Publication: An Assessment of Water, Sanitation and Hygiene Access in Bangladesh's Community Health Clinics
Loading...
Files in English
521 downloads
Published
2019-06
ISSN
Date
2019-07-01
Author(s)
Editor(s)
Abstract
Adequate water, sanitation and hygiene (WASH) in health care facilities plays a critical role in ensuring improved health care utilization and reducing disease burden due to reinfection. WASH in health facilities is now gaining momentum with the new SDG targets that governments have vowed to meet. This goal calls for a baseline examination of existing WASH conditions in health facilities. Using data collected through a census of all community health clinics in Bangladesh, this paper presents an analysis of the state of WASH in Bangladesh's rural, public health facilities highlighting that the lack of functionality of WASH facilities is a widespread problem across the country. The paper also identifies priority areas for action when considering the prevalence of poverty and chronic undernutrition at the upazilla level.
Link to Data Set
Citation
“Alam, Bushra Binte; Joseph, George; Shrestha, Anne; Islam, Khairul; Lahiri, Santanu; Ayling, Sophie. 2019. An Assessment of Water, Sanitation and Hygiene Access in Bangladesh's Community Health Clinics. Policy Research Working Paper;No. 8924. © World Bank. http://hdl.handle.net/10986/31996 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Publication Climate and Social Sustainability in Fragility, Conflict, and Violence Contexts(Washington, DC: World Bank, 2026-01-07)Climate change is widely recognized as a driver of violent conflict, but its broader social effects remain less understood. Ignoring these dimensions risks a vicious cycle where climate policies might undermine socially just adaptation. Evidence is still limited on how climate shocks influence political participation, trust, or migration. This paper helps fill that gap by examining links between climate change, conflict, and social sustainability, with a focus on inclusion, resilience, cohesion, and legitimacy. Using secondary data from 2019–24, the study applies simple correlation-based methods to test three hypotheses on the nature, severity, and composition of these associations. The analysis combines multiple climate impact measures, new conflict classifications, recent social sustainability frameworks, and controls for population and geography. The results reveal strong correlations—not causation—between climate events and contexts of fragility, conflict, and violence. Climate impacts are most pronounced in both national and subnational conflict settings. The study also finds robust links between fragility, conflict, and violence and low levels of social sustainability, reflecting its role as both a driver and consequence of conflict. Some dimensions—such as violent events and insecurity—appear weaker in areas most affected by climate shocks. Two of the hypotheses are supported, and one remains inconclusive.Publication The Macroeconomic Implications of Climate Change Impacts and Adaptation Options(Washington, DC: World Bank, 2025-05-29)Estimating the macroeconomic implications of climate change impacts and adaptation options is a topic of intense research. This paper presents a framework in the World Bank's macrostructural model to assess climate-related damages. This approach has been used in many Country Climate and Development Reports, a World Bank diagnostic that identifies priorities to ensure continued development in spite of climate change and climate policy objectives. The methodology captures a set of impact channels through which climate change affects the economy by (1) connecting a set of biophysical models to the macroeconomic model and (2) exploring a set of development and climate scenarios. The paper summarizes the results for five countries, highlighting the sources and magnitudes of their vulnerability --- with estimated gross domestic product losses in 2050 exceeding 10 percent of gross domestic product in some countries and scenarios, although only a small set of impact channels is included. The paper also presents estimates of the macroeconomic gains from sector-level adaptation interventions, considering their upfront costs and avoided climate impacts and finding significant net gross domestic product gains from adaptation opportunities identified in the Country Climate and Development Reports. Finally, the paper discusses the limits of current modeling approaches, and their complementarity with empirical approaches based on historical data series. The integrated modeling approach proposed in this paper can inform policymakers as they make proactive decisions on climate change adaptation and resilience.Publication Institutional Capacity for Policy Implementation: An Analytical Framework(Washington, DC: World Bank, 2026-01-07)State capacity is an important prerequisite for policy implementation, yet at the country level it is difficult to measure, assess, and reform. This paper proposes a focus on institutional capacity: the ability of public institutions to implement the specific policy mandates for which they are responsible. Based on a review of existing literature, the paper defines the different dimensions that compose institutional capacity and groups them