Background: Sanitation and hygiene coverage in Bangladesh remain inadequate, with >25% of the population not accessing basic services and >70% not accessing safely managed services (SMS). Low coverage causes significant health, social, environmental and economic impacts on the population. Methods: This study models the economic damages of inadequate sanitation, the costs of providing sanitation, and cost-benefit ratios. Costs include capital, operations and maintenance. Damages include health impacts (medical costs, lost productivity, value of life) and loss of time from accessing sanitation. Benefits include averted damages, reuse of sanitation products as biofertilizer and greenhouse gas emissions reduced. Data are sourced from reports of government and development partners, and peer reviewed literature. Results: The economic cost of inadequate sanitation in Bangladesh is US12. 7 billion in 2024, which is equivalent to 3% of Gross Domestic Product. Major contributors are the opportunity costs of time (20. 7%) and premature death (77. 0%). Medical costs equate with 2. 2% of total healthcare expenditure. The total cost of reaching universal household SMS from 2024-2030 is US21. 5 billion. Benefits exceed costs by 3. 8 times (rural 5. 4 and urban 2. 4) over the course of 20 years and generate an annual economic rate of return of 85%. Cost per DALY averted is US1, 153. Conclusion: The economic burden of inadequate sanitation remains high in Bangladesh due to health and productivity impacts of shared and unimproved sanitation and the low rates of safe human excreta management. High economic returns of providing SMS shown in this study suggests SMS investment is a deserving use of public and private funds.
Hutton et al. (Fri,) studied this question.