According to WHO (2012) in the report "Global costs and benefits of drinking-water supply and sanitation interventions to reach the MDG target and universal coverage" (www.who.int/water_sanitation_health/publ..._costs/en/index.html), "the main contributor to overall benefits of sanitation is the value of time savings which accounts for more than 70% of total benefits in all regions, and is as high as 80% to 90% of total benefits in most regions. In SSA and S Asia an important contribution comes from health benefits, especially the value of saved lives. Health care savings – which tend to be financial in nature – vary across regions between 5% and 13% of total benefits".

I'd be interested to hear your views on this statistic.

Jonathan

Dr. Jonathan Parkinson
Programme Manager - Urban Sanitation Initiative

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Dear Jonathan,

thanks for that posting! Just a quick one from my side.

I have not yet read the publication but I was just reading your posting and asked myself if this 70 % is the time saved due to less queuing in front of toilets or better access (closer facilites) or if it is the time "gained" due to not lying in bed with diarrhoea (being productive)...

Have a nice evening and best regards,
Enno

Dear Jonathan,
thanks very much for that link, I did not know that study.
Your post shows clearly the advantage of having a forum (crowd intelligence), pointing to aspects which one might have lost (I for sure) when not pointed to, although the information is very interesting – it is just too much information on the web. But it shows also how crucial it is to give some basic information, just to enable the others to validate if the larger text is interesting or not.
In this case I would like to stress: Very interesting data and approaches. I really enjoy the sensitivity analysis carried out. The study gives a lot of aspects which would have to be discussed.
Table A for instance “Total financial capital costs to expand coverage to achieve MDG targets and attain universal access of improved drinking-water sources and sanitation”. The numbers were a surprise to me. As I´m working in LA and therefore more familiar with the situation here, I saw figures for water very close to the figures for wastewater concerning the urban access. Thinking a little bit further I came to the conclusion that these figures again are aimed only to the so called “improved sanitation” which can be a just a sewer without any treatment ….. so no wonder drinkingwater provision is valued expensive. This is really a severe problem of the “improved access” statistics. From my understanding the figures in LA should be at least triple for the sanitation, as we only have around 30% of wastewater treatment and about 50% of sewer in the urban areas in LA. No Cent is calculated for this, as the access to a toilet is already “improved” sanitation. A very bad concept. Where is the aspect of fecal sludge management in the non-served areas? These are costs which always are missing in the “improved” sanitation figures. Worse… a government which “wastes” money on a fecal sludge concept is punished, as it is not contributing to “improved” sanitation. This is a severe fault in the MDG concept! If you install a wastewater treatment plant, if you introduce a service model for non-sewer served areas… you don´t get anything of political value. Donors are not interested as they don´t contribute to MDG, politicians are not interested as they don´t get credit. So technically speaking, if you have to install a new water treatment plant to guarantee the save access to water….that gives you credit points, if you just try to treat the wastewater in order to prevent the necessity of a new water treatment plant….no credit is given. This aspect is not discussed in the study or did I get something wrong?

The bad news for the sanitation side is…when you calculate the necessary investment for treatment or service models in urban areas the necessary investments go up VERY much and therefore the very attractive Cost Benefit figure of sanitation goes down quite a bit. But maybe the Water figures would go down a bit as well as less investment is needed for save drinking water.

The study apparently tries to focus on maintaining at least the gained infrastructure although I did not quite understand how this entered in the numbers (pag 9).
But back to the question of time saving. Already in the previous studies the very, very high valuation of the time saving has been a critical point to me. From a “selling point” of view in sanitation it is very attractive to have a return by 5 (or more) for every Cent invested. If this were real, I guess we would have a very quick improvement. Maybe I´m wrong, but here are my thoughts:
The concept of using 30% of GPD per capita makes the study much closer to the real return for a country, but I guess (did not find any number to prove that wrong or right) that the contribution of the poorest (which typically are the ones who do not have access to real sanitation) to the GPD of a country is not 30%. This drives rapidly to a potentially cynical discussion, but if we would like to achieve a view that a government sees the direct value, rather than a “nice to know figure”, than it might be interesting to go further than the study does. It would be necessary to analyze for each country which are the direct tangible costs to a government and the real return by a better water and sanitation provision (not only “improved”). I know, it is almost impossible. But I always had the feeling that the governments are not that impressed by the “apparent” economic possibility which demonstrates the figure of a cost benefit of 5. Maybe a REAL economic cost benefit by 2 would be of more help and attractiveness?

