Socio-economic Impacts of Water Supply and Sanitation Projects

I. Background
1. The provision of safe drinking water and basic sanitation is among the most
critical challenges for achieving sustainable development over the next decade.
Water is intrinsically interconnected with the MDGs and basic sanitation was
added to the catalogue at the 2002 World Summit on Sustainable Development in
Johannesburg. To halve by 2015 the proportion of people without sustainable
access to safe drinking water and basic sanitation is one of the numerical and
time-bound targets defined for the MDGs.
2. However, the provision of safe drinking water and basic sanitation contributes to
sustainable improvements in peoples lives regarding their health and education
situation, the preconditions for productive employment as well as for the
eradication of extreme hunger and the empowerment of women.

MDGs and Water and Sanitation Projects

MDG 1 MDG 2 MDG 3

Eradicate Extreme Poverty Achieve Universal Promote Gender Equality
and Hunger Primary Education and Empower Women

MDG 8 Water and MDG 4

Develop a Global Partnership Reduce Child Mortality
for Development Sanitation

MDG 7 MDG 6 MDG 5

Ensure Environmental Control HIV/AIDS, Malaria Improve Maternal Health
Sustainability and other Diseases

3. The impact water supply and sanitation projects on the different aspects such as
the health situation as well as the empowerment is not generally quantified and
only sometimes qualified based on specific empirical studies. Impact
assessments are used to evaluate the programmes, but there are many
methodological issues involved in making these assessments which mainly deal
with problems about validity (or the truthfulness of claims being made) and
reliability (wether observations of a particular impact will be seen similarly by
different observers). Validity can be improved by quantification and measurement.
4. This concept note gives a brief overview over core issues related to impact
dimensions for water supply and sanitation projects and provides guidance on the
following questions:
! To what extent and how is the impact orientation of water supply and
sanitation reflected in Financial Cooperation projects and programmes?
! What are the different impacts on peoples living conditions to be expected
from the provision of safe water and basic sanitation ?
Socio-Economic Impacts of Water Supply and Sanitation Projects 2

! How, under which preconditions and to what extent can water supply and
sanitation projects contribute to improvements in the health, education and
poverty situation of people ?
! What experiences have been recorded regarding the impact of water and
sanitation projects on the different dimensions ?

II. Impact-Orientation in FC
5. Since the mid 1990s, impact orientation and efficiency of aid delivery have been
at the center of the international discussion on development cooperation. The
formulation of the MDGs was a first step towards formulating joint development
goals and indicates the commitment of the international community to a renewed
focus on poverty reduction. The Paris Declaration calls for both partner countries
and donors to adopt a managing for results approach to development
cooperation. This implies managing and implementing aid in a way that focuses
on the desired results and uses information to improve decision making.
6. Impact orientation of development cooperation has long been a core element of
Financial Cooperation (FC) projects and programmes. The log-frame approach is
based on defining inputs, outputs, outcomes and impacts for the interventions and
requires the analysis of the underlying impact chains as well as the associated
risks and assumptions. For water and sanitation projects, the development goals
and project/programmes objectives defined in the logframe are in line with the
MDGs. MDG Goals and Targets are often reflected on the different levels in the
logframe.
7. However, the time and costs required to measure the impact empirically and the
protracted methodological issues often exceed a justifiable effort in the context of
development cooperation projects and programmes. In most cases, it is more
appropriate to consider the typical impact chains, to assess their validity for the
specific situation, in particular with regard to preconditions and complementary
factors essential for the impact and to make an informed assessment of the
impact of the interventions. In order to inform this process, the typical impact
chains as discussed below have been analysed for the different project types and
illustrated with qualitative and quantitative results from empirical studies. These
guidelines provide information on relevant issues for assessing the impact, such
as information to be gathered during the feasibility study or compulsory
complementary aspects to be reflected in the project design.

