WATER AND SANITATION PROGRAM: TECHNICAL PAPER 72418 Economic Assessment of Sanitation Interventions in the Philippines A six-country study conducted in Cambodia, China, Indonesia, Lao PDR, the Philippines and Vietnam under the Economics of Sanitation Initiative (ESI) November 2011 The Water and Sanitation Program is a multi-donor partnership administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. THE WORLD BANK Water and Sanitation Program East Asia & the Pacific Regional Office Indonesia Stock Exchange Building Tower II, 13th Fl. Jl. Jend. Sudirman Kav. 52-53 Jakarta 12190 Indonesia Tel: (62-21) 5299 3003 Fax: (62 21) 5299 3004 Water and Sanitation Program (WSP) reports are published to communicate the results of WSP’s work to the development community. Some sources cited may be informal documents that are not readily available. 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Economic Assessment of Sanitation Interventions in the Philippines A six-country study conducted in Cambodia, China, Indonesia, Lao PDR, the Philippines and Vietnam under the Economics of Sanitation Initiative (ESI) Economic Assessment of Sanitation Interventions in the Philippines Executive Summary A. Introduction The Philippines is well on its way to achieving the sanita- (ESI) showed that the economic costs of poor sanitation in tion target, which is part of a combined drinking water and the Philippines amount to PhP77.8 billion or US$1.4 bil- sanitation target within the Millennium Development Goal lion at 2005 prices (Rodriguez et al. 2008). About 71% of (MDG) 7. As of 2008, about 76% of its population had these costs are accounted for by health-related losses. access to improved sanitation facilities (JMP 2010). This is nearly 18 percentage points higher than the estimates for B. Study Aims and Methods 1990 and 3 percentage points short of the MDG target for This study aims to generate evidence on the costs and ben- sanitation. efits of sanitation improvements in different contexts in the Philippines. Conducted with a view towards identifying the Despite its progress, there are still a number of concerns most economically efficient options under different condi- regarding the overall state of sanitation in the country. First, tions, it aims to contribute to the decision making processes the Joint Monitoring Programme (JMP) estimates suggest of government, donor agencies, non-governmental organi- that close to 7 million people in the country still practice zations (NGOs) and other institutions. open defecation. Another 15 million people do not have ac- cess to improved sanitation facilities. Second, while differ- The study quantified the costs and benefits associated with ences have narrowed over time, there continues to be a wide various sanitation options in different study sites. The ben- divide in access to improved sanitation across the regions. efits included the impacts on health, water sources and Households in rural areas continue to have lower access to treatment, access time, and the reuse of human excreta. The improved sanitation compared to those living in urban ar- costs included capital or investment costs and the recur- eas. Households in the island of Mindanao also have sig- rent costs associated with various sanitation options. The nificantly lower access to sanitation compared to those liv- costs and benefits of the sanitation options were synthesized ing in other parts of the country. This is most noticeable in using standard indicators of economic efficiency. These in- the Autonomous Region of Muslim Mindanao (ARMM), dicators included the benefit-cost ratio, cost-effectiveness where access to improved sanitation in 2006 was below the ratio, net present value, internal rate of the return, and pay- national average in 1990. Third, there is an urgent need for back period of sanitation options. Cost-effectiveness ratios improvement in the management of human excreta, even — cost per disability life year averted, cost per disease case for households that have access to improved sanitation fa- averted, cost per death averted — were also calculated. cilities. The Water and Sanitation Program’s (WSP) project Sustainable Sanitation for East Asia (SuSEA 2008) report- C. Data Sources and Study Sites ed that the design of most septic tanks does not conform The study used primary and secondary sources of data in to the standards prescribed by the Department of Health the analysis. Primary data were obtained from surveys in six (DOH). Septic tank management, especially desludging, sites that have recently been the focus of intensified sanita- also requires improvement. This study revealed that about tion improvement efforts — Alabel, Bayawan, Dagupan, half of the respondents with their own septic tanks have not San Fernando (coastal and upland regions) and Taguig. emptied their facilities in the past five years, if ever. Finally, The instruments for the primary data collection included the costs of poor sanitation remain high. The previous study focus group discussions (FGD) and surveys on households, conducted under WSP’s Economics of Sanitation Initiative markets, physical locations and health institutions. A tour- www.wsp.org iii Economic Assessment of Sanitation Interventions in the Philippines | Executive Summary ist survey of departing visitors was conducted at the Ninoy tanks� had the most favorable indicators for urban areas. Aquino International Airport. A survey of businesses in Toilets with access to wastewater facilities and shared toi- Metro Manila and Southern Luzon was also implemented. lets had the least favorable indicators for rural areas. Urine Secondary evidence was sourced from international and Diversion-Dehydration Toilet (EcoSan), or UDDT-E, had local published literature, project and government docu- the lowest benefit-cost ratios in urban areas. ments and surveys, and data from various institutions. The opinions of experts in the local sanitation sector were also The high benefit-cost ratio for wet and dry pit latrines in ru- solicited to validate and fill in knowledge gaps from pri- ral sites is due to their relatively low investment and recur- mary or secondary sources. rent costs. The most favorable benefit-cost ratios in urban areas are for wet pit latrines and toilets with access to septic Table A shows the sanitation interventions that were exam- tanks (not desludged). In the case of wet pit latrines, the ined in each of the study sites. In the analysis, the benefits reason for the favorable estimate is its low investment costs. from the interventions were compared against a baseline of On the other hand, the relatively high benefit-cost ratios for open defecation, as well as comparing different rungs on toilets that flush to septic tanks are due to the high benefits. the sanitation “ladder.� In particular, the values are largely affected by the estimates for Taguig, where incomes are higher than the other study D. Main Economic Analysis Results sites. Such large incomes tend to raise the gains from avert- The key finding of the study is that there are net benefits ed opportunity costs associated with improved health and associated with all of the interventions evaluated. The reduced travel time. The estimates from the introduction benefit-cost ratios were greater than one for all interven- of wastewater and sludge treatment to toilets that flush to tions (Figure A), suggesting that the monetized gains ex- septic tanks should be interpreted with care. The main rea- ceed every peso that is spent for the intervention. In rural son is that the benefits associated with treatment, especially areas, the most favorable results were found for wet and dry its implications for the environment and reuse, were not pit latrines. On the other hand, “toilets that flush to septic quantified in the study. The potential links of an improved TABLE A: SANITATION OPTIONS COMPARED IN THE STUDY SITES San Fernando San Fernando Alabel Bayawan Dagupan Taguig Coastal Upland Rural Rural Urban Urban Rural Urban Open defecation • • • • • • Community/public toilets • • Shared toilets • • Private dry latrines: simple dry pits • Private dry latrines: urine diversion - dehydration toilets (EcoSan) or UDDT-E • • Private wet latrines (improved) • • • Septic tank: Not-watertight and/or dumping of sludge and/or effluent flow directly to • • • waterway/body Septic tank: Improved, with sludge removal and septage treatment facility • • Septic tank: Improved, with sludge removal and constructed wetland • Sewage/Sewerage: Decentralized conventional treatment • iv Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Executive Summary FIGURE A: BENEFIT-COST RATIOS IN THE RURAL AND URBAN SITES, IDEAL SETTING1 community toilets 2.9 1.7 shared toilets 2.3 5.0 dry pit latrines 7.9 wet pit latrines 4.5 2.0 UDDT-E 1.5 septic tanks, 2.7 not desluged 5.6 septic tanks, desluged 2.3 and treated at STF 4.3 septic tanks, waste water 1.6 treated at constructed wetland sewers 4.3 Rural Urban 0 1 2 3 4 5 6 7 8 Note: STF = septage treatment facility; UDDT-E = urine-diversion dehydration toilet (EcoSan) 1 Dry pit latrines and toilets with access to wastewater treatment at a constructed wetland were not examined for urban sites. Community toilets, wet pit latrines and toilets with access to sewers were not examined for rural sites. environment to business costs and tourism could also raise every peso that is invested in such facilities. This result is es- the benefit-cost ratios for such facilities. pecially important in situations where funds for sanitation improvements are scarce. Third, the cost effectiveness ratios The study also estimated cost-effectiveness indicators which of toilets in urban areas that are subject to off-site treatment are mainly focused on the health impacts of the sanitation are lower than toilets with access to septic tanks which are options. Figure B summarizes the key results using the costs not desludged. This finding strengthens the case for off-site for each disability life year (DALY) averted from each op- treatment in urban areas. Fourth, the results reinforce the tion. It indicates that the lowest costs per health unit gained widely held belief that the viability of a sanitation option were found for dry pit latrines and wet pit latrines in ru- is sensitive to site-specific conditions. This is partially sup- ral and urban areas, respectively. It also shows that costs ported by the differences in the efficiency indicators across per DALY averted are lower for toilets with access to septic rural and urban areas. The differences are even more pro- tanks compared to UDDT-E facilities. In the case of urban nounced in the study sites. For example, the benefit-cost households, cost per DALY falls further, relative to toilets ratio for septic tanks in Alabel is 2.8 versus 5.6 in Taguig. with access to septic tanks that are not desludged, with the The difference can also be partially accounted for by the introduction of off-site treatment facilities. higher income level of Taguig residents which tends to raise the opportunity costs from poor sanitation. The implications of the results above are as follows: First, it pays to invest in sanitation improvements. All interventions The results presented above were conducted under ideal set- for all the sites had gains that exceed investment and recur- tings; i.e., these do not account for actual conditions and rent costs. Second, low-cost sanitation options, i.e., wet and practices in the study sites. Accounting for these factors dry pit latrines, deliver relatively high economic benefits for led to efficiency indicators that were slightly less favorable www.wsp.org v Economic Assessment of Sanitation Interventions in the Philippines | Executive Summary FIGURE B: COST PER DISABILITY LIFE YEAR AVERTED IN RURAL AND URBAN SITES, IDEAL SETTING, 000 PESOS1 community toilets 131 264 shared toilets 115 112 dry pit latrines 133 wet pit latrines 124 372 UDDT-E 459 septic tanks, 227 not desluged 442 septic tanks, desluged 325 and treated at STF 401 septic tanks, waste water 344 treated at constructed wetland sewers 435 Rural Urban 0 100 200 300 400 500 1 See notes to Figure A. than those presented earlier (Figure C). The result is based ties and toilets that flush to septic tanks were evaluated (i.e., on findings in sites that (a) not all household members use in the same location). This compromises the comparability improved toilets regularly, (b) not all toilet facilities fully of the results between the two sets of interventions because isolate water from human excreta, (c) not all households re- of inter-site variations. Second, the quantitative analysis did cycle human waste, (d) not all households with improved not include a number of benefits associated with improved facilities are connected to a treatment facility and (e) house- sanitation. These include the impacts on the environment, holds continue to practice boiling water despite having tourism, business, and intangible aspects (comfort, prestige, access to improved sanitation (suggests that water in the privacy, convenience and safety). While these impacts were community is still perceived to be unsafe despite the sanita- analyzed qualitatively, their potential impacts on the quan- tion intervention). With its benefit-cost ratio under actual titative estimates should not be ignored. The reasons are as settings being less than half of its value under ideal settings, follows: First, the importance of privacy, convenience and the most noticeable decline was for septic tanks that are safety are likely to raise the benefits of toilets that are located desludged at septage treatment facilities (STFs). This is due within or very near the house. Hence, it is likely to raise the to the under-utilization of the STF in Alabel, where the benefit-cost ratios of toilets that have access to septic tanks benefit-cost ratio under actual conditions was found to be relative to dry pits, wet pits, shared toilets and community less than one. toilets. Similarly, the ability to quantify the benefits associ- ated with comfort and prestige are likely to raise the net It is important to note some limitations of the analysis. gains associated with toilets that flush to septic tanks. Third, First, there is no single site in which both UDDT-E facili- the benefit-cost ratios associated with toilets that have ac- vi Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Executive Summary FIGURE C: BENEFIT-COST RATIOS UNDER IDEAL AND ACTUAL SETTINGS, BY INTERVENTION1 1.7 community toilets 2.9 1.4 shared toilets 2.0 4.7 dry pits 5.0 4.2 wet pits 6.2 1.5 UDDT-E 1.8 septic tanks, 3.4 not desluged 4.1 septic tanks, 1.8 treated at STF 3.3 septic tanks, 1.5 with waste water treatment 1.6 3.6 sewers 4.3 0 1 2 3 4 5 6 7 Actual Setting Ideal Setting 1 Represents simple averages for the sites. cess to wastewater and treatment facilities are likely to be nualized for comparability across interventions and with higher if their environmental benefits are fully accounted recurrent cost, represent the expenses for constructing and for in the analysis. Such estimates are also likely to become installing the facilities. For toilets that have access to treat- more favorable if the cleaner environments translate to ment facilities (wastewater treatment, STF, and sewers), the higher tourism revenues and lower business costs. costs combine the expenses incurred for the toilet and the treatment facilities. E. Disaggregated Results The succeeding paragraphs discuss the other results of the Figure D shows the estimated annual costs per household study. Sub-sections E1 to E5 summarize the key inputs to of various sanitation options, with both investment and re- the cost-benefit analysis. Sub-sections E6 to E9 present the current costs included. It indicates a wide divergence in the results from the qualitative analysis. costs between the various options, ranging from PhP1,011 (US$23) for dry pits in rural areas to PhP6,769 (US$152) E1. COSTS OF INTERVENTIONS for toilets with access to sewers in urban areas.1 There are Data on investment and recurrent costs per household were also differences in costs in the rural and urban sites for simi- compiled and estimated for each intervention. Recurrent lar types of interventions. For example, the costs of UDDT- costs are annual expenditures for the operation and main- E facilities in rural areas were found to be lower than their tenance of the facilities. Investment costs, which were an- counterparts in urban areas. Cost differences for a particular 1 Unless otherwise noted, all peso values are converted to US$ using 2008 average exchange rate of US$1= PhP44.48. www.wsp.org vii Economic Assessment of Sanitation Interventions in the Philippines | Executive Summary FIGURE D: ANNUAL ECONOMIC COST PER HOUSEHOLD OF SANITATION OPTIONS, PESOS (2008)1 community toilets 1,931 2,328 shared toilets 2,263 1,011 dry pits 1,259 wet pits 1,355 3,835 UDDT-E 4,113 septic tanks, 3,496 not desluged 4,761 septic tanks, 5,426 treated at STF 6,646 septic tanks, 5,607 with waste water treatment sewers 6,769 Rural Urban 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 1 See notes in Figure A. technology are accounted for by variations in the materials where local government units partly or wholly financed the used for construction and prices across the sites. Annualized construction of the toilet facilities. For some of the UDDT- investment costs accounted for a larger proportion of the E facilities in San Fernando (Fishermen’s village) and the total costs in all interventions. Its contribution to total costs Gawad Kalinga village, the toilets were part of a housing is as follows: community toilets (59%), shared toilets (73% project which will eventually be paid by the households in urban sites and 68% in rural sites), dry pits (93%), wet through monthly amortizations for the houses. Govern- pits (67% in urban sites and 75% in rural sites), UDDT-E ment and the private sector had a major role in financing (80% in urban sites and 78% in rural sites), toilets with ac- the construction of all treatment facilities. Such was the cess to septic tanks that are not desludged (78% in urban case for the STFs in Alabel (government) and Taguig (Ma- sites and 77% in rural sites), toilets where septic tanks are nila Water), the constructed wetland in Bayawan (govern- desludged at STFs (79% in urban sites and 66% in rural ment), and the sewers in Taguig (Manila Water). However, sites), toilets with access to a constructed wetland (71%) households are eventually expected to pay for most of these and toilets with access to sewers (81%). facilities through various user fees. With a few notable exceptions, households generally fi- E2. HEALTH BENEFITS nanced the construction of toilet facilities themselves. Ex- Health benefits are based on the averted costs of diseases ceptions include the construction of the community toi- associated with poor sanitation. The diseases included in lets in Dagupan, UDDT-E facilities in San Fernando, and the study were diarrhea, helminthes, and malnutrition-re- private toilets in the Gawad Kalinga Village in Bayawan, lated diseases like malaria, acute lower respiratory infection viii Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Executive Summary FIGURE E: ANNUAL HEALTH COSTS PER HOUSEHOLD IN (ALRI), and measles. Using information from the interna- RURAL AND URBAN SITES, PESOS tional literature and survey sites, the study estimated the 5,773 costs in terms of health care (treatment and medication), productivity (lost productive time for sick persons and 6,000 5,094 their carers) and premature death (valued using the human capital approach). As a whole, annual health-related costs 5,000 were estimated to be in excess of PhP5,000 (US$112) per baseline costs per household household in the rural and urban sites (Figure E). Despite higher estimated mortality in the rural sites, total health- 4,000 related costs per household were higher in the urban sites. 2,985 This is caused by higher productivity losses which are in 3,000 2,845 turn explained by higher incomes in urban sites. Most of 1,819 the health-related costs were attributed to diarrheal disease because of its relatively high incidence rate. Children under 2,000 1,261 968 the age of five years also had the highest costs among the 988 different age groups since they are most vulnerable to diar- 1,000 rheal diseases. In the rural sites, for example, about 73% of the health costs per household were due to diarrhea among Premature Total death children under the age of five years. 0 Healthcare Productivity Rural Urban Averted health costs in the study depended on the sanita- tion option that was available to the household before and that purchased bottled water cited safety as the reason for after the intervention. For rural households that initially their choice of the water source. However, water treatment practiced open defecation, the projected gain from an in- did not appear to be a common practice in the sites. Only tervention that provides access to basic improved sanitation about one in five respondents said that they treated drink- facilities was slightly more than PhP2,000 (US$45) per ing water. Of these, nearly three in four respondents used household, or about 40% of the costs. For urban house- boiling as a method for treating water. holds that already have access to basic improved sanitation, the provision of access to treatment facilities was estimated Water benefits were calculated by assuming that house- to cause benefits that were approximately 20% of the base- holds will seek less expensive water sources (both financial line health costs. and hauling), practice water treatment less, or use cheaper methods for water treatment. However, given the findings E3. WATER BENEFITS stated in the previous paragraph, the estimated changes Water benefits were based on the premise that poor sanita- were not large. The result was a projected annual savings tion contributes to water pollution. Pollution in turn alters per household of PhP279 (US$6) for more convenient wa- the behavior of households by forcing them to obtain water ter sources that can be used for drinking water, and PhP65 from expensive sources or distant sources and practice water (US$1.5) for fewer requirements for water treatment. treatment. The costs of obtaining drinking water go beyond financial costs (e.g., the price paid for bottled water); it also E4. ACCESS TIME SAVINGS includes hauling costs associated with traveling to farther Households that practice open defecation or only have ac- places for water. The household survey provided some sup- cess to community and shared toilets incur costs not ex- port to the asserted link between pollution and household perienced by those who have access to private toilets. The behavior. The results show that about 38% of the house- sources of these costs are time spent traveling to a place for holds in urban sites used piped water sources because of defecation or waiting in a queue before using the toilet in its quality. Another 17% of the respondents mentioned the case of those who use community and shared toilets. safety. On the other hand, about 66% of the households Such costs are also incurred by people who accompany chil- www.wsp.org ix Economic Assessment of Sanitation Interventions in the Philippines | Executive Summary dren to a place of defecation. The survey confirmed that collected waste is used as fertilizer for a botanical garden or households in the sites recognize the value of the time that is the green zone of a landfill site. lost from accessing toilets. Almost all the respondents who do not have access to private latrines said that proximity E6. INTANGIBLE BENEFITS OF SANITATION is an important characteristic of toilets (94%). An equally OPTIONS large proportion of households who already have access to Intangibles are determinants of personal welfare such as private toilets also claimed satisfaction with the proximity comfort, privacy, convenience, safety, status and prestige. of their current facilities. Some of the key findings on the intangible aspects of sanita- tion are as follows: First, the FGDs found that the respon- The amount of time that is lost in accessing toilets was dents have a common desire for cleaner surroundings. The found to be significant. From the household survey, about respondents also said that the absence of toilets contributed 20 days per year are lost for the average household. This to the practice of open defecation in their areas. Second, the translated to annual costs of about PhP1,700 (US$38) per respondents felt a sense of shame associated with open def- household in the rural and urban sites. While the estimated ecation. Several respondents said they covered their faces, losses from rural and urban sites are very close to each other, either with their hands or a piece of cloth, to avoid being the sources of these costs are quite different. Annual time recognized by their neighbors whenever they defecate in the losses in rural areas (32 days/household) were found to be open. In contrast, households with private toilets reported a three times as much as in urban areas. However, incomes, feeling of pride associated with owning such a facility. The and therefore opportunity costs, in urban areas are much source of this pride varies from one group to the next. Some higher than in rural areas. It is also important to note that said that owning a private toilet no longer required them the estimates are conservative as these only cover losses as- to ask permission from their neighbors in order to use the sociated with time spent accessing place of defecation, and toilets. For others, having a private toilet was viewed as an not urination. The extent to which omission understates improvement in their social status in the community. Those the true losses is difficult to determine because there are no who previously did not have toilets also expressed greater existing estimates of the time spent searching for a place to confidence in inviting guests to their homes now that they urinate. However, the findings from the FGD, where par- owned a private toilet. Third, about three out of four re- ticipants claimed urinating up to seven times a day, suggest spondents in the household survey said that their greatest that the additional losses could be significant. concern was the safety of their children. This is consistent with the finding in the FGD that respondents prefer a toilet E5. EXCRETA REUSE BENEFITS that is near the house. The study also found that the prefer- Benefits from reuse are based on the potential savings or ence for proximity was also based on its potential to save earnings from using human excreta and/or urine as inputs time and create a feeling of safety for women at night or for the production of fertilizer or energy (biogas). With when it is raining. While valuing the intangibles is difficult, an exclusive focus on fertilizer, the study found that only the household survey asked the respondents about their UDDT-E users in San Fernando reuse human waste. About willingness to pay for an improved toilet. The average value a third of these respondents reuse waste, with an average provided by the respondents was about PhP2,500 (US$56), household saving on fertilizer that is slightly more than an amount capable of purchasing or constructing a dry pit PhP500 (US$11) per year. There are three other points latrine, but much less than the value of their preferred sani- that are worth noting. First, the processed fertilizer was tation option. Most of the respondents (78%) expressed only meant for home use and was not sold in the market. preference for a toilet that is connected to a septic tank. Second, reuse was more prevalent in upland areas. In the upland region of San Fernando, 87% of the respondents E7. EXTERNAL ENVIRONMENT said they reuse human waste as fertilizer. This proportion is The external environment refers to the area outside of the about four times as much as those who lived in the coastal toilet itself and is not related to accessing toilets. It excludes areas. Third, in the coastal regions, the local government water pollution, which was covered in a separate compo- collects the human waste from the UDDT-E facilities. The nent of the study. One objective here is to get a sense of x Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Executive Summary how the respondents perceived the overall state of sanita- ten visitors said that they could not find a toilet at a time tion in their community. In this regard, the respondents of need. gave the impression that their respective environments were in need of improvement, based on an average rating of less A quarter of the survey respondents said they had gastro- than 3 out of a maximum 5 (very good) for various aspects intestinal problems during their stay. On average, affected of sanitation. The lowest ratings were given to smell from visitors were incapacitated for nearly three days but felt the sewage/defecation/waste (1.9), the presence of insects (2.1) symptoms for slightly more than four days. This is a cost and rodents around uncollected waste (2.0), and dust and to tourism. The amount that they could have spent during dirt in shops/markets/restaurants (2.1). those days of illness less the amount they spent for treat- ment (about US$18 per tourist) represents foregone earn- The survey found that households which have access to im- ings for the tourism industry. proved sanitation also contributed to the pollution of their local communities. Apart from the poor septic tank man- Despite incidence of illness, nearly nine in ten visitors ex- agement, the survey found that slightly more than a tenth pressed an intention to return to the country. Furthermore, of households with septic tanks still practiced open defeca- a significant proportion (82%) said that they will recom- tion. About a third of these households also urinate in the mend the country as a tourist destination to friends. open and close to one in five households do not properly dispose of the stools of their children. There were also in- E9. BUSINESS BENEFITS dications that the design and management of pit latrines Sanitation affects the business environment and costs of require improvement. Twenty four out of 30 respondents doing business, especially of those that are very sensitive admitted that their pit latrines overflowed “sometimes.� In to water quality. To get an impression of the perceptions addition, 18 out of 30 respondents said that their pits have of businessmen, a survey was conducted of owners/manag- experienced seepage or flooding. Many toilets also had in- ers of selected firms that are mostly located around Laguna sect problems. Lake. Most of the respondents confirmed that the avail- ability of clean water is important to their business. This is E8. TOURISM BENEFITS especially the case for resort owners, food processing indus- Decisions of tourists to visit or return to a country might tries, and fish pond/cage owners. On the other hand, own- be sensitive to sanitation conditions — e.g., quality of water ers of travel agencies said that sanitation as whole matters resources, quality of the environment, food safety, availabil- to their business because it affects the desired destinations ity of toilets in public places, and health risks, etc. While of their clients. such impacts were not directly quantified, the study con- ducted a survey of foreign visitors who were about to leave The respondents considered a pleasant environment, which the country. The focus of the exercise was to get impressions includes favorable sanitation conditions, as very important of how sanitation in the Philippines affected the perceptions to their business. This was supported by their concerns over of tourists and the overall quality of their stay in the coun- the poor quality of the rivers that flow into Laguna Lake. try. The results could be significant to the Philippines in About a third of the respondents also said that they would light of the importance of tourist revenues to the economy. expand their operations if sanitation conditions improved considerably. The survey found that visitors enjoyed their stay in the Phil- ippines as a whole. This was particularly the case for visits to It is important to note that the links between sanitation and beaches and forests or natural areas. However, the respon- tourism and sanitation and business are not mutually exclu- dents assessed that general sanitation conditions can still sive. For example, in 2009, a typhoid outbreak in Calamba, stand some improvement, especially for the capital (Metro Laguna hurt resort owners in the area who were heavily de- Manila). On the question of toilet availability, only one in pendent on domestic and foreign tourists.2 2 Laguna Lake is surrounded by Laguna (east, west and south), Rizal (north to northwest) and Metro Manila (northwest). Water in the lake comes from catchment areas and 21 major tributaries. Some of the 21 main tributaries are Pagsanjan river, Sta. Cruz river, Balanak river, Marikina river, and Mangangate river. www.wsp.org xi Economic Assessment of Sanitation Interventions in the Philippines | Executive Summary F. Recommendations The major finding of this study is that all interventions This study is an initial attempt to generate an economic evaluated have benefits that exceed costs, when compared evidence base in the Philippines and examine ways in which with no sanitation facility or open defecation. The high net evidence can be practically applied in sanitation decision benefits from low-cost sanitation options, such as wet pit making. A handful of projects and sites were selected for the latrines in urban areas and dry pit latrines in rural areas, analysis; hence it does not provide an exhaustive assessment also suggest that these technologies should not be ignored of the economics of sanitation in the Philippines. Several in any plans for sanitation improvements, especially in situ- data inputs were based on non-site-specific data, and there ations where funds are scarce. Net benefits from sanitation was limited quantitiative assessment and monetization of interventions also vary considerably from one site to the the benefits for some impacts. Therefore, further research is next. This suggests a careful consideration of site conditions needed on the potential impacts of poor sanitation and on before interventions are implemented. the efficiency of sanitation interventions. Future research needs to include the following: Based on the findings, the study recommends the follow- 1. Generating reliable site-specific and age-group-spe- ing: cific incidence and mortality rates for sanitation- 1. Intensify efforts to increase access to improved sani- related diseases such as diarrhea, helminthes, etc. tation. Because many people who do not have access Value of statistical life estimates associated with poor to improved sanitation are poor, such an initiative sanitation will also enhance estimates on the value of will also require the active participation of govern- averting premature death. ment, donor agencies, and other institutions. This 2. Establishing rigorous and site-specific quantitative is also essential for projects that require large initial links between sanitation and (a) disease incidence investments, such as off-site treatment systems and (attribution factors), (b) tourism, (c) water use and sewers. access, (d) water quality and (e) business activity. 2. Resource constraints are likely to require a clear 3. Generating more reliable estimates of the potential definition of priorities. While important, economic benefits from the reuse of human waste as fertilizer considerations measured in this study such as inter- and biogas. This includes households (UDDT-E) vention costs and efficiency are not the only criteria and the reuse of wastewater and sludge treated in for choosing technologies and program approaches. STFs. Intangible impacts, socio-cultural issues, availaibility 4. Establishing stronger evidence on the performance of suppliers, financing, and household willingness to of projects in actual settings. This also includes re- pay are all important when making the decision on cently introduced demand-driven programs in the which technology to choose and how to deliver or Philippines such as Community-Led Total Sanita- implement it. tion (CLTS), and the evaluation of various imple- 3. In providing access to improved sanitation, decision mentation and financial approaches. makers should be cognizant of initial conditions in 5. Further attempts are needed to quantify the intan- the project sites. The reason is that there is no single gible benefits (e.g., comfort, prestige, privacy, etc) type of intervention that is economically efficient in and environmental benefits of improved sanitation, all settings. Hence, understanding the conditions in and the importance of these benefits in household or project sites is likely to increase the chances of suc- community willingness to pay for sanitation. cess for the intervention. 4. Intensifying knowledge and information campaigns on personal hygiene, maintenance of sanitation fa- cilities and desludging of septic tanks are needed. This effort should not be limited to households, but must be expanded to capacity building in local gov- ernment units and sanitation suppliers. xii Economic Assessment of Sanitation Interventions Foreword In its recognition of sanitation as a key aspect of human Despite its recognized importance, sanitation continues to development, target 10 of the Millennium Development lose ground to other development targets when it comes Goal 7 includes access to safe sanitation: “to reduce by half to priority setting by governments, households, the private between 1990 and 2015 the proportion of people without sector and donors. This fact is hardly surprising given that access to improved sanitation.� This reflects the fact that sanitation remains a largely taboo subject, neither is it an access to improved sanitation is a basic need: at home as “attractive� subject for media or politicians to promote well as at the workplace or school, people appreciate and as a worthy cause. Furthermore, limited data exist on the value a clean, safe, private and convenient place to urinate tangible development benefits for decision makers to jus- and defecate. Good sanitation also contributes importantly tify making sanitation a priority in government or private to achieving other development goals such as child mortal- spending plans. ity reduction, school enrollment, nutritional status, gender equality, clean drinking water, environmental sustainability Based on this premise, the World Bank’s Water and Sanita- and quality of life of slum dwellers. tion Program (WSP) in East Asia and the Pacific region is leading the “Economics of Sanitation Initiative� (ESI) to compile existing evidence and to generate new evidence on socio-economic aspects of sanitation. The aim of ESI is to assist decision makers at different levels to make informed choices on sanitation policies and resource allocations. Phase 1 of the Economics of Sanitation Initiative in 2007- 08 conducted and published a “sanitation impact� study, which estimated the economic and social impacts of un- improved sanitation on the populations and economies of the Philippines and other countries of Southeast Asia. This study showed that the economic impacts of poor sanitation are US$1.4 billion per year for the Philippines, or US$16.8 per capita. This is equivalent to 1.5% of the annual GDP. These and other results were disseminated widely to nation- al policy makers, sector partners, and decentralized levels of the Philippines. The current volume reports the second major activity of ESI, which examines in greater depth the costs and ben- efits of specific sanitation interventions in a range of field settings in the Philippines. The purpose is to provide in- formation to decision makers on the impact of their deci- sions relating to sanitation — to understand the costs and www.wsp.org xiii Economic Assessment of Sanitation Interventions in the Philippines | Foreword benefits of improved sanitation in selected rural and urban locations, as well as to enable a better understanding of the overall national level impacts of improving sanitation cov- erage in the Philippines. On the cost side, decision makers and stakeholders need to understand more about the timing and size of costs (e.g., investment, operation, maintenance), as well as financial versus non-financial costs, in order to make the appropriate investment decision that increases in- tervention effectiveness and sustainability. On the benefit side, the monetary as well as non-monetary impacts need to be more fully understood in advocating for improved sanitation as well as making the optimal sanitation choice. For cost-benefit estimations, a sample of sites representing different contexts of the Philippines was selected to assess efficiency of sanitation interventions, and thus illustrate the range and sizes of sanitation costs and benefits. The research under this program is being conducted in Cambodia, China, Indonesia, Lao PDR, the Philippines, and Vietnam. Similar studies are also ongoing in selected South Asian, African and Latin American countries. While WSP has supported the development of this study, it is an “initiative� in the broadest sense, which includes the active contribution of many people and institutions (see Acknowledgments). xiv Economic Assessment of Sanitation Interventions Abbreviations and Acronyms ADB Asian Development Bank ALRI Acute Lower Respiratory Infection ARMM Autonomous Region of Muslim Mindanao AusAID Australian Agency for International Development BCR Benefit-cost ratio CAPS Center for Advanced Philippine Studies CBA Cost-benefit analysis CER Cost-effectiveness ratio CLTS Community-Led Total Sanitation DALY Disability-adjusted life-year DENR Department of Environment and Natural Resources DGIS Directorate General of International Cooperation DILG Department of the Interior and Local Government DOH Department of Health DPWH Department of Public Works and Highways EAP East Asia and the Pacific EcoGov Environmental Governance Project EcoSan Ecological sanitation ESI Economics of Sanitation Initiative FDI Foreign direct investment FGD Focus group discussion www.wsp.org xv Economic Assessment of Sanitation Interventions in the Philippines | Abbreviations and Acronyms FSSI Foundation for a Sustainable Society, Inc. GDP Gross domestic product GTZ Deutsche Gesellschaft für Technische Zusammenarbeit (German Agency for Technical Cooperation) HH Household IRR Internal rate of return ISSUE Integrated Support for Sustainable Urban Environment JMP Joint Monitoring Programme LGU Local government unit LINAW Local Initiative for Affordable Wastewater MDG Millennium Development Goal MTSP Manila Third Sewerage Project NCR National Capital Region NGO Non-governmental organization NPV Net present value NTU Nephelometic turbidity units PAA Program Approach Analysis PCWS Philippine Center for Water and Sanitation PBP Payback period PhP Philippine Peso PNSDW Philippine National Standards for Drinking Water xvi Economic Assessment of Sanitation Interventions in the Philippines Economic Assessment of Sanitation Interventions in the Philippines | Abbreviations and Acronyms RWSSP Rural Water Supply and Sanitation Project SCOTIA Sustainable Coastal Tourism in Asia SIDA Swedish International Development Cooperation Agency STF Septage treatment facility SuSEA Sustainable Sanitation for East Asia UDDT Urine Diversion-Dehydration Toilet UNICEF United Nations Children’s Fund USAID United States Agency for International Development VIP Ventilated improved pit WB World Bank WDDP Water Districts Development Project WHO World Health Organization WSH Water, Sanitation and Health WSP Water and Sanitation Program WSSPEP Water Supply and Sanitation Enhancement Program WWT Wastewater treatment www.wsp.org xvii Glossary Benefit-cost ratio (BCR): the ratio of the present value of the stream of benefits to the present value of the stream of costs. The higher the BCR the more efficient the intervention. Cost per case averted: the discounted value of the costs for each case of a disease that is avoided because of an intervention. Cost per DALY averted: the discounted value of the costs for each DALY that is avoided because of an intervention. Cost per death averted: the discounted value of the costs for each death that is avoided because of an intervention. Cost-effectiveness ratio (CER): the ratio of the present value of the future costs to the present value of the future health benefits in non-monetary units (cases, deaths, disability-adjusted life-years). The lower the CER the more efficient the intervention. Disability-Adjusted Life-Year (DALY): a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability. One DALY can be thought of as one lost year of “healthy� life (WHO 2010). Ecological sanitation (EcoSan): a new paradigm in sanitation that recognizes human excreta and water from households not as waste but as resources that can be recovered, treated where necessary and safely used again. It is based on the systematic implementation of reuse and recycling of nutrients and water as a hygienically safe, closed-loop and holistic alternative to conventional sanitation solutions (GTZ 2009). Improved sanitation: the use of the following facilities in home compounds: flush/pour-flush to piped sewer system/septic tank/pit latrine, ventilated improved pit (VIP) latrine, pit latrine with slab, or composting toilet (JMP 2008). Shared sanitation facilities: sanitation facilities of an otherwise acceptable type shared between two or more households. Only facilities that are not shared or not public are considered improved (JMP 2008). Open defecation: the practice of disposing human feces in fields, forests, bushes, open bodies of water, beaches or other open spaces or disposed of with solid waste (JMP 2008). Intangible benefits: Benefits of improved sanitation which are difficult to quantify. These include impacts on the quality of life, comfort, security, dignity, personal and cultural preferences, among others. xviii Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Glossary of Terms Internal rate of return (IRR): the discount rate for which the present value of the stream of net benefits is zero. In other words, the discount rate for which the BCR equals unity (1). Net benefit: the difference between the present value of the stream of benefits and the present value of the stream of costs. Net present value (NPV): the discounted value of the current and future stream of net benefits from a project. Payback period (PBB): represents the number of periods (e.g., years) that are necessary to recover the costs incurred for a project. Sewage: water-borne human or animal wastes removed from residences, buildings, institutions, industrial and commercial establishments together with groundwater, surface water and storm water. Liquid and solid waste carried off in sewers or drains. Septage: The sludge produced on individual onsite wastewater-disposal systems, principally septic tanks and cesspools. The contents of septic tanks. Sewerage: A network of pipelines, ditches, channels including pumping stations and force mains, service connections including other devices for the collection, transport, and treatment of sewage. Strategic sanitation: a concept based on the following principles (Rosenweig and Perez 2002): • Ensuring that any plan to improve sanitation services is financially sustainable • Consulting households to understand what sanitation solutions are in use and what expectations people have • Using a public consultation process with stakeholders to discuss the options • Including a specific health component to maximize health benefits • Selecting an appropriate model for managing the provision of sanitation services to ensure sustainability Unimproved sanitation: the use of the following facilities anywhere: flush/pour flush without isolation or treatment, pit latrine without slab/open pit, bucket, hanging toilet/hanging latrine, use of a public facility or sharing any improved facility, no facilities, bush or field (open defecation) (JMP 2008). www.wsp.org xix Acknowledgments The Economics of Sanitation Initiative was conducted in Cambodia, China (Yunnan Province), Indonesia, Lao PDR, the Philippines and Vietnam. The study was led by the East Asia and and the Pacific Office of the World Bank’s Water and Sanitation Program (WSP), with the contribution of WSP teams and consultants in each of the participating countries. The study took two years to complete, and has undergone several major peer review processes. Guy Hutton (WSP Senior Water and Sanitation Economist and Task Team Leader) led the development of the concept and methodology for the ESI, the management and coordination of the country teams, and provision of regional tools and templates. Bjorn Larsen contributed to the development of generic data collection tools and the health methodology. The study benefited from the continuous support of other WSP staff: Almud Weitz, Isabel Blackett, Yosa Yuliarsa, Irvan Tjondronegoro, Martin Albrecht and WSP support staff. In the Philippines, the study team consisted of U-Primo E. Rodriguez (WSP Consultant and country lead), Nelissa Jamora (WSP Consultant), Jeremy Ockelford (WSP Consultant), Dieldre Harder (Survey team lead), and EdKarl Galing (WSP Country Coordinator). The focus group discussions and most of the surveys were implemented by the Resources, Environment, and Economics Center for Studies, Inc. (REECS) and Consultants for Engineering Science and Technology, Inc. (CEST). Other key members of the survey team were Mike Vergara (health), Carmela Taguiam (sociology), Christine Leda-Paatan (statistics), Malou Eugenio (lead for San Fernando and Dagupan), Lhea Santos, Ailene Gabrillo, Brenda Fe Quiapos, Aileen Gay Casem, Liezel Sembran, Clarissa Andrade (lead for Alabel), Rowena Sorigo, Marita Rosaot, Bonifacio Sope, David Longao, Catherine Cuico, Donald Bracamonte, Liza Laus (lead for Bayawan), Milagrena Baguio, Arianne Golez, Donald Chiu, Lito Lomonggo, Nicolas Elemia, Louisa Bite (lead for Taguig), Jelyn Doctor, Razella Hufancia, Teresita Fernandez, Norlyn Sareno, Catherine Bolante, Joel Doctor, Jefferson Apuada, and Temistocles Rigor. The water quality survey was conducted by Intertek Testing Services Phils, led by Sandra Bucal and Mines Mercado. Other members of the water survey team were Francis Legaspi, Grace Milan, Fred Buot, Edmy dela Vega, Rod Zapanta and Ricky Nam-ay. The country team is very grateful for the untiring support of Leila Elvas, Shiela dela Torre and Emma Sacote of WSP in the completion of this study. The study also benefited from various individuals who generously provided technical advice and guidance, information necessary for the identification of potential survey sites, and assistance in the implementation of the field surveys. Without going into the details, and in no particular order, these are: Allan Rivera and staff (Municipal Environment and Natural Resources Office, Alabel, Sarangani), Boji Gendrano and Lyn Capistrano (PCWS), Bonifacio Magtibay (WHO), Carlito Santos (WSP Consultant), Christopher Rey Ancheta (World Bank), Dan Lapid (CAPS), Danilo Rivera (Brgy. Captain, Western Bicutan), Eduardo Posadas, Jr. and staff (San Fernando City Health Office), Eva Matibag (Wastewater Department, MWCI), Fe Crisilla Banluta (DILG), Gerry Parco (World Bank), Imelda Balbuena (GTZ EcoSan Coordinator), Jonas Maronilla (Bremen Overseas Research and Development Agency), Kathrina Gonzales (Philippine Institute for Development Studies), Leodegario de Castro (CAPS), Leonardo Carbonell and staff (Dagupan City Health Office), Lisa Lumbao (PADCO), Liza Batulan (Brgy. health worker in Pugaro, Dagupan xx Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Acknowledgments City), Luis Cruz (DOH), Marc Uhlig, Mark Mulingbayan (Manila Water), Michael Mananquil (City Engineer’s Office, Bayawan, Negros Oriental), Michelle Salom-Banzon, Rolando Metin (SuSEA project), Jaime Galvez-Tan (SuSEA-TAMS Team Leader), Romeo Basada (Southern Mindanao Integrated Coastal Zone Management Project of DENR), Ronald Muana (MWCI), Rory Gayanilo, Rosalyn Cortes, Rosario Villaluna (STREAMS of Knowledge), and Ulrike Lipkow (GTZ Adviser, Dumaguete, Negros Oriental). The study team wishes to thank Municipal/City Mayors German Saraña, Jr. (Bayawan, Negros Oriental), Alipio Fernandez, Jr. (Dagupan, Pangasinan), Pablo Ortega (San Fernando, La Union), Corazon Grafilo (Alabel, Sarangani), and Cesar Perez (Los Baños, Laguna) for their warm reception and support to the study and/or survey teams. Peer reviewers of the Philippines report were Eduardo Perez (WSP), Agustin Arcenas (University of the Philippines School of Economics), Jemima Sy (WSP) and Lilia Cassanova (CAPS). Given the collaborative nature of the study, the Philippines report benefited from technical inputs and developments from other country teams. In addition, peer reviewers from ESI Phase 1 are thanked for their valuable inputs which carried over to Phase 2 (see Acknowledgments in Phase 1 study). The ESI has been financed by the regional component of the Sustainable Sanitation in East Asia (SUSEA) program, which is funded by the Swedish International Development Agency (SIDA). The Asian Development Bank (ADB) co-financed the consultant teams in Indonesia, the Philippines and Vietnam. The study in Yunnan Province (China) was co-financed by the USAID’s ECO-Asia program. WSP and the report authors are grateful to the funding agencies for their support. www.wsp.org xxi Reference for citation: Economic assessment of sanitation interventions in the Philippines. U-Primo Rodriguez, Guy Hutton, Nelissa Jamora, Dieldre Harder, Jeremy Ockelford and EdKarl Galing. World Bank, Water and Sanitation Program. 2011. Other country and synthesis reports: Economic assessment of sanitation interventions in Cambodia. Sam Sok Heng, Guy Hutton, Poch Kongchheng, Kov Phyrum. Water and Sanitation Program. World Bank. 2011. Economic assessment of sanitation interventions in Indonesia. Asep Winara, Guy Hutton, Oktarinda, Edi Purnomo, Koderi Hadiwardoyo, Indon Merdykasari, Takdir Nurmadi, Bert Bruinsma, Dedek Gunawan, Dadang Fadilah, Martin Albrecht. World Bank, Water and Sanitation Program. 2011. Economic assessment of sanitation interventions in Lao People’s Democratic Republic. U-Primo Rodriguez, Guy Hutton, Alan Boatman. World Bank, Water and Sanitation Program. 2012. Economic assessment of sanitation interventions in Vietnam. Nguyen Viet Anh, Guy Hutton, Hoang Thuy Lan, Phan Huyen Dan, Le Thu Hoa, Bui Thi Nhung. World Bank, Water and Sanitation Program. 2012. Economic assessment of sanitation interventions in Yunnan Province, People’s Republic of China. Liang Chuan, Guy Hutton, Yang Liqiong, Fang Jinming, Zhang Tiwei, Dong Lin, Zhang Pu, Luo Ronghuai. World Bank, Water and Sanitation Program. 2011. Economic assessment of sanitation interventions in Southeast Asia. Guy Hutton, U-Primo Rodriguez, Asep Winara, Nguyen Viet Anh, Sam Sok Heng, Kov Phyrum, Liang Chuan, Isabel Blackett, Almud Weitz. World Bank, Water and Sanitation Program. 2012. Summary reports are available for each country, in both English and in the local languages. All country reports are accessible from http://www.wsp.org/pubs/index.asp xxii Economic Assessment of Sanitation Interventions Content Executive Summary ................................................................................................................................ iii A. Introduction.................................................................................................................................. iii B. Study Aims and Methods . ........................................................................................................... iii C. Data Sources and Study Sites ..................................................................................................... iii D. Main Economic Analysis .............................................................................................................. iv E. Disaggregated Results .................................................................................................................vii F. Recommendations . .....................................................................................................................xii Foreword . ............................................................................................................................................... xiii Abbreviations and Acronyms . ............................................................................................................... xv Glossary of Terms . ................................................................................................................................ xviii Acknowledgments . ................................................................................................................................ xx Content .................................................................................................................................................. xxiii Selected Development Indicators for the Philippines ........................................................................ xxxiv I. Introduction....................................................................................................................................... 1 1.1 Sanitation Coverage and Overview of the Sanitation Sector ......................................................... 1 1.2 Studies on the Costs and Benefits of Sanitation in the Philippines ................................................ 4 1.3 The Road Ahead . ........................................................................................................................ 5 II. Study Aims . ...................................................................................................................................... 6 2.1 Overall Purpose ........................................................................................................................... 6 2.2 Study Aims .................................................................................................................................. 6 2.3 Specific Study Uses ..................................................................................................................... 6 2.4 Research Questions . ................................................................................................................... 6 III. Methods ............................................................................................................................................ 9 3.1 Technical Sanitation Interventions Evaluated ................................................................................ 9 3.2 Costs and Benefits Evaluated ..................................................................................................... 11 3.3 Field Studies ............................................................................................................................... 12 3.4 National Studies . ........................................................................................................................ 24 IV. Local Benefits of Improved Sanitation and Hygiene ..................................................................... 27 4.1 Health ......................................................................................................................................... 27 4.2 Water . ........................................................................................................................................ 34 4.3 Access Time ............................................................................................................................... 42 4.4 Reuse of Human Excreta ............................................................................................................ 47 4.5 Intangible Sanitation Preferences ................................................................................................ 48 4.6 External Environment .................................................................................................................. 53 4.7 Project Performance and Actual Benefits in the Field Sites .......................................................... 57 4.8 Summary of Local Benefit ........................................................................................................... 62 www.wsp.org xxiii V. National Benefits of Improved Sanitation and Hygiene . ............................................................... 65 5.1 Tourism . ..................................................................................................................................... 65 5.2 Business ..................................................................................................................................... 70 5.3 Sanitation Reuse Markets ........................................................................................................... 74 5.4 Health ......................................................................................................................................... 75 5.5 Summary of Benefits . ................................................................................................................. 76 VI. Costs of Improved Sanitation and Hygiene ................................................................................... 78 6.1 Cost Summaries ......................................................................................................................... 78 6.2 Financing Sanitation and Hygiene ............................................................................................... 81 6.3 Sanitation Option by Income Group ............................................................................................ 84 6.4 Costs of Moving up the Ladder . ................................................................................................. 86 VII. Efficiency of Improved Sanitation and Hygiene ............................................................................. 89 7.1 Efficiency of Sanitation Improvements Compared to No Facility .................................................. 89 7.2 Efficiency of Alternatives for Moving up the Sanitation Ladder ..................................................... 92 7.3 Cost Variations and Efficiency Estimates ..................................................................................... 93 7.4 Poverty Analysis . ........................................................................................................................ 96 7.5 Scaling up Results for National Policy Making ............................................................................. 96 7.6 Concluding Remarks .................................................................................................................. 98 VIII. Discussion ...................................................................................................................................... 100 8.1 Study Messages and Interpretation . .......................................................................................... 100 8.2 Utilization of Results in Decision Making . ................................................................................... 102 8.3 Delivering Sanitation Improvements to Target Beneficiaries ........................................................ 103 IX. Recommendations ......................................................................................................................... 107 References . ........................................................................................................................................... 112 Annex 1: Implementation Approaches ................................................................................................. 118 Annex Tables ......................................................................................................................................... 120 xxiv Economic Assessment of Sanitation Interventions List of Tables Table 1. Sanitation coverage in the Philippines, % of households . .................................................... 1 Table 2. Benefits of improved sanitation included in this study ......................................................... 11 Table 3. Sanitation and hygiene interventions evaluated per site ...................................................... 15 Table 4. Unit values for economic cost of time per day and of loss of life, pesos, 2008..................... 19 Table 5. Sample sizes for tourist survey, by main origin of tourists . .................................................. 24 Table 6. Sample size for business survey, by main sectors of firms .................................................. 25 Table 7. Disease rates attributable to poor sanitation and hygiene for children under 5 years, annual rates per 1000 persons, 2008 ................................................................................. 27 Table 8. Treatment seeking behavior for diarrhea, under 5s only ...................................................... 29 Table 9. Unit costs associated with treatment of diarrhea, pesos, 2008 ........................................... 30 Table 10. Average health care cost per person per year in field sites, by disease, age group and rural/urban location, pesos .......................................................................................... 30 Table 11. Average productivity cost per person per year in field sites, by disease, age group and rural/urban location, pesos .......................................................................................... 31 Table 12. Average mortality cost per person per year in field sites, by disease, age group and rural/urban location, pesos ................................................................................................. 32 Table 13. Perceived difference in diarrheal incidence since improved sanitation, in all field sites ......... 33 Table 14. Annual costs per household of poor sanitation and hygiene, and annual costs averted of improved sanitation, pesos, 2008 ...................................................................... 33 Table 15. Water resources in field sites............................................................................................... 35 Table 16. Water access and costs in the survey sites ........................................................................ 38 Table 17. Water access and household treatment costs averted as a result of improved sanitation, pesos ................................................................................................................ 42 Table 18. Preferences related to toilet convenience ............................................................................ 45 Table 19. Respondents’ understanding of sanitation .......................................................................... 48 Table 20. Reasons for current sanitation coverage — top responses ................................................. 49 Table 21. Concerns of those practicing open defecation, % of respondents ...................................... 52 Table 22. Preferences related to toilet comfort and status................................................................... 