Marc Jeuland

Water and sanitation

Asset management planning provides a structured and auditable process for planning long term investment in infrastructure. The irrigation sector has a pressing need for an efficient means to facilitate strategic investment decisions based upon a clear overview of objectives, options, costs, benefits and competing needs. This paper describes research carried out in Indonesia to assess the feasibility of transferring asset management planning procedures developed for the United Kingdom water industry to the irrigation sector. The 6-month study found notable similarities and some differences between the two applications. Modified procedures were developed accordingly and tested in field trials. It is concluded that there are significant opportunities for the application of the approach as developed in the UK using statistically based sampling procedures. From the experience of the study and the field trials the approach is found to be highly relevant and practicable.

Benefits and costs of improved cookstoves: assessing the implications of variability in health, forest and climate impacts.

Current attention to improved cook stoves (ICS) focuses on the “triple benefits” they provide, in improved health and time savings for households, in preservation of forests and associated ecosystem services, and in reducing emissions that contribute to global climate change. Despite the purported economic benefits of such technologies, however, progress in achieving large-scale adoption and use has been remarkably slow. This paper uses Monte Carlo simulation analysis to evaluate the claim that households will always reap positive and large benefits from the use of such technologies. Our analysis allows for better understanding of the variability in economic costs and benefits of ICS use in developing countries, which depend on unknown combinations of numerous uncertain parameters. The model results suggest that the private net benefits of ICS will sometimes be negative, and in many instances highly so. Moreover, carbon financing and social subsidies may help enhance incentives to adopt, but will not always be appropriate. The costs and benefits of these technologies are most affected by their relative fuel costs, time and fuel use efficiencies, the incidence and cost-of-illness of acute respiratory illness, and the cost of household cooking time. Combining these results with the fact that households often find these technologies to be inconvenient or culturally inappropriate leads us to understand why uptake has been disappointing. Given the current attention to the scale up of ICS, this analysis is timely and important for highlighting some of the challenges for global efforts to promote ICS.

Cost-Effectiveness of New-Generation Oral Cholera Vaccines: A Multisite Analysis

OBJECTIVES We evaluated the cost-effectiveness of a low-cost cholera vaccine licensed and used in Vietnam, using recently collected data from four developing countries where cholera is endemic. Our analysis incorporated new findings on vaccine herd protective effects. METHODS Using data from Matlab, Bangladesh, Kolkata, India, North Jakarta, Indonesia, and Beira, Mozambique, we calculated the net public cost per disability-adjusted life year avoided for three immunization strategies: 1) school-based vaccination of children 5 to 14 years of age; 2) school-based vaccination of school children plus use of the schools to vaccinate children aged 1 to 4 years; and 3) community-based vaccination of persons aged 1 year and older. RESULTS We determined cost-effectiveness when vaccine herd protection was or was not considered, and compared this with commonly accepted cutoffs of gross domestic product (GDP) per person to classify interventions as cost-effective or very-cost effective. Without including herd protective effects, deployment of this vaccine would be cost-effective only in school-based programs in Kolkata and Beira. In contrast, after considering vaccine herd protection, all three programs were judged very cost-effective in Kolkata and Beira. Because these cost-effectiveness calculations include herd protection, the results are dependent on assumed vaccination coverage rates. CONCLUSIONS Ignoring the indirect effects of cholera vaccination has led to underestimation of the cost-effectiveness of vaccination programs with oral cholera vaccines. Once these effects are included, use of the oral killed whole cell vaccine in programs to control endemic cholera meets the per capita GDP criterion in several developing country settings.