III. Impacts of improved water supply and sanitation

8. Water supply and sanitation are essential for human health and survival, for food
security and the empowerment of women as well as the education of girls, for
reduction in productivity losses due to morbidity and malnutrition, for the
management and protection of natural resources. Although the crucial importance
has been widely recognized, the right to safe water and adequate sanitation
remains a promise unfulfilled for the worlds poorest citizens. The lack of access
to safe drinking water and to basic sanitation impedes economic development,
thwarts progress towards gender equality and puts the health in danger. The
unsustainable exploitation of natural resources is often due to insufficient or
inadequate water supply and sanitation. The arguments in support of expanding
the access to water supply and sanitation services and promote environmental
sustainability can be expressed in terms of human values, human rights as well

Susanne Hesselbarth October 2005

Socio-Economic Impacts of Water Supply and Sanitation Projects 3

as in health and economic terms. Each of these dimensions shall be analyzed in

the following, describing the ways and interlinked aspects by which improved
water supply and sanitation contribute to the aspired impacts and by
demonstrating their relation to the 8 MDGs.
9. Access to basic services like water supply and sanitation is a moral and ethical
imperative rooted in the cultural and religious tradition of societies around the
world. The United Nation have affirmed the Right to Water in 2002, recognizing
that the right to water is indispensable for leading a life in human dignity and a
prerequisite for the realization of other human rights. It states that the human right
to water entitles everyone to sufficient, safe, acceptable, physically accessible
and affordable water for personal and domestic use. The statement echoes the
importance that adequate water supply and sanitation has for the health situation,
for economic and social development and for an ecological balance.
10.MDG 1: Poverty and Hunger: Assuring the water supply for the household has
significant consequences both in terms of time and monetary costs. At the same
time, insufficient and inadequate water supply and sanitation result in increased
health risks for the population and a higher morbidity and mortality due to water-
related diseases. Improving water supply and sanitation will have a positive
impact on the individual income and poverty situation of the beneficiary
household. Reducing the time and energy burden of water collection by providing
safe water at a nearer distance will enable household members to engage in
other activities, among them productive and income generating activities.
Improved water quality will reduce the health risks and also the costs of
preventing and treating ill family members. Furthermore, the reduction of working
days lost to water-related diseases will also have a positive impact on the
households income situation.
11.By reducing the water-related health risks and thereby improving the health status
of the population, domestic water supply and sanitation also has an impact on the
nutritional situation of poor people. Healthy people are better able to absorb the
nutrients in food than those suffering from water-and-sanitation related diseases,
particularly worms which rob their hosts of calories. Furthermore, a reduction of
the distance to the nearest safe water sources, will also have a positive impact on
the energy (calo ries) required for securing the household water needs. With the
reduced time burden from improved water services, more time can be spend on
productive activities either directly in food production or in other income-
generating activities.

MDG 1: Eradicate Extreme Poverty and Hunger

Time savings due

to improved access MDG 1
Income-genera-
ting activities Eradicate Extreme Poverty
and Hunger
Water and Better Target: to halve, between 1990
Sanitation health and 2015, the proportion of
Reduced costs people living on less than a
for medicine dollar a day and those who
suffer hunger

Reduced costs
for water

Susanne Hesselbarth October 2005

Socio-Economic Impacts of Water Supply and Sanitation Projects 4

12.MDG 2: Primary Education: Improved water supply and sanitation facilities exert
their positive impact on primary education through several channels. Relieving
girls from their water fetching duties can improve their school attendance as can
the installation of separate sanitation facilities at the schools. Both boys and girls
school attendance and educational achievements improve significantly with
reduced health-risks and better nutritional status from improved water supply and
sanitation as well as reduced injuries and strain from water carrying, in particular
for girls. Chronic early childhood diarrhea can result in permanent effects on brain
development with the resulting impact on a childs learning achievements.

MDG 2: Achieve Universal Primary Education

Time savings due

to improved access MDG 2
Achieve Universal Primary
Precondition for Education
attendance
Water and Target: to ensure that, by
Sanitation 2015, all boys and girls
Regular school complete primary school
attendance
Better
health