52 Table 23. Sanitation coverage information per field site ...................................................................... 57 Table 24. Summary of local impacts of sanitation improvement ......................................................... 64 Table 25. Background characteristics of respondents ........................................................................ 67 Table 26. Sanitary experience in relation to toilets and hand washing ................................................. 67 Table 27. Health troubles experienced by visitors ............................................................................... 68 Table 28. Costs of doing business: production (in columns: main sectors represented) ...................... 72 Table 29. Costs of doing business: sales ........................................................................................... 73 Table 30. Estimated impacts of increased reuse of human excreta . ................................................... 75 Table 31. National health impacts of poor sanitation .......................................................................... 76 Table 32. Summary of average cost of different sanitation and hygiene options for rural households, pesos, 2008 ................................................................................................... 78 Table 33. Summary of average cost of different sanitation and hygiene options for urban households, pesos, 2008 ................................................................................................... 79 www.wsp.org xxv Actual and optimal use of treatment facilities, 2008 ............................................................ 81 Table 34. Investment costs as a proportion of household income, by intervention, percent ................ 86 Table 35. Incremental costs of moving up the sanitation ladder, all sites, pesos, 2008........................ 87 Table 36. Rural area efficiency measures for main groupings of sanitation interventions, Table 37. compared to “no toilet� ...................................................................................................... 90 Urban area efficiency measures for main groupings of sanitation interventions, Table 38. compared to “no toilet� ...................................................................................................... 91 Rural area efficiency measures for main groupings of sanitation interventions, Table 39. comparing different points on the sanitation ladder, ideal setting . ....................................... 94 Urban area efficiency measures for main groupings of sanitation interventions, Table 40. comparing different points on the sanitation ladder . ........................................................... 95 Efficiency measures for three different population poverty profiles ....................................... 97 Table 41. Typical nationwide sanitation subgroups versus field site characteristics ............................. 98 Table 42. Benefit-cost ratios under alternative assumptions . ............................................................ 102 Table 43. Classification of subsidies . ................................................................................................ 104 Table 44. xxvi Economic Assessment of Sanitation Interventions List of Figures Figure 1. Sanitation coverage in different regions of the Philippines, %, 2000 and 2007 . ................ 2 Figure 2. Flow of data collected (inputs) and eventual cost-benefit assessments (outputs) .............. 9 Figure 3. Representation of the sanitation “ladder�. ......................................................................... 10 Figure 4. Location of the selected field sites in the Philippines ....................................................... 12 Figure 5. Overview of methods for estimating field-level benefits of improved sanitation . ............... 18 Figure 6. Comparison of direct disease rates for all age groups, per 1000 persons . ...................... 28 Figure 7. Relative risk reduction of fecal-oral diseases and helminthes from different sanitation and hygiene interventions . .............................................................................. 32 Figure 8. Health costs of unimproved sanitation (A), and health costs averted of improved sanitation options (B) ...................................................................................................... 34 Figure 9. Test results for E-Coli and Coliform by site (A) and water source (B) ................................ 36 Figure 10. Turbidity readings in field sites, in nephelometic turbidity units (NTUs) ............................. 37 Figure 11. Extent of isolation of human excreta in field sites, % of respondents ............................... 38 Figure 12. Households citing poor water quality from their principal drinking water source, % of respondents . .............................................................................................................. 39 Figure 13. Cited reasons for using water sources — rural versus urban, % of responses ................. 40 Figure 14. Household water treatment practices, % of responses ................................................... 40 Figure 15. Household water treatment costs, by method, pesos ..................................................... 41 Figure 16. Change in water treatment practices after receiving a new latrine, % of responses ......... 41 Figure 17. Place of defecation of households with no “own� toilet, % of responses ......................... 43 Figure 18. Daily time spent accessing toilet outside plot for those with no toilet ............................... 43 Figure 19. Practices related to young children ................................................................................. 43 Figure 20. Preferences related to toilet convenience, % of responses .............................................. 44 Figure 21. Opportunity cost of time — what respondents would spend an extra 30 minutes a day doing, % of possible points....................................................................................... 45 Figure 22. Average number of days saved per year per household member .................................... 46 Figure 23. Average annual value of time savings per household member, pesos .............................. 46 Figure 24. Households with UDDT-E facilities in San Fernando who are reusing feces and urine, % of responses ..................................................................................................... 47 Figure 25. Average annual value of savings from reuse with UDDT-E facilities in San Fernando, pesos ............................................................................................................................. 47 Figure 26. Level of satisfaction with current toilet option, improved versus unimproved . .................. 50 Figure 27. Reasons to get a toilet for those currently without toilet access, average score ............... 51 Figure 28. Scoring of different types of living area ............................................................................ 53 Figure 29. Overall state of sanitation in the study sites ..................................................................... 54 Figure 30. Proportion of households with unimproved sanitation practice, % ................................... 55 Figure 31. Implication of current toilet option for external environment ............................................. 56 Figure 32. Perceptions of environmental sanitation state, by option type ......................................... 56 Figure 33. Contribution of households, % ........................................................................................ 58 Figure 34. Choice to participate and other benefits provided to the households .............................. 59 Figure 35. Appropriate technology.................................................................................................... 59 www.wsp.org xxvii Figure 36. Indicators for households with access to toilet facilities, % .............................................. 60 Figure 37. Pit latrines/septic tanks within 10 to 20 meters from a well, % of households . ................ 61 Figure 38. Open defecation and urination in the project sites, % of households ............................... 61 Figure 39. Adjustment variables for benefits, % of responses .......................................................... 62 Figure 40. Places visited and enjoyment of stay . ............................................................................. 66 Figure 41. General sanitary experience ............................................................................................ 66 Figure 42. Factors of most concern to tourists, % ........................................................................... 68 Figure 43. Intention to return, % ...................................................................................................... 69 Figure 44. Reasons for hesitating to return, % ................................................................................. 69 Figure 45. Rating of environmental sanitation conditions in the location of the business survey interview ......................................................................................................................... 70 Figure 46. Importance of environmental sanitation conditions for locating the company . ................. 71 Figure 47. Implications of improved sanitation for expanding business in the Philippines . ................ 74 Figure 48. Economic costs per rural household for major items, pesos . .......................................... 79 Figure 49. Economic costs per urban household for major items, pesos ......................................... 80 Figure 50. Proportion of rural sanitation costs financed from different sources, % ............................ 82 Figure 51. Proportion of urban sanitation costs financed from different sources, %........................... 83 Figure 52. Access to sanitation facilities by income group in rural areas, percent ............................. 84 Figure 53. Access to sanitation facilities by income group in urban areas, percent ........................... 85 Figure 54. Incremental costs of moving up the sanitation ladder, rural and urban sites, pesos, 2008 ............................................................................................................................... 88 Figure 55. Benefit-cost ratio, all sanitation options in all rural sites, ideal setting ............................... 90 Figure 56. Benefit-cost ratio, all sanitation options in all urban sites, ideal setting . ........................... 92 Figure 57. Estimated costs of the superstructure for UDDT-E facilities, by type of wall material, 000 pesos, 2006 prices .................................................................................................. 96 Figure 58. Investment costs that will make the benefit-cost ratio equal to unity, selected sites and technologies, 000 pesos per household ................................................................... 96 Figure 59. Implementation approaches and partnerships in the 10 projects .................................... 106 xxviii Economic Assessment of Sanitation Interventions List of Annex Tables Annex Table A 1. Coverage, % of households, by region ................................................................ 120 Annex Table A 2. Selection of field sites for economic study . .......................................................... 121 Annex Table A 3. Assessment of advantages and limitations of different design options . ................ 123 Annex Table A 4. Diseases linked to poor sanitation and hygiene, and primary transmission routes and vehicles .............................................................................................. 124 Annex Table A 5. Water quality measurement parameters per location and test method ................. 125 Annex Table A 6. Key formulas, variables and data sources for calculating monetized benefits ....... 125 Annex Table A 7. Households sampled versus total households per village/community . ................. 126 Annex Table A 8. Sample sizes of other surveys in study sites ........................................................ 130 Annex Table B 1. Health rates for diseases, by site, values are per 1000 persons............................ 131 Annex Table B 2. Comparison of data sources for selected diseases .............................................. 133 Annex Table B 3. Evidence on treatment seeking behavior for other diseases ................................. 134 Annex Table B 4. Unit costs associated with treatment of diseases ................................................. 135 Annex Table C 1. Water quality . ...................................................................................................... 136 Annex Table C 2. Water pollution from poor sanitation and wastewater management (% of households) ......................................................................................................... 141 Annex Table C 3. Water access and treatment practices, and related cost, per site ........................ 142 Annex Table C 4. Households citing poor water quality, by site . ...................................................... 142 Annex Table C 5. Cited reasons for using water sources - all sites . ................................................. 143 Annex Table C 6. Treatment practices (all sites) ............................................................................... 144 Annex Table C 7. Water access and household treatment costs averted ......................................... 144 Annex Table D 1. Place of defecation of households with no “own� toilet ........................................ 145 Annex Table D 2. Daily time spent accessing toilet for those with no toilet ....................................... 145 Annex Table D 3. Practices related to young children ...................................................................... 145 Annex Table D 4. Preferences related to toilet convenience, from households ................................. 146 Annex Table D 5. Average time saved per person or household per year (in days) ........................... 146 Annex Table D 6. Value of time per person/household per year (in pesos) ....................................... 146 Annex Table E 1. Important characteristics of a toilet for those currently without ............................. 147 Annex Table E 2. Level of satisfaction with current toilet option ....................................................... 147 Annex Table F 1. Scoring of different types of living area ................................................................. 148 Annex Table F 2. Proportion of households with and without toilet with unimproved sanitation practice ............................................................................................................... 149 Annex Table F 3. Implication of current toilet option for external environment .................................. 150 Annex Table F 4. Perceptions of environmental sanitation state, by option type .............................. 151 Annex Table F 5. Ranking importance of environmental sanitation, by option type .......................... 152 Annex Table F 6. Household choices and other interventions . ........................................................ 153 www.wsp.org xxix Annex Table F 7. Financing from household and project sources .................................................... 153 Annex Table F 8. Appropriate technology ....................................................................................... 154 Annex Table F 9. Actual program performance in relation to key selected indicators for program effectiveness, rural and mixed sites only ................................................ 155 Annex Table F 10. Actual program performance in relation to key selected indicators for program effectiveness, urban sites only ............................................................... 156 Annex Table F 11. Actual program performance in relation to key selected indicators for .......................................................................................... 157 program effectiveness. Annex Table G 1. Places visited (% respondents) and enjoyment of stay ......................................... 158 Annex Table G 2. General sanitary experience ................................................................................. 158 Annex Table G 3. Sanitary experience in relation to toilets and hand washing .................................. 159 Annex Table G 4. What factors were of most concern? ................................................................... 159 Annex Table G 5. Health troubles .................................................................................................... 160 Annex Table G 6. Intention to return ................................................................................................ 160 Annex Table G 7. Reasons for hesitating to return to the Philippines . .............................................. 161 Annex Table H 1. Rating of environmental sanitation conditions in the location of the business survey interview (1 = best; 5 = worst) . ................................................................. 162 Annex Table H 2. Importance of environmental sanitation conditions for locating the company ....... 162 Annex Table I 1. Alabel average cost per household for different sanitation and hygiene options, using full (economic) cost (pesos, year 2008) ......................................... 163 Annex Table I 2. Bayawan average cost per household for different sanitation and hygiene options, using full (economic) cost (pesos, year 2008) ......................................... 164 Annex Table I 3. Dagupan average cost per household for different sanitation and hygiene options, using full (economic) cost (pesos, year 2008) ......................................... 165 Annex Table I 4. San Fernando (coastal regions) average cost per household for different sanitation and hygiene options, using full (economic) cost (pesos, year 2008) ...... 166 Annex Table I 5. San Fernando (upland) average cost per household for different sanitation and hygiene options, using full (economic) cost (pesos, year 2008) . .................... 167 Annex Table I 6. Taguig average cost per household for different sanitation and hygiene options, using full (economic) cost (pesos, year 2008) ......................................... 168 Annex Table I 7. Proportion of rural households selecting different sanitation options, by sites, by rural-urban regions . ............................................................................... 169 Annex Table I 8. Incremental costs of moving up the sanitation ladder ........................................... 171 Annex Table J 1. Alabel (rural), efficiency measures for main groupings of sanitation interventions, compared to “no toilet� .................................................................. 173 Annex Table J 2. Bayawan (rural), efficiency measures for main groupings of sanitation interventions, compared to “no toilet� .................................................................. 174 xxx Economic Assessment of Sanitation Interventions Annex Table J 3. San Fernando-upland (rural), efficiency measures for main groupings of sanitation interventions, compared to “no toilet� . ................................................. 175 Annex Table J 4. Dagupan (urban), efficiency measures for main groupings of sanitation interventions, compared to “no toilet� .................................................................. 176 Annex Table J 5. San Fernando-coastal (urban), efficiency measures for main groupings of sanitation interventions, compared to “no toilet� . ................................................. 177 Annex Table J 6. Taguig (urban), efficiency measures for main groupings of sanitation interventions, compared to “no toilet�................................................................... 178 Annex Table K 1. Alabel (rural), efficiency measures for main groupings of sanitation interventions, comparing different points on the sanitation ladder . ....................... 179 Annex Table K 2. Bayawan (rural), efficiency measures for main groupings of sanitation interventions, comparing different points on the sanitation ladder . ....................... 179 Annex Table K 3. San Fernando-upland (rural), efficiency measures for main groupings of sanitation interventions, comparing different points on the sanitation ladder . ....... 180 Annex Table K 4. Dagupan (urban), efficiency measures for main groupings of sanitation interventions, comparing different points on the sanitation ladder . ....................... 180 Annex Table K 5. San Fernando-coastal (urban), efficiency measures for main groupings of sanitation interventions, comparing different points on the sanitation ladder . ....... 181 Annex Table K 6. Taguig (urban), efficiency measures for main groupings of sanitation interventions, comparing different points on the sanitation ladder . ....................... 182 Annex Table K 7. Sensitivity Analysis: Cost-benefit ratios (ideal setting)............................................ 183 Annex Table K 8. Sensitivity Analysis: Elasticity (% change in CBA ratio/% change in the exogenous variable) ............................................................................................. 184 Annex Table K 9. Basic features of sanitation programs .................................................................. 185 Annex Table K 10. Basic interventions and program approaches of sanitation programs . ................. 186 www.wsp.org xxxi Selected Development Indicators for the Philippines Variables Value Population Total population (millions, 2008) 90.5 Rural population (%) 49.21 Urban population (%) 50.81 Annual population growth (%) (2000-2007) 2.0 Under 5 population (% of total) (2000) 12.6 Under 5 mortality rate (deaths per 1,000) (2004) 5.1 Female population (% of total) (2008, projected) 49.7 Population below poverty line (%) (2006) 32.9 Economic Currency name Philippine Peso (PhP) Year of cost data presented 2008 Currency exchange with USD (average, 2008) 44.5 GDP per capita (USD) (2008) 1,863.4 GDP per capita in International $, adjusted for 3,773.0 purchasing power (2008) Sanitation Improved total (%) (2008) 76.0 Improved rural (%) (2008) 69.0 Improved urban (%) (2008) 80.0 Open defecation (%) (2008) 8 1 Estimates are based on the 2007 census I. Introduction 1.1 Sanitation Coverage and Overview of the tween rural and urban areas was substantially lower than Sanitation Sector the 24 percentage point difference in 1990. The Philippines has made substantial progress in increas- ing the access of its people to improved sanitation. Re- Figure 1 provides information on sanitation coverage for cent estimates from the Joint Monitoring Programme for the different regions of the Philippines. It indicates that the Water Supply and Sanitation (JMP) of the World Health National Capital Region (NCR), Ilocos, and Central Luzon Organization (WHO) and the United Nations Children’s had the highest proportions of households with access to Fund (UNICEF) indicate that 76% of the population of improved sanitation facilities in 2007. In contrast, the Au- the country had access to improved sanitation facilities in tonomous Region of Muslim Mindanao (ARMM) lagged 2008 (Table 1).1 This is a significant improvement from the behind the other regions, with only about 51% of its house- 58% that was estimated in 1990. Moreover, the propor- holds having access to improved sanitation facilities. The tion of the population who practice open defecation was estimates also indicate double-digit increases in the propor- halved over the same period from 16% in 1990 to 8% in tion of families with access to improved sanitation in all 2008. The Philippines is clearly well on its way to achieving regions between 2000 and 2007. The largest gains ranged the Millennium Development Goal (MDG) of reducing by from 13 percentage points in the Southern Mindanao to half the proportion of its population in 1990 who did not 25 percentage points in the ARMM. As a result, there was have access to improved sanitation facilities. a narrower gap between the regions in terms of access to improved sanitation in 2007 compared to 2000. Another positive development is the dramatic increase in the access to improved sanitation in rural areas. As of 2008, Two common patterns emerge from the analysis of second- 69% of rural households had access to improved sanitation. ary data. First, there have been noticeable improvements in This was 23 percentage points higher than its counterpart sanitation coverage over the last decade and a half. Second, for 1990. While access to improved sanitation in urban ar- the gap in terms of access to improved sanitation facilities eas was still higher by 11 percentage points, the gap be- across regions has narrowed over the same period. TABLE 1: SANITATION COVERAGE IN THE PHILIPPINES, % OF HOUSEHOLDS Rural Urban Total Coverage type 1990 2008 1990 2008 1990 2008 Improved private facility 1 46 69 70 80 58 76 Unimproved private facility 22 3 8 0 15 1 Shared facility 9 14 14 16 11 15 Open defecation 23 14 8 4 16 8 Source: JMP (2010) 1 The JMP (2008) defines an improved sanitation facility “as one that hygienically separates human excreta from human contact� (p.39). This includes flush or pour-flush latrines connected to a piped sewer system, septic tank or pit latrine and ventilated improved pit latrine. On the other hand, unimproved facilities include pit latrines without slab or platform, hanging latrines, and bucket latrines. Pour-flush toilets that discharge into open drains, ditches or other bodies of water and facilities shared by two or more households are also considered unimproved. www.wsp.org 1 Economic Assessment of Sanitation Interventions in the Philippines | Introduction FIGURE 1: SANITATION COVERAGE IN DIFFERENT REGIONS OF THE PHILIPPINES, %, 2000 AND 2007 Autonomous Region 51 of Muslim Mindanao 26 83 Caraga 65 77 Central Mindanao 52 73 Southern Mindanao 60 80 Northern Mindanao 62 74 Western Mindanao 51 72 Eastern Visayas 54 71 Central Visayas 53 77 Western Visayas 54 74 Bicol Region 55 86 Southern Tagalog 69 89 Central Luzon 74 84 Cagayan Valley 66 87 Ilocos Region 72 Cordillera 79 Administrative Region 55 87 National Capital Region 76 2007 2000 0 20 40 60 80 100 Source: Annex Table A1 Despite the progress made by the Philippines, the JMP million people practice open defecation. The gap in sanita- (2008) data suggest that 24% percent of the population still tion access between rural and urban households still needs do not have access to improved sanitation facilities. With an to be further narrowed. For instance, access to improved estimated population of 90.5 million persons in 2008, this sanitation for the ARMM region in 2007 (51%) was the implies that about 21.7 million people do not have access same proportion as the region with the second lowest access to improved sanitation facilities. Of this, approximately 7.2 rate (Western Mindanao) in 2000. 2 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Introduction Information on sanitation coverage also needs to be viewed The costs associated with poor sanitation are large. A previ- with caution. Citing information from the 2003 World ous phase of the Economics of Sanitation Initiative (ESI) Health Survey of the World Health Organization (WHO), estimated the overall economic costs of poor sanitation to the JMP (2008b) indicated that a relatively small propor- be in the order of US$1.4 billion or PhP77.8 billion (at tion of Philippine households had private toilets which 2005 prices) per year, or PhP923.7 (at 2005 prices) per per- flush to septic tanks. Of the 78% of urban households that son per year (Rodriguez et al. 2008)3. Equivalent to about had access to improved sanitation facilities, only about 21 1.5% of gross domestic product (GDP) for 2005, nearly percentage points had access to toilets that flush to sep- three-quarters of this amount was attributable to health- tic tanks. In the case of rural households, only 14% of all related costs. households had toilets that flush to septic tanks. There is also some uncertainty over the values being presented here. Policy makers in the Philippines recognize the importance For example, the National Statistical Coordination Board of increasing access to improved sanitation. For example, (2006) reported that 42% of all households in 2000 had Chapter 3 of the Medium-Term Development Plan 2004- private access to water-sealed, sewer/septic tanks. Regard- 10 stated the following target: “Ensure that all barangays/ less of the values, it is clear that a larger proportion of the municipalities will be provided with water supply services population do not have private access to toilets that flush to that have corresponding sanitation facilities for proper dis- septic tanks. More recent data from the WHO (2009) also posal of wastewater and septage …� (NEDA 2004). There is show that only 6.7% of urban households had toilets that also an array of laws and regulations which date as far back flush to a sewage system. An even lower proportion (2.1%) as 1949 with the provision on the drainage of buildings in was reported for rural households. the Civil Code of the Philippines (RA 386). More recent measures were the formulation of the National Sewerage Another important issue is the design and management of and Septage Management Program (NSSMP) and estab- septic tanks. Poor design and mismanagement can contrib- lishment of Water Quality Management Areas (WQMA) ute to the pollution and increased exposure to health risks. in the Clean Water Act of 2004 (RA 9275). In 2007, the In a survey of six sites in the Philippines, WSP’s Sustainable DOH also developed the Operations Manual on the Rules Sanitation for East Asia project (SuSEA 2008) reported that and Regulations Governing the Collection, Handling, the majority of the septic tanks did not conform to the de- Transport, Treatment and Disposal of Domestic Septage as sign recommended by the Department of Health (DOH).2 a supplement to the implementing rules and regulations of The World Bank and PPIAF (2005) also noted that there Chapter 17 of the Sanitation Code. Citing the economic are septic tanks that drain into uncovered drainage systems. costs of poor sanitation from the ESI Impact Study, a senate Septic tank management is also an issue. While aggregate resolution (PSR No. 326) was introduced in 2008. The res- data are unavailable, surveys indicate that households do olution called for an inquiry, in aid of legislation, into the not regularly desludge their septic tanks. In a survey in “deplorable state of hygiene and sanitation in the country.� Marikina City, Metro Manila, the USAID (2007) found that 37% of respondents have never emptied their septic There continues to be a big divide between recognizing tanks. In a separate survey, the USAID and City of San Fer- the costs of poor sanitation and appropriate actions aimed nando (2006) found that 71% of respondents never emp- at addressing these costs. Public investments in sanita- tied their septic tanks or did so more than five years prior to tion continue to receive low priority. A study by Manasan the survey. Similar results were found from the surveys con- (2008) showed two important points to support this as- ducted for this study. The SuSEA (2008) also reported that sertion. First, general government expenditures on water desludging trucks without close access to a septage treat- and sanitation account for a very small proportion of total ment facility generally dispose of the waste in open fields, expenditures on basic social services. In 2006, expenditures drainage systems or water bodies. on water and sanitation amounted to PhP12 per person (at 2 The survey sites in the SuSEA study were Bauko, Dagupan City, Guiuan, Polomolok, General Santos City and Alabel. 3 The study used JMP sanitation coverage statistics for 2004. www.wsp.org 3 Economic Assessment of Sanitation Interventions in the Philippines | Introduction 2000 prices, or about PhP19.3 at 2008 prices) - approxi- such studies, especially at the national level or representing mately 0.9% of per capita expenditures on basic social ser- a range of settings which typify the Philippines. vices. Second, per capita expenditures have declined sub- stantially over time. Per capita spending in 2006 was only 1.2 Studies on the Costs and Benefits of about 40% of its value in 1997. Sanitation in the Philippines Most of the studies on costs focused on the impacts on wa- While data is difficult to obtain, interventions specific to ter pollution and sanitation and did not explicitly attempt sanitation also appear small relative to total expenditures to isolate the costs which are solely attributable to poor on water and sanitation. The World Bank (2003) reported sanitation.4 With the exception of a World Bank (2003) re- that sanitation accounted for only about 3% of total invest- port which also estimated the costs to tourism and water ments in water supply and sanitation in 1999, while 97% resources, these studies focused exclusively on the health went to water supply investments. impacts. While this is a difficult task indeed, it is necessary to convince decision makers to provide more attention and At present, many government agencies are tasked with ad- investments to the sector. To date, the most comprehen- dressing sanitation problems in the country. These include sive analysis of costs of poor sanitation in the Philippines is the Department of Health (DOH), Department of Envi- the ESI Impacts Study (Rodriguez et al. 2008). The study ronment and Natural Resources (DENR), Department evaluated the impacts of poor sanitation not only on health, of Public Works and Highways (DPWH), Department but also on water use including household uses and value of Finance (DOF), Department of the Interior and Local of fish catch, access time, and tourism. However, the study Government (DILG), and local government units (LGU). did not provide an analysis of the various sanitation options While this reflects the multi-dimensional nature of sanita- which are available to decision makers. tion, the existing set-up makes it harder to formulate and implement sanitation programs and strategies. The coordi- There are studies which provide information on various op- nation problems associated with having multiple govern- tions, with some including estimates of the costs associated ment agencies in charge of sanitation concerns were empha- with specific technologies.5 Other studies also compared sized by Dr. Jaime Galvez Tan, former Secretary of Health various technologies with a specific option. For example, and Team Leader for the Technical Assistance Management Santos et al. (2007) and Partnerships in Environment Services (TAMS) for SuSEA Philippines. In a presentation Management for the Seas of East Asia (PEAMSEA 2006) at the Second Sanitation Summit in Manila in 2008, he evaluated various wastewater treatment technologies. On raised the question of “Who is in charge?�– referring to the the other hand, the Netherlands Water Partnership (NWP absence of a lead agency for initiatives in the improvement 2006) compared the costs of three types of urine diversion of sanitation conditions in the country (Galvez-Tan 2008). toilets. The discussion above asserts two points. First, the costs of There are also a few studies which attempted a cost-benefit poor sanitation are high and should not be ignored. Sec- analysis of sanitation options. Uhlig (2008), for example, ond, there is a need for more action from government and analyzed urine diversion dehydration toilets in the city of other stakeholders. Convincing these institutions requires Bayawan, Negros Occidental. Another evaluated UDDT-E concrete analysis on the costs of poor sanitation. Equally in San Fernando, La Union (FSSI et al. 2006).While these important is the need for rigorous studies on various op- studies provide valuable information for the decision mak- tions that are available as these will provide decision mak- er, they tend to be site- and/or technology-specific. There is ers with analyses of choices from which they can make clearly a need for an analysis of the various options that has informed judgments. Unfortunately, there are very few of a wider scope and geographical coverage. 4 Examples include the World Bank (2007), World Bank (2003) and Arcenas (2009). 5 Examples of such studies are Dueñas (2008), World Bank (2007b, 2000, 1996), Carajay and Herrera (2006), Lapid (2005), WPEP (2005) GTZ (2004), Municipal Government of Panglao (undated), APDC-BAI (undated), SCOTIA (undated-a and undated-b). 4 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Introduction 1.3 The Road Ahead One method that can be used to evaluate various sanitation options is cost-benefit analysis (CBA). The objective of the technique is to generate a monetary measure of the stream of benefits and costs from an investment project or policy. It can estimate the (a) expected economic return (return per US$ invested), (b) net present value, and (c) the in- ternal rate of return of investments or policy initiatives. It therefore aids decision-makers in identifying whether the net benefits from a project or policy are positive or negative. In the presence of multiple options, a CBA may provide a valuable input for priority setting. The analysis is important in enhancing the chances that scarce resources are efficiently allocated to projects that pro- vide acceptable levels of net benefits. Moreover, it also helps evaluate the costs, budget impacts and benefits of sanita- tion alternatives, should additional funds become available to finance further investments. Furthermore, the analysis provides information that can be used for advocacy of de- velopment interventions, assuming CBA findings are favor- able for the evaluated interventions. The remainder of this report is organized as follows: Chap- ter 2 describes the overall objectives and aims of the study. It also explains some of the key research questions that will be addressed in subsequent chapters. Chapter 3 discusses the methodology of the study. It describes the costs and benefits to be evaluated and the key indicators used in the analysis of the various options. The chapter also describes the study sites and data collection methods. Chapter 4 pres- ents the local or site-specific benefits associated with im- proved sanitation while Chapter 5 describes some of the broader benefits to the economy. Chapter 6 presents the costs associated with various sanitation options. It also de- scribes the costs as a household moves up the sanitation ladder. Chapter 7 combines the information in Chapters 4 to 7 by way of a cost-benefit and cost-effectiveness analysis. It also compares the various efficiency indicators across vari- ous sanitation options. Chapter 8 provides a discussion of the results and Chapter 9 concludes with the recommenda- tions of the study. www.wsp.org 5 II. Study Aims 2.1 Overall Purpose The purpose of the Economics of Sanitation Initiative (ESI) This study also contributes to the debate on approaches to is to promote evidence-based decision making using im- sanitation financing and ways of scaling up sanitation im- proved methodologies and data sets, thus increasing the provements to meet national targets. effectiveness and sustainability of public and private sanita- tion spending. 2.3 Specific Study Uses By providing hard evidence on the costs and benefits of im- Better decision making techniques and economic evidence proved sanitation, the study will: themselves are also expected to stimulate additional spend- • Provide advocacy material for increased spending on ing on sanitation to meet and surpass national coverage tar- sanitation, and to prompt greater attention of sector gets. stakeholders to efficient implementation and scaling up of improved sanitation. 2.2 Study Aims • Enable the inclusion of efficiency criteria in the se- The aim of this current study is to generate robust evi- lection of sanitation options in government and do- dence on the costs and benefits of sanitation improvements nor strategic planning documents, and in specific in different programmatic and geographic contexts in the sanitation projects and programs. Philippines, leading to the selection of the most efficient • Bring greater focus on appropriate technology and sustainable sanitation interventions and programs. Ba- through increased understanding of the marginal sic hygiene aspects are also included, insofar as they affect costs and benefits of moving up the “sanitation lad- health outcomes. der� in different contexts. • Provide the empirical basis for improved estimates of The evidence is presented in simplified form and distilled the total costs and benefits of meeting sanitation tar- into key recommendations to increase uptake by a range of gets (e.g., MDG target), and contribute to national sanitation financiers and implementers, including different strategic plans for meeting and surpassing the MDG levels of government and sanitation sector partners, as well targets. as households and the private sector. • Contribute to the design of feasible financing op- tions through identification of the beneficiaries as Standard outputs of cost-benefit analysis include benefit- well as cost incidence of sanitation programs. cost ratios, internal rate of return, payback period, and net benefits (see Glossary). Cost-effectiveness measures relevant 2.4 Research Questions to health impacts will provide information on the costs of In order to fulfill the overall purpose of the study, research achieving health improvements. In addition, intangible questions were defined to have a direct bearing on sanita- aspects of sanitation not quantified in monetary units are tion policies and decisions, distinguished for overall effi- highlighted as being crucial to the optimal choice of sanita- ciency questions (i.e., cost versus benefit), and for costs and tion interventions. benefits separately.6 6 “Costs� (and “benefits�) refer simultaneously to financial and economic costs (and benefits), unless otherwise specified. 6 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Study Aims understand the nature and timing of costs and benefits, as well as how non-economic aspects affect the implementa- BOX 1. RESEARCH QUESTIONS ON SANITATION tion of sanitation interventions, hence affecting their even- EFFICIENCY tual efficiency (see Box 2 and Box 3). Furthermore, given i. Are benefits greater than the costs of that several impacts of improved sanitation cannot easily be sanitation interventions? By what proportion quantified in monetary terms, this study attempts to give do benefits exceed costs (benefit-cost ratio — BCR)? greater emphasis to these impacts in the overall cost-benefit assessment. ii. What is the annual internal rate of return (IRR)? In addition, other research questions are crucial to an ap- iii. How long does it take for a household propriate interpretation and use of information on sanita- to recover its initial investment costs, at different levels of cost sharing (payback tion costs and benefits. Most importantly, the full benefit of period — PBP)? a sanitation intervention may not be received due to factors iv. What is the net gain of each sanitation in the field that affect the uptake and compliance with the intervention (net present value — NPV)? intervention. These factors need to be better understood to What is the potential interest of sanitation advise future program design. for business opportunities? v. What is the cost of achieving standard health gains such as averted death, cases and disability-adjusted life-year (DALY)? BOX 2. RESEARCH QUESTIONS ON SANITATION vi. How does economic performance vary COSTS across sanitation options, program i. What is the range of costs for each approaches, locations, and countries? What technology option in different field settings? factors explain performance? What factors determine cost levels (e.g., quality, duration of hardware and software services)? The major concern in economic evaluation is to understand ii. What proportion of costs are capital, program and recurrent costs, for different economic and/or financial efficiency — in terms of return interventions? What are necessary on investment and recurrent expenditure. Hence the focus maintenance and repair interventions, and of economic evaluation is on what it costs to deliver an in- costs, to extend the life of hardware and tervention and what the returns are. Several different ef- increase sustainability? ficiency measures allow examination of the question from iii. What proportion of total (economic) cost different angles, such as number of times by which benefits is financial in nature? How are financial exceed costs, the annual equivalent returns, and the time and economic costs financed in each field to repay costs and start generating net benefits (see Box 1). location? Also, as sanitation and hygiene improvement also fall with- iv. How do costs per sanitation option vary by in the health domain, economic arguments can be made for income group? What is the average cost investment in sanitation and hygiene interventions with the per sanitation option as a percentage of annual household cash income, by income health budget, if the health return per unit cost invested is quintile? competitive compared with other uses of the same health v. What are the incremental costs of moving budget. from a sanitation improvement to another — i.e., up the sanitation ladder — for specified As well as overall efficiency questions, it is useful from deci- populations to meet sanitation targets? sion making, planning, and advocacy perspectives to better www.wsp.org 7 Economic Assessment of Sanitation Interventions in the Philippines | Study Aims BOX 3. RESEARCH QUESTIONS ON SANITATION BENEFITS i. What local evidence exists for the links between sanitation and the following impacts on: health, water quality and water users, land use, time use, welfare, tourism, and the business environment? ii. What is the size of the economic benefit related to health expenditure, health-related productivity and premature mortality; household water uses; time savings; and other welfare impacts? iii. What proportion of each benefit accrues to households who invest in sanitation and what proportion is external to the investor? iv. What is the actual or likely willingness to pay of households and other agencies for improved sanitation? What is up-front versus annual recurrent willingness to pay? v. How do benefits accrue or vary over time? vi. How is improved sanitation — and the related costs and benefits — tangibly linked with poverty reduction? What is the potential impact on national income and economic growth? vii. What is the overall household and community demand (expressed and latent demand) for improved sanitation? 8 Economic Assessment of Sanitation Interventions III. Methods The study methodology in the Philippines follows a stan- ments, as well as other benefits that may accrue outside the dard approach developed at the regional level reflecting sanitation improvement site, are excluded. Hence, Output established cost-benefit techniques (Boardman et al. 2006, 3 synthesizes the quantitative and qualitative findings to Gramlich, 1998), which have been adapted to sanitation in- generate overall conclusions and recommendations. terventions and the Philippines field study based on specific research needs and opportunities. As shown in Figure 2, the 3.1 Technical sanitation interventions study consists of a field component which leads to quan- evaluated titative cost-benefit estimates as well as an in-depth study The type of sanitation evaluated in this study is household of qualitative aspects of sanitation. Two types of field-level human excreta management. Interventions to improve hu- cost-benefit performances are presented: Output 1 reflects man excreta management at the household level focus on ideal performance assuming the intervention is delivered, both onsite and off-site sanitation options. One of the key maintained, and used appropriately; Output 2 reflects ac- aims of this study, where possible, is to compare the relative tual performance based on observed levels of intervention efficiency of different sanitation technologies. Basic hygiene effectiveness in the field sites. Both of these analyses are aspects of sanitation are also included, insofar as they affect partial, given that intangible benefits of sanitation improve- health outcomes and intangible aspects. FIGURE 2: FLOW OF DATA COLLECTED (INPUTS) AND EVENTUAL COST-BENEFIT ASSESSMENTS (OUTPUTS) www.wsp.org 9 Economic Assessment of Sanitation Interventions in the Philippines | Methods Interventions that jointly address human waste with do- costs. The progression shown in Figure 3 is not necessar- mestic wastewater management (especially in urban areas) ily true in all settings and hence needs to be altered based and with animal waste management (in the case of biogas on setting-specific features (e.g., rural or urban, different generation) are also considered. In Vietnam, the study in- physical/climatic environments such as soil type or water cludes other sanitation improvements, covering solid, agri- scarcity). Furthermore, a higher technology will only pro- cultural, and trade village wastes. vide an improved level of service if it is maintained and operated properly. To qualify as an economic evaluation study, a cost-benefit analysis compares at least two alternative intervention op- While previous studies have estimated the costs and ben- tions. It usually includes comparison with the baseline of efits of achieving the MDG target and universal sanita- “do nothing.� However, comparing two sanitation options tion coverage, sanitation options considered should not be will rarely be enough since, ideally, the analysis should com- restricted by “unimproved� and “improved� sanitation as pare all sanitation options that are feasible for each setting defined by the WHO/UNICEF JMP. For example, some — in terms of affordable, technically feasible, and culturally households will be interested to upgrade from one type of acceptable options — so that a clear policy recommenda- improved sanitation to another type, such as from VIP to tion can be made based on efficiency of a range of sanitation septic tank, or from septic tank to sewerage. Other house- options, among other factors. holds are faced with a decision whether to replace a facility that has reached the end of its useful life. Under some pro- Technical sanitation options include all those interven- gram approaches, e.g., Community-Led Total Sanitation tions that move households up the sanitation technology (CLTS), households are also encouraged to move up the ladder and, thus, bring benefits. Figure 3 presents a gen- ladder, even if it does not imply a full move to JMP-defined eralized sanitation technology ladder. The upward slope of “improved� sanitation, such as the use of shared or unim- the ladder reflects the assumption of greater benefits as the proved private latrines. household climbs the ladder, but (generally) with higher FIGURE 3: REPRESENTATION OF THE SANITATION TECHNOLOGY “LADDER� Costs per household Pour or mechanical flush with sewerage Pour or mechanical flush with septic tank Pour or mechanical flush latrine with pit Improved dry pit latrine with appropriate excreta management or reuse Improved public or shared latrine Unimproved pit latrine Water Quality Intangibles Public or unimproved shared latrine Health Status Open defecation Access Time (to land or water) Bene�ts per household 10 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Methods 3.2 Costs and benefits evaluated critical mass of households has improved their sani- Sanitation costs are the denominator in the calculation ben- tation. These benefits may include: health impacts efit-cost and cost-effectiveness ratios, and are thus crucial related to environmental exposure to pathogens to the evaluation of sanitation option efficiency. Summary (e.g., water sources, open defecation practices), aes- cost measures include the total annual and lifetime costs, thetics of environmental quality, and usability of lo- cost per household and cost per capita. For financing and cal water sources for productive activities. Given the planning purposes, this study disaggregates costs for each challenges in designing studies to distinguish these sanitation option by capital and recurrent costs, and by fi- benefits from household direct benefits, this study nancier. The incremental costs of moving up the sanitation classified local level external benefits with household ladder are also assessed. direct benefits. 3. Wider scale external benefits: These result from im- To maximize the usefulness of an economic analysis for proved sanitation at the macro level. Benefits may diverse audiences, the benefits of improved sanitation and include: water quality for productive uses, tourism, hygiene are divided into three categories: local business impact, and foreign direct investment. They can either be linked to coverage in specific areas 1. Household direct benefits: These are incurred by or zones (e.g., tourist area or industrial zone), or the the households who are making the sanitation im- country generally (e.g., investment climate). As well provement. The actual or perceived benefits will as improved management of human excreta, other drive the decision by the household to invest in contributors to environmental improvement such as sanitation, and will also guide the type of sanitation solid waste management and wastewater treatment improvement chosen. These benefits may include: need to be considered. health impacts related to household sanitation and hygiene, local water resource impacts, access time, In brief, this study distinguishes between the economic intangible impacts, house prices, and the value of analysis results and local community impacts, where the human excreta reuse. sanitation and hygiene improvements take place, and na- 2. Local level external benefits: These are potentially tional level impacts. Table 2 shows the impacts included incurred by all households living in the environment in the current study, distinguishing between those impacts where households improve their sanitation. Howev- that are expressed in monetary units and those that are ex- er, some of the benefits may not be substantial until a pressed in non-monetary units. TABLE 2: BENEFITS OF IMPROVED SANITATION INCLUDED IN THIS STUDY Socio-economic impacts evaluated in Level Impact Monetary terms ($ values) Non-monetary terms (non-$) • Health care costs • Disease and mortality rates Health • Health-related productivity • Quality of life impacts • Premature death • Gender impacts • Water sourcing Domestic Water Linking poor sanitation, water quality and practices Local benefits • Household treatment Other welfare Time use Convenience, comfort, privacy, status, security, gender Environmental quality Aesthetics of household and community environment Output reuse Fertilizer generated • Sanitation-tourism link: potential impact of poor sanitation on tourist numbers Tourism • Income losses associated with loss of tourists Tourism and • Tourist health costs business • Sanitation-business link: potential impact of poor sanitation Business on local business and FDI • Costs of averting negative impacts of poor sanitation www.wsp.org 11 Economic Assessment of Sanitation Interventions in the Philippines | Methods While the focus of this study is on household sanitation, The six sites selected for the study were Alabel, Bayawan, the importance of institutional sanitation also needs to be Dagupan, San Fernando (upland and coastal regions), and highlighted. For example, improved school sanitation may Taguig (Figure 4). San Fernando was originally envisioned affect decisions for children (especially girls) to start or stay as one site, but was eventually divided into the upland and in school until the end of the secondary level, and work- coastal regions to capture the potential differences in the place sanitation affects decisions of the workforce (espe- benefits and costs associated with the two environments. cially women) to take or continue work with a particular Figure 4 shows the location of these sites in the Philippines. employer. These impacts are incremental and beyond the It indicates that four sites (Dagupan, San Fernando and scope of this study. Taguig) are located in Luzon, while Bayawan and Alabel are located in the Visayas and Mindanao, respectively. The next sections describe the study methods for the three major study components: the field level cost-benefit assess- SITE 1: ALABEL ment (3.3), the assessment of program effectiveness (3.4) Alabel is a first class municipality and is the capital of Saran- and national level impacts (3.5). gani province in Region XII (Soccsksargen). Composed of one urban and 11 rural barangays, it is bounded by South 3.3 Field studies Cotabato (northwest), Malugon (northeast), Malapatan 3.3.1 FIELD SITE SELECTION AND DESCRIPTION (southeast) and Sarangani Bay (southwest). It has four According to good economic evaluation practice, interven- rivers (Maribulan, Domolok, Molo and Lun Padidu) and tions evaluated should reflect the options faced by house- two lakes (Bito and Mofong). Based on the 2007 national holds, communities and policy makers. Therefore, locations census (NSO 2008a), Alabel had a population of 71,872 should be selected which contain a range of sanitation op- persons. Its population density of about 133 persons per tions which are typically available in the Philippines, cov- square kilometer (persons/km2) is nearly half of the Phil- ering both urban and rural sites. By sampling a range of ippine average of 295 persons/km2. Alabel is located in a representative locations, the study results can be generalized relatively poor region that had an average annual family in- outside the study settings, and hence be more useful for come of PhP113,919 (US$2,220)7 in 2006 and a per capita national and local level planning purposes. gross regional domestic product (GRDP) of PhP57,708 (US$1,250)8 in 2007 (NSCB 2008). Both values were low- The principal criterion for site selection applied in this er than the average for the country as a whole.9 Municipal study is that there has been a sanitation project or program records from Alabel indicated that 81% of families in the implemented in the past five years, and at some level of municipality had access to toilets which flush into a septic scale that allows minimum sample sizes of 30 households tank as of 2008. For the same year, 6% still used pit latrines to be collected per sanitation option per site. Once the list while 13% practiced open defecation. of projects and programs has been established, a further set of criteria was applied in order to reduce the short-list to six The ESI field survey in Alabel was conducted in barangays locations or projects (based on the available budget). These Poblacion, Kawas, Maribulan, and Baluntay. With the ex- criteria include (i) logistical feasibility for research to be ception of Poblacion, the barangays covered in the survey conducted; (ii) potential for collaboration with project/pro- are classified as rural areas. gram; (iii) being representative of the Philippines in terms of geophysical, climatic, demographic and socio-economic SITE 2: BAYAWAN characteristics. Annex Table A2 shows the list of projects Bayawan is a third class city located in the province of Ne- considered for the study. gros Oriental in Region VII (Central Visayas). Composed 7 US$1= PhP51.3, 2006 exchange rate 8 US$1= PhP46.2, 2007 exchange rate 9 The NSCB (2008) reported that the average annual family income in 2006 and per capita GDP of the Philippines for 2007 were PhP172,730 and PhP74,947, respectively. 12 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Methods FIGURE 4: LOCATION OF THE SELECTED FIELD SITES IN THE PHILIPPINES www.wsp.org 13 Economic Assessment of Sanitation Interventions in the Philippines | Methods of five urban and 23 rural barangays, it is bounded by Ma- Based on the 2007 national census (NSO 2008a), the city binao (north), Sta. Catalina (east), Tanjay City (southeast), had a population of 159,554 persons. Its population den- Basay (west), and Kabangkalan City (northwest). It has a sity of about 4,020 persons/km2 is more than ten times the 15 kilometer coastline from east to west and a 60 kilome- national average. Dagupan city is located in a relatively poor ter coastline from the south to the northern portion of the region in the country. The average annual family income of city. The city has four major rivers; namely, Sicopong, Ilog, Region I was PhP142,358 (US$2,773) in 2006 while its Pagatban, and Bayawan. Based on the 2007 national census per capita gross regional product was PhP38,053 (US$825) (NSO 2008a), the city had a population of 110,250 per- in 2007 (NSCB 2008). Despite this, Dagupan appears to sons and a population density of about 158 persons/km2. be a relatively prosperous city. Poverty incidence in the city Bayawan is also located in a relatively poor region in the was nearly 11% in 2003 (NSCB 2005), which was less country. The average annual family income of Region VII than half the national average and Region I incidence rate was PhP144,288 (US$2,812) in 2006 while its per capita of about 24% (NSCB undated). Sanitation coverage data is GRDP in 2007 was PhP69,797 (US$1,512) (NSCB 2008). available for the years 2004 to 2006. It indicates that nearly As with Region XII, both values were lower than the aver- 61% of households in the city had access to toilets which age for the country as a whole. The most recent sanitation flush to water-sealed pits in 2006. This was followed by toi- data from the Bayawan City Health Office is for the year lets which flush to septic tanks (25%), improved pits with 2000. It indicates that about 65% of families in the city had slab (4%) and unimproved open pits (2%). Close to 9% of access to toilets which flush into a septic tank. Other fami- families were estimated to practice open defecation. lies had access to flush toilets connected to a sewer network (1%), bucket/hole in ground (3%), ventilated improved The ESI field survey in Dagupan was conducted exclusively pit latrines (3%), flush toilets to pit (2%), and composting in barangay Pugaro. This is a coastal barangay that is also toilets/UDDT-E (less than 1%). About 26% of its popula- adjacent to Pugaro River.10 The houses in the barangay are tion practiced open defecation during that period. It is also also located approximately 500 meters from the sea. worth noting that the canals in the city streets are catego- rized as sewer lines. The main sewer line represents canals SITES 4 AND 5: SAN FERNANDO-COASTAL AND with a width of 1 meter while the secondary sewer line rep- SAN FERNANDO-UPLAND resents canals with a width of 0.7 meter. San Fernando is a third class city and is the capital of the province of La Union in Region I. It is bounded by the The ESI field survey in Bayawan was conducted in baran- municipalities of San Juan (north), Bauang (south), Bagu- gays Banga, Tinago, and Villareal. Tinago is classified as an lin (east), Naguilian (east), and the South China Sea in the urban barangay while the other two are rural barangays. In west. Composed of eight urban and 51 rural barangays, the survey, special attention was paid to a Gawad Kalinga it had a population of approximately 114,813 persons in village in barangay Villareal. 2007. Its population density of about 1,073 persons/km2 is more than three times the national average. Like Dagu- SITE 3: DAGUPAN CITY pan, it is located in a relatively poor region. However, San Dagupan is a second class city in the province of Pangasinan Fernando appears to be prosperous relative to other cities in Region I (Ilocos). Composed of 31 urban barangays, it and municipalities in the region. As of 2003, its poverty is bounded by Binmaley (west), Calasiao (south), Mangal- incidence rate of slightly over 14% is about 10 percentage dan (east), San Fabian (northeast), and the Lingayen Gulf points lower than the national and provincial averages. (north). Apart from a coastline that spans a total land area of nearly 12 kilometers, Dagupan also has seven major riv- Sanitation coverage statistics for the years 2006 to 2008 are ers — Magueragday-Anolid, Bayaoas, Calmay, Patogcawen, available from the City Health Report. The report indicates Dawel, Tanap, Pantal rivers. Dagupan is a low-lying area that slightly more than 65% of households in the city had that experiences flooding especially during the rainy season. access to water-sealed toilets in 2008. For the same period, 10 Pugaro river is part of the Pantal River stretch. 14 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Methods another 25% of the population had access to flush type toi- SITE 6: TAGUIG lets.11 The remainder of the households had access to shared Taguig is a first class city located in the National Capital toilets (3%), public toilets (less than 1%), composting toi- Region (NCR). It is bounded to the south by Laguna Lake lets/UDDT-E (less than 1%), unimproved open pits (less and Muntinlupa, and by various cities in other areas. The than 0.1%) and unclassified (5%). While official statistics major bodies in Taguig are Laguna Lake, Napindan channel do not report values for open defecation, interviews in ba- (upper mouth of Pasig river), and Taguig river. Other rivers/ rangay Nagyubyuban revealed that households still defecate creeks that flow across the city are Bagumbayan, Mauling/ in the bushes and near creeks. In addition, men from baran- Tabacuhan, Hagunoy, Tipas/Labasan, and Sta. Ana. The gays San Agustin and Ilocanos Sur admitted to defecating city is in a relatively high income region. The average annu- along the shoreline. al family income of the NCR of PhP310,860 (US$6,058) in 2006 (NSCB 2008) was nearly two times/twice the na- The ESI field survey for the upland site was conducted in tional average. On the other hand, the per capita GRDP Nagyubyuban. The survey for the coastal sites was imple- of the NCR was PhP223,332 (US$4,839) in 2007 (NSCB mented in barangays San Agustin, Poro, and Ilocanos Sur. 2008), or close to three times the national average. The Special attention was also given to a village of relocated fish- City Sanitation Office reported sanitation coverage statis- ermen in barangay Poro. These fishermen, who were origi- tics from 2003 to 2008.12 It indicated that about 87% of nally from Ilocanos Sur and Ilocanos Norte, were relocated the residents of the city had access to sanitary toilets13 — to an area with 97 housing units that have an UDDT-E about 7 percentage points higher than the value reported facility. San Agustin and Nagyubyuban are considered rural for 2003. The ESI field survey was conducted in barangay barangays, while the other sites are urban barangays. West Bicutan. TABLE 3: SANITATION AND HYGIENE INTERVENTIONS EVALUATED PER SITE San Fernando San Fernando Alabel Bayawan Dagupan Taguig Coastal Upland Rural Rural Urban Urban Rural Urban Open defecation • • • • • • Community/public toilets • • Shared toilets • • Private dry latrines: simple dry pits • Private dry latrines: urine diversion - dehydration toilets (EcoSan) or UDDT-E • • Private wet latrines (improved) • • • Septic tank: Not-watertight and/or dumping of sludge and/or effluent flow directly to • • • waterway/body Septic tank: Improved, with sludge removal and septage treatment facility • • Septic tank: Improved, with sludge removal and constructed wetland • Sewage/Sewerage: Decentralized conventional treatment • STF = septage treatment facility; UDDT-E = urine-diversion dehydration toilet (EcoSan) 11 No other information is available regarding these flush-type toilets. 