into two cross-cutting categories: organizational dimensions (personnel, financial resources, information systems, and management practices) and governance dimensions (transparency, independence, and accountability). The paper proposes measures for organizational and governance dimensions using existing data, shows intra-institutional variation of these measures within countries, and discusses how new data could be collected for better measurement of these concepts. Finally, the paper illustrates how the framework can be used to diagnose the sources of common problems related to weak policy implementation.Publication South Africa’s Fragmented Cities: The Unequal Burden of Labor Market Frictions(Washington, DC: World Bank, 2026-01-08)Using high-resolution administrative, census, and satellite data, this paper shows that South African cities are characterized by spatial mismatches between where people live and where jobs are located, relative to 20 global peers. Areas within 5 kilometers of commercial centers have 9,300 fewer residents per square kilometer than expected, which is 60 percent below the global median. Poor, dense neighborhoods are most affected. In Johannesburg, a 10-percentile increase in distance from the nearest business hub corresponds to a 3.7-percentile drop in asset wealth (a proxy of household wellbeing) and 4.9-percentile drop in employment. In Cape Town, the declines are 4.0 and 3.7 percentiles, respectively. Employment is 87 percent lower in the poorest decile than the richest in Johannesburg and 61 percent lower in Cape Town. These findings suggest that South Africa’s spatial organization of people and economic activity constrains agglomeration and reinforces inequality. This methodology provides a scalable and standardized data-driven framework to analyze spatial accessibility and agglomeration frictions in complex, data-constrained urban systems.Publication Investment in Emerging and Developing Economies(Washington, DC: World Bank, 2026-01-07)The world faces a pressing challenge to meet key development objectives amid slowing growth and rising macroeconomic and geopolitical risks. With the number of job seekers rising rapidly, infrastructure shortfalls continuing to be large, and climate costs mounting, the case for a significant investment push has never been stronger. Yet the capacity to respond in many emerging markets and developing economies has eroded. Since the global financial crisis, investment growth has slowed to about half its pace in the 2000s, with both public and private investment weakening. Foreign direct investment inflows—a critical source of capital, technology, and managerial know-how—have also fallen sharply and become increasingly concentrated, leaving low-income countries with only a marginal share. The risks of further retrenchment are significant, as trade tensions, policy uncertainty, and elevated debt levels continue to weigh on investment. Reigniting momentum will require ambitious domestic reforms to strengthen institutions, rebuild macro-fiscal stability, and deepen trade and investment integration—the foundations of a supportive business climate. At the same time, international cooperation is indispensable. A renewed commitment to a predictable system of cross-border trade and investment flows, combined with scaled-up financial support and sustained technical assistance, is essential to help emerging markets and developing economies—especially low-income countries and economies in fragile and conflict situations—bridge financing gaps and implement the domestic reforms needed to restore investment as an engine of growth, jobs, and development.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Economic Impacts of Inadequate Sanitation in Bangladesh(World Bank, Washington, DC, 2012-01)This study estimates the nonmonetary, financial, and economic costs of poor sanitation in the areas of health, drinking water, and domestic water, as well as user preference and welfare. Financial costs refer to the direct financial expense paid in monetary terms by someone, such as changes in household and government spending and real income losses for households. Nonmonetary costs consist of both longer-term financial impacts (such as less educated children, fewer children, and loss of working people due to premature death or relevant morbidity), and nonfinancial implications, such as the value of loss of life, time-use of adults and children, and intangible impacts. Bangladesh has made inadequate progress toward the sanitation-related millennium development goal (MDG) target. The country's financial commitment and political priority for sanitation also has shown inadequate progress (Water-Aid, 2008). Therefore, to mitigate the adverse effects of poor sanitation and hygiene practices, intervention is necessary. The aim of this study is to provide concrete evidence of the impact poor sanitation has on the population and the environment and, consequently, on the economy. This study provides estimates of the current and long-term effects of poor sanitation, which cover not only the negative impacts of poor sanitation but also the potential gains that different sanitation interventions could achieve. Policy makers and water and sanitation advocacy organizations are the