13.MDG 3: Gender Equality: In most societies, ensuring the households water

supply falls under responsibility of the women. Considerable time and energy are
being spent daily on collecting water and caring for family members suffering from
water-related illnesses. Improving water supply and sanitation impacts positively
on womens living conditions by giving them more time for productive endeavors,
adult education, empowerment activities and leisure. At the same time, reducing
the distance to the water supply and sanitation facilities will also improve the
security and safety and reduce the risk of harassment. Improved water, sanitation
and hygiene impacts on the socio-cultural position of women and has the
potential to provide them with privacy and dignity as well as increased status
within the family and wider community. Female representation on water boards
and user committees strengthens the role of women in society and has far-
reaching socio-cultural impacts.
MDG 3: Promote Gender Equality and Empower Women

Time savings due

to improved access MDG 3
Income-genera-
ting activities Promote gender Equality
and Empower Women
Water and Better Target: to eliminate gender
Sanitation health disparities in primary and
Reduced care for secondary education
family members preferably by 2005 and at all
levels by 2015
Regular school
attendance

Susanne Hesselbarth October 2005

Socio-Economic Impacts of Water Supply and Sanitation Projects 5

14.MDG 4: Child Mortality: Water-related diseases are the most common cause of
death and illness among the poor population in developing countries and children
under 5 are particularly affected. Of the 1,8 Mio deaths per year due to diarrhea,
over 90% of children under 5. But also with regard to the other water-borne
diseases caused by the consumption of contaminated water (diarrhea, typhoid,
cholera), water-washed diseases caused by insufficient water for personal
hygiene (skin and eye diseases, diarrhea), water-based diseases such as guinea-
worm and schistosomiasis (caused through contact with infected water) as well as
diseases transmitted by water-related insect vectors (malaria) children are
disproportionally affected. Providing sustainable access to safe water supply and
basic sanitation together with hygiene education can bring about a major
reduction of water-related health risks and child morbidity and mortality.

MDG 4: Reduce Child Mortality

Reduction of water- MDG 4

related diseases Reduce Child Mortality

Lower Target: to reduce by two-thirds,

Water and between 1990 and 2015, the
Mortality
Sanitation mortality rate among children
under five

Better nutritional Lower risks of

status other diseases

15.MDG 5: Maternal Mortality: A reduction in maternal mortality depends strongly

on the water supply and sanitation situation. A contributory factor to poor maternal
health is conta minated water and poor hygiene, leading to infection and slow
postnatal recovery. Good water supply facilities will support fewer miscarriages
from heavy water transport and safer home birth. At the same time a better
general health condition due to reduced health risks linked to insufficient water
and sanitation will also have a positive impact on maternal mortality. However,
reducing the health risk by improving water supply and sanitation needs to be
linked to improving hygiene practices in order to bring about the desired impacts.
This is particularly valid for postnatal hygiene practices, both concerning midwifes
and the mothers.
MDG 5: Improve Maternal Health

Time and energy

savings due to MDG 5
improved access Less Improve Maternal Health
miscarriages
Target: to reduce by three-
Water and quarters, between 1990 and
Sanitation 2015, the ration of women
Lower dying in childbirth
susceptibility to
other diseases
Reduction of water
and hygiene-related
diseases

Susanne Hesselbarth October 2005

Socio-Economic Impacts of Water Supply and Sanitation Projects 6

16.MDG 6: Other Diseases: Insufficient water supply and sanitation as well as

inappropriate hygiene practices are associated with number of different diseases,
as described above. Arsenic contamination in drinking water has been recognized
as a important health risk, in particular in Bangladesh. Increased levels of salt in
the drinking water, in some cases associated with the salination of soil and water
ressources, can lead to kindney problems. Eliminating stagnant, standing water
around the households and water points can contribute to reducing the incidence
of malaria, in particular in dry areas with few natural mosquito breeding places. At
the same time, reducing the incidence of water-borne, water-washed and water-
based diseases through improved services and hygiene behaviors will have a
positive impact on reducing the susceptibility to other illnesses. For people living
with HIV/AIDS, water, sanitation and hygiene is extremely important in reducing
the incidence of opportunistic infections.