12 Disaggregated data are not available. 13 Sanitary toilets refer to water-sealed, sewer/septic tank and closed pit. www.wsp.org 15 Economic Assessment of Sanitation Interventions in the Philippines | Methods Table 3 shows the interventions that were evaluated for each was not available or incomplete for a specific technology, study site. It indicates that about two to three interventions the study consulted experts in order to make a reasonable were analyzed for each site, and these were at varying points estimate. Some of the key points about the estimated costs of the sanitation ladder. The analysis in Dagupan and San are the following: Fernando focused more at the lower end of the sanitation • Components of investment costs. Investment costs ladder, with interventions ranging from community and represent the expenditures on labor and materials shared toilets to private wet latrines. In contrast, the op- for the construction and installation of facilities. In tions considered for Alabel, Bayawan, and Taguig were at the case of toilets, these include the expenditures for the higher end of the sanitation ladder — i.e., including constructing the substructure and superstructure, sludge and wastewater treatment. and the installation of toilet bowls. Where applica- ble, the costs of septic tank and treatment facilities Despite having a mix of rural and urban barangays in the were also included in the computations. survey, Alabel is treated in the cost-benefit analysis as a rural • Recurrent costs. These refer to expenditures for the area. One reason is that more than 60% of the respondents maintenance and operations of the facilities. For with access to a septic tank (with and without desludging) some of the facilities (UDDT-E, STF and other were from rural barangays. Another reason is that Alabel treatment facilities), the information was obtained has a population density that is slightly more than a tenth from the operators and the survey. However, no such of the least dense urban site in the study (San Fernando). Its estimates were available for toilets that flush to pits population density is also lower than Bayawan, a rural site and septic tanks. For these facilities, recurrent costs in the study. Given the points raised above, it was decided included in the analysis were water used for flushing by the study team that the outcomes for Alabel are more and cleaning toilets, desludging and repairs over the likely to reflect conditions in rural areas rather than urban course of its productive life. The values were calcu- areas. lated using assumptions that were based on the avail- able literature on water use, prices and maintenance 3.3.3 COST ESTIMATION METHODOLOGY costs of facilities. This study estimated the comprehensive costs of different • Adjustments to the cost of UDDT-E facilities. sanitation options. Cost estimation was based on informa- Based on the data collected from the Center for tion from three data sources (sanitation program or project Advanced Philippine Studies (CAPS), the cost of documents, the provider or supplier of sanitation services, constructing and installing an UDDT-E facility was and the ESI household questionnaire, described in 3.3.4). PhP14,214 (US$320) (adjusted to 2008 prices). This Data from these three sources were compiled, compared, is for a facility that has a substructure made from and adjusted, and entered into standardized cost tabulation concrete and walls made of flatsheets. However, esti- sheets. Annual equivalent costs of different sanitation op- mated costs from a separate study (FSSI et al. 2006) tions were calculated based on annualized investment cost were higher — PhP21,030 (US$473) for a facility (taking into account the estimated length of life of hardware made of light materials and PhP43,894 (US$987) and software components) and adding annual maintenance for a facility with more durable materials --- than and operational costs. For data analysis and interpretation, the CAPS estimate. There were two cost estimates costs were also broken down by financiers. Information used in this study. The first was to assume costs of from documents of sanitation projects and providers as well PhP14,214 (US$320) for the UDDT-E facilities in as market prices was supplemented with interviews with the upland region of San Fernando (barangay Na- key resource persons to ensure correctness of interpretation, gyubyuban). This was done because the facilities in and to enable adjustment where necessary. that region appear to be made of light materials. The second was to make an upward adjustment to the Cost estimates from the Philippines combine information costs of the UDDT-E facilities in the coastal region from the ESI survey, and documents from government of San Fernando. This was done to account for the agencies and operators. In situations where the information more durable (concrete) facilities found at the fisher- 16 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Methods men’s village in barangay Poro. The adjustment fac- tured. This included capturing the current situation in each tor (PhP43,894/PhP21,030) was based on the ratio type of household (e.g., health status and health seeking, of the costs in the FSSI study. water practices, time use), as well as understanding atti- • Standardizing costs for toilets that flush to a septic tudes towards poor and improved sanitation, and the fac- tank. To increase the comparability of the estimates, tors driving household and institutional decisions to invest and partially to address the fact that the design of in sanitation. These data were supplemented with evidence toilets vary within the study sites, the study adopted from other local, national and international surveys and a standard design for costing the cubicles, toilets and data sets on variables that could not be scientifically cap- septic tanks across the study sites. Hence, differences tured in the field surveys. These included disease incidence in cost estimates are attributable solely to variations and mortality rates, changes in disease rates associated with in prices and labor costs. The only exception was for improvements in sanitation access and economic variables the toilets in Bayawan which had a combined esti- (incomes and discount rates), etc. mate of the costs. Figure 5 presents an overview of the methods for estimating It is important to note that there are a number of limita- the benefits of moving up the sanitation ladder. The actual tions to the cost data that will be used in the study. The size of the benefit will depend on the specific sub-type of most significant of these limitations is the absence of in- sanitation intervention implemented. formation on program or software costs. This suggests that costs as a whole are likely to be underestimated in the study. The specific methods for calculating the sanitation benefits Another difficulty is that costs can exhibit wide variations are described below. for each toilet facility. Where available, these costs were ob- tained from sources specific to each site. However, there are Health: For the purposes of cost-benefit and cost-effective- other instances in which the cost of a facility in one site is ness analysis, three types of disease burden are evaluated: adopted for another site with a minor adjustment for price numbers of cases (incidence or prevalence), numbers of differences across sites. deaths, and disability-adjusted life-years (DALYs). Diseases included are all types of diarrheal disease, helminthes and 3.3.4 BENEFIT ESTIMATION METHODOLOGY diseases related to malnutrition. Malnutrition is partially Economic evaluation of sanitation interventions should be caused by environmental factors including poor water, based on sufficient evidence of impact, thus giving unbiased sanitation and hygiene, and the presence of malnutrition estimates of economic efficiency. Hence the appropriate at- increases the risk of, and fatality from, other diseases (e.g., tribution of causality of impact is crucial, requiring a robust malaria, acute lower respiratory infection, measles, etc.) (see study design. Annex Table A3 presents alternative study de- Annex Table A4). Health costs averted through improved signs for conducting economic evaluation studies, starting sanitation are calculated by multiplying overall health costs at the top with the most valid scientific approaches, down per household by the relative health risk reduction from to the least valid at the bottom. Given that the most valid improved sanitation and/or hygiene measures. Health costs scientific approach (a randomized time-series intervention are made up of disease treatment costs, productivity losses study) was not possible within the timeframe and resources and premature mortality losses. For cost-effectiveness anal- of this study, the most valid remaining option was to con- ysis, DALYs are calculated by combining the morbidity ele- struct an economic model for assessment of the cost-benefit ment (made up of disease rate, disability weight and illness of providing sanitation interventions and of moving from duration) and the mortality element (mortality rate and one sanitation coverage category to the next. A range of life expectancy). Standard weights and disease duration are data were used in this model, reflecting households with sourced from the Global Burden of Disease study (WHO and without improved sanitation, to ensure that before and 2008), and average life expectancy for the Philippines of after intervention scenarios were most appropriately cap- 70.8 years is used.14 14 This is the weighted average of the estimated life expectancy of males (67.83 years) and females (73.8 years) for 2005. The raw data was taken from the Philippine Statistical Yearbook (NSCB 2008). www.wsp.org 17 Economic Assessment of Sanitation Interventions in the Philippines | Methods FIGURE 5: OVERVIEW OF METHODS FOR ESTIMATING FIELD-LEVEL BENEFITS OF IMPROVED SANITATION BENEFIT POPULATION WITH POPULATION WITH BENEFIT CATEGORY UNIMPROVED SANITATION IMPROVED SANITATION ESTIMATED Data on health risk per person, Generic risk reduction, Averted health care costs, HEALTH by age category & socioeconomic using international literature reduced productivity loss, status reduce deaths Data on water source and Observed changes Reduced water sourcing WATER treatment practices in practices in populations and water treatment costs with improved sanitation Data on time to access toilet Observed reductions in time Opportunity cost of time ACCESS TIME per person per day to access toilet applied to time gains Attitudes and preferences Bene�ts cited of improved Strength of preferences for INTANGIBLES of householders to sanitation sanitation different sanitation aspects and willingness to pay Practices related Value gained, based on REUSE to excreta reuse sales or own use • Rates of morbidity and mortality are sourced from or an actual financial loss for adults with paid work. various data sets for three age groups (0-4 years, 5-14 The unit cost values are based on the average income years, 15+ years), and compared and adjusted to re- rates per location. For adults a rate of 30% of the flect local variations in those rates. National disease average income is applied, reflecting a conservative and mortality rates were adjusted to rates used for estimate of the value of time lost. For children 5-14 the field sites based on socio-economic character- years, sick time reflects lost time at school which istics of sampled populations. As not all diarrheal has an opportunity cost, valued at 15% of the aver- diseases are from fecal-oral transmission, an attribu- age income. For children under five, the time of the tion fraction of 0.88 is applied for these diseases. For child carer or caregiver is applied at 15% of the aver- helminthes, an attribution factor of unity was used age income. Values are provided in Table 4. in the study — i.e., cases are fully attributed to poor • Premature death costs are calculated by multiply- sanitation. Methods for the estimation disease and ing the mortality rate by the unit value of a death. mortality rates from indirect diseases via malnutri- Although premature death imposes many costs on tion are provided in the ESI Impact Study report societies, it is difficult to value precisely. The method (Rodriguez et al. 2008). employed by this study — the human capital ap- • Health care costs are calculated by applying treat- proach (HCA) — approximates economic loss by es- ment seeking rates for different health care providers timating the future discounted income stream from to the disease rates, per population age group. The a productive person, from the time of death until calculations also take into account hospital admis- the end of (what would have been) their productive sion rates for severe cases. Unit costs of services and life. While this value may undervalue premature loss patient travel and sundry costs are applied based on of life, as there is a value to human life beyond the treatment seeking. productive worth of the workforce, the study faced • Health-related productivity costs are calculated by limited alternative sources of value due to a lack of applying time off work or school to the disease rates, studies (e.g., value-of-a-statistical-life15). Values are per population age group. The economic cost of time provided in Table 4, including VOSL adjusted to the lost due to illness reflects an opportunity cost of time Philippines from developed country studies. 15 VOSL studies attempt to value what individuals are willing to pay to reduce the risk of death (e.g., safety measures) willing to accept for an increase in the risk of death.These values are extracted either from observations of actual market and individual behavior (“hedonic pricing�) or from what individuals stated in relation to their preferences from interviews or written tests (“contingent valuation�). Both these approaches estimate directly the willingness to pay of individuals, or society, for a reduction in the risk of death, and hence are more closely associated with actual welfare loss compared with the HCA. 18 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Methods TABLE 4: UNIT VALUES FOR ECONOMIC COST OF TIME PER DAY AND OF LOSS OF LIFE, PESOS, 2008 Daily value of time Value of life Technique 0-4 years 5-14 years 15+ years 0-4 years 5-14 years 15+ years Rural Human capital approach1 53 53 106 653,325 1,022,456 1,071,496 VOSL2 3,490,237 3,490,237 3,490,237 Urban Human capital approach1 53 53 106 653,325 1,022,456 1,071,496 VOSL 2 3,490,237 3,490,237 3,490,237 1 2% real GDP or wage growth per year, discount rate = 8% 2 The VOSL of US$2 million is transferred to the study countries by adjusting downwards by the ratio of GDP per capita in each country to GDP per capita in the USA. The calculation is made using official exchange rates, assuming an income elasticity of 1.0. Direct exchange from higher to lower income countries implies an income elasticity assumption of 1.0, which may not be true in practice. • Risk reductions of illness and death associated with • Accessing water from the source. Because households improved sanitation and hygiene interventions are pay more or walk further to access water from clean- assessed from previous reviews of the internation- er sources such as drilled wells, or they pay more for al literature (Esrey et al. 1985; Esrey and Habicht piped water, it would in theory reduce these costs if 1986; Esrey et al. 1991; Prüss and Mariotti 2000; sanitation was improved. For example, traditionally, Fewtrell et al. 2005, Waddington et al. 2009), and people prefer the taste of water from shallow wells are applied and adjusted to reflect risk reduction in to deeper wells, and hence would likely return to local settings based on baseline health risks and in- use of shallow wells or wells closer to their home if terventions applied. they could guarantee cleaner and safer water. Also, in some instances, water access and treatment costs of Water: While water has many uses at the community level water utilities may be lower if they use local and less as well as for larger-scale productive purposes (e.g., indus- contaminated water sources. Hence, expected per- try), the focus of the field study is use for domestic pur- centage cost reductions are applied to current costs poses, in particular drinking water. The most specific link of clean water access to estimate cost savings from between poor management of human excreta and water improved sanitation. quality is the safety aspect, which causes communities to • Household treatment of water. Traditionally, many take mitigating actions to avoid consuming unsafe water. households treat their water due to concerns about These include reducing reliance on surface water and more safety and appearance. This is commonly true even use of wells or treated piped water supply or bottled water. for piped treated water supplies. Boiling is the most It even involves the need to rely less on shallow dug wells popular method because it is perceived to guarantee which are more easily contaminated with pathogens, and to that water will be safe for drinking. However, boiling drill deeper wells. water can require considerable cash outlays or it con- sumes their time for collecting fuel. Furthermore, Water quality measurement was conducted by the Inter- boiling water for drinking purposes is more costly to tek Testing Services Philippines Inc. as part of this study in the environment due to the use of wood, charcoal or representative field sites, to enable a detailed analysis of the electricity, with correspondingly higher CO2 emis- impacts of improved sanitation on local water quality (see sions than other treatment methods. If sanitation is Annex Table A5). This study measures the actual or poten- improved and the pathogens in the environment re- tial economic impacts of improving sanitation on two sets duced to low levels, then households may feel more of mitigation measures: ready to use a simple and less costly household treat- www.wsp.org 19 Economic Assessment of Sanitation Interventions in the Philippines | Methods ment method such as filtration or chlorination. Or if tools do exist for quantitative assessment of intangible ben- piped sources could be trusted, as in most industrial- efits such as contingent valuation method, and willingness ized countries, households may no longer need to to pay surveys are commonly used to value environmental treat their water. Hence, based on observations and goods. However, there are many challenges to the applica- expected future household treatment practices under tion of these methods in field settings which affect their a situation of improved sanitation, the cost savings reliability and validity, and ultimately appropriate interpre- associated with changes in water treatment practices tation of quantitative results. Furthermore, willingness to are calculated. pay often captures more than just the intangible variables being examined, but will also capture preferences that have Access time: When households have their own private la- been valued elsewhere (e.g., health and water benefits). This trine, many of them will save time every day, compared to current study therefore attempts only to understand and the alternative of going to the bush or using a shared facil- measure sanitation knowledge, practices and preferences in ity for their toilet needs. The time used for each sanitation terms of ranking scales and descriptive presentation. This option will vary from household to household, and from enables a separate set of results to be provided alongside the person to person, as children, men, women, and the el- monetary-based efficiency measures. derly all have different sanitation preferences and practices. Therefore, this study calculates the time savings for differ- External environment: Likewise, the impacts of poor sani- ent population groups of improved sanitation, based on ob- tation practices on the external environment are also difficult servations of households both with and without improved to quantify in monetary terms. Hence, this study attempts sanitation. The value of time is based on the same values as only to understand and measure practices and preferences health-related time savings (see above). in relation to the broader environment, in terms of ranking scales and descriptive presentation. Given human-related Excreta reuse: Human excreta, if handled properly, can be sanitation is only one of several factors in environmental a safe source of fertilizer, wastewater for irrigation or aqua- quality, other aspects — sources of water pollution, solid culture, or biogas. However, improved human excreta re- waste management, and animal waste — are also addressed use is not commonly practiced in the Philippines. Only the to understand human excreta management within the over- UDDT-E users in the two San Fernando sites were found to all picture of environmental quality. re-use human excreta for fertilizer. The value of excreta re- use is measured through assessment of both the nonmarket A summary of the key formulas, variables and data sources value (when used by the household, which either saves costs used for calculating the monetized benefits is provided in or generates additional benefit) and the market value (when Annex Table A6. sold at a price). This enables calculation of an average value per household practicing safe human excreta reuse. In the 3.3.4 DATA SOURCES case of combined human and animal excreta reuse (as in the Given the range of costs and benefits estimated in this case of biogas), both the full cost and the full benefit of the study, a range of data sources were defined including both biogas digester are included. up-to-date evidence from the field sites as well as evidence from other data bases or studies. Given the limitations of Intangibles: Intangibles are major determinants of person- the field study, some elements of some benefits needed to al and community welfare such as comfort, privacy, conve- be gathered from other more reliable sources. Routine data nience, safety, status and prestige. Due to their often very systems such as the health information system are often of private nature, intangibles are difficult to elicit reliable re- poor quality and incomplete, while larger more reliable na- sponses from individuals, and some may vary considerably tionwide or local surveys may be out of date, or were not from one individual and social group to another. Intangi- conducted in the ESI field locations. bles are therefore difficult to quantify and summarize from a population perspective, and are even more difficult to val- Under the supervision of the ESI region and country leads, ue in monetary terms for a cost-benefit analysis. Economic the survey was led by Ms. Dieldre Harder of the Resources, 20 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Methods Environment, and Economics Center for Studies, Inc. (RE- The household questionnaire was applied to a total of 1,270 ECS). Four teams were deployed for the surveys. Each team households over the six sites, or roughly 212 households had one area supervisor, one research associate/assistant, per site divided over households with improved and un- and four to five enumerators. improved sanitation. In most sites, control sites were also established for comparison with intervention sites. An- A month prior to the survey, area supervisors engaged in nex Table A7 presents the sample sizes per sanitation op- pre-data collection in their respective sites. The objective tion and per field site. Representing approximately 6% of was to obtain an estimate of the population of households the total possible respondents, the number of respondents from which the sample of respondents can be drawn. Infor- was initially selected with a view towards having the same mation was obtained from municipal records. If unavail- margin of error for each site and intervention. However, able, especially for households practicing open defecation, exceptions were made in interventions/options that had a the area supervisors consulted Barangay Health Workers. relatively limited number of potential respondents. An ex- The ESI team also conducted site visits and focus group ample here was the number of households in Alabel whose discussions to familiarize themselves with conditions in the septic tanks have been emptied. Only 44 potential respon- sites as well as potential issues and concerns. dents were identified and a complete enumeration of these respondents was implemented. Another example was the In the course of the survey, the teams stayed in the sites for number of UDDT-E users in the upland region of San Fer- an average of two to three weeks. However, in situations nando. Prior to the survey, 49 potential respondents were with high refusal rates and bad weather, the survey teams identified but only 17 were found to be actually using their extended their stay in the sites by a few days. facilities. Given the situation, all 17 target respondents were interviewed in the survey. For interventions with a suffi- The contents of the field tools applied are introduced brief- ciently large population, the respondents were randomly ly below (the tools applied in the Philippines are available selected. Replacements were included in cases where the from WSP). original respondents refused to be interviewed. Field tool 1: Household questionnaire. Household ques- On average, the interviews lasted about one hour and 15 tionnaires consisted of two main parts: the first was for minutes per household. Across all sites, about one in ten household representatives (the senior male and/or female households refused to be interviewed. The rate of refusal household member, based on availability at time of inter- was higher for households practicing open defecation in view), while the second was a shorter observational compo- barangay San Agustin, San Fernando City. Two other prob- nent covering mainly physical water, sanitation and hygiene lems were encountered in the conduct of the surveys. First, features of the household. The interview part consisted of the initial information provided on the types of latrines of sections on: the respondents was incorrect in several instances. This led to deviations between the planned and actual interviews • Socio-economic and demographic information, and conducted for the different sites/interventions (see Annex household features Table A7). Second, respondents also complained about the • Current and past household sanitation options and length of the interview, especially when it interfered with practices, and mode of receipt their household activities. • Perceived benefits of sanitation, and preferences re- lated to external environment It is also important to note that there were no significant • Household water supply sources, treatment and stor- differences in the manner in which rural and urban house- age practices holds reacted to the interviews. However, the enumerators • Health events and health treatment seeking noted that households in urban areas were more apprehen- • Hygiene practices sive in providing information on their income and assets • Household solid waste practices and in allowing the enumerators to enter their houses. www.wsp.org 21 Economic Assessment of Sanitation Interventions in the Philippines | Methods Field tool 2: Focus group discussion. The purpose of the ber 2009. The study enabled assessment of the impact of focus group discussion (FGD) was to elicit behavior and specific local sanitation features on water quality. It also en- preferences in relation to water, sanitation, and hygiene abled a broader comparison of water quality between study from different population groups, classified (if possible) by sites with different sanitation coverage levels. Water sources sanitation coverage (with versus without) and by gender. tested in each site included ground water (dug shallow The topics covered in the FGDs followed a generic template wells, deeper drilled wells), standing water (ponds, lakes, of discussion topics, but the depth of discussion was dic- canals), and flowing water (rivers, wastewater channels). tated by the readiness of the participants to discuss the top- Annex Table A5 and A8 shows the type of test and location ics. The added advantage of the FGD approach is to discuss per parameter, and the number and type of water sources aspects of sanitation and hygiene that may not otherwise be tested. Parameters measured varied per water source, but revealed by face-to-face household interviews, and to either generally included E. coli, Biological Oxygen Demand for arrive at a consensus or otherwise to reflect the diversity of 5 days (BOD5), Chemical Oxygen Demand (COD), Dis- opinions and preferences for sanitation and hygiene among solved Oxygen (DO), Nitrates, Ammonical Nitrogen, con- the population. ductivity, turbidity, pH, and residual chlorine. A total of 18 FGDs were conducted in all the sites. Led Field tool 5: Market survey. For economic evaluation, local by Dr. Carmela Taguiam (sociologist), three to four FGDs, prices are required to value the impacts of improved sani- each lasting about one and half hours, were conducted for tation and hygiene. Selected resource prices, and in some each site. More than 180 people participated in the FGDs cases, resource quantities, were recorded from the most (see Annex Table A8). appropriate local source. These include (where available): labor prices (average wage, minimum wage) and employ- Field tool 3: Physical location survey. A survey of the phys- ment rate, water prices by different sources, water treatment ical environment was conducted in all field locations. The filters, fuel prices, sanitation improvement costs, soap costs, main purpose was to identify important variables in relation fertilizer costs (when excreta is used for fertilizer), and phar- to water, sanitation and hygiene in the general environment, macy drug costs. The market surveys were implemented in covering land use, water sources, and environmental qual- all the sites. ity. This information was triangulated with the household surveys and FGDs as well as the water quality measurement Field tool 6: Health facility survey. Given the importance survey, to enable appropriate conclusions about the extent of health impacts, a separate survey was conducted in one of poor sanitation and links to other impact variables. This to three health facilities serving each field site (Annex Table survey was conducted by Ms. Louisa Bite (Taguig), Ms. A8). Variables collected include numbers of patients with Lisa Laus (Bayawan), Ms. Clarissa Andrade (Alabel), and different types of WSH-related disease, and the types and Ms. Marilou Eugenio (Dagupan and San Fernando). cost of treatment provided by the facility. Data were sup- plemented by information collected from municipal/city Field tool 4: Water quality measurement. Because poor health offices. sanitation has detrimental impacts on water quality, special attention was paid in this study to identify the relationship Other data sources: In addition to the data collected from between the type and coverage of toilets in the selected field the field sites, information was gathered from other sources sites and the quality of local water bodies. Given the time to support the field-level cost-benefit study, such as reports, scale of this present study, it was not possible to measure interviews, and data sets. These include: water quality variables before the project or program was • Demographic and health survey: regional incidence implemented; neither was it possible to compare wet season rates, under-five mortality rates and dry season measurements. The water quality measure- • Local government publications: site-specific infor- ment survey was contracted to Intertek Testing Services mation on demographic and economic data, sanita- Phils. and carried out in the months of August and Septem- tion coverage, drinking water sources, health statis- 22 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Methods tics, prices of goods and services and water bodies shows the annual equivalent rate of return of spend- • National statistics: regional demographic and eco- ing on sanitation, and can be compared with other nomic data, price deflators development projects or alternative uses of funds • Local literature: costs and lifespan of toilet facilities, (e.g., earning interest in a bank account). water consumption and related information, water 4. The payback period (PBP) is the time after which treatment costs benefits have been paid back, assuming initial costs • International health literature: rates of disease, and exceed benefits (due to capital cost) and over time effectiveness of WSH interventions to avert disease benefits exceed costs, thus leading to a break-even point. 3.3.5 DATA ANALYSIS 5. The net present value (NPV) is the net discounted The types of costs and benefits included in the study are benefits minus the net discounted costs. listed in Section 3.2. This section describes how costs, ben- efits and other relevant data are analyzed to arrive at overall Results are presented by field site and for each sanitation cost-benefit estimates. improvement option compared with no sanitation option (i.e., open defecation). Also, selected steps up the sanitation The field level cost-benefit analysis generates a set of effi- ladder are presented, such as from shared latrine to private ciency measures from site-specific field studies, focusing latrine, from dry pit latrine to wet pit latrine, or from wet on actual implemented sanitation improvements, includ- pit latrine to sewerage. The efficiency ratios are presented ing household and community costs and benefits. The costs both under conditions of well-delivered sanitation pro- and benefits are estimated in economic terms for a 20 year grams which lead to well-functioning sustainable sanitation period for each field site, using average values based on the systems, as well as sanitation systems and practices under field surveys and supplemented with other data or assump- actual conditions, observed from the program approach tions. Five major efficiency measures are presented: analysis (Section 3.4). Given that not all sanitation benefits 1. The benefit-cost ratio (BCR) is the present value of have been valued in monetary units, these benefits are de- the future benefits divided by the present value of scribed and presented in non-monetary units alongside the the future costs, for the 20 year period. Future costs efficiency measures. Gender issues are particularly central in and benefits (i.e., beyond the first year) are discount- the presentation of intangible benefits. ed to present value using a discount rate of 8% (sen- sitivity analysis: low 5%, high 10%). The 8% dis- The results described above reflect data on the input vari- count rate was used in a recent study conducted by ables of the “average� population. Therefore, to assess Montenegro et al. (2005). The “high� discount rate whether intervention efficiency is higher or lower in dif- that will be used in the sensitivity analysis follows the ferent income categories and socio-demographic groups, rate used by Predo (2003), Catelo et al. (2001), and input values for poor and vulnerable groups without sanita- Ebarvia (1997). The “low� discount rate of 5% was tion are entered into the economic model, and compared chosen arbitrarily. with the average and with high income groups. The main 2. The cost-effectiveness ratio (CER) is the present variables varying are household size, value of time, disease value of the future health benefits in non-monetary and mortality rates, water supply and treatment practices, units (cases, deaths, disability-adjusted life-years) di- and the investment (cost) most likely to be made in the vided by the present value of the future costs, for the sanitation option. 20 year period. Future costs and health benefits (i.e., beyond the first year) are discounted to present value Further assessments are conducted to enable national inter- using a discount rate (see above). pretation of efficiency results. This involves entering input 3. The internal rate of return (IRR) is the discount rate values in the economic model corresponding to national at which the present value equals zero — that is, the averages for rural and urban areas, which is likely to give costs equal the benefits — for the 20 year period. It different results from the specific field sites. www.wsp.org 23 Economic Assessment of Sanitation Interventions in the Philippines | Methods TABLE 5: SAMPLE SIZES FOR TOURIST SURVEY, BY MAIN ORIGIN OF TOURIST Holiday tourists Business visitors Tourist nationality First time Repeat First time Repeat Total Total Total visitors visitors visitors visitors Europe 26 33 59 9 10 19 78 North America 17 33 50 5 8 13 63 Asia 10 5 15 5 1 6 21 Australia/New Zealand 7 10 17 0 7 7 24 Rest of the world 0 0 0 3 0 3 3 Total 60 81 141 22 26 48 189 3.4 National studies National level studies served two main purposes: (a) to as- the departure lobby of the Ninoy Aquino International Air- sess the impacts of improved sanitation outside field sites port (NAIA) Terminal 1. Table 5 shows the sample size by to enable a more comprehensive cost-benefit analysis (tour- type of visitor, major categories of nationality, and whether ism, business and sanitation reuse value); and (b) to com- they are return visitors or not. plement or supplement data collected at field level to enable better assessment of local level impacts. The survey was applied in English and Korean, the latter to enable more Asian tourists to be included. Conducted 3.4.1 TOURIST AND VISITOR SURVEY during the period of 4-8 May 2009, the survey method was There exists an arguable link between sanitation and tour- a mix of drop-off and face-to-face interviews, depending ism, but for which, to date, very little hard evidence exists. on the preference of the respondent. The rejection rate was Poor sanitation and hygiene affect tourists in two ways: quite high, more than 40%. Eleven of the 200 responses 1. Short term welfare loss and expenses. Tourists get were discarded because the questionnaires were not com- sick from diarrhea, intestinal worms, hepatitis, etc, pleted. On average, a questionnaire was completed in 20 which have direct health care costs, and tourists are minutes. The survey form included questions on the fol- exposed to environments with poor sanitation, thus lowing topics: resulting in a reduction in holiday enjoyment. • Length of trip, places stayed and price category of 2. Reduced tourist numbers. In the longer term, hotel tourists stay away from tourist locations which are • Level of enjoyment of different locations visited, and deemed to be unsafe (from a health perspective) or reasons unpleasant, such as unclean water, smelly environ- • Sanitary condition of places visited, and availability ment or without proper toilets. Tourists may stay of toilets away either because they already had an unpleasant • Water and sanitation-related sicknesses suffered, per- experience themselves in a tourist site and choose ceived sources, days of sickness, and type and cost of not to come back; or they have been recommended treatment sought not to visit a location due, among other things, to • Major sources of concern for a holiday stay in the poor sanitation. Philippines • Intention to return to the Philippines, recommenda- This present study attempts to explore these two impacts via tion to friends, and reasons a survey of non-resident foreign visitors. Aside from holiday tourists, business visitors were also included to get personal 3.4.2 BUSINESS SURVEY views of business visitors and hence make an important Poor sanitation also has the potential to affect businesses. link with the business survey (Section 3.4.2). A total of 141 Two types of impacts are assessed, the local-level “micro� holiday tourists and 48 business visitors were interviewed at impact and the higher-level “macro� impact: 24 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Methods 1. Businesses located in areas with poor sanitation may In order to assess both these hypothesized effects, a total of pay higher costs (e.g., having to pay more to access 17 firms were surveyed through face-to-face interviews and clean water) or lose income (due to customers being in some cases, in-depth discussions. Table 6 shows the num- unwilling to visit the location). It should be noted, ber of firms, by sector, and by number of employees. These though, that the customer losses assessed here are firms were selected based on the hypothesized link between not necessarily absolute losses to the country, as cus- sanitation and their business, and the importance of the tomers may have the choice to go elsewhere — i.e., sector and specific firm to the economy of the Philippines. to other businesses located in other areas. Naturally, the survey of foreign firms was of those firms that 2. Foreign businesses who decide not to locate in the have already located in the Philippines, and hence a key cat- Philippines. Among the many reasons for decid- egory of firm — those that had decided against locating in ing whether to locate a business in the Philippines, the Philippines — did not form part of the sample. Howev- sanitation may be one of them. There are several er, foreign firms were asked about the factors affecting their pathways through which poor sanitation may affect decision to locate in the Philippines, and their experiences a business’ decision to locate in the Philippines: (a) of the country. health of the workforce, due to actual statistics or business leader perceptions of poor health of a na- The survey form included questions on the following top- tion’s workers; (b) poor (perceived) quality of water ics: for use by the business, and the related costs; (c) gen- • Ownership, sector, activities, employees and location eral poor environment (solid waste, unsightliness) of firm (production, sales, etc) which affects the ability to do business; and (d) un- • Perceptions of sanitation at company location desirability for foreign staff to be located in the Phil- • Factors affecting decision to locate in country or ippines due to the poor sanitary conditions, among area, and intention to relocate other things. • The production and sales costs related to different as- pects of poor sanitation (health, water, environment) TABLE 6: SAMPLE SIZE FOR BUSINESS SURVEY, BY MAIN • Potential costs and benefits of improved sanitation SECTORS OF FIRMS related to the business Main business or No. of Number of employees sector of firm firms 0-9 10-50 51-200 3.4.3 NATIONAL SANITATION MARKETS Aquaculture 2 1 1 0 Sanitation markets include institutions that facilitate the Retail: Wet markets 1 3 3 0 0 sale of goods arising from the reuse of human excreta as Resort/restaurants 4 2 0 2 fertilizer, soil conditioners and biogas. While the reuse of Slaughterhouse 2 1 1 0 sanitation “outputs� is limited to date in the Philippines, it is useful to estimate the potential economic benefits of these Travel 2 0 1 1 activities. Such an analysis will help support policy makers Water/ice 2 2 0 0 and the private sector to assess whether reuse options could Food processing 2 0 1 1 be economically and financially viable to stimulate invest- Total 17 9 4 4 ment in this area. Hence this study calculates the potential 1 Wet markets are places where live or slaughtered animals, fruits and economic value based on assumptions of different adoption vegetables, and other produce are sold. Hygiene standards in such places levels and output values, ranging from realistic to higher are usually inferior to supermarkets. (potential) adoption and price levels. www.wsp.org 25 Economic Assessment of Sanitation Interventions in the Philippines | Methods 3.4.4 NATIONAL HEALTH STATISTICS The field surveys provided data from the sampled house- holds and health facilities on disease incidence for selected diseases related to poor sanitation. For some sites, other studies conducted in the same locality provided alterna- tive sources of disease incidence data. However, constraints in data robustness at the field level requires supplementa- tion of these data with estimates on disease incidence and mortality rates from other sources, and adjustment to the health conditions of the specific field sites. Data were there- fore sourced from national surveys (e.g., Demographic and Health Survey) and research studies as well as internation- ally compiled statistics for the Philippines or the Southeast Asia region (World Health Organization; Disease Control Priorities Project 2). The data from these different sources were compared in terms of quality and applicability to the field sites, to finally select the most appropriate values for use in the cost-benefit analysis and the national health over- view. 26 Economic Assessment of Sanitation Interventions IV. Local Benefits of Improved Sanitation and Hygiene This chapter presents the local impacts of improved sanita- 4.1.1 DISEASE BURDEN OF POOR SANITATION tion and hygiene. In particular, it covers the following top- AND HYGIENE ics: Table 7 shows the disease burden associated with poor sani- tation and hygiene among children under the age of five • Health (Section 4.1) years. It indicates an estimated 4,558 disease cases, two • Water (Section 4.2) deaths and 18 DALYs lost per 1,000 children each year in • Access time (Section 4.3) rural areas. While estimated disease incidence and DALYs • Reuse of human excreta (Section 4.4) are not too different from those in urban areas, mortality • Intangibles (Section 4.5) rates for children living in rural areas are about 50% (2.2 • External environment (Section 4.6) per 1,000 against 1.5 per 1000) higher than in urban ar- • Projects and actual benefits (Section 4.7) eas. Diarrheal diseases account for the largest proportion of • Summary of results (Section 4.8) cases, deaths and DALYs lost. 4.1 Health Site-specific rates used in the study are presented in Annex The following sub-sections discuss the key values and as- Table B1. While the estimates do not differ too much across sumptions used in the calculation of the health benefits. the sites, Dagupan had the highest incidence rates among It also summarizes the estimated benefits for the different children under the age of five years. On the other hand, the study sites. highest mortality rates were estimated for the upland region TABLE 7: DISEASE RATES ATTRIBUTABLE TO POOR SANITATION AND HYGIENE FOR CHILDREN UNDER 5 YEARS, ANNUAL RATES PER 1000 PERSONS, 2008 Rural sites Urban sites Disease Cases Deaths DALYs Cases Deaths DALYs Direct diseases Diarrhea 4,120.6 1.32 6.0 4,159.5 0.87 6.0 Helminthes 369.7 0.01 2.3 369.7 0.01 2.3 Indirect diseases Malnutrition nc 0.05 0.8 nc 0.05 0.8 Malaria 0.4 0.02 0.2 0.4 0.01 0.2 ALRI 67.6 0.60 5.7 46.0 0.35 5.2 Measles nc 0.11 1.0 nc 0.06 0.9 Other diseases nc 0.12 1.5 nc 0.12 1.5 Total 4,558.3 2.22 17.5 4,575.5 1.47 16.9 Note: nc = not calculated Source: Annex Table B1 www.wsp.org 27 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene of San Fernando. Such differences are explained by adjust- Figure 6 shows the incidence rates for direct diseases for ments in national disease incidence and mortality rates that all age groups and sites. The values reported here are lower were implemented in order to more closely reflect condi- than those in Table 7 because incidence rates for diarrheal tions in the study sites. For example, diarrheal disease rates diseases are lower for older age groups. were adjusted using DHS data on diarrheal incidence of children under the age of five years in the rural and urban 4.1.2 Health care costs regions. The revised incidence rates were then applied to Health care costs are estimated based on the number of the rural and urban households of each of the sites in or- cases, proportion of illnesses treated by each provider, and der to arrive at an estimate of the appropriate site-specific unit costs associated with each provider. incidence rate. A similar adjustment was made for the in- cidence rates of ALRI, and the mortality rates of diarrheal Table 8 presents a summary of treatment seeking rates for diseases and ALRI. No adjustments were made for the other diarrhea among children below five years. It is based on the diseases. ESI household survey and indicates that the majority of the respondents practiced self-treatment. In addition, this To some extent, quality of life impacts associated with mor- practice appears to be more prevalent in urban areas. While bidity are reflected in the DALY calculations above, and in more than 40% of the respondents in rural and urban areas the estimates of health care and productivity costs (see later sought treatment at public health providers, a larger propor- sections). However, it fails to fully capture the pain, suffer- tion of respondents in urban areas sought advice or bought ing, and discomfort that come with disease. For example, medicines from pharmacies. The survey results suggest that the FGDs found that adults continue to report for work respondents adopt multiple practices for treating diarrheal even though they are sick. Hence, while there might not disease. Based on the FGDs, this behavior was explained be a financial loss of income for these sick adults, the ad- by households initially attempting to deal with the disease ditional discomfort associated with working at a time of through self-treatment. Patients are then brought to formal illness is not captured in the analysis. care facilities when the disease gets worse. It is important to FIGURE 6: COMPARISON OF DIRECT DISEASE RATES FOR ALL AGE GROUPS, PER 1000 PERSONS 780 Summary Rural 374 809 Urban 380 715 Alabel 372 879 Bayawan 379 Dagupan 856 By site 397 San Fernando-Coastal 734 370 San Fernando-Upland 674 372 819 Taguig 373 Helminthes Diarrhea 0 200 400 600 800 1000 Source: Annex Table B1 28 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene note that, in the case of diarrheal diseases, this pattern was • 5-14 years old: 23.1% (Dagupan ) to 31.2% (Bay- more or less observed for all age groups. The only major dif- awan); and ference is that adults (i.e., people over the age of 15 years) • Over 15 years old: 11.1% (Dagupan and Taguig) to were less likely to visit public health providers (Annex Table 21.5% (Bayawan). B3). Treatment seeking behavior for people experiencing ALRI-like symptoms also had a similar pattern as diarrheal For ALRI, in-patient admission rates were based on respon- diseases but a larger proportion of the respondents went to dents who displayed ALRI-like symptoms two weeks prior public health providers. to the survey. Since there were very few responses for in- patient admission in the survey, two assumptions had to be Among those who went to hospitals, in-patient admission adopted. The first is that in-patient admission rates do not rates vary by disease, age group and location. In the case of vary by site. The other is that the in-patient admission rates diarrheal diseases, the rates were based on the survey results. between the age groups 0-4 years and 5-14 years are the Given the relatively small number of responses for each of same. In the end, the in-patient admission rates used for all the sites however, the approach was to calculate the in-pa- the sites were 3.6% (under the age of 15 years) and 7.7% tient admission rates for the different age groups in the rural (15 years and over). and urban sites as a whole. The rates for each age group in the sites were then calculated by taking the weighted aver- There was no available information on in-patient admission age of the in-patient admission rates for rural and urban rates for helminthes and malaria. In the case of malaria, the areas. The weights used were based on the site-specific pop- study adopted the rates for ALRI. On the other hand, an ulation of persons (by age group) living in the urban and in-patient admission rate of zero was used for helminthes. rural areas. The result was an in-patient admission rate with This was based on interviews with doctors who said that the following ranges: people who suffer from helminthes are basically out-patient • 0-4 years old: 12.3% (Dagupan and Taguig) to cases and that those who are admitted are really as a result 16.6% (Bayawan); of complications arising from other diseases. TABLE 8: TREATMENT SEEKING BEHAVIOR FOR DIARRHEA, UNDER 5S ONLY % seeking treatment from2 No Data Source Observations1 Private treatment Public Informal Self- formal Pharmacy 4 (%) provider3 care treatment5 clinic Urban ESI sites 65 42.0 9.5 3.8 68.9 62.5 4.6 DHS (2003) 6 na 36.2 na na 15.1 23.4 Rural ESI sites (under 5s) 24 45.8 12.5 0.0 37.5 54.2 12.5 DHS (2003)6 na 28.6 na na na 20.5 21.3 Notes: na = not applicable 1 Number of people who reported illness and — responded to question on treatment facility, or responded to question on pharmacy, or responded to question on self treatment. Some households had 4 respondents per question. 2 This represents a percentage of relevant responses (not necessarily the total number of observations). Response rates are different for each of the columns, e.g., some responded to the question on public providers while others did not. The sums from the ESI survey may exceed 100% because multiple responses were allowed. 3 Includes Barangay Health Centers 4 The questionnaire asked if the respondent purchased medicine from a pharmacy. Hence, this does not necessarily refer to people seeking treatment from a pharmacy. 5 Represents people who used medicine already available at home prior to disease and those who received some form of treatment at home 6 Information from the DHS presented add up to a number that is less than 100%. The reason is that there are categories in the survey (e.g., oral rehydration therapy and other treatments) which do not fit the categories in the table. Source: Annex Table B3 www.wsp.org 29 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene Unit costs for treating diarrheal disease are provided in costs in the urban sites were about 20% higher. The differ- Table 9. It indicates that the out-patient costs of formal ences between the costs were mostly accounted for by doc- care (public and private hospitals and clinics) were about tors’ fees and room rates, which were higher in urban areas. PhP645 (US$15) and PhP693 (US$16) per case in rural Incidental expenses capture transport costs associated with and urban areas, respectively. These costs are composed of traveling to the facility. Along with the costs of informal doctors’ fees and payments for medicine in private hospi- care, the values used for these items were drawn from the tals. Information from public hospitals, which indicated ESI household survey. lower costs, was ignored on the assertion that the presence of subsidies in these facilities imply that the payments made Annex Table B4 presents other unit costs associated with di- by the patients were less likely to reflect the full economic arrhea, such as the costs of medicines bought at pharmacies costs of treatment. Doctors’ fees were obtained from the and self-treatment. It also presents the unit costs associated hospital survey and were generally assumed to be the same with helminthes, ALRI and malaria. for all sites and age groups for reasons of consistency across sites. However, higher costs were used for Taguig because Table 10 shows the annual health care costs per person (by of the high cost of medical services in the National Capi- age group) and disease attributed to poor sanitation and tal Region. Information on the required medication was hygiene in the Philippines. The values account for the unit obtained from informal interviews with doctors. Costs of costs of the diseases and their respective incidence rates. in-patient treatment are composed of doctors’ fees, labora- The table indicates three clear patterns. First, health care tory tests, room rates and medication. The values in Table costs per person in urban areas were slightly higher than 9 indicate that in-patient costs for treating diarrhea in the in rural areas. Second, diarrheal diseases accounted for the rural sites were about PhP2,910 (US$65) per patient while largest proportion of health care costs per person. This is TABLE 9: UNIT COSTS ASSOCIATED WITH TREATMENT OF DIARRHEA, PESOS, 2008 Outpatient cost Inpatient cost (PhP) Health provider Average length of Health care2 Health care (PhP) Incidentals1 (PhP) Incidentals1 (PhP) stay (days) (PhP) Formal Care Rural 645 64 4 2,910 71 Urban 693 64 4 3,464 71 Informal Rural 55 nc na na na Urban 55 nc na na na Notes: nc = cot computed, na = not applicable 1 Incidentals: transport costs per out-patient visit and per in-patient stay. 2 In-patient health care costs are presented per stay Source: Annex Table B4 TABLE 10: AVERAGE HEALTH CARE COST PER PERSON PER YEAR IN FIELD SITES, BY DISEASE, AGE GROUP AND RURAL/ URBAN LOCATION, PESOS Rural Urban Disease 0-4 yrs 5-14 yrs 15+ yrs 0-4 yrs 5-14 yrs 15+ yrs Diarrheal disease (mild) 2,652.5 359.6 151.6 2,666.5 379.8 133.5 Helminthes 31.9 86.3 42.5 36.3 103.3 44.7 Malaria 0.1 - - 0.2 - - ALRI 16.4 - - 20.8 - - Total 2,700.9 445.9 194.2 2,723.8 483.1 178.2 30 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene especially the case among children under the age of five, counted for the time of the carer. In the case of children be- where about 98% of the costs were attributed to diarrheal tween the ages of 5 and 14, the time of the patient was also diseases. Given the high unit costs associated with malaria counted to include the lost school days or, for some, work- and ALRI for in-patient care, this may be explained by the ing days. On the other hand, lost productivity among chil- high incidence of diarrhea relative to other diseases. Third, dren under the age of five years from ARLI was estimated health care costs of children under the age of five years were to be 3.7 days. Due to the absence of data, it was assumed substantially higher than any other age group. In rural areas that the productivity losses for helminthes and malaria are for example, health care costs for this age group amounted the same as diarrhea and ALRI, respectively. to about PhP2,701 (US$61) per person. This is approxi- mately 6 times larger than the costs for children between The value of the lost time can be estimated by the value the ages of 5 and 14 years, and more than 10 times larger of the income that patients and carers could have earned than the costs for adults (over 15 years). While this may be during the period of the illness. Recognizing the alternative explained mostly by the higher incidence of diarrhea in this approaches to the valuation of opportunity costs (e.g., lost age group, it is important to note that the relative differ- income), the study used regional GDP per capita as the ba- ences across age groups are overstated because malaria and sis for approximating foregone income. However, the values ALRI were not accounted for in the health costs for people were scaled down to 15% and 30% of GDP per capita per over the age of five years. day for under fives and the other age groups, respectively. The adjustment follows the approach in the ESI Impact 4.1.3 PRODUCTIVITY COSTS Study (Rodriguez et al. 2008) to account for the possibility There are two sources of productivity costs that are associ- that not all of the time lost was spent on productive activi- ated with disease. The first is the cost to a patient who is ties. It was also an attempt to arrive at more conservative unable to perform his/her regular activities. A second cost, estimates of the impacts. which is often ignored, is that of the carer who takes time away from his/her regular activities in order to look after Table 11 shows the productivity losses per person arising the patient. The study attempts to estimate the productivity from the assumptions discussed above. It indicates losses losses associated with these two costs. of slightly above PhP200 (US$4.5) per person for children under the age of five years and adults in rural areas. In the In valuing productivity losses, the respondents were asked case of children under the age of five years, the explanation about the number of days in which household members rests heavily on the relatively high incidence of disease, par- were sick. Respondents were also asked about the amount ticularly diarrhea. On the other hand, the costs for adults of time spent by the carer in looking after the patient. The are explained mostly by the relatively high valuation of their survey found that, on average, lost productivity from diar- time losses, which is two times higher than children under rheal diseases was 1.1 (under 5 age group), 3.4 (5-14 age five on a daily basis, and the relatively high number of pro- group), and 4.1 (over 15 years) days. The number of lost ductive days that are lost per person. As a result of its rela- productive days for children under five years was lower than tively high incidence rate, the productivity losses per person the other age groups in part because the values only ac- can be explained mostly by diarrheal diseases. Productivity TABLE 11: AVERAGE PRODUCTIVITY COST PER PERSON PER YEAR IN FIELD SITES, BY DISEASE, AGE GROUP AND RURAL/ URBAN LOCATION, PESOS Rural Urban Disease 0-4 yrs 5- 14 yrs 15+ yrs 0-4 yrs 5- 14 yrs 15+ yrs Diarrheal disease (mild) 197.0 76.8 89.9 339.9 128.9 160.5 Helminthes 17.6 68.1 118.8 30.2 114.4 212.1 Malaria 0.1 - - 0.1 - - ALRI 10.4 - - 13.0 - - Total 225.2 145.0 208.6 383.2 243.3 372.6 www.wsp.org 31 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene costs in urban areas are at least 60% higher than the losses risk of fecal-oral disease and helminthes infection associ- in rural areas mostly because of the relatively high regional ated with each scenario. The left-hand scenarios (basic im- GDP for Taguig.16 proved sanitation) are relevant mainly for rural areas, while the right-hand scenarios (moving to treatment of sewage 4.1.4 MORTALITY COSTS and wastewater) are relevant mainly for urban areas. Each Table 12 shows the costs associated with premature death sanitation scenario is combined with handwashing, which (mortality). The values were computed by multiplying the is recognized to provide a further health impact. probability of death (accounting for disease incidence) and FIGURE 7: RELATIVE RISK REDUCTION OF FECAL-ORAL the value of life using the human capital approach (Table DISEASES AND HELMINTHES FROM DIFFERENT SANITATION 4). There are three clear findings indicated by Table 12. AND HYGIENE INTERVENTIONS First, mortality costs are higher in rural sites. For children under the age of five years in the rural sites, the per capita 1.0 cost of mortality was about PhP1,305 (US$29). Roughly 32% higher than its counterpart for urban areas, this was explained mostly by the higher mortality rates used in the 0.8 rural sites (see Table 7). Second, in the case of children un- der the age of five years, a large proportion of the costs are due to diarrheal diseases. Third, the highest costs are report- 0.6 ed for children under the age of five years. In rural sites for example, costs for this age group are more than ten times higher than the costs for the other age groups. This is due to 0.4 the high diarrheal incidence rate assumed for this age group and the fact that mortality costs associated with malaria and ALRI were not calculated for the other age groups. 0.2 4.1.5 AVOIDED HEALTH COSTS Health effects are central to the arguments of improving 0.0 sanitation and hygiene. Since limited evidence exists on the actual impact of sanitation or hygiene programs on health Fecal-Oral Helminthes outcomes in the Philippines, this study draws on interna- Note: See methods’ section for the references and Hutton et al. (2011) for tional evidence. Figure 7 shows the different risk exposure a more detailed discussion of the selected values. scenarios being compared in this study, and the relative SN = sanitation; HW = handwashing TABLE 12: AVERAGE MORTALITY COST PER PERSON PER YEAR IN FIELD SITES, BY DISEASE, AGE GROUP AND RURAL/URBAN LOCATION, PESOS Rural Urban Disease 0-4 yrs 5- 14 yrs 15+ yrs 0-4 yrs 5- 14 yrs 15+ yrs Diarrheal disease (mild) 859.9 102.0 104.8 568.4 66.7 71.0 Helminthes 3.7 - - 3.4 - - Malnutrition 29.8 - - 29.8 - - Malaria 10.0 - - 9.2 - - ALRI 292.5 - - 268.7 - - Other diseases 109.4 - - 109.4 - - Total 1,305.3 102.0 104.8 988.8 66.7 71.0 16 The regional GDP for Taguig was based on estimates for the NCR. 32 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene The ESI household survey provides some support to the ear- to movements up the sanitation ladder, which is reflected lier assertion that lower disease incidence is associated with in Figure 8. Households with access to shared/public toilets moving up the sanitation ladder. Annex Table B3 shows this or dry and wet latrines are likely to have had no access (i.e., for the case of diarrhea. However, the implied risk reduc- practicing open defecation) prior to receiving their toilets. tions appear to be smaller than those shown in Figure 7. On the other hand, households who have septic tanks are The survey also asked the respondents whether they have more likely to have had access to shared/public toilets or pit observed changes in diarrheal disease incidence in any of latrines prior to receiving the technology. the household members since receiving their new latrine. Their responses suggest that lower incidence was noticed Table 14 summarizes the total costs per household of poor for those receiving access to basic sanitation facilities (Table sanitation and hygiene for the field sites. It shows that the 13). For example, more than 90% of those who recently health cost for the average rural household in the sites was had access to shared/public toilets and wet latrines said about PhP5,094 (US$115) per year. About 57% of these that the incidence of diarrheal disease among household costs were accounted for by health care. The remainder was members was “probably less� or “a lot less.� About 70% of divided between productivity and mortality costs. The es- those who received dry pits also had the same observation. timated health cost for the average urban household was Households who recently had access to septic tanks and/or PhP5,773 (US$130) per year. While the costs are still domi- sludge removal had a different observation. More than 75% nated by health care, the contribution of productivity losses of the respondents in this category said that they did not was significantly higher than in urban areas. This was driv- notice any changes in diarrheal disease incidence. Notwith- en mostly by the relatively high regional GDP of Taguig. standing the other factors that might affect diarrheal disease Table 14 also summarizes the estimated costs averted from incidence as well as the sampling strategy adopted in the sanitation improvements. It shows that health costs fall by survey, the results might be capturing diminishing returns PhP1,914 (US$43) as a household moves from open defe- TABLE 13: PERCEIVED DIFFERENCE IN DIARRHEAL INCIDENCE SINCE IMPROVED SANITATION, IN ALL FIELD SITES Answer to question “Have you noticed an observable change in diarrheal disease rates in any household members since you Households Total received the new latrine?