Well. Just some thoughts to a very large field of discussion.
Regards
Christoph

Hi Christoph,

thanks for that posting and yes, I agree this shows very much the potential of the crowd intelligence!

Your analysis is quite comprehensive and I only would like to comment on one thing quite briefly.


I just came back from the IWA International Word Water Congress in Busan, Korea and there Neil Macleod pointed out the need for seeing sanitation as a service (e.g. person getting access to a proper sanitation sercvice in terms of the WHOLE sanitation chain) rather than an infrasturucture (e.g. just links in the sanitation chain such as toilets pipes or tank trucks). This pretty much is in line with your argumentation regarding the faultiness of the MDG (JMP) concept...

So far so good but what is the way forward of finding a better and new revolutionary yardstick? Are there any initiatives?

Thanks and best,
Enno

It all depends on the way the statistics are collected and their interpretation. There is a huge difference between rich countries and low-income countries, as well as between urban and rural situations. Statistics can be used (manipulated) to create affirmative information for a strategy.

In looking at the best sanitation option and their effectiviness, the entire cycle from food intake, toilet design and waste processing for re-utilisation needs to be reviewed up to the point of growing food again. In some capitalized societies, sanitation consists of a “Flush and Forget” model. This model requires full sewerage treatment by local government (which is often not done) and is unaffordable for low-income people and certainly not sustainable in most countries. Hence, sewage is dumped in open water.

Sanitation systems based on large amounts of good quality drinking water being used for flushing faeces mixed with urine into a communal sewerage system have high costs.
(a) Very large amounts of good quality drinking water need to be purified and piped to the residents. Users correctly adscribe high value to clean drinking water at their residents as it save large amounts of collecting time and reduces diseases. It is probably this element the WHO focusses on.
(b) Costly residential connected sewerage system needs to be installed and maintained with the Flush and Forget system. This is often done in rich countries.
(c) Highly diluted sewage water needs to be purified before discharging into open water. This is often not done in all rich countries and more than often not done in less rich countries. The system becomes even more expensive when the sewerage system also receives rainwater, which further dilutes the mixture. Therefore, in many countries, the rainwater diluted raw sewage is discharged into open water causing bacterial pollution and general health risks for the entire population, in particular people living downstream.

The cost of a sewerage system and cleaning the raw sewage is about twice as high as the production and transport of clean drinking water (from wells). Hence, the more water used, the higher becomes the cost of the sewage treatment. Although municipalities organise the water supply and finance these sewerage costs, the funding is through taxation of the population. These cost differences are probably not taken into account in the WHO study.

 The cost of a sanitation system is divided into water supply, individual house installation and the waste and sewerage treatment process, back to clean water.

 Each sanitation system has investment, maintenance and operational costs. Each system has a lifetime and eventually needs to be replaced. The UDT and UDDT systems are often not included or compared.

 Every sanitation system has a public health cost (disease or prevention). In developing countries, the public health cost needs to be compounded with the weakness of people having intestinal worms and those who have diarroeah and cannot work. These cost (less or lack of income) are seldom taken into consideration.

One of the problems with many statistical health assessments in developing countries is the fact that base-line studies are not available. Usually only data are collected from local clinics and hospitals. People who have worms and are weak or do not work because of poor health, do usually not appear in these statistics.

A water-based flush toilet system will have life-time cost and environmental consequences for water supply and sewage treatment. Providing a water-based sanitation facility in an individual house not only has a construction cost (materials, labour), but health, operational, maintenance and public taxation costs as well. With increasing population density and the need to keep the open water clean, the public maintenance and taxation costs will increase over time.
To keep the surface water clean, ALL sewage needs to be completely cleaned. Municipalities can oblige the installation of septic tanks before sewage is drained into a soak away (rural) or the urban sewer. When sewage is drained directly into the sewer, the cleaning costs increase, which in turn increases the cost of the public connection to the sewerage system. Discharging raw sewage into open water should be prohibited in all housing situations, even at the remote village level. These lack of investments are surely not included in the financial figures of the study.