MDG 6: Combat HIV/AIDS, Malaria and other Diseases

Time and energy

savings due to MDG 6
improved access Combat HIV/AIDS, Malaria
and other Diseases
Lower
Water and susceptibility to Target: to halt and to begin to
Sanitation other diseases reverse the spread of
HIV/AIDS and the incidence of
malaria and other major
diseases
Reduction of water
and hygiene-related
diseases

17.MDG 7: Environmental Sustainability: Insufficient or inadequate water supply

and sanitation is very often associated with an unsustainable exploitation of
natural resources. Improved water management, including industrial pollution
control and water conservation is a key factor for maintaining ecosystem integrity.
Adequate treatment and disposal of excreta and both household and industrial
wastewater contribute to less pressure on freshwater resources. Furthermore,
improved sanitation reduces flows of human excreta into waterways and reducing
the respective health and environmental risks. Furthermore, water, sanitation and
hygiene is important for improving the lives of slum dwellers, by reducing the risks
of contracting water-related illnesses, relieving the burden on women and opening
opportunities for small-scale enterprises.

Susanne Hesselbarth October 2005

Socio-Economic Impacts of Water Supply and Sanitation Projects 7

MDG 7: Ensure Environmental Sustainability

Reduced
Improved Environmental Risks MDG 7
Ensure Environmental
Sanitation
Sustainability

Economic Target: Principle of sustainable

Water and Sustainability development
Sanitation Target: to, by 2015, halve the
proportion of people without
sustainable access to safe
Reduced drinking water
Water Losses Improved Target: Improvement for slum
Coverage dwellers

Ecological
Sustainability

18.The relevance of the different impacts described above varies across regions and
between project types. Improving water supply in rural areas where water
sources are at great distances from the villages will have a different impact on the
time burden associated with water collection than urban water supply
improvements. At the same time, the environmental benefit deriving from
improved wastewater management will most probably have a greater impact on
ecosystem health than basic sanitation in rural areas. Three selected projects are
presented in the following section to illustrate the potential impact of rural water
supply projects, urban water supply projects and wastewater projects. For each
project type, one specific impact dimension is highlighted.

IV. Selected Case Studies

19.Drinking water supply in Tanzanias Hai District remained a serious problem
until the end of the 1980s. The quality of the water from the numerous sources
along the slopes of the Kilimanjaro was excellent, but the existing pipeline system
was only rudimentary. The majority of the population had to fetch water from open
furrows and ditches. Women spend lo ng hours per day in order to secure the
daily water supply needed by their families. Furthermore, this water was polluted
with bacteria and other pathogens as well as toxic chemicals from the use of
mineral fertilizers and plant protection agents on the surrounding coffee
plantations. Consequently, the population suffered from numerous diseases
caused by dirty water: diarrhea, worm diseases, skin and eye infections.
20.The local authorities supported by the Protestant Church engaged in ensuring
drinking water supplies in the Hai Districts. Starting in 1989 and with grants
provided through KfW Entwicklungsbank, catchments were built for springs ad
streams, pipelines built and rehabilitated and public standpipes installed in the
villages along the pipeline. At the same time, water user committees were
founded in the settlements located in the supply area which united to form a
Water Supply Trust. The Trust was registered as a non-profit enterprise and was
assigned by the government to operate the water supply sys tem. Approximately
45.000 people are currently being supplied with clean drinking water and surveys
by the Ministry of Health indicate that water-borne diseases have decreased
significantly. The positive health effects are amplified by the fact that the sanitary
situation in the project area has also improved considerably. Nearly all families
have invested in latrines. Two women in charge of hygiene issues are integrated

Susanne Hesselbarth October 2005

Socio-Economic Impacts of Water Supply and Sanitation Projects 8

in each water user committee and are responsible for providing advise and for
educating people about health and hygiene.
21.In addition to the positive impact on the health situation and on gender relations,
an overall improvement of the living conditions is voiced by the population. The
length of time women spent providing water for the family was reduced from up to
4 h to 5 to 20 minutes per day. The improved water supply increased the
opportunities for women to improve their economic productivity. The time formerly
dedicated to fetching water was freed up for income generation. Most women
reported increasing their productive work in agriculture, in particular for growing
bananas, ground nuts, cassava and vegetables on small plots. The agricultural
produce were partly used to complement the family diet and partly sold at nearby
markets. In some villages, women organised themselves in banana growers
associations and sold their products in nearby towns. Time was also devoted to
other income generating activities such as handicrafts, sewing, and food
processing.