� (% of total responses) Disease in sample responses Probably Probably A lot less No A lot more less more Shared/public 217 58 43 50 5 2 0 Dry pit 88 43 42 28 30 0 0 Wet pit 156 23 52 39 9 0 0 Septic tank (sludge not 178 12 0 8 83 0 8 removed) Septic tank (sludge 315 49 8 12 76 4 0 removed and treated) Note: None of those households which have access to sewerage answered this question. TABLE 14: ANNUAL COSTS PER HOUSEHOLD OF POOR SANITATION AND HYGIENE, AND ANNUAL COSTS AVERTED OF IMPROVED SANITATION, PESOS, 2008 Cost (baseline risk) Cost averted Costs Rural (OD to basic Urban (OD to Urban (basic sanitation Rural Urban sanitation) sewerage) to sewerage) Health care 2,845 2,985 1,061 1,745 627 Productivity 988 1,819 422 1,231 452 Premature death 1,261 968 430 503 180 Total 5,094 5,773 1,914 3,478 1,259 www.wsp.org 33 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 8: HEALTH COSTS OF UNIMPROVED SANITATION (A) AND HEALTH COSTS AVERTED OF IMPROVED SANITATION OPTIONS (B) 4,000 3,000 3,500 savings per household (pesos) 2,500 3,000 baseline costs per household 2,500 2,000 2,000 1,500 1,500 1,000 1,000 500 500 0 0 Rural Urban Premature Death Productivity Health Care (A) (B) cation to access to basic sanitation in rural areas. In the case Pollutants would be diluted naturally and natural bacte- of urban households, a shift from open defecation to having riological processes would toreduce pollution load in ar- sewerage access causes a 60% cost reduction or PhP3,478 eas with small populations and abundant water resources. (US$78). As expected, a movement from basic sanitation to However, given the high population density in many parts sewerage access causes a smaller reduction in health costs. of the Philippines — the city of Manila alone had a popu- For the typical urban household in the sites, this reduction lation density of 66,482 persons per square kilometer in was estimated to be about PhP1,259 (US$28). 2007 (NSCB 2008) — sufficient dilution and natural treat- ment processes are not guaranteed, and water quality indi- 4.2 Water cators presented below suggest that significant pollution is The Philippines is well-endowed with water resources. It taking place. has about 200,000 hectares of lakes, 31,000 hectares of riv- ers, 19,000 hectares of reservoirs, and 246,063 hectares of 4.2.1 WATER RESOURCES swamplands (BFAR, 2004). Moreover, the country has a Table 15 summarizes the water resources that are found in coastline that stretches over a distance of 32,289 kilome- the sites. It indicates that most of the sites are near the sea ters. Biochemical oxygen demand (BOD) on many of these and have access to rivers. The features of the water bodies inland water resources is high, with pollutants coming from vary significantly. For example, as many as seven rivers can agriculture, industry, and domestic sources. The ESI Impact be found in Taguig and the rivers in Alabel have an average study showed that domestic sources contributed 763 thou- width that range from two (Molo river) to 22 (Maribulan sand metric tons of BOD to inland water sources in 2005. river) meters. Creeks and canals are also common in the This came from an estimated 4 million metric tons of feces, sites. The presence of these water bodies means that the sites 34 million m3 of urine, and at least 1,962 million m3 of gray are exposed to the risks associated with water pollution. It water. Aside from BOD, there is also bacteriological and also raises the potential of poor sanitation practices contrib- pharmaceutical contamination of water resources. uting to water pollution. 34 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene TABLE 15: WATER RESOURCES IN FIELD SITES Name of water Resource Field Site Remarks body (if applicable) Mofong Lake (small) surface area (hectares): 3.18 Lake Alabel Mofong Lake (big) surface area (hectares): 7.5 Bito Lake surface area (hectares): 126; depth (meters): 15 Maribulan width (meters): 21.93; depth (meters): 0.351; flow rate (meters/second): 0.69; length (meters): 27,737 Domolok width (meters): 14.53; depth (meters): 0.26; flow rate (meters/second): 0.645; length (meters): 16,450 Alabel Molo width (meters): 2.3; depth (meters): 0.058 ; flow rate (meters/second):0.57; length (meters): 6,200 Lun Padidu width (meters): 11.12; depth (meters): 0.211; flow rate (meters/second): 0.8 Pangatban River Sicopong Bayawan Ilog Bayawan River Dagupan (Pugaro only) Pugaro River Taguig width (meters): 15 (ave); depth (meters): 1.8; flow rate (meters/second): 2.7; length (km; site): 10.3 Napindan Channel Bugumbayan/ Tabacuha Taguig Mauling Creek Hagonoy Tipas/Labasan Sta. Ana Alabel Saranggani Bay 230 kilometers coastline1 Bayawan Sulu Sea Length (km): 15 Coastline Dagupan Lingayen Gulf Length (km): 11.97 South China Sea San Fernando San Fernando Bay Alabel n.a. Creek (discharge area for WWTP) Dagupan (Pugaro only) Manamikdak Creek Carlatan Creek Catbangen Creek Creek San Fernando Pagdaraoan Ilocanos Creek n.a. located at lower Nagyubyuban Taguig n.a. located near the PNR site, Western Bicutan BATODO CIP width (meters): 1.62; depth (meters): 0.23; flow rate (meters/second): 0.53 Alabel Kawas CIP width (meters): 1.3; depth (meters): 0.58; flow rate (meters/second): 0.69 SACI Pumping width (meters): 0.88; depth (meters): 0.073; flow rate (meters/second): 0.34 Canals Bayawan n.a. many of the streets in the site have canals that are categorized as sewer lines Dagupan n.a. Taguig n.a. 1 This is the entire coastline of Saranggani Bay www.wsp.org 35 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene 4.2.2 WATER QUALITY AND ITS DETERMINANTS The association between Coliform readings and access to A water quality survey was implemented in the sites in or- sanitation appears to be weak as Bayawan and San Fer- der to triangulate water quality readings with household nando are at two extremes in terms of sanitation coverage practices and perceptions. This section discusses selected (Figure 9). However, this result must be interpreted with findings while Annex Table C1 provides the full results of care as the sanitation statistics presented are for the entire the survey. province or city. It therefore includes sanitation coverage in barangays which were not part of the survey. Figure 9 (Panel A) summarizes the results of tests for E. coli and Coliform on 61 wells, surface waters and boreholes in Figure 9 (Panel B) also shows that the highest number and the study sites.17 It indicates that 57 out of the 61 water proportion of water sources that failed the test—28 out of sources tested negative for the presence of E. coli. However, the 32 sources tested—were surface waters. This was fol- more than two-thirds (42 out of 61) of the water sources lowed by bore holes where nearly half of the samples failed had Coliform readings in excess of 8 MPN/100 ml. Given the test for Coliform. the use of these sources for drinking water. A more seri- ous concern is that 15 out of the 30 known drinking wa- The water quality survey also tested for turbidity, or the ter sources tested had readings that were higher than the cloudiness of the water caused by small suspended parti- standard set in the 2007 Philippine National Standards for cles. Measured in terms of Nephelometic Turbidity Units Drinking Water (PNSDW).18 The findings were particular- (NTU), high turbidity levels suggest a heavy concentration ly alarming in Bayawan as all seven water sources tested had of small suspended particles. Figure 10 reports the findings failing marks for Coliform (based on PNSDW). However, from tests of turbidity on 35 water bodies in the sites. A only two of the seven water sources were used for drinking big concern was the result that six out of the ten known water. A greater cause for concern could be the results for drinking water sources which were tested for turbidity had San Fernando, where eight of the water sources that failed readings that were higher than the PNSDW of five NTU. the test were used for drinking. FIGURE 9: TEST RESULTS FOR E.COLI AND COLIFORM BY SITE (A) AND WATER SOURCE (B) 11 22 Alabel 3 6 1 Bore Hole 19 22 7 12 Bayawan 1 7 28 32 3 10 Surface Water 0 32 Dagupan 5 28 11 23 7 San Fernando 0 17 Dug & 0 4 Shallow Wells 7 2 10 Taguig 0 7 61 13 4 61 Total 61 All Sites 4 42 42 0 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70 Number Tested Positive for Coliform Tested for E.coli Tested for Coliform Positive for E.coli No Access to Improved Sanitation (% of Households) Positive for E.coli Positive for Coliform (A) (B) 17 Coliform is a group of bacteria that may be vegetative or fecal in origin. E. coli is a species of coliform whose presence may be indicative of pollution from human or animal waste. 18 The Philippine National Standard for Drinking Water requires a total Coliform reading that is less than 1.1 MPN/100 ml. 36 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 10: TURBIDITY READINGS IN FIELD SITES, IN NEPHELOMETIC TURBIDITY UNITS (NTUs) Canal/Ditch 43.0 Mofong Lake 7.0 Alabel Maturation Pond (open) 6.0 Creek (discharge area) - open 46.0 Maribulan River 53.0 Coastline/Beach (within WW) 28.0 Dagupan Bayawan Pond (open) 4.0 Manampa Spring (source of bayawan water) 184.0 Pagatban River 79.0 Coastline/Beach Area 9.0 Pugaro River 52.0 Manamikdak Creek 15.0 Stagnant Water (inside the community) 30.0 Coastline (beach area) 3.4 Coastline (beach area) 9.0 Coastline (beach area) 6.0 Spring, Groundwater 4.7 11.0 San Fernando Creek Canal/Small Creek (discharge area) 46.0 Coastline (beach area) 3.3 Canal/Estero 108.0 HH Private Dug Well 4.0 Spring Water 0.2 Spring Water 0.6 Creek 1.3 Dug Well 1.0 Taguig River 36.0 Pond (open) 12.0 Pond (open) 14.0 Taguig Creek 89.0 Creek 299.0 Creek 32.0 La Mesa Dam - Intake Water 6.0 La Mesa Dam - Treated Water 3.0 Unprotected Well (open) 4.0 0.0 50.0 100.0 150.0 200.0 250.0 300.0 Nephelometic Turbidity Units Source: Annex Table C1 The study also obtained BOD and COD readings for 32 for drinking water, had relatively high Coliform levels. This inland and coastal water resources in the study sites. Com- is further supported by the high turbidity readings where paring against the effluent guidelines for class C type waters about half of the known drinking water sources do not con- in Administrative Order 35 of the DENR, nine and 15 out form to the standards set by the PNSDW. of the 32 water samples collected in the study had higher concentrations of BOD and COD, respectively.19 Among Figure 11 shows the proportion of households in the sur- the different study sites, the highest proportion of BOD vey with sanitation facilities that are likely to contribute to readings that exceeded the DENR guidelines were for San water pollution. It indicates that about 69% of the house- Fernando (four out of ten water bodies). Bayawan and Da- holds in the sites have facilities that do not isolate or only gupan each had three out of four water bodies with COD partially isolate contaminants that contribute to water pol- readings exceeding the DENR guidelines. lution. Households that have toilets which flush to sewers or septic tanks that are desludged and treated at an STF are As a whole, the test results presented above suggest that assumed to have full isolation in the ideal analysis.20 Open there is a lot of room for improvement in the quality of defecation to water bodies represents no isolation. All other water in the study sites. This is especially the case since a practices or facilities are assumed to only partially isolate large proportion of the water sources, including those used contaminants that contribute to water pollution. 19 These findings account for differences in the standard set for various water bodies. Class C refers to water bodies that may be used for fishing, recreational water use (boating, etc.) and as industrial water supply. The requirements for class C are less stringent compared to class B type waters which are used for recreational activities such as bathing and swimming. For more details about the water quality readings in the cities and the DENR standards, please see Annex Table C.1. 20 The analysis assumes an ideal situation in which there is no leakage in the sewers and septic tanks. The extent to which these sanitation facilities can isolate contaminants will of course be comprised if leakages exit. www.wsp.org 37 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 11: EXTENT OF ISOLATION OF HUMAN EXCRETA IN FIELD SITES, % OF RESPONDENTS 4 Alabel 76 0 Bayawan 17 15 Dagupan 85 0 San Fernando 100 1 Taguig 48 4 All Sites 65 0 20 40 60 80 100 Partially Isolated Not Isolated percent of households Source: Annex Table C2 TABLE 16: WATER ACCESS AND COSTS IN THE SURVEY SITES Water Source Item Rural Urban All sites % access 37.6 33.5 35.0 Piped water Average monthly cost (PhP) 143.5 422.3 316.1 Non-piped protected % access 15.3 26.3 22.4 Bottled water Average monthly cost (PhP) 184.0 351.5 310.8 % access - 0.2 0.2 Tanker truck Average monthly cost (PhP) - 884.0 884.0 % access 46.0 40.0 42.1 Others Average monthly cost (PhP) 1.8 4.4 3.4 % access 1.1 - 0.4 Unprotected Average monthly cost (PhP) 0.2 - 0.2 Source: Annex Table C3 4.2.3 HOUSEHOLD WATER ACCESS AND of respondents). This is followed by piped water (35%) TREATMENT COSTS and bottled water (22%). The relatively high proportion of One of the major consequences of polluted water in wells, households using other non-piped protected sources can be springs, rivers, and lakes is that populations and water sup- explained by the price. On average, financial costs for this ply agencies will have to treat water, or treat water more source amounted to only PhP3 per month per household, intensively, for safe human use. Alternatively, populations or nearly a hundredth of the monthly costs for the piped wa- and water supply agencies can access cleaner water from ter. While the pattern is more or less the same for the rural different and more distant sources, thus increasing access and urban sites, two differences are worth noting. The first costs. Those who do not take precautionary measures are is that a larger proportion of households in the urban sites exposed to a higher risk of infectious disease, or poison- relied on bottled water. The second is the higher spending ing due to chemical content. Table 16 shows the household of urban households for each source. In the case of piped sources of drinking water and the average monthly water water, monthly expenditure was almost three times larger in source costs. It indicates that the largest source of water for the urban sites compared with the rural sites. Site-specific all the sites was other non-piped protected sources (42% data on water access is presented in Annex Table C3. 38 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 12: HOUSEHOLDS CITING POOR WATER QUALITY FROM THEIR PRINCIPAL DRINKING WATER SOURCE, % OF RESPONDENTS 5 Bad appearance 11 Piped water (Treated) 9 2 Bad smell 4 4 1 Bad taste 3 2 1 With sediments 4 3 0 Bad appearance 0 0 0 Bottled water Bad smell 1 1 5 Bad taste 3 3 3 With sediments 0 1 17 Bad appearance 2 untreated piped): Others 10 Non-piped protected source (Including 4 Bad smell 0 2 6 Bad taste 0 3 17 With sediments 0 10 100 Bad appearance 100 100 Unprotected sources 0 Bad smell 0 0 0 Bad taste 25 11 0 With sediments 0 0 0 20 40 60 80 100 Rural Urban All Source: Annex Table C4 Figure 12 summarizes the data for the householders’ re- readings reported earlier. In the case of households who use sponses to the question on characteristics of poor quality non-piped protected sources, the highest number of com- water. It provides a comparison between rural and urban plaints was on the presence of sediments and bad appear- areas, and between four major water sources. The highest ance. Households who use bottled water as their primary number of complaints was found to be for the bad appear- drinking water source were the only exception. For these ance of water. This is especially the case for households who users, the most number of complaints had to do with bad use unprotected sources as their primary drinking water taste. source. The result is not surprising given the high turbidity www.wsp.org 39 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 13: CITED REASONS FOR USING WATER SOURCES, 4.2.4 HOUSEHOLD RESPONSE TO % OF RESPONSES CONTAMINATED WATER AND RELATED COSTS 38 Households may respond to traditional water sources they 2 know to be polluted in one or more of several ways: chang- Piped water 13 ing purchased source, walking farther to haul free water, 17 or water treatment. They may connect to a piped water source (if available and affordable), harvest rainwater, pur- 19 chase bottled water or bring in a tanker (more in urban 1 areas). Figure 13 shows the reasons that were cited by all Bottled water 0 the respondents for their choice of water source. For most 69 users, the quality of the water was the main reason for their choice. A distant second for piped water and non-piped 40 protected water users was safety. The only exception was for Non-piped 1 bottled water users where safety was the primary reason for protected 2 their choice of the water source. Annex Table C5 presents 19 information from the different sites in the study. It indicates that the patterns observed for all households are more or 80 less the same for the rural and urban regions. Unprotected 0 0 Households may also treat drinking water at home in re- 0 sponse to water pollution. The survey found that only about 21% of the households treat water (Figure 14). Moreover 0 10 20 30 40 50 60 70 80 water treatment was more commonly practiced among ur- Quality Quantity Cost Safety ban households. About 15% of all households boil water to Source: Annex Table C5 ensure safety, while 6% of the households use other treat- 1 Reasons under quality include good taste, good color and clarity, and ment methods (see Annex Table C5 for the details). less or no solids, sediments or particles. Safety was included because it is usually the primary reason behind the choice of households for drinking water. Figure 15 shows the annual water treatment costs per 2 Tanker trucks were not included because there were no responses. household in the rural and urban sites. It indicates that an- 3 “Bottled water� costs were not included because there were no responses. 4 No responses for quantity, cost and safety for “Unprotected� sources. nual costs for boiling water were about PhP1,205 (US$27) for the average rural household in the survey. This is about FIGURE 14: HOUSEHOLD WATER TREATMENT PRACTICES, % PhP327 (US$7) less than the costs for the average urban OF RESPONSES household. Costs associated with the other treatment meth- 79 ods were substantially lower than costs for boiling water for No treatment 77 84 rural and urban households. 15 Changes in access to sanitation facilities and water sup- Boiling 16 plies could affect the water treatment practices of house- 13 holds. In the household survey, the respondents were asked 6 whether their treatment practices changed two years after Others 7 they received their new latrine or had access to improved 4 water sources. Figure 16 reports the results from the survey. All sites 0 20 40 60 80 100 The major finding is that only a small proportion of the Urban households changed their treatment practice. In the case Rural of households that received new latrines, about 18% of the Source: Annex Table C6 respondents said that their treatment practices changed. On 40 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 15: HOUSEHOLD WATER TREATMENT COSTS, BY METHOD, PESOS 2,935 Alabel 0 0 228 Bayawan 0 0 1,010 Sites Dagupan 0 87 1,064 San Fernando - Coastal 360 77 2,059 San Fernando - Upland 0 0 1,813 Taguig 360 0 Summary 1,205 Rural 360 77 2,935 Urban 360 83 Boiling Chemical 0 500 1000 1500 2000 2500 Of�cial improved �lter percent of households Source: ESI survey FIGURE 16: CHANGE IN WATER TREATMENT PRACTICES AFTER RECEIVING A NEW LATRINE, % OF RESPONSES the other hand, slightly more than a fifth of households said that their treatment practices changed after having access 80 to improved water supplies. It is interesting to note that urban households appear to be more responsive to chang- 70 es in sanitation access and improvements in water supply. 60 For example, 20% of the urban respondents said that their percent of households treatment practice changed after receiving a new latrine. 50 This is six percentage points higher than rural households. However, these values need to be treated with caution as 40 about a tenth of the respondents do not know or recall if their water treatment practices changed. In all, the impli- 30 cation of this finding is that improvements in sanitation 20 will have limited impacts on water treatment practices. At the very least, one cannot expect all households to change 10 their water treatment practices following an improvement in sanitation and/or water supply access. This is likely to be 0 due to a mixture of entrenched habits on the one hand, and the fact that household wastewater is only one of several Rural Urban All sources of contamination of water bodies. Source: ESI household survey www.wsp.org 41 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene 4.2.5 HOUSEHOLD WATER COSTS AVERTED is in part supported by the earlier finding that water treat- FROM IMPROVED SANITATION ment practices do not really change much following an Table 17 summarizes the averted annual costs of an average improvement in sanitation and water supply (Figure 16). household in terms of accessing water and water treatment. Another reason is that a shift towards other lower cost treat- The averted costs assume that the reduction in water pollu- ment practices and water sources still entails a cost, be it a tion arising from improved sanitation will alter the behav- financial or opportunity cost of collecting water. This par- ior of households with respect to where they access water tially offsets the reduction in costs brought about by the supplies and water treatment. In the case of water access shift away from the higher financial cost alternative. Finally, costs, it was assumed that there will be a 10% reduction in there are instances in which the opportunity for reducing the costs of drinking water sourced from expensive sources costs is very low. In Alabel, for example, only 2% of the — bottled water or tanker trucks. The water reduction from respondents practiced water treatment. Hence, even if all of these water sources was then offset by water sourced from these households stop treatment after the improvement in piped sources, if available. Water from piped sources which sanitation, it is unlikely that the impacts on the province as are used for non-drinking purposes was then assumed to a whole are going to be large. be replaced by cheaper sources, e.g., deep wells, which are available in the sites. In the end, the general assumption was 4.3 Access time that there is no change in piped water consumption so that 4.3.1 ACCESS TIME AND TIME SAVED all that is reflected is the shift from expensive sources (bot- Households who do not own toilets are likely to spend time tled water and tanker trucks) to inexpensive water sources traveling to and from a place where they can defecate. The (e.g., deep wells). In the case of water treatment, the cost household survey for this study found that a large major- savings were based on a comparison of the water treatment ity of these households indeed go to a place outside of the practices of households which have access to improved and immediate vicinity of their house. At least 67% of adult unimproved sanitation in the study sites. women in rural areas who do not have their own toilets travel to a location that is outside of their plot (Figure 17). TABLE 17: WATER ACCESS AND HOUSEHOLD TREATMENT The proportions are higher in the case of men (73%) and COSTS AVERTED AS A RESULT OF IMPROVED SANITATION, PESOS children aged 5-14 years (77%) in rural areas. Moreover, Annual average costs saved per household the survey found that a larger proportion of people who following 100% sanitation coverage own toilets and are living in urban areas travel outside of Site Water their plot in order to defecate. In the case of women, the Water source Total difference between those living in urban and rural areas is treatment access about 20 percentage points. Average rural 55 28 83 Average urban 403 85 488 Figure 18 shows that a considerable amount of time is spent Average all traveling to the place of defecation, waiting to access toi- 279 65 344 sites lets, and/or getting some privacy. In the case of the rural Source: Annex Table C7 sites, the travel and waiting time among children was about 18 minutes per trip. It was slightly longer for adult males The values in Table 17 indicate that the savings from im- and females. Travel and waiting time in the urban sites were provements in sanitation are also quite small. The estimated about half as long as in the rural sites. The amount of lost annual savings from water access and treatment costs were time is actually larger than what is indicated by the amount PhP279 (US$6) and PhP65 (US$1.5), respectively. These of time spent per trip. The reason is that, on average, people values capture the point that it is impossible for all the costs need to make this trip more than once in a day. Women in to be averted following an improvement in sanitation. For the rural sites and men in the urban sites traveled to their one, sanitation is not the only source of water pollution. In place of defecation at an average of 1.2 times a day. This relation to this, water treatment practices are also likely to means that the amount of time lost for women in the rural be a function of perceptions regarding water quality. This sites averages about 24 minutes per day. It is important to 42 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 18: DAILY TIME SPENT ACCESSING TOILET OUTSIDE note that the values in Figure 18 underestimate the amount PLOT FOR THOSE WITH NO TOILET of time spent for accessing toilets. The reason is that the estimates are focused only on defecation and excludes uri- 20 Rural nation. 1.2 Women There is also time loss in case of children under the age of 9 Urban five years. Figure 19 shows that about 33% of the families in 1.1 the sites accompanied young children when they defecate. 20 This means a time loss not only for the child but also for Rural the person who needs to accompany the child to the place 1.2 Men of defecation. In addition, there is some evidence that chil- 9 dren under the age of five tend to visit the toilet more often. Urban 1.1 The survey results show that young children in urban areas visited their place of defecation at an average 1.74 times in 18 a day (Annex Table D3). This was about 49% higher than Rural 1.1 Children the average for adult males who are living in urban areas. 8 FIGURE 17: PLACE OF DEFECATION OF HOUSEHOLDS WITH Urban NO “OWN� TOILET, % OF RESPONSES 1.0 0 5 10 15 20 25 28 Neighbor Time per trip (minutes) Trips per day 2 Source: Annex Table D2 Women 4 Own plot 11 FIGURE 19: PRACTICES RELATED TO YOUNG CHILDREN 67 Outside plot 87 80 24 Neighbor 2 70 3 60 Men Own plot percent of household 8 50 73 Outside plot 91 40 20 Children (Aged 5-14 years) Neighbor 30 5 3 20 Own plot 12 10 77 Outside plot 83 0 0 20 40 60 80 100 Propotion of those with no own Rural Urban toilet using different places (%) 1 This includes children who defecate in the yard and other means of stool disposal. Source: Annex Table D1 Source: Annex Table D3 www.wsp.org 43 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 20: PREFERENCES RELATED TO TOILET CONVENIENCE, % OF RESPONSES 90 Households with satis�ed with the Satis�ed or very the toilets (%) private toilets proximity of 96 Households who use 90 shared/public toiltes 70 89 Saves time Reasons to get 99 a toilet (%) No toilets: 86 Proximity 98 0 20 40 60 80 100 Rural Urban percent of respondents Source: Annex Table D4 4.3.2 TIME SAVING PREFERENCES AND UNIT VALUES OF TIME the feeling of safety for women especially when they need There is evidence that households appreciate the value of to use the toilet at night or when it is raining. On the other time associated with having private toilets. Figure 20 shows hand, the participants who cited the ability to use the toi- that about 98% of households who do not have toilets in let quickly said that not having to wait in a queue was the the urban sites cited proximity as an important character- reason for their preference. The respondents in Taguig went istic of having private toilets. A slightly higher proportion one step further by mentioning that controlling the urge to (99%) of these households agreed that having private toilets defecate or urinate can have negative health consequences. saves time. The survey also found that households in the rural sites have a slightly lower appreciation of the time sav- While the preferences of men and women appear to be very ings. close to each other, there is a noticeable difference in the rankings for rural and urban households. In the case of ru- The importance of proximity is also revealed in the survey ral households, the ability to go quickly only ranked second results for households that already have toilets. Figure 20 to having a latrine near the house. This result was driven shows that 90% of rural and 96% of urban households with mostly by the results of the FGDs in Bayawan and the up- private toilets said they were satisfied or very satisfied with land region of San Fernando. the proximity of their toilets. The proportion of households who were satisfied or very satisfied with proximity of their The household questionnaire asked the respondents to rank toilets was considerably lower for those that only have ac- three options out of 13 choices on what they would do if cess to shared/community toilets in the urban sites. they had an extra 30 minutes in a day. This was asked to get a sense of what the respondents could have done with Table 18 provides the average rankings on toilet preferences the time losses discussed earlier. In processing the results, with respect to convenience and is based on FGDs con- three points were given to an option that was ranked first, ducted in the six study sites. The highest ranked responses two points were given to an option that was ranked second were having a latrine being near or in the house and being and one point was given to an option that was ranked third. able to go quickly when the need arises. The participants Figure 21 shows the results for the options that received the cited that the first feature allowed them to save time which highest proportion of the total points possible. It indicates could be used for other activities. Another reason cited was that leisure, sleep/rest, performance of household chores 44 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene and working or helping with income generation were the The findings above support the earlier decision to use a top four choices among the households in the urban and value of time that is lower than regional GDP per person rural sites, regardless of toilet access. Among those who own — i.e., 30% of regional GDP per capita for adults and 15% toilets, the top choices were leisure (urban sites) and sleep/ of regional GDP per capita for children. While it can be rest (rural sites). On the other hand, top choices for house- argued that the proportions used are somewhat arbitrary, it holds who do not own toilets were household chores (urban captures the point that not all of the spare time is used for and rural sites) and sleep/rest (urban sites). income generating activities. TABLE 18: PREFERENCES RELATED TO TOILET CONVENIENCE Sites Region Gender All Attribute San San Alabel Bayawan Pugaro Fernando Fernando Taguig Urban Rural Male Female Sites -Coastal -Upland Latrine being near the 3.0 1.0 1.0 2.3 1.3 2.7 2.4 1.5 1.8 2.1 2.0 house Not having to wait in 2.0 3.5 2.5 2.5 3.0 2.5 2.4 3.0 2.7 2.7 2.7 line Being able to go quickly 1.0 2.5 2.5 1.8 2.3 1.0 1.4 2.2 1.8 1.7 1.7 when the need arises Time saving which can 4.0 3.0 4.0 3.5 3.5 3.8 3.8 3.3 3.6 3.6 3.6 be used for other acts The values represent average ratings for the different features or attributes. A value of 1 means that the feature is the top priority or is the most important. Source: Focus group discussions FIGURE 21: OPPORTUNITY COST OF TIME — WHAT RESPONDENTS WOULD DO WITH AN EXTRA 30 MINUTES A DAY, % OF POSSIBLE POINTS 6 15 Urban - With toilet 24 23 10 18 Rural - With toilet 17 21 7 21 Urban - No toilet 17 21 12 25 Rural - No toilet 13 16 0 5 10 15 20 25 Working Leisure House chores Sleep/rest Source: ESI survey www.wsp.org 45 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 22: AVERAGE NUMBER OF DAYS SAVED PER YEAR PER HOUSEHOLD MEMBER 6 Women 2 4 6 Men 3 4 5 Children 2 3 9 Young children 0 5 32 Per household 10 20 0 5 10 15 20 25 30 35 Rural Urban All sites days Source: Annex Table D5 FIGURE 23: AVERAGE ANNUAL VALUE OF TIME SAVINGS PER HOUSEHOLD MEMBER, PESOS 500 Women 368 413 518 Men 371 422 211 Children 148 170 0 Young children 261 398 261 1,701 Per household 1,700 1,701 0 500 1,000 1,500 2,000 Rural Urban All pesos Source: Annex Table D6 4.3.3 TOTAL VALUE OF TIME SAVED Using the values presented in Section 4.3.2, Figure 22 shows of its counterpart in the urban sites. In the case of the rural the potential amount of time (measured in days) that could sites, the highest potential savings came from not having to be saved by a household from having access to a private toi- accompany a child to a place of defecation. The savings here let. It indicates that an average of 20 days in a year could be amounted to about nine days per child per year. saved by a household from having access to a toilet. More- over, the savings for the average household in the rural sites The results cited above point to a potentially large underes- (32 days) were more than three times larger than the savings timation of the costs from accessing toilets in the ESI Im- 46 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene pact Study (Rodriguez et al. 2008). Due to lack of data, the It is important to note that the calculations presented above ESI Impact Study assumed a person who does not have his/ are likely to be an underestimate of the value of lost time. her own toilet spends five minutes a day in finding a place The reason is that these do not account for the time spent to defecate. Given the average household size of 5.2 in the looking for a place to urinate. The magnitude by which the survey sites, this implies an annual savings of 6.6 days per values are underestimated could be significant as the par- household. This is only about a third of the estimated losses ticipants in the FGDs said that they urinate up to seven (20 days) which were presented in Figure 22. Assuming times in a day. However, valuing the time lost is tricky with that the results for the study sites are representative of the women and with men who are unlikely to travel far in order entire country, this suggests that the costs associated with to urinate, compared to a place where they have to defecate. access time presented in the ESI Impact Study should be about three times larger. 4.4 Reuse of human excreta Of all the study sites, only households with UDDT-E facili- Given the results in Figure 22 and the assumptions on the ties in San Fernando were found to re-use human excreta value of time, Figure 23 shows the estimated annual time and urine as fertilizer.21 Figure 24 shows that the practice savings per household. It indicates that a typical household was very common in the upland region, with 86% of the in the site can save about PhP1,700 (US$38) from hav- households re-using waste. However, only about a fifth of ing a private toilet. While time savings in rural and urban UDDT-E users in the coastal areas were estimated to re-use areas are almost the same, the sources of the savings are waste. The survey also found that the annual value from the very different. While households in urban areas have higher reuse of fertilizer was slightly more than PhP500 (US$11) incomes compared to rural areas, people in rural areas were per household (Figure 25). These results are based on the found to spend more time searching for a toilet compared reported savings from fertilizer because none of the UDDT- to their counterparts in urban areas. E users in the sample sold their output. FIGURE 24: HOUSEHOLDS WITH UDDT-E FACILITIES IN SAN FIGURE 25: AVERAGE ANNUAL VALUE OF SAVINGS FROM FERNANDO WHO ARE RE-USING FECES AND URINE, % OF REUSE WITH THE UDDT-E FACILITIES IN SAN FERNANDO, RESPONSES PESOS 100 600 80 500 400 60 300 40 200 20 100 0 0 Source: ESI household survey Source: ESI household survey 21 Manila Water also uses treated sludge from the Taguig STF as soil conditioner for sugar plantations. However, its economic value was not examined in this study. www.wsp.org 47 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene 4.5 Intangible sanitation preferences The FGD attempted to elicit how the respondents in the Due to a lack of studies examining the intangible aspects of different sites understand the meaning of sanitation. As a sanitation, the data presented here are based entirely from whole, the responses can be divided into methods or ac- ESI fieldwork.24 The data are from two main sources: a close tions on the part of the households and conditions or situ- ended household questionnaire which was applied to the ations that the respondents believe to be a satisfactory state most senior available household member, and FGDs, which of sanitation (Table 19). were held for both men and women of different ages. These two surveys collected perceptions, opinions, and prefer- In the case of conditions, the most common response was ences from a representative section of the communities (see a very general statement about a clean environment. In San Section 2.3 for methods and sampling approach). Four sets Fernando-coastal and Taguig, the meaning of a clean envi- of results are described here; namely, (a) an understanding ronment was qualified to refer to the home and commu- of what is sanitation; (b) reason for sanitation coverage (c) nity. More specific answers were obtained from Taguig as satisfaction with the current sanitation option; (d) for those the respondents also understood sanitation to mean a func- without a toilet, reasons to get a toilet, characteristics of a tioning drainage system, access to safe and clean water, and toilet, and willingness to pay for an improved toilet. good health. The same is also true for Alabel, where the re- TABLE 19: RESPONDENTS’ UNDERSTANDING OF SANITATION Classification1 Site Sanitation concept discussed Methods Conditions Clean environment (home & community) • San Fernando - coastal: Poro/San Agustin Good hygiene • Right attitude & discipline in maintaining cleanliness • Clean environment • San Fernando - upland: Nagyubyuban Clean source of water • A toilet where people can defecate • Sanitary/clean environment • Good hygiene • Alabel Clean air • Pleasant view of the village • Clean environment • Good nutrition • Proper washing of utensils • Bayawan Proper cleaning of latrines • Proper waste disposal • Discipline in cleanliness • Clean home and environment • Personal hygiene • Functioning drainage system (not clogged) • Taguig Correct way of waste disposal • Good health • Access to safe water and clean toilet • Source: Focus group discussions 1 Methods are responses that refer to actions or measures that can lead to improved sanitation conditions. On the other hand, conditions are situations that the respondents believe to be a satisfactory state of sanitation. 22 Interested readers may also consult SuSEA (2008), USAID (2007), and USAID and the City of San Fernando (2006). 48 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene spondents cited clean air and a pleasant view of the village. “no budget.� This is supported in the FGDs by the finding The most common response in the case of methods was that “poverty� is a reason for not having toilets. Lack or the good hygiene. Other responses include cleaning of utensils, absence of space for which to build a toilet appears to be latrines and proper waste disposal. The respondents in San the second most important reason for not having toilets. Fernando-upland also cited having a toilet where people Consistently cited in the FGDs, it also ranked second in the can defecate in their understanding of sanitation. It is also household surveys for urban areas. Based on the household important to note that the respondents in barangay Puga- surveys, other major reasons for not having toilets are low ro (Dagupan) said that they had no idea what sanitation water level (rural areas) and (non-) ownership of the dwell- means. ing (urban areas). Table 20 shows the reasons for the current sanitation cov- While the FGDs did not provide a clear idea on the rank- erage of households. It indicates that the main reason for ings for each locality, there were many reasons cited for hav- not having a toilet is economic in nature. This is reflected ing toilets. The impacts on health and the desire for cleaner in the relatively high rankings for “cost is too high� and surroundings were common responses in rural and urban TABLE 20: REASONS FOR CURRENT SANITATION COVERAGE — TOP RESPONSES Household interview Focus Group Discussions Location Why families without Why people do not have toilets Why families with toilet have a toilet toilets do not have a toilet 1. Cost is too high 1. Could not tolerate smell and experienced 1. Lack of space Alabel 2. Low water level health problems 3. Toilet ruined by flood 2. Grew up having toilets 1. Cost is too high 1. Intervention: Toilets were donated (none cited) Bayawan 2. Newly transferred 2. Intervention: Households transferred to 3. Never been offered toilet facilities units with toilets 1. Cost is too high 1. Embarrassment associated with being seen 1. Poverty Dagupan 2. Do not own house/land defecating in the open 3. No space in or near the house 2. Pollution San Fernando - 1. Cost is too high1 (none cited) 1. Poverty coastal 2. No budget 2. Lack of space [not applicable]2 1. Intervention: Introduced to EcoSan (none cited) San Fernando - 2. Could not tolerate smell and experienced upland health problems 1. Cost is too high 1. Intervention: Toilets were donated 3 1. Poverty 2. No space in or near the house 2. Intervention: Introduced to EcoSan 2. Lack of space 3. Do not own house/land 3. Intervention: Households transferred to units with toilets Taguig 4. Deteriorating environment made the children sick 5. Desire to have cleaner and healthier surroundings 1. Cost is too high 1. Could not tolerate smell and experienced 1. Poverty 2. No space in or near the house health problems4 2. Lack of space 3. Do not own the house/land 2. Pollution 3. Realization of health benefits Average urban 4. Embarrassment of being seen in the open 5. Realization that they were the ones being adversely affected by open defecation 6. Exposure to housing that had toilets 7. Grew up having toilets 1 There were only two respondents in the HH survey for OD. 2 The sample does not include OD. 3 These five options had equal rankings. 4 The seven reasons had equal rankings. Source: FGDs www.wsp.org 49 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene areas. In the course of the FGD, the respondents mentioned The respondents in the household survey were asked about that the absence of toilets led to open defecation. The re- their level of satisfaction with their existing toilets. In doing spondents also said that the human excreta, animal excreta so, they were given a set of attributes to rank between 1 (not and solid wastes led to illnesses among the households. In- satisfied) to 5 (very satisfied). The findings from the house- tervention, be it from government agencies and other in- hold are presented in Figure 26. It indicates that households stitutions, also appears to be an important reason for the with access to improved sanitation have a high level of sat- presence of toilets among rural households. For example, isfaction with their toilet options as the average ratings for the local government unit in San Fernando introduced the the attributes ranged from 4.4 to 4.8. Households that do EcoSan concept to households that did not have toilets. The not have access to improved sanitation still appear to be shame and embarrassment associated with practicing open satisfied but to a lesser degree. defecation was also cited as a reason for having toilets. Some respondents in the FGD said that, when defecating in the The household survey asked households without toilets to open, they covered their faces with their hands or a piece of rate possible reasons for acquiring toilets. They were asked cloth to avoid being recognized by their neighbors. to rate each reason on a scale of one (not important) to five FIGURE 26: LEVEL OF SATISFACTION WITH CURRENT TOILET OPTION, IMPROVED VERSUS UNIMPROVED1 4.3 Dangerous animals 4.6 3.2 Showering 4.7 3.8 Avoid rain 4.7 3.7 Night use of toilet 4.8 4.5 Convenience for elderly 4.7 3.7 Convenience for children 4.6 4.6 Conflict avoidance 4.7 4.7 Health 4.8 4.2 Maintaining 4.5 3.2 Visitors 4.5 3.2 Status 4.5 4.3 Cleanliness 55 4.4 4.5 Toilet position 4.7 Unimproved Improved 0.0 1.0 2.0 3.0 4.0 5.0 Source: Annex Table E1 1 1= not satisfied to 5 = very satisfied 50 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene (important). Figure 27 shows that all of the choices were ness to pay for improved toilets. A more rigorous approach deemed important by the respondents. The scores were very was conducted by Harder et al. (2011) in estimating the close to each other and it is difficult to identify the main willingness to pay for sanitation services in Dagupan City. reason with a high degree of confidence. However, the top The study found that households were willing to pay an answers were (a) comfortable toilet position comfort (com- average of PhP552 per year for desludging services.24 It also fort), having privacy at the toilet (privacy), and cleanliness found that households were willing to pay PhP1,224 per and freedom from unpleasant odors and insects (cleanli- year for a sewerage system. In comparing the findings with ness). the costs of the facilities, the study concluded that the will- ingness to pay of the households was sufficient to finance The survey results also revealed that the respondents with desludging services in the city. However, PhP1,244 annu- no toilet are willing to pay an average of about PhP2,500 ally per household is not sufficient to pay for a sewerage (US$56) for an improved toilet (Annex Table E1). This val- system. ue is very low and is not sufficient to finance the construc- tion of a standard toilet. At best, such an amount could Table 21 shows some of the concerns of households who only afford a dry pit latrine.23 The respondents showed a practice open defecation. Of the options provided, it seems strong preference (78% of respondents) for toilets that are that the highest concern was for the safety of their children connected to a septic tank. (37%). This result supports the finding in Figure 27 where the households who do not have access to improved sanita- The value provided above is a rough estimate and was not tion indicated a lower level of satisfaction in terms of allow- obtained using a rigorous approach for calculating willing- ing children to use toilets without supervision. FIGURE 27: REASONS TO GET A TOILET FOR THOSE CURRENTLY WITHOUT TOILET ACCESS, AVERAGE Clean environment 4.8 Having a toilet disposal system that does not pollute yours, neighbors’, or your community's environment 4.7 Having a toilet disposal system that does not require emptying (piped sewer vs septic tank) 4.3 Pour-flush compared to dry pit latrine 4.4 Proximity of toilet to house 4.8 Having privacy when at the toilet 4.8 Having a toilet not needing to share with other households 4.8 Cleanliness and freedom from unpleasant odors and insects 4.8 Comfortable toilet position 4.8 0 1 2 3 4 5 Source: Annex Table E2 1 1= not important to 5 = very important 23 Estimates of toilet costs are presented in Chapter 6. 24 This assumes that septic tanks are desludged every three years. www.wsp.org 51 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene TABLE 21: CONCERNS OF THOSE PRACTICING OPEN DEFECATION, % OF RESPONDENTS Responses (%) Attribute No. Responding Never Sometimes Often Have you felt in danger when going for OD? 221 54 28 18 Are you worried about the safety of your children? 209 38 25 37 Have you heard about someone being attacked by 221 87 11 2 animals? Source: ESI household survey TABLE 22: PREFERENCES RELATED TO TOILET COMFORT AND STATUS Sites Region Gender All Attribute San San Alabel Bayawan Pugaro Fernando Fernando Taguig Urban Rural Male Female Sites -Coastal -Upland Comfort1 Position of the toilet 5.7 3.0 3.0 3.5 3.0 4.3 4.2 3.2 4.2 3.4 3.8 Size of the cubicle 5.3 4.5 4.0 4.8 6.0 5.2 4.9 5.1 5.5 4.6 5.0 Cleanliness 1.7 1.0 2.0 2.3 1.5 1.7 1.9 1.6 1.5 1.8 1.7 Smell 3.0 2.0 3.0 2.8 3.3 2.7 2.8 2.7 2.4 3.1 2.7 Enclosed nature 1.3 4.5 4.5 3.8 3.3 2.0 2.7 3.8 3.2 3.0 3.1 (private) Aversion to the 4.0 6.0 4.5 4.5 4.0 5.2 4.7 4.8 4.5 5.0 4.8 presence of animals Status2 Not being seen as 3.3 1.5 2.0 3.5 2.5 3.5 3.3 2.5 2.8 2.8 2.8 going to the toilet Pride in owning your 2.7 1.5 2.0 1.3 1.3 1.2 1.6 1.3 1.4 1.7 1.5 own toilet Having an expensive 1.3 4.0 3.5 1.8 3.5 2.7 2.3 3.1 2.9 2.7 2.8 fancy toilet model Being able to invite 2.7 3.0 2.5 3.8 2.8 2.8 3.0 3.2 3.1 2.8 3.0 certain kinds of guests to the home, or having them accept the invitation 1 The values represent the average ratings for the six attributes. A value of 1 means that the feature is the most important while a value of 6 means that the feature is the least important. 2 The values represent the average ratings for the four attributes. A value of 1 means that the feature is the most important while a value of 4 means that the feature is the least important. Source: Focus group discussions The relatively high level of satisfaction, especially among the respondents placed the highest priority on cleanliness those who have access to improved toilets and the concerns (Table 22). The rankings were also very similar across gen- of households who practice open defecation, can be appre- ders and for sites. Of the five study sites, only the respon- ciated better in the context of the responses to questions on dents in Alabel had a different preference in this category. toilet preferences in the FGD. The top response in this study site was having an enclosed toilet, highlighting an apparent preference for more privacy. The respondents were asked to rank a number of features However, their preference for cleanliness came a very close with respect to comfort, and status. In terms of comfort, second. 52 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene The FGDs also asked the respondents about the intangible The first response was given by groups that already have toi- gains they derive from owning a toilet. In this regard, the lets and are probably seeking an upgrade of their facilities. highest rank was for the pride associated with having a toi- On the other hand, the last two responses were provided by let (Table 22). The finding was consistent across genders groups who have a history of practicing open defecation. and sites. One exception is Alabel, where the highest rank was given to “having an expensive fancy toilet.� The feature 4.6 External environment of not being seen going to the toilet was also a top choice “External� environment refers to the area outside the toilet in Bayawan and Dagupan. The reasons mentioned for the itself and is not related to toilet use. It can include living choice were not having to ask permission from anybody areas, public areas, and private land, which can all be af- when they need to use the latrine. Toilet ownership was also fected by open defecation practices and unimproved toilet viewed as an indication in the community that the social options. The consequences on water pollution will not be status of the household has improved. Other features that discussed here because it has already been covered in Sec- were rated highly by specific groups are: tion 4.2. The sources of data are the ESI surveys: physi- • Having a fancy and expensive type of toilet (house- cal location survey, household interviews, and focus group holds with desludged septic tanks in Alabel; men discussions. Given that the external environment is also with private toilets in Poro/San Agustin, San Fer- spoiled from other sources of poor sanitation — mainly in- nando; and women with access to sewers in Taguig) adequate solid waste management practices — these have • Confidence in inviting guests to their home without also been assessed to understand the contribution of each, having to bring the guests to their neighbor’s toilet and relative preferences regarding their improvement. (men in Pugaro, Dagupan; and women with UD- DT-E toilets in Nagyubyuban, San Fernando) Figure 28 shows scoring of the quality of environmental • Not being seen going to the toilet (women in Puga- sanitation. It shows that the respondents are aware that ro, Dagupan; and men in Bayawan) flooding does not occur often in the sites and that open FIGURE 28: SCORING OF DIFFERENT TYPES OF LIVING AREA Land is flooded permanently with poor quality sitting water 1.1 activities occur in do the following neighborhood: To what extent Land flooded seasonally pervasive (4) 1.6 never (1) to your Garbage/waste dumpsites/land�lls 1.3 Land affected by sewage drains and wastewater 1.7 Open defecation 2.1 Insects around uncollected waste etc 2.1 Rodents around uncollected waste etc 2.0 very bad (1) to very good (5) State of sanitation in the Dust & dirt in shops/markets/restaurants 2.1 neighborhood: Dust & dirt in streets/roads/alleys 2.4 Smell from sewage/defecation/waste 1.9 Smoke from burning waste/garbage 2.5 Accumulation of storm/rain water 2.9 Open/visible sewage or wastewater 2.8 Uncollected/undisposed household waste/ 2.7 0.0 0.5 1.0 1.5 2.0 2.5 3.0 Note: 1 = very bad to 5 = very good; Source: Annex Table F1 www.wsp.org 53 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene defecation occurs in their neighborhood sometimes. How- tanks, and pit latrines in the study sites. Among those who ever, the respondents recognize that the state of sanitation have access to toilets, about a third and slightly more than in their neighborhood can stand improvement. All the a tenth of the respondents in the study sites urinated and characteristics stated in the questionnaire had an average defecated in the open, respectively. Close to a fifth of the rating of less than three out of a possible five (very good). respondents also disposed of the stool of their children in The lowest ratings were given to the presence of rodents the environment. In all cases, the poor practices appear to and insects (2.0), and the smell from sewage, defecation be more prevalent among urban households. Septic tank and waste (1.9). management practices also require improvement. Among households with facilities over the age of five years, about In attempting to get an overall picture of the state of sanita- 50% emptied their septic tanks. Of these households, about tion in the sites, a simple average of the scores is presented 7% did so more than five years from the date of the survey. in Figure 29. It suggests that the state of sanitation, as rated This implies that almost half of the households with such by the respondents, in all the sites can stand improvement. septic tanks have neither desludged their facility nor did so Moreover, the ratings of rural households were higher than in a period beyond the period in which such facilities should their counterparts in the urban sites. Among the study sites, be emptied. In the case of pit latrines, about 80% of those the highest ratings were for Alabel and Bayawan. While in- who responded said that their facilities sometimes overflow. dicative of the state of sanitation, it is difficult to read too Moreover, about 60% said that their pits have experienced much into these findings because the values were based on seepage or flooding. However, some care needs to be exer- a subjective assessment of the respondents. cised in interpreting the findings for pit latrines because of the very low response rate. Out of the 187 households that It is important to note that households which have access own dry and wet pits, only 30 households from the upland to improved sanitation facilities may still contribute to pol- region of San Fernando responded to the questions. Hence, lution in the environment. Figure 30 summarizes some there is no information to say whether the other sites expe- findings for households that have access to toilets, septic rienced seepage/flooding or pit overflow.25 FIGURE 29: OVERALL STATE OF SANITATION IN THE STUDY SITES1 Alabel 3.4 Bayawan 3.4 Dagupan 2.0 Sites San Fernando - Coastal 2.0 San Fernando - Upland 2.1 Taguig 2.3 Rural 3.1 Summary Urban 2.3 All 2.4 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 Source: Annex Table F1 1 1 = very bad to 5 = very good 25 Other sites which have pit latrines are Alabel, Dagupan, and the coastal region of San Fernando. 54 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 30: PROPORTION OF HOUSEHOLDS WITH UNIMPROVED SANITATION PRACTICE, % 19 Stool of children disposed in the environment 25 Households with access 7 33 to toilet Open urination (sometimes, often) 34 30 13 Open defecation (sometimes, often) 16 6 14 Age of septic tank unknown and desludged 50 0 Households with septic tanks 50 Built more than 5 years ago and desludged 56 29 13 Built 2-5 years ago and desludged 31 5 1 Don’t know 1 Last time septic tanks were desludged (for septic tanks aged 5 years and above) 0 7 More than 5 years ago 4 27 93 Within the last 5 years 95 73 80 Pit overflowed (yes, sometimes) 0 with pit latrines Households 80 60 Experience seepage/flooding into pit 0 60 0 20 40 60 80 100 Rural Urban All Source: Annex Table F2 www.wsp.org 55 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 32: PERCEPTIONS OF ENVIRONMENTAL SANITATION The respondents were also asked regarding the perceived STATE, BY OPTION TYPE1 benefits of improved sanitation in terms of reducing pol- 3.5 Rubbish 2.3 lution in the neighborhood or community and in reduc- 2.7 ing smell around the house. A score of five means that the 3.5 Sewage 2.5 households are very satisfied while a score of one means that 2.8 they are not satisfied. Figure 31 presents the responses for 3.3 Standing water 2.7 households with different sanitation facilities in rural and 2.9 urban areas. It shows that the different groups were highly 3.4 Smoke 2.6 satisfied with the way in which their facilities reduce pollu- 2.9 tion in their neighborhood and smell inside their homes. 3.3 Smell 2.2 However, the ratings of households with dry pit latrines 2.6 and shared toilets in terms of reducing pollution were lower 2.8 Dirt outside 2.3 than the other households. 2.5 FIGURE 31: IMPLICATION OF CURRENT TOILET OPTION FOR 2.9 EXTERNAL ENVIRONMENT1 Dirt inside 2.4 2.6 4.7 2.5 No toilet Rodents 2.0 4.6 2.2 Shared toilet 4.1 2.5 Insects 1.9 2.2 Unimproved 4.6 0.0 1.0 1.5 2.0 2.5 3.0 3.5 4.0 Smell around house pit or bucket 4.8 Rural Urban All sites 4.3 Compost toilet 4.4 Source: Annex Table F4 1 1 = very bad, 5 = very good 4.2 Dry pit latrine The previous paragraphs described the state of sanitation in 5.0 the sites by examining the evaluation of the respondents of Wet pit latrine 4.8 the various aspects of sanitation. The general implication 4.7 of the findings was that, by the respondents’ own account, Sewer/septic tank 4.8 more work needs to be done in order to achieve satisfactory 4.4 sanitary conditions. Crucial to understanding why these No toilets 4.6 conditions occurred and perhaps the willingness of the re- Pollution of your or neighboors’ environment 3.9 spondents to address them is how important they perceive Shared toilet improved sanitation conditions. In the household survey, Unimproved 4.5 the respondents were asked about the importance of select- pit or bucket 4.8 ed aspects of sanitation. They were asked to give a score of 4.2 one (not important) to five (very important) to each of the Compost toilet aspects presented in Figure 32. The results indicate that they 4.5 place the highest level of importance on the collection and 3.6 Dry pit latrine disposal of waste, garbage or rubbish (rubbish, 2.7); open, visible sewage or wastewater (sewage, 2.8); accumulation 4.7 Wet pit latrine 4.7 of rain and storm water (standing water, 2.9); smoke from burning waste, garbage and rubbish (smoke, 2.9); and smell 4.6 Sewer/septic tank 4.8 from sewage, defecation and waste (smell, 2.6). There are three points about the results that are worth noting. First, it Urban Rural 0 1 2 3 4 5 seems that the level of importance assigned to these aspects Source: Annex Table F3 was not too high as the averages fall below the mid-point 1 1 = not satisfied, 5 = very satisfied 56 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene (three) of the range of possible ratings (one to five). Second, 4.7 Project performance and actual benefits in the importance of these aspects was higher for the rural sites the field sites relative to the urban sites. Finally, cross-tabulating these re- 4.7.1 PROJECT COVERAGE sults with their assessment of sanitation conditions (Figure Many of the sanitation options in the field sites were made 29) suggests that the aspects on which they put the highest available to the households through projects initiated and importance were generally those aspects which received the implemented by government, donor agencies, private firms most positive evaluation. The only major exception appears and NGOs. Table 23 summarizes the sanitation options to be smell, which was ranked as being among the most received by households through recent projects/programs. important aspects and yet had a state which they assessed as It excludes households that continue to practice open def- not being too good. ecation or facilities that were constructed in the absence of TABLE 23: SANITATION COVERAGE INFORMATION PER FIELD SITE Households Project Years Site Setting Intervention Interviewed in Reached by Project Name Institutions Involved Start End ESI survey program Over Southern Mindanao Integrated Alabel Rural STF 44 20061 20071 DENR, JBIC 14,000 Zone Management Project3 Toilets & Covered under Local Housing Local government Bayawan Rural constructed 180 700 2004 20063 Board Act of 1999 of the local & GTZ wetland government. Urban Community 65 approx. na 20075 na Local government Dagupan toilets 8004 Rural & UDDT-E 64 215 2004 2010 ISSUE 1 and ISSUE 2 Local Urban government, San CAPS, WASTE, Fernando SWAPP, IDEEAS, FSSI, DGIS Urban Community 65 1256 na na na Local government toilets Urban STF 91 Over 2006 2007 Component of the Third Manila Manila Water 200,0007 Sewerage Project Company Incorporated, Taguig World Bank, Land Bank of the Philippines Sewer 84 1,1408 na 19959 Centennial Village was BCDA, Manila system at constructed under the Water, World Bank Centennial management of the Bases Village Conversion Development Authority (BCDA). The operation and management of the sewerage facilities were turned over to Manila Water, which in turn rehabilitated the facilities under the Second Manila Sewerage Project. 1 Construction began in February 2006 and the STF was inaugurated in Oct 2007. 2 The STF is one of seven treatment facilities constructed under the project. 3 Houses turned over to the beneficiaries. 4 Based on the 2007 Census, barangay Pugaro had a population of 4,063 persons. 5 The facilities were completed in September 2006 but turned over on January 2007. 6 Based on the FGD, these represent the number of households using the community toilets at barangay San Agustin. 7 The STF is projected to serve an area that has more than a million persons. Apart from Taguig, it also services San Juan, Mandaluyong, Pasig, Makati, Pateros and Cainta. 8 This represents the number of housing units at the Centennial Village. 9 Completion of the Centennial Village. www.wsp.org 57 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene any recent initiatives beyond that of the household. As ex- Out of the 1,270 households included in the ESI survey, pected, the projects differ in terms of the facilities provided 374 households received toilets through various projects. to the households. The projects in Dagupan were confined Within this group, more than 96% (358 households) of the to the provision of latrines. In contrast, the project in Bay- households received toilets from the program or an agency awan was broader as the local government provided homes or the local government. The households also contributed that had built-in toilets and a constructed wetland for the to the programs (see Figure 33). Most of the contribution community. There was a mix of projects in San Fernando, was in the form of labor (21%) and very few of the house- ranging from simple distribution of urine diversion-dehy- holds contributed cash (less than 1%). The average labor dration toilets to those that provided houses (Fishermen’s contribution was about 6 days. Village in Barangay Poro). It is important to note that 180 of the respondents in Figure The projects/programs were implemented on the initiative 33 were beneficiaries of the Gawad Kalinga Village in Bay- of local government units (San Fernando, Dagupan), a pri- awan. As part of the project, these households contributed vate sector operator on behalf of a public authority (Taguig) labor, on average about seven days per household, but not and the national government (Alabel). However, NGOs, cash. However, these households are also expected to pay a donor agencies and other private institutions also played an monthly amortization of PhP280 (US$6) for the house for important role in funding and implementation of the proj- 15 years. This means that financial contributions are being ects. For example, the provision of urine-diversion toilets in paid for the toilets through their monthly amortization.26 San Fernando was funded by the Directorate General of In- ternational Cooperation (DGIS) of the Netherlands Minis- Based on the household survey, Figure 34 summarizes other try of Foreign Affairs, with NGOs and private institutions key features of these projects. First, it indicates that the ma- including CAPS, Solid Waste Management Association of jority of the respondents were neither offered a choice nor the Philippines (SWAPP) and others providing coordina- given alternative options with respect to the facilities pro- tion, capacity building, technical advice, etc. In the case of vided. Second, most of the programs were accompanied by the STF in Taguig, the World Bank lent money to Manila an information campaign, especially for the households that Water through the Land Bank of the Philippines (LBP), a received private toilets. Third, only 5% of the households government financial institution. that were given access to community toilets said that they were also provided access to water. This is in sharp contrast FIGURE 33: CONTRIBUTION OF HOUSEHOLDS, % to households which were provided private toilets, where 25.0 77% of the households claimed that they also received ac- cess to water. However, this finding must be interpreted with care because 73% of the beneficiaries were from the 20.0 Gawad Kalinga relocation site at Bayawan. If the respon- dents from this site were removed from the analysis, then 15.0 only about a third of the beneficiaries were provided access to water. While not discounting the need for water in pro- percent moting hygiene practices, it is important to note that the 10.0 remaining households received urine diversion-dehydration toilets that only require water for cleaning. 