What Works in Fighting Diarrheal Diseases in Developing Countries? A Critical Review

The Millennium Development Goals call for reducing by half theproportion of people without sustainable access to safe drinkingwater. This goal was adopted in large part because clean waterwas seen as critical to fighting diarrheal disease, which kills2 million children annually. There is compelling evidence thatprovision of piped water and sanitation can substantially reducechild mortality. However, in dispersed rural settlements, providingcomplete piped water and sanitation infrastructure to householdsis expensive. Many poor countries have therefore focused insteadon providing community-level water infrastructure, such as wells.Various traditional child health interventions have been shownto be effective in fighting diarrhea. Among environmental interventions,handwashing and point-of-use water treatment both reduce diarrhea,although more needs to be learned about ways to encourage householdsto take up these behavior changes. In contrast, there is littleevidence that providing community-level rural water infrastructuresubstantially reduces diarrheal disease or that this infrastructurecan be effectively maintained. Investments in communal waterinfrastructure short of piped water may serve other needs, andmay reduce diarrhea in particular circumstances, but the casefor prioritizing communal infrastructure provision needs tobe made rather than assumed. JEL codes: Q56, Q52, O22