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

In 1979 Walsh and Warren, published an influential short article* which argued that there was gross disparity between the cost-effectiveness of water supply and sanitation, costed at $10,000 per death averted in 1996 prices, and selective primary health care, costed at $600-750 per death averted in 1996 prices. This seemed to many a justification for ignoring water supply and sanitation. This paper presents a new model of cost-effectiveness which shows that when cost-effectiveness analysis is limited to health-sector costs, environmental health interventions are clearly as cost-effective as many of the well-known child survival interventions. The paper is presented in six chapters. Following a brief introduction, chapter 2 describes a framework developed by the Environmental Health Project (EHP) for integrating environmental health interventions with child survival. Chapter 3 discusses the impact and effectiveness of hygiene interventions that can be used to control childhood diarrhoea. It uses these as an example to show how the cost-effectiveness model can be applied. Chapter 4 explains the principles underlying the proposed cost-effectiveness model and how the costs of the interventions were estimated. Chapter 5 presents the results obtained by applying the model. Chapter 6, the final chapter, presents conclusions and recommendations.

*Walsh, Julia A., and Kenneth S. Warren (1979). Selective primary health care: An interim strategy for disease control in developing countries. The New England Journal of Medicine, vol. 301, no. 18, p. 967-974