Children's health improves on average as a result of policy interventions that expand access to piped water. However, the gains largely bypass children in poor and poorly educated families.

August 2001Children's health improves on average as a result of policy interventions that expand access to piped water. However, the gains largely bypass children in poor and poorly educated families.The effects of public investments aimed at directly improving children's health are theoretically ambiguous, since the outcomes also depend on indirect effects through parental inputs. Jalan and Ravallion investigate the role of such inputs in influencing the incidence of child health gains from access to piped water in rural India.Using propensity score matching methods, they find that the prevalence and duration of diarrhea among children under five are significantly less on average for families with piped water than for families without it. But health gains largely bypass children in poor families, particularly when the mother is poorly educated. The authors' findings point to the importance of combining infrastructure investments with effective public action to promote health knowledge and income poverty reduction.This paper - a product of Poverty, Development Research Group - is part of a larger effort in the group to better measure and understand the welfare impacts of development projects. The study was funded by the Bank's Research Support Budget under the research project quot;Policies for Poor Areasquot; (RPO 681-39). The authors may be contacted at [email protected] or [email protected].

The evaluation of reproductive, maternal, newborn, and child health (RMNCH) by the Disease Control Priorities, Third Edition (DCP3) focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. Volume 3 focuses on developments since the publication of DCP2 and will also include the transition to older childhood, in particular, the overlap and commonality with the child development volume. The DCP3 evaluation of these conditions produced three key findings: 1. There is significant difficulty in measuring the burden of key conditions such as unintended pregnancy, unsafe abortion, nonsexually transmitted infections, infertility, and violence against women. 2. Investments in the continuum of care can have significant returns for improved and equitable access, health, poverty, and health systems. 3. There is a large difference in how RMNCH conditions affect different income groups; investments in RMNCH can lessen the disparity in terms of both health and financial risk.

Water, sanitation and hygiene (WASH) investments are widely seen as essential for improving health in early childhood. However, the experimental literature on WASH interventions identifies inconsistent impacts on child health outcomes, with relatively robust impacts on diarrhea and other symptoms of infection, but weak and varying impacts on child nutrition. In contrast, observational research exploiting cross-sectional variation in water and sanitation access is much more sanguine, finding strong associations with diarrhea prevalence, mortality and stunting. In practice, both literatures suffer from significant methodological limitations. Experimental WASH evaluations are often subject to poor compliance, rural bias, and short duration of exposure, while cross-sectional observational evidence may be highly vulnerable to omitted variables bias. To overcome some of the limitations of both literatures, we construct a panel of 442 subnational regions in 59 countries with multiple Demographic Health Surveys. This large subnational panel is used to implement difference-in-difference regressions that allow us to examine whether longer term changes in water and sanitation at the subnational level predict improvements in child morbidity, mortality and nutrition. We find results that are partially consistent with both literatures. Improved water access is statistically insignificantly associated with most outcomes, although water piped into the dwelling predicts reductions in child stunting. Improvements in sanitation predict large reductions in diarrhea prevalence and child mortality, but are not associated with changes in stunting or wasting. We estimate that sanitation improvements can account for just under 10% of the decline in child mortality from 1990-2015.

Van der Klaauw and Wang focus on infant and child mortality in rural areas of India. They construct a flexible duration model framework that allows for frailty at multiple levels and interactions between the child's age and individual socioeconomic, and environmental characteristics. The model is estimated using the 1998-99 wave of the Indian National Family and Health Survey. The estimated results show that socioeconomic and environmental characteristics have significantly different effects on mortality rates at different ages. These are particularly important immediately after birth. The authors use the estimated model for policy experiments. These indicate that child mortality can be reduced substantially, particularly by improving the education of women and reducing indoor air pollution caused by cooking fuels. In addition, providing access to electricity and sanitation facilities can reduce under-five-years mortality rates significantly. This paper--a product of the Environment Department--is part of a larger effort in the department to improve our understanding of environmental determinants of child mortality in rural India.

Identifying policies which can improve water sector management is critically important given the global burden of water-related disease. Each year, 1 in 10 child deaths—roughly 800,000 in total—is the direct result of diarrhea. Can private-sector participation (PSP) in the urban piped water sector improve child health? The author uses child-level data from 39 African countries during 1986–2010 to show that introducing PSP decreases diarrhea among urban dwelling children under five years of age by 5.6 percentage points, or 35 percent of its mean prevalence. PSP also leads to greater reliance on piped water. To attribute causality, the author exploits time variation in the private water market share controlled by African countries’ former colonizers. A placebo analysis reveals that PSP does not affect symptoms of respiratory illness in the same children, nor does it affect a rural control group unaffected by PSP.

This book highlights the multi-pronged strategy for achieving sustainable rural domestic water supply in India. It deepens the understanding of groundwater (predominant source of water supply) behaviour in response to natural processes in different geological settings, analyses the factors influencing the performance of water supply schemes; identifies the conditions under which groundwater-based drinking water sources become sustainable, suggests measures for improving the sustainability of drinking water wells in hard rock regions (covering 2/3rd of India’s geographical area), presents a decision-making framework for planning rural water supply schemes in the country for ensuring long-term sustainability, and suggests physical strategies and policy measures for achieving them. The analyses for development and validation of various models that explain groundwater system behaviour and performance of rural water supply schemes are undertaken for different geological settings in Maharashtra, as the state represents a microcosm of the various hydrological, topographical, and geohydrological conditions encountered in the country. The final analysis for proposing nation-wide strategies considers the various hydrological, geological, geohydrological, and topographical and climatic settings and groundwater contamination and pollution in the country.