1. Examining the Influence of Economic and Political Factors Upon Access to Improved Water and
Sanitation in Select African Nations, 2005-2008
Dlorah Jenkins, MPH [dlorahj1@gmail.com]; Christine Stauber, MS, PhD; Monica Swahn, MPH, PhD
Institute of Public Health, Georgia State University; Atlanta, GA
●
Today, 884 million people worldwide lack access to
safe drinking water and 2.6 billion are without access to
improved sanitation facilities.
●
Many nations are on track towards meeting the
Millennium Development Goals of decreasing the
proportion of those without improved water and
sanitation, however, progress in many developing
nations is lacking.
●
The purpose of this study was to determine what
influence political and economic factors have on the
availability of improved water and sanitation in
developing nations, focusing on sub-Saharan Africa.
●
This study addressed the following research questions:
1) Do political factors, specifically political stability
(PS) and government effectiveness (GE), have an
impact upon the availability of improved water and
sanitation resources in sub-Saharan Africa? 2) Is gross
national income (GNI) associated with the availability
of improved water and sanitation resources?
●
Data from the Demographic and Health Surveys of
11 sub-Saharan African nations conducted from 2005-
2008 and from the World Bank indicators on PS, GE
and GNI were analyzed using logistic regression models
to examine the association between political and
financial indicators and access to water and sanitation.
●
A total of 109,606 observations were included in this
study.
●
The majority had access to improved drinking water
sources (65.9%) and travel times <30 minutes (83.3%).
●
Most used no form of household water treatment
(81.1%) and did not have an improved sanitation facility
(64.1%).
●
Overall, the strength and direction of the association
between economic/political factors and access to water
and sanitation varied.
●
GE and GNI had the strongest positive associations
with access to improved water source and household
water treatment. GNI was positively associated with
access to improved sanitation; political stability was
inversely associated with travel time to water source.
●
The results of this study indicate that GNI, PS, and
GE are associated with water and sanitation access in
sub-Saharan Africa. With this information, context-
specific intervention to improve and expand water and
sanitation services in the region can be developed,
focusing on building stable, effective governments, and
alleviating the burden of poverty.
ABSTRACTABSTRACT INTRODUCTIONINTRODUCTION
●
The burden posed by unsafe water and unimproved
sanitation falls heavily upon citizens of the developing
world, wherein nearly 1.2 billion live without any form
of sanitation, and one-fifth live without access to safe
water sources.
●
Target 3 of the Environmental Sustainability
Millennium Development Goal is to “Halve, by
2015, the proportion of the population without
sustainable access to safe drinking water and
basic sanitation.
●
While many nations are on track towards meeting
this goal, progress in many developing nations is
severely lacking, particularly in sub-Saharan Africa.
RESEARCH QUESTIONSRESEARCH QUESTIONS
●
The purpose of this study was to determine the
influence of economic and political factors upon
access to improved water and sanitation services
in sub-Saharan African. The following research
questions were addressed:
●
What is the current availability of improved
water and sanitation resources in sub-Saharan
Africa?
●
Do political factors, specifically political
stability and government effectiveness, have an
impact upon the availability of improved water
and sanitation resources in sub-Saharan Africa?
●
Is gross national income associated with the
availability of improved water and sanitation
resources?
●
Is there a disparity in access to water and
sanitation resources in urban and rural settings?
