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August 28, 2014
WASH-related
Mortality Trends in
Sub-Saharan Africa
2
Contextual Factors
& Initial Conditions
{IWRM}Policy (mix)
InstitutionsWater Law
Organizations
ProcessIntegration/Coordination
Decentralization
Participation
WRM
IWRM
�Water resources
endowment/distribution/level
of development
�Level of economic
development Nation/RB
�Political factors (Democracy
National/local levels,
Decentralization, Governance)
�Social/cultural factors (local
experience with self
governance and service
provision)
�etc
Mohamed Ait Kadi – Zaragoza 0708
Improved Water: Total (Urban & Rural)
UNICEF and WHO. 2012. Progress on drinking water and sanitation: 2012 update.
Available at: http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-report-2012-en.pdf Accessed on 28 Jan 2013.
Some Good News!
Childhood mortality rates are declining & the
rate of decline is accelerating.
Across 21 regions of the world, rates of
neonatal, post-neonatal, and childhood
mortality are declining, and there is evidence
of accelerating declines from 2000 to 2010
compared with 1990 to 2000 (including Sub-
Saharan Africa).
Rajaratnam et al. (2010). “Neonatal, post-neonatal, childhood, and under-5 mortality
for 187 countries, 1970–2010: a systematic analysis of progress towards
Millennium Development Goal 4.” The Lancet. May 24.
Water & sanitation-related mortality
1950-2050, by world region
WASH-related Mortality– China, India, Brazil, & Nigeria (1950-2050)
0.00
0.05
0.10
0.15
0.20
0.25
19
50
19
60
19
70
19
80
19
90
20
00
20
10
20
20
20
30
20
40
20
50
WSH
Mo
rta
lity
Ra
te (%
)
Year
China
India
Brazil
Nigeria
Emerging &Threshold Countries in SSA
Source: Radalet 2010
o 17 emerging countries: dramatic
changes in economic growth,
poverty reduction, and political
accountability since the mid-1990s.
o Avg. annual GDP growth of 3.2%,
between 1996 and 2008 (all 17
emerging countries)
o 6 threshold countries: considerable
but less dramatic change
WASH Mortality Categories
High Mortality
Low Mortality
Moderate Mortality;
Insufficient Decline
Moderate Mortality;
Sufficient Decline
High Mortality
Stagnant Moderate decline
High Mortality
High Mortality
Stagnant Moderate decline
o Highest WASH mortality rates, both
at baseline and in projections
o Stagnant progress in reducing
WASH mortality in some counties
(mostly fragile and oil states)
o Moderate decline in other
countries (mostly threshold and
emerging economies)
o Moderate WASH mortality rates,
for the Sub-Saharan Africa region
o Progress is insufficient to achieve
South Asian levels of WASH
mortality by 2050
Moderate Mortality;
Insufficient Decline
Moderate Mortality, Insufficient Decline (Little Progress)
Moderate Mortality,
Sufficient Decline (Good Progress)
o Moderate WASH mortality rates,
for the Sub-Saharan Africa region
o Progress is sufficient to achieve
South Asian levels of WASH
mortality by 2050.
o Mostly threshold and emerging
economies
Moderate Mortality;
Sufficient Decline
Low Mortality
o Historically low WASH mortality
rates, comparable to South Asia
o By 2050, WASH mortality projected
to be near zero
Low Mortality
WASH Modeling Framework
Population
Growth
Economic
Growth
WASH
Coverage
WASH-Related
Mortality
Economic
Benefits
-
+
- +
That’s good! That’s good!
Baseline assumptions: representative countries
Population
Baseline assumptions: representative countries
GDP per Capita
Best and Worst Case Assumptions:
Nigeria
Base Best Worst
Avg. Annual GDP Growth 4.1% 4.5% 3.7%
Coverage
Piped Water Coverage GDP Elasticity 9.5 14.5 4.5
Piped Water Coverage % Urban Elasticity 0.35 0.6 0.1
Improved Water Coverage GDP Elasticity 4.5 9 0
Improved Water Coverage % Urban Elasticity 0.3 0.5 0.1
Improved Sanitation Coverage GDP Elasticity 8 14 2
Improved Sanitation Cov. % Urban Elasticity 0.45 0.8 0.1
Mortality
WSH Mortality GDP Elasticity -0.2 -0.3 -0.1
WSH Mortality Piped WatSan Elasticity -0.02 -0.03 -0.01
WSH Mortality Log Piped WatSan Elasticity -0.5 -0.7 -0.3
WSH Mortality Improved Water Elasticity -0.0275 -0.045 -0.01
Results …
WASH Mortality Categories:
Representative Countries
High Mortality
Low Mortality
Moderate Mortality;
Insufficient Decline
Moderate Mortality;
Sufficient Decline
High Mortality
Nigeria
Kenya South Africa
Stagnant
Democratic Rep.
of Congo
Moderate decline
Ethiopia
WASH Mortality Categories
High Mortality
Low Mortality
Moderate Mortality;
Insufficient Decline
Moderate Mortality;
Sufficient Decline
High Mortality
Stagnant
Burundi
Central African Rep.
Chad
DRC
Guinea Bissau
Niger
Somalia
Moderate decline
Angola
Burkina Faso
Ethiopia
Liberia
Mali
Sierra Leone
Benin
Cameroon
Comoros
Congo
Cote d'Ivoire
Ghana
Guinea
Madagascar
Malawi
Mauritania
Mozambique
Nigeria
Rwanda
Sudan
Tanzania
Togo
Uganda
Zambia
Zimbabwe
Botswana
Equatorial
Guinea
Eritrea
Gambia
Kenya
Lesotho
Namibia
Senegal
Swaziland
Cape Verde
Gabon
Mauritius
Seychelles
South Africa
WASH Mortality Rate by Country Grouping
WASH Mortality Rate: Projections
WASH-related Deaths by country grouping
Total WASH-Related Deaths: Projections
Population without Improved W&S coverage
(Representative Countries)
Model Overview
Assemble country-level data sets and estimate empirical relationships using regression analysis
Collect secondary data
Coverage with water & sanitation services
WASH-related mortality
Other control variables
Assess associations with WASH-related mortality rates
Assess associations with piped and improved water and
sanitation coverage
Simulate outcomes (1990-2050)
WASH-related mortality rates
Piped service + improved water coverage
Calculate WASH-related deaths (1990-2050)
Adjust coverage estimates for piped water + sewer
Calculate WTP to avoid mortality (1990-2050)
Sensitivity analyses on model
parameters
Baseline assumptions: representative countries
Improved Water Coverage
Economic & Population Projections
� Drivers of coverage and WASH-related
mortality
Population by country grouping
GDP by country grouping
GDP per Capita, by country grouping
Projections: Wash-mortality Rates,
Wash-related Death
Projections by Country Groupings
WASH Mortality Rate, by category
Best/Worst Cases
Best/Worst Cases
Oil and Mineral Exporters
WASH Mortality Rate, 2008
Oil and Mineral Exporters
WASH Mortality Rate, 2008
Oil and Mineral Exporters
WASH Deaths, 2008
Oil and Mineral Exporters