Methods to assess household excreta disposal practices are critical for informing public health outcomes of efforts to improve sanitation in developing countries. We present a new metric, the Safe San Index (SSI), to quantify the hygienic safety of a household's defecation and human feces disposal practices in India, where behavioral outcomes from on-going public expenditures to construct household sanitation facilities and eliminate open defecation are poorly measured. We define hygienic safety of feces disposal as capture in a hygienic sanitation facility. The SSI consists of 15 self-report items and two sub-scales, Latrine Use Frequency and Seven-Day Open Defecation Rate. Households are scored on a standardized scale from 0 (no defecation safely captured) to 100 (all defecation safely captured). We present results of a pilot study in Odisha, India to apply the Index to assess excreta disposal behaviors among rural households and evaluate the reliability and validity of the Index for estimating the rate of correct and consistent sanitation facility usage of household with an improved latrine.

Measuring the Safety of Excreta Disposal Behavior in India with the New Safe San Index: Reliability, Validity and Utility

The Health Consequences of Armed Conflict in Sub-Saharan Africa : How Much Do Conflict Intensity and Proximity Matter?

Armed conflict affects combatants and noncombatants directly through casualties, but other effects on health are less visible and more difficult to measure Recent studies in the public health literature and in the comparative social sciences have increasingly reported on the negative effects of armed conflict on health Most of these studies have relied on aggregate, macro-level data to compare effects between countries, but few have examined the micro-level foundations of this relationship This study attempts to understand the extent of the effects of armed conflict on individual health and to explore whether conflict intensity and proximity present challenges to health that have not previously been documented Using individual level survey data and a measure of self-assessed health improves our understanding of the links between health and armed conflict in sub-Saharan Africa

https://www.jstor.org/stable/info/10.2979/africonfpeacrevi.2.1.1

The Health Consequences of Armed Conflict in Sub-Saharan Africa: How Much Do Conflict Intensity and Proximity Matter?

Often, resource and development economists do not explicitly analyze institutions, with their energies devoted to using econometrics and microeconomic models, even though they may think that institutions are important. They can use three strategies to further institutional analysis in resource and development econometrics: (1) recognizing institutional variables, (2) using multilevel thinking and estimation, and (3) drawing causal graphs. I illustrate each strategy with examples from three past studies, by others and myself: (a) biomass extraction from Ranthambore National Park, (b) air pollution in Goa, and (c) carbon and forest livelihoods across countries.

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Analyzing Institutions in Resource and Development Econometrics: Recognizing Institutions, Exploring Levels, and Querying Causes

In order to meet Millennium Development Goals it is imperative that improved sanitation facilities along with availability of potable water, the two basic facilities for human development could be met effectively by the state intervention. However, despite significant investments over the last 20 years, India still faces the most daunting sanitation challenge and its sanitation is rated as the second worst in the world after China. At present only 28 per cent of people in rural areas have access to toilets leading to severe burden on community, health services and considerable losses to productivity to the nation. With a view to assessing health impact of water borne diseases this study provides first an assessment of direct impact of water and sanitation facilities on incidence of selected diseases in major Indian states. This is followed by an estimation of indirect impact through a case study of Karnataka which brings out sub-state level disparities within the state. Our estimation through regressions and stochastic frontier analysis indicate that quantitative significance of sanitation status is revealed both directly in incidence of selected diseases and indirectly on health system efficiency at sub-state (district) level coefficients. These results indicate that for more equitable health outcomes and an improved efficiency of health system, adequate infrastructure facilities like safe drinking water supply, toilets and electricity are necessary. These inputs may help to reduce disparities and improve the outcomes in deficient districts of Bagalkot, Kolar, Kodagu and Uttar Kannada. Thus in the final section based on our estimates, policy measures are suggested which emphasize that more efficient health outcomes could be achieved by overcoming investment needs through different innovative measures adopted to regions and locations comprising of higher subsidy to sanitation, better management of existing programmes and community participation.

Health Impact of Water Borne Diseases and Regional Disparities in India

The paper explores sanitation and health in rural Uttarakhand, India. Data from a primary survey of 1530 households in 2004/05 are analysed. Factors affecting diarrhea episodes and latrine availability are studied. As expected latrine availability affects episodes of diarrhea negatively, while the availability of water has a positive effect on latrine availability and use. Education, poverty and the Swajal programme have significant effects on latrine availability.

An Empirical Study of Sanitation and Health in Rural Uttarakhand, India

The extraction of forest biomass – through fodder and fuelwood collection, and grazing – is one of the key sources of conflict between villagers and the managers of such protected areas as Ranthambhore National Park in India. Differences among households across and within villages with respect to indicators of livestock, wealth, and biomass extraction (grazing, and fuelwood and fodder collection) are studied using non-parametric methods, using data from a survey of 227 households in 4 different villages in, and near Ranthambhore National Park. There are substantial, statistically significant differences among the four differently located villages with respect to indicators of livestock, wealth, and biomass extraction. The interior village has the greatest livestock holding and the greatest percentage of households using the park. The resettled village also has a substantial dependence. Within one of the villages, differences among households of different castes are also substantial. While Brahmin households have low dependence on the park, Gujjar and Koli households have a high dependence for both grazing and fuelwood, and Berwa households have a high dependence for fuelwood. In addition, social, economic and physical correlates of biomass (grazing, and fuelwood and fodder collection) user categories are studied, using an econometric analysis in a multinomial logit framework. About two-thirds of the households surveyed used the park. Caste and distance from the park are found to have high substantive significance.

Inter- and intra-village diversity among forest dependent households in Ranthambhore National Park, India

While the first order effects of access to clean water and of personal hygiene and sanitation on health have been well documented, the effects of community hygiene and sanitation, along with personal hygiene and sanitation, have not been comprehensively studied. In this paper, incorporating the features of models from agricultural household (Bardhan and Udry, 1999) and reciprocal externalities (Dasgupta, 1993), we present a simple model of health externalities of households' hygiene and sanitation, showing how the choices of one household affects ill-health incidences of other households. Then using micro level survey data of 1,530 households in rural Uttarakhand, India, we show that both household and community hygiene are significant inputs in the determination of households' ill-health incidences (i.e. diarrhea, cholera, typhoid, dysentery, worm infestation and jaundice), with the latter having greater impact than the former, over and above effects attributable to households' socioeconomic status. That is, there is a large health externality of a household's hygiene and sanitation. In the presence of such health externality of households' hygiene and sanitation, which is strongly associated with the access to safe water, universal access to safe water may be required to combat water-related illnesses. This implies that the governments' consideration of alternative proposals to improve water services must be informed by health externalities in households' hygiene and sanitation, and in the provision of water across communities.

Vikram Dayal

Papers

An Empirical Study of Sanitation and Health in Rural Uttarakhand, India

Inter- and intra-village diversity among forest dependent households in Ranthambhore National Park, India

Neighbors Can Make You Sick: Hygiene, Sanitation and Health