The Child Health Implications of Reorganizing the Urban Water Sector, January 2011.
Katrina Kosec, Stanford University.
Each year, diarrheal diseases claim the lives of nearly 2 million people{ninety per-cent of them children under the age of fi ve. The problem is especially critical in Africa, which has ten percent of the world’s population but accounts for forty per-cent of child deaths. Can private sector participation (PSP) in the urban pipedwater industry improve child health? Allowing the private sector to provide basic infrastructure such as piped water is politically controversial, with some arguing that the private sector is more ecient and will lead to improvements in accessand quality, and others arguing that privatization will cause access and quality tosu er.
This paper uses a novel panel dataset on the sub-national regions of 25 African countries over 1985-2006 to shed light on this question. This is the period during which nearly all African countries that today have PSP in water introduced those arrangements. analysis suggests that the introduction of PSPdecreases diarrhea among under- ve children by about four percentage points, or23%. An instrumental variables analysis that uses variation in the share of theworld water market controlled by former colonizing countries suggests that the effects may be twice as large. The di fference between the OLS and the IV results can be explained by the fact that privatization is more likely when the water sector is already distressed and causing health problems.
Importantly, the diarrheal disease reduction bene fits of PSP appear to be greatest among the least-educated households, and smallest among the most-educated households. PSP in water also appears to be associated with signi cantly higher rates of reliance on piped wateras the primary water source, suggesting that increased access may be driving child health improvements.