target audience of this study.Publication Water, Sanitation and Children’s Health : Evidence from 172 DHS Surveys(2010-04-01)This paper combines 172 Demography and Health Survey data sets from 70 countries to estimate the effect of water and sanitation on child mortality and morbidity. The results show a robust association between access to water and sanitation technologies and both child morbidity and child mortality. The point estimates imply, depending on the technology level and the sub-region chosen, that water and sanitation infrastructure lowers the odds of children to suffering from diarrhea by 7-17 percent, and reduces the mortality risk for children under the age of five by about 5-20 percent. The effects seem largest for modern sanitation technologies and least significant for basic water supply. The authors also find evidence for the Mills-Reincke Multiplier for both water and sanitation access as well as positive health externalities for sanitation investments. The overall magnitude of the estimated effects appears smaller than coefficients reported in meta-studies based on randomized field trials, suggesting limits to the scalability and sustainability of the health benefits associated with water and sanitation interventions.Publication Geo-Spatial Modeling of Access to Water and Sanitation in Nigeria(World Bank, Washington, DC, 2018-02)The paper presents the development and implementation of a geo-spatial model for mapping populations' access to specified types of water and sanitation services in Nigeria. The analysis uses geo-located, population-representative data from the National Water and Sanitation Survey 2015, along with relevant geo-spatial covariates. The model generates predictions for levels of access to seven indicators of water and sanitation services across Nigeria at a resolution of 1×1 square kilometers. The predictions promise to hone the targeting of policies meant to improve access to basic services in various regions of the country.Publication Papua New Guinea : Sanitation, Water Supply and Hygiene in Urban Informal Settlements(Washington, DC, 2014-10)In 2012 Papua New Guinea undertook a national Service Delivery Assessment of rural water, rural sanitation, urban water and urban sanitation services to identify coverage and targets, how well services are being delivered and the financing shortfalls in these subsectors. Immediately following this assessment, stakeholders, through a national policy task force, have developed a draft of the country s first National Water, Sanitation and Hygiene (WASH) Policy. During the course of the assessment and policy development, peri-urban and informal settlements have been consistently identified as areas which are underserviced and overlooked for water and sanitation services. The need to provide affordable and appropriate services in settlements, as well as improve health and living conditions, was highlighted. Amongst stakeholders, it was agreed that baseline information on WASH conditions in settlements was needed in order to develop strategies and to respond appropriately to needs of settlements in the future. Previous settlement research has focused on urbanization, housing ownership, land issues, employment, and anthropology, but WASH has not been researched specifically or in depth. Therefore in 2014, the Water and Sanitation Program of the World Bank (WSP), together with key stakeholders, conducted research in informal settlements in the capital Port Moresby and a representative provincial town (Wewak) to understand the conditions, aspirations, barriers and opportunities to improve water, sanitation and hygiene for informal settlers.Publication Water, Sanitation, and Hygiene(Washington, DC, 2003-11)Better hygiene and access to drinking water and sanitation will accelerate progress toward two millennium development goals (MDGs): 'reduce under-five child mortality rate by 2/3 between 1990 and 2015' and "by 2015 halve the proportion of people without sustainable access to safe drinking water and basic sanitation". Meeting the latter goal will require infrastructure investments of about US$23 billion per year, to improve water services for 1.5 billion more people (292,000 people per day) and access to safe sanitation for 2.2 billion additional people (397,000 per day). Water supply, sanitation, and hygiene are about more than health. Saved time, particularly for women and children, is a major benefit. Beneficiaries of water and sanitation projects in India reported these benefits: less tension/conflict in homes and communities; community unity, self-esteem, women's empowerment (less harassment) and improved school attendance (Water Aid 2001). Improved hygiene (hand washing) and sanitation (latrines) have more impact than drinking water quality on health outcomes, specifically reductions in diarrhea, parasitic infections, morbidity and mortality, and increases in child growth (Esrey et al 1991; Hutley et al 1997). Most endemic diarrhea is not water-borne, but transmitted from person to person by poor hygiene practices, so an increase in the quantity of water has a greater health impact than improved water quality because it makes it possible (or at least more feasible) for people to adopt safe hygiene behaviors (Esrey et al 1996).
