The Health Impact of Water and Sanitation Utilities Privatization and Regulation in Sub-Saharan Africa

Lisa Bagnoli, Salvador Bertoméu-Sánchez, A. Estache
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Abstract

As of 2017, the urban access rate to safe water sources in 2017 stood at 84% while rural access was still around 45%. The rates for sanitation were 44% and 22%, respectively. Since the 1980s many high-profile reforms supported by international organizations have been implemented in the region in an attempt to close the access gaps in the water and sanitation sector (WSS). Two recommendations with high international exposure were an increased role for large-scale private sector participation in the management and financing of national or regional utilities and the creation of separate sector regulatory agencies to increase the independence of regulation. Both reforms seemed to contribute to improved water access rates, at least for the urban population, but not enough to catch up with the demands of a fast-growing population; and both failed to deliver on sanitation. The progress these initiatives allowed was correlated with improvements in the average health outcomes for some indicators (i.e., under-five mortality associated to diarrhea) but once again, it was not enough and was not fairly distributed. Indeed, improvements seem to have mostly benefited upper- and middle-income groups. Unfortunately, an evaluation of the health effects of these two reforms have not yet been fully established empirically, which is why it seems prudent to talk about correlations rather than causal effects. Most of the statistically robust evidence on the impact of utilities and regulatory reforms on health is incomplete because details of several dimensions of these reforms and their context are not measured consistently across countries or within countries. In addition, the small amount of econometric evidence available is based on pre-2010 data for SSA. The imperfect data is however solid enough to suggest that without further governance changes in the region, the health risks are likely to increase. This is because due to the high population growth rate of the region, closing the access gaps is likely to get tougher considering current investment levels and technological choices. The necessary changes require improving the match between policy and technological choices, including service delivery technologies that are consistent with the ability to pay and the tariff and subsidy levels adopted to ensure cost recovery without excluding any category of users.
撒哈拉以南非洲水和卫生设施私有化和管制对健康的影响
截至2017年,2017年城市安全水源普及率为84%,农村安全水源普及率仍在45%左右。卫生设施普及率分别为44%和22%。自20世纪80年代以来,在国际组织的支持下,该地区实施了许多引人注目的改革,试图缩小水和卫生部门(WSS)的获取差距。两项受到国际高度关注的建议是,增加大规模私营部门参与国家或区域公用事业的管理和筹资的作用,以及设立单独的部门管理机构,以增加管理的独立性。这两项改革似乎都有助于提高供水率,至少对城市人口来说是这样,但还不足以满足快速增长的人口的需求;两家公司都未能在卫生方面有所作为。这些举措所取得的进展与某些指标(即与腹泻有关的五岁以下儿童死亡率)的平均健康结果的改善有关,但这仍然不够,而且分配不公平。事实上,改善似乎主要受益于中高收入群体。不幸的是,对这两项改革的健康影响的评估尚未充分建立经验,这就是为什么谈论相关性而不是因果关系似乎是谨慎的。关于公用事业和监管改革对卫生的影响的大多数统计上强有力的证据是不完整的,因为这些改革的几个方面及其背景的细节没有在国家之间或国家内部得到一致的衡量。此外,现有的少量计量经济学证据是基于2010年以前的SSA数据。然而,不完善的数据足以表明,如果不进一步改变该地区的治理,健康风险可能会增加。这是因为由于该地区的高人口增长率,考虑到目前的投资水平和技术选择,缩小接入差距可能会变得更加困难。必要的改变需要改善政策和技术选择之间的匹配,包括与支付能力相一致的服务提供技术以及为确保不排除任何类别的用户而采取的关税和补贴水平。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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