5.0 The analysis above excluded households in Alabel and Tagu- ig because no toilets were provided in these survey sites. 0.0 While households in these sites did not participate in the decision to construct the treatment facilities, the beneficia- Source: Annex Table F6 26 A quantitative analysis of the contribution of the households to the costs of the facilities is provided in Section 6.2. 58 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 34: CHOICE TO PARTICIPATE AND OTHER BENEFITS PROVIDED TO THE HOUSEHOLDS % sufficient for flushing. Referring only to owners of dry pit latrines, Figure 35 also shows that some of these households 27 Yes experienced flooding or overflowing in their pits. 21 a choice (%) Offered No 73 4.7.3 SELECTED IMPACTS ON TARGET 65 BENEFICIARIES 0 Not applicable Initiatives to implement sanitation improvements may be 12 assessed in different ways. In the case of projects, it is pos- Yes 37 sible to compare the quantity and quality interventions Given options (%) 35 against the project targets. Another way would be to ex- No 63 amine the impact on the target beneficiaries after the proj- 51 ect completion. Figure 36 focuses on the latter. It summa- 0 rizes selected performance indicators for all interventions, Not applicable 12 regardless of the presence of projects in all the field sites. Yes 98 The indicators represent the (a) behavior of the survey re- Accompanied with 54 spondents with respect to hygiene, toilet maintenance, awareness (%) hygiene No 2 defecation, and urination, (b) positioning of latrines and 32 septic tanks, and (c) water availability. The information was Not applicable 0 drawn from the household questionnaire and observational 12 instruments. Details for the specific sites are presented in 77 Annex Tables F9 and F10. Yes 5 with water (%) FIGURE 35: APPROPRIATE TECHNOLOGY % Provided 23 No 80 1.6 with insuf�cient Sometimes % households 1 for flushing Not applicable 6.7 12 water 0 20 40 60 80 100 0.1 17 Often Privates toilets Privates toilets (Bayawan & (Bayawan & San Fernando) San Fernando) 19.2 Sometimes % households pit flooding Source: Annex Table F7 with ries have a choice in selecting the firm that will empty their 19.2 septic tanks. However, the options are a bit more limited Often in Taguig. The reason is the presence of an environmental charge that is automatically included in the water bill of the households. This fee is designed to support the sanitation 11.5 Sometimes % households services provided by the water utility. pit overflow with 4.7.2 APPROPRIATENESS OF TECHNOLOGY 7.7 Figure 35 summarizes a few indicators related to the ap- Often propriateness of the technologies in the sites. It indicates that about 1.6% of the households in all sites said that there 0 5 10 15 20 is not enough water for flushing. This finding was mostly All sites Bayawan (Gawad Kalinga Village) due to beneficiaries at the Gawad Kalinga Village, where Source: Annex Table F8 about 7% of respondents said that water is sometimes not www.wsp.org 59 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 36: INDICATORS FOR HOUSEHOLDS WITH ACCESS TO TOILET FACILITIES, % Washed hands with soap yesterday 100 Personal hygiene Washing hands after defecation 100 Soap for washing hands is available inside or near the toilet facility 85 Signs of feces/waste around toilet 3 tenance main- Toilet Signs of insects in toilet 96 Using bush for urination 32 Defecation and urination Using bush for defecation 13 Children using or stool disposed in toilet/latrine 40 Children seen defecating in yard 86 Pit latrine/septic tank within 20m of well 74 and septic of latrines Position tanks Pit latrine/septic tank within 10m of well 45 Running water in or near toilet 61 Water availability Using bucket to withdraw water from well 1 Using well which is not covered 1 0 20 40 60 80 100 percent Source: Annex Table F9 and F10 Figure 36 shows that, on the basis of handwashing behav- design could stand improvement as the enumerators ob- ior, the respondents practice good personal hygiene as all served that 96% of the facilities had insects in the toilet. the respondents claimed to wash their hands after defeca- Moreover, the respondents mentioned that quite a few of tion. However, the enumerators in the survey found that them still defecate or urinate in the open. More than half only about 85% of the toilets had soap inside or near the of the respondents also do not dispose of the stool of their cubicle. This implies that some of the respondents washed children properly and continue to observe children defecat- their hands elsewhere or brought the soap with them to the ing in the yard. The enumerators also found that running toilet. It may also be an indication that the earlier findings water in or near the toilet was only available 61% of the on handwashing behavior are overstated. While personal time. This means that many households have to haul water hygiene practices were impressive, toilet maintenance and to flush or clean the latrines every time they use it. 60 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 37: PIT LATRINES/SEPTIC TANKS WITHIN 10 TO 20 FIGURE 38: OPEN DEFECATION AND URINATION IN THE METERS FROM A WELL, % OF HOUSEHOLDS PROJECT SITES, % OF HOUSEHOLDS 1 Bayawan: 0 Bayawan: Constructed wetland 17 Constructed wetland 67 0 San Fernando (Rural): 9 San Fernando (Rural): Ecosan/UDDT 49 UDDT-E 0 Dagupan: 57 Dagupan: 25 Public toilets Public toilets 89 48 San Fernando (Urban): 29 San Fernando (Urban): 38 Public toilets Public toilets 68 93 San Fernando (Urban): 29 San Fernando (Urban): 45 Ecosan/UDDT 71 UDDT-E 100 Taguig: 2 Alabel: 44 Septic tanks desludged at STF 5 Desludged at STF 100 0 Taguig: Average (Including 45 With access to sewers households not covered 1 by projects/programs) 74 Alabel: 0 0 20 40 60 80 100 Desludged at STF Pit latrine/septic tank Pit latrine/septic tank 2 within 10m of well within 20m of well Average (Including 13 Source: Annex Table F9 and F10 households not covered by projects/programs) 32 There might also be room for improvement in the position- 0 20 40 60 80 100 ing of septic tanks and pit latrines as more than 40% of Open defecation Open urination these facilities are located 10 to 20 meters from wells (see Source: Annex Table F9 and F10 Figure 37). However, this result must be interpreted with care because the actual risks associated with the position hand, the proportion of households practicing open def- of the latrines and septic tanks are also influenced by fac- ecation was higher among those who have access to public tors like soil type and condition (permeability), depth to toilets (Dagupan and San Fernando) and UDDT-E users aquifer, gradient, quality of wells, etc. In addition, the op- (urban regions of San Fernando). portunity to construct facilities which are far enough from water sources might be severely constrained in urban areas. 4.7.4 IDEAL TO ACTUAL BENEFITS There are a number of reasons that may prevent the full Despite the availability of toilets, there is still evidence realization of the benefits from a sanitation intervention. that households continue to defecate and/or urinate in the For example, the extent to which the health benefits are open. This appears to be a more serious problem among realized from an improved sanitation option depends on households that have access to UDDT-E facilities in San whether the facility is used by the beneficiary. If very few Fernando (both rural and urban sites) and public toilets of the beneficiaries actually use a sanitation facility, then in Dagupan and San Fernando (Figure 38). On the other the likelihood of getting diseases will not be very different www.wsp.org 61 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene FIGURE 39: ADJUSTMENT VARIABLES FOR BENEFITS, % OF RESPONSES Alabel 95 Households using toilet Bayawan 98 regularly Dagupan 92 San Fernando - Coastal 90 San Fernando - Upland 90 Taguig 90 Alabel 100 Households with access Bayawan 3 to sewers/STF Dagupan 0 San Fernando - Coastal 0 San Fernando - Upland 0 Taguig 100 Alabel 67 instead of off-plot options Household members Bayawan 85 using own toilet Dagupan 33 San Fernando - Coastal 71 San Fernando - Upland 97 Taguig 79 0 20 40 60 80 100 percent Source: Annex Table F11 from those who practice open defecation or use inferior op- ditions — i.e., where sanitation facilities are used at opti- tions. In other words, the benefits from having access to im- mal levels, maintained properly, and complemented with proved sanitation will be limited. In the case of hygiene, the appropriate hygiene practices. Second, the benefits will be health gains from having access to improved sanitation op- adjusted with the aid of selected indicators from the field tions might be reduced if the beneficiaries do not wash their sites. The adjusted values will be called actual benefits in the hands after defecating. Hence, it is important to check if analysis. The actual and ideal benefits will then be used to such a practice is common among the beneficiaries. Similar generate two sets of efficiency measures — ideal and actual arguments can be made for the other benefits of improved conditions — in Chapter 7. sanitation — water source, water treatment, access time, and reuse. Figure 39 shows selected indicators for the field sites. It in- dicates that at least 90% of the households in the sites use This study will attempt to capture the inability to fully real- their (improved) toilets regularly. This implies a high likeli- ize the gains from an intervention by making a distinction hood that the health benefits from improved sanitation are between ideal and actual benefits, and adopting the follow- going to be realized for these sites. All households in the ing procedure: First, the benefits quantified in Sections 4.1 sample for Alabel (urban barangays only) and Taguig have to 4.4 will be treated as gains occurring under ideal con- access to treatment facilities. This is due to the presence of 62 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene the STF in both sites and the sewer system at the Centen- ies. For all its limitations, the indicators presented in this nial Village in Taguig. The opposite is true for the house- study highlight the point that the full benefits of improved holds in Dagupan and San Fernando. This implies that the sanitation may not be realized in the absence of changes full benefits of improved sanitation are less likely to be real- in hygiene behavior and use of toilet facilities. Second, the ized from the two sites because off-site sludge and waste- non-optimal use of public facilities such as STFs and com- water disposal facilities are not available. The proportion of munity toilets will have cost implications for the analysis. household members using off-plot options represents the Given the fixed costs of installing these facilities, non-op- potential for realizing the gains associated with access time. timal use implies that costs per households will be higher Figure 39 indicates that the beneficiaries from Dagupan are compared to optimal use. The actual impacts on costs per the least likely to obtain the full benefits because a large household are discussed in Chapter 6. proportion of them still have to walk to a place of defeca- tion. The full set of indicators for the field sites is presented 4.8 Summary of local benefits in Annex Table F11. These values will be used to estimate Table 24 summarizes the local benefits associated with ac- the actual efficiency of sanitation interventions. cess to improved sanitation under ideal conditions. It pres- ents the quantitative benefits for the rural and urban sites There are two important points to note about the calcula- that were reported earlier. These represent the estimated tion of actual and ideal benefits. First, the values presented gains per household on an annual basis. The table also re- in Figure 39 should be seen as an initial step in developing a ports the qualitative benefits that were not quantified in the set of measures that could be used for evaluating the actual analysis. The majority of these benefits were sourced from benefits. Some of the indicators may be refined further with the surveys and FGDs in the study sites. more available information. For example, the proportion of people who wash their hands after defecation may be aug- The quantified benefits suggest that gains associated with mented with information on the frequency with which they access time are likely to be the highest source of benefits for do it. A person who washes his/her hands is less likely to get rural and urban households. However, this must be inter- sick if he/she engages in the practice more often. Some of preted with care because of two reasons. First, health care the indicators might also have to be combined with other costs averted are likely to be the largest individual source of measures to generate a more accurate assessment of actual benefits in urban sites if households that practice open def- practices. For example, handwashing may be combined ecation are provided with toilets that have access to sewers. with information on the cleanliness of the toilet bowl or Second, combined health benefits (i.e., health care + pro- the cubicle itself, or even food preparation. However, the ductivity + mortality) of moving from open defecation to development of such indicators and how these will be used toilets that have access to sewers provide the largest source to adjust the benefits can be the subject of further stud- of benefits to rural and urban households. www.wsp.org 63 Economic Assessment of Sanitation Interventions in the Philippines | Local Benefits of Improved Sanitation and Hygiene TABLE 24: SUMMARY OF LOCAL IMPACTS OF SANITATION IMPROVEMENT Benefits of improved sanitation and hygiene Quantitative benefit Benefit (PhP/household, annual) Qualitative Benefit Rural Urban Health Health care costs averted Health burden and quality of life • Avoided pain and discomfort because of illness: 9 DALYs averted per 1000 households OD to Basic 1,061 1,114 per year for basic sanitation and 15 with improved WWM. Note: The values represent simple averages for all the sites. OD to Sewerage 1,663 1,745 • Avoided income losses from other diseases associated with poor sanitation. Productivity costs averted OD to Basic 422 778 OD to Sewerage 668 1,231 Mortality costs averted OD to Basic 430 323 OD to Sewerage 655 430 Water Savings from access costs 55 403 Overall quality • Improved water quality (smell, appearance, lower contaminants, etc.) for drinking, Savings from treatment 28 85 domestic purposes, recreation and other purposes. All the respondents who accessed costs drinking water from unprotected sources said that the water had a bad appearance. Another 11% of these respondents said that the water had a bad taste. Among respondents who accessed water from non-piped protected sources, 10% said that the water had a bad appearance or the presence of sediments. Access time 1,701 1,700 • Convenience associated with having access to private toilets: Of the 4 choices provided to respondents, the strongest preference was given to “being able to go quickly when the need arises.� • Additional: time loss associated with urination: Some respondents in the FGDs said that they urinate up to 7 times a day. The estimated gain from access to improved sanitation could have been larger if these were taken into account. Intangibles nc nc • On the aspect of comfort, the respondents gave the highest priority to cleanliness. • On the aspect of status, the respondents gave the highest priority to the pride associated with having a private toilet. This was complemented by the results of the FGD where some of the participants cited greater confidence in inviting guests to their home after receiving a toilet. In addition, there were respondents who said that they had to cover their faces, so that they will not be recognized, whenever they defecate in the open. • Privacy was also important as “not being seen going to the toilet� was ranked second by the respondents on the aspect of status. • Safety was also important as 37% of the respondents said that they were often worried whenever their children had to defecate in the open. In the FGD, some of the participants said that having toilets made them feel safer, especially for women using toilets at night or when it is raining. External Environment nc nc • The responses to the ESI household survey showed that the state of the environment in the study sites could stand improvement. With scores ranging from 1 (very bad) to 5 (very good), the poorest scores were given to smell from sewage/defecation/waste (1.9), rodents around uncollected waste (2.1), and insects around uncollected waste (2.1). The average of scores in all sites given to various environmental conditions was 2.4. Reuse 561 551 • The benefits could have been larger if the reuse of human excreta as biogas was included in the analysis. Similar results could be expected if the reuse of sludge and wastewater from off-site treatment plants was included. Note: nc = not calculated; OD = open defecation 64 Economic Assessment of Sanitation Interventions V. National Benefits of Improved Sanitation and Hygiene This chapter presents the national impacts of improvements World Bank (2003) noted an observed 60% fall in hotel in sanitation. In particular, it presents the results on: occupancy rates in 1997 at Boracay island, one of the top • Tourism (Section 5.1) tourist destinations in the Philippines, after a DENR water • Businesses and foreign investment (Section 5.2) quality monitoring report which declared that high levels of • Sanitation reuse markets (Section 5.3) coliform made the water unsafe for recreational activities. • National health (Section 5.4) While it is difficult to quantify the monetary impacts, this 5.1 Tourism study attempted to assess the relationships between selected Tourism is an important economic activity in the Philip- aspects of sanitation and tourism. The analysis is based on pines. In 2007 alone, the country attracted 2.9 million a survey of 189 visitors at the Ninoy Aquino International visitors that spent close to US$4.5 billion (NSCB 2008).27 Airport who were about to leave the Philippines. Nearly Virola (2009) cited that the direct gross value added from three-fourths of the respondents came from North America tourism accounted for about 6.2% of GDP from 2000 to and Europe (Table 25). Asia, Australia/New Zealand and 2007. He also noted that the employment share to total Africa accounted for the remainder of the respondents. The employment of industries directly related to tourism aver- visitors were in the country either as tourists (75%) or on aged 9.5% between 2000 and 2008.28 business (25%). Staying in the country for an average of more than two weeks, about 70% of these visitors either Decisions of tourists to visit a country can be influenced by stayed with friends or relatives (27%) or in hotels that cost sanitation conditions. The quality of water resources (for less than US$90 per night (43%). drinking water and recreation), quality of the environment (smell and sights), food safety (hygiene and food prepara- The visitors were asked to rate how much they enjoyed se- tion), general availability of toilets in public places, and lected sites in the country. A value of five was assigned if health risks can affect the decisions of tourists to visit a des- the site was enjoyed “very much� while a value of one was tination. Disease epidemics, whether or not these are influ- assigned if the visitor did not enjoy the site (“not at all�). enced by sanitation conditions, are also likely to discourage The results are shown in Figure 40. As a whole, the survey tourists from visiting a site. One example is the outbreak findings indicate that the visitors most enjoyed their visits of typhoid fever in Calamba, Laguna in 2008 that was to beaches and forests in the Philippines. The average rating suspected to be caused by contaminated and inadequately for the capital (Manila) was slightly lower and the lowest treated water (Tayag 2008). Home to more than 200 re- rating was given to historical sites in the country. However, sorts, news of the outbreak affected tourism in the area. A their assessment of these sites was still above the midpoint newspaper report cited that one owner estimated a 60% de- (three) of the possible range of scores (one to five). Hence, it cline in the number of regular customers at the time of the might still be possible to conclude that the tourists enjoyed outbreak (PDI 2008). A disease epidemic is not a necessary their trip to the capital and historic sites but it was not as condition for a sanitation-related decline in tourism. The much as to the other sites in the country. 27 This does not include the estimated 180,739 overseas Filipinos who went back to the country and spent US$343.85 million (NSCB 2008). 28 The World Travel and Tourism Council (WTTC 2008) projected that in 2008 industries directly associated with tourism accounted for 4% and 3% of total employment and GDP, respectively. Incorporating industries that are indirectly associated with tourism generates significantly higher estimates of the contribution to total employment (10%) and GDP (9%). www.wsp.org 65 Economic Assessment of Sanitation Interventions in the Philippines | National Benefits of Improved Sanitation and Hygiene The visitors were also asked to rate sanitary conditions in were somewhere between fair to good, ranging from 3.0 to general and at selected locations in the country. They were 3.9. The visitors perceived that sanitation conditions in ho- asked to make a rating on a scale of one to five, with a tels were the best compared to the other locations/amenities value of five suggesting that sanitary conditions are “very included in the survey. On the other hand, the lowest aver- good.� As a whole, the average rating for general sanitation age rating was for the capital (Manila) at 3.0. The percep- conditions was 2.9 (Figure 41). There was barely a differ- tions among tourists and business travelers do not appear ence between the perceptions of tourists and businessmen to differ much but business travelers were generally more as a whole. At the extremes however, the business visitors generous with their ratings. who stayed at the cheapest hotels (less than US$60 a night) had the lowest rating for general sanitation conditions. In Table 26 provides more specific information on sanitation contrast, tourists who stayed in moderately priced hotels conditions as perceived or experienced by foreign visitors. (US$60 to US$119 per night) had the highest rating.29 This The respondents were asked to rate the conditions of toi- suggests that more work needs to be done in terms of im- lets in hotels, restaurants, airports, bus stations, and public proving the impressions of foreign visitors regarding general toilets around the city. These were ranked on a scale of one sanitation conditions. (“very poor�) to five (“very good�). As a whole, the highest rating was for hotels. With an average of 3.8 (fair to good), While perceptions regarding general sanitation conditions this rating was consistently the highest among tourists and were not really impressive, the assessments for specific loca- businessmen. In contrast, the lowest average rating was for tions were slightly better. The survey found that the ratings bus stations (2.2) and the city of Manila (2.6). FIGURE 40: PLACES VISITED AND ENJOYMENT OF STAY1 FIGURE 41: GENERAL SANITARY EXPERIENCE1 3.17 3.7 Manila 3.9 Other cities 4.00 3.00 3.7 2.98 3.7 Capital city 3.00 Historical sites 3.8 2.97 3.7 3.75 4.1 Restaurant 3.82 Beaches 4.0 3.73 4.1 3.34 Open water 3.13 4.1 3.37 Natural forests 4.2 3.70 4.1 Swimming pool 3.96 3.8 3.61 Traveling within 3.8 3.91 the Philippines 3.8 Hotel 4.24 3.79 0.0 1.0 2.0 3.0 4.0 5.0 2.87 Tourists Business All visitors General sanitary conditions 2.85 2.88 1 score: 5 = very much, 1 = not at all Source: Annex Table G1 0.0 1.0 2.0 3.0 4.0 5.0 All visitors Business Tourists 1 score: 5 = very good, 1 = very poor Source: Annex Table G2 29 This ignores the responses of foreign visitors who stayed with friends or relatives, or who did not know how much was paid for their hotel rooms. 66 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | National Benefits of Improved Sanitation and Hygiene TABLE 25: BACKGROUND CHARACTERISTICS OF RESPONDENTS North Variable Asia America and Australia/NZ Others Total Europe No. of tourists interviewed 21 141 24 3 189 Male 90 82 92 100 85 Gender (%) Female 10 18 8 0 15 Average no. of previous trips to country 1 5 4 0 4 Average length of stay of this trip (days) 12 16 16 23 16 Tourist 71 77 71 0 75 Purpose of visit (%) Business 29 23 29 100 25 1 - 29 10 8 17 0 9 30 - 59 10 20 38 0 21 60 - 89 29 13 8 0 14 Hotel Tariff in (US$) 90 - 119 19 8 8 33 10 120 - 149 5 6 0 0 5 150 + 10 18 4 0 15 Other 1 19 28 25 67 27 1 Stayed with friends/family or does not know because the tariff was paid by the company Source: ESI Tourism survey TABLE 26: SANITARY EXPERIENCE IN RELATION TO TOILETS AND HAND WASHING1 Water and soap for hand Quality of toilets in Toilet availability washing Hotel Category N Tariff Restau- Air- Bus sta- % could not % impact Restau- Bus sta- Hotels Cities find when Cities rants ports tions on stay rant tions needed 1-29 14 3.3 3.2 3.9 1.9 2.2 28.6 22.2 76.9 42.9 36.4 30-59 34 3.6 3.4 3.6 2.5 2.4 20.6 18.8 70.0 42.9 38.9 60-89 24 3.5 3.2 3.2 2.6 2.6 25.0 13.3 85.0 40.0 33.3 Tourists 90-119 10 3.8 3.3 3.4 1.5 1.0 10.0 - 100.0 - - 120+ 25 4.1 3.8 3.4 2.0 2.9 8.3 45.5 88.0 33.3 58.3 Others2 34 3.4 3.6 3.6 2.1 2.9 14.7 13.3 70.0 41.7 50.0 Subtotal 141 3.6 3.5 3.5 2.3 2.6 17.9 20.0 78.6 39.2 43.2 1-29 3 5.0 4.0 5.0 - 5.0 33.3 - 100.0 - 100.0 30-59 5 2.8 2.5 2.3 1.0 1.0 - - 50.0 - - 60-89 3 4.0 3.0 3.3 2.0 2.5 33.3 - 66.7 - 50.0 Business 90-119 8 4.1 3.5 2.3 - 2.5 - 16.7 83.3 - 100.0 120+ 12 4.6 3.6 2.9 2.5 2.0 - 25.0 100.0 100.0 100.0 Others2 17 4.3 3.8 3.5 - 3.3 - - 91.7 - 100.0 Subtotal 48 4.2 3.5 3.1 2.0 2.8 4.2 11.8 87.5 50.0 80.0 Total 189 3.8 3.5 3.4 2.2 2.6 14.4 18.4 80.7 40.0 47.6 1 score: 1 = very poor to 5 = very good; N=number of respondents 2 Stayed with friends/family or does not know because the tariff was paid by the company Source: Annex Table G3 www.wsp.org 67 Economic Assessment of Sanitation Interventions in the Philippines | National Benefits of Improved Sanitation and Hygiene FIGURE 42: FACTORS OF MOST CONCERN TO TOURISTS, %1 Slightly more than one in seven foreign visitors stated that 62 they were not able to find a toilet in a time of need. This Drinking water 71 happened more often with tourists as about 17.9% of these 64 visitors reported not finding a toilet at a time of need, or more than four times more often than businessmen. Such 12 a situation might be a cause for concern as about 18.4% of Tap water 7 the visitors giving a “yes� response to this question said that 11 this had an impact on their stay. 21 Swimming pool Tourists were also asked to state their experience with re- 14 spect to the availability of soap and water for handwashing water 20 in restaurants, bus stations and public toilets. The responses presented to them were on a scale of one (“never�) to five 5 (“always�). On this aspect, about 81% of the visitors said Food 7 that soap and water was available sometimes to always in 5 restaurants. About half of the respondents had the same as- 0 10 20 30 40 50 60 70 80 sessment for bus stations and the city as a whole. Tourists Business All visitors The respondents were also asked to select three out of a pos- sible nine aspects which concerned them the most during 1 A respondent can identify up to 3 factors Source: Annex Table G4 their stay in the Philippines. Figure 42 summarizes the re- TABLE 27: HEALTH TROUBLES EXPERIENCED BY VISITORS Average Source of gastro-intestinal tract number of Medical care (%) infections days of Hotel Category N Tariff Total Water Water for Inca- with Food Symp- Out- In- Average % you hygienic pacita- None Shop infec- eaten toms patient patient cost (US$) drank purposes tion tions 1-29 14 7 50.0 57.1 14.3 14.3 6.9 1.4 75.0 12.5 0.0 12.5 1.0 30-59 34 12 35.3 28.6 14.3 57.1 5.0 3.8 63.6 27.3 0.0 9.1 30.0 60-89 24 8 33.3 66.7 0.0 33.3 2.8 1.9 62.5 0.0 0.0 37.5 5.5 Tourists 90-119 10 4 40.0 66.7 0.0 33.3 4.0 4.0 60.0 20.0 0.0 20.0 20.0 120+ 25 6 24.0 50.0 0.0 50.0 2.3 0.8 60.0 0.0 0.0 40.0 3.0 Others 2 34 9 26.5 50.0 0.0 37.5 5.4 3.8 50.0 12.5 12.5 25.0 42.0 Subtotal 141 46 32.6 51.4 5.7 37.1 4.5 2.7 62.2 13.3 2.2 22.2 17.4 1-29 3 0 0.0 - - - - - - - - - - 30-59 5 0 0.0 - - - - - - - - - - 60-89 3 0 0.0 - - - - - - - - - - Business 90-119 8 0 0.0 - - - - - - - - - - 120+ 12 0 0.0 - - - - - - - - - - Others2 17 2 11.8 50.0 0.0 50.0 8.5 8.5 0.0 100.0 0.0 0.0 21.0 Subtotal 48 2 4.2 50.0 0.0 50.0 8.5 8.5 0.0 100.0 0.0 0.0 21.0 Total 189 48 25.4 51.4 5.4 37.8 4.4 2.9 59.6 17.0 2.1 21.3 17.8 1 Stayed with friends/family or does not know because the tariff was paid by the company; N = total number of respondents Source: Annex Table G5 68 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | National Benefits of Improved Sanitation and Hygiene FIGURE 43: INTENTION TO RETURN, % FIGURE 44: REASONS FOR HESITATING TO RETURN, % 43 95 Sanitation 33 40 90 29 85 Cost 33 percent of respondents 30 80 14 No need 33 75 20 70 14 Not safe 0 65 10 60 0 10 20 30 40 50 Tourists Business percent of responses Will return to the Philippines Will advise friends to visit the Philippines All visitors Source: Annex Table G6 Source: Annex Table G7 sults from the survey and Annex Table G4 provides the de- Figure 44 shows key factors which cause tourists to hesitate tails. As a whole, the key concern was with water. Drinking to return to the country. This was a question asked to all re- water emerged as a concern of 64% of all the respondents. spondents, irrespective of whether they said they intended Water in swimming pools (20%) and tap water (11%) were to return. About 40% of those who responded said that a far second and third among the top concerns. sanitation was a major factor for their hesitation. Another key factor was costs. It is important to be careful with the Apart from impressions about sanitation conditions, actual results presented in the previous sentence because only ten health problems experienced by the visitors could also af- respondents answered this part of the tourism question- fect the decisions of tourists to re-visit the country or to naire. However, this may be due in part to the finding in recommend it as a destination to friends and relatives. Figure 36 that many of the visitors plan to return to the Table 27 shows selected statistics on the gastro-intestinal Philippines. tract problems faced by the visitors during their stay in the country. It indicates that about a quarter of the respondents While the actual contribution of sanitation conditions to experienced gastro-intestinal problems. Moreover, the inci- visitors who do not intend to return and/or recommend the dence rate among tourists is nearly eight times higher than country to their friends is difficult to determine, the values business travelers. On average, visitors felt the symptoms presented above suggests that there is an impact. Such an for slightly more than four days and were incapacitated effect may be felt in terms of reduced number of repeat for about three days. They also spent an average of about visitors and potential visitors who did not visit on advice US$18 for treatment. of friends. This represents costs to the country in terms of foregone tourism earnings. To the extent that poor sanita- Despite the not too positive assessment of sanitation condi- tion contributes to the disease episodes of visitors while in tions, concerns and disease episodes experienced by tour- the country, the number of days in which the visitor was in- ists in the country, about 88% of the visitors still intend to capacitated represents a cost to the country. The cost could return to the Philippines (Figure 43). In addition, 82% of be measured by the amount that they could have spent if the visitors said that they will recommend the country to they were not sick against the amount that they actually friends. spent because of the illness. The spending on treatment, www.wsp.org 69 Economic Assessment of Sanitation Interventions in the Philippines | National Benefits of Improved Sanitation and Hygiene FIGURE 45: RATING OF ENVIRONMENTAL SANITATION which is paid to health care services in the country, would CONDITIONS IN THE LOCATION OF THE BUSINESS SURVEY INTERVIEW1 have to be subtracted from such costs. Air quality from excreta 3.00 The discussion above provides qualitative information on the possible impacts of sanitation on tourism. However, Air quality from solid waste 2.14 this is not sufficient to calculate the monetary impacts. Working on similar principles, the work in the ESI Impact Study (Rodriguez et al. 2008) provided a crude estimate of Air quality from vehicles 2.29 the costs. In assuming that poor sanitation contributes 5% Management to lost tourism revenues, the study estimated losses in the of industrial solid waste 2.29 order of PhP2.2 billion or US$40.1 million per year (2005 prices). Household/of�ce solid waste 2.08 5.2 Business and FDI Toilets in public places 2.18 Sanitation affects the business environment, particularly the sectors that require clean water — e.g., food production Household coverage 2.58 and processing, including restaurants, hotels, and resorts. with private toilets The business survey in the Philippines focused on estab- Management lishments around Laguna Lake, the largest inland body of 2.80 of industrial wastewater water in the country with a total surface area of 900 km2. Laguna Lake is located in the major growth region of the Management of sewage 2.67 country and its watershed spans 14 cities and 17 munici- palities located within the province of Laguna and Rizal, State of canals 3.38 and rainwater drainage and parts of Batangas, Cavite, Quezon, and Metro Manila. Water quality in rivers 3.75 The lake is known for its fish pens and provides other im- portant uses such as source of municipal water supplies, 0 1 2 3 4 transportation route, power generation, recreation and 1 1 = best; 5 = worst tourism, and also as waste sink. Although classified only Source: Annex Table H1 for non-contact recreation such as fishing, boating and sail- ing, the lake is used for swimming in some communities recreational swimming pools and restaurants. One restau- and many popular lakeshore resorts near Mount Makiling rant owner said that clean water is important to avoid food extract hot spring waters for health spas and beauty treat- and drinking water contamination. They often receive for- ments. eign tourists who are very sensitive to the quality of food and water. Controlling further degradation and improving water qual- ity are significant challenges faced by local governments and Four food processing establishments confirmed the impor- lakeshore residents. Households living around the lake and tance of water quality as it affects production quality and the rivers flowing to it contribute more than 60% of its pol- the possibility of contamination of goods for human con- lution, while industrial waste adds another 20% (Manda sumption. Even abattoirs are affected by the quality of wa- 2009). ter they use during slaughtering because meat is eventually used for human consumption. The survey interviewed three hotel resort owners (two for- eign and one local) near Laguna Lake. While hot springs Fish pond and fish cage owners near the lake are very sensi- are heated by nearby Mount Makiling, the importance of tive to water quality as it affects the quality, taste, and even water quality cannot be ignored because the resorts offer the growth of aquatic life. Market vendors, on the other 70 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | National Benefits of Improved Sanitation and Hygiene FIGURE 46: IMPORTANCE OF ENVIRONMENTAL SANITATION hand, are more sensitive to the cleanliness of the surround- CONDITIONS FOR LOCATING THE COMPANY1 ings because it affects customers’ perception of the quality of their products. Travel agencies consider sanitation as one Availability of cheap 3.50 decision factor for tourist destinations. Travelers are wary of and good land locations and hotels that are deemed unsanitary. Pleasant environment for your Business owners were asked to rate their perceptions of staff (Clean environment free of 4.81 garbage, good air quality, sanitation in the location of their establishments on a scale proper sewerage and sanitation) of one (best) to five (worst). Except for the travel agencies, all firms are in the province of Laguna. Thus, their views Water quality directly available generally reflect the situation in the local community and of from nature 4.07 Laguna Lake, as the closest body of water. Figure 45 sum- (rivers, lakes, ground) marizes the respondents’ answers to the different aspects of sanitation. On average, respondents considered “water quality in rivers� in the worst possible condition. These riv- Workforce health 4.62 ers flow to Laguna Lake and are thus major concerns for the community. Many of the respondents had a high rat- 0 1 2 3 4 5 ing of the local government’s management of solid waste and cited the regularity of pick-up of household and office 1 1 = unimportant; 5 = important waste. Source: Annex Table H2 Respondents acknowledged the importance of having a pleasant environment for the employees and customers work means an increased burden on other workers and may of the business (Figure 46). The environment affects the hamper operations as their employees have well-defined re- working conditions of the staff, as well as the perceptions of sponsibilities. customers regarding the quality of service or product. The health of the employees has an impact on their work perfor- Similarly, poor water quality significantly affects their busi- mance, particularly if it results in absences from work and nesses, as a majority of their services rely on clean water. For an additional burden on other staff that would carry out the example, hot spring resorts need clean water to fill up their responsibilities of the sick employee. While availability of swimming pools. Tourists demand clean water not only for cheap and good land is a consideration, many of the busi- recreation purposes but also for their own consumption. nesses own the land and do not pay rent, thus putting less Most respondents claim that their source of water is ad- weight on this factor. One business owner remarked that equate for production purposes, while five firms said that “cheap and good� are relative terms. Businesses consider the they have to treat water to ensure the quality that they serve cost of land rent in their decision but noted that it did not to their customers. Resorts need to add more chlorine to greatly deter them from locating their businesses in Laguna. swimming pools, while water/ice businesses need to treat When asked about the major factors that affected their de- water to meet strict requirements for human drinking. cisions, many respondents allude to the beauty of the town, being near the mountain and the lake, and the presence of Consistently, businesses confirmed that poor local environ- hot springs. Laguna is also accessible to Metro Manila and ment affects not only their operations, but also how cus- other major cities and has good sources of water. tomers perceive the quality of their service or product. Em- ployees are also affected through poor working conditions Business owners confirmed that poor workforce health af- in performing their tasks effectively. fects their businesses (Table 28). Except for the two travel agencies, almost all considered this factor as very important Respondents reported that they had lost some business days in their operations. Respondents noted that absence from in the past due to local environmental factors. However, www.wsp.org 71 Economic Assessment of Sanitation Interventions in the Philippines | National Benefits of Improved Sanitation and Hygiene TABLE 28: COSTS OF DOING BUSINESS: PRODUCTION (IN COLUMNS: MAIN SECTORS REPRESENTED) Response by sector No. with Resort Water Variable: Firms who say that ... response hotel/ Food vendor/ Abba- Total/ pro- Fish Market Travel restau- ice toir Average cessing rant plant Health Poor workforce health affects their business 12 5 5 5 5 5 5 4 4.9 (Score: 1 = unimportant; 5 = important) Water Water quality is adequate for production 16 4 2 0 2 2 3 1 14.0 (no. of firms responding “yes�) Poor water quality affects their business (Score:1 15 5 5 5 5 5 5 4 4.9 = unimportant; 5 = important) They treat their own water 16 3 0 2 0 0 0 0 5.0 (no. of firms responding “yes�) Poor local environment (1 = unimportant; 5 = important) Affects customers 15 5 5 5 4 5 5 4 4.8 Affects current workers 11 5 5 5 5 4 5 4 4.8 Affects staff recruitment 3 5 5 - - - - 1 3.7 Affects suppliers 3 - 5 - - - 5 4 4.7 Other aspects Loss of business days due to local environmental 16 1 1 1 1 2 1 0 7.0 factors (no. of firms saying ‘yes’) Fees paid for poor environment (no. of firms 16 4 2 2 0 2 3 0 13.0 saying ‘yes’) Considered moving facilities to other locations 16 1 1 0 1 1 0 0 4.0 The location of sales office affects business (1 = 16 5 5 5 5 5 5 - 5.0 unimportant; 5 = important) The location of sales office affects business (no. 16 5 5 5 5 5 5 - 5.0 of firms saying ‘yes’) Considered moving sales outlets to other parts of 16 1 1 0 1 1 0 0 4.0 town (no. of firms saying ‘yes’) the disruption in their business operations was caused by velopment Authority (LLDA) that oversees the lake. Mar- natural calamities, such as typhoons, which led to flooding ket vendors pay sanitation fees on a daily basis to the local or water overflow from the lake. While there were reports government for the maintenance of the public market. Two of typhoid outbreak in a nearby town in 2008, it was not a food processing companies said that they acquired permits major reason to temporarily close their businesses. A study and clearance from LLDA to discharge wastewater to La- on the impacts of the typhoid fever outbreak estimated a guna Lake. In January 1997, an Environmental User Fee loss of PhP29.57 million (US$664,793) in the local com- System (EUFS) was introduced by the LLDA in the lake munity and identified the source of water as the main cause region covering industrial firms in food processing, pigger- of the incident (Espaldon et al. 2008). The outbreak also ies/slaughterhouses, beverages, dyes and textiles, pulp and resulted in a shift in water use from public water utility paper, and food chains and restaurants (Nepomuceno un- connections to other drinking sources such as bottled min- dated). The EUFS used biochemical oxygen demand and eral water. Several business owners confirmed that they pay total volume of wastewater as a major basis for the fee com- fees to the local government and to the Laguna Lake De- putation. 72 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | National Benefits of Improved Sanitation and Hygiene All respondents strongly felt that the location of the sales of- to their businesses, 81% of the respondents (13 out of 16) fices affected their business (Table 28). Each firm also has its ranked the need for clean water, followed by the cleanliness own system of maintaining the cleanliness of the surround- of the surroundings. There was a divide in whether their re- ings (Table 29). A fish pen owner in Laguna Lake narrated spective businesses would be adversely affected by improved how they organize a lake clean-up three to four times a year. sanitation standards that would result in higher company However, respondents do not consider moving to another costs (Figure 47). These improved standards are beneficial location due to sanitation or environmental problems in not only to the company but to the local community as Laguna, though some mentioned the possibility of opening well. One travel agency owner remarked that they would up new branches in another area with similar environment be more confident and have more destinations to offer their and ambiance as in their current firm location. clients with improved sanitation standards and regulations in the country. However, they were quick to point out that The majority of the respondents did not find it necessary to the Philippines already has a good set of laws regarding en- expand their operations at the moment, especially because vironment and sanitation and that the government should expansion requires significant financial capital. When asked focus more on monitoring and enforcing these rules. about the most important aspect of sanitation in relation TABLE 29: COSTS OF DOING BUSINESS: SALES No. of Response by sector Variable: Firms re- Resort hotel/ Food Water ven- Total/Av- who say that ... sponse Abbatoir Fish Market Travel restaurant processing dor/ ice plant erage “Measures taken 15 • regular • strict • regular • regular • regular • regular • regular to deal with poor cleaning hygiene cleaning clean- clean- clean- clean- environment • mainte- policy • regular ing ing ing ing include..� nance • no wearing water • regular • hires • own recy- of perfume testing disin- help/ cling • low waste • reuse of fecting cleaning • segrega- policy excess • water is crew tion of • custom- water for tested • lake wastes ized watering regularly clean- • hires grease plants up help/ trap to and cleaning reduce cleaning crew pollutant surround- • annual • no plastic ings renova- bag, tion follow- • own filter ing local ordinance • regular cleaning • public bid- ding of re- cyclables “If yes, factors • costs • costs • costs • costs preventing us from • risks • site for • site for moving include..�1 relocation reloca- tion “If no, we have not • new loca- • satis- • costs • satis- • satisfied moved because..�1 tion fied with • satis- fied with • no com- current fied with current petition location current location location 1 This is a follow-up to the question on whether the firm has considered moving to another part of town. www.wsp.org 73 Economic Assessment of Sanitation Interventions in the Philippines | National Benefits of Improved Sanitation and Hygiene FIGURE 47: IMPLICATIONS OF IMPROVED SANITATION FOR EXPANDING BUSINESS IN THE PHILIPPINES The JMP (2010) estimated that about 24% of households in 2008 practiced open defecation or did not have access to improved sanitation (Table 30). Moreover, the proportion Could improved sanitation standards and regulations of households under such conditions was higher in rural adversely affect your areas (31%) than in urban areas (20%). Applying these es- decision to stay in this country or to stay in business, and 43.8 timates to the household population of the country in 2008 the level of operations, if these suggests that there are about 4.6 million families who could lead to higher company cost? be potential UDDT-E users and that 2.8 million of these (% saying yes) families would be located in rural areas. Assuming that all these families get access to UDDT-E facilities, practice ex- creta and urine reuse, and save as much as the households in San Fernando, then the potential savings for reuse amount If sanitation improved to slightly over PhP2.5 billion (US$57.2 million) per year. considerably, do you envisage About 61% of that amount is expected to be generated in 33.3 expanding operations here? (% saying yes) rural areas. The estimates above are optimistic and, at best, only capture the market potential. For one, not all of the households are expected to re-use waste. Assuming that the households 0 10 20 30 40 50 follow the pattern in San Fernando and only 34% re-use waste, then the estimated savings fall to about PhP875 mil- 5.3 Sanitation reuse markets lion (US$19.7 million). It is also not likely that all 4.6 mil- With an agriculture, fishery and forestry sector that ac- lion households can be provided with UDDT-E facilities counts for close to one-fifth of GDP, there is a large market because the costs of installation might be prohibitive. Space for fertilizer in the Philippines. Rough estimates from the constraints might also make it more difficult to provide ESI Impact Study (Rodriguez et al. 2008) indicated that, UDDT-E facilities to households in urban areas. valued at 2005 prices, sales of chemical and organic fertil- izer were about PhP23 billion (US$410 million) in 2004 A more conservative target might be to provide half of and PhP20 billion (US$390 million) in 2006. These esti- the households who practice open defecation with access mates are indicative of the potential for which fertilizer that to UDDT-E facilities (Scenario 1). In this case, Table 31 is based on human waste can be used. indicates that the indicated gains will be about PhP155 million (US$3.5 million) per year. A more optimistic sce- As mentioned in Section 4, only the UDDT-E users in San nario which extends to half of all households with unim- Fernando were re-using human excreta and urine as fertil- proved access is projected to generate benefits in the order izer. The households in this site said that their fertilizer was of PhP437 million (US$9.8 million) per year. only used at home and only a small proportion (34%) of the households was re-using human excreta. The savings per It is important to note that the estimates provided above household were valued at about PhP550 (US$12) per year. are incomplete. First, it excludes other uses of human waste like biogas. Second, it ignores the benefits from convert- National estimates of savings from excreta reuse, or earn- ing human waste which are processed at treatment facili- ings should households decide to sell their output to the ties like the sludge as soil conditioners for agricultural land market, are difficult to calculate. For one, the study has not and treated wastewater for watering public green spaces found a study that provided an estimate of the number of (see Howell-Alipalo 2007). Finally, it excludes the potential households that are doing so at the national level. Hence, gains to the industries that accrue to markets that provide the estimates provided here should be interpreted as indica- inputs for the construction, maintenance and operations of tive of the potential savings or earnings. sanitation options and facilities. 74 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | National Benefits of Improved Sanitation and Hygiene TABLE 30: ESTIMATED IMPACTS OF INCREASED REUSE OF HUMAN EXCRETA Rural Urban Total Key coverage statistics (% of households, 2006) 1 Open defecation 14 4 8 Unimproved (excluding shared latrines) 14 16 15 Shared/Community toilets 3 0 1 Total 31 20 24 Number of households (millions, 2008) Open defecation 1.2 0.4 1.6 Unimproved (excluding shared latrines) 1.2 1.5 2.7 Shared/Community toilets 0.3 - 0.3 Total 2.8 1.8 4.6 Value of savings per household (PhP) 2 561 541 nc Potential benefits (millions of PhP)3 Open defecation to UDDT-E 700 199 899 Unimproved (excluding shared latrines) to UDDT-E 700 796 1,496 Shared/Community toilets to UDDT-E 150 - 150 Total 1,550 995 2,545 Proportion of households reusing waste4 34% 34% 34% Adjusted potential benefits (millions of pesos) 5 Open defecation to UDDT-E 241 68 309 Unimproved (excluding shared latrines) to UDDT-E 241 274 514 Shared/Community toilets to UDDT-E 52 - 52 Total 533 342 875 Scenario 1: Half of households practicing OD receive UDDT-E toilets 120 34 155 2: Half of households with unimproved access receive UDDT-E toilets 266 171 437 nc = not calculated 1 JMP (2008) 2 Based on the savings of UDDT-E users. The values for rural sites were taken from San Fernando-upland while values for urban sites were taken from San Fernando-coastal. 3 Assumes all households above receive UDDT-E toilets and re-use their waste. 4 Results for San Fernando combined. 5 Potential benefits x Proportion of households re-using 5.4 Health The national health benefits from sanitation improvements billion) per year. The estimated costs for urban households will depend on the costs of sanitation per household, the are higher because of higher health costs per household. reduction in relative risks associated with sanitation options Households with improved facilities but no access to sew- and sanitation access coverage in the country. Information ers have the highest proportion of the health costs. This on the first two variables was discussed in Section 4 while result is driven solely by the number of households, nearly the third was presented in Section 1. 13 million out of a total of 18 million, in this group. It is also worth noting that the current estimates are higher than Table 31 presents the estimated health costs associated the health-related costs in the ESI Impact Study (US$1 bil- with sanitation and the potential benefits from sanitation lion). This is due to changes in economic and demographic improvements. It indicates that the costs of sanitation in conditions between 2005 and 2008, sanitation coverage, re- the aggregate amount to about PhP63.6 billion (US$1.4 finements in the methodology and improved data sources. www.wsp.org 75 Economic Assessment of Sanitation Interventions in the Philippines | National Benefits of Improved Sanitation and Hygiene TABLE 31: NATIONAL HEALTH IMPACTS OF POOR SANITATION Item Rural Urban Total Sanitation access (% of households, 2006) Open Defecation1 14 4 8 Unimproved (includes shared)1 17 16 16 Improved (not sewers)2 67 73 nc Improved (sewers) 3 2 7 nc No. of households (millions) 4 Open Defecation 1.2 0.4 1.6 Unimproved (includes shared) 1.5 1.5 3.0 Improved (not sewers) 6.0 6.7 12.7 Improved (sewers) 0.2 0.6 0.8 Total 8.9 9.2 18.1 Health costs per household (PhP) Open Defecation5 5,094 5,773 nc Unimproved (includes shared) 6 3,180 3,604 nc Improved (not sewers) 6 3,180 3,604 nc Improved (sewers)7 2,025 2,295 nc Total Estimated health costs (million PhP)8 Open Defecation 6,355 2,122 8,476 Unimproved (includes shared) 4,817 5,298 10,115 Improved (not sewers) 18,957 24,272 43,229 Improved (sewers) 379 1,413 1,792 Total 30,508 33,104 63,612 HEALTH ECONOMIC BENEFITS OF SANITATION IMPROVEMENT (million PhP) Scenario 1: All households have access to sewers9 12,463 12,018 24,481 Scenario 2: OD and unimproved get access to improved sanitation (but not sewers), others 1,194 399 1,592 stay in same category Notes: nc = not calculated, 1JMP (2008), 2calculated as a residual, 32008 World Health survey, 4estimated here, 5CBA: annual costs per household, 6Cost - cost averted of OD to basic, 7Cost - cost averted of OD to sewers, 8no. of hh x health cost per household, 9no. of hh x (health cost/hh - cost for sewers/hh) The estimated benefits from sanitation improvements will less than PhP1.6 billion or about US$35.8 million. This depend on the groups that will receive the interventions as actually goes beyond the MDG goals, which the country is well as the options made available to them. Scenario 1 in already close to achieving. Table 31 illustrates the case in which all households have ac- cess to sewers. It indicates that the projected gains amount 5.5 Summary of benefits to about PhP24.5 billion (US$549.6 million) per year or Sections 5.1 to 5.4 examined the broader benefits from im- slightly more than a third of the estimated health costs. proved sanitation in the country. It provided a range of an- However, the costs of pursuing such an objective are likely nual benefits from sanitation markets for two scenarios. The to be very high and its suitability to all parts of the country first represents the gains from providing UDDT-E facilities is also suspect. Without providing a specific option, Sce- to half of the population who practice open defecation. The nario 2 shows the benefits associated with having improved second shows the benefits from a more optimistic scenario sanitation access to half of the households that currently do which extends the provision of UDDT-E facilities to half of not have it. The estimated benefits amount to about slightly the households that do not have access to improved sanita- 76 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | National Benefits of Improved Sanitation and Hygiene tion. Health benefits were also represented by two scenari- os. The first can be treated as an upper limit as it represents the estimates from a situation in which all the households in the country have access to sewers. The second scenario, which appears more achievable in the medium term, cap- tures the provision of access to improved sanitation (not necessarily access to sewers) to half of the population that currently have unimproved facilities. While the gains to business and tourism were not quantified in this study, the benefits from improved sanitation could also be significant. The ESI Impact Study (Rodriguez et al. 2008), for example, estimated the tourism gains to be in the order of PhP2.2 billion (US$40.1 million) per year at 2005 prices. www.wsp.org 77 VI. Costs of Improved Sanitation and Hygiene This chapter presents aggregated and disaggregated costs of There are wide differences in costs across the various sanita- sanitation options. It also describes the costs from different tion options. Table 32 shows that the annualized costs per perspectives — investment/recurrent and payer. At the end, household in the rural sites range from PhP1,011 (US$23) in Section 6.4, marginal costs of moving up the sanitation for dry pits to PhP5,607 (US$126) for toilets that have ac- ladder are provided. cess to wastewater treatment. There is also a wide variation in the expected useful life of the sanitation options. Dry pits 6.1 Cost summaries are expected to last for about a year while other options are This section summarizes the costs per household of various projected to last for more than 20 years. It is important to sanitation options. It provides information on investment note that the expected lives of some toilet options were ad- and recurrent costs, and the expected useful life of the dif- justed downwards to account for the frequency of use. This ferent facilities.30 Investment costs were annualized to per- was the case for shared and community toilets which were mit a comparison between the sanitation options. It also assumed to last half and a third as long as private toilets, presents hygiene costs, which capture the average expen- respectively. ditures on soap and water for maintaining good personal hygiene, that may be combined with the sanitation options As in the rural sites, there is also a wide disparity in the to provide a more comprehensive analysis. However, invest- costs and expected lives of the technologies examined in the ment costs for hygiene programs were not included in the urban sites. Table 33 shows that the annualized costs per analysis due to lack of data. Site-specific information on household in the urban sites range from PhP1,355 (US$31) costs is provided in Annex Tables I1 to I6. for wet pits to PhP6,769 (US$152) for toilets that have ac- TABLE 32: SUMMARY OF AVERAGE COST OF DIFFERENT SANITATION AND HYGIENE OPTIONS FOR RURAL HOUSEHOLDS, PESOS, 2008 Total cost Investment cost Estimated life Intervention Sites2 (Pesos/household/year) (% of total cost) (years)1 Hygiene 1,217 0% na A,B,SF-C,SF-U Shared toilets 2,328 68% 13 SF-U Dry pit 1,011 93% 1 A,B,SF-C,SF-U Wet pit 1,259 73% 6 A,B,SF-C,SF-U UDDT-E 3,835 78% 15 SF-C,SF-U Toilets to septic tank 3,496 77% 25 A,B Toilets to septic tank and desludged at STF 5,426 79% 25 A Toilets with wastewater treatment 5,607 71% 25 B na = not applicable 1 Refers to length of life of hardware before full replacement 2 A: Alabel; B: Bayawan; D: Dagupan; SF-C: San Fernando-Coastal; SF-U: San Fernando-Upland; T: Taguig Source: Annex Tables I1 to I6 30 Program costs, which represent expenditures for software (promotion, education, monitoring) were not included in the analysis because of a lack of information in the sites. 