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The World Bank Research Observer Advance Access published online on May 4, 2007
The World Bank Research Observer, doi:10.1093/wbro/lkm002
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© The Author 2007. Published by Oxford University Press on behalf of the International Bank for Reconstruction and Development / THE WORLD BANK. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

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

Alix Peterson Zwane and Michael Kremer

Alix Peterson Zwane (corresponding author) is Assistant Cooperative Extension Specialist in the Department of Agriculture and Resource Economics at the University of California, Berkeley and a member of the Giannini Foundation; her e-mail address is zwane{at}are.berkeley.edu
Michael Kremer is Gates Professor of Developing Societies in the Department of Economics at Harvard University and fellow at the National Bureau of Economic Research; his e-mail address is mkremer{at}fas.harvard.edu

JEL codes: Q56, Q52, O22

The Millennium Development Goals call for reducing by half the proportion of people without sustainable access to safe drinking water. This goal was adopted in large part because clean water was seen as critical to fighting diarrheal disease, which kills 2 million children annually. There is compelling evidence that provision of piped water and sanitation can substantially reduce child mortality. However, in dispersed rural settlements, providing complete piped water and sanitation infrastructure to households is expensive. Many poor countries have therefore focused instead on providing community-level water infrastructure, such as wells. Various traditional child health interventions have been shown to 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 households to take up these behavior changes. In contrast, there is little evidence that providing community-level rural water infrastructure substantially reduces diarrheal disease or that this infrastructure can be effectively maintained. Investments in communal water infrastructure short of piped water may serve other needs, and may reduce diarrhea in particular circumstances, but the case for prioritizing communal infrastructure provision needs to be made rather than assumed.


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