DiseaseDisease DeathsDeaths11
% of% of
WASH-WASH-
relatedrelated
deathsdeaths11
DALYsDALYs22
% of% of
WASH-WASH-
relatedrelated
DALYsDALYs22
DiarrhoealDiarrhoeal
diseasesdiseases 895,000895,000 55%55% 28,684,00028,684,000 47.7%47.7%
IntestinalIntestinal
nematodenematode
infectionsinfections
400400 0%0% 1,572,8001,572,800 2.6%2.6%
TrachomaTrachoma 00 0%0% 601,000601,000 1.0%1.0%
Schisto-Schisto-
somiasissomiasis 36,00036,000 2%2% 1,502,0001,502,000 2.5%2.5%
LymphaticLymphatic
filariasisfilariasis – – 908,000908,000 1.5%1.5%
MalariaMalaria 335,000335,000 21%21% 12,867,00012,867,000 21.4%21.4%
Onchocer-Onchocer-
ciasisciasis 00 0%0% 38,00038,000 0.0%0.0%
TotalTotal
WASH-WASH-
relatedrelated
1,631,0001,631,000 – 60,088,00060,088,000 –
% of% of
regionalregional
totaltotal
15%15% – 16%16% –
METHODSMETHODS
●
Data was analyzed from the Demographic and Health
Surveys of 11 sub-Saharan African nations from 2005-
2008.
●
Frequencies were produced and reported as
percentages.
●
Odds ratios were produced by logistic regression
analyses to examine the association between continuous
economic/political variables and dichotomous WASH-
related dependent variables.
●
Crosstabulated ORs were produced for dichotomous
independent variables (Upper 50th
percentile vs. Lower 50th
percentile) and dichotomous dependent variables.
●
Chi-square analyses were performed to explore the
discrepancies between observed and expected proportions
of private and shared sanitation facilities.
RESULTSRESULTS
Table I. Deaths and DALYS Attributed to WASH-related
diseases in sub-Saharan Africa, 2004
1
Source: WHO, Estimated deaths attributable to water, sanitation, and
hygiene ('000), by disease and region, 2004.
2
Source: WHO, Burden of disease (in DALYs) attributable to water,
sanitation, and hygiene ('000), by disease and region, 2004
●
The majority of this study population had access to
improved drinking water sources and shorter travel
times to their sources.
●
Most did not use any form of household water
treatment and did not have an improved sanitation
facility.
RuralRural
ResidenceResidence
ImprovedImproved
DrinkingDrinking
Water SourceWater Source
Time toTime to
Water,Water,
≤≤ 30min30min
In HomeIn Home
WaterWater
TreatmentTreatment
ImprovedImproved
SanitationSanitation
FacilityFacility
PrivatePrivate
SanitationSanitation
FacilityFacility
64.6%64.6% 65.9%65.9% 83.3%83.3% 18.9%18.9% 35.9%35.9% 50.2%50.2%
Table IV. Summary of Frequency Data for Study Population
RESULTS, Cont.RESULTS, Cont.
SUMMARYSUMMARY
●
GNI was positively associated with access to improved water
sources and sanitation facilities. In general, nations with higher
average incomes are better able to fund water/sanitation projects and
households with higher incomes are able to afford the
construction/installation of water and sanitation facilities.
●
Political stability was found to have a strong positive association
with shorter travel times to water. Conflict and political instability
have been found to negatively impact water and sanitation
infrastructure, thus affecting the availability and convenience of these
services.
●
Government effectiveness was found to have strong, positive
associations with improved water and household water treatment,
and was also positively associated with improved sanitation and
access to private sanitation facilities.
●
Large-scale programs to education the public on the risks of
water-related disease and HWT promotion require
coordination between various government-run and public
entities, a feat that is beyond the capabilities of an ineffective
government. Likewise, coordination of a large-scale sanitation
project is beyond the capacity of an ineffective government.
●
Ineffective governments are also often ignorant of the needs
of the general population.
●
The findings from this study suggest that urban-rural setting is a
better predictor of access to improved water and sanitation and
travel time to water source than economic and/or political factors.
●
This study also confirmed the fact that shared sanitation facilities
are more common in urban areas than in rural areas. This is due to:
1) housing density, which hinders the installation of sanitation
facilities and 2) rapid population growth – installation of facilities
cannot keep up with the rate of growth.
●
Working towards poverty alleviation would appear to be a critical
step towards improving access to safe water and adequate sanitation
in developing regions.
