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The value of water supply and sanitation in development: an assessment.

D A Okun

Department of Environmental Sciences and Engineering, School of Public Health, University of North Carolina, Chapel Hill 27599-7400.

The attractiveness of oral rehydration therapy (ORT), a new and simple ministration that averts many child deaths from diarrhea among children, is diverting attention among donor agencies from the importance of water supply and sanitation (WS&S) in developing nations. The principal factor that led to the adoption of ORT is its apparent low cost per diarrheal death averted in children when compared with WS&S. However, WS&S provides many more benefits that are essential to sustaining the lives saved by ORT and vital to maintaining and enhancing the lives of adults and children. Among many other benefits WS&S prevents spread of the causes of diarrhea, controls many other water- and sanitation-related diseases, releases women from the heavy and time-consuming burden of carrying water from distant sources, and improves the quality of life in the community. Cost comparisons between WS&S and ORT are misleading. WS&S is a long-term investment in preventive health while ORT is a response to an immediate life-threatening situation. WS&S interventions eliminate unsanitary conditions leading to illness and death while ORT has no effect on the causes of diarrheal morbidity. The costs of WS&S are not high: $5 to $10 per capita annually. Without WS&S and hygiene education ORT programs are not likely to effect long-term improvement in child health status. ORT and WS&S programs are complementary; one should not displace the other.

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