It is useful that the WHO tries to put data to some developments, but when the manner in which these data are collected are not known, the information can tell anything.

Dear Enno,

I've been a bit busy the past few months... (is it December already!?) and I have to admit that I missed the discussion that this posting triggered.

Thanks for your excellent question.

According to table 7 on page 30, the Sanitation access time saved per person related to moving from OD to private latrine is 0.5 hours per day per person. But p.4 states "Economic benefits related to savings from the health improvements of upgraded WSS services relate to seeking less health care, to reduced losses of productive time due to disease and to a reduction in premature mortality" and Table 6 refers to "days lost from work due to each case of sickness" (estimated to be 5 days).

So, the answer to your question is not immediately apparent but I think it is both time saved not looking for somewhere to defecate and time saved from not lying in bed with diarrhoea (being productive). If this is the case, then it is important to note that the economic benefit attributed to "time" is very much related to the "health" benefit.

I will ask Guy Hutton to respond to this as this is a very important point for us to clarify.

Replies/responses to other postings will come later (hopefully not in 3 months time!).

best regards,

Jonathan

Dear Christoph, Sjoerd et al,

Briefly on a couple of points which both relate to the full costs and the full benefits of wastewater systems. Christoph makes the argument that benefits of wastewater/fecal sludge treatment are not taken into account and that donors are not interested in treatment as they don´t contribute to MDGs.

To my knowledge there have in fact been large investments in treatment (from IFIs not donors) but much of this has not been proven to be cost beneficial due to poor management/O+M. I would agree that the full economic benefits are not well assessed and their seems to be insufficient data to support a better monetarisation of benefits.

I think the authors of the study recognise that this part of the economic evaluation is not very strong. There is however some work that is focused on a quantification of these benefits in economic terms - so there is potential for improvement e.g.

link.springer.com/chapter/10.1007%2F978-...81-2365-0_24?LI=true
www.dkm.ie/uploads/pdf/reports/Water_cba_paper.pdf

Christoph makes the argument that benefits of wastewater/fecal sludge treatment are not taken into account and that donors are not interested in treatment as they don´t contribute to MDGs. There is in an increasing movement at international level (Marseille World Water Forum, Rio+2o and currently focus on development of a Sustainable Development Target and related monitoring indicators to address this issue. IWA is working closely with the UN-Water Wastewater Taskforce on this and I will try to give some further information about this next week.

best regards

Jonathan

Cost-benefit financial figures are often based on measurable monetary income as opposed to monetary losses if the action will not be taken. In sanitation and sewage treatment the value of a healthy clean (surface water) environment is not easily quantified. Over the last 200 years the surface water near habitated areas has been so much polluted by human waste that we accept a certain level of pollution. Standards for maximum pollution have been established.
A really clean (water) environment is rarely valued in monetary terms, resulting in variable costs and levels of cleaning up for polluted water depending on the local standards for clean and the environmental interests of the municipality concerned. Too many organisations expect that nature will do the final cleaning-up of BOD and pollutants have been disminued to certain standard levels. Yet with these (maximum) levels fish cought from these waters may have unacceptable high levels of chemicals and metals.
When national and international bodies do not put a value to a really naturally clean environment, the cost-benefit ratio for cleaning up sewage will remain negative.

Dear Enno,
Thanks for your question.
You can see the distribution of economic benefits in Figures 6 to 9 of the new WHO cost and CBA study
apps.who.int/iris/bitstream/10665/75140/...SE_WSH_12.01_eng.pdf



In rural areas, access time is more from journey time than queuing time.
All the best
Guy

Thanks Jon, thanks Guy,

Great document! I only knew the earlier ones published by Guy, Laurence Haller and Jamie Bartram (2007). They are also available on susana.org (www.susana.org/lang-en/library?view=ccbk...mp;type=2&id=784 and www.susana.org/lang-en/library?view=ccbk...mp;type=2&id=578).

Can we share this document in the SuSanA library as well? I think there will be quite a big number of interested people... Also in the context of developing a new and better yardstick.

Also quite interesting that it is really the access time that makes up the big fraction...

Have a good evening and best regards,
Enno