●
Future research should explore the interaction of economic and
political variables, as well as other societal factors that may influence
WASH resources.
METHODS, Cont.METHODS, Cont.
Improved drinking waterImproved drinking water
sourcessources
Unimproved drinking waterUnimproved drinking water
sourcessources
Piped water into dwelling,Piped water into dwelling,
plot or yardplot or yard
Public tap/standpipePublic tap/standpipe
Tubewell/boreholeTubewell/borehole
Protected dug wellProtected dug well
Protected springProtected spring
RainwaterRainwater
Unprotected dug wellUnprotected dug well
Unprotected springUnprotected spring
Small cart with tank/drumSmall cart with tank/drum
Tanker truckTanker truck
Surface water (river, damn, lake,Surface water (river, damn, lake,
pond, stream, channel,pond, stream, channel,
irrigation, channel)irrigation, channel)
Bottled waterBottled water
●
Rural residents were found to have generally less
access to improved water/sanitation than urban
residents.
ImprovedImproved
DrinkingDrinking
WaterWater
SourceSource
Time toTime to
Water,Water,
≤≤ 30min30min
HouseholdHousehold
WaterWater
TreatmentTreatment
ImprovedImproved
SanitationSanitation
FacilityFacility
PrivatePrivate
SanitationSanitation
FacilityFacility
% Urban% Urban 85.785.7 95.395.3 20.520.5 58.758.7 37.837.8
% Rural% Rural 55.055.0 77.077.0 18.018.0 23.423.4 26.926.9
OR: UrbanOR: Urban 4.914.91 6.026.02 1.171.17 4.664.66 0.630.63
Table V. Access to Improved Water and Sanitation:
Urban vs. Rural
Improved SanitationImproved Sanitation
FacilitiesFacilities
Unimproved SanitationUnimproved Sanitation
FacilitiesFacilities
Flush or pour-flush to:Flush or pour-flush to:
piped sewer systempiped sewer system
septic tankseptic tank
pit latrinepit latrine
Ventilated improved pitVentilated improved pit
latrine (VIP)latrine (VIP)
Pit latrine with slabPit latrine with slab
Composting toiletComposting toilet
Flush or pour-flush toFlush or pour-flush to
elsewhere (street, ditch,elsewhere (street, ditch,
yard/plot, open sewer, etc.)yard/plot, open sewer, etc.)
Pit latrine without slab or openPit latrine without slab or open
pitBucketpitBucket
Hanging toilet or hangingHanging toilet or hanging
latrinelatrine
No facilities or bush or fieldNo facilities or bush or field
(open defecation)(open defecation)
Table III. Improved/Unimproved Sanitation Facilities
Table VI. Significant Positive Associations, Results of
Multivariate Logistic Regression Analyses (p-value <.001)Table II. Improved/Unimproved Drinking Water Sources
ImprovedImproved
DrinkingDrinking
WaterWater
Time toTime to
Water,Water,
≤≤ 30min30min
HouseholdHousehold
WaterWater
TreatmentTreatment
ImprovedImproved
SanitationSanitation
FacilityFacility
PrivatePrivate
SanitationSanitation
FacilityFacility
GNIGNI 1.031.03
(1.03-1.03)(1.03-1.03)
-- -- 1.061.06
(1.06-1.06)(1.06-1.06)
--
PSPS -- 5.115.11
(4.92-5.32)(4.92-5.32)
-- -- 1.171.17
(1.13-1.21)(1.13-1.21)
GEGE 2.682.68
(2.55-2.82)(2.55-2.82)
-- 2.852.85
(2.69-3.02)(2.69-3.02)
1.211.21
(1.15-1.27)(1.15-1.27)
1.721.72
(1.63-1.82)(1.63-1.82)
Figure I. Percentage of Population Without
Access to Improved Water and Sanitation:
Sub-Saharan Africa, 1990-2015
359359