Sanitation in developing countries

Mortality and morbidity rates in developing countries are dominated by infectious and parasitic diseases, mainly excreta-related. Policy makers in developing countries have relied heavily on oral rehydration therapies, with a relative neglect of other approaches, including investments in sanitation. Similarly, while much has been written about the demand for water, little is known about the determinants of sanitation or it's impact on health. My thesis seeks to address both questions by analyzing cross-country data and household surveys of Pakistan and South Africa. I begin by examining the experience of industrialized countries when they were investing in sanitation systems in the nineteenth century, and conclude that the path they took is not appropriate for today's developing countries. Next, I describe how excreta-related diseases are spread, and technological aspects of sanitation. I also carry out a rough cost-benefit calculation to investigate the viability of sanitation and find that Pakistani households cannot justify such investments on health alone. Investigating the determinants of national levels of sanitation, I find that income levels are critical. Moreover, sanitation has no impact on health, in levels or in changes, across countries. Next, I turn to the analysis of household surveys. In urban Pakistan, I find that sanitation is a community choice rather than a household choice. For both urban and rural areas, sanitation access is an income effect, and also depends on complementary inputs. Sanitation has no statistical impact on health in rural areas, but has a small effect in urban areas. For both countries, the quality of sanitation makes a small difference to health: higher quality sanitation has no statistical effect, but poorer quality sanitation can worsen health. In South Africa, decades of Apartheid show up in sanitation. Most whites enjoy access to flush toilets and indoor plumbing, while blacks do not. However, relative to Pakistani households, urban blacks enjoy higher quality sanitation. While income levels are important, so too is household size in both countries. Overall, my analysis suggests that sanitation access and its health impacts are largely country-specific.