Public Standpost in Tanzanias Hai District

22.In the late 1990s, the quality of life and the development perspectives of
Diyarbakir, a city in the south east of Turkey with about 1 million inhabitants,
were significantly constrained by an insufficient water suppy and sanitation
situation. Migration towards the urban area from the surrounding villages put
additional pressure on the existing systems. Less than half of the inhabitants were
connected to the central sewerage system dating from the late 1970s, around
600.000 people were using on-site facilities. Particularly in the densely populated
old parts of the town, regular flooding of the system which was used both for rain
and wastewater resulted in unhygienic conditions. The infiltration of the

Susanne Hesselbarth October 2005

Socio-Economic Impacts of Water Supply and Sanitation Projects 9

wastewater and the overflow from cesspits contaminated the sources and wells
used for supplying the town with drinking water.
23.In the shantytowns inhabiteted by the migrants from the rural areas, the sanitatory
conditions were particularly precarious. The waste water collected by the system
is led through those marginal settlements in open ditches and results in
unacceptable health risks. Furthermore, the waste water was being used for
irrigation of the small orchards and vegetable gardens on the outskirts of
Diuyarbakir which produced more than half of the fruit and vegetable supply for
the town. The heavy contamination of the agricultural produce with pathogens as
well as the unacceptable sanitary conditions in the shantytowns resulted in a high
incidence of water-related diseases. The incidence of thyphoid increased
threefold and of amoebiasis fivefold between 1990 and 1996 due to the health
risk associated with the unsufficient water and waste water situation.
24.Further negative consequences resultet from the fact that the watse waterwas not
treated but directly dicharged into the river Tigris. During the summer month, the
basic discharge of the Tigris was not sufficient to dilute the waste water to an
acceptable level. The resulting contamination of the water led to the near
extinction of fish iand the destruction of the natrual ecosystem.
25.The improvement of the sewerage system, namely the construction of a treatment
plant, the extension of the existing sewage network and the establishment of a
system for the emptying of the on-site facilities, has had a very positive impact on
the living condition of the population and in particular has reduced the health risks
related to the insufficient water supply and sanitation situation. Between 2002 and
2004, the incidence of typhoid as well as hepatitis A decreased by over 50%
each, dysentary was reduced by 48% during the same period and the number of
diarrhoea cases dropped from 5.989 in 2002 by 38% to 3.736 in 2003.
26.The reduction of technical water losses in the city of Al-Mukalla and the
improvement of the water supply of the population was the objective of the Water
Losses Reduction Programme in Yemen. The administrative and technical
water losses in Al-Mukalla amounted to 41% of total production in 1994 and the
provision of the population with safe drinking water could only be ensured with an
unsustainable exploitation of the existing water resources. The interventions were
focussed on the inner city zones in the old part of town characterized by high
population density and the poor condition of the obsola te network. The
programme measures included the rehabilitation of the network and the
installation of water meters.
27.Between 1994 and 2004, the daily water production was increased by a factor of
2,8 compared to the 1994 production. The specific per capita consumption
increased from 44 l/cd to 97 l/cd improving the coverage of the water needs of the
population. The continued distribution of the increased production demanded by
the population through the existing network would have led to enourmeous
increases in water losses, both in relative and in absolute terms. Therefore,
parallel to the increase in production, the total water losses for the supply system
of Al-Mukalla were reduced from 41% to 29,9%, the focal inner city zones even
down to 21,2%. The technical water losses in the rehabilitated part of the network
were measured at an average of 7,5%, administrative losses accounting for
around 13,7%.
28.The reduction of the water losses and the improvement of the water supply
situation on the city of Al-Mukalla had a positive impact on the sustainable use of
Susanne Hesselbarth October 2005
Socio-Economic Impacts of Water Supply and Sanitation Projects 10

the existing water ressources. Whereas initially the high losses combined with the
relatively low water production resulted in an insufficient per capity supply, the
loss reduction already increased the available share for consumption and reduced
the drain on the existing ressources. Improved water management and water
supply and sanitation contribute to the sustainable exploitation of natural
resources and provides for maintaining ecosystem integrity.

Susanne Hesselbarth October 2005