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Water & Sanitation Solutions for AP to avert Diarrheal Deaths

Diarrheal disease caused nearly 1.7 million deaths globally in 2016. Nearly 0.8 million of these deaths occurred in India of which 90% were due to unsafe drinking water, sanitation and hygiene according to estimates by the Global Burden of Disease. 
 
In Andhra Pradesh, more than 30,000 deaths were caused by diarrheal disease and intestinal infections (mainly typhoid and paratyphoid) in 2016, constituting 8% of all deaths in the state according to GBD 2016. 
 
To address these issues, four interventions are analysed by economist, Bjorn Larsen. Benefits and costs are presented as a ratio of annualized benefits and annualized costs over the expected useful life of each intervention. 
 
About 73% of households in Andhra Pradesh had access to an improved drinking water source in 2015-16 according to the National Family Health Survey 4 (NFHS 4). 
 
Only 19% of households practiced point-of-use (POU) treatment of their drinking water in 2005-06 (Andhra Pradesh & Telangana), mainly by filtering (11%) and boiling (8%) (NFHS 3). Moreover, 14% of the population in Andhra Pradesh (and Telangana) had more than 30 minutes round-trip to their drinking water source in 2005-06 (NFHS 3), particularly affecting women and children. 
 
Providing urban households without an improved drinking water source with piped water to dwelling, or rural households with a tube well/borehole would cost ₹1,233 to 1,753 per household. 
 
This includes initial capital cost of piped water supply or tube well/borehole and annual operations and maintenance cost. For urban areas the annualized cost of improved drinking water sup-ply is estimated at ₹228.02 crores per year and for rural areas annualized cost is estimated at ₹440.32 crores per year. 
 
The intervention would benefit about 4.7 million households. The largest benefits are avoided mortality and productivity benefits in terms of time savings from water sources closer to dwelling. 
 
For urban intervention annualized benefits are estimated at ₹1,079 crores per year and for rural areas annualized benefits are estimated at ₹1,135 crores per year. 
 
Only 19% of households in Andhra Pradesh (and Telangana) practiced appropriate methods of point-of-use (POU) treatment of drinking water a decade ago, compared to over 20% nation-wide in India according to the NFHS 3 (2005-06). 
 
A behavioural change campaign that promotes household POU treatment of drinking water with a filter would cost 342.2 crores, targeting 1.4-2.8 million households (the cost for them to start POU treatment by filtering of drinking water has been factored). 
 
It is estimated that about 1,200-2,400 deaths and 2.6-5.1 million cases of diarrheal illness will be averted per year. Total value of the health and productivity benefits of the intervention is estimated at ₹1,035.6 crores per year. 
 
About 61% of households in AP had a sanitary toilet facility in 2015 according to the Swachhta Status Report 2016. The most common household sanitation facility in Andhra Pradesh is a flush/pour-flush toilet in both urban and rural areas. Therefore, this intervention targets 95% household coverage with improved, non-shared sanitation is applied. 
Costs of household sanitation include initial capital cost, periodic emptying of pit or septic tank (once in 5 years), annual operations and maintenance cost, cost or time for cleaning of sanitation facility, and cost of sanitation promotion programs by the government. 
 
The annualized cost per household is estimated at ₹5,577 for rural households and ₹8,229 for urban households. It is estimated that over 7,000 deaths and 15.4 mil-lion cases of diarrheal illness will be averted per year due to this intervention. The total value of the annualized health and productivity benefits of the intervention is estimated at ₹2,199.6 crores for urban areas and ₹1,4201.1 crores for rural areas. 
 
Finally, the researcher looks at promotion of the use of sanitation facilities. The Swachhta Status Report 2016 found that 2.2% of household members continue to practice Open Defecation after construction of sanitation facilities. 
 
Non-use is more prevalent in rural areas (2.7%) than in urban areas (1.1%). The intervention is a behavioural change campaign that promotes the consistent use of existing sanitation facilities. 
 
The total annualized cost (both BCC program and additional costs of improved water, etc) of this intervention is ₹67.4 crores. The intervention would end Open Defecation among 72-145 thousand household members. It is estimated that 14-28 deaths and about 30-61 thousand cases of diarrheal illness will be averted per year. 
 
The total value of the annualized health and productivity benefits of the intervention is estimated at ₹95.9 crores. 

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