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Research
How valuable are environmental health interventions?
Evaluation of water and sanitation programmes in India
a b b c
Subhrendu K Pattanayak, Christine Poulos, Jui-Chen Yang Sumeet Patil
Objective To evaluate and quantify the economic benefits attributable to improvements in water supply and sanitation in rural India.
Methods We combined propensity-score “pre-matching” and rich pre–post panel data on 9500 households in 242 villages located
in four geographically different districts to estimate the economic benefits of a large-scale community demand-driven water supply
programme in Maharashtra, India. We calculated coping costs and cost of illness by adding across several elements of coping and illness
and then estimated causal impacts using a difference-in-difference strategy on the pre-matched sample. The pre–post design allowed
us to use a difference-in-difference estimator to measure “treatment effect” by comparing treatment and control villages during both
periods. We compared average household costs with respect to out-of-pocket medical expenses, patients’ lost income, caregiving costs,
time spent on collecting water, time spent on sanitation, and water treatment costs due to filtration, boiling, chemical use and storage.
Findings Three years after programme initiation, the number of households using piped water and private pit latrines had increased
by 10% on average, but no changes in hygiene-related behaviour had occurred. The behavioural changes observed suggest that the
average household in a programme community could save as much as 7 United States dollars per month (or 5% of monthly household
cash expenditures) in coping costs, but would not reduc
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