Groundwater Quality and Its Health Impact: An Assessment of Dental Fluorosis in Rural Inhabitants of the Main Ethiopian Rift

This study aims to assess the link between fluoride content in groundwater and its impact on dental health in rural communities of the Ethiopian Rift. A total of 148 water samples were collected from two drainage basins within the Main Ethiopian Rift (MER). In the Ziway-Shala basin in particular, wells had high fluoride levels (mean: 9.4±10.5mg/L; range: 1.1 to 68 mg/L), with 48 of 50 exceeding the WHO drinking water guideline limit of 1.5mg/L. Total average daily intake of fluoride from drinking groundwater (calculated per weight unit) was also found to be six times higher than the No-Observed-Adverse-Effects-Level (NOAEL) value of 0.06 mg/kg/day. The highest fluoride levels were found in highly-alkaline (pH of 7 to 8.9) groundwater characterized by high salinity; high concentrations of sodium (Na⁺), bicarbonate (HCO₃⁻), and silica (SiO₂); and low concentrations of calcium (Ca²⁺). A progressive Ca²⁺ decrease along the groundwater flow path is associated with an increase of fluoride in the groundwater. The groundwater quality problem is also coupled with the presence of other toxic elements, such as arsenic (As) and uranium (U). The health impact of fluoride was evaluated based on clinical examination of dental fluorosis (DF) among local residents using the Thylstrup and Fejerskov index (TFI). In total, 200 rural inhabitants between the ages of 7 and 40 years old using water from 12 wells of fluoride range of 7.8-18 mg/L were examined. Signs of DF (TF score of ≥ 1) were observed in all individuals. Most of the teeth (52%) recorded TF scores of 5 and 6, followed by TF scores of 3 and 4 (30%), and 8.4% had TF scores of 7 or higher. Sixty percent of the teeth exhibited loss of the outermost enamel. Within the range of fluoride contents, we did not find any correlation between fluoride content and DF. Finally, preliminary data suggest that milk intake has contributed to reducing the severity of DF. The study highlights the apparent positive role of milk on DF, and emphasizes the importance of nutrition in management efforts to mitigate DF in the MER and other parts of the world.

Water resources planning under climate change: Assessing the robustness of real options for the Blue Nile

This article presents a methodology for planning new water resources infrastructure investments and operating strategies in a world of climate change uncertainty. It combines a real options (e.g., options to defer, expand, contract, abandon, switch use, or otherwise alter a capital investment) approach with principles drawn from robust decision-making (RDM). RDM comprises a class of methods that are used to identify investment strategies that perform relatively well, compared to the alternatives, across a wide range of plausible future scenarios. Our proposed framework relies on a simulation model that includes linkages between climate change and system hydrology, combined with sensitivity analyses that explore how economic outcomes of investments in new dams vary with forecasts of changing runoff and other uncertainties. To demonstrate the framework, we consider the case of new multipurpose dams along the Blue Nile in Ethiopia. We model flexibility in design and operating decisions—the selection, sizing, and sequencing of new dams, and reservoir operating rules. Results show that there is no single investment plan that performs best across a range of plausible future runoff conditions. The decision-analytic framework is then used to identify dam configurations that are both robust to poor outcomes and sufficiently flexible to capture high upside benefits if favorable future climate and hydrological conditions should arise. The approach could be extended to explore design and operating features of development and adaptation projects other than dams.

Why ?improved? water sources are not always safe

Existing and proposed metrics for household drinking-water services are intended to measure the availability, safety and accessibility of water sources. However, these attributes can be highly variable over time and space and this variation complicates the task of creating and implementing simple and scalable metrics. In this paper, we highlight those factors - especially those that relate to so-called improved water sources - that contribute to variability in water safety but may not be generally recognized as important by non-experts. Problems in the provision of water in adequate quantities and of adequate quality - interrelated problems that are often influenced by human behaviour - may contribute to an increased risk of poor health. Such risk may be masked by global water metrics that indicate that we are on the way to meeting the worlds drinking-water needs. Given the complexity of the topic and current knowledge gaps, international metrics for access to drinking water should be interpreted with great caution. We need further targeted research on the health impacts associated with improvements in drinking-water supplies.

