# 2.2. The economic cost of water disruption

The economic value of IWS on health most likely exceeds US$3 billion per year. Assuming that a diarrheal disease leads to between 4 and 7 days of loss of productive work –for the sick or the caregiver–and that treatment costs are between USD 2 and 4 (Rozenberg & Hallegatte, 2015), then the cost is estimated to be between USD 650 and 1,100 millions each year (Table 3). Furthermore, if we consider that each infection attributable to the three studied bacteria – _Campylobacter_ , _Cryptosporidium_ , and _Rotavirus_ – lead to a similar episode of diarrhea, the estimate of the overall cost of intermittent water supply escalates to between USD 3,100 and 5,480 millions. The total economic cost – without considering the direct wellbeing impact of being sick – already reaches between USD 3 and 6 billion per year.

**Table 3: Annual health cost of Intermittent Water Supply.**

|**Region**|**Cost** **of**<br>**infection (in**<br>**millions of**<br>**USD), low**<br>**impact**<br>**scenario**|**Cost of**<br>**infection**<br>**(in**<br>**millions**<br>**of USD),**<br>**high**<br>**impact**<br>**scenario**|**Cost**<br>**diarrhea**<br>**(in**<br>**millions**<br>**of USD),**<br>**low**<br>**impact**<br>**scenario**|**Cost of**<br>**diarrhea**<br>**(in**<br>**millions**<br>**of USD),**<br>**high**<br>**impact**<br>**scenario**|**Total cost (in**<br>**millions of**<br>**USD), low**<br>**impact**<br>**scenario**|**Total cost (in**<br>**millions of**<br>**USD), high**<br>**impact**<br>**scenario**|
|---|---|---|---|---|---|---|
|Africa|91.43|161.08|23.98|42.25|115.41|203.33|
|Americas, LMI*|139.72|244.95|36.61|64.18|176.33|309.13|
|Eastern<br>Mediterranean,<br>LMI|286.95|503.11|75.57|132.50|362.52|635.61|
|Europe, LMI|292.43|512.41|76.65|134.31|369.08|646.73|
|South East Asia|559.77|983.40|147.31|258.79|707.08|1242.18|
|Western<br>Pacific,LMI|548.37|961.32|143.93|252.31|692.30|1213.63|
|Global|2328.58|4083.62|611.93|1073.14|2940.51|5156.76|

_Source : authors based on Bivins et al. (2017) and Rozenberg & Hallegatte (2015). * LMI = Low middle income countries_ Unreliable water network also impacts gender equality. When water services are limited, this vital resource needs to be collected from public standpipes, wells, bore holes, rivers or storage drums served by private tankers, with WHO data estimating that 72 per cent of this burden falls on women (Birch, 2011). Evidence in Lusaka, Zambia, shows that outages increase the time young girls spend at their chores, possibly at the expense of their education (Ashraf et al., 2017). In respect of sanitation, too, women living in poorly served settlements are characteristically responsible for disposing of fecal matter in their compounds, or accompanying their children to appropriate sites (Chant, 2007). Even if journeys are short in terms of distance, they may take long to execute where crossing inhospitable terrain, or queuing at outlets, is involved.<sup>8</sup> Furthermore, it is now widely reported in a range of settings that women and girls

> 8 Data on the time spent to fetch water are usually for rural households with no piped connection. No estimate of the time needed for connected households who experience a water supply outage could be identified.

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