A role for water supply and sanitation in the child survival revolution.

Current strategy for the "child survival revolution," as supported by by agencies such as UNICEF and USAID, give low priority to improvements in water supply and sanitation, because it has been concluded that these interventions are not cost-effective. This conclusion is incorrect. Because water supply and sanitation projects have multiple impacts, care needs to be used in applying conventional cost-effectiveness techniques. Because adequate water supply and sanitation facilities are necessary but not sufficient conditions for health improvements, the provision of improved facilities may be essential even though it does not have a large, immediate impact on health status. The long-run effect on child survival is probably much greater than would be expected on the basis of assessment of immediate effects on diarrheal disease. Morbidity due to diarrheal diseases is generally substantially affected by water supply and sanitation improvement projects. It appears that there are serious flaws in the analytic methods being used to decide on priorities for child survival activities.