78 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Costs of Improved Sanitation and Hygiene TABLE 33: SUMMARY OF AVERAGE COST OF DIFFERENT SANITATION AND HYGIENE OPTIONS FOR URBAN HOUSEHOLDS, PESOS, 2008 Total cost Investment cost Estimated life Intervention Sites2 (Pesos/household/year) (% of total cost) (years)1 Community toilets 1,931 59% 8 D,SF-C Shared toilets 2,263 73% 12.5 D UDDT-E 4,113 80% 20 SF-C Wet pit 1,355 67% 6 D,SF-C Toilets to septic tank 4,761 78% 25 T Toilets to septic tank and desludged at STF 6,646 66% 25 T Toilets to sewers 6,769 81% 25 T 1 Refers to length of life of hardware before full replacement 2 A: Alabel; B: Bayawan; D: Dagupan; SF-C: San Fernando-Coastal; SF-U: San Fernando-Upland; T: Taguig Source: Annex Tables I1 to I6 FIGURE 48: ANNUAL ECONOMIC COSTS PER RURAL HOUSEHOLD FOR MAJOR ITEMS, PESOS 1,651 with wastewater treatment 3,957 1,143 Toilets to septic tank, desludged and treated at STF 4,283 820 to septic tank, not desludged 2,676 850 UDDT-E 2,985 346 Wet pits 913 70 Dry pits 941 740 Shared toilets 1,589 1,217 Hygiene 0 1,000 2,000 3,000 4,000 5,000 Recurrent (annual) Capital (annualized) pesos www.wsp.org 79 Economic Assessment of Sanitation Interventions in the Philippines | Costs of Improved Sanitation and Hygiene cess to sewers. There is also a wide variation in the expected Figure 49 illustrates the main contributors to economic useful life of the sanitation options. Wet pits are expected cost in urban areas. It indicates that annualized investment to last for about six years while toilets are projected to last costs range from PhP913 (US$21) per household (wet pit about four times longer. latrines) to PhP5,477 (US$123) per household (toilets with access to sewers) in the urban sites. On the other hand, re- Figure 48 illustrates the main contributors to economic current costs range from PhP443 (US$10) per household cost in rural areas. It indicates that annualized investment per year (wet pit latrines) to PhP2,250 (US$51) per house- costs range from PhP913 (US$21) per household (wet pit hold per year (toilets have access to a STF). As with rural latrines) to PhP4,283 (US$96) per household (toilets with areas, annualized investment costs dominate the costs of the septic tanks and access to a STF) in the rural sites. Recurrent facilities. The highest shares were found for UDDT-E facili- costs range from PhP70 (US$1.6) (dry pits) to PhP1,651 ties (80%) and toilets that have access to sewers (81%). The (US$37) (toilets with wastewater treatment) per household lowest contribution of investment costs to total costs is for per year. As a whole, annualized investment costs account community toilets (59%). for the majority of the costs of the technologies. The high- est contribution was found for dry pits (93%), and this is The costs presented above assume that facilities are used due to the very low costs for maintenance and operations at optimal rates. Costs per household are likely to rise if (recurrent costs of such facilities.) facilities are under-utilized because of fixed costs, such as FIGURE 49: ANNUAL ECONOMIC COSTS PER URBAN HOUSEHOLD FOR MAJOR ITEMS, PESOS 1,292 sewers 5,477 Toilets to 2,250 septic tank and desludged at STF 4,396 1,058 septic tank, not desludged 3,703 836 UDDT-E 3,277 443 wet pits 913 619 shared toilets 1,644 797 community toilets 1,134 0 1,000 2,000 3,000 4,000 5,000 6,000 Recurrent (annual) Capital (annualized) pesos 80 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Costs of Improved Sanitation and Hygiene TABLE 34: ACTUAL AND OPTIMAL USE OF TREATMENT FACILITIES, 2008 Taguig (Sewer Bayawan system at Alabel (STF) (Constructed Taguig (STF) Centennial wetland) Village) Number of users (households) Optimal use 6,760 800 45,708 1,140 Actual use 240 800 34,667 1,140 Investment costs (pesos per household) Optimal use 10,160 15,327 7,398 18,934 Actual use 286,182 15,327 9,754 18,934 Recurrent costs (pesos per household) Optimal use 394 187 1,192 234 Actual use 2,520 187 1,192 234 construction costs, salaries of regular employees, etc. Table on the different sanitation options. However, there are a 34 shows how costs per household rise with the under-utili- number of exceptions. First, households only contributed zation of the various treatment facilities in the study. about 69% of the costs of installing UDDT-E facilities in the upland region of San Fernando, as represented here by 6.2 Financing sanitation and hygiene barangay Nagyubyuban. The reason is that the government This section discusses the various groups that finance the provided the urine-diversion toilets and the substructure. sanitation options. At the outset, it is important to note Hence, only the cost of the superstructure and recurrent two points regarding the estimates. First, the contributions costs of the facility were shouldered by the households. In of government, donor agencies, NGOs and perhaps the pri- addition, the households contributed labor to the installa- vate sector are underestimated here. The reason is that pro- tion of the facilities. Second, the toilets in Bayawan are rep- gram costs, which are more likely to be attributed to these resented by households in the Gawad Kalinga Village. This stakeholders, are excluded in the analysis because of lack of is part of a housing project in which the costs of the housing data. Second, there are a few situations in which the costs units, including the toilets and septic tanks, were paid for attributed to households are underestimated. One example by government. In the calculation of the initial costs, only is Bayawan, where the household contributed labor in the the contribution of the households to maintaining and op- construction of the housing unit (not just the toilet) but erating the toilets were counted. Third, about 75% of the was not valued in the costing of the toilet because of insuffi- initial payments for toilets to septic tanks (desludged at a cient information. Third, all values are based on annualized STF) in Alabel were paid for by the households. This es- investment costs per household. As mentioned earlier, this sentially represents the cost of the toilet facilities and septic adjustment permits a comparison across sanitation options, tanks. The remainder of the costs, which are attributed to and between investment and recurrent costs. Finally, the re- government, represents the construction, maintenance and sults are distinguished by the stakeholder that makes initial operations of the STF. Fourth, the highest contribution of and final payments. Initial payments are attributed to stake- government is with toilets to septic tank (with wastewater holders that provide the initial outlay. On the other hand, treatment) in Bayawan. This is for the Gawad Kalinga Vil- final payments are attributed to stakeholders that eventually lage with the costs of constructing, maintaining and oper- shoulder the costs. ating the constructed wetland being attributed to the local government. Figure 50 shows the financial sources of funding for the var- ious options in the rural sites. It indicates that households Figure 50 also indicates that households have a larger share are generally responsible for making the initial payments of the eventual costs of the sanitation options. In the case www.wsp.org 81 Economic Assessment of Sanitation Interventions in the Philippines | Costs of Improved Sanitation and Hygiene FIGURE 50: PROPORTION OF RURAL SANITATION COSTS FINANCED FROM DIFFERENT SOURCES, % Hygiene 100 Shared toilets 100 Dry pits 100 Initial payment Wet pits (Alabel) 100 UDDT-E (San Fernando - Upland) 69 Toilets to septic tank (Alabel) 100 Toilets to septic tank (Bayawan) 26 Toilets to septic tank (w/ treatment at STF; Alabel) 75 Toilets to septic tank (w/ wastewater treatment; Bayawan) 15 Hygiene 100 Shared toilets 100 Dry pits 100 Final payment Wet pits (Alabel) 100 UDDT-E (San Fernando - Upland) 69 Toilets to septic tank (Alabel) 100 Toilets to septic tank (Bayawan) 100 Toilets to septic tank (w/ treatment at STF; Alabel) 100 Toilets to septic tank (w/ wastewater treatment; Bayawan) 58 0 20 40 60 80 100 Household Government of the toilets in Bayawan, all the costs are eventually attrib- tion (DGIS) of the Netherlands Ministry of Foreign Af- uted to households because of the monthly amortization fairs funded the capacity building and infrastructure for that they pay for the housing units. On the other hand, it urine-diversion toilets in San Fernando. NGOs and private is assumed that all the construction and recurrent costs of institutions provided coordination, capacity building and the STF in Alabel are shouldered by households through advice. user fees. Figure 51 shows the financial sources of funding for the While it is not reflected in the diagram, it is important various options in the urban sites. The story is more or less to note that donor agencies and NGOs made an impor- similar to rural sites in the sense that households generally tant contribution to the sanitation interventions in the shoulder the initial payments for the facilities. However, the rural sites. The STF in Alabel was part of the Southern private sector played a more active role in financing sanita- Mindanao Integrated Coastal Zone Management Project tion options. Some of the key points from Figure 51 are (SMICZMP) which received assistance from the Japan as follows: First, community toilets are represented by the Bank for International Cooperation (JBIC). The EcoGov facilities in barangay Pugaro of Dagupan. The construction project of the USAID also provided technical assistance in of the facilities was funded by the local government and the the operationalization of the STF. The constructed wetland contribution of the households was through the mainte- in Bayawan received technical assistance from the GTZ. nance and operations of the facilities. Second, the share of Finally, the Directorate General of International Coopera- households in the acquisition of UDDT-E facilities in the 82 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Costs of Improved Sanitation and Hygiene FIGURE 51: PROPORTION OF URBAN SANITATION COSTS FINANCED FROM DIFFERENT SOURCES, % Hygiene 100 Community toilets 26 Shared toilets 100 Initial payment Wet pit 100 UDDT-E 35 Toilets to septic tank 100 Toilets to septic tank (sludge treatment at STF; Taguig) 72 Sewers 70 Hygiene 100 Community toilets 26 Shared toilets 100 Final payment Wet pit 100 UDDT-E 90 Toilets to septic tank 100 Toilets to septic tank (sludge treatment at STF; Taguig) 100 Sewers 100 0 20 40 60 80 100 Household Government Private urban sites of San Fernando is lower than their counterparts As with the rural sites, the household sector generally shoul- in the rural sites. The reason is that part of the households dered a larger proportion of the eventual costs of the facili- in the urban sites are from the Fishermen’s Village, which ties. This is particularly the case for the STF (Taguig) and were beneficiaries of a housing project that was financed by sewer systems (Taguig)31 and is based on the assumption the local government. Hence, the initial investment costs that the user fees paid by the households cover the invest- for these households were financed by the local govern- ment and recurrent costs of such facilities. In the case of the ment. Moreover, the local government also incurs a fraction households with access to UDDT-E facilities in San Fer- of the recurrent costs through the collection of sludge and nando, the attribution of the bulk of the costs to the house- the provision of the ash that is necessary in the operation holds is based on the fact that they have to pay a monthly of the UDDT-E in the housing units. Third, the construc- amortization for their housing units. tion and recurrent costs of the STF and sewerage facilities in Taguig were initially paid from a World Bank loan to It is also important to note that donor agencies and NGOs the government but ultimately paid back by the borrower had an important role in the construction of the facilities who was a private firm, Manila Water. The remainder of the in urban areas. For example, the STF and sewer facilities in costs, which are paid for by the households, is attributed to Taguig were made possible through a loan by Manila Water the toilet facilities and septic tanks. to the World Bank. 31 The Manila Water charges all its consumers an environmental fee that is equal to 10% of the water bill. This supports the sanitation services provided by the firm and entitles households to empty their septic tanks on a regular five-year cycle. Households who do not have their septic tanks desludged at a pre-arranged time will have to pay an additional fee of PhP900. Households that have access to sewer lines are charged an amount equal to 40% of their water bill. www.wsp.org 83 Economic Assessment of Sanitation Interventions in the Philippines | Costs of Improved Sanitation and Hygiene FIGURE 52: ACCESS TO SANITATION FACILITIES BY INCOME GROUP IN RURAL AREAS, PERCENT1 100 90 80 Open defecation Unimproved pit 70 Dry pits Shared toilets 60 UDDT-E percent Wet pits Toilets to septic tanks 50 Toilets to septic tanks, desludged or with WWT 40 30 20 10 0 1 2 3 4 5 Income group Source: Annex Table I7 1 The income groups are households with a monthly income of below PhP5,000 (1), PhP5,000 – 9,999 (2), PhP10,000-19,999 (3), PhP20,000-35,000 (4) and over PhP35,000 (5) 6.3 Sanitation option by income group This study did not compare costs of the same sanitation ries of a relocation program who otherwise might not have options across income groups, but instead determined the had the access if not for the intervention. If Gawad Kalinga type of technology that was available to the different house- beneficiaries are removed from the analysis, then the main holds. Figure 52 shows the sanitation options for the differ- conclusion is that open defecation was the most common ent income groups in the rural sites. It indicates that a large practice among the members of income groups 1 and 2. proportion of the high income households (i.e., incomes over PhP20,000 per month or groups 4 and 5) had access The story does not differ much in the urban sites (Figure to at least a toilet that flushes to a septic tank. It also shows 53). A large proportion of the high income households had that about half of the low income households (i.e., groups 1 access to at least a toilet with a septic tank. In the group with and 2) had access to an STF or wastewater treatment. How- the lowest income, open defecation and community toilets ever, this finding must be interpreted with care because a were the most common options. While many households large proportion of the households in this group came from in the second income group still practiced open defecation the Gawad Kalinga village in Bayawan. These are beneficia- (20%), wet pits (19%) were also among the top options. 84 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Costs of Improved Sanitation and Hygiene FIGURE 53: ACCESS TO SANITATION FACILITIES BY INCOME GROUP IN URBAN AREAS, PERCENT1 100 90 80 Open defecation Community toilets 70 Shared toilets UDDT-E 60 Wet pits percent Toilets to septic tanks Toilets to septic tanks, 50 desludged or with WWT Toilets to sewer 40 30 20 10 0 1 2 3 4 5 Income group Source: Annex Table I7 1 The income groups are households with a monthly income of below PhP5,000 (1), PhP5,000 – 9,999 (2), PhP10,000-19,999 (3), PhP20,000-35,000 (4) and over PhP35,000. The information above provides some evidence that low in- five income groups in the study. Using the information on come households tend to be located closer to the bottom investment or installation costs in the study, it shows that of the sanitation ladder. Combined with earlier findings in such costs rise as a proportion of income as households se- the FGD that costs are a barrier to the acquisition of toilets, lect an option that is higher-up on the sanitation ladder. this tends to suggest that poorer households are likely to A household earning PhP2,500 per month, the mid-point be more sensitive to the relatively high investment costs of for households belonging to income group 1, will need to more advanced sanitation options. invest around 3% of its annual income for the construction of a dry pit. However, this will rise to about two-and-a-half Financing sanitation options becomes a bigger issue when years’ worth of income (255%) if the household installs a examined in the context of various income groups. Ignor- toilet that has access to a septic tank. The costs are clearly ing public facilities and services for the moment, financ- prohibitive for the low income groups, especially since these ing is important even with private facilities. Table 35 shows groups spend a relatively large proportion of their income the ratio of the investment costs to annual incomes of the on food. This is also reflected in the earlier results which www.wsp.org 85 Economic Assessment of Sanitation Interventions in the Philippines | Costs of Improved Sanitation and Hygiene showed that (a) a relatively large proportion of households income group 1, to allocate the amounts necessary to pay in these income groups practice open defecation (Figures 52 for the loans. These two points reinforce the need to gov- and 53) and (b) why some form of intervention from gov- ernment and other institutions to assist in the provision of ernment and other institutions was needed for these house- facilities. holds to gain access to improved facilities. A comparison of annualized investment costs with annual incomes obviously While it is obvious that government and other institutions leads to considerably lower ratios. For example, annualized would need to help with financing the construction of pub- investment costs for UDDT and toilets were only about lic facilities such as community toilets, septage treatment 10% of annual income for the first income group. This sug- facilities and sewer systems, the capacity and willingness of gests that some form of access to credit might be necessary households to pay user fees raise issues on the sustainability to allow these households to gain access to improved sani- of such interventions for the long term. To illustrate, an tation facilities. However, such an assertion must be inter- analysis implemented by Harder et al. (2011) in Dagupan preted with care for two reasons. First, the values indicated City found that households in the city were willing to pay in the table reflect a scenario where credit is obtained at zero amounts that were sufficient to sustain desludging services interest and with a duration equal to the expected life of in the city but not a sewerage program. the facility. In the case of toilets with access to septic tanks for example, this is equivalent to a zero-interest loan over 6.4 Costs of moving up the ladder a 25 year period. For facilities of similar cost to the UD- Table 36 shows the costs of moving up the sanitation lad- DTs found in the upland region of San Fernando, it may der in all the field sites. In general, incremental costs are be a loan that is 15 years long. Such financing schemes will positive as a household moves up the sanitation ladder. This be very difficult, if not impossible, if one relies solely on reflects the earlier finding that more advanced sanitation the commercial bank system. Second, even if zero-interest options tend to be more expensive, especially because of schemes over long periods are available, it may still be very investment costs. However, there are two instances in which difficult for low income households, especially for those in the incremental costs are negative. The first is in the move- TABLE 35: INVESTMENT COSTS AS A PROPORTION OF HOUSEHOLD INCOME, BY INTERVENTION, PERCENTa Income UDDT-E UDDT-E Dry pit Wet pit Toilets to septic tanks group (Type 1) (Type 2) Total Investment outlay to income 1 3.1% 18.3% 149.3% 218.5% 531.7% 2 1.0% 6.1% 49.8% 72.8% 177.2% 3 0.5% 3.0% 24.9% 36.4% 88.6% 4 0.3% 1.7% 13.6% 19.9% 48.3% 5 0.2% 1.3% 10.7% 15.6% 38.0% Annualized investment cost to income 1 3.1% 3.0% 10.0% 10.9% 10.6% 2 1.0% 1.0% 3.3% 3.6% 3.5% 3 0.5% 0.5% 1.7% 1.8% 1.8% 4 0.3% 0.3% 0.9% 1.0% 1.0% 5 0.2% 0.2% 0.7% 0.8% 0.8% a The values above use the midpoint of the income for each group. The only exception is group 5, which uses lower bound (PhP35,000) of incomes. The income groups are households with a monthly income of below PhP5,000 (1), PhP5,000 – 9,999 (2), PhP10,000-19,999 (3), PhP20,000-35,000 (4) and over PhP35,000 (5). 86 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Costs of Improved Sanitation and Hygiene TABLE 36: INCREMENTAL COSTS OF MOVING UP THE SANITATION LADDER, ALL SITES, PESOS, 2008 TO Toilets to septic tank, COST ITEM Toilets to desludged Toilets to Shared toilets Dry pits Wet pits UDDT-E septic tank at STF or sewers wastewater treatment Community 332 (576) 1,844 1,999 4,322 4,838 toilets1 Shared toilets2 (1,317) (1,069) 1,506 1,168 3,9283 n.b. Dry pits 2 248 2,823 2,485 5,245 n.b. Wet pits 2,667 2,821 5,144 5,4131 FROM UDDT-E 154 2,477 2,6561 Toilets to septic 2,323 2,0081 tank Toilets to septic 1231 tank, desludged at STF or wastewater treatment Notes: Unless specified otherwise, simple average of rural and urban households; n.b. = no basis 1 based on urban sites only; 2 based on rural sites only; 3 simple average of STF treatment and constructed wetland Source: Annex Table I8 ment from community to shared toilets. The other is in the wet pit latrine in an urban area. While there might be dif- movement from community and shared toilets to a dry pit ferences in the magnitudes, the pattern of the cost changes latrine. are also the same for the specific sites covered in the study. It is also important to note that some caution must be exer- The observed pattern for all sites is also generally reflected cised in interpreting the incremental costs of moving from in rural and urban areas (Figure 54). In rural sites, the in- an UDDT-E facility to a toilet that has access to a septic cremental costs of moving from dry pits and onwards are tank in the rural sites. The reason is that there is no single positive. However, the incremental costs of moving from a rural (and urban) site in which the costs of both facilities shared toilet to a dry pit and from UDDT-E to septic tanks were evaluated. Hence, differences in incremental costs are are negative. On the other hand, the incremental costs are likely to be severely compromised by inter-site price and negative as the household moves from a shared toilet to a cost variations. www.wsp.org 87 Economic Assessment of Sanitation Interventions in the Philippines | Costs of Improved Sanitation and Hygiene FIGURE 54: INCREMENTAL COSTS OF MOVING UP THE SANITATION LADDER, RURAL AND URBAN SITES, PESOS, 2008 RURAL Shared toilets to dry pit (1,317) Dry pit to wet pit 248 Wet pit to UDDT-E 2,576 UDDT-E to septic tanks (no desludging) (339) Septic tanks (no desludging) 2,761 to STF or wastewater treatment URBAN Community to shared 332 Shared to wet pit (908) Wet pit to UDDT-E 2,758 UDDT-E to septic tanks (no desludging) 647 Septic tanks (no desludging) to STF or wastewater treatment 1,886 STF or wastewater 123 treatment to sewers (1,500) (1,000) (500) - 500 1,000 1,500 2,000 2,500 3,000 pesos 88 Economic Assessment of Sanitation Interventions VII. Efficiency of Improved Sanitation and Hygiene This Chapter synthesizes the information in Chapters 4 to tions, the most favorable estimates were found for wet pits. 6 to present the efficiency of sanitation options under ideal This intervention not only had the highest BCRs and NPVs and actual conditions. Alongside the quantitative cost-ben- but also required the least time to recover the initial invest- efit and cost-effectiveness ratios, it also discusses the non- ment (lowest PBB). Dry pits had the second best favorable quantified impacts. The chapter consists of four sections: BCRs and NPVs and, like wet pits, initial investments can be recovered within a year. In contrast, the least favorable • Efficiency of sanitation interventions, compared estimates were found for toilets with access to wastewater with open defecation (Section 7.1) treatment (1.6) and shared toilets (1.7). The findings sug- • Efficiency of moving from improved sanitation op- gest that low-cost technologies, particularly dry and wet tions to other options “higher� up the sanitation lad- pits, are worth pursuing especially for low-income groups. der (Section 7.2) • Cost variations and their impacts on efficiency esti- The cost-effectiveness measures, which are focused more mates (Section 7.3) on targets associated with human health, were most favor- • Contextualization of the results in a national context able to dry pit latrines, followed closely by wet pit latrines. (Sections 7.4 and 7.5) UDDT-E facilities, closely followed by toilets with access to a STF and wastewater treatment facilities, were found 7.1 Efficiency of sanitation improvements to have the highest costs for achieving the specified targets. compared to no facility These findings also imply that low-cost options provide the cheapest means to achieve health targets. 7.1.1 QUANTITATIVE ANALYSIS Economic analysis combines evidence on the costs and ben- The efficiency indicators associated with actual conditions efits of the sanitation improvements. Efficiency indicators were, as one might expect, less favorable than the estimates are introduced in Chapter 3 and defined in the Glossary. All under ideal conditions. The difference was very noticeable the indicators presented here were calculated by estimating for the toilet facilities that have access to a STF. A BCR that costs and benefits over a planning horizon of 20 years, and was less than unity under actual program conditions sug- discounting future costs and benefits to the present day us- gests that something is wrong with the utilization of such ing a discount rate of 8%. facilities. Moreover, the BCR (actual use) was greater than unity for toilets that had access to septic tanks but not the Table 37 summarizes the results for the rural sites under STF. This means that the problem lies solely with the STF. ideal and actual settings. Under ideal settings, the efficiency On closer inspection of the data, the source of the poor indicators show that all the sanitation options yield posi- BCR was the under-utilization of the STF in Alabel (see tive net benefits. The BCRs were all greater than unity and Chapter 6). With very few households being served relative the NPVs for all the options were positive. Internal rates of to the optimal scale of operations, estimated investment return for all the projects were also high, with the lowest and maintenance costs per household under actual condi- rate still exceeding 25%. Among the various sanitation op- tions were also higher than what these should be. www.wsp.org 89 Economic Assessment of Sanitation Interventions in the Philippines | Efficiency of Improved Sanitation and Hygiene TABLE 37: RURAL AREA EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARED TO “NO TOILET“ Toilets to Toilets with Shared Toilets to septic tank and Item Scenario Dry pits Wet pits UDDT-E wastewater toilets septic tank desludged at treatment STF Sites1 SF-U SF-U A SF-U A, B A B No. of households of ESI survey 24 24 28 14 216 44 180 Cost-benefit measures (Weighted average for sites) Benefits per peso of Ideal 1.7 5.0 7.9 2.0 2.7 2.3 1.6 input (Php) Actual 1.6 4.7 5.7 1.8 2.3 0.2 1.5 Internal rate of return Ideal 38 >100 >100 35 46.9 31.3 25.2 (%) Actual 33 >100 >100 31 36.8 -13.8 20.8 Payback period (years) Ideal 5.0 1.0 1.0 4 4.0 5.0 6.0 Actual >20 1.0 1.0 11 6.8 8.0 >20 Net present value (PhP) Ideal 15,426 38,630 79,827 31,379 57,844 56,456 44,038 Actual 12,968 35,817 54,467 26,919 44,470 (233,672) 32,732 Cost-effectiveness measures (Weighted average for sites) Cost per DALY averted Ideal 264,037 112,226 133,339 371,808 227,374 325,280 343,512 (PhP) Actual 294,868 125,330 140,390 415,222 234,738 2,354,029 350,945 Cost per case averted Ideal 1,017 432 506 1,432 854 1,242 2,866 (PhP) Actual 1,135 483 532 1,599 882 8,989 3,008 Cost per death averted Ideal 4,505,503 1,915,005 2,694,546 6,344,488 3,738,315 6,694,415 5,070,759 (PhP) Actual 5,031,594 2,138,614 2,837,046 7,085,311 3,865,941 48,446,955 5,178,443 1 A = Alabel, B = Bayawan, SF-U = upland region of San Fernando Source: Annex Tables J1 to J3 Figure 55 illustrates the site-specific BCRs for the sanita- FIGURE 55: BENEFIT-COST RATIO, ALL SANITATION OPTIONS tion options in the rural sites. It shows that all interven- IN ALL RURAL SITES, IDEAL VS ACTUAL SETTING tions yield benefits which are higher than costs under ideal Shared toilets 1.6 (San Fernando - Upland) conditions. The highest net benefits accrue to the wet pits 1.7 in Alabel while the lowest net benefits are for the toilets Dry pits 4.7 (San Fernando - Upland) 5.0 with access to wastewater treatment (constructed wetland) Wet pits 5.7 in Bayawan. (Alabel) 7.9 UDDT-E 1.8 Table 38 summarizes the results for the urban sites. Under (San Fernando - Upland) 2.0 ideal settings, the estimated BCRs and NPVs show that all Alabel 2.0 the sanitation options yield net benefits. The IRRs for all to septic tanks, not desludged 2.8 the projects were also quite high, with the lowest rate about 2.4 Toilets Bayawan 26%. Among the various sanitation options, the most fa- 2.7 vorable estimates were found for toilets that flush to septic 2.3 Average 2.7 tanks. These were followed by wet pits and toilets that had Treatment at STF 0.2 access to STF or sewers. In contrast, UDDT-E facilities had the lowest BCR. Payback periods were also generally Toilets to (Alabel) 2.3 septic tanks With wastewater treatment 1.5 quite short, with all but one facility requiring less than five (Bayawan) 1.6 years to recover costs. The main difference with rural sites is BCR (Actual) BCR (Ideal) 0 2.0 4.0 6.0 8.0 that relatively expensive options, i.e., from toilets to septic tanks, have very favorable efficiency measures. Source: Annex Table J1 to J3 90 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Efficiency of Improved Sanitation and Hygiene TABLE 38: URBAN AREA EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARED TO “NO TOILET“ Toilets to Community Shared Toilets to septic tank and Item Scenario UDDT-E Wet Pits Sewerage toilets toilets septic tank desludged at STF Sites1 D,SF-C D SF-C D,SF-C T T T No. of households of ESI survey 65 48 50 122 92 91 84 Cost-benefit measures (Weighted average for sites) Benefits per peso of Ideal 2.9 2.3 1.5 4.5 5.6 4.3 4.3 input (Php) Actual 1.7 1.3 1.3 2.8 4.5 3.4 3.6 Internal rate of return Ideal >100 47.7 25.9 >100 >100 >100 95.3 (%) Actual 47 12 17 >100 >100 87 66 Payback period (years) Ideal 2 4 8 1 2 2 3 Actual 4 8 >20 2 2 3 >20 Net present value (PhP) Ideal 29,966 28,290 24,413 45,928 196,324 201,358 194,005 Actual 11,660 7,011 6,740 24,037 151,932 154,601 149,133 Cost-effectiveness measures (Weighted average for sites) Cost per DALY averted Ideal 131,408 114,753 458,985 123,941 442,426 400,517 434,768 (PhP) Actual 143,206 125,055 512,579 137,019 454,031 423,640 444,755 Cost per case averted Ideal 495 435 1,744 469 1,620 1,477 1,268 (PhP) Actual 540 474 1,948 519 1,663 1,562 1,627 Cost per death averted Ideal 3,054,696 2,713,390 10,193,025 2,232,613 10,424,838 9,604,657 8,150,356 (PhP) Actual 4,233,751 2,957,007 11,383,228 2,460,908 10,698,270 10,159,166 10,455,063 1 A = Alabel, D = Dagupan, SF-C = coastal region of San Fernando, T = Taguig Source: Annex Tables J4 to J6. The results for the cost-effectiveness measures tend to favor Figure 56 shows the site-specific BCRs for all the sanita- low-cost technologies, particularly shared toilets and wet pit tion options in all the urban sites. It indicates that all in- latrines. As with the rural sites, the least favorable estimates terventions yield benefits which are higher than costs. The were found for UDDT-E facilities. Toilets that have access highest net benefits accrued to toilets with access to septic to septic tanks were found to have relatively high costs for tanks (not desludged) in Taguig while the lowest net ben- achieving the specified health targets. However, cost-effec- efits were for the UDDT-E facilities in the coastal region of tiveness ratios tend to fall when households that have septic San Fernando. The results also show considerable inter-site tanks also have access to STFs and sewer systems. While the variation in the BCRs of wet pits. In Dagupan, the BCR for findings here tend to favor low-cost technologies in meeting wet pits was estimated to be 5.2. This is about 40% higher health targets, the estimates provide evidence on the po- than the BCR of 3.7 for the coastal region of San Fernando. tential contribution of off-site treatment facilities in urban regions. 7.1.2 QUALITATIVE ANALYSIS It is very likely that the efficiency indicators presented in The efficiency indicators under actual conditions were also the previous section are underestimating the net benefits. less favorable than the estimates under ideal conditions. The reason is that there are a number of on-site and off-site The differences are most noticeable with community toilets, benefits which were not included in the analysis. shared toilets and wet pit latrines. For these technologies, the BCRs under actual conditions were only about 60% of Among the on-site benefits excluded in the analysis are oth- their counterparts under actual conditions. er diseases associated with poor sanitation such as hepatitis www.wsp.org 91 Economic Assessment of Sanitation Interventions in the Philippines | Efficiency of Improved Sanitation and Hygiene and parasitic diseases. Time savings associated with urina- by their neighbors whenever they defecate in the open. On tion is another on-site benefit which was not incorporated the other hand, households that have private toilets claimed in the analysis. a feeling of pride associated with owning such a facility. The source of this pride varies from one group to the next. More favorable efficiency estimates are also likely to be ob- Some said that owning a private toilet no longer required tained if it is possible to quantify the intangibles — com- them to ask permission from their neighbors in order to use fort, prestige, personal safety of women and children, etc. the toilets. For others, having a private toilet was viewed as With the details discussed in Chapter 4, the key results an improvement in their social status in the community. from the ESI household surveys and FGDs are as follows: Those who previously did not have toilets also expressed First, the FGDs found that the respondents have a com- confidence in inviting guests to their homes. Third, about mon desire for cleaner surroundings. The respondents also three out of four respondents in the household survey said said that the absence of toilets contributed to the practice that their biggest concern was for the safety of their chil- of open defecation in their areas. Second, the respondents dren. This is consistent with the finding in the FGD that feel a sense of shame associated with open defecation. Some the respondents prefer a household that is near the house. respondents said that they covered their faces, either with The FGD also found that the preference for proximity was their hands or a piece of cloth, to avoid being recognized also based on its potential to save time and the feeling of safety for women at night or when it is raining. While valu- FIGURE 56: BENEFIT-COST RATIO, ALL SANITATION OPTIONS ing the intangibles is difficult to do, the household survey IN ALL URBAN SITES, IDEAL VS ACTUAL SETTING asked the respondents about their willingness to pay for an 1.7 improved toilet. The average value provided by the respon- Dagupan dents was about PhP2,500 (US$56), an amount which is Community toilets 2.9 only capable of purchasing a dry pit latrine, while most of 1.7 San Fernando - Coastal 2.1 the respondents (78%) expressed preference for a toilet that is connected to a septic tank. 1.7 Average 2.9 Off-site benefits include the impacts on tourism, business Shared 1.3 toilets Dagupan and aesthetics (external environment). The impacts of re- 2.3 duced water pollution on fisheries and the recreational uses UDDT-E 1.3 of water are also potentially important considerations. San Fernando - Coastal 1.5 Dagupan 2.7 7.2 Efficiency of alternatives for moving up the 5.2 sanitation ladder Wet pits 2.8 San Fernando - Coastal 3.7 7.2.1 QUANTITATIVE ANALYSIS 2.8 This section discusses the incremental net benefits for Average 4.5 movements up the sanitation ladder. This is important for septic tank, not desludged 4.5 decision makers who are considering investments in more (Taguig) 5.6 advanced sanitation options. The analysis is relevant to the Toilets with access to septic tank, treatment at STF 3.4 Philippines because many households already have access (Taguig) 4.3 to unimproved sanitation options compared to open def- 3.6 ecation. Hence, in most cases, the key question might be sewers (Taguig) to upgrade from a low cost option (e.g., dry pits and com- 4.3 munity toilets) to more expensive technologies (e.g., septic 0 1 2 3 4 5 6 BCR (Actual) BCR (Ideal) tanks and treatment facilities). The question is also relevant Source: Annex Table J4 to J6 from the viewpoint of upgrading the facilities of households 92 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Efficiency of Improved Sanitation and Hygiene that already have access to improved sanitation facilities — water savings, respectively. Non-quantified benefits such e.g., constructing an STF or sewer systems. as aesthetics (external environment), tourism and business might also be higher for more advanced sanitation options. Table 39 presents performance indicators as rural house- All these benefits have the potential to raise the incomes holds move up the sanitation ladder. The results are mixed not only of the direct beneficiaries of sanitation improve- and vary from one improvement to the next. Based on the ments but of the other households as well. Accounting for BCRs, the movement from shared toilets to private dry pits these impacts may raise the benefit-cost ratio of a sanitation led to higher net benefits. In contrast, a movement from dry improvement from a wet pit to toilets that have access to pits to UDDT-E facilities has a BCR that is less than unity. off-site treatment facilities. However, the extent to which An upgrade from UDDT-E toilets to toilets that flush to capturing these benefits will improve the viability of more septic tanks generated higher net benefits but further im- advanced sanitation options is difficult to determine. provements which incorporate sludge and wastewater treat- ment had lower net benefits. However, the findings should 7.3 Cost variations and the efficiency be treated with care because the apparent reductions in net estimates benefits as households move up the sanitation ladder were Costs could vary within a particular technology. This could driven solely by the relatively large increases in the invest- be due to differences in materials used as well as the size ment and recurrent costs of the interventions. of the facility. Figure 57 provides an example by showing the differences in costs for UDDT-E facilities that use dif- Table 40 presents performance indicators associated with ferent materials for the walls of the superstructure. Given moving up the sanitation ladder in the urban sites. Based the many different and combinations of materials for con- on the BCRs, only movements from shared toilets to wet structing toilets and treatment facilities, this section will pit latrines and from UDDT-E to toilets to septic tanks not attempt to estimate the efficiency indicators for differ- have positive net benefits. As in the rural sites, the apparent ent variations within a given sanitation technology. Rather, reductions in net benefits for movements up the sanitation it will calculate the economically feasible level of costs for ladder were caused by the relatively large increases in the selected technologies. This is done by estimating the level costs of the interventions. In the case of the cost effective- of investment costs that will make the BCR equal to unity ness indicator, the results indicate lower costs of meeting for a given technology. The analysis effectively identifies the health targets as septic tanks are desludged and treated at a maximum costs for selected facilities before these become STF or toilets have access to treated sewer systems. economically unfeasible. FIGURE 57: ESTIMATED COSTS OF THE SUPERSTRUCTURE 7.2.2 QUALITATIVE ANALYSIS FOR UDDT-E FACILITIES, BY TYPE OF WALL MATERIAL, 000 PHP, 2006 PRICES The qualitative impacts discussed in Section 7.1.2 may have an effect on the results provided above. For example, well- Corrugate sheet 11.6 functioning sludge and wastewater treatment facilities are Sawali 11.8 more effective in reducing environmental contamination compared to septic tanks or wet pit latrines. However, the Flexiboard 12.5 former carry a higher investment and recurrent cost than the latter, and also usually involve the use of more water Flatsheet 12.6 for flushing. Better isolation and/or effluent removal from Plywood 12.8 water released to the environment means lower pollution and higher potential gains associated with fisheries and All concrete 35.3 recreational activities in inland waters. Another example is the use of treated sludge as soil conditioners and recycling 0 10.0 20.0 30.0 40.0 Cost in 000 pesos treated wastewater (see Howell-Alipalo 2007). Both rep- Source: CAPS resent gains in the form of higher farm productivity and Notes: This assumes a substructure made of concrete hollow blocks. Estimates are also available for substructures that have a steel frame. The cost of the UDDT bowl is not included in the estimates above. www.wsp.org 93 Economic Assessment of Sanitation Interventions in the Philippines | Efficiency of Improved Sanitation and Hygiene TABLE 39: RURAL AREA EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARING DIFFERENT POINTS ON THE SANITATION LADDER, IDEAL SETTING1 TO Toilets to Toilets to septic tank Dry pits Wet pits UDDT-E Sewerage septic tank and desludged FROM at STF Benefits per peso of input (PhP, ideal) Shared toilets 3.0 4.7 1.2 1.6 1.3 1.0 Dry pits 1.6 0.4 0.5 0.4 0.3 Wet pits 0.3 0.3 0.3 0.2 UDDT-E 1.4 1.1 0.8 Toilets to septic tanks 0.8 0.6 Toilets to septic tanks and desludged at STF 0.7 Payback period (years, ideal)2 Shared toilets (4) (4) (1) (1) 0 1 Dry pits 0 3 3 4 5 Wet pits 3 3 4 5 UDDT-E 0 1 2 Toilets to septic tanks 1 2 Toilets to septic tanks and desludged at STF 1 Cost per DALY averted (PhP, ideal) 3 Shared toilets (151,812) (130,699) 107,771 (36,663) 61,243 79,475 Dry pits 21,113 259,582 115,148 213,055 231,287 Wet pits 238,469 94,035 191,942 210,173 UDDT-E (144,434) (46,527) (28,296) Toilets to septic tanks 97,907 116,138 Toilets to septic tanks and desludged at STF 18,232 Cost per case averted (PhP, ideal) Shared toilets (585) (511) 415 (162) 225 1,850 Dry pits 74 1,000 422 810 2,434 Wet pits 926 349 736 2,361 UDDT-E (577) (190) 1,435 Toilets to septic tanks 388 2,012 Toilets to septic tanks and desludged at STF 1,624 Cost per dealth averted (PhP, ideal) Shared toilets (2,590,497) (1,810,957) 1,838,985 (767,188) 2,188,913 565,256 Dry pits 779,541 4,429,483 1,823,310 4,779,410 3,155,753 Wet pits 3,649,942 1,043,769 3,999,869 2,376,213 UDDT-E (2,606,173) 349,927 (1,273,729) Toilets to septic tanks 2,956,100 1,332,444 Toilets to septic tanks and desludged at STF (1,623,657) 1 Site-specific comparisons are provided in Tables K1 to K3. 2 A negative value suggests that the new intervention (to) has a lower payback period than the original intervention (from) 3 A negative value suggests that the cost per DALY averted with the new intervention (to) is lower than the cost per DALY with the original intervention (from) 94 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Efficiency of Improved Sanitation and Hygiene TABLE 40: URBAN AREA EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARING DIFFERENT POINTS ON THE SANITATION LADDER, IDEAL SETTING1 TO Toilets to Shared Toilets to septic tank Wet pits UDDT-E Sewerage toilets septic tank and desludged FROM at STF Benefits per peso of input (PhP, ideal) Shared toilets 0.8 1.5 0.5 1.9 1.5 1.5 Dry pits 1.9 0.7 2.4 1.9 1.9 Wet pits 0.3 1.3 1.0 1.0 UDDT-E 3.7 2.8 2.8 Toilets to septic tanks 0.8 0.8 Toilets to septic tanks and desludged at STF 1.0 Payback period (years, ideal)2 Shared toilets 2 (1) 6 0 0 1 Dry pits (3) 4 (2) (2) (1) Wet pits 7 1 1 2 UDDT-E (6) (6) (5) Toilets to septic tanks 0 1 Toilets to septic tanks and desludged at STF 1 Cost per DALY averted (PhP, ideal) 3 Shared toilets (16,656) (7,468) 327,577 311,018 269,109 303,360 Dry pits 9,188 344,233 327,674 285,765 320,015 Wet pits 335,045 318,486 276,577 310,827 UDDT-E (16,559) (58,468) (24,217) Toilets to septic tanks (41,909) (7,659) Toilets to septic tanks and desludged at STF 34,251 Cost per case averted (PhP, ideal) Shared toilets (60) (26) 1,249 1,125 982 773 Dry pits 34 1,309 1,185 1,042 833 Wet pits 1,275 1,151 1,008 799 UDDT-E (123) (267) (476) Toilets to septic tanks (143) (352) Toilets to septic tanks and desludged at STF (209) Cost per death averted (PhP, ideal) Shared toilets (341,306) (822,083) 7,138,329 7,370,142 6,549,961 5,095,660 Dry pits (480,777) 7,479,635 7,711,448 6,891,267 5,436,966 Wet pits 7,960,412 8,192,225 7,372,044 5,917,743 UDDT-E 231,813 (588,368) (2,042,669) Toilets to septic tanks (820,181) (2,274,482) Toilets to septic tanks and desludged at STF (1,454,301) 1 Site-specific comparisons are provided in Tables K1 to K3. 2 A negative value suggests that the new intervention (to) has a lower payback period than the original intervention (from) 3 A negative value suggests that the cost per DALY averted with the new intervention (to) is lower than the cost per DALY with the original intervention (from) www.wsp.org 95 Economic Assessment of Sanitation Interventions in the Philippines | Efficiency of Improved Sanitation and Hygiene Figure 58 shows the economically feasible investment costs FIGURE 58: INVESTMENT COSTS THAT WILL MAKE THE BENEFIT-COST RATIO EQUAL TO UNITY, SELECTED SITES AND for UDDT-E facilities and toilets that have access to septic TECHNOLOGIES, 000 PHP, 2008 PRICES tanks and treatment facilities in the various study sites. In the case of toilet facilities that have access to septic tanks sewers Toilets 249 to (desludged and treated at a STF) in Taguig, the maxi- Taguig 58 mum investment cost was PhP238,900 (US$5,371). This means that such a facility in Taguig will still have a BCR 239 treated at STF Taguig septic tanks, that is greater than unity for as long as it is smaller than 47 Toilets to this amount. Similar estimates for Alabel (PhP116,200 or US$2,612) are lower than their counterparts for Taguig 116 Alabel because of differences in economic (e.g., incomes), health 46 (e.g., disease rates) and other conditions in the sites. Dif- 228 not desludged ferences with the other technologies are due to differences Taguig septic tanks, 40 Toilets to across the sites and differences in the associated benefits with each intervention. 109 Alabel 36 It is also important to note that the cost estimates used in the analysis were considerably lower than the maximum 57 San Fernando - Coastal costs. For example, Figure 58 shows that the costs used for UDDT-E 32 UDDT-E facilities in the coastal region of San Fernando 54 were only about 57% of the maximum costs. In the case of San Fernando - Upland toilets with access to septic tanks in Taguig, whether des- 15 ludged or not, the costs used in the analysis could rise five- Maximum costs 0 100 200 300 fold and the BCR would still be greater than unity. Cost used in the analysis Cost/household, 000 pesos 7.4 Poverty analysis Note: The facility in San Fernando upland is only projected to last for 10 Table 41 shows the results for three different population years. sub-groups. It indicates net benefits for very poor and poor households from the installation of wet pit latrines in the for households belonging to income groups 2 and 4, respec- rural sites and community toilets in the urban sites. How- tively. A similar pattern can be observed from the provision ever, net benefits were lower in an upgrade from wet pit la- of community toilets for urban households. All this means trines to toilets with access to sewerage systems in urban ar- is that the net gains relative to income tend to be larger for eas. The experiment also shows that net benefits accruing to lower income groups. non-poor households were higher than poor and very poor households. Given the relatively high disease incidence and 7.5 Scaling up results for national policy mortality rates for poor households, this was mostly due to making the high opportunity costs (incomes) of non-poor house- The aim of this study goes beyond the assessment of the holds. However, the results here should be interpreted with improvements in sanitation options in the field sites. The care because poor households are likely to put a greater val- ultimate objective is to use the results from the sites in the ue on each peso of benefits compared to rich households. formulation of national policies related to improvements in This is partially reflected in the ratio of the net benefits to sanitation access. Field sites were carefully selected so that the income of each household group. In the case of wet pit the results can be applied to various locations and popula- latrines for rural households, the net present value of the tion groups in the country. Results from Alabel and Bay- intervention is 2.17 times of the annual household income awan are useful in evaluating options for rural-coastal re- for group 1. This ratio falls substantially to 0.84 and 0.39 gions which are dominated by relatively poor households 96 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Efficiency of Improved Sanitation and Hygiene TABLE 41: EFFICIENCY MEASURES FOR THREE DIFFERENT POPULATION POVERTY PROFILES Urban example: OD to Urban example: wet pits to Rural example: OD to wet pits community toilets sewerage Efficiency Sce- Very Poor Non-poor Very Poor Non-poor Very poor Poor Non-poor measure nario poor (income (income poor (income (income (income (income (income (income group 2) group 4) (income group 2) group 4) group 1) group 2) group 4) group 1) group 1) Cost-benefit measures Benefits per Ideal 9.6 11.0 16.4 2.7 6.0 20.0 0.2 0.2 0.2 peso Actual 8.4 9.3 12.4 1.5 3.7 15.1 0.7 0.7 0.7 Payback Ideal 1 1 1 2 1 1 >20 9 2 period (years) Actual 1 1 1 4 2 1 >20 >20 5 Net present Ideal 65,006 75,362 115,968 24,971 75,288 285,779 (48,091) (48,091) (48,091) value (PhP) Actual 55,997 55,997 85,966 7,475 39,923 212,909 (5,540) (5,540) (5,540) Net present Ideal 2.17 0.84 0.39 0.83 0.84 0.95 (1.60) (0.53) (0.16) value ($)/ Household income Cost-effectiveness measures Cost per Ideal 50,566 53,966 62,205 161,101 174,319 201,813 514,408 556,612 644,402 DALY averted Actual 53,318 56,762 65,756 291,754 280,000 221,988 107,309 102,986 81,648 (PhP) Cost per Ideal 157 175 220 498 570 719 1,591 1,821 2,296 case averted Actual 165 184 232 902 916 791 332 337 291 (PhP) Cost per Ideal 719,910 1,019,781 2,629,573 2,272,948 3,332,136 7,010,338 7,257,683 10,639,746 22,384,503 death averted Actual 759,097 1,072,614 2,779,655 4,286,185 5,846,302 9,584,605 888,304 1,211,636 1,986,393 (PhP) (Table 42). The results may be delineated further into An important finding of this study is that low-cost sani- communities where open defecation is very common (Bay- tation options yield net benefits and have relatively short awan) and those in which prevalence is relatively low (San payback periods. For rural areas in an upland setting, this Fernando). Dagupan and San Fernando-coastal apply to is exemplified by the findings for dry pits and, to a lesser urban-coastal regions. The results for San Fernando-upland extent, shared toilets in San Fernando. The positive net are relevant for poor households in the rural-upland regions benefits from wet pits in Dagupan and San Fernando high- of the country. Finally, the findings from Taguig are useful lighted potential options for urban areas in a coastal setting. for analyses in a highly urbanized setting that has a high As a whole, such findings mean that low-cost technologies population density and relatively high incomes. To some offer a viable option for situations in which stakeholders extent, the findings from Dagupan and the coastal region of have limited resources and, as more likely in the case of San Fernando facilitate a comparison with an urban setting urban areas, where space is also a constraint. However, there that has a lower population density and income. are some factors that must be taken into account before a policy is formulated regarding the sanitation options above. Formulating a national policy on sanitation options is a dif- Since dry pits and wet pits do not last as long as other sani- ficult task. Limited financial resources in the light of po- tation options, stakeholders must constantly raise funds in tentially large investments on sanitation options cannot be order to finance such projects. On the other hand, arrange- ignored. The sustainability of such investments in terms of ments regarding the maintenance and operation of shared maintenance and operations over time should also be con- and community toilets must also be considered. Hence, sidered. Moreover, it is unlikely that a single sanitation op- low-cost options might be more useful in the short term, tion fits all settings. especially when raising funds is a serious constraint. www.wsp.org 97 Economic Assessment of Sanitation Interventions in the Philippines | Efficiency of Improved Sanitation and Hygiene TABLE 42: TYPICAL NATIONWIDE SANITATION SUBGROUPS VERSUS FIELD SITE CHARACTERISTICS Popula- Aver- Poverty tion den- age inci- Population (000s, GDP per Sanitation coverage (% of sity (per- annual dence % of 2007) capita households, 2006) sons/ family (% of Province/ Baran- Classifi- urban km2) income families) Location city gays cation Baran- gays Province/ Baran- 2007 000 2007, 2003 OD Unim- Shared city gays PhP, 000 PhP, proved 2006 current prices Alabel Pobla- Socck- 1st class 8% 71.9 34.0 132.9 113.9 57.8 37.0 13.0 6.0 na cion (U), sargen munici- Kawas (R), (12) pality Maribulan (R), Balun- tay (R) Bayawan Banga (R), Central 3rd class 18% 110.3 17.9 157.7 144.3 69.8 58.3 25.5 2.6 na Tinago (U), Visayas city Villareal (R) (7) Dagupan Pugaro (U) Ilocos (1) 2nd class 100% 149.6 4.1 4,020.3 142.4 38.1 10.8 8.7 2.0 na city San Poro (U), Ilocos (1) 3rd class 19% 114.8 11.0 1,073.2 142.4 38.1 14.7 na 0.1 3.8 Fernando - Ilocanos city coastal Sur (U), San Agus- tin (R) San Nagyubyu- Ilocos (1) 3rd class 19% 114.8 1.2 1,073.2 142.4 38.1 14.7 na 0.1 3.8 Fernando - ban (R) city upland Taguig West Bicu- NCR 1st class 100% 613.3 124.2 13,485.9 310.9 223.3 5.2 13.0 tan (R) city Aggregate Rural 43,594 na 108.6 na 36.0 14.0 10.0 4.0 Urban 44,949 na 231.1 na 15.1 5.0 13.0 1.0 National 88,543 295 172.7 75.0 24.4 8.0 12.0 2.0 U = urban, R = rural, na = not available If more funds are available and longer term impacts are a open defecation. Moreover, lower cost-effectiveness ratios greater concern, more advanced sanitation options could be for such facilities in Taguig suggest their efficiency in ad- considered. UDDT-E and toilets with access to septic tanks dressing health-related concerns in dense urban areas. Apart could be considered for upland and coastal settings of ru- from the usual cost considerations however, the size of the ral areas, respectively. For UDDT-E facilities, some support market should be considered before wastewater and septage can be found from the BCR for the upland region of San treatment facilities are constructed. This is exemplified by Fernando. On the other hand, the findings in Alabel and the under-utilization of the STF in Alabel which led to a Bayawan support the case for septic tanks while the results benefit-cost ratio that is less than unity under actual condi- for Taguig provide evidence of net benefits in dense urban tions. areas. It must be noted, however, that the use of UDDT-E facilities in urban areas should be considered with caution. 7.6 Concluding remarks The findings for the urban-coastal regions of San Fernando, As a whole, the study found that there were net benefits where only 20% of the UDDT-E users recycle waste, tend for all the interventions considered in the sites. These were to defeat the key concept behind the approach. shown by BCRs that are greater than unity and NPVs that were positive. Net benefits were generally higher for low- Wastewater and septage treatment facilities should not be cost technologies, particularly dry and wet pits in rural areas ruled out altogether. Findings in Alabel, Taguig, and Bay- and wet pits in urban areas. The BCRs were also high for awan show net benefits in such technologies relative to toilets that flush to septic tanks, especially for the highly 98 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Efficiency of Improved Sanitation and Hygiene urbanized setting of Taguig. Low-cost sanitation options also tend to have lower costs associated with given health targets (cost-effectiveness ratios) and faster payback periods. However, it is worth noting that the cost-effectiveness ratios improve with the introduction of sewers and other treat- ment facilities in dense urban areas. Efficiency indicators under actual settings tend to be less favorable than under ideal settings. These were most notice- able for facilities with multiple users — e.g., the STF in Alabel and shared and community toilets in the urban sites. All this emphasizes the need for the proper use and opera- tion of such facilities. The net benefits calculated in the study might actually be underestimated. Intangible benefits such as comfort, pres- tige, and the personal safety of women and children were not quantified in the analysis. Benefits which accrue out- side of the household (national benefits) such as aesthet- ics, tourism, business, and water (fisheries and other uses of inland waters) were also excluded from the quantitative analysis. Since these benefits might be more significant to sanitation options at the top of the ladder — e.g., wastewa- ter treatment and the benefits to inland waters — the net gains from such interventions are higher than the values estimated here. www.wsp.org 99 VIII. Discussion 8.1 Study messages and interpretation costs have a direct financial impact on households. Patients 8.1.1 MAIN MESSAGES that use public hospitals pay subsidized rates for health care The key finding of the study is that there are net benefits as- and therefore have lower financial costs. The rest of the eco- sociated with all of the interventions evaluated. The benefit- nomic costs are paid for by society in the form of govern- cost ratios were greater than one for all interventions, rang- ment subsidies. ing from 1.5 (UDDT-E facilities in urban areas) to 7.9 (wet pit latrines in rural areas). With few exceptions, net benefits Improved sanitation generates other benefits to society be- are less favorable as households move up the sanitation lad- sides the potential lower government subsidies for health der. In general, these are explained by higher incremental care. The contribution of sanitation investments to a clean- costs compared to incremental benefits. Exceptions include er environment, particularly water resources, benefits so- the movement from (a) shared toilets to dry pit latrines in ciety as a whole. The benefits come in the form of lower rural areas and (b) shared toilets to wet pit latrines in urban clean-up costs and the potential increase in the use of wa- areas; where the costs of facilities located higher in the sani- ter resources for activities such as fishing and recreation. tation ladder are lower. Another exception is the movement Even larger benefits to the community and to the country from UDDT-E facilities to toilets with access to septic tanks as a whole could arise if the cleaner environment and water in rural and urban areas, where BCRs improve despite the resources contribute to higher tourist revenues and lower increase in costs. However, some care must be exercised in business costs. All of these suggest the importance of the interpreting the latter results because of differences in site- participation of government and other NGOs in addressing specific conditions (e.g., incomes, initial disease rates, etc.) the problem of sanitation. The participation of these insti- In addition, there are benefits which were not included in tutions is not limited to funding sanitation projects. It also the study that could have made the results for some inter- includes campaigns to increase awareness of the importance ventions more favorable. These include intangible benefits of proper sanitation and hygiene. (e.g., comfort, prestige, privacy status and safety) environ- mental benefits, and impacts on tourism and business. The study found larger net benefits per household from sanitation options for high income households compared It is important to note that many of the quantified ben- to low income households. However, such a result must efits are not financial in nature; i.e., associated with a re- be treated with care for the following reasons. First, each duction in out-of-pocket expenses due to poor sanitation. peso that is gained or saved is likely to be more important Gains in terms of averted health-related productivity and to poor households. Second, poor households have less ac- mortality losses, lost productive time due to accessing toi- cess to improved sanitation and are therefore more vulner- lets and water sources and, perhaps, the reuse of human able to the negative impacts of poor sanitation. Third, poor excreta in the plots of the households are non-financial in households are likely to have a lower capacity to address the nature. The only clear financial gains are the potential for negative impacts of poor sanitation. This is especially the reduced health care expenditures (treatment and medica- case in paying for health care expenditures because a larger tion) and savings on water treatment and purchased water proportion of their income is allocated to food. All this access costs. Health care costs in the study used prices in suggests that, despite the lower estimated net benefits, im- private health facilities. This suggests that not all of these provements in sanitation have an important role in easing 100 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Discussion the burden of poverty. An obvious channel by which this allows them to relax while using the facility. In the case of occurs is through lower health care costs for poor house- women, personal safety was a more important concern. holds. However, increased productivity by way of lower time lost due to illness, traveling to access latrines in the 8.1.2 ROBUSTNESS OF RESULTS case of private toilets and perhaps traveling to access clean There are uncertainties surrounding the values of the inputs water sources are equally important. used in the quantitative analysis. Some of the main inputs are (in parenthesis are the basis for or the actual values used There is a gender dimension to sanitation which was not in the analysis): quantified in the analysis but is nonetheless worth noting. The results presented here, which are based on the FGD • Value of productive time (regional GDP per capita) and household surveys, are classified as (a) toilet practices, • Value of premature death (human capital approach) (b) toilet cleaning, and (c) toilet preference. • Proportion of productive time lost per day due to poor sanitation (30% for adults and 15% for chil- The FGD showed that men and women generally use toi- dren under the age of five years) lets for defecation and urination. However, site-specific • Diarrheal disease rate (WHO estimates partially ad- living conditions and customs caused differences in toilet justed by estimates from the DHS) practices. Males in barangay Pugaro claimed that they uri- • Costs of sanitation options (literature search, expert nate outside of the house. On the other hand, males in ba- opinion, surveys) rangay Nagyubyuban said that they urinate in the rice pad- dies. Women expressed a preference for urinating in toilets. There are a number of sources of uncertainty in the values However, some admitted to urinating in their backyard or used above. The first is the presence of alternative values that potty chambers when they can no longer hold back the urge could have been used in the analysis. This is the case for the to do so. Women also claimed that they regularly wash their values of productive time and premature death. The second hands with soap and water after defecation and urination. is the absence of rigorous studies to support the values used While men in urban areas also made the same claim, there in the analysis — e.g., proportion of productive time used is some variation in the behavior of men in rural areas. Fish- per day. Third, there might be instances in which the values ermen who defecate at sea said that they wash their hands are available but these are not precise or specific enough in only after getting home. After urinating these men either terms of the study sites (regional GDP and WHO disease wash their hands with water or simply wipe their hands on rate) and the period of analysis (WHO disease rates). Final- their pants. ly, there are estimates that by nature exhibit wide variances in the estimates — e.g., costs of sanitation options. Some of The FGD also found that toilet cleaning, which includes these uncertainties are partially addressed by the estimates brushing the bowl with soap and water, was the primary under different settings (sites) and scenarios (ideal versus responsibility of women. Nonetheless, men in all the sites actual). However, it is useful to examine how sensitive the claimed that they participate or help in toilet cleaning. Men results are to changes in these variables. with private toilets in Poro/San Agustin, Alabel, and Taguig claimed to be more involved and meticulous in maintain- Table 43 shows the benefit-cost ratios from a sensitivity ing toilets. However, men in households that do not have analysis of key assumptions. This involves changing an as- private toilets said that their participation in cleaning toilets sumption in the analysis and recalculating the BCR. For was limited to flushing after use. example, Experiment 1 uses average wage rates in calcu- lating the BCR instead of the GDP per capita, which was Based on the FGD, men and women generally share com- used in the baseline (results presented in Chapter 7). The mon preferences for toilets. For example, both prefer toilets results indicate that average BCR for community toilets that are constructed near or in the house. However, they will be slightly lower under Experiment 1 (2.4) compared differed in their responses on comfort issues. The major- to the baseline (2.5). One major conclusion from Table 44 ity of men claimed that they want a clean toilet because it is that the benefit-cost ratios for the different interventions www.wsp.org 101 Economic Assessment of Sanitation Interventions in the Philippines | Discussion generally remain greater than one in the experiments. The 8.1.3 GENERALIZING RESULTS only exception is for UDDT-E facilities following a 100% The selection of the field sites and groups of respondents in increase in the costs of the facilities (Experiment 7). To be the study were motivated mostly by the existence of recently more specific, the estimate refers to the costs of UDDT-E completed sanitation programs. The outcomes of the study facilities in the coastal region of San Fernando (see Annex are relevant for the following settings in the Philippines: Table L9). However, such a result should be interpreted • Urban regions that have relatively high incomes and with care. In the baseline, the construction and installation population densities: Taguig costs of an UDDT-E facility in the site were assumed to • Urban regions that have relatively low incomes and be PhP32,172 (US$723). A 100% increase brings the cost population densities: Dagupan and San Fernando- of the facility to a level that is at par if not higher than the Coastal cost of a standard toilet that has access to a septic tank, and • Rural coastal regions: San Fernando-Coastal and makes it less likely that a household will invest in such an Alabel expensive UDDT-E facility. • Rural upland regions: San Fernando-Upland The results in Table 43 also suggest that the benefit-cost ra- This suggests that the application of results to a national tios are most sensitive to changes in the inputs used for valu- assessment will require cognizance of the conditions within ing premature death (Experiment 2) and to a lesser extent towns or provinces or regions in the country. Such condi- the costs of sanitation options (Experiments 6 and 7). For tions include existing sanitation coverage, health status, in- Experiment 2, the benefit-cost ratio is estimated to rise by comes, access to water, population density, age composition 0.8% for a one percent increase in the input used for valu- of the population, sanitation options under consideration, ing premature death. This also suggests that, on the whole, etc. the estimated benefit-cost ratios are generally conservative because the current values used for premature death (based 8.2 Utilization of results in decision making on the human capital approach) are only about a third of 8.2.1 POTENTIAL USES OF RESULTS the estimates with the VSOL approach. The results of the study have many uses in the decision making processes in the sanitation sector. It can be used as a TABLE 43: BENEFIT-COST RATIOS UNDER ALTERNATIVE ASSUMPTIONS Experiment2 Technology Baseline 1 2 3 4 5 6 7 Community toilets 2.5 2.4 6.1 3.3 2.6 2.4 2.1 1.9 Shared toilets 2.0 2.1 5.1 2.7 2.2 2.1 1.6 1.3 Dry pit latrines 5.0 5.5 14.1 7.0 5.8 5.5 3.8 2.9 Wet pit latrines 5.6 5.4 15.9 6.6 5.7 5.5 4.1 3.3 UDDT-E 1.8 1.5 3.8 1.9 1.5 1.5 1.1 0.9 Toilets to septic tanks (no desludging) 3.7 3.6 11.2 4.1 3.7 3.6 2.9 2.5 Toilets to septic tanks (desludged and treated 3.3 3.2 9.7 3.6 3.3 3.2 2.4 1.9 at STF) Toilets with wastewater treatment (constructed 1.9 1.8 5.0 2.4 1.9 1.8 1.4 1.1 wetland) Toilets to sewer 3.3 3.2 9.3 4.0 3.4 3.3 2.5 2.1 Average responsiveness 1 nc 0.1 0.8 0.1 0.2 0.2 (0.5) (0.4) Notes: measured as the ratio of the percentage change in the benefit cost ratio for a 1% change in exogenous variable for the experiment; Experiment 1 2 1: using average wages per region instead of GDP per region; Experiment 2: 100% of time for adults and 50% of time for children; Experiment 3: VSOL instead of GDP; Experiment 4: 10% increase in diarrheal incidence rates; Experiment 5: 10% decrease in diarrheal incidence rates; Experiment 6: 50% increase in initial costs; Experiment 7: 100% increase in initial costs Source: Annex Table K7 102 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Discussion source for advocacy in sanitation improvements. In particu- DENR. Local government units may also find these useful lar, it can be used to emphasize the benefits associated with in the formulation of site-specific plans. In as much as do- improved sanitation and the net benefits associated with nors and NGOs are consulted in the planning process, the various sanitation options. Such advocacy can be targeted study results can assist these institutions in their collabora- to households in terms of investing in toilets. Equally im- tion with national government agencies and local govern- portant is convincing government, donors, and other insti- ment units. It goes without saying that such results are also tutions of the importance of investments in basic sanitation relevant in the projects of these donors and NGOs. facilities and off-site treatment facilities. The results of the study can also be used to sensitize the The findings and approach can also be used in selecting the media on the impacts of sanitation improvements and on appropriate sanitation interventions in various sites. This is the various sanitation options. This helps in the advocacy particularly important in identifying the technologies that component which may eventually increase the awareness of will yield the highest net returns in the long term. In situ- households on the costs and benefits of sanitation improve- ations where funds are scarce, the study also showed that ments. there are net benefits from investments in low-cost sanita- tion technologies. However, since many of these low-cost 8.2.3 INTEGRATING ECONOMIC technologies have lower estimated useful lives, it must be CONSIDERATIONS INTO A DECISION MAKING emphasized that such choices are likely to be more suitable PROCESS to meeting short term considerations. In real life, there are many factors that influence decisions, some are evidence-based while others are related to political The results of this study provide valuable inputs for a na- decision making. The study showed how economic anal- tional analysis of sanitation options and the formulation ysis, in terms of quantifying costs and benefits and even- of plans to meet national targets. As inputs for a national tually calculating net benefits, can be used for generating analysis, the results could be used to evaluate and select be- decision-making tools. The analysis could be extended for tween options in various settings. The framework and, to a a broader analysis of options. However, such an exercise limited extent, the assumptions and data used here could may require an extensive set of criteria. Such criteria may also be adopted for settings or technologies that were not include the availability of resources, selection of the appro- covered in the study. priate implementation and financing approaches, and the acceptability and willingness of the target