Harvard Institute for International Development, Harvard University

Abstract

This paper reviews and summarizes the results of studies of household water use in rural areas of sub-Saharan Africa that offer clues to the effects of household water resources on rural productivity. We attempt to consider all the possible ways that household water supplies could affect productivity and to present whatever evidence on these links is available. The purpose of the review is to identify which of the connections between water supply and productivity are likely to be most important for rural households in Africa and to indicate where further field research is needed most. The first section continues with a brief description of the links between household water supplies and productivity and of the scope of the review. The next two sections summarize current data on access to safe water in rural areas of sub-Saharan Africa and on household water use. The paper then discusses the health costs of rural water supplies, combining information on the burden of water-related diseases in Africa, the productivity costs of these diseases, and the impact of water supply interventions. The costs of collecting water from distant sources are examined in Section 5. Section 6 reviews the cost and cost-effectiveness of water supply interventions. The paper concludes with a summary of findings and recommendations for further research.

Introduction

...The unit of analysis on which this paper concentrates is the household. The question of what constitutes a "household" is open to debate, especially when the geographic area of interest is an entire continent. Berman et al. (1994) provide a good explanation of why the household is the most appropriate level of analysis, though not the only relevant one, for work on public health. They note, "we feel that household processes are becoming more critical as determinants of impact as health interventions increasingly rely on behavior change to produce benefits. There is ample evidence of success in providing access tohealth-improving inputs but failure in their appropriate use...[The household] is the unit to which many public health interventions are addressed, often depending on the internal processes of households for their success." The household is also the relevant unit when considering the cost of disease in terms of the quantity and quality of labor available, since households often replace the labor of sick workers with that of other household members. Following the advice of Berman et al. (1994), we will define the household on the basis of the functional criterion that is of interest to us: domestic water supply. For thepurpose of this paper, a household is a group of people who secure their water for drinking, cooking, washing, etc. from a common source and from one or more common carriers of water...