Child survival and environmental health interventions : a cost-effectiveness analysis

This paper develops a new model for calculating the cost-effectiveness of EH measures to argue the viability of including them in child survival activities. The new model differs from the Walsh and Warren model in that costs are limited to interventions that are financed from the health sector budget and lead to health impact. The new model is based on three assumptions. (1) The costs of physical infrastructure are not assumed to be a burden to the health sector budget. Some level of service is commonly financed by a combination of user charges and public health subsidies for construction through public works. (2) The indicative cutoff value for cost-effectiveness is $150 per disability adjusted life year. (3) The most cost-effective model adds hygienic practices to water supply and sanitation measures. Situations where independently financed water supply and sanitation infrastructure is already available should be viewed as opportunities for EH interventions. After a brief introduction, Chapter 2 describes a framework developed by USAID"s EH Project for integrating environmental health interventions with child survival. Chapter 3 discusses the impact and effectiveness of hygienic interventions that can be used to control childhood diarrhea, and uses this as an example to show how the cost-effectiveness model can be applied. The principles underlying the proposed cost-effectiveness model and how the costs of the interventions were estimated are discussed in Chapter 4. Chapter 5 uses a case study from Mexico to apply the model, followed by conclusions and recommendations in Chapter 6. The major conclusion is that, if we exclude Walsh and Warren"s assumption that the health sector alone must bear the costs of water and sanitation infrastructure, EH interventions prove to be as cost-effective as other interventions in the current child survival package. Includes bibliography.