Privatizing Africa’s Urban Water Supply: Good or Bad for Child Health?

Photo by Margaret W. Nea. Source: Flickr (Bread for the World)

Every year, 1 in 10 child deaths—approximately 800,000—are the direct result of diarrhea. Of these deaths, 88 percent are preventable by guaranteeing access to safe drinking water and sanitation supplies.

The situation is particularly dire in Africa south of the Sahara. Almost two-fifths (39 percent) of people living in the region are without safe drinking water. The region is home to 15 percent of the world’s population but accounts for more than half of child deaths.

This is why identifying policies that can improve water management is critically important.

One possible method to improve water safety is private sector participation (PSP). Allowing PSP in the marketplace has the potential to encourage the availability and quality of piped water supplies, especially in environments where the government doesn’t provide enough of them.

Could PSP in the urban piped water sector improve child health? I examined this question in my recent discussion paper, The Child Health Implications of Privatizing Africa’s Urban Water Supply.

PSP in the water sector is controversial. Some policymakers have resisted it because water provision is a natural monopoly, firms are not subject to direct competition. Moreover, historically firms have shown less interest in the water sector than in other sectors, like energy, telecommunications, and roads. Finally, water is essential for life, and a clean water supply has many positive health externalities—possibly making a case for government intervention in the marketplace.

By matching data from nearly 100 household surveys in 39 African countries with secondary data on experiences with PSP-managed water, I was able to identify how PSP affects people’s lives. I first found that PSP gives a big boost to use of piped water supplies. This is important given research showing that those with piped water have higher-quality water at the source, use larger quantities of water, and are less likely to store water in containers, all of which help reduce the prevalence of diarrhea. PSP is also associated with less time spent collecting water, since the piped supplies tend to be closer to the home.

Quite importantly, I also found that introducing PSP decreases diarrhea in urban children under age five by 5.6 percentage points—a 35 percent reduction in the average incidence of diarrhea. As we would expect, PSP does not seem to affect diseases unassociated with water supplies—specifically, respiratory illnesses.

My findings suggest that PSP in the urban piped water sector considerably improves the health of young children by reducing the prevalence of diarrhea. This is one possible, partial solution to the global burden of diarrheal disease that policymakers should consider.

With contributions from Grace Lerner

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