Post on 06-Apr-2018
transcript
8/3/2019 Waterand Sanitation- Part 2
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Chapter _ 3Lecture _ 1
Water management practices
and health economics
Part 2
IWRM and Health
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The legacy of the Brundtland years
Health high on the international
political agenda, with a consistentfocus on ill-health-poverty links
WHO Commission on Macro-economics and Health: safe water and adequate sanitation among themost cost-effective interventions for
lasting health gains Combined GDP of countries in sub-
Saharan Africa would be US$100 billion more had malaria beeneffectively controlled 40 years ago
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Some perspectives on water, poverty and health
Africa South of the Sahara has 10% of the global population, yet 24% of the global burden of disease
linked to environmental health determinants
Water supply and sanitation coverage reaches just over half the population; 60% of the rural population lacks
both
In 2000, communicable diseases constitute the singlelargest category in terms of DALYs lost: 73.2% upfrom 65.9 in 1990
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Some perspectives on water, poverty and health
The 2000 Burden of Disease estimates related to
Environmental Health determinants stand at 103million DALYs lost (29% of total)
Further analysis by income group suggests that 55% of this burden affects the poorest fifth of the population,
andthat of this segment, 81% accrues to the rural poor
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A clustered approach to reducing the environmental health risks to which the poor are exposed can accelerate a reduction in their burden of disease
The Top Three Environmental Health-related
Burden of Disease clusters areTotal EH BoD in Mn of DALYs lost
Total pop. Poorest 1/5
Vector-borne diseases 40.9 25.1
Water-related diseases 25.8 14.3
Respiratory infections 24.6 13.5
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A clustered approach to reducing the environmental health risks to whichthe poor are exposed can accelerate a reduction in their burden of disease
The challenges:
To effectively include health as a parameter in decision
making in IWRM To strengthen environmental health component of
health sector programmes so they have capacity torespond to the needs in IWRM
To establish cross-sectoral compatibility in terms of
boundaries, scale and level of decision-making For professionals to learn to understand each other¶s
language and to trust and respect professionals fromother disciplinary backgrounds in an open dialogue
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A combination of Burden of Disease estimates and cost-effectiveness
analyses can differentiate those water supply and sanitation interventionsthat give poor largest incremental health gains for least possible costs.
Recent WHO analyses to attribute
a disease burden to water,sanitation and hygiene risk factorsshow they account for:
2.1 million deaths each year
(3.9% of total) 76 million DALYs lost each year
(5.3% of total)
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A combination of Burden of Disease estimates and cost-effectiveness
analyses can differentiate those water supply and sanitation interventionsthat give the poor largest incremental health gains for least possible costs.
Maximum health gains in absolute terms:
provide the most basic water supply services to those
who have no access at all provide water supply and sewage connection to
individual households
Most cost-effective interventions:
Disinfection at point-of-use through chlorinetreatment and safe storage vessels combined withlimited hygiene education
Targeting key behavioural change (hand washing)
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Annual funding per intervention
world-wide (billions of US$)
1.3 1.49.1
17.8
77.2
-
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Disinfection Halve pop w/o
access to WS
Halve pop w /o
access to
WS&S
Improved WS
& Sanitation
Piped WS &
Sewer
Connection
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A combination of Burden of Disease estimates and cost-effectiveness
analyses can differentiate those water supply and sanitation interventionsthat give the poor largest incremental health gains for least possible costs.
The challenges:
IWRM should always have a Water Supply
and Sanitation component Burden of Disease and Cost-effectiveness
criteria need to be included in the decision-making about water supply and sanitation andin IWRM
Water supply and sanitation projects need tohave a component that documents Burden of Disease reduction and health gains
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A significant part of the burden of disease of poor, vulnerable communitiescan be attributed to the way we develop water resources and manage them.
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A significant part of the burden of disease of poor, vulnerable communities can be attributed to the way we develop water resources and manage them.
Ethiopia, Tigray: micro dams cause a seven-fold
intensification of malaria transmission intensity Senegal, Richard Toll: irrigated rice and sugar caneschemes cause the intestinal schistosomiasis prevalencerate to explode from 0 to 90%
Sri Lanka, Mahaweli System H: Japanese encephalitis
outbreaks due to irrigation extension combined with pig rearing
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A significant part of the burden of disease of poor, vulnerable
communities can be attributed to the way we develop water resources and manage them.
Environmental management measures for health
protection and promotion are a cost-effective option provided they are included at the planning and designstage ± Environmental modification
capital intensive, lasting infrastructure works
± Environmental manipulationrecurrent environmental management activities with a potential for community participation
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A significant part of the burden of disease of poor, vulnerable
communities can be attributed to the way we develop water resources and manage them.
Environmental management: design options at zero extra costs (e.g. larger diameter
of outlets in dams)
operational options at zero extra costs (e.g. flushing,reservoir management)
options with dual benefits (e.g. alternate wetting anddrying as part of rice irrigation practice: improvedyields, less vectors, less methane)
capital investment in structural improvements (e.g.self-draining hydraulic structures, canal-lining, doublespillways for dams)
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A significant part of the burden of disease of poor, vulnerable
communities can be attributed to the way we develop water resources and manage them.
The challenges:
Include training on environmental management for
health in curricula of water professionals Promote best practice in integrated planning andmanagement of water resources (cf. WorldCommission on Dams)
Convince finance ministries that including health
safeguards in water resources development projects issound economics
Mobilise NGOs to adopt similar proceduresstrategically into their development activities
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A review of water resources sector policies and programmes can help identifyopportunities to improve the health status of vulnerable communities.
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A review of water resources sector policies and programmes can helpidentify opportunities to improve health status of vulnerable communities.
Ethiopia¶s Water Sector Development Programme ± By 2016:
Water supply :
Urban coverage increase 74 to 98%
R ural water supply coverage from 23 to 71%.
Irrigation :
Small scale irrigation adds ~ 127,000 ha. to current 200,000 ha.
R emaining expansion ~ 147,000 ha. will be medium and large scale.
Hydropower :
Six medium-scale, 15 small-scale hydropower plants completed;
63 medium-scale, 67 small-scale hydropower plants under development.
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A review of water resources sector policies and programmes can help
identify opportunities to improve the health status of vulnerablecommunities.
Ethiopia¶s Water Sector Development Programme
An estimated US$7.5 billion will be needed over the next 15 years to achieve
the objectives contained in the programme.
The breakdown by sub-sector is :
water supply and sewerage extension 39%
hydropower capacity development 26%
irrigation development 23%water resources management 9%
institution/capacity building 3%
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A review of water resources sector policies and programmes can help identifyopportunities to improve the health status of vulnerable communities.
The challenges:
Use policy and programme development in the water sector as anopportunity for capacity building in integrated thinking
Educate sectoral ministries that time invested in policy reviews
for health is time well-invested