Cost-effectiveness of water quality interventions for preventing diarrhoeal disease in developing countries

• Published in: Journal of water and health Vol. 5; no. 4; pp. 599 - 608
• Main Authors: Clasen, Thomas, Haller, Laurence, Walker, Damian, Bartram, Jamie, Cairncross, Sandy
• Format: Journal Article
• Language: English
• Published: England IWA Publishing 01.12.2007
• Subjects: Benchmarks; Boreholes; Child mortality; Chlorination; Cost analysis; Cost recovery; Cost-Benefit Analysis; Developing Countries; Diarrhea - prevention & control; Disinfection; Epidemiology; Filtration; Flocculation; Health; Households; Humans; Intervention; LDCs; Microorganisms; Models, Econometric; Mortality; Organizations; Water Purification - economics; Water Purification - methods; Water quality; Water Supply - economics; World Health Organization; Africa
• ISSN: 1477-8920; 1996-7829
• DOI: 10.2166/wh.2007.010

Using effectiveness data from a recent systematic review and cost data from programme implementers and World Health Organization (WHO) databases, we conducted a cost-effectiveness analysis to compare non-piped in source- (dug well, borehole and communal stand post) and four types of household- (chlorination, filtration, solar disinfection, flocculation/disinfection) based interventions to improve the microbial quality of water for preventing diarrhoeal disease. Results are reported for two WHO epidemiological sub-regions, Afr-E (sub-Saharan African countries with very high adult and child mortality) and Sear-D (South East Asian countries with high adult and child mortality) at 50% intervention coverage. Measured against international benchmarks, source- and household-based interventions were generally cost effective or highly cost effective even before the estimated saving in health costs that would offset the cost of implementation. Household-based chlorination was the most cost-effective where resources are limited; household filtration yields additional health gains at higher budget levels. Flocculation/disinfection was strongly dominated by all other interventions; solar disinfection was weakly dominated by chlorination. In addition to cost-effectiveness, choices among water quality interventions must be guided by local conditions, user preferences, potential for cost recovery from beneficiaries and other factors.