The Challenge of Improving Water and Sanitation Services in Less Developed Countries

This paper argues that there are many challenges to designing and implementing water and sanitation interventions that actually deliver economic benefits to the households in developing countries. Perhaps most critical to successful water and sanitation investments is to discover and implement forms of service and payment mechanisms that will render the improvements worthwhile for those who must pay for them. In this paper, we argue that, in many cases, the conventional network technologies of water supply and sanitation will fail this test, and that poor households need alternative, non-network technologies. However, it will not necessarily be the case that specific non-network improved water supply and/or sanitation technologies will always be seen as worthwhile by those who must pay for them. We argue that there is no easy panacea to resolve this situation. For any intervention, the outcome is likely to be context-dependent. An intervention that works well in one locality may fail miserably in another. For any given technology, the outcome will depend on economic and social conditions, including how it is implemented, by whom, and often on the extent to which complementary behavioral, institutional and organizational changes also occur. For this reason, we warn against excessive generalization: one cannot, in our view, say that one intervention yields a rate of return of x % while another yields a return of y %, because the economic returns are likely to vary with local circumstances. More important is to identify the circumstances under which an intervention is more or less likely to succeed. Also for this reason, when we analyze a few selected water and sanitation interventions, we employ a probabilistic rather than a deterministic analysis to emphasize that real world outcomes are likely to vary substantially.

Cost―benefit comparisons of investments in improved water supply and cholera vaccination programs

This paper presents the first cost-benefit comparison of improved water supply investments and cholera vaccination programs. Specifically, we compare two water supply interventions -- deep wells with public hand pumps and biosand filters (an in-house, point-of-use water treatment technology) -- with two types of cholera immunization programs with new-generation vaccines -- general community-based and targeted and school-based programs. In addition to these four stand-alone investments, we also analyze five combinations of water and vaccine interventions: (1) borehole+hand pump and community-based cholera vaccination, (2) borehole+hand pump and school-based cholera vaccination, (3) biosand filter and community-based cholera vaccination, (4) biosand filter and school-based cholera vaccination, and (5) biosand filter and borehole+hand pump. Using recent data applicable to developing country locations for parameters such as disease incidence, the effectiveness of vaccine and water supply interventions against diarrheal diseases, and the value of a statistical life, we construct cost-benefit models for evaluating these interventions. We then employ probabilistic sensitivity analysis to estimate a frequency distribution of benefit-cost ratios for all four interventions, given a wide variety of possible parameter combinations. Our results demonstrate that there are many plausible conditions in developing countries under which these interventions will be attractive, but that the two improved water supply interventions and the targeted cholera vaccination program are much more likely to yield attractive cost-benefit outcomes than a community-based vaccination program. We show that implementing community-based cholera vaccination programs after borehole+hand pump or biosand filters have already been installed will rarely be justified. This is especially true when the biosand filters are already in place, because these achieve substantial cholera risk reductions on their own. On the other hand, implementing school-based cholera vaccination programs after the installation of boreholes with hand pump is more likely to be economically attractive. Also, if policymakers were to first invest in cholera vaccinations, then subsequently investing in water interventions is still likely to yield positive economic outcomes. This is because point-of-use water treatment delivers health benefits other than reduced cholera, and deep boreholes+hand pumps often yield non-health benefits such as time savings. However, cholera vaccination programs are much cheaper than the water supply interventions on a household basis. Donors and governments with limited budgets may thus determine that cholera vaccination programs are more equitable than water supply interventions because more people can receive benefits with a given budget. Practical considerations may also favor cholera vaccination programs in the densely crowded slums of South Asian and African cities where there may be insufficient space in housing units for some point-of-use technologies, and where non-networked water supply options are limited.

Water quality risks of ‘improved’ water sources: evidence from Cambodia

The objective of this study was to investigate the quality of on‐plot piped water and rainwater at the point of consumption in an area with rapidly expanding coverage of ‘improved’ water sources.

Water quality perceptions and willingness to pay for clean water in peri-urban Cambodian communities

This paper studies household demand for improved water quality in peri-urban Cambodia, with particular attention paid to the influence of water quality on willingness to pay (WTP). Utilizing data from 915 household surveys, we analyze responses to a contingent valuation scenario using multivariate logit regression techniques that account for subjective perceptions of water quality. We estimate a mean household WTP for improved water quality of US