sanitation

Estimating the cost of achieving basic water, sanitation, hygiene, and waste management services in public health-care facilities in the 46 UN designated least-developed countries: a modelling study

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Summary

Background

An alarming number of public health-care facilities in low-income and middle-income countries lack basic water, sanitation, hygiene (WASH), and waste management services. This study estimates the costs of achieving full coverage of basic WASH and waste services in existing public health facilities in the 46 UN designated least-developed countries (LDCs).

Methods

In this modelling study, in-need facilities were quantified by combining published counts of public facilities with estimated basic WASH and waste service coverage. Country-specific per-facility capital and recurrent costs to deliver basic services were collected via survey of country WASH experts and officials between Sept 24 and Dec 24, 2020. Baseline cost estimates were modelled and discounted by 5% per year. Key assumptions were adjusted to produce lower and upper estimates, including adjusting the discount rate to 8% and 3% per year, respectively.

Findings

An estimated US$6·5 billion to $9·6 billion from 2021 to 2030 is needed to achieve full coverage of basic WASH and waste services in public health facilities in LDCs. Capital costs are $2·9 billion to $4·8 billion and recurrent costs are $3·6 billion to $4·8 billion over this time period. A mean of $0·24–0·40 per capita in capital investment is needed each year, and annual operations and maintenance costs are expected to increase from $0·10 in 2021 to $0·39–0·60 in 2030. Waste management accounts for the greatest share of costs, requiring $3·7 billion (46·6% of the total) in the baseline estimates, followed by $1·8 billion (23·1%) for sanitation, $1·5 billion (19·5%) for water, and $845 million (10·7%) for hygiene. Needs are greatest for non-hospital facilities ($7·4 billion [94%] of $7·9 billion) and for facilities in rural areas ($5·3 billion [68%]).

Interpretation

Investment will need to increase to reach full coverage of basic WASH and waste services in public health facilities. Financial needs are modest compared with current overall health and WASH spending, and better service coverage will yield substantial health benefits. To sustain services and prevent degradation and early replacement, countries will need to routinely budget for operations and maintenance of WASH and waste management assets.

Source: Lancet

On July 28, the UN General Assembly adopted a non-binding resolution calling on states and international organisations “to scale up efforts to provide safe, clean, accessible and affordable drinking water and sanitation for all”. Water and sanitation are now enshrined as basic human rights. However, of 163 delegates from member nations who voted on this resolution, 41 abstained and did not fully endorse this right. Why?

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On July 28, the UN General Assembly adopted a non-binding resolution calling on states and international organisations “to scale up efforts to provide safe, clean, accessible and affordable drinking water and sanitation for all”. Water and sanitation are now enshrined as basic human rights. However, of 163 delegates from member nations who voted on this resolution, 41 abstained and did not fully endorse this right. Why?
Some delegates felt the decision to hold the vote was pre-emptive, and all countries could have reached consensus—and thereby avoided the need for a vote—if more time was allowed to interpret legal outcomes of the move for public and private suppliers. Most delegates who abstained, and some who endorsed the resolution, were anticipating a report to be published later this year by an independent expert appointed by the UN Human Rights Council (HRC). The Brazilian delegate, who voted yes, decried the absence of an “appropriate forum” to debate the resolution, and the UK’s delegate, who abstained, said that the resolution was not proposed “with consensus in mind”. Nevertheless, the justifications given by the 41 countries that abstained, including the USA, Japan, and Canada, were not convincing.
Irrespective of politicking at the UN, 884 million people worldwide do not have regular access to clean water, and 2·6 billion do not have access to basic sanitation. The 2010 Millennium Development Goal 7 report states that the target of halving the number of people without access to safe water is on course to be met by 2015, but provision of sanitation is not. The practice of open defecation by 1·1 billion people is not only “an affront to human dignity”, but also the key source of faecal—oral transmitted diseases such as diarrhoea, which causes 1·3 million deaths per year in children younger than 5 years.
A little more than 5 years through the UN General Assembly’s Water for Life Decade, adequate supply of water and sanitation is far from universal. When the HRC’s report is published, the hope is that no country obstructs a binding commitment to provide clean water and sanitation for all.
source:LANCET