beneficiaries in 8.2.2 TRANSLATING EVIDENCE TO ACTIONS sanitation programs. The results of this study are useful to various groups. Stake- holders in the water and sanitation sector can use the results 8.3 Delivering sanitation improvements to for strategic plans and the formulation of budgets. The re- target beneficiaries sults of the cost-benefit and cost-effectiveness analysis can 8.3.1 KEY APPROACHES IN THE DELIVERY OF assist in deciding on the appropriate technologies for dif- SANITATION IMPROVEMENTS ferent settings in the country. The results from the program There are many instances in which improvements in sanita- approach analysis also stress the importance of carefully tion facilities can only be made available through projects considering suitable implementation and financing ap- or programs implemented by the government (national and proaches for identified sanitation initiatives. On the other local), donor agencies, private firms, and NGOs. There are hand, the cost estimates can provide valuable inputs in the two main reasons why this is the case. First, in the case of formulation of budgets. latrines and toilets, the households who do not have these facilities are often poor and will have difficulty in paying To the extent that plans will be formulated at the national for such facilities. This point was illustrated in Chapter 6 level, the results can be used by line agencies involved in through findings that (a) the highest proportion of house- the sanitation sector like the DOH, DILG, DPWH, and holds that practice open defecation belong to lower income www.wsp.org 103 Economic Assessment of Sanitation Interventions in the Philippines | Discussion groups, and (b) the investment outlay for sanitation facili- beneficiaries to contribute to the investment. A range of dif- ties could range from 3.1% (dry pits) to 255% (toilet with ferent types of subsidies is provided in Table 44. access to septic tanks) of the annual incomes of the poorest households in the study. Second, off-site treatment facilities Implementation approaches are concerned with the way in like STFs often require investment outlays that are beyond which projects/programs facilitate the delivery of sanitation the means of households in the community. Moreover, the interventions to target beneficiaries. These approaches can fact that these facilities benefit communities rather than be classified as follows (see Appendix 1 for the definitions): just one household raises questions on how the investment (a) community-led total sanitation (CLTS); (b) sanitation outlays will be financed or distributed among the potential marketing; (c) informed choice; (d) supply-driven; and beneficiaries. (e) strategic urban sanitation. Implementation approaches may also be accompanied by measures that motivate hy- In practice there have been many ways in which access to giene behavior change. It is important to note that a specific improved sanitation facilities have been delivered to house- project/program may include a mix of the elements of the holds and communities. There are two important dimen- aforementioned approaches. sions in this process — financial and implementation ap- proaches. Sanitation programs/projects may also involve partnerships, or agreements between two or more stakeholders to share Financial approaches refer to the manner in which funds knowledge, skills and responsibilities. Such partnerships are provided. These include direct payments for the provi- may be at the level of implementation and/or financing, sion of software and hardware, leveraging funds from other and may involve a collaboration between the government sources, and the use of various subsidies to encourage the and the private sector or different levels of government. TABLE 44: CLASSIFICATION OF SUBSIDIES Subsidy Description This represents payments (in the form of cash or vouchers) to the recipient Direct subsidies household which is then able to “spend� to access a range of services. The use of public money to construct new infrastructure. In rural areas and some urban contexts the most common form is payment of part or all of the cost of Infrastructure subsidies household toilets. In urban areas public funds are typically mobilized to pay for shared elements of networks (sewers and treatment for example). Payment of charge for connection to a sewer (which may be a barrier to use of the Connection subsidies network). Payment (usually government/public) to a service provider to offset some or all of the Operational subsidies costs of supplying a service. Subsidies to small-scale operators Operational subsidy (in various forms) provided to bring down the costs of operation of small-scale service providers. Cross-subsidies This occurs when one group of users contributes to part of the costs of providing services to another group. Consumption subsidies This occurs when tariffs for sewerage services are kept artificially low. This represents a subsidy towards the cost of “consumption� of the service, or a consumption subsidy. Output-based subsidies This is provided to services successfully delivered (effective sanitation) rather than inputs (excavation, pipes and toilets). Regulatory advantages Inadvertent subsidies occurring when policy is used to favor certain types of service delivery. Subsidized credit Subsidies and guarantees to micro-finance institutions (MFIs) who can then lend money for sanitation investments to households at reduced interest rates. Source: Evans et. al. (2009) 104 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Discussion 8.3.2 APPROACHES IN THE PHILIPPINES ing for projects were grants and loans from development Of the many programs/projects that have been imple- banks and bilateral donors. For LINAW and SCOTIA, the mented in the Philippines, this study initially considered USAID provided “catalyst� funding to its contractor, which reviewing 26 programs/projects that date as far back as was used to leverage the investment costs of infrastructure 1991. However, this number was reduced to 10 because from local government sources and the local private sector. of the lack of available information. The projects/programs reviewed in this study are: Figure 59 summarizes the implementation approaches and • Water Districts Development Project (WDDP): partnerships involved in the 10 projects reviewed in the Sewerage, Sanitation and Drainage Development; study. It indicates that the supply-driven and strategic ur- • Rural Water Supply and Sanitation Project (RWSSP); ban sanitation were the most common approaches. It is im- • Rural Water Supply and Sanitation Project Phase V portant to note that it contains elements of various imple- (RWSSP-V); mentation approaches. The SuSEA project for example, had • Water Supply and Sanitation Enhancement Program all but one (sanitation marketing) of the implementation (WSSPEP); approaches. The MTSP had elements of strategic sanitation • Local Initiative for Affordable Wastewater — Phases and hygiene behavior change. Partnerships in implementa- 1 and 2 (LINAW); tion were the most common among the projects/programs • Environmental Governance Project (EcoGov); Ma- reviewed. In the case of SCOTIA, all partnership arrange- nila Third Sewerage Project (MTSP); ments in the study were present. The specifics of the imple- • Integrated Support for Sustainable Urban Sanitation mentation approaches and partnership arrangements are — Phases 1 and 2 (ISSUE); presented in Annex Table K10. • Sustainable Coastal Tourism in Asia (SCOTIA); and • Sustainable Sanitation for East Asia (SuSEA) — Based on project documents, the outputs (hardware only) Philippines Program. of the different projects were as follows: • WDDP: 2,056 toilet bowls distributed to house- Two of the study sites in the CBA were also components of holds and 400 septic tanks constructed; the programs/projects reviewed here. These are the UDDT- • ISSUE: 215 urine-diversion toilets distributed to E toilets in San Fernando (ISSUE) and the septage treat- households; ment facility in Taguig (MTSP). Annex Table K9 presents • RWSSP: 60,817 pit latrines for households, 242 toi- some basic information on projects examined in this study. lets in schools, and 117 public toilets; • EcoGov (as of mid-2009): communal septic tanks The earliest project began in 1999 (WTDP) and some of for 40 households, 12 wastewater treatment plants, the most recent projects are still on-going at the time of the with an additional seven by the end of September study (MTSP, SuSEA Philippines, and ISSUE Phase 2). A 2009; pattern in the earlier projects was the focus on water sup- • RWSSP-V: toilets in 47 schools and 11 public toilets ply, with sanitation as a subsidiary component. Some of the • LINAW: an estimated 144,000 people with access to later projects were for sanitation only. improved sanitation after the project; and • SCOTIA: five wastewater treatment facilities, five Most of the projects were implemented by or through reed bed treatment systems, and ten UDDT-E facili- the local government units, with coordination at the na- ties. tional level by a government line agency. The three proj- ects funded by USAID (LINAW, EcoGov, and SCOTIA) 8.3.3 A CALL FOR A MORE THOROUGH were managed by a contractor with limited involvement of ASSESSMENT OF APPROACHES national government agencies. The Third Manila Sewerage A thorough assessment of the program approaches has been Project was implemented by a private concessionaire (Ma- very difficult to conduct in the Philippines for two reasons. nila Water Company Incorporated). With the exception First, there is a lack of project documentation evaluating of USAID-sponsored projects, the main sources of fund- project success, especially after project completion. Sample www.wsp.org 105 Economic Assessment of Sanitation Interventions in the Philippines | Discussion FIGURE 59: IMPLEMENTATION APPROACHES AND PARTNERSHIPS IN THE 10 PROJECTS CLTS 1 Implementation approach Sanitation marketing 0 Informed choice 2 Supply driven 5 Strategic urban sanitation 5 Hygiene behavior change 4 Implementation partnership 7 Partnership Financing partnership 3 Public-private sector 5 Public-public sector 5 0 1 2 3 4 5 6 7 8 Number of projects Source: Annex Table K10 sizes have also been very limited and hence unable to make Given the above, this paper makes a call for further stud- reliable inferences. Second, some of the approaches (CLTS, ies in the evaluation of the various implementation and informed choice, and social marketing) are fairly new to the financing approaches in the sanitation sector. Such stud- Philippines, which make it difficult to get a clear picture ies could include developing a clear and robust framework of their longer term impacts and efficiency in delivering and indicators with which the approaches could be evalu- sanitation services compared to other approaches. However, ated. Moreover, the difficulties encountered in attempting evaluating the effectiveness of the approaches is important such a study in the Philippines seem to indicate that initial in order to ensure that the target beneficiaries get the most attempts might be with analyses that are cross-country in from projects/programs. It is also essential in avoiding mis- nature or in countries where there is a sizeable number of takes committed in previous projects. well-documented projects. 106 Economic Assessment of Sanitation Interventions IX. Recommendations This chapter outlines the key recommendations of the assumed that a person who does not have access to a private study. Many of these recommendations are not new and toilet spends about five minutes a day in accessing a place to are simply reiterated on the strength of the findings of the defecate. This is equivalent to about 6.6 days a year for an current study. average family. The current study showed that the assump- tions in ESI-1 underestimate the time losses. Information Recommendation 1: Intensify efforts to from the field sites indicate that the time losses are about increase access to improved sanitation 20 days in a year for the average household, with dispro- Despite the progress of the country in meeting the MDG portionately large losses for the average rural household (32 targets for sanitation, there is a sizeable number of people days). The field surveys and FGDs also attempted to elicit who still practice open defecation or use unimproved sani- information on the difficult-to-quantify dimensions asso- tation facilities. Chapter 1 showed that about 24% of the ciated with poor sanitation. For households that recently Philippine population, or about 21.7 million people, did acquired access to private toilets, some of the key findings not have access to improved sanitation facilities as of 2008. include (a) the pride felt by the household in owning the Moreover, there is evidence that existing “improved� sani- facility, (b) the confidence to invite guests to their homes, tation facilities may require upgrades, re-design or repair. (c) perceived benefits of not being seen by others when a The SuSEA project, for example, cited the presence of septic person goes to a toilet. The study also found that there is tanks that do not comply with standards set by the DOH. a sense of shame and embarrassment from practicing open In the case of the community toilets in Bgy. Pugaro, Dagu- defecation. Some respondents in the FGDs claimed to have pan, this study found that some of the facilities are in a state covered their faces with their hands or a piece of cloth to of disrepair. While the extent to which this is occurring at avoid being recognized by their neighbors while practicing the national level is unknown, it indicates that a segment open defecation. of the population is still partially exposed to the dangers associated with poor sanitation. Apart from avoiding the costs of not having access to im- proved sanitation, the call for greater investments is also The points above suggest a need to intensify investments supported by the finding that there are net gains from to increase access to improved sanitation and to rehabili- such investments. For the urban sites in this study, it was tate and redesign existing facilities. The costs of doing so estimated that a one peso investment in an improved sani- can be significant. ESI-1 attempted to quantify the costs tation facility can yield net returns ranging from PhP1.5 associated with poor sanitation on health, water for drink- (UDDT-E) to PhP5.6 (toilets with access to septic tanks). ing and other uses, toilet access and tourism. The current For the rural sites, the benefits per peso of investment range study attempted to refine some of these costs and take a from PhP1.6 (toilets with access to wastewater treatment) closer look at the several intangible benefits from improved to PhP7.9 (wet pits). Moreover, the finding that the net sanitation through field surveys, interviews and focus group returns are highest for dry pits in rural areas and second discussions. One important finding in refining the costs is highest for wet pits in urban areas suggest that investments in the time spent accessing a private toilet. In ESI-1, it was do not have to be for the relatively expensive options. www.wsp.org 107 Economic Assessment of Sanitation Interventions in the Philippines | Recommendations Recommendation 2: There is a need for more Recognizing resource constraints, it is essential for decision active participation of government, donor makers to define their priorities. These priorities go beyond agencies and other institutions in addressing target groups as it is also necessary to identify whether ben- the need for improved sanitation. efits are for the long or short term. Many of the people who do not have access to improved sanitation facilities are poor. Section 6.3 of this study found The focus should be on target groups that are most vulner- that the highest rates of open defecation were for low in- able, especially in locations that are lagging behind in terms come households. Among those residing in rural areas, of access to improved sanitation. Clearly, the most vulner- around 29% and 15% of the survey respondents belonging able group are children under the age of five years. This to income groups 1 and 2, or households earning less than means a strong focus on poor regions or locations where a PhP10,000 a month, practice open defecation. The pattern larger proportion of the population are children. A strong is not too different for urban areas. Apart from the higher emphasis should also be given to rural areas since these con- probability that these families do not own housing units, tinue to lag behind urban areas. However, areas where poor the cost of sanitation facilities relative to the incomes of urban households are concentrated should not be over- these households is relatively high. For households earning looked because of the higher risks of disease transmission. about PhP2,500 per month or income group 1, the total Specific attention also appears to be needed in Mindanao, investment costs, which just represent expenditures for in- especially the ARMM, because this region continues to be stalling facilities, can range from 3% (dry pits) to 255% behind the rest of the country in terms of sanitation im- (toilets with access to a septic tank) of annual household provements. income. The study also showed that the costs can be sig- nificant even if such households were provided long term Defining the planning horizon over which sanitation ben- loans at zero interest. In the case of families belonging to efits are projected to be realized is also very important. If income group 1 for example, this could be around 10% of the objective is to provide benefits over the short term, the annual household income. While this might not seem large, low cost technologies (e.g., pit latrines and community toi- it is important to note that such families already allocate a lets) might be sufficient. Apart from favorable BCRs, these very large proportion of their incomes to food. These stress interventions also have a relatively short payback period. the point that poor households will have difficulty financ- For example, this study found that investment costs for dry ing sanitation facilities. This argument is further supported and wet pit latrines can be recovered within a year. How- by the findings from the FGDs where respondents cited ever, these interventions have a short expected life. Decision economic factors for not having a toilet. In this exercise, the makers, be it the households, government or donor agen- highest ranked reasons for not having a toilet were “cost is cies, will therefore have to raise funds constantly in order too high� and “no budget.�. Hence, it is essential for gov- to replace these facilities. If the objective is to generate ben- ernment and other institutions to take an active role in pro- efits over the long term, then interventions that are higher viding access to poor households. Since this is already being up the sanitation ladder, including treatment facilities, are done, as exemplified in the study sites, it may therefore be more attractive. In saying this however, provisions either interpreted as a call for more active participation. in the form of funds or mechanisms must be made for the proper maintenance and operations of these projects. The costs provided in the previous paragraph focus more on access to on-site sanitation facilities. It goes without say- Recommendation 4: In providing access to ing that government and other institutions should be more improved sanitation, key institutions must be active in facilitating the construction of off-site treatment cognizant of initial conditions and potential in facilities. project sites. In selecting between the specific options, decision makers Recommendation 3: In providing access to must be aware of the initial conditions of the target ben- improved sanitation, there is a need to define eficiaries. Such an understanding is essential to increasing priorities. the success and sustainability of the option that is chosen. 108 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Recommendations This is supported by the findings in the study that an option Lessons from monitoring and evaluation of projects will could have divergent efficiency indicators in different sites. also help in determining if these are replicable in other sites. Observations from the sites also provide evidence for this Moreover, these provide information on the adjustments recommendation, where some of the BCRs and other ef- necessary to ensure greater success of future projects. Im- ficiency indicators are substantially less favorable under ac- pact studies should also be implemented in order to exam- tual conditions compared to ideal conditions. An example ine the extent to which the target beneficiaries gained from is Alabel, where the STF was being under-utilized at the the project. Unfortunately, the PAA component of this time of the survey. This led to unfavorable efficiency indica- study found very little documentation on these activities. tors under actual program conditions, which contradicted It found a lack of follow up work on completed projects the results under ideal conditions. The UDDT-E users in and, if it was being done, a lack of documents from which the coastal region are also an example. The study found that to base the analysis. only about one in five users in the site was recycling human waste. While the efficiency indicators were favorable to the On a broader scale, a review of the enabling environment technology in the site, the finding that the majority of the (legislation, rules, regulations and guidance) should be con- beneficiaries were not re-using seems contrary to the con- ducted. This should assess the dissemination and effective- cept of EcoSan. nesss of previous projects on the enabling environment and identify needs and gaps for further work. Where appropriate, this must be complemented with a re- view of the capacity and training needs of local government Recommendation 6: Further education and units to implement and maintain sanitation projects. This information campaigns on personal hygiene should cover social, technical and environmental aspects of and on the maintenance of sanitation facilities sanitation as well as current implantation approaches. The are needed. objective of the exercise is to develop appropriate responses, Further education and information campaigns are needed including procedures, guidance and training courses. in the area of sanitation. This includes the usual campaigns being conducted on personal hygiene and more. One exam- Recommendation 5: Sanitation projects must ple is septage management. In the course of the survey, and be adequately monitored and evaluated. with supporting evidence from other studies, it was found Adequate and continuous monitoring and evaluation of that many households have not desludged their toilets or sanitation projects is a must. This helps identify problems did so way beyond the prescribed period. Apart from the and proper action in the implementation of the projects, risks involved with overflowing septic tanks, such a practice and is supported by study findings that actual BCRs are also erodes the ability of the facility to reduce the release of lower than ideal BCRs, which suggest that the facilities are effluents in the environment. Informing households about not being used at optimal levels. This recommendation is the risks associated with overflowing septic tanks and the also based on observations in the selected study sites. For proper maintenance of these facilities is one of the many example, during a site visit of the ESI research team to ba- small steps in reducing the costs of poor sanitation. Another rangay Pugaro in 2009, it was observed that some of the example is finding that open defecation and urination are community toilets were in a state of disrepair and not being still present even for households that already have access to used. A similar observation was cited by the survey team in toilets. The surveys conducted in this study found that at the upland region of San Fernando. The initial intention in least 49% of respondents who have access to either UDDT- the site was to survey 49 beneficiaries. However, only 17 E or community toilets in San Fernando and Dagupan still were interviewed because the rest of the beneficiaries were urinate in the open. In the case of households with access to no longer using the facilities provided to them. The reasons community toilets in Dagupan, about 57% of the respon- range from households having a standard toilet which made dents said that they continue to practice open defecation. the UDDT-E facility redundant to households not having While putting an end to such practices may well require the funds to construct the superstructure that will house the a mix of interventions, efforts and information campaigns toilet provided. should continue if only to emphasize the risks and costs as- www.wsp.org 109 Economic Assessment of Sanitation Interventions in the Philippines | Recommendations sociated with such practices. death associated with poor sanitation. These are very important because, as shown by the results in ESI- Perhaps the information campaigns should also go as far 1, health related costs represent the largest propor- as defining sanitation. While they seem to be aware of the tion of the costs of poor sanitation. In the current consequences of poor sanitation, some participants in the cost-benefit analysis, avoided health costs were also FGD do not appear to have a full grasp of the meaning of among the major benefits associated with each in- sanitation. This is reflected in the mix of explanations pro- tervention. vided during the exercise. At the extreme, the respondents • Establishing rigorous and site-specific quantitative in barangay Pugaro, Dagupan said that they do not under- links between sanitation and (a) disease incidence stand the meaning of sanitation. (attribution factors), (b) tourism, (c) water use and access, (d) water quality, (e) environment and (f ) Following the results of the program approach analysis, ed- business activity. This involves identifying a rigor- ucation and information campaigns should not be limited ous methodology and estimates for establishing the to the beneficiaries of improved sanitation access. It should magnitude of the benefits associated with improved also extend to building understanding in local government sanitation, and if possible, with specific sanitation units so that sanitation is given a higher priority in public options. This can be relevant especially in the case spending. of treatment systems which are likely to cause an improvement in the quality of the environment as Recommendation 7: Stricter enforcement of a whole and of water bodies. The improvements as- sanitation laws and ordinances. sociated with these resources could in turn translate The first chapter of this study presented a list of sanita- to a clearer understanding of the benefits to tourism tion laws and ordinances which go as far back as 50 years. and business activities. In the current study, STFs Despite this, there are signs that such laws are not being and sewer systems were found to have lower efficien- followed. The SuSEA project for example cited the case of cy indicators than on-site facilities such as dry and septic tanks not complying with the standards set by the wet pits. Part of the explanation here could be due to DOH. the inability of the study to fully account for the en- vironmental and health benefits associated with such Recommendation 8: Further research on the off-site interventions. impacts of poor sanitation. • Generating more reliable estimates of the potential Following the limitations cited in Chapter 8, there is clearly benefits from the reuse of human waste as fertilizer a need for more research in the sanitation sector. These in- and biogas. This includes households (UDDT-E) clude: and the reuse of wastewater and sludge treated in • Generating more specific information on access to STFs. sanitation facilities. The current practice involves • Establishing stronger evidence on the performance collecting information on the facilities available to of projects in actual settings. This also includes re- households. There is no national information on the cently introduced programs in the Philippines such state of existing facilities; i.e., whether these facili- as CLTS, and the evaluation of the various financial ties are functioning properly. There is also very little and implementation approaches. information on whether the design of such facilities conforms to pre-determined specifications, as is the case with septic tanks. • Generating reliable site-specific and age-group-spe- cific incidence and mortality rates for sanitation- related diseases such as diarrhea, helminthes, etc. Value of statistical life estimates for the Philippines will also enhance estimates on the value of premature 110 Economic Assessment of Sanitation Interventions References ADPC [Asian Disaster Preparedness Center]. 2008. Flood port. Economy and Environment Program for Southeast disaster mitigation and river rehabilitation by Marikina City, Asia. Downloaded from http://www.idrc.org.sg/eepsea/ev- Philippines, Safer Cities 22: Case studies on mitigating disas- 7994-201-1-DO_TOPIC.html on 7 May 2009. ters in Asia and the Pacific, Bangkok: Asian Disaster Pre- paredness Center, August, 8 p. Department of Health, 2005. 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These are: • Community-led total sanitation (CLTS) involves facilitating a process to inspire and empower rural communities to stop open defecation and to build and use latrines, without offering external subsidies to purchase hardware such as pans and pipes. It focuses on igniting a change in sanitation behavior rather than constructing toilets. As the name implies, it concentrates on the whole community rather than on individual behaviors — collective benefit from stopping open defecation (OD) can encourage a more cooperative approach. It is fundamental that CLTS involve no individual household hardware subsidy and does not prescribe latrine models. It includes encouragement of local innovation for low cost toilet models using locally available materials so that people can select an affordable model that suits them best. (Kar & Pasteur, 2005; Kar & Chambers, 2008). • Sanitation marketing: Sanitation marketing uses marketing techniques to achieve social objectives associated with sanitation. It is composed of four components — product, price, place and promotion (WSP, 2004). It works on the principle that the latrines should be affordable (price), responsive to the needs of users (product), and installed at the home of the user (place). Promotion, on the other hand, represents the effective use of various means to create awareness and convince consumers to use the product. Social marketing projects generally work by supporting and developing the local private sector and small-scale entrepreneurs to develop such skills and products. Households then buy the toilet of their choice directly from the private sector operator. • Informed choice: This is based on providing consumers a full understanding of the costs and benefits of all available options of a toilet, including the options for individual components. Through the approach, households, communities and municipalities are informed about the benefits and disadvantages of different sanitation technology options before making their own decision as to which option/s to adopt. • Supply-driven: This is a top-down supply-driven approach in which sewers or toilets are provided from a central planning viewpoint with “one-size-fits-all� solutions, giving people little choice in the technology they receive. Bureaucrats or technocrats determine the type of technology, costs and expected contribution of the users. The approach generally fails to take into account the expressed needs and conditions of the users of the sanitation facilities. 118 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex • Strategic urban sanitation: Based on a concept first proposed by Albert Wright of the World Bank, strategic urban sanitation was developed into a practical approach by GHK Research and Training in association with WEDC and Water and Sanitation Program, South Asia, 2000 and further developed and applied in Latin America and the Caribbean by Rosenweig and Perez (2002). It is based on the following principles: −− Focus on town-wide solutions that expand coverage to as many residents as possible. −− Ensure that any plan to improve sanitation services is financially sustainable. −− Consult households on sanitation options that are currently in use and according to their expectations. −− Engage in public consultations to discuss the options with stakeholders. −− Include a specific health component. −− Select an appropriate model for managing the provision of sanitation solutions. • Hygiene behavior change: This involves initiatives to change the sanitation and water-related behavior of people towards improved hygiene practices. The traditional, and now generally discredited approach, is the rather didactic “hygiene education� — essentially telling people about the diseases associated with water and excreta, and what they should change in their behavior to avoid these. In recent years the emphasis has changed to a more participatory approach based on adult learning. www.wsp.org 119 Annex Tables ANNEX TABLE A1: COVERAGE, % OF HOUSEHOLDS, BY REGION 2000 2007 Region Improved Unimproved No toilet Improved Unimproved No toilet Philippines 62.9 28.4 8.7 76.3 18.0 5.7 National Capital Region (NCR) 75.6 23.4 1.0 87.2 12.6 0.2 Cordillera Administrative Region (CAR) 54.8 41.6 3.5 78.6 20.9 0.5 1 Ilocos Region 71.5 27.0 1.5 87.3 12.7 - 2 Cagayan Valley 65.7 32.3 2.1 84.0 16.0 0.1 3 Central Luzon 73.6 22.9 3.4 89.0 10.9 0.2 4 Southern Tagalog 68.6 23.3 8.1 86.2 13.6 0.2 5 Bicol Region 55.5 28.9 15.6 74.4 25.3 0.4 6 Western Visayas 54.2 31.5 14.3 77.0 22.3 0.7 7 Central Visayas 53.2 25.7 21.1 71.1 28.6 0.4 8 Eastern Visayas 54.2 21.9 23.9 71.5 27.9 0.6 9 Zamboanga Peninsula, Western 50.8 35.5 13.8 73.6 26.0 0.4 Mindanao 10 Northern Mindanao 61.5 32.2 6.3 80.2 19.7 0.1 11 Davao Region, Southern Mindanao 60.2 34.2 5.6 73.3 26.5 0.3 12 SOCCSKSARGEN, Central Mindanao 52.2 40.4 7.5 77.1 22.8 0.2 13 Caraga 65.3 24.8 9.9 82.8 16.8 0.5 Autonomous Region of Muslim Mindanao 26.0 62.0 12.0 51.1 48.9 0.1 (ARMM) Note: The values for each region and year may not add up to 100 because of rounding 120 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE A2: SELECTION OF FIELD SITES FOR ECONOMIC STUDY Site Project/ Intervention Direct beneficiaries No Location Agency Specific Intervention Classification 1 Households2 Others DENR, funded Septic Tank and Septage 1 Alabel OSWT & OSTS Yes by JICA Treatment Facility Engineered Wetland/ 2 Bayawan City DILG/GTZ OSTS Yes Wastewater Treatment GTZ/Gawad 3 Bayawan City UDDT-E OSWT Yes Kalinga SIDA/SUSEA/ 4 Dagupan Toilets OSWT Yes LGU 5 Dumaguete Linaw Septic Tanks OSWT Yes 6 Dumaguete Linaw Aerobic Pond OSTS Public market Rodriguez 7 (formerly Manila Water Septage Treatment Facility OSTS Yes Montalban) 8 San Fernando City ISSUE/CAPS UDDT-E Toilets OSWT Yes 9 Taguig Manila Water Septage Treatment Plant OSTS Yes Septic Tank and Septage 10 U.P. Diliman Manila Water OSTS Yes Treatment Facility (STF) Hospital, public market, 11 Antipolo City EcoAsia Wastewater Treatment OSTS slaughterhouse 12 Caba ISSUE UDDT-E Toilets OSWT Yes 13 Cabilao PCWS Toilets Others School Hospital, public market, 14 Calbayog Linaw Wastewater Treatment OSTS slaughterhouse 15 Don Victoriano PCWS Biogas Septic Tank OSWT Yes Hospital, public market, 16 Dumaguete Linaw Wastewater Treatment OSTS slaughterhouse 17 El Nido SCOTIA UDDT-E OSTS Yes Sewerage and Central 18 El Nido SCOTIA PS Yes Treatment Project 19 El Nido SCOTIA Wastewater Treatment OSTS Public market Giluntugan Island, 20 SCOTIA UDDT-E OSWT Yes Mactan 21 Ilocos Sur DILG/GTZ Toilets Others Bus terminal, school Hospital, public market, 22 Malaybalay Linaw Wastewater Treatment OSTS slaughterhouse Hospital, public market, 23 Marikina City Linaw Wastewater Treatment OSTS slaughterhouse Hospital, public market, 24 Maycauyan PSA Wastewater Treatment OSTS slaughterhouse 25 Mindoro Oriental DILG/GTZ Toilets Others Bus terminal 26 Moalboal SCOTIA UDDT-E OSWT Yes 27 Moalboal SCOTIA Wastewater Treatment OSTS Resort www.wsp.org 121 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE A2: SELECTION OF FIELD SITES FOR ECONOMIC STUDY (CONTINUED) Site Project/ Intervention Direct beneficiaries No Location Agency Specific Intervention Classification 1 Households2 Others Hospital, public market, 28 Naga City Linaw Wastewater treatment OSTS slaughterhouse 29 Nueva Vizcaya DILG/GTZ Toilets Others Bus terminal 30 Panglao SCOTIA Reed Bed System OSTS Bar/Restaurant 31 San Fernando City ISSUE/CAPS UDDT-E toilets OSWT School Hospital, public market, 32 San Fernando City ISSUE/CAPS Wastewater Treatment OSTS slaughterhouse 33 Santol ISSUE UDDT-E Toilets OSWT Yes 34 Sorsogon ISSUE UDDT-E Toilets OSWT Yes 35 Sta. Rosa ISSUE UDDT-E Toilets OSWT Yes Hospital, public market, 36 Sta. Rosa PSA Wastewater Treatment OSTS slaughterhouse 37 Surigao City PCWS Biogas Septic Tank OSWT Yes 38 Tagbiliran City DILG/GTZ DEWATS OSTS Yes Biogas Septic Tank - 39 TBD PCWS OSWT Yes Experimental use Hospital, public market, 40 Zamboanga City PSA Wastewater Treatment OSTS slaughterhouse 41 Bais ISSUE UDDT-E Toilets OSWT Yes Balicasag Island, 42 SCOTIA UDDT-E OSWT Yes Panglao 43 Danao ISSUE UDDT-E Toilets OSWT Yes Sabang, Puerto 44 SCOTIA UDDT-E OSWT Yes Galera Sabang, Puerto Sewerage and Central 45 SCOTIA PS Yes Galera Treatment Plant 46 Tingloy Island PCWS UDDT-E OSWT Yes 47 PCWS Biogas Septic Tank OSWT Yes Tiaong, Brgy. Pugaro, Dagupan Local 48 Public Toilets OSN Yes Government 1 OSN = on-site sanitation, OSWT = on-site disposal, watertight tank (includes UDDT), OSTS = on-site treatment system, PS = piped collection system 2 Sites for which households are the direct beneficiaries of the projects. 122 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE A 3. ASSESSMENT OF ADVANTAGES AND LIMITATIONS OF DIFFERENT DESIGN OPTIONS No. Design Advantages Limitations Designs involving field data collection 1 Economic study designed entirely • Addresses the specific questions of the • Expensive and long time period for research purposes, including research • May not capture health impact matching and randomization of • Highly scientific design • Limited generalisability comparison groups 2 Economic research attached • Captures health impact with degree of • Expensive and long time period to other research studies (e.g., precision • Few ongoing clinical trials randomized clinical trial) • Can conduct additional research on other • Requires collaboration from start impacts • Trials may not reflect real conditions • Add-on research cost is small • Limited comparison options • Statistical analysis possible 3 Economic research attached • Add-on research cost is small • Few pilot programs available to pilot study, with or without • Options are policy relevant • Pilots often not designed with scientific randomization • Matched case-control possible evaluation in mind (e.g., before vs. after • Can start research in mid-pilot surveys) • Pilot conditions not real life • Limited comparison options 4 Economic research attached to • Reflects real life conditions (e.g., uptake • No research infrastructure routine government or NGO/donor and practices) • No scientific design programs, without randomization • Research addresses key policy questions • Limited comparison options • Matched case-control possible Designs involving secondary data collection 5 Collection of data from a variety • Relatively low cost • Results imprecise and uncertain of local sources to conduct a • Short time frame feasible • Actual real-life implementation issues not modeling study • Can compare several options and settings addressed in research model • Can mix locally available and non-local data 6 Extraction of results from previous • Low cost • Limited relevance and results not trusted economic studies • Results available rapidly by policy makers • Gives overview from various interventions • Published results themselves may not be and settings precise www.wsp.org 123 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE A 4. DISEASES LINKED TO POOR SANITATION AND HYGIENE, AND PRIMARY TRANSMISSION ROUTES AND VEHICLES Primary Disease Pathogen Vehicle transmission route Diarrheal diseases (gastro-intestinal tract infections) Rotavirus diarrhea Virus Fecal-oral Water, person-to-person Fecal-oral and urine- Typhoid/Paratyphoid Bacterium Food, water + person-person oral Vibrio cholera Bacterium Fecal-oral Water, food Escherichia Coli Bacterium Fecal-oral Food, water + person-person Amebiasis (amebic dysentery) Protozoa 1 Fecal-oral Person-person, food, water, animal feces Giardiasis Protozoa 1 Fecal-oral Person-person, water (animals) Salmonellosis Bacterium Fecal-oral Food Shigellosis Bacterium Fecal-oral Person-person +food, water Campylobacter Enteritis Bacterium Fecal-oral Food, animal feces Helicobacter pylori Bacterium Fecal-oral Person-person + food, water Protozoa Other viruses 2 Virus Fecal-oral Person-person, food, water Malnutrition Caused by diarrheal disease and helminthes Helminthes (worms) Intestinal nematodes 3 Roundworm Fecal-oral Person-person + soil, raw fish Digenetic trematodes (e.g., Fecal/urine-oral; Flukes (parasite) Water and soil (snails) Schistosomiasis Japonicum) fecal-skin Cestodes Tapeworm Fecal-oral Person-person + raw fish Eye diseases Trachoma Bacterium Fecal-eye Person-person, via flies, fomites, coughing Adenoviruses (conjunctivitis) Protozoa 1 Fecal-eye Person-person Skin diseases Ringworm (Tinea) Fungus (Ectoparasite) Touch Person-person Scabies Fungus (Ectoparasite) Touch Person-person, sharing bed and clothing Other diseases Hepatitis A Virus Fecal-oral Person-person, food (especially shellfish), water Hepatitis E Virus Fecal-oral Water Poliomyelitis Virus Fecal-oral, oral-oral Person-person Leptospirosis Bacterium Animal urine-oral Water and soil - swamps, rice fields, mud Sources: WHO http://www.who.int/water_sanitation_health/en/ and [75, 76] 1 There are several other protozoa-based causes of GIT, 2 Other viruses include: 3 Intestinal nematodes include: including • Adenovirus – respiratory and gastro- • Ascariasis (roundworm - soil) • Balantidium coli – dysentery, intestinal ulcers intestinal infections • Trichuriasis trichiura (whipworm) • Cryptosporidium parvum - gastrointestinal infections • Astrovirus – gastro-intestinal infections • Ancylostoma duodenale/Necator • Cyclospora cayetanensis - gastrointestinal infections • Calicivirus – gastro-intestinal infections americanus (hookworm) • Dientamoeba fragilis – mild diarrhea • Norwalk viruses – gastro-intestinal • Intestinal Capillariasis (raw freshwater fish • Isospora belli/hominus – intestinal parasites, gastro- infections in Philippines) intestinal infections • Reovirus – respiratory and gastro- intestinal infections 124 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE A 5. WATER QUALITY MEASUREMENT PARAMETERS PER LOCATION, AND TEST METHOD Test conducted for Parameter Test Location Surface water Well water Piped tap water E-coli (cfu/100 ml) Coliscan Laboratory Yes Yes No Biological Oxygen Demand 5 day incubation Laboratory Yes No No (BOD5) (mg/L) Chemical Oxygen Demand 5 day incubation Laboratory Yes No No (COD) (mg/L) Dissolved Oxygen (DO) (mg/L) Hach DO Probe On-site and Laboratory Yes No No Nitrate (NO3-) (mg/L) Hach Photometer Laboratory Yes No No Ammonical Nitrogen (mg/L) Hach Photometer Laboratory Yes Yes No Conductivity (µS/cm) YSI Conductivity Laboratory Yes Yes No Meter Turbidity (NTU) TurbidiMeter On-site and Laboratory Yes Yes No pH pH Probe On-site and Laboratory Yes No No Water temperature (oC) Hach ThermoProbe On-site and Laboratory Yes No No Residual chlorine (Cl) Field Kit On-site No No Yes (in places provided with centralized chlorinated water supply) (mg/L) www.wsp.org 125 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE A 6. KEY FORMULAS, VARIABLES AND DATA SOURCES FOR CALCULATING MONETIZED BENEFITS Impacts included Variable Data sources 1. HEALTH (All calculations are made using disaggregated data inputs on disease and age grouping: 0-4 years, 5-14 years, 15+ years) Diarrheal disease incidence (0-4 years) DHS Diarrheal disease incidence (over 5 years) WHO stats Helminthes prevalence Global review Indirect diseases incidence (malaria, ALRI) WHO statistics 1.1 Health care savings Malnutrition prevalence UNICEF/WHO statistics Calculation: Attribution of fecal-oral diseases to poor [Prevalence or incidence X Attribution to WHO. Value = 88% sanitation poor sanitation X ((% seeking outpatient care X visits per case X unit cost per visit Attribution of helminthes to poor sanitation Global review. Value = 100% (medical and patient)) + DHS, SES, ESI household survey, health (Inpatient admission rate X days per case X % disease cases seeking health care statistics unit cost per day (medical and patient))] X Proportion of disease cases averted Outpatient visits per patient Inpatient admission rate Health facility statistics, ESI household Inpatient days per admission survey Health service unit costs Other patient costs (transport, food) ESI household survey % disease cases averted International literature review 1.2 Health morbidity-related productivity Days off productive activities ESI household survey gains National economic data Calculation: World Bank data [Prevalence X Attribution to poor sanitation Basis of time value: GDP per capita X Days off productive activities X Value of Average product per capita (at sub-national time] X Proportion of disease cases averted level, where available) – 30% for adults, 15% for children Mortality rate (all diseases) National and WHO statistics National economic data World Bank data 1.3 Premature mortality savings Basis of time value: GDP per capita Annual value of lost production of working Calculation: adults (human capital approach), from the [Mortality rate X Attribution to poor time of death until the end of (what would sanitation X Value of life] X Proportion of have been) their productive life. disease cases averted Discount rate for future earnings Government cost of capital estimate (8%) Long-term economic growth Assumption Meta-analyses from developed country Value-of-statistical-life studies 1.4 Disability-adjusted life-years (DALY) Duration of disability ESI household survey averted Disability weighting WHO burden of disease project Calculation: Healthy life expectancy WHO statistics DALY = YLD+YLL YLD: discounted disability based on weight Discount rate for future disease burdens Government cost of capital estimate (8%) and years equivalent time YLL: discounted future years of healthy life Morbidity and mortality rates Various: see 1.1 and 1.3 (above) lost 126 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE A 6. KEY FORMULAS, VARIABLES AND DATA SOURCES FOR CALCULATING MONETIZED BENEFITS (CONTINUED) Impacts included Variable Data sources 2. WATER (for household use) (weighted average costs were estimated for each water source and for each household water treatment method) Drinking water sources (%) in wet and dry ESI household survey seasons 2.1 Household water access savings Annual financial cost per household, per water ESI household survey; ESI market survey source Calculation: Annual costs X % costs reduced, per water Annual non-financial cost per household, per ESI household survey source water source Proportion of access cost reduction under scenario of 100% improved sanitation, per ESI household survey; assumption water source Proportion of households treating their water, ESI household survey, validated by other 2.2 Household water treatment savings by method national statistics (DHS, SES) Full annual cost per water treatment method ESI household survey; ESI market survey Calculation: (% households treating water per method ESI household survey; assumption: as well as X annual cost) X % households who stop Proportion of households currently treating stopping treatment, households may switch treating who stop treating under scenario of 100% to an alternative –cheaper – treatment method improved sanitation if the cleaner water sources enable different water purification methods 3. ACCESS TIME SAVINGS (weighted average costs estimated for each age category and gender — young children, children and male and female adults) Household composition (demographics) ESI household survey Sanitation practice, by age group ESI household survey Average round trip time to access site of open ESI household survey defecation or shared toilet Calculation: % household members using OD X Time Average number of round trips to defecation ESI household survey saved per trip due to private toilet X average site per day trips per day X value of time National economic data World Bank data Basis of time value: GDP per capita Average product per capita (at sub-national level, where available) – 30% for adults, 15% for children 4. EXCRETA REUSE GAINS (reuse of excreta as fertilizer from either UDDT or double-vault pit latrine; and reuse of energy value from biogas digester) % households using reuse methods ESI household survey Calculation: % households using product themselves ESI household survey (% households using product themselves X value in own use) + (% households selling % households selling product to others ESI household survey product X selling price) Selling price ESI household & market survey Value in own use ESI market survey; assumption www.wsp.org 127 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE A 7. HOUSEHOLDS SAMPLED VERSUS TOTAL HOUSEHOLDS PER VILLAGE/COMMUNITY Improved Unimproved Septic Septic Dry pit Number of Sewer- tanks Dry pit Pit Site tanks Wet la- households age (des- latrines Pub- latrines (not yet pit la- trines Shared OD Total (treat- ludged (UDDT- lic (unim- des- trines (oth- ed)1 and E) proved) ludged)2 ers) treated) Sample Actual 44 77 34 70 225 Planned 44 77 34 70 225 Alabel Total 44 889 57 433 1,423 % Sampled Actual 100 9 60 16 16 Planned 100 9 60 16 16 Sample Actual 180 37 217 Planned 181 33 214 Bayawan Total 488 33 521 % Sampled Actual 37 112 42 Planned 37 100 41 Sample Actual 9 61 48 65 40 223 Planned 70 49 53 30 202 Dagupan Total 408 119 143 30 700 % Sampled Actual 17 40 45 133 32 Planned 17 41 37 100 29 Sample Actual 61 47 65 7 2 182 Planned 74 61 31 0 22 188 San Total 614 63 31 - 22 730 Fernando % Sampled Actual 10 75 210 - 9 25 Planned 12 97 100 - 100 26 Sample Actual 17 24 39 80 Planned 49 38 87 San Fernando Total 1 17 107 124 - Upland % Sampled Actual 100 59 65 Planned 288 36 70 128 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE A 7. HOUSEHOLDS SAMPLED VERSUS TOTAL HOUSEHOLDS PER VILLAGE/COMMUNITY (CONTINUED) Improved Unimproved Septic Septic Dry pit Number of Sewer- tanks Dry pit Pit Site tanks Wet la- households age (des- latrines Pub- latrines (not yet pit la- trines Shared OD Total (treat- ludged (UDDT- lic (unim- des- trines (oth- ed)1 and E) proved) ludged)2 ers) treated) Sample Actual 84 91 92 76 343 Planned 82 79 83 69 313 Taguig Total 3350 1456 9872 400 15,078 % Sampled Planed 3 6 1 19 2 Actual 2 5 1 17 2 Sample Actual 84 315 178 156 47 24 87 130 7 225 1,190 Planned 82 304 230 108 61 - 49 84 0 224 1,142 All sites Total 3,350 1,988 11,169 671 63 - 119 174 - 918 18,452 % Sampled Actual 3 16 2 23 75 - nc 75 - 25 6 Planned 2 15 2 16 97 - nc 48 - 24 6 Notes: Total number of households is based on estimates conducted prior to the survey. 1 Decentralized Conventional treatment 2 Many of the households here have access to desludging www.wsp.org 129 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE A 8. SAMPLE SIZES OF OTHER SURVEYS IN STUDY SITES Focus Group Discussion Health facilities Water quality measurement Site Group Women Men Hospital Clinic Wells Surface Piped water Unimproved 8 9 Alabel Improved 11 8 1 - 7 5 3 Sub-total 19 17 Unimproved 5 5 Bayawan Improved 10 10 1 2 2 8 5 Sub-total 15 10 Unimproved 4 6 Dagupan Improved 10 10 2 - 6 4 0 Sub-total 14 16 Unimproved 5 5 San Improved 20 21 1 1 13 10 5 Fernando Sub-total 25 26 Unimproved 5 6 Taguig Improved 15 14 2 - 2 8 6 Sub-total 20 20 Unimproved 27 31 Total Improved 66 63 7 3 30 35 19 Total 93 94 130 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE B 1. HEALTH RATES FOR DISEASES, BY SITE, VALUES ARE PER 1000 PERSONS San San Average Average Disease Alabel Bayawan Dagupan Fernando - Fernando - Taguig rural sites urban sites Coastal Upland Number of cases (All age groups) Direct diseases Diarrhea 779.8 808.9 715.4 879.3 856.2 733.6 673.8 819.3 Helminthes 374.2 380.2 372.5 379.0 396.7 370.0 371.6 373.3 Number of cases (Under the age of 5 years) Direct diseases Diarrhea 4,120.6 4,159.5 4,142.0 4,121.1 4,159.5 4,151.2 4,120.6 4,159.5 Helminthes 369.7 369.7 369.7 369.7 369.7 369.7 369.7 369.7 Indirect diseases Malnutrition 274.7 233.7 278.0 270.0 285.0 285.0 285.0 162.0 Malaria 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 ALRI 67.6 46.0 55.7 67.4 46.0 50.6 67.6 46.0 Total (under 4,833.0 4,809.2 4,845.8 4,828.5 4,860.5 4,856.8 4,843.3 4,737.5 5s) Number of deaths (All age groups) Direct diseases Diarrhea 0.26 0.16 0.19 0.29 0.16 0.16 0.23 0.16 Helminthes 0.01 0.00 0.01 0.01 0.00 0.01 0.01 0.00 Number of deaths (under the age of 5 years) Direct diseases Diarrhea 1.32 0.87 1.09 1.41 0.82 0.95 1.42 0.82 Helminthes 0.01 0.01 0.01 0.01 0.01 0.01 0.01 0.00 Indirect diseases Malnutrition 0.05 0.05 0.05 0.05 0.05 0.05 0.05 0.05 Malaria 0.02 0.01 0.02 0.02 0.01 0.01 0.02 0.01 ALRI 0.60 0.35 0.46 0.60 0.35 0.40 0.60 0.35 Measles 0.11 0.06 0.08 0.11 0.06 0.07 0.11 0.06 Other 0.12 0.12 0.12 0.12 0.12 0.12 0.12 0.12 diseases Total (under 2.22 1.47 1.82 2.31 1.41 1.61 2.33 1.41 5s) www.wsp.org 131 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE B 1. HEALTH RATES FOR DISEASES, BY SITE, VALUES ARE PER 1000 PERSONS (CONTINUED) San San Average Average Disease Alabel Bayawan Dagupan Fernando - Fernando - Taguig rural sites urban sites Coastal Upland Disability Life Years (DALYs): All age groups Direct diseases Diarrhea 1.13 1.17 1.03 1.27 1.23 1.06 0.97 1.18 Helminthes 2.25 2.29 2.24 2.28 2.39 2.23 2.24 2.25 Disability Life Years (DALYs): Under the age of 5 years Direct diseases Diarrhea 6.0 6.0 6.0 5.9 6.0 6.0 5.9 6.0 Helminthes 2.3 2.3 2.3 2.3 2.3 2.3 2.3 2.3 Indirect diseases Malnutrition 0.8 0.8 0.8 0.8 0.8 0.8 0.8 0.7 Malaria 0.2 0.2 0.2 0.2 0.2 0.2 0.2 0.2 ALRI 5.7 5.2 5.5 5.8 5.7 5.7 5.8 4.6 Measles 1.0 0.9 1.0 1.0 1.0 1.0 1.0 0.8 Other 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1.5 diseases Total (under 17.5 16.9 17.2 17.6 17.5 17.5 17.6 16.0 5s) 132 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE B 2. COMPARISON OF DATA SOURCES FOR SELECTED DISEASES Disease Age Data source Cases/1000 persons ESI Survey 138.89 DHS 2,765.89 Under 5 WHO (2005) 4,140.79 WHO rates (used in ESI 1) 4,506.95 FHSIS 29.16 ESI Survey 345.62 Diarrhea WHO (2005) 520.00 Age 5-14 WHO rates (used in ESI 1) 327.80 FHSIS 3.51 ESI Survey 628.57 WHO (2005) 260.00 Age 15+ WHO rates (used in ESI 1) 163.90 FHSIS 2.10 Under 5 Brooker (2003) 369.66 Age 5-14 Brooker (2003) 459.66 Helminthes SuSEA Survey (2008) 490.00 Age 15+ Brooker (2003) 342.47 Malnutrition Severe underweight (<-3SD) FNRI (2003) 88.00 Moderate underweight (-2 to Under 5 FNRI (2003) 192.00 -3 SD) Mild underweight (-1 to 2 SD) FNRI (2003) 293.00 Non-underweight (>-1SD) FNRI (2003) 427.00 WHO (2005) 0.39 Under 5 FHSIS 0.39 Malaria Age 5-14 FHSIS 0.37 Age 15+ FHSIS 0.18 WHO (2005) 56.54 Under 5 DHS 2,867.46 ALRI FHSIS 14.43 Age 5-14 FHSIS 3.98 Age 15+ FHSIS 2.26 Under 5 FHSIS 0.04 Hepatitis A&E Age 5-14 FHSIS 0.08 Age 15+ FHSIS 0.05 www.wsp.org 133 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE B 3. EVIDENCE ON TREATMENT SEEKING BEHAVIOR FOR OTHER DISEASES % seeking treatment from No Data source by disease, Observa- Public Private Private Self treat- treatment rural/urban and year tions Pharmacy provider formal clinic informal care ment (%) Diarrhea ESI Sites (2008, urban) 0-4 years 65 42.0 9.5 3.8 68.9 62.5 4.6 5-14 years 13 46.2 15.4 0.0 76.9 61.5 0.0 15 and over 27 11.9 17.8 0.0 65.4 59.3 7.4 ESI Sites (2008, rural) 0-4 years 24 45.8 12.5 0.0 37.5 54.2 12.5 5-14 years 11 45.5 9.1 0.0 45.5 54.5 9.1 15 and over 36 16.2 16.2 0.0 50.0 60.2 11.1 ESI All sites (2008, all sites) 0-4 years 89 43.1 10.5 2.6 60.0 60.2 6.7 5-14 years 24 45.8 12.5 0.0 62.5 58.3 4.2 15 and over 63 14.6 16.7 0.0 56.5 54.0 9.5 DHS (2003): 0-4 years All sites 714 32.4 - - 17.78 22.4 Rural - 36.2 - - 15.10 23.4 Urban - 28.6 - - 20.50 21.3 Symptoms of ALRI ESI Sites (2008, urban) 0-4 years 110 28.6 19.0 4.2 62.5 70.0 5.5 5-14 years 16 0.0 18.8 0.0 73.3 62.5 0.0 15 and over 12 18.5 27.7 0.0 60.0 63.6 0.0 Diarrhea ESI Sites (2008, rural) 0-4 years 76 42.5 10.3 6.4 53.3 53.3 6.6 5-14 years 10 61.3 0.0 8.8 60.0 70.0 0.0 15 and over 6 33.3 0.0 0.0 83.3 33.3 0.0 ESI All sites (2008, all sites) 0-4 years 186 34.6 15.0 5.2 58.7 63.2 5.9 5-14 years 26 29.9 4.3 4.3 68.0 65.4 0.0 15 and over 18 24.1 18.0 0.0 68.8 52.9 0.0 DHS (2003): 0-4 years All sites 1,835 46.3 - - - - Rural - 50.5 - - - - Urban - 42.9 - - - - 134 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE B 4. UNIT COSTS ASSOCIATED WITH TREATMENT OF DISEASES Outpatient cost (PhP) Inpatient cost (PhP) Health provider Health care Incidentals 1 ALOS 2 Health care3 Incidentals1 Diarrhea Formal care Rural (ref) 645 64 4 2,910 71 Urban (ref) 693 64 4 3,464 71 Informal Rural (ref) 55 Urban (ref) 55 Pharmacy Rural (ref) 212 Urban (ref) 219 Self-treatment Rural (ref) 64 Urban (ref) 64 Helminthes Formal care Rural (ref) 319 64 Urban (ref) 365 64 Informal Rural (ref) 55 Urban (ref) 55 Pharmacy Rural (ref) 119 Urban (ref) 117 Self-treatment Rural (ref) 64 Urban (ref) 64 ALRI and Malaria Formal care Rural (ref) 545 46 5 3,535 58 Urban (ref) 593 46 5 4,248 58 Informal Rural (ref) 27 Urban (ref) 27 Pharmacy Rural (ref) 199 Urban (ref) 199 Self-treatment Rural (ref) 64 Urban (ref) 64 1 Incidentals: non-health patient costs such as transport, food, and incidental expenses, per outpatient visit and per inpatient stay. 2 ALOS: average length of stay. 3 Inpatient health care costs are presented per stay www.wsp.org 135 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE C 1. WATER QUALITY1 Ammo- Water Residual Turbi- Conduc- Site/ Rural/ Water BOD COD DO Nitrate niacal Water Classifi- Chlorine dity tivity (mS pH E .coli Coliform3 Barangay Urban Source (mg/L) (mg/L) (mg/L) (mg/L) Nitrogen uses2 cation (ppm) (NTU) at 25oC) (mg/L) ALABEL Kawas Rural Canal / Ditch Surface - 9 15 43 637 2.8 0.27 < 0.2 7.0 positive positive1 - Dumulok Rural Mofong Lake Surface - 3 17 7 142 6.3 0.05 < 0.2 6.0 negative positive 2 CBD Public Hand Kawas Rural Bore Hole - - - - 1,039 - - < 0.2 - negative negative CBD Pump Private Hand Poblacion Urban Bore Hole - - - - 1,610 - - 3.82 - negative positive2 B Pump Communal Poblacion Urban Bore Hole - - - - 590 - - < 0.2 - positive positive1 CBD Hand Pump HH Private R1 = 0; Poblacion Urban Piped - - - - - - - - - - CB Tap R2=0 Water from distribution R1 = 0.11; Poblacion Urban plant (after Piped - - - - - - - - - - CBD R 2 = 0.06 chlorination feeder) R1 =0; Poblacion Urban Storage Tank Piped - - - - - - - - - - CBD R 2 =0 Piped Water from Bore hole Note: This replaces HH Kawas Rural Bore Hole - - - - 816 - - < 0.2 - negative negative B Private Tap since it has not been in use for 3 years. negative note: positive for Maturation Coliform Rural Pond (open): Surface - 27 83 6 100 5 0.09 0.29 6.0 negative MPN Alabel STF value= >8.0 MPN/ 100mL Creek (discharge Poblacion Urban Surface - 9 10 46 627 4.3 0.59 < 0.2 7.0 positive positive1 B area) - open channel Maribulan Rural Surface - 25 50 53 454 4.4 0.3 < 0.2 7.0 negative positive2 B River Private HH - Piped Water (via Solar Poblacion Urban Dug Well - - - - 666 - - < 0.2 - negative negative CBD Powered Distribution system ) HH Private Tap (from R1 = 0; Solar Bagacay Rural Dug Well R2=0 - - - - - - - - - - CBD Powered Distribution System) Open Dug Bagacay Rural Dug Well - - - - 690 - - < 0.2 - negative negative CBD Well 136 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE C 1. WATER QUALITY1 (CONTINUED) Ammo- Water Residual Turbi- Conduc- Site/ Rural/ Water BOD COD DO Nitrate niacal Water Classifi- Chlorine dity tivity (mS pH E .coli Coliform3 Barangay Urban Source (mg/L) (mg/L) (mg/L) (mg/L) Nitrogen uses2 cation (ppm) (NTU) at 25oC) (mg/L) BAYAWAN Coastline / Beach GK Village Rural (within WW Surface - 14 287 28 41,200 3.6 - < 0.2 8.4 negative positive2 B discharge area) GK Village Rural Pond (open) Surface - 7 37 4 1,318 1.2 - 7.34 7.0 negative positive2 - Manampa Spring Manampa Rural (Source of Surface - 16 62 184 262 5.6 0.33 < 0.2 7.0 negative positive2 CBD Bayawan water district) Bayawan Pagatban Rural Surface - 11 62 79 1,812 5.4 0.24 < 0.2 8.0 negative positive2 CBD City River Community GK Village Rural Bore Hole - - - - 1,454 - - < 0.2 - negative positive2 CB Public Well Private Well GK Village Rural Bore Hole - - - - 702 - - < 0.2 - negative positive2 CB (Dug Well) R1 = 0.22; Tinago Urban HH Tap Water Piped - - - - - - - - - - CBD R2 = 0.30 R1 = 0.11; GK Village Rural HH Tap Water Piped - - - - - - - - - - CBD R2 = 0.10 Household R1 = 0.09; GK Village Rural Piped - - - - - - - - - - CBD Tap Water R2 = 0.11 Bayawan Bayawan R1 = 0.35; Urban Piped - - - - - - - - - - CBD City Water District R 2 = 0.50 Household R1 = 0.34; Banga Rural Piped - - - - - - - - - - CBD Tap Water R 2 = 0.40 Coastline / Tinago Urban Surface - 1 821 9 38,900 5 - < 0.2 8.4 positive positive1 B Beach Area DAGUPAN Pugaro Urban Pugaro River Surface - 150 250 52 12,890 7.2 0.49 < 0.2 8.6 negative positive2 - Manamikdak Pugaro Urban Surface - 50 83 15 1,988 5.4 < 0.001 < 0.2 8.9 negative positive2 - Creek Stagnant Water Pugaro Urban Surface - 111 185 30 5,810 3.9 < 0.001 3.96 8.8 negative positive2 - (inside the community) Public Open Pugaro Urban Dug Well - - - < 0.3 1,040 - - < 0.2 - negative negative CBD Well Pugaro Urban Public Well Bore Hole - - - - 564 - - < 0.2 - negative negative CBD Private Hand Pugaro Urban Bore Hole - - - - 1,168 - - 6.61 - negative negative CBD Pump Public Hand Pugaro Urban Bore Hole - - - - 505 - - < 0.2 - negative negative CBD Pump Public Well (inside school) - Jetmatic Pugaro Urban Bore Hole - - - - 463 - - < 0.2 - negative negative CBD converted from hand pump Coastline Pugaro Urban Surface - 50 597 3.4 44,200 3.3 < 0.001 < 0.2 9.1 negative positive2 B (beach area) Pugaro Urban Public Well Bore Hole - - - - 1028 - - < 0.2 - negative positive2 CBD www.wsp.org 137 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE C 1. WATER QUALITY1 (CONTINUED) Ammo- Water Residual Turbi- Conduc- Site/ Rural/ Water BOD COD DO Nitrate niacal Water Classifi- Chlorine dity tivity (mS pH E .coli Coliform Barangay Urban Source (mg/L) (mg/L) (mg/L) (mg/L) Nitrogen uses2 cation (ppm) (NTU) at 25oC) (mg/L) SAN FERNANDO Coastline Poro Rural Surface - 58 578 9 36,600 4.4 0.04 < 0.2 8.4 negative positive2 - (Beach area) Coastline Ilocanos Sur Urban Surface - 108 1073 6 39,400 4.3 - < 0.2 8.4 negative positive2 - (Beach area) R1 = 0.05; Ilocanos Sur Urban HH Tap Water Piped - - - - - - - - - - CBD R2 =0.05 supplied water R1 = 0.05; Ilocanos Sur Urban HH Tap Water - - - - - - - - - - CBD near main R2 =0.06 source Community Poro Rural Bore Hole - - - - 627 - - < 0.2 - negative negative CBD Well Private Deep Poro Urban Bore Hole - - - - 976 - - < 0.2 - negative positive2 CB Well R1= 0; R2 Poro Rural HH Tap Water Piped - - - - - - - - - - CBD =0 supplied R1= 0.10; Poro Rural HH Tap Water near main - - - - - - - - - - CBD R2 =0.10 source Spring , Lon-Oy Rural Groundwater Surface - 2 8 4.7 102.5 5 0.06 3.96 5.5 negative positive2 CBD (MLUWD) Spring , Naguirangan Rural Groundwater Bore Hole - - - - 546 - - 0.44 - negative negative CBD (MLUWD) Spring , Bauang Rural Groundwater Bore Hole - - - - 420 - - < 0.2 - negative negative CBD (MLUWD) Spring , Dili Rural Groundwater Bore Hole - - - - 477 - - < 0.2 - negative negative CBD (MLUWD) Poro Rural Creek Surface - 55 805 11 34,800 3.8 0.1 < 0.2 8,2 negative positive2 B Canal / Small Creek (discharge Ilocanos Sur Urban Surface - 164 392 46 763 1.1 - 5.14 7.7 negative positive2 - area - from the city to the sea) Coastline San Agustin Urban Surface - 20 805 3.3 36,400 4.1 - < 0.2 8.5 negative positive2 B (beach area) San Agustin Urban Canal / Estero Surface - 352 475 108 921 1.2 - 14.83 8.1 negative positive2 - San Agustin Urban HH Tap Water Piped - - - - - - - - - - - - HH Private San Agustin Urban Bore Hole - - - - 1,163 - - 3.38 - negative positive2 CBD Deep Well HH Private San Agustin Urban Dug Well - - - 4 580 - - 0.73 - negative positive2 CB Dug Well HH Public San Agustin Urban Well / Hand Bore Hole - - - - 1,437 - - 2.79 - negative positive2 CBD Pump Nagyubyu- Rural Spring Water Surface - 5 8 0.22 644 1.8 0.12 < 0.2 7.2 negative negative CBD ban Nagyubyu- Rural Spring Water Surface - 2 5 0.59 486 1.6 0.35 < 0.2 7.1 negative positive2 CBD ban 138 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE C 1. WATER QUALITY1 (CONTINUED) Ammo- Water Residual Turbi- Conduc- Site/ Rural/ Water BOD COD DO Nitrate niacal Water Classifi- Chlorine dity tivity (mS pH E .coli Coliform Barangay Urban Source (mg/L) (mg/L) (mg/L) (mg/L) Nitrogen uses2 cation (ppm) (NTU) at 25oC) (mg/L) Nagyubyu- Rural Creek Surface - 5 12 1.31 592 3.2 0.32 < 0.2 7.9 negative positive2 - ban Nagyubyu- Rural Private Well Bore Hole - - - - 642 - - < 0.2 - negative positive2 CBD ban Nagyubyu- Rural Public Well Bore Hole - - - - 514 - - < 0.2 - negative positive2 CBD ban Nagyubyu- Rural Dug Well Dug Well - - - 0.95 353 - - < 0.2 - negative negative CBD ban Nagyubyu- Rural Groundwater Bore Hole - - - - 622 - - < 0.2 - negative positive2 CBD ban Nagyubyu- Rural Groundwater Bore Hole - - - - 825 - - < 0.2 - negative positive2 CBD ban TAGUIG Taguig City Urban Taguig River Surface - 124 149 36 384 <0.05 - 7.05 7.4 negative negative - Diego Silang Urban Pond (open) Surface - 30 47 12 618 1.4 - 11.16 7.0 negative positive2 - Centennial Urban Pond (open) Surface - 24 60 14 747 1 - 2.06 5.9 negative positive2 - Village Western Urban Creek Surface - 352 616 89 799 <0.05 - 41.41 7.7 negative positive2 - Bicutan Western Urban Creek Surface - 180 435 299 1,432 0.7 - 32.31 10.2 negative positive2 - Bicutan Western Urban Creek Surface - 29 74 32 374 <0.05 - 11.46 10.2 negative negative - Bicutan La Mesa La Mesa Dam, Balara, Urban Dam -Intake Surface - 18 23 6 111 3 - <0.2 8.3 negative positive2 CBD Quezon City Water La Mesa La Mesa Dam, Balara, Urban Dam -Treated Surface - 11 14 3 121 2.2 - <0.2 7.5 negative positive2 CBD Quezon City Water HH Water Centennial R1= 0.63; Urban Supply (Tap Piped - - - - - - - - - - CBD Village R2= 0.69 Water) HH Water R1= 0.10; Diego Silang Urban Supply (Tap Piped - - - - - - - - - - CBD R2= 0.16 Water) Manila Water R1= 1.33; distribution Urban Piped - - - - - - - - - - CBD R2= 1.39 line HH Water Western R1= 1.08; Urban Supply (Tap Piped - - - - - - - - - - CBD Bicutan R2= 1.08 Water) Western R1= 0.93; Urban Piped - - - - - - - - - - CBD Bicutan R2= 0.98 Manila Water R1= 1.33; distribution Urban Piped - - 0 - - - - - - - CBD R2= 1.39 line Western Public Shallow Urban - - - - 128 - - <0.2 - negative negative CBD Bicutan Standpipe Well Western Unprotected Urban Dug Well - - - 4 2,270 - - <0.2 - negative positive2 - Bicutan Well (Open) ; www.wsp.org 139 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables Notes: 1 Philippine National Standards for Drinking Water 2007 E Coli Total Coliform BOD COD Turbidity DO (ml/L) (mg/L) (mg/L) (NTU) Philippine National Standards for Drinking Water None <1.1 MPN/100mL None None 5 NTU 0.3 min detected at the 2007 (nephelo- farthest point of distribution metric system; 1.5 max detected at turbidity any point in the distribution unit ) system DENR Administrative Order No. 35 Effluent None 10,000 MPN/100 50 100 None None Guidelines; Inland waters Class C mL DENR Administrative Order No. 35 Effluent None None 100 200 None None Guidelines; Coastal waters Class SC DENR Admin. Order No. 34 Classification/Water None 50 MPN/100 mL 1 none 5 mg/L None quality Criteria, Fresh Surface waters Class AA DENR Admin. Order No. 34 Classification/Water None 1,000 MPN/100 5 none 5 mg/L None quality Criteria, Fresh Surface waters Class A mL DENR Admin. Order No. 34 Classification/Water None 1,000 MPN/100 5 none 5 mg/L None quality Criteria, Fresh Surface waters Class B mL DENR Adm. Order No. 34 Classification/Water None 5,000 MPN/100 7-10 none 5 mg/L None quality Criteria, Fresh Surface waters Class C mL DENR Admin. Order No. 34 Classification/Water None None 10-15 none 3 mg/L None quality Criteria, Fresh Surface waters Class D 2 C: Cooking, B: Bathing, D: Drinking 3 Positive1 = positive for E Coli, Positive2 = negative for E Coli but positive for coliform with a reading that is higher than 8 MPN/100 ml 140 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE C 2. WATER POLLUTION FROM POOR SANITATION AND WASTEWATER MANAGEMENT (% OF HOUSEHOLDS) Degree of isolation Province/Region Barangay None Partial Full Baluntay 0.0 0.0 100.0 Kawas 0.0 89.6 10.4 Alabel Bagacay 0.0 0.0 100.0 Poblacion 9.5 64.8 25.7 Maribulan 0.0 0.0 100.0 Banga 0.0 100.0 0.0 Tinago 0.0 100.0 0.0 Bayawan Villareal 5.9 94.1 0.0 GK Village 0.0 2.2 97.8 Pugaro 14.8 85.2 0.0 San Fernando: Upland Nagyubuyuban 0.0 100.0 0.0 San Agustin 0.0 100.0 0.0 Fishermen's village San Fernando: Coastal 0.0 100.0 0.0 (Poro) Ilocanos Sur 0.0 100.0 0.0 Taguig Western Bicutan 0.6 48.4 51.0 Summary by rural/urban classification Rural 0.2 56.2 43.6 Urban 5.5 69.8 24.7 by site Alabel 4.4 76.0 19.6 Bayawan 0.5 16.6 82.9 Dagupan 14.8 85.2 0.0 San Fernando 0.0 100.0 0.0 Taguig 0.6 48.4 51.0 All sites 3.6 65.0 31.4 1 Only includes households that defecate in rivers, lakes and other water bodies, also applies to wet and pit latrines 2 Combines 3 toilet types: (a) non-desludged septic tanks, (b) shared toilets, (c) public toilets. Also includes septic tanks that were desludged more than 5 years ago or desludged at a period not known to the respondent 3 Those with access to sewers (Taguig) or have had their septic tanks desludged within the last 5 years www.wsp.org 141 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE C 3. WATER ACCESS AND TREATMENT PRACTICES, AND RELATED COST, PER SITE Non-piped Piped water Non-piped protected source unprotected source (treated) Bottled water Tanker truck Others Field site Average Average Average Average Average % % % % % monthly monthly monthly monthly monthly access access access access access cost cost cost cost cost Alabel 43.1 42.8 2.7 25.5 - - 54.2 0.9 - - Bayawan 69.6 136.6 19.4 125.0 - - 10.6 0.9 0.5 - Dagupan - - 8.1 152.8 - - 91.9 0.7 - - San Fernando - Coastal 10.2 161.3 34.1 273.0 - - 55.7 5.3 - - San Fernando - Upland - - - - - - 95.2 0.5 4.8 0.3 Taguig 51.9 540.9 46.1 363.6 0.6 884.0 1.5 139.8 - - Summary Rural 37.6 143.5 15.3 184.0 - - 46.0 1.8 1.1 0.2 Urban 33.5 422.3 26.3 351.5 0.2 884.0 40.0 4.4 - - All sites 35.0 316.1 22.4 310.8 0.2 884.0 42.1 3.4 0.4 0.2 ANNEX TABLE C 4. HOUSEHOLDS CITING POOR WATER QUALITY, BY SITE San San Water Site Alabel Bayawan Dagupan Fernando Fernando Taguig Rural Urban All source - coastal - upland Bad appearance1 (%) 14.4 5.3 na 100.0 na 7.4 5.5 11.2 9.0 Piped Bad smell (%) 1.0 2.6 na 61.1 na 5.1 2.4 4.3 3.6 water (treated) Bad taste (%) 0.0 0.7 na 55.6 na 4.0 1.2 3.2 2.5 With sediments (%) 3.1 0.7 na 55.6 na 4.0 1.2 4.3 3.2 Bad appearance1 (%) 0.0 0.0 0.0 0.0 na 0.0 0.0 0.0 0.0 Bottled Bad smell (%) 0.0 0.0 0.0 3.3 na 1.3 0.0 0.9 0.7 water Bad taste (%) 0.0 4.8 0.0 11.7 na 3.8 4.7 2.7 3.2 With sediments (%) 0.0 0.0 0.0 3.3 na 0.0 3.1 0.0 0.7 Non-piped Bad appearance1 (%) 14.8 8.7 0.0 13.0 27.5 0.0 17.0 1.7 10.3 protected source Bad smell (%) 1.6 8.7 0.0 3.0 6.3 20.0 3.7 0.4 2.2 (including untreated Bad taste (%) 7.4 4.3 0.0 4.0 3.8 0.0 5.7 0.0 3.2 piped): others With sediments (%) 12.3 13.0 0.0 24.0 12.5 20.0 17.0 0.4 9.7 Bad appearance1 (%) na 0.0 na na 50.0 100.0 100.0 100.0 100.0 Non- Bad smell (%) na 0.0 na na 0.0 0.0 0.0 0.0 0.0 protected Bad taste (%) na 0.0 na na 0.0 25.0 0.0 25.0 11.1 sources With sediments (%) na 0.0 na na 0.0 0.0 0.0 0.0 0.0 142 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE C 5. CITED REASONS FOR USING WATER SOURCES - ALL SITES1 San San Water Reason Rural Urban All Alabel Bayawan Dagupan Fernando - Fernando - Taguig source2 Coastal Upland Quality (%) 52.1 29.4 37.8 54.6 51.7 na 18.9 na 17.4 Piped water Quantity (%) 4.8 1.1 2.5 0.0 5.3 na 1.5 na 1.1 (treated) Cost (%) 10.3 14.3 12.8 0.0 11.3 na 20.4 na 22.5 Safety (%) 14.5 18.3 16.9 20.6 14.6 na 16.8 na 15.2 Quality (%) 25.0 17.3 19.0 50.0 31.0 11.1 16.5 na 16.5 Bottled Quantity (%) 0.0 0.9 0.7 0.0 0.0 0.0 0.9 na 1.3 water3 Safety (%) 65.6 69.5 68.7 50.0 64.3 83.3 68.8 na 68.4 Quality (%) 43.0 36.6 40.2 53.3 39.1 37.6 35.2 33.8 0.0 Non-piped Quantity (%) 1.0 0.0 0.6 0.8 0.0 0.0 0.0 2.5 0.0 protected: Others Cost (%) 1.0 3.4 2.1 0.0 8.7 3.4 1.0 1.3 20.0 Safety (%) 17.0 22.1 19.3 12.3 21.7 22.0 33.3 3.8 60.0 Non-piped unprotected Quality (%) 80.0 na 80.0 na 100.0 na na 75.0 na source4 na = not applicable 1 Reasons under quality include good taste, good color and clarity, and less or no solids, sediments or particles. Safety was included because it is usually the primary reason behind the choice of households for drinking water. 