1. Water supply and sanitation affecting health

2. Presentation overview Objectives Last decade WSS coverage Vietnam National Health Survey Diarrheal illness and poverty Analysis of WSS and health Conclusions and recommendations

3. Background Objectives: –Assess health risks of drinking water supply and sanitation –Identify population at risk of illness –Assist in identifying water and sanitation sector priorities Large sample (36,000 households, 61 provinces) Information on; –sources of household drinking water supply, –sanitation facilities, –household behavior, e.g boiling and treating of drinking water, –identified pollution sources near dug wells, –prevalence and indicators of severity of diarrheal illness –socio-economic status, e.g. living standard, education level etc

4. Water and sanitation in the last decade Source: From Vietnam National Health Survey 2001-02. Report by Ministry of Health, Vietnam. 2004. The data are from the Vietnam Living Standard Survey 1992/93 and 1997/98, and the Vietnam National Health Survey 2001/02

5. Sources of drinking water

6. Toilet facilities in the last decade Source: From Vietnam National Health Survey 2001-02. Report by Ministry of Health, Vietnam. 2004. The data are from the Vietnam Living Standard Survey 1992/93 and 1997/98, and the Vietnam National Health Survey 2001/02

7. Types of toilets

8. Findings from VNHS data Source : Calculated from the Vietnam National Health Survey 2002. Ministry of Health. Vietnam WATER, SANITATION AND HEALTH

10. Means of days of ADI by Age Group

12. Index of Disease Burden (Acute Diarrheal Illness) All age groups

13. Factors influencing ADI (under 5) Factors influencing ADI ( 5 or older)

14. Factors influencing ADI (all population) * Only for people using dug well

15. Factors influencing # of disease days of ADI (all ages) Population by quintile have using dug well close to pollution source

16. Population using surface water by quintile

17. Population by quintile using dug well with nearby pollution source

18. Population with no toilet by quintile

19. % population using river, lake, spring, pond as water supply % population with pollution source near drinking water source (i.e. dug well) % population with no toilet

20. Proportion of population using dug well water Proportion of population with pollution source near water source (% of population with dug well)

21. Proportion of population using rain water for drinking by quintile

22. Proportion of population that always boil their drinking water Treatment of Drinking Water Proportion of population that rarely or never boil their drinking water

23. Population using treated water by quintile*

24. Conclusions Impressive gains in WSS coverage rates Poverty associated with significantly higher ADI in children but not in adults Surface water, polluted dug wells and lack of toilet facilities are causing higher ADI rates Lack of toilet is also associated with longer duration of ADI We do not find any difference in ADI for tap water, clean dug wells, drilled wells, rain water, or piped spring water We do not find any higher ADI for simple toilet compared to other types of toilets Education is associated with lower ADI, suggesting the importance of hygiene promotion in reducing ADI The poor have much lower coverage rates of safe water supply and toilet facilities Lack of safe water is partiularly prevalent in some of the northern, central highlands, and MRD areas Lack of toilet facilities is prevalent in northern mountainous and central parts of Vietnam It should be noted that the study only assessed infectious disease (ADI) in relation to water supply, and not other types of water pollution health risks.

25. Recommendations Priority should be given to providing WSS to those without any services. Second priority must be to address dug well pollution. This requires further understanding of cost-effective sollutions It seems less important to focus on upgrading of services for those already with basic coverage (other than polluted dug wells). Additional health benefits could be gained by targeting poor households because of their higher ADI rates Hygiene promotion should be an integral part of WSS provision The study has identified provinces of particular priority for WSS programs

26. END