Water supply and

sanitation affecting health

 Presentation overview

• Objectives
• Last decade WSS coverage
• Vietnam National Health Survey
• Diarrheal illness and poverty
• Analysis of WSS and health
• Conclusions and recommendations
 Background
• Objectives:
– Assess health risks of drinking water supply and sanitation
– Identify population at risk of illness
– Assist in identifying water and sanitation sector priorities

• Large sample (36,000 households, 61 provinces)

• Information on;
– sources of household drinking water supply,
– sanitation facilities,
– household behavior, e.g boiling and treating of drinking water,
– identified pollution sources near dug wells,
– prevalence and indicators of severity of diarrheal illness
– socio-economic status, e.g. living standard, education level etc
Water and sanitation in the last decade
Drinking water source
60%

50%

40%
1992-93
30% 1997-98
2001-02
20%

10%

0%
Tap water Drilled well Rainwater Dug well Surface Other
water source

Source: From Vietnam National Health Survey 2001-02. Report by Ministry of Health, Vietnam.
2004. The data are from the Vietnam Living Standard Survey 1992/93 and 1997/98, and the
Vietnam National Health Survey 2001/02
Sources of drinking water
Piped mountain
Other water Bought water
spring water

Dug well (no Dug well (with

pollution source) pollution source)

Surface water

Rain water

Drilled well water

Tap water
Toilet facilities in the last decade
40%

35%

30%

25%
1992-93
20% 1997-98
2001-02
15%

10%

5%

0%
Flush toilet Double Simple Other toilet Joint toilet No toilet
with septic compost/ toilet
tank pour flush

Source: From Vietnam National Health Survey 2001-02. Report by Ministry of Health, Vietnam.
2004. The data are from the Vietnam Living Standard Survey 1992/93 and 1997/98, and the
Vietnam National Health Survey 2001/02
 Types of toilets

No toilet
Other
Suilabh, pour
Simple toilet, flush toilet
single vault. Double vault
compose latrine

Toilet draining
to pond/animal
shelter

Flush toilet
 WATER, SANITATION AND
HEALTH

Findings from VNHS data

Source : Calculated from the Vietnam

National Health Survey 2002.
Ministry of Health. Vietnam
 ADI prevalence by Age Group and Quintile
10%
8.2%
8% 7.1%
6.6%
6% 5.4%
4.2%
4%
2.2% 2.3% 2.1% 2.2% 1.9%
2%

0%
Poor Near poor Average Better-off Rich
Under 5 5 and older
 Means of days of ADI by Age Group

3.50 3.10
3.00
2.50
2.50

2.00

1.50

1.00

0.50

0.00
Under 5 Over 5
 Number of days of ADI by Age and Quintile
5.00

4.00
3.3 3.1 3.3
3.0 2.9 2.8
3.00 2.6 2.4 2.5 5 and older
2.0
2.00 under 5

1.00

0.00
Poor Near Average Better-off Rich
poor
Index of Disease Burden (Acute
Diarrheal Illness)
All age groups
60%
51%
50%
40% 34% Factors influencing
ADI (under 5)
30% 27%
20%
10%
0%
-10%
-14%
-20%
Using No toilet Mother not Quintile
surface water finished
primary 50%

40% 44%

30% 33%

Factors influencing 20% 23% 24%

ADI (5 or older) 10%

0%
Using No toilet Unfinised Ethinic
surface water primary minority
Factors influencing ADI (all population)

40% 36%
35%
30%
25%
20% 15%
15%
10%
5%
0%
Pollution source close to No toilet
dug well*

* Only for people using dug well

0.40
Factors influencing
# of disease days
0.30 0.35
0.33

of ADI (all ages)

0.20

0.10

0.00
-0.12
-0.10

-0.20
No toilet Ethnic minority Quintile

30%
27.1% 26.1%
25%
23.2%
20% 20.3%

Population by 15%

quintile have using

13.1%
10%

dug well close to 5%

pollution source 0%
Poor Near poor Average Better-off Rich
Population using surface water by quintile

20%
18%
17.2%
16%
14%
12%
10% 10.4%
9.0%
8%
6.7%
6%
4%
3.1%
2%
0%
Poor Near poor Average Better-off Rich
Population by quintile using dug well with
nearby pollution source
30%
27.1% 26.1%
25%
23.2%
20% 20.3%

15%
13.1%
10%

5%

0%
Poor Near poor Average Better-off Rich
 Population with no toilet by quintile

40%
35% 36.0%

30%
25%
20%
15% 15.9%

10% 10.3%
5% 5.3%
1.4%
0%
Poor Near poor Average Better-off Rich
 %
% population using population
river, lake, with no
spring, pond as toilet
water supply

% population with
pollution source
near drinking
water source (i.e.
dug well)
 Proportion of
population with
Proportion of pollution
population using source near
dug well water water source (%
of population
with dug well)
Proportion of population using rain water
for drinking by quintile
22%
20%
18%
16% Whole
14% population
12% Rural
10% Urban
8%
6%
4%
2%
0%
Poor Near Average Better- Rich
Poor off
Treatment of Drinking Water
100%
Population always boiling drinking water (quintile)
87.3%
83.3%
79.1%
80% 75.1%
62.9%
60%

40%

20%

0%
Proportion of
Poor Proportion of Average
Near poor population that
Better-off Rich
population that rarely or never boil
always boil their their drinking
drinking water water
 Population using treated water by
quintile*
30%
28.1%
26.0% 26.9%
25%
22.6%
20%

15%
13.2%
10%

5%

0%
Poor Near poor Average Better-off Rich
 Conclusions
• Impressive gains in WSS coverage rates
• Poverty associated with significantly higher ADI in children but not in adults
• Surface water, polluted dug wells and lack of toilet facilities are causing higher ADI
rates
• Lack of toilet is also associated with longer duration of ADI
• We do not find any difference in ADI for tap water, clean dug wells, drilled wells,
rain water, or piped spring water
• We do not find any higher ADI for simple toilet compared to other types of toilets
• Education is associated with lower ADI, suggesting the importance of hygiene
promotion in reducing ADI
• The poor have much lower coverage rates of safe water supply and toilet facilities
• Lack of safe water is partiularly prevalent in some of the northern, central
highlands, and MRD areas
• Lack of toilet facilities is prevalent in northern mountainous and central parts of
Vietnam
• It should be noted that the study only assessed infectious disease (ADI) in relation
to water supply, and not other types of water pollution health risks.
 Recommendations

• Priority should be given to providing WSS to those without

any services.
• Second priority must be to address dug well pollution. This
requires further understanding of cost-effective sollutions
• It seems less important to focus on upgrading of services for
those already with basic coverage (other than polluted dug
wells).
• Additional health benefits could be gained by targeting poor
households because of their higher ADI rates
• Hygiene promotion should be an integral part of WSS
provision
• The study has identified provinces of particular priority for
WSS programs
END