Evaluation of basic sanitation in Brazil: an approach on sectoral efficiency and impact on population health in developing regions.
Basic sanitation. Environment. Brazilian municipalities. Performance measurement. DEA. Impact on health. SEA
The process of universalization of basic sanitation reveals as an inducer of a better quality of life and population health according to the specialized literature. Public policy-making and stimulating public and private investment have come to play a prominent role in providing access to piped water and basic sanitation facilities. This is especially in developing countries and as part of a recent global effort which aim at universalizing, by 2030, the drinking water supply services and the sanitation conditions, both fundamental for human life and sustainable development goals. Given this situation, the aim of this study is to estimate the performance of integrated management of basic sanitation in Brazilian municipalities and its impact on population health in regions with low human development. Empirical model is developed that relates three aspects of this issue: evaluation of the relationship between performance and low coverage of basic sanitation provision in Brazilian municipalities, analysis of the dynamics of the basic sanitation sector in Brazil between 2008 and 2016, regarding productivity from the national regulatory framework, and the evaluation of the role of the expansion of basic sanitation in municipalities of a Brazilian region which is widely known for its low social development and a high level of child mortality. The Multiple Data Envelopment Analysis (M-DEA) and Structural Equation Analysis (SEA) approaches are used in this study with microdata from the Brazilian Basic Sanitation Information System, Demographic Census, Basic Education Census, Brazilian Unified Health System Information Technology Department and United Nations Development Programme. The main results corroborate that the lack of basic sanitation infrastructure in households is potentiated by the inefficiency of managing the sector's operational and financial resources, causing perverse effects on the high level of child mortality in the Brazilian poorest regions. It is estimated that the analyzed sanitation companies may increase their operational and service coverage results by more than 60% in the municipalities where such companies operate and that the 10% increase in access to household sanitary sewage is associated to a reduction of 5.7 deaths per 1,000 born alive. The results found provides subsidies to support decision making by sanitation managers and public policy makers in the country at microanalytic level. This enables a better competitive position in the sector for integrated sanitation management and its universalization in Brazil, as solid support in favor of prioritizing public investment on basic sanitation projects particularly in the poorest regions.