Users also downloaded
Showing related downloaded files
Publication Drivers and Obstacles to Banking SMEs : The Role of Competition and the Institutional Framework(Washington, DC: World Bank, 2008-12)This paper studies the factors banks perceive as drivers and obstacles to financing small and medium enterprises (SMEs), focusing on the role of competition and the institutional framework. Using a survey of banks in Argentina and Chile, the paper shows that, despite alleged differences in the countries' environments regarding rules, regulations, and ease of doing business, SMEs have become a strategic segment for most banks in both countries. In particular, banks have begun to target SMEs due to the significant competition in the corporate and retail sectors. They perceive the SMEs market as highly profitable, large, and with good prospects. Moreover, banks are developing coping mechanisms to overcome the particular institutional obstacles present in each country and to compete for SMEs. Banks' interest in SMEs is not based on government programs, yet policy action might help reduce the cost of providing financing, especially long-term lending.Publication Military Expenditure : Threats, Aid, and Arms Races(World Bank, Washington, DC, 2002-11)Using global data for the period 1960-99, the authors estimate neighborhood arms races. They find that the level of military expenditure is strongly influenced by the expenditure of neighbors. The authors estimate an "arms race multiplier," finding that an initial exogenous increase in military expenditure by one country is more than doubled in both the originating country and its neighbor. An implication is that military expenditure is, to an extent, a "regional public bad." Potentially, there is an offsetting public good effect if rebellions are deterred by military expenditure. However, instrumenting for military expenditure, the authors find no deterrence effect of military spending on the risk of internal conflict. So there appears to be no regional public good effect offsetting the public bad arising from a neighborhood arms race.Publication Taxes, Spending, and Equity: International Patterns and Lessons for Developing Countries(Washington, DC: World Bank, 2025-11-17)Taxes and public spending underpin the basic administration of government and finance the human capital and infrastructure investments needed for economic growth. They can also have a significant and immediate impact on poverty and inequality. The question of how public finance can support longer-term growth objectives while promoting equity has become even more important in recent years, given the high fiscal deficits and debt levels most countries emerged with in the aftermath of the COVID-19 pandemic. These included the increasing cost of debt and the need to restart environmentally sustainable growth while helping households address the learning losses and other social scars caused by the pandemic. This paper examines the global evidence on which households pay which taxes and who benefits from what spending, and critically, the net effect on different households across the income distribution. The aim is to identify the patterns and lessons that emerge for designing progressive fiscal policies. A global dataset of 96 countries is assembled, spanning all regions of the world and all national income levels, grounded in the Commitment to Equity (CEQ) approach to fiscal incidence.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Direct and Indirect Impacts of Transport Mobility on Access to Jobs: Evidence from South Africa(Washington, DC: World Bank, 2025-11-12)Access to jobs is essential for economic growth. In Africa, unemployment rates are notably high. This paper reexamines the relationship between transport mobility and labor market outcomes, with a particular focus on the direct and indirect effects of transport connectivity. As predicted by theory, wages are influenced by the level of commuting deterrence. Generally, higher earnings are associated with longer commute times and/or higher commuting costs. Local accessibility is also important, especially for individuals with time constraints. Both direct and indirect impacts are found to be significant in South Africa, where job accessibility has been challenging since the end of apartheid. For the direct impact, the wage elasticity associated with commuting costs is significant. Returns on commute are particularly high for women. Local accessibility to socioeconomic facilities, such as shops and health services, is also found to have a significant impact, consistent with the concept of mobility of care. To enhance employment, therefore, it is crucial to connect people not only to job locations but also to various socioeconomic points of interest, such as markets and hospitals, in an integrated manner. This integration will enable individuals to spend more time working and commuting longer distances.