2 Tanker trucks were not included because there were no responses. 3 “Bottled water� costs not included because there were no responses. 4 No responses for quantity, cost and safety of “unprotected� sources. www.wsp.org 143 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE C 6. TREATMENT PRACTICES (ALL SITES) Treatment practice (% of total responses) Stand and HH in Filter Field site settle for sample Filter (home- Boiling Chlorine removal other none (mechanical) made) of solids & sediments Alabel 225 1.3 - - - - - 98.7 Bayawan 217 17.7 - - 0.5 0.5 0.5 80.9 Dagupan 223 25.3 0.9 - - - - 73.8 San Fernando - 84 18.3 - - 11.0 - - 70.7 Coastal San Fernando - 178 16.9 13.0 0.6 - - - 69.6 Upland Taguig 343 14.2 - 5.4 3.0 1.2 0.3 75.8 Summary Rural 452 12.7 0.7 0.2 2.3 0.2 0.2 83.7 Urban 818 16.4 2.7 2.2 1.2 0.5 0.1 76.7 All sites 1,270 15.1 2.0 1.5 1.6 0.4 0.2 79.2 ANNEX TABLE C 7. WATER ACCESS AND HOUSEHOLD TREATMENT COSTS AVERTED Annual average costs saved per household following 100% sanitation coverage Site Water source access Water treatment Alabel 36.3 0.5 Bayawan 63.3 35.6 Dagupan 26.1 117.2 San Fernando - Coastal 208.6 24.0 San Fernando - Upland 1.4 49.3 Taguig 843.4 117.1 Average rural 55.2 28.0 Average urban 402.5 85.5 144 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE D 1. PLACE OF DEFECATION OF HOUSEHOLDS WITH NO “OWN� TOILET Women Men Children (aged 5-14 years) Sites Own Outside Own Outside Own Outside Neighbor Neighbor Neighbor N plot plot N plot plot N plot plot (%) (%) (%) (%) (%) (%) (%) (%) (%) Alabel 70 0.0 4.3 95.7 93 0.0 3.2 96.8 98 0.0 3.1 96.9 Bayawan 20 5.0 20.0 75.0 17 5.9 11.8 82.4 32 9.4 15.6 75.0 Dagupan 253 31.6 3.6 64.8 330 27.9 2.1 70.0 286 23.8 2.1 74.1 San Fernando 3 0.0 0.0 100.0 2 0.0 0.0 100.0 0 - - - Taguig 14 35.7 28.6 35.7 12 25.0 25.0 50.0 22 27.3 18.2 54.5 Summary Rural 299 28.4 4.3 67.2 388 24.5 2.6 72.9 372 19.9 2.7 77.4 Urban 61 1.6 11.5 86.9 66 1.5 7.6 90.9 66 4.5 12.1 83.3 N=number of responses ANNEX TABLE D 2. DAILY TIME SPENT ACCESSING TOILET FOR THOSE WITH NO TOILET Women Men Children Sites Time per trip No. of times per Time per trip No. of times per Time per trip No. of times per and waiting day and waiting day and waiting day Alabel 16.76 1.19 17.00 1.22 14.20 1.08 Bayawan 14.58 0.96 13.98 1.00 14.75 1.00 Dagupan 12.38 1.28 12.22 1.15 12.03 1.14 San Fernando 15.00 1.00 16.00 1.00 6.00 1.00 Taguig 8.26 0.98 7.24 1.03 5.75 0.85 Summary Rural 19.97 1.16 19.90 1.21 18.38 1.07 Urban 9.24 1.06 9.27 1.07 8.06 0.98 All sites 12.87 1.10 12.97 1.12 11.19 1.01 ANNEX TABLE D 3. PRACTICES RELATED TO YOUNG CHILDREN Average number Parents accompanying Parents accompanying of times visited in Sample their children outside Other practices2 Site young children the day prior to the size1 the yard survey Count % Count % Count % Alabel 11 0 - 0 - - 11 100.0 Bayawan 6 0 - 0 - - 6 100.0 Dagupan 20 18 90.0 17 85.0 1.67 2 10.0 Taguig 21 1 4.8 1 4.8 3.00 20 95.2 Summary Rural 7 0 - 0 - - 7 100.0 Urban 51 19 37.3 18 35.3 1.74 32 62.7 All sites 58 19 32.8 18 31.0 1.74 39 67.2 1 This refers to the total number of families who responded to the question. The response rate to this question is quite low, representing only about 24.3% of all families who have children. Also note that there were no responses for San Fernando. 2 This represents children who defecated within the yard or other means of disposal. www.wsp.org 145 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE D 4. PREFERENCES RELATED TO TOILET CONVENIENCE, FROM HOUSEHOLDS Perceived benefits of sanitation (B6.1): Those without toilet: reasons to get a toilet proximity cited as satisfied or very satisfied Site Proximity is an important Those with toilet Those without toilet Saves time (B7.16) characteristic (B7.17) Alabel 91.0 na 1 98.6 95.7 Bayawan 90.6 na 1 78.4 81.1 Dagupan 100.0 61.9 100.0 95.0 San Fernando - Coastal 80.2 83.1 100.0 2 100.02 San Fernando - Upland 55.6 89.7 na 1 na 1 Taguig 96.6 na 1 100.0 98.7 Summary Rural 90.3 89.7 89.2 86.5 Urban 96.3 69.7 99.3 98.0 All sites 93.8 73.3 96.0 94.2 1 na= none of the households in the survey share or use public toilet 2 Two observations only ANNEX TABLE D 5. AVERAGE TIME SAVED PER PERSON OR HOUSEHOLD PER YEAR (IN DAYS) Adult time with Site Women Men Children Average per person Average per household young children Alabel 5.0 5.3 3.9 0.0 4.68 19.2 Bayawan 3.5 3.5 3.7 0.0 3.63 16.8 Dagupan 4.0 3.6 3.5 5.4 3.70 23.1 San Fernando 3.8 4.1 1.5 0.0 3.90 18.6 Taguig 2.0 1.9 1.2 4.4 1.69 10.7 Summary Rural 5.9 6.1 5.0 8.5 5.69 32.4 Urban 2.5 2.5 2.0 0.0 2.33 10.4 All sites 3.6 3.7 2.9 5.2 3.40 20.0 ANNEX TABLE D 6. VALUE OF TIME PER PERSON/HOUSEHOLD PER YEAR (IN PESOS) Site Women Men Children Adult time with young children Average per person Alabel 429 448 165 - 1,389 Bayawan 353 354 187 - 1,310 Dagupan 222 197 96 572 1,399 San Fernando 210 224 42 - 945 Taguig 567 523 172 465 1,973 Summary Rural 500 518 211 - 1,701 Urban 368 371 148 398 1,700 All sites 413 422 170 261 1,701 146 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE E 1. LEVEL OF SATISFACTION WITH CURRENT TOILET OPTION Those with improved sanitation Those with unimproved sanitation Characteristic Sewer Wet pit Dry pit Compost Unimproved Shared / septic Average No toilet Average latrine latrine toilet pit or bucket toilet tank Toilet position 4.75 4.67 3.04 4.38 4.66 4.00 4.56 4.25 4.54 Cleanliness 4.58 4.51 2.71 3.72 4.44 3.29 4.33 5.00 4.31 Status 4.60 4.60 3.17 4.41 4.54 3.29 3.22 4.50 3.25 Visitors 4.59 4.77 3.00 4.22 4.55 4.14 3.16 4.75 3.22 Maintaining 4.54 4.62 3.71 4.13 4.50 4.00 4.15 4.75 4.16 Health 4.83 4.75 3.79 4.45 4.76 4.00 4.71 4.50 4.68 Conflict avoidance 4.68 4.81 4.17 4.42 4.68 4.53 4.63 4.75 4.64 Convenience for 4.71 4.56 3.00 4.05 4.58 3.33 3.68 5.00 3.69 children Convenience for 4.72 4.88 4.14 4.49 4.72 3.33 4.55 4.75 4.53 elderly Night use of toilet 4.85 4.78 3.50 4.78 4.79 3.86 3.63 5.00 3.66 Avoid rain 4.82 4.66 2.26 4.61 4.70 3.57 3.83 5.00 3.84 Showering 4.83 4.71 1.71 4.28 4.69 3.60 3.15 5.00 3.19 Dangerous animals 4.78 4.53 2.52 3.84 4.59 3.14 4.35 5.00 4.32 ANNEX TABLE E 2. IMPORTANT CHARACTERISTICS OF A TOILET FOR THOSE CURRENTLY WITHOUT Characteristic No. of responses Average score Comfortable toilet position 220 4.83 Cleanliness and freedom from unpleasant odors and insects 220 4.81 Having a toilet not needing to share with other households 219 4.76 Having privacy when at the toilet 220 4.83 Proximity of toilet to house 218 4.79 Pour-flush compared to dry pit latrine 215 4.44 Having a toilet disposal system that does not require emptying (piped sewer vs septic tank) 216 4.28 Having a toilet disposal system that does not pollute your, neighbors’, or your community’s 220 4.68 environment Clean environment 219 4.80 Willingness to pay for improved toilet? 221 2,534 Type of toilet they would get (%) Toilet to piped sewer 1.7 Toilet to septic tank 78.2 Wet pit 19.2 Ventilated pit latrine 0.9 www.wsp.org 147 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE F 1. SCORING OF DIFFERENT TYPES OF LIVING AREA Site Averages Item San San Alabel Bayawan Dagupan Fernando- Fernando- Taguig Rural Urban All Coastal Upland State of sanitation in the neighborhood: very bad (1) to very good (5) Uncollected/ undisposed 3.6 4.2 1.8 1.9 2.0 2.6 3.5 2.3 2.7 household waste/ garbage Open/visible sewage or 3.6 4.1 2.2 2.0 2.3 2.5 3.5 2.5 2.8 wastewater Accumulation of 3.2 3.8 2.8 2.2 2.6 2.6 3.3 2.7 2.9 storm/rain water Smoke from burning waste/ 3.4 4.1 2.1 2.1 2.0 2.8 3.4 2.6 2.5 garbage Smell from sewage/ 3.4 4.0 1.6 1.9 2.2 2.2 3.3 2.2 1.9 defecation/waste Dust & dirt in 3.2 3.0 2.1 2.2 1.9 2.3 2.8 2.3 2.4 streets/roads/alleys Dust & dirt in shops/markets/ 3.3 2.9 2.2 2.2 2.3 2.4 2.9 2.4 2.1 restaurants Rodents around uncollected waste 3.4 2.3 1.7 1.7 2.0 1.9 2.5 2.0 2.0 etc Insects around uncollected waste 3.4 2.6 1.6 1.6 1.7 1.8 2.5 1.9 2.1 etc Simple average 3.4 3.4 2.0 2.0 2.1 2.3 3.1 2.3 2.4 To what extent do the following activities occur in your neighborhood: Never (1) to Pervasive (4) Open defecation 1.8 1.3 3.7 2.5 1.9 1.5 1.6 2.4 2.1 Land affected by sewage drains and 1.8 1.5 2.1 1.9 1.3 1.7 1.5 1.9 1.7 wastewater Garbage/waste 1.9 1.4 2.7 1.8 1.6 1.5 1.5 1.9 1.3 dumpsites/landfills Land flooded 1.9 1.7 2.0 2.4 1.1 1.9 1.7 2.1 1.6 seasonally Land flooded permanently with 1.8 1.5 1.4 1.8 1.0 1.3 1.5 1.5 1.1 poor quality sitting water Simple average 1.8 1.5 2.4 2.1 1.4 1.6 1.6 2.0 1.6 148 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE F 2. PROPORTION OF HOUSEHOLDS WITH AND WITHOUT TOILET WITH UNIMPROVED SANITATION PRACTICE Last time septic tanks were Households with access Households with septic Households with pit Households with no desludged (for septic tanks to toilet tanks latrines toilet aged 5 years and above) B1.8 Built Age of B1.5 B1.6 Built Dis- more septic B7.7 B7.10 Site Open Open 2-5 Experience Pit over- posal than 5 tank More Disposal See defe- urina- years Within seepage/ flowed child years un- than 5 Don’t child children cation tion ago the last flooding (yes, stool ago known years know stool in defecat- (some- (some- and 5 years into pit some- in envi- and and ago environ- ing in times, times, des- times) ron- des- des- ment yard often) often) ludged ment1 ludged ludged Alabel 0.6 1.9 7.7 25.0 47.6 nr 90.0 10.0 - nr nr 62.9 81.4 Bayawan 0.6 16.7 1.7 - nr - nr nr nr na na 54.1 83.8 Dagupan 39.3 73.8 41.0 nr 28.6 nr 50.0 - 50.0 nr nr 77.5 75.0 San Fernando - 18.8 55.1 19.9 na na na na na na nr nr 100.0 50.0 Coastal San Fernando - 27.4 81.0 22.6 na na na na na na 60.0 80.0 na na upland Taguig 0.7 3.4 20.2 na 53.0 50.0 94.9 5.1 - na na 69.7 68.4 Summary - - Rural 6.3 30.2 7.4 5.0 28.8 - 73.3 26.7 - 60.0 80.0 50.0 86.5 Urban 16.2 34.2 25.5 31.3 56.4 50.0 95.3 3.8 0.9 nr nr 74.8 70.9 All sites 12.6 32.7 18.9 12.5 50.4 14.3 92.6 6.6 0.8 60.0 80.0 66.7 76.0 na = not applicable, nr = not reported 1 Responses such as: put in drain or ditch, thrown in garbage, buried in ground, left in the open, used diaper then buried, and used diaper then thrown into the river www.wsp.org 149 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE F 3. IMPLICATION OF CURRENT TOILET OPTION FOR EXTERNAL ENVIRONMENT Improved sanitation Unimproved sanitation Characteristic Sewer Wet pit Dry pit Compost Unimproved Shared / septic Average No toilet Average latrine latrine toilet pit or bucket toilet tank Pollution of your or neighbors’ environment (question B6.1) Alabel 4.7 4.5 4.6 Bayawan 4.6 4.6 4.8 4.8 Dagupan 5.0 5.0 5.0 4.6 4.6 San Fernando - 4.6 4.2 4.4 4.6 4.6 coastal San Fernando - 3.6 4.6 3.9 3.9 4.4 4.4 upland Taguig 4.8 4.8 Average rural 4.8 4.7 4.5 4.8 4.6 4.6 Average urban 4.6 4.7 3.6 4.2 4.5 3.9 4.4 4.8 4.4 Average all 4.7 4.7 3.6 4.3 4.7 3.9 4.6 4.8 4.5 Smell around house (question B6.1) Alabel 4.8 4.7 4.8 Bayawan 4.7 4.7 5.0 5.0 Dagupan 5.0 5.0 5.0 4.7 4.7 San Fernando 4.7 4.1 4.4 4.6 4.6 Taguig 4.2 4.8 0.0 4.1 4.7 0.0 Average rural Average urban 4.8 4.8 4.4 4.8 4.6 4.6 Average all 4.7 5.0 4.2 4.3 4.6 4.1 4.7 5.0 4.6 150 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE F 4. PERCEPTIONS OF ENVIRONMENTAL SANITATION STATE, BY OPTION TYPE Level of improved (Q I3)1 Perception of environmental sanitation state (Q I1)2 Inter- Flood- Open Site vention/ Stag- Flooded ed Stand- Dirt def- Gar- Rub- Sew- Dirt Ro- In- Control nant seaso- per- ing Smoke Smell out- eca- bage bish age inside dents sects water nally ma- water side tion nently Interven- 1.6 1.7 1.8 1.9 1.8 3.7 3.7 3.4 3.4 3.5 3.2 3.3 3.4 3.3 tion Alabel Control 2.5 1.9 2.1 2.2 1.9 3.3 3.5 3.0 3.4 3.2 3.2 3.3 3.4 3.5 Interven- 1.1 1.5 1.3 1.7 1.5 4.4 4.4 4.0 4.3 4.3 3.1 3.0 2.3 2.6 tion Bayawan Control 2.5 1.5 2.0 1.7 1.6 2.8 2.6 2.6 3.1 2.3 2.8 2.8 2.4 2.6 Interven- 3.6 2.1 2.7 2.0 1.4 1.8 2.3 2.9 2.1 1.6 2.0 2.2 1.7 1.6 tion Dagupan Control 3.7 2.0 2.7 2.1 1.5 1.7 2.1 2.4 2.2 1.8 2.5 2.3 1.8 1.8 San Fer- nando Interven- 2.0 1.5 1.9 1.0 1.0 1.5 2.1 2.1 1.4 1.7 1.7 2.2 1.8 1.6 Nagyubyu- tion ban Control 1.9 1.2 1.5 1.1 1.0 2.0 2.3 2.7 2.1 2.3 1.9 2.3 2.0 1.7 Poro Interven- 1.2 1.4 1.3 1.3 1.2 2.3 2.2 2.3 2.4 2.0 2.3 2.2 2.4 1.8 (Fishermen’s tion Village) Control 2.4 1.9 2.1 2.4 2.1 1.9 2.3 2.5 2.0 1.4 2.1 2.0 1.8 1.8 Interven- 2.9 1.9 1.7 2.7 2.0 1.9 1.9 2.0 2.1 2.0 2.3 2.3 1.6 1.7 tion San Agustin Control 2.9 2.3 1.9 2.8 2.0 1.8 1.9 2.2 2.0 1.9 2.1 2.3 1.3 1.4 Interven- 1.2 1.5 1.3 1.7 1.2 2.6 2.7 2.7 2.9 2.4 2.4 2.6 2.1 2.0 tion Taguig Control 2.7 2.4 2.2 2.7 1.6 2.3 1.9 2.1 2.3 1.6 1.8 1.9 1.2 1.2 Summary Rural 1.6 1.5 1.5 1.7 1.5 3.5 3.5 3.3 3.4 3.3 2.8 2.9 2.5 2.5 Urban 2.4 1.9 1.9 2.1 1.5 2.3 2.5 2.7 2.6 2.2 2.3 2.4 2.0 1.9 All 2.1 1.7 1.8 1.9 1.5 2.7 2.8 2.9 2.9 2.6 2.5 2.6 2.2 2.2 1 Represents average response (1 = not important to 5 = very important) 2 Represents average response (1 = very bad to 5 = very good) www.wsp.org 151 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE F 5. RANKING IMPORTANCE OF ENVIRONMENTAL SANITATION, BY OPTION TYPE Level of Importance according to perception of environmental sanitation improved Intervention/ management (Q I.2) Site (Q I3) Control Standing Dirt Dirt Q I.41 Q I.52 Rubbish Sewage Smoke Smell Rodents Insects water outside inside Intervention 2.7 2.2 4.8 4.9 4.6 4.7 4.8 4.7 4.8 4.8 4.8 Alabel Control 2.8 2.4 4.9 4.9 4.8 4.8 4.9 4.8 4.9 4.8 4.8 Intervention 2.7 2.6 4.8 4.7 4.5 4.2 4.5 3.7 3.7 4.5 4.4 Bayawan Control 2.9 2.4 4.4 4.3 3.9 3.4 4.5 3.3 3.3 3.9 3.9 Intervention 2.5 2.0 5.0 4.8 4.6 4.9 5.0 4.9 4.9 5.0 5.0 Dagupan Control 2.4 2.2 4.9 4.6 4.1 4.6 4.8 4.7 4.5 4.8 4.9 San Fernando Intervention 2.5 2.3 4.7 4.2 4.0 4.5 4.6 4.3 4.4 4.4 4.4 Nagyubyuban Control 2.3 2.1 4.8 4.2 4.2 4.5 4.4 4.7 4.2 4.7 4.8 Poro Intervention 2.9 2.8 5.0 4.9 4.6 4.7 4.6 4.7 4.7 4.9 5.0 (Fishermen’s Village) Control 2.3 2.2 4.9 4.7 4.6 4.7 4.9 4.6 4.7 4.9 4.9 Intervention 2.6 2.2 4.8 4.6 4.4 4.5 4.6 4.5 4.4 4.8 4.8 San Agustin Control 2.4 2.3 4.9 4.4 4.1 4.4 4.6 4.5 4.5 4.8 4.9 Intervention 2.8 2.6 5.0 4.7 4.7 4.7 4.9 4.7 4.5 4.9 4.9 Taguig Control 2.8 2.6 4.9 4.9 4.7 4.7 4.9 4.7 4.5 4.9 4.9 Summary Rural 2.7 2.4 4.8 4.6 4.4 4.4 4.6 4.2 4.1 4.6 4.6 Urban 2.7 2.4 4.9 4.7 4.6 4.7 4.8 4.7 4.6 4.9 4.9 All 2.7 2.4 4.9 4.7 4.5 4.6 4.7 4.5 4.5 4.8 4.8 1 What level of priority do you think the local government should give to improve waste collection and to implement laws for improving sanitation condi- tions in your neighborhood? (Response: 1 = low priority to 3 high priority) 2 Do you think the local government already has the funds to deal with the major causes of sanitary conditions in your neighborhood? (Response: 1 = no funds to 3 = sufficient funds) 152 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE F 6. FINANCING FROM HOUSEHOLD AND PROJECT SOURCES Of the households who received toilets from external/programs/ community Households who Rural/ received toilets from % of Site Intervention Sample urban an external program/ % who % who Labor households agency/community contributed contributed contribution who cash labor (man-days) contributed materials Constructed Bayawan Rural 180 180 0.0 27.8 7.1 0.0 wetland Community Dagupan Urban 65 65 0.0 0.0 - 0.0 toilets San Fernando Rural UDDT-E 47 47 0.0 29.8 3.7 27.7 Community 65 49 0.0 8.2 4.9 0.0 Urban toilets UDDT-E 17 17 5.9 41.2 3.0 29.4 Totals 374 358 0.3 20.9 5.9 5.0 ANNEX TABLE F 7. HOUSEHOLD CHOICES AND OTHER INTERVENTIONS Hygiene awareness Water intervention (%) - Did the offered (%) - Did the Was household given a Was household given a program/community program/community choice to participate? choice of options (%) provide hygiene provide water (%) Number of awareness at the services to your Rural/ same time? household? Site Intervention households urban interviewed No, No, Yes, Yes, Not choice Not Not Not not choice volun- appl- not appl- Yes No appli- Yes No appli- volun- availa- tary icable availa- icable cable cable tary ble ble STF (desludged) 44 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 Rural Septic tanks (not Alabel 77 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 desludged) Urban Wet latrines 28 3.6 0.0 96.4 0.0 3.6 96.4 0.0 3.6 96.4 0.0 3.6 96.4 Constructed Bayawan Rural 180 21.7 78.3 0.0 22.2 77.8 0.0 97.8 1.7 0.0 91.1 7.8 1.1 wetland Shared toilets 48 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 Dagupan Urban Public toilets 65 6.2 93.8 0.0 26.2 73.8 0.0 46.2 53.8 0.0 4.6 95.4 0.0 Wet latrines 61 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 UDDT-E 47 44.7 55.3 0.0 74.5 25.5 0.0 95.7 4.3 0.0 46.8 53.2 0.0 Rural Dry pit latrines 24 37.5 8.3 54.2 29.2 16.7 54.2 41.7 4.2 54.2 8.3 37.5 54.2 San Shared toilets 39 28.2 10.3 61.5 33.3 5.1 61.5 35.9 2.6 61.5 5.1 33.3 61.5 Fernando Public toilets 65 35.4 35.4 24.6 43.1 27.7 24.6 61.5 9.2 24.6 6.2 64.6 24.6 Urban UDDT-E 17 41.2 58.8 0.0 94.1 5.9 0.0 100.0 0.0 0.0 5.9 94.1 0.0 Wet latrines 61 3.3 4.9 91.8 6.6 1.6 91.8 8.2 0.0 91.8 1.6 6.6 91.8 STF (desludged) 91 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 Septic tanks (not Taguig Urban 92 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 desludged) Decentralized 84 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0 sewerage All sites 1,023 11.4 26.4 61.9 15.6 22.2 61.9 32.9 4.8 61.9 19.5 18.2 62.1 www.wsp.org 153 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE F 8. APPROPRIATE TECHNOLOGY % households with Number of % households with % households with pit Rural / insufficient water for Site Intervention households pit flooding overflow urban flushing interviewed Sometimes Often Sometimes Often Sometimes Often STF (desludged) 44 0.0 0.0 - - - - Rural & Alabel Urban Septic tanks (not 77 1.3 0.0 - - - - desludged) Urban Wet latrines 28 0.0 0.0 - - - - Constructed Bayawan Rural 180 6.7 0.0 - - - - wetland Shared toilets 48 0.0 0.0 - - - - Dagupan Urban Public toilets 65 0.0 1.5 - - - - Wet latrines 61 0.0 0.0 - - - - UDDT-E 47 0.0 0.0 - - - - Rural Dry pit latrines 24 0.0 0.0 21.7 21.7 13.0 8.7 San Shared toilets 39 2.7 0.0 0.0 0.0 0.0 0.0 Fernando Public toilets 65 0.0 0.0 - - - - Urban UDDT-E 17 0.0 0.0 - - - - Wet latrines 61 0.0 0.0 - - - - STF (desludged) 91 0.0 0.0 - - - - Septic tanks (not Taguig Urban 92 1.1 0.0 - - - - de-sludged) Decentralized 84 0.0 0.0 - - - - sewerage All sites 1,023 1.6 0.1 19.2 19.2 11.5 7.7 - not applicable or no response 154 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE F 9. ACTUAL PROGRAM PERFORMANCE IN RELATION TO KEY SELECTED INDICATORS FOR PROGRAM EFFECTIVENESS, RURAL AND MIXED SITES ONLY Bayawan SF Alabel Variable Septic Constructed Dry pit Shared Wet STF UDDT-E tanks (not wetland latrines toilets Latrines (desludged) desludged) Local Local Households interviewed mix mix mix Households Households government government Local National Provider of facilities - - - - - government government Toilets 5,607.5 3,906.3 1,748.4 2,328.5 1,259.1 5,426.0 4,080.2 Treatment facilities 180 47 11 15 1 0 0 Approx. cost/HH (PhP, annualized costs, capital and 5,607.5 3,906.3 1,748.4 2,328.5 1,259.1 5,426.0 4,080.2 recurrent) Number of toilets not provided by government, NGOs, donors 180 47 11 15 1 0 0 and other institutions % of households, with members who sometimes or often: Use bush for defecation 0.6 8.5 45.8 20.5 0.0 0.0 1.3 Use bush for urination 16.7 48.9 87.5 82.1 0.0 2.3 2.6 Had children defecating in yard 99.4 100.0 95.8 97.4 92.9 100.0 93.5 % of households who: Had children using or stool 77.8 34.0 33.3 23.1 46.4 47.7 45.5 disposed in toilet/latrine Washed hands with soap 100.0 100.0 100.0 100.0 100.0 100.0 100.0 yesterday Wash hands after defecation 100.0 100.0 100.0 100.0 100.0 100.0 100.0 % of households with members who were observed: Using well which is not covered 0.0 0.0 0.0 0.0 0.0 12.5 12.5 Using bucket to withdraw water 0.0 0.0 0.0 0.0 0.0 15.4 12.2 from well Pit latrine/septic tank within 10m 0.0 0.0 0.0 22.7 66.7 43.8 30.2 of well Pit latrine/septic tank within 20m 66.7 0.0 0.0 22.7 100.0 100.0 72.1 of well Signs of feces/waste around - - - - 0.0 2.9 4.0 toilet Signs of insects in toilet - - - - 92.9 94.4 98.0 Running water in or near toilet - - - - 46.7 66.7 61.2 Soap available inside or near the - - - - 60.0 91.7 88.0 toilet facility for washing hands - not applicable or no response www.wsp.org 155 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE F 10. ACTUAL PROGRAM PERFORMANCE IN RELATION TO KEY SELECTED INDICATORS FOR PROGRAM EFFECTIVENESS, URBAN SITES ONLY Dagupan San Fernando Taguig Variable Septic Shared Public Public Wet STF (de- Decentralized Wet latrines UDDT-E tanks (not toilets toilets toilets latrines sludged) sewerage desludged) Households interviewed 48 65 61 65 17 61 91 92 84 Provider of facilities Local Local Local Toilets mix Households Mix Households Households Households government government government Treatment facilities - - - - - - Private firm - Private firm Approx. cost/HH (PhP, annualized costs, capital and 2,262.9 1,596.3 1,259.1 2,266.1 4,143.5 1,451.7 6,646.3 4,760.8 6,768.9 recurrent) Number of toilets not provided by government, NGOs, donors 0 65 0 49 17 5 0 0 0 and other institutions % of households, with members who sometimes or often: Use bush for defecation 52.1 56.9 16.4 29.2 29.4 14.8 2.2 0.0 0.0 Use bush for urination 87.5 89.2 49.2 67.7 70.6 44.3 5.5 3.3 1.2 Had children defecating in yard 77.1 38.1 59.0 73.8 64.7 60.7 98.9 94.5 98.8 % of households who: Had children using or stool 18.8 7.7 32.8 27.7 29.4 26.2 37.4 38.0 33.3 disposed in toilet/latrine Washed hands with soap 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 yesterday Wash hands after defecation 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 % of households with members who were observed: Using well which is not covered 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Using bucket to withdraw water 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 from well Pit latrine/septic tank within 74.5 25.0 82.8 37.9 45.5 78.0 - - - 10m of well Pit latrine/septic tank within 97.9 48.4 96.6 93.1 100.0 96.6 - - - 20m of well Signs of feces/waste around - - - - - - - - - toilet Signs of insects in toilet - - - - - - - - - Running water in or near toilet - - - - - - - - - Soap available inside or near the toilet facility for washing - - - - - - - - - hands - not applicable or no response 156 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE F 11. ACTUAL PROGRAM PERFORMANCE IN RELATION TO KEY SELECTED INDICATORS FOR PROGRAM EFFECTIVENESS Site (setting) SF - SF - Alabel Bayawan Dagupan Taguig Impact Indicator Coastal Upland rural/ rural/ rural urban rural urban urban urban First step health % household members improvement (basic using improved toilet 95% 98% 92% 90% 90% 97% sanitation) regularly % households connected Second step health to sewerage and sewerage 100% 3% 0% 0% 0% 100% improvement (WWM) treated Health (hygiene % households washing 100% 100% 100% 100% 100% 100% intervention) hands after defecation % of households with facilities that partially or fully Water source 96% 100% 85% 100% 100% 99% isolate water from human excreta % households using non- Water treatment boiling household water 98% 79% 69% 83% 82% 82% treatment methods % household members using own toilet instead of 67% 85% 33% 71% 97% 79% off-plot options Access time -Men 73% 87% 35% 73% 96% 84% -Women 76% 86% 42% 70% 97% 84% -Children 5-14 58% 80% 28% 68% 96% 73% -Children 0-4 45% 85% 16% 71% 100% 63% Own use: % households applying human excreta in Reuse 0% 0% 0% 21% 88% 0% own land or using human excreta for fertilizer www.wsp.org 157 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE G 1. PLACES VISITED (% RESPONDENTS) AND ENJOYMENT OF STAY Traveling within the Hotel Manila Historical sites Beaches Natural forests Category N Philippines tariff % Score % Score % Score % Score % Score 1-29 14 92.9 3.4 35.7 3.6 78.6 4.2 64.3 4.3 85.7 92.9 30-59 34 82.4 3.4 44.1 3.3 76.5 4.2 47.1 4.1 94.1 82.4 60-89 24 95.8 3.6 50.0 3.2 70.8 4.0 50.0 4.2 83.3 95.8 Tourist 90-119 10 100.0 3.5 30.0 3.7 60.0 4.7 30.0 4.3 90.0 100.0 120+ 25 88.0 4.2 56.0 4.1 72.0 3.9 44.0 4.1 76.0 88.0 Others 1 34 73.5 3.8 35.3 4.3 70.6 3.8 47.1 4.0 85.3 73.5 Sub-total 141 85.8 3.7 43.3 3.7 72.3 4.1 47.5 4.1 85.8 85.8 1-29 3 100.0 3.3 - - 66.7 4.5 - - 100.0 100.0 30-59 5 80.0 3.8 - - 40.0 2.0 20.0 2.0 80.0 80.0 60-89 3 66.7 4.0 - - - - - - 66.7 66.7 Business 90-119 8 87.5 3.6 - - 25.0 4.0 37.5 3.7 75.0 87.5 Others1 12 75.0 3.8 8.3 4.0 8.3 4.0 16.7 4.5 66.7 75.0 120+ 17 88.2 4.3 17.6 3.7 17.6 5.0 23.5 5.0 76.5 88.2 Sub-total 48 83.3 3.9 8.3 3.8 20.8 4.0 20.8 4.2 75.0 83.3 TOTAL 189 85.2 3.7 34.4 3.7 59.3 4.1 40.7 4.1 83.1 3.8 1 Others = either stayed with friends/family or does not know because the tariff was paid by the company ANNEX TABLE G 2. GENERAL SANITARY EXPERIENCE General Swim- Open Other Category Hotel tariff N sanitary Hotel Restaurant Capital ming pool water cities conditions 1-29 14 2.1 3.1 3.1 3.0 3.7 2.6 3.0 30-59 34 2.5 3.8 3.6 3.1 3.6 2.9 2.0 60-89 24 3.3 3.7 3.6 3.5 3.5 3.1 3.5 Tourist 90-119 10 3.0 4.0 3.8 3.5 4.1 2.7 - 120+ 25 3.2 4.0 4.3 3.9 3.9 3.3 3.0 Others1 34 3.0 3.8 3.1 3.2 3.8 3.1 4.0 Sub-total 141 2.9 3.8 3.6 3.4 3.7 3.0 3.0 1-29 3 2.0 4.0 5.0 - 5.0 1.0 - 30-59 5 2.0 3.0 3.0 2.0 3.0 3.3 - 60-89 3 2.7 4.0 4.0 - 3.7 2.5 - Business 90-119 8 2.6 4.1 3.6 3.0 3.5 3.0 4.0 Others 1 12 3.0 4.6 4.0 4.0 3.7 3.1 3.0 120+ 17 3.3 4.6 4.7 3.6 4.1 3.2 5.0 Sub-total 48 2.8 4.2 4.0 3.1 3.8 3.0 4.0 TOTAL 189 2.9 3.9 3.7 3.3 3.8 3.0 3.2 1 Others = either stayed with friends/family or does not know because the tariff was paid by the company 158 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE G 3. SANITARY EXPERIENCE IN RELATION TO TOILETS AND HAND WASHING Water and soap for hand Quality of toilets in Toilet availability washing Hotel % could Category N % tariff Restau- Bus not find Restau- Bus Hotels Airports City impact City rants stations when rants stations on stay needed 1-29 14 3.3 3.2 3.9 1.9 2.2 28.6 22.2 76.9 42.9 36.4 30-59 34 3.6 3.4 3.6 2.5 2.4 20.6 18.8 70.0 42.9 38.9 60-89 24 3.5 3.2 3.2 2.6 2.6 25.0 13.3 85.0 40.0 33.3 90-119 10 3.8 3.3 3.4 1.5 1.0 10.0 - 100.0 - - Tourist 120+ 25 4.1 3.8 3.4 2.0 2.9 8.3 45.5 88.0 33.3 58.3 Others 1 34 3.4 3.6 3.6 2.1 2.9 14.7 13.3 70.0 41.7 50.0 Sub-total 141 3.6 3.5 3.5 2.3 2.6 17.9 20.0 78.6 39.2 43.2 1-29 3 5.0 4.0 5.0 - 5.0 33.3 - 100.0 - 100.0 30-59 5 2.8 2.5 2.3 1.0 1.0 - - 50.0 - - 60-89 3 4.0 3.0 3.3 2.0 2.5 33.3 - 66.7 - 50.0 90-119 8 4.1 3.5 2.3 - 2.5 - 16.7 83.3 - 100.0 Business 120+ 12 4.6 3.6 2.9 2.5 2.0 - 25.0 100.0 100.0 100.0 Others 1 17 4.3 3.8 3.5 - 3.3 - - 91.7 - 100.0 Sub-total 48 4.2 3.5 3.1 2.0 2.8 4.2 11.8 87.5 50.0 80.0 TOTAL 189 3.8 3.5 3.4 2.2 2.6 14.4 18.4 80.7 40.0 47.6 1 Others = either stayed with friends/family or does not know because the tariff was paid by the company ANNEX TABLE G 4. WHAT FACTORS WERE OF MOST CONCERN? Hotel Swimming pool Category N Drinking water Tap water Food tariff water 1-29 14 57 29 14 0 30-59 34 57 7 29 7 60-89 24 62 15 15 8 Tourist 90-119 10 50 25 25 0 120+ 25 67 17 17 0 Others 1 34 69 0 25 6 Sub-total 141 62 12 21 5 1-29 3 50 0 0 50 30-59 5 0 0 100 0 60-89 3 100 0 0 0 Business 90-119 8 50 0 50 0 120+ 12 75 25 0 0 Others1 17 100 0 0 0 Sub-total 48 71 7 14 7 TOTAL 189 64 11 20 5 1 Others = either stayed with friends/family or does not know because the tariff was paid by the company www.wsp.org 159 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE G 5. HEALTH TROUBLES Average number GIT Medical care (%) of days of: Hotel Category N Water Water for Av. tariff Food Symp- Incapa- N % you hygienic No OP IP Shop Cost eaten toms citation drank purposes (US$) 1-29 14 7 50 57 14 14 7 1 75 13 0 13 1 30-59 34 12 35 29 14 57 5 4 64 27 0 9 30 60-89 24 8 33 67 0 33 3 2 63 0 0 38 6 Tourist 90-119 10 4 40 67 0 33 4 4 60 20 0 20 20 120+ 25 6 24 50 0 50 2 1 60 0 0 40 3 Others 1 34 9 26 50 0 38 5 4 50 13 13 25 42 Sub-total 141 46 33 51 6 37 5 3 62 13 2 22 17 1-29 3 0 0 - - - - - - - - - - 30-59 5 0 0 - - - - - - - - - - 60-89 3 0 0 - - - - - - - - - - Business 90-119 8 0 0 - - - - - - - - - - 120+ 12 0 0 - - - - - - - - - - Others 1 17 2 12 50 0 50 9 9 0 100 0 0 21 Sub-total 48 2 4 50 0 50 9 9 0 100 0 0 21 TOTAL 189 48 25 51 5 38 4 3 60 17 2 21 18 1 Others = either stayed with friends/family or does not know because the tariff was paid by the company ANNEX TABLE G 6. INTENTION TO RETURN Return to Philippines? (%) Advise friends to come? (%) Hotel Category N Do not Do not tariff Yes No Maybe Yes No Maybe know know 1-29 14 93 0 7 0 69 15 15 0 30-59 34 85 3 9 3 76 6 15 3 60-89 24 88 0 8 4 86 5 5 5 90-119 10 90 0 10 0 90 0 10 0 Tourist 120+ 25 92 0 8 0 87 0 13 0 Others1 34 82 3 12 3 76 3 18 3 Sub-total 141 87 1 9 2 80 4 13 2 1-29 3 67 0 0 33 33 0 33 33 30-59 5 60 20 20 0 80 0 20 0 60-89 3 100 0 0 0 100 0 0 0 90-119 8 88 0 13 0 67 0 33 0 Business 120+ 12 100 0 0 0 100 0 0 0 Others1 17 94 6 0 0 100 0 0 0 Sub-total 48 90 4 4 2 89 0 9 2 TOTAL 189 88 2 8 2 82 3 12 2 1 Others = either stayed with friends/family or does not know because the tariff was paid by the company 160 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE G 7. REASONS FOR HESITATING TO RETURN TO THE PHILIPPINES Reasons for hesitancy in returning (% cited) Hotel Category N Main Contributory tariff Sanitation Cost No need Not safe Sanitation Cost No need Not safe 1-29 14 - - - - 50 0 50 0 30-59 34 0 0 100 0 0 33 67 0 60-89 24 - - - - - - - - Tourist 90-119 10 100 0 0 0 - - - - 120+ 25 0 100 0 0 - - - - Others1 34 50 25 0 25 50 0 50 0 Sub-total 141 43 29 14 14 29 14 57 0 1-29 3 0 0 100 0 0 0 100 0 30-59 5 0 100 0 0 - - - - 60-89 3 - - - - - - - - Business 90-119 8 - - - - - - - - 120+ 12 - - - - - - - - Others 1 17 100 0 0 0 - - - - Sub-total 48 33 33 33 0 0 0 100 0 TOTAL 189 40 30 20 10 25 13 63 0 1 Others = either stayed with friends/family or does not know because the tariff was paid by the company www.wsp.org 161 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE H 1. RATING OF ENVIRONMENTAL SANITATION CONDITIONS IN THE LOCATION OF THE BUSINESS SURVEY INTERVIEW (1 = BEST; 5 = WORST) Resort Water Food Variable hotel/ vendor/ Abattoir Fish Market Travel All processing Restaurant Ice plant Number of companies 4 2 2 2 2 3 2 17 Water quality in rivers 3.8 3.0 5.0 4.0 4.0 3.0 3.5 3.75 State of canals and rainwater 3.0 3.0 4.5 3.0 3.5 3.7 3.0 3.38 drainage Management of sewage 2.0 - - - - - 3.0 2.67 Management of industrial - 2.0 - 3.0 - - 3.5 2.80 wastewater Household coverage with 2.3 2.5 2.0 3.0 3.0 - 3.0 2.58 private toilets Toilets in public places 2.0 3.0 2.5 2.0 - 1.3 4.0 2.18 Household/office solid waste 2.5 2.0 1.5 2.0 1.5 - 2.5 2.08 Management of industrial - 2.0 - 2.0 - 1.7 5.0 2.29 solid waste Air quality from vehicles 2.5 2.5 3.0 1.5 1.0 1.7 4.0 2.29 Air quality from solid waste 1.5 - - 1.0 1.0 5.0 2.5 2.14 Air quality from excreta - - - - - - 3.0 3.00 - no answer or not applicable ANNEX TABLE H 2. IMPORTANCE OF ENVIRONMENTAL SANITATION CONDITIONS FOR LOCATING THE COMPANY Resort Water Food Variable hotel/ vendor/ Abattoir Fish Market Travel All processing Restaurant Ice plant Workforce health 4.0 5.0 5.0 5.0 5.0 5.0 4.0 4.6 Water quality directly available from nature (rivers, 5.0 3.0 3.0 3.0 5.0 5.0 4.0 4.1 lakes, ground) Pleasant environment for company staff (clean environment free of garbage, 4.5 5.0 5.0 5.0 5.0 5.0 4.0 4.8 good air quality, proper sewerage and sanitation) Availability of cheap and 4.0 4.0 5.0 3.0 1.0 na 4.0 3.5 good land na = no answer 162 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE I 1. ALABEL AVERAGE COST PER HOUSEHOLD FOR DIFFERENT SANITATION AND HYGIENE OPTIONS, USING FULL (ECONOMIC) COST (PESOS, YEAR 2008) Cost Item Hygiene Wet pits Toilets to septic tank Toilets to septic tank and desludged at STF Investment costs: Initial one-off spending 1. Capital - 913 3,331 4,283 2. Program - - - - SUB-TOTAL - 913 3,331 4,283 Recurrent costs: Average annual spending 3. Operation 573 131 186 397 4. Maintenance - 215 563 746 5. Program - - - - SUB-TOTAL 573 346 749 1,143 Average annual cost calculations Duration1 - 6 25 25 Cost/household 573 1,259 4,080 5,426 Cost/capita 120 - - - Of which: % capital 0% 0% 0% 0% % program 0% 0% 0% 0% % recurrent 100% 0% 0% 0% Observations 2 Rural 225 6 77 17 Urban 0 0 0 Total 225 6 77 17 1 Refers to length of life of hardware before full replacement 2 Number of households www.wsp.org 163 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE I 2. BAYAWAN AVERAGE COST PER HOUSEHOLD FOR DIFFERENT SANITATION AND HYGIENE OPTIONS, USING FULL (ECONOMIC) COST (PESOS, YEAR 2008) Cost Item Hygiene Toilets to septic tank Toilets with wastewater treatment Investment costs: Initial one-off spending 1. Capital - 2,395 3,957 2. Program - - - SUB-TOTAL - 2,395 3,957 Recurrent costs: Average annual spending 3. Operation 995 373 560 4. Maintenance - 478 1,091 5. Program - - - SUB-TOTAL 995 851 1,651 Average annual cost calculations Duration1 - 25 25 Cost/household 995 3,246 5,607 Cost/capita 187 610 1,054 Of which: % capital 0% 74% 71% % program 0% 0% 0% % recurrent 100% 26% 29% Observations 2 Rural 215 180 180 Urban Total 215 180 180 1 Refers to length of life of hardware before full replacement 2 Number of households 164 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE I 3. DAGUPAN AVERAGE COST PER HOUSEHOLD FOR DIFFERENT SANITATION AND HYGIENE OPTIONS, USING FULL (ECONOMIC) COST (PESOS, YEAR 2008) Cost Item Community toilets Shared toilets Wet pits Investment costs: Initial one-off spending 1. Capital 1,087 1,644 913 2. Program - - - SUB-TOTAL 1,087 1,644 913 Recurrent costs: Average annual spending 3. Operation 412 412 131 4. Maintenance 97 206 215 5. Program - - - SUB-TOTAL 510 619 346 Average annual cost calculations Duration1 8 13 6 Cost/household 1,596 2,263 1,259 Cost/capita 275 390 217 Of which: % capital 68% 73% 73% % program 0% 0% 0% % recurrent 32% 27% 27% Observations 2 Rural Urban 65 48 61 Total 65 48 61 1 Refers to length of life of hardware before full replacement 2 Number of households www.wsp.org 165 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE I 4. SAN FERNANDO (COASTAL REGIONS) AVERAGE COST PER HOUSEHOLD FOR DIFFERENT SANITATION AND HYGIENE OPTIONS, USING FULL (ECONOMIC) COST (PESOS, YEAR 2008) Cost Item Hygiene UDDT-E Community toilets Wet pits Investment costs: Initial one-off spending 1. Capital - 3,277 1,181 913 2. Program - - - - SUB-TOTAL - 3,277 1,181 913 Recurrent costs: Average annual spending 3. Operation 1,100 - 542 324 4. Maintenance - 836 542 215 5. Program - - - - SUB-TOTAL 1,100 836 1,085 539 Average annual cost calculations Duration1 na 20 8 6 Cost/household 1,100 4,113 2,266 1,452 Cost/capita 204 810 420 269 Of which: % capital 0% 80% 52% 63% % program 0% 0% 0% 0% % recurrent 100% 20% 48% 37% Observations 2 Rural 33 33 Urban 17 65 61 Total 33 50 65 61 1 Refers to length of life of hardware before full replacement 2 Number of households 166 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE I 5. SAN FERNANDO (UPLAND) AVERAGE COST PER HOUSEHOLD FOR DIFFERENT SANITATION AND HYGIENE OPTIONS, USING FULL (ECONOMIC) COST (PESOS, YEAR 2008) Cost Item Hygiene Shared toilets Dry pits UDDT-E Investment costs: Initial one-off spending 1. Capital - 1,589 941 2,297 2. Program - - - - SUB-TOTAL - 1,589 941 2,297 Recurrent costs: Average annual spending 3. Operation 1,100 542 70 480 4. Maintenance - 198 - 401 5. Program - - - - SUB-TOTAL 1,100 740 70 881 Average annual cost calculations Duration1 - 13 1 10 Cost/household 1,100 2,328 1,011 3,178 Cost/capita 231 488 212 666 Of which: - - % capital 0% 68% 93% 72% % program 0% 0% 0% 0% % recurrent 100% 32% 7% 28% Observations 2 Rural 84 24 24 14 Urban - - - - Total 84 24 24 14 1 Refers to length of life of hardware before full replacement 2 Number of households www.wsp.org 167 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE I 6. TAGUIG AVERAGE COST PER HOUSEHOLD FOR DIFFERENT SANITATION AND HYGIENE OPTIONS, USING FULL (ECONOMIC) COST (PESOS, YEAR 2008) Toilets to septic tank and Cost Item Toilets to septic tank Sewerage desludged at STF Investment costs: Initial one-off spending 1. Capital 3,703 4,396 5,477 2. Program - - - SUB-TOTAL 3,703 4,396 5,477 Recurrent costs: Average annual spending 3. Operation 425 1,021 542 4. Maintenance 633 1,229 750 5. Program - - - SUB-TOTAL 1,058 2,250 1,292 Average annual cost calculations Duration1 25 25 25 Cost/household 4,761 6,646 6,769 Cost/capita 938 1,309 1,334 Of which: - - - % capital 78% 66% 81% % program 0% 0% 0% % recurrent 22% 34% 19% Observations2 Rural - - - Urban 92 91 84 Total 92 91 84 1 Refers to length of life of hardware before full replacement 2 Number of households 168 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE I 7. PROPORTION OF HOUSEHOLDS SELECTING DIFFERENT SANITATION OPTIONS, BY SITES, BY RURAL-URBAN REGIONS Income group Income group Income group Income group Income group Cost Item Average 1 2 3 4 5 Open defecation Alabel 68 20 4 - - 31 Bayawan 19 14 14 50 na 17 Dagupan 26 14 9 - - 18 San Fernando-Coastal 2 2 - - - 1 Taguig 71 39 10 - - 22 Unimproved pits San Fernando-Upland 10 7 - - na 8 Community toilets Dagupan 36 27 20 - - 29 San Fernando-Coastal 48 36 27 - na 37 Shared toilets Dagupan 25 22 14 - - 22 San Fernando-Upland 41 50 75 100 na 46 Dry pits San Fernando-Upland 33 21 13 - na 29 UDDT-E San Fernando-Coastal 26 33 27 20 25 28 San Fernando-Upland 16 21 13 - na 17 Wet pits Alabel 20 27 4 - - 15 Dagupan 14 32 46 80 100 27 San Fernando-Upland 24 29 45 80 25 34 Alabel 10 47 51 39 67 34 Dagupan - 5 11 20 - 4 Taguig 11 30 34 25 17 27 Toilets to septic tanks, desludged or with WWT Taguig 16 17 27 38 43 27 Alabel 2 5 42 61 33 20 Bayawan 81 86 86 50 na 83 Sewers Taguig 2 14 29 38 40 24 www.wsp.org 169 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE I 7. PROPORTION OF HOUSEHOLDS SELECTING DIFFERENT SANITATION OPTIONS, BY SITES, BY RURAL-URBAN REGIONS (CONTINUED) Income group Income group Income group Income group Income group Cost Item Average 1 2 3 4 5 Rural Open defecation 29 15 6 4 0 20 Unimproved pits 2 1 0 0 0 1 Community toilets 0 0 0 0 0 0 Shared toilets 9 5 7 4 0 7 Dry pits 7 2 1 0 0 5 UDDT-E 4 2 1 0 0 3 pits 6 12 2 0 0 6 Toilets to septic tanks 3 20 33 35 67 15 Toilets to septic tanks, 39 43 49 58 33 43 desludged or with WWT Toilets to sewers 0 0 0 0 0 0 Total 100 100 100 100 100 100 Urban Open defecation 28 20 8 0 0 16 Unimproved pits 0 0 0 0 0 0 Community toilets 32 19 10 0 6 17 Shared toilets 12 8 3 0 0 6 Dry pits 0 0 0 0 0 0 UDDT-E 8 9 6 3 3 7 Wet pits 14 19 18 15 6 16 Toilets to septic tanks 2 13 23 22 14 14 Toilets to septic tanks, 3 6 17 30 37 12 desludged or with WWT Toilets to sewers 0 5 18 30 34 11 Total 100 100 100 100 100 100 170 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE I 8. INCREMENTAL COSTS OF MOVING UP THE SANITATION LADDER TO Facility Toilets Toilets to septic tank, Shared Dry pits Wet pits UDDT-E to septic desludged at STF or Sewers toilets tank wastewater treatment Alabel Wet pits 2,821 4,167 Toilets to septic tank 1,346 Bayawan Toilets to septic tank 2,361 Dagupan Community toilets 667 (337) Shared toilets (1,004) San Fernando (Coastal) Community toilets (814) 1,847 Wet pits 2,662 San Fernando (Upland) Shared toilets (1,317) 849 Dry pits 2,166 Taguig Toilets to septic tank 1,886 2,008 FROM Toilets to septic tank, desludged 123 at STF or wastewater treatment Average: All rural sites Community toilets Shared toilets (1,317) (1,069) 1,506 1,168 3,928a\ Dry pits 248 2,823 2,485 5,245 Wet pits 2,576 2,237 4,998 UDDT-E (339) 2,422 Toilets to septic tanks 2,761 Average: All urban sites Community toilets 332 (576) 2,182 2,830 4,715 4,838 Shared toilets (908) 1,850 2,498 4,383 4,506 Dry pits Wet pits 2,758 3,405 5,291 5,413 UDDT-E 647 2,533 2,656 Toilets to septic tank 1,886 2,008 Toilets to septic tank, desludged 123 at STF or wastewater treatment www.wsp.org 171 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE I 8. INCREMENTAL COSTS OF MOVING UP THE SANITATION LADDER (CONTINUED) TO Facility Toilets Toilets to septic tank, Shared Dry pits Wet pits UDDT-E to septic desludged at STF or Sewers toilets tank wastewater treatment Average: All sites1 Community toilets2 332 (576) 1,844 1,999 4,322 4,838 Shared toilets 3 (1,317) (1,069) 1,506 1,168 3,928 n.b.4 Dry pits3 248 2,823 2,485 5,245 n.b. FROM Wet pits 2,667 2,821 5,144 5,4132 UDDT-E 154 2,477 2,6562 Toilets to septic tank 2,323 2,0082 Toilets to septic tank, desludged 1232 at STF or wastewater treatment Notes: 1 Unless specified otherwise, simple average of rural and urban households; 2 based on urban sites only; 3 based on rural sites only; 4 n.b.= no basis 172 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE J 1. ALABEL (RURAL), EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARED TO “NO TOILET� Sanitation only Sanitation & Hygiene Toilets Toilets Item Scenario to septic to septic Toilets to Toilets to Wet pits tank and Wet pits tank and septic tank septic tank desludged desludged at STF at STF Number of observations 28 36 44 28.0 36 44 Cost-benefit measures 0.0 Benefits per peso of input Ideal 7.9 2.8 2.3 5.4 2.5 2.0 (PhP) Actual 5.7 2.0 0.2 4.0 1.9 0.3 Ideal >100 40.8 31.3 >100 41.2 30.4 Internal rate of return (%) Actual >100 25.6 -13.8 >100 25.9 -14.3 Ideal 1.0 4.0 5.0 1.0 4.0 5.0 Payback period (years) Actual 1.0 6.0 8.0 1.0 >20 >20 Ideal 79,827 59,141 56,456 79,871 59,185 53,896 Net present value (PhP) Actual 54,467 33,778 -233,672 54,511 33,822 -236,232 Cost-effectiveness measures Cost per DALY averted Ideal 133,339 370,936 325,280 149,973 320,161 328,195 (PhP) Actual 140,390 390,553 2,354,029 99,073 332,109 2,100,760 Ideal 506 1,407 1,242 570 1,010 1,244 Cost per case averted (PhP) Actual 532 1,481 8,989 2,837,046 1,262 7,960 Cost per death averted Ideal 2,694,546 7,495,988 6,694,415 3,046,318 5,396,973 6,619,105 (PhP) Actual 2,837,046 7,892,411 48,446,955 3,046,318 6,747,272 42,329,408 www.wsp.org 173 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE J 2. BAYAWAN (RURAL), EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARED TO “NO TOILET� Sanitation only Sanitation & Hygiene Item Scenario Toilets with Toilets with Toilets to septic Toilets to septic wastewater wastewater tank tank treatment treatment Number of observations 180 180 180 180 Cost-benefit measures Benefits per peso of input Ideal 2.7 1.9 2.2 1.6 (PhP) Actual 2.4 1.7 2.0 1.5 Ideal 48.1 27.1 47.2 25.2 Internal rate of return (%) Actual 39.0 22.6 38.2 20.8 Ideal 4.0 6.0 4.0 6.0 Payback period (years) Actual 7.0 18.0 7.0 >20 Ideal 57,584 49,881 55,380 44,038 Net present value (PhP) Actual 46,608 38,576 44,404 32,732 Cost-effectiveness measures Ideal 198,661 324,271 233,282 343,512 Cost per DALY averted (PhP) Actual 203,575 332,291 238,330 350,945 Ideal 744 1,214 1,947 2,866 Cost per case averted (PhP) Actual 762 1,244 2,043 3,008 Ideal 2,986,781 4,875,262 3,443,602 5,070,759 Cost per death averted (PhP) Actual 3,060,647 4,995,833 3,516,731 5,178,443 174 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE J 3. SAN FERNANDO-UPLAND (RURAL), EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARED TO “NO TOILET� Sanitation only Sanitation & Hygiene Item Scenario Shared Shared Dry pits UDDT-E Dry pits UDDT-E toilets toilets Number of observations 24 24 14 24 24 14 Cost-benefit measures Benefits per peso of input Ideal 1.7 5.0 2.0 1.2 2.4 1.5 (PhP) Actual 1.6 4.7 1.8 1.2 2.3 1.4 Ideal 37.8 >100 35.3 29.9 >100 28.5 Internal rate of return (%) Actual 33.1 >100 30.8 25.5 >100 24.2 Ideal 5.0 1.0 4.0 7.0 1.0 5.0 Payback period (years) Actual >20 1.0 11.0 >20 1.0 >20 Ideal 15,426 38,630 31,379 8,853 32,057 22,397 Net present value (PhP) Actual 12,968 35,817 26,919 6,396 29,244 17,938 Cost-effectiveness measures Ideal 264,037 112,226 371,808 296,414 187,683 373,601 Cost per DALY averted (PhP) Actual 294,868 125,330 415,222 320,408 202,876 403,844 Ideal 1,017 432 1,432 1,144 724 1,441 Cost per case averted (PhP) Actual 1,135 483 1,599 1,236 783 1,558 Cost per death averted Ideal 4,505,503 1,915,005 6,344,488 5,084,556 3,219,437 6,408,598 (PhP) Actual 5,031,594 2,138,614 7,085,311 5,498,481 3,481,526 6,930,311 www.wsp.org 175 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE J 4. DAGUPAN (URBAN), EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARED TO “NO TOILET� Sanitation only Sanitation & Hygiene Item Scenario Community Shared Community Shared Wet pits Wet pits toilets toilets toilets toilets Number of observations 65 48 61 65 48 61 Cost-benefit measures Benefits per peso of input Ideal 2.88 2.29 5.25 1.86 1.67 2.89 (PhP) Actual 1.73 1.32 2.72 1.23 1.06 1.65 Ideal >100 47.7 >100 >100 41.5 >100 Internal rate of return (%) Actual 46.9 12.3 >100 33.2 12.3 >100 Ideal 2 4 1 2 4 1 Payback period (years) Actual 4.00 8.00 2.00 >20 >20 >20 Ideal 29,966 28,290 53,161 24,906 23,230 48,101 Net present value (PhP) Actual 11,660 7,011 21,483 6,600 1,951 16,423 Cost-effectiveness measures Ideal 131,408 114,753 103,306 170,505 159,889 74,021 Cost per DALY averted (PhP) Actual 143,206 125,055 112,581 181,202 172,358 159,803 Ideal 495 435 389 355 379 279 Cost per case averted (PhP) Actual 540 474 424 684 649 603 Ideal 3,054,696 2,713,390 2,401,443 2,199,301 2,338,027 1,728,976 Cost per death averted (PhP) Actual 4,233,751 2,957,007 2,617,053 4,233,751 3,993,367 3,733,769 176 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE J 5. SAN FERNANDO-COASTAL (URBAN), EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARED TO “NO TOILET� Sanitation only Sanitation & Hygiene Item Scenario Community Community UDDT-E Wet pits UDDT-E Wet pits toilets toilets Number of observations 65 50 61 65 50 61 Cost-benefit measures Benefits per peso of input Ideal 2.1 1.5 3.7 1.4 1.3 2.1 (PhP) Actual 1.7 1.3 2.8 1.2 1.0 1.7 Ideal 75.5 25.9 >100 55.1 3.4 >100 Internal rate of return (%) Actual 44.8 17.0 >100 28.9 -12.2 >100 Ideal 3 8.00 1 4 10.00 2.00 Payback period (years) Actual 4 >20 2.00 >20 >20 >20 Ideal 19,876 24,413 38,694 13,241 15,186 32,060 Net present value (PhP) Actual 12,214 6,740 26,591 5,580 -2,487 19,957 Cost-effectiveness measures Ideal 182,914 458,985 144,575 131,033 328,801 198,762 Cost per DALY averted (PhP) Actual 204,272 512,579 161,456 244,543 355,423 214,855 Ideal 695 1,744 549 499 1,252 757 Cost per case averted (PhP) Actual 776 1,948 613 931 1,353 818 Ideal 4,062,099 10,193,025 2,063,783 2,924,621 7,338,752 4,436,316 Cost per death averted (PhP) Actual 4,536,416 11,383,228 2,304,763 5,460,370 7,936,182 5,024,788 www.wsp.org 177 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE J 6. TAGUIG (URBAN), EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARED TO “NO TOILET� Sanitation only Sanitation & Hygiene Toilets Toilets Item Scenario to septic to septic Toilets to Toilets to tank and Sewerage tank and Sewerage septic tank septic tank desludged desludged at STF at STF Number of observations 92 91 84 92 91 84 Cost-benefit measures Benefits per peso of input Ideal 5.6 4.3 4.3 4.3 3.5 3.6 (PhP) Actual 4.5 3.4 3.6 3.5 2.9 3.0 Ideal >100 >100 >100 >100 >100 95.3 Internal rate of return (%) Actual >100 3.0 69.9 >100 87 65.9 Ideal 2 2 3 2 2 3 Payback period (years) Actual 2.00 3.00 3.00 >20 >20 >20 Ideal 196,324 201,358 202,288 192,870 193,074 194,005 Net present value (PhP) Actual 151,932 154,601 157,416 148,478 146,318 149,133 Cost-effectiveness measures Cost per DALY averted Ideal 442,426 400,517 394,448 430,845 440,100 434,768 (PhP) Actual 454,031 423,640 404,794 438,881 461,261 444,755 Ideal 1,620 1,477 1,455 1,163 1,288 1,268 Cost per case averted (PhP) Actual 1,663 1,562 1,493 1,611 1,688 1,627 Cost per death averted Ideal 10,424,838 9,604,657 9,459,108 7,505,658 8,275,767 8,150,356 (PhP) Actual 10,698,270 10,159,166 9,707,210 10,393,606 10,843,079 10,455,063 178 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE K 1. ALABEL (RURAL), EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARING DIFFERENT POINTS ON THE SANITATION LADDER FROM/TO HYGIENE IMPACT Toilets to septic tank Item Scenario Toilets to septic tank Toilets to septic tank Toilets to septic tank and desludged at STF and desludged at STF Cost-benefit measures Ideal 0.8 0.9 0.9 Benefits per peso of input (PhP) Actual 0.1 0.9 1.0 Ideal (9.5) 0.4 (0.9) Internal rate of return (%) Actual (39.4) 0.3 (0.5) Ideal 1 - - Payback period (years) Actual 2 - - Ideal (2,684) 44 (2,561) Net present value (PhP) Actual (267,450) 44 (2,561) Cost-effectiveness measures Ideal (45,656) (50,775) 2,914 Cost per DALY averted (PhP) Actual 1,963,476 (58,444) (253,269) Ideal (165) (397) 2 Cost per case averted (PhP) Actual 7,508 (219) (1,030) Ideal (801,573) (2,099,015) (75,310) Cost per death averted (PhP) Actual 40,554,544 (1,145,138) (6,117,546) ANNEX TABLE K 2. BAYAWAN (RURAL), EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARING DIFFERENT POINTS ON THE SANITATION LADDER FROM/TO HYGIENE IMPACT Toilets to septic tank Item Scenario Toilets to septic tank Toilets to septic tank Toilets to septic tank and desludged at STF and desludged at STF Cost-benefit measures Ideal 0.7 0.8 0.9 Benefits per peso of input (PhP) Actual 0.7 0.8 0.9 Ideal (21.0) (0.9) (1.9) Internal rate of return (%) Actual (16.4) (0.8) (1.8) Ideal 2 - - Payback period (years) Actual 11 - - Ideal (7,703) (2,204) (5,844) Net present value (PhP) Actual (8,033) (2,204) (5,844) Cost-effectiveness measures Ideal 125,610 34,621 19,241 Cost per DALY averted (PhP) Actual 128,716 34,755 18,654 Ideal 470 1,203 1,652 Cost per case averted (PhP) Actual 482 1,281 1,764 Ideal 1,888,481 456,822 195,497 Cost per death averted (PhP) Actual 1,935,185 456,084 182,610 www.wsp.org 179 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE K 3. SAN FERNANDO-UPLAND (RURAL), EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARING DIFFERENT POINTS ON THE SANITATION LADDER FROM/TO HYGIENE IMPACT Item Scenario Shared toilets Dry pits Shared Dry pits UDDT-E Dry pits UDDT-E UDDT-E toilets Cost-benefit measures Benefits per peso of input Ideal 3.0 1.2 0.4 0.7 0.5 0.8 (PhP) Actual 3.0 1.2 0.4 0.8 0.5 0.8 Ideal - (2.5) - (7.9) - (6.8) Internal rate of return (%) Actual - (2.3) - (7.6) - (6.6) Ideal (4) (1) 3 2 - 1 Payback period (years) Actual - - 10 - - - Ideal 23,204 15,953 (7,250) (6,572) (6,572) (8,982) Net present value (PhP) Actual 22,848 13,951 (8,897) (6,572) (6,572) (8,982) Cost-effectiveness measures Ideal (151,812) 107,771 259,582 32,377 75,458 1,794 Cost per DALY averted (PhP) Actual (169,538) 120,354 289,893 25,540 77,546 (11,379) Ideal (585) 415 1,000 127 292 10 Cost per case averted (PhP) Actual (653) 463 1,116 101 300 (41) Ideal (2,590,497) 1,838,985 4,429,483 579,054 1,304,432 64,110 Cost per death averted (PhP) Actual (2,892,981) 2,053,717 4,946,698 466,887 1,342,913 (155,000) ANNEX TABLE K 4. DAGUPAN (URBAN), EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARING DIFFERENT POINTS ON THE SANITATION LADDER FROM/TO HYGIENE IMPACT Shared Item Scenario Community toilets Community Shared toilets Wet pits toilets toilets Shared toilets Wet pits Wet pits Cost-benefit measures Benefits per peso of input Ideal 0.8 1.8 2.3 0.6 0.7 0.6 (PhP) Actual 0.8 1.6 2.1 0.7 0.8 0.6 Ideal - - - - (6.2) - Internal rate of return (%) Actual (34.6) - - (13.7) - - Ideal 2 (1) (3) - - - Payback period (years) Actual 4 (2) (6) - - - Ideal (1,676) 23,195 24,872 (5,060) (5,060) (5,060) Net present value (PhP) Actual (4,649) 9,822 14,472 (5,060) (5,060) (5,060) Cost-effectiveness measures Ideal (16,656) (28,102) (11,446) 39,097 45,137 (29,285) Cost per DALY averted (PhP) Actual (18,151) (30,625) (12,474) 37,995 47,303 47,221 Ideal (60) (106) (46) (140) (56) (110) Cost per case averted (PhP) Actual (65) (115) (50) 144 174 179 Cost per death averted Ideal (341,306) (653,253) (311,947) (855,395) (375,364) (672,467) (PhP) Actual (1,276,743) (1,616,698) (339,955) - 1,036,359 1,116,716 180 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE K 5. SAN FERNANDO-COASTAL (URBAN), EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARING DIFFERENT POINTS ON THE SANITATION LADDER FROM/TO HYGIENE IMPACT Item Scenario Community toilets UDDT-E Community UDDT-E Wet pits UDDT-E Wet pits Wet pits toilets Cost-benefit measures Benefits per peso of input Ideal 0.7 1.8 2.4 0.7 0.8 0.6 (PhP) Actual 0.8 1.7 2.3 0.7 0.8 0.6 Ideal (49.6) - - (20.4) (22.5) - Internal rate of return (%) Actual (27.8) - - (15.9) (29.2) - Ideal 5 (2) (7) 1 2 1 Payback period (years) Actual - (2) - - - - Ideal 4,537 18,818 14,281 (6,634) (9,227) (6,634) Net present value (PhP) Actual (5,474) 14,377 19,852 (6,634) (9,227) (6,634) Cost-effectiveness measures Ideal 276,072 (38,339) (314,410) (51,881) (130,184) 54,187 Cost per DALY averted (PhP) Actual 308,307 (42,815) (351,123) 40,271 (157,157) 53,399 Ideal 1,049 (146) (1,195) (196) (492) 207 Cost per case averted (PhP) Actual 1,171 (163) (1,334) 155 (594) 205 Ideal 6,130,926 (1,998,316) (8,129,242) (1,137,478) (2,854,273) 2,372,533 Cost per death averted (PhP) Actual 6,846,813 (2,231,652) (9,078,465) 923,954 (3,447,047) 2,720,024 www.wsp.org 181 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE K 6. TAGUIG (URBAN), EFFICIENCY MEASURES FOR MAIN GROUPINGS OF SANITATION INTERVENTIONS, COMPARING DIFFERENT POINTS ON THE SANITATION LADDER FROM/TO HYGIENE IMPACT Toilets to septic tank, Toilets to septic tank desludged at Toilets to Item Scenario STF Toilets to septic tank, Sewerage Toilets to septic tank desludged at septic tank, STF Sewerage Sewerage desludged at STF Cost-benefit measures Benefits per peso of Ideal 0.8 0.8 1.0 0.8 0.8 0.8 input (PhP) Actual 0.8 0.8 1.0 0.8 0.8 0.8 Ideal - - - - - - Internal rate of return (%) Actual - - 66.9 - 77.9 (4.0) Ideal - 1 1 - - - Payback period (years) Actual 1 1 - - - - Ideal 5,034 5,964 930 (3,454) (8,283) (8,283) Net present value (PhP) Actual 2,669 5,485 2,815 (3,454) (8,283) (8,283) Cost-effectiveness measures Cost per DALY averted Ideal (41,909) (47,979) (6,069) (11,581) 39,583 40,320 (PhP) Actual (30,390) (49,237) (18,847) (15,150) 37,621 39,961 Cost per case averted Ideal (143) (166) (22) (457) (189) (186) (PhP) Actual (101) (170) (70) (52) 126 135 Cost per death averted Ideal (820,181) (965,730) (145,549) (2,919,181) (1,328,890) (1,308,752) (PhP) Actual (539,104) (991,060) (451,956) (304,665) 683,913 747,853 182 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE K 7. SENSITIVITY ANALYSIS: COST-BENEFIT RATIOS (IDEAL SETTING) Experiment Technology Site Baseline 1 2 3 4 5 6 7 Dagupan 2.9 2.8 7.1 3.8 3.0 2.8 2.2 1.7 San Fernando- Community toilets 2.1 2.0 5.1 2.8 2.2 2.0 2.1 2.1 Coastal Simple average 2.5 2.4 6.1 3.3 2.6 2.4 2.1 1.9 Dagupan 2.3 2.2 5.8 2.9 2.4 2.2 1.7 1.3 Shared toilets San Fernando-Upland 1.7 1.9 4.5 2.5 2.0 1.9 1.5 1.2 Simple Average 2.0 2.1 5.1 2.7 2.2 2.1 1.6 1.3 Dry pit latrines San Fernando-Upland 5.0 5.5 14.1 7.0 5.8 5.5 3.8 2.9 Alabel 7.9 7.6 23.6 8.9 8.0 7.7 5.7 4.5 Dagupan 5.2 5.1 14.2 6.4 5.4 5.1 3.9 3.1 Wet pit latrines San Fernando- 3.7 3.6 9.9 4.5 3.8 3.6 2.8 2.3 Coastal Simple average 5.6 5.4 15.9 6.6 5.7 5.5 4.1 3.3 San Fernando- 1.5 1.3 3.3 1.6 1.3 1.3 1.0 0.8 Coastal UDDT-E San Fernando-Upland 2.0 1.7 4.3 2.1 1.7 1.7 1.3 1.0 Simple average 1.8 1.5 3.8 1.9 1.5 1.5 1.1 0.9 Alabel 2.8 2.7 8.5 3.2 2.9 2.8 2.0 1.5 Toilets to septic tank (no desludging) 2.7 2.6 7.6 3.3 2.7 2.6 2.7 2.7 (no desludging) Taguig 5.6 5.4 17.5 5.8 5.6 5.5 4.1 3.2 Simple average 3.7 3.6 11.2 4.1 3.7 3.6 2.9 2.5 Alabel 2.3 2.2 6.5 2.7 2.3 2.2 1.6 1.2 Toilets to septic tank (desludged and treated at Toilets to septic tank 4.3 4.1 12.9 4.6 4.3 4.2 3.3 2.7 STF) (desludged and 3.3 3.2 9.7 3.6 3.3 3.2 2.4 1.9 treated at STF) Toilets with wastewater treatment (constructed Bayawan 1.9 1.8 5.0 2.4 1.9 1.8 1.4 1.1 wetland) Toilets to sewer Taguig 4.3 4.2 13.1 4.6 4.4 4.3 3.1 2.5 All interventions Simple average 3.3 3.2 9.3 4.0 3.4 3.3 2.5 2.1 Notes: Experiment 1: using average wages per region instead of GDP per region; Experiment 2: 100% of time for adults and 50% of time for children; Experiment 3: VSOL instead of GDP; Experiment 4: 10% increase in diarrheal incidence rates; Experiment 5: 10% decrease in diarrheal incidence rates; Experiment 6: 50% increase in initial costs; Experiment 7: 100% increase in initial costs www.wsp.org 183 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE K 8. SENSITIVITY ANALYSIS: ELASTICITY (% CHANGE IN CBA RATIO/% CHANGE IN THE EXOGENOUS VARIABLE) Experiment Technology Site 1 2 3 4 5 6 7 Dagupan 0.1 0.6 0.1 0.3 0.3 -0.5 -0.4 Community toilets San Fernando-Coastal 0.1 0.6 0.1 0.3 0.3 0.0 0.0 Simple average 0.1 0.6 0.1 0.3 0.3 -0.3 -0.2 Dagupan 0.1 0.7 0.1 0.3 0.3 -0.5 -0.4 Shared toilets San Fernando-Upland 0.1 0.6 0.1 0.3 0.3 -0.5 -0.4 Simple Average 0.1 0.6 0.1 0.3 0.3 -0.5 -0.4 Dry pit latrines San Fernando-Upland 0.1 0.6 0.1 0.2 0.2 -0.6 -0.5 Alabel 0.1 0.9 0.1 0.1 0.1 -0.6 -0.4 Dagupan 0.1 0.7 0.1 0.2 0.2 -0.5 -0.4 Wet pit latrines San Fernando-Coastal 0.1 0.7 0.1 0.2 0.2 -0.5 -0.4 Simple average 0.1 0.8 0.1 0.2 0.2 -0.5 -0.4 San Fernando-Coastal 0.1 0.6 0.1 0.2 0.2 -0.5 -0.4 UDDT-E San Fernando-Upland 0.1 0.6 0.1 0.2 0.2 -0.5 -0.4 Simple average 0.1 0.6 0.1 0.2 0.2 -0.5 -0.4 Alabel 0.1 0.9 0.1 0.1 0.1 -0.6 -0.5 Toilets to septic tank Bayawan 0.2 0.8 0.1 0.1 0.2 0.0 0.0 (no desludging) Taguig 0.1 0.9 0.0 0.1 0.1 -0.5 -0.4 Simple average 0.1 0.9 0.0 0.1 0.1 -0.4 -0.3 Alabel 0.1 0.8 0.1 0.2 0.2 -0.6 -0.4 Toilets to septic tank (desludged and treated at STF) Taguig 0.1 0.9 0.0 0.1 0.1 -0.5 -0.4 Simple average 0.1 0.8 0.0 0.1 0.1 -0.5 -0.4 Toilets with wastewater treatment Bayawan 0.1 0.7 0.1 0.2 0.3 -0.5 -0.4 (constructed wetland) Toilets to sewer Taguig 0.1 0.9 0.0 0.1 0.1 -0.6 -0.4 Simple average 0.1 0.8 0.1 0.2 0.2 -0.5 -0.4 Minimum 0.1 0.6 0.0 0.1 0.1 -0.6 -0.5 All interventions Maximum 0.2 0.9 0.1 0.3 0.3 0.0 0.0 Range 0.1 0.4 0.1 0.3 0.3 0.6 0.5 Standard deviation 0.0 0.1 0.0 0.1 0.1 0.2 0.1 Notes: Experiment 1: using average wages per region instead of GDP per region; Experiment 2: 100% of time for adults and 50% of time for children; Experiment 3: VSOL instead of GDP; Experiment 4: 10% increase in diarrheal incidence rates; Experiment 5: 10% decrease in diarrheal incidence rates; Experiment 6: 50% increase in initial costs; Experiment 7: 100% increase in initial costs 184 Economic Assessment of Sanitation Interventions Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE K 9. BASIC FEATURES OF SANITATION PROGRAMS Project Implementing Funding No. Project name Sites value (m Start year End year agency source US$) Water Districts Cabanatuan, San Development Project: Fernando, Candon, World Bank 1 Sewerage, Sanitation LBP/LGU 17.9 1999 2006 Calbayog, Panabo and the (loan) and Drainage province of Palawan Development (WDDP) Rural Water Supply ADB/ 2 and Sanitation Project 20 poorest provinces1 DPWH 31.3 1997 2004 government (RWSSP) Rural Water Supply and Ilocos Sur, Nueva Vizcaya, JBIC/ 3 Sanitation Project Phase Occidental Mindoro and DILG 9 2001 2007 government V (RWSSP-V) Oriental Mindoro Water Supply and 4 Sanitation Enhancement (nationwide) DILG/NWRB AUSAID/WSP 1.9 2002 2006 Program (WSSPEP) Local Initiative for Dumaguete, Iloilo, USAID Affordable Wastewater 5 Muntinlupa, Naga, Contractor USAID 0.8 2003 2007 (Phases 1 and 2) Calbayog and Malaybalay through LGUs (LINAW) Northern Luzon, Central Visayas, Western, Central Environmental USAID and Southern Mindanao, 6 Governance Project Contractor USAID 19 2004 2009 including the Autonomous (EcoGov) through LGUs Region of Muslim Mindanao (ARMM) Manila Third Sewerage LBP/Manila World Bank 7 Metro Manila 84.5 2005 2010 Project (MTSP) Water (loan)/local Integrated Support for Sustainable Urban DGIS 8 San Fernando CAPS 0.4+ 2004 2010 Sanitation (Phases 1 (Netherlands) and 2) (ISSUE) Mactan Island, Moalboal Sustainable Coastal USAID Island, Panglao Island, 9 Tourism in Asia Contractor USAID 1.5 2004 2008 El Nido, Puerto Galera, (SCOTIA) through LGUs Balayan Bay Bauko Municipality , Sustainable Sanitation WB Contractors Dagupan City , Guian 10 for East Asia (SuSEA) – through DOH SIDA/SuSEA 3.0 2007 2010 , General Santos City , Philippines Program and DENR Polomolok , Alabel 1 The provinces were Benguet, Abra, Mountain Province, Ifugao, Kalinga, Apayao, Batanes, Aurora, Romblon, Masbate, Guimaras, Antique, Southern Leyte, Eastern Samar, Biliran, Basilan, Agusan Sur, Surigao Sur, Sulu, Tawi-Tawi www.wsp.org 185 Economic Assessment of Sanitation Interventions in the Philippines | Annex Tables ANNEX TABLE K 10. BASIC INTERVENTIONS AND PROGRAM APPROACHES OF SANITATION PROGRAMS Project name Item Summary WDDP RWSSP RWSSP-V WPEP1 LINAW ECOGOV MTSP ISSUE SCOTIA SuSEA Target beneficiaries Households (Direct) x x x x x 5 Others x x x x x x x x 8 Output: Hardware Sewerage and drainage systems x x 2 Septic tanks x x x 3 Toilet bowls and related facilities x x x x x 5 Treatment facilities (STF, wastewater, sewer) x x x x x 5 Water supply x x 2 Output: Software Sewerage treatment plan and/or design x x x 3 Capacity building of LGUs/local communities x x x x 4 Health and hygiene education/promotion x x x 4 Other information campaigns x x x 3 Water quality and monitoring program x x 2 Contribution to local ordinances x x 2 Knowledge products x x x 3 Implementing approach CLTS x 1 Sanitation marketing 0 Informed choice x x 2 Supply driven x x x x x 5 Strategic urban sanitation x x x x x 5 Hygiene behavior change x x x x 4 Partnership arrangements Implementation partnership x x x x x x x 7 Financing partnership x x x 3 Private/public sector partnership x x x x x 5 Public/public partnership x x x x x 5 Documents reviewed Project completion report x x x x x 5 Case studies/field studies & other reports x x x x x x 6 Midterm review x 1 1 The implementation approach for the WSSPEP was not assessed. 186 Economic Assessment of Sanitation Interventions