Context:
Achieving access to clean water for sanitation and hygiene is marked as an important goal to improve health – especially of children – and development, including as one of the Millennium Development Goals. Figures of access to improved water and sanitation for 2012 taken from WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation indicate that Peru is still lagging in the Latin American and Caribbean region despite progress over the last decades. Access to improved water was 96 per cent on average in Latin American and Caribbean countries but 87 per cent in Peru, while access to improved sanitation was 89 per cent in Latin American and Caribbean countries and 73 per cent in Peru. Wide urban-rural disparities in access are also present across Latin American and Caribbean countries and Peru is no exception. By 2012 about 91 per cent of Peru’s population had access to improved water in urban areas in contrast to 72 per cent in rural areas while 81 per cent had access to improved sanitation in urban areas in contrast to just 45 per cent in rural areas.
In response to such challenges, the Peruvian government has made large investments in improving community access to water, including constructing approximately 500,000 new communal water taps between 2006 and 2011, under the aegis of its Programa Agua para Todos (PAPT). The government also implemented Programa Nacional de Agua y Saneamiento Rural (PRONASAR), currently under Programa Nacional de Saneamiento Rural (PNSR), to increase the sustainable use of new and rehabilitated water supply and sanitation facilities in rural areas and small towns. Overall, access to improved water and sanitation had increased in Peru from 1986 to 2010 and has presumably increased further because of PAPT and PRONASAR. The percentage of children with access to piped water increased from 38 per cent in 1986 to 69 per cent in 2010 among children under the age of 5 years, which a particularly dramatic increase in rural areas. National access to flush toilets increased from 23 per cent to 47 per cent while access to latrines increased from 9 per cent to 36 per cent. Over the same time, rates of child diarrhea, malnutrition, and stunting fell.
In this study, the authors sought to make causal claims about whether improving access to sanitation and hygiene led to these improvements in child health outcomes.