may reduce diarrhea in particular circumstances, but the case for prioritizing communal infrastructure provision needs to be made rather than assumed.
Keywords: diarrheal diseases; clean water; sanitation; child health; behavior change
JEL Codes: O22; Q52; Q56
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| 10% increase in improved water and sanitation services (I15) | 4% reduction in infant mortality (I14) |
| piped water and sanitation infrastructure (L95) | child mortality (J13) |
| increased handwashing (I19) | reduced diarrhea incidence (Q16) |
| point-of-use water treatment (L95) | reduced diarrhea incidence (Q16) |
| communal rural water infrastructure (P32) | weak evidence of significant health impacts (I12) |