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Open AccessReview

Quantifying Averted Disability-Adjusted Life Years as a Performance Indicator for Water Quality Interventions: A Review of Current Methodologies and Challenges

1
Department of Environment Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
2
Mortenson Center for Engineering in Developing Communities, University of Colorado at Boulder, Boulder, CO 80309, USA
*
Author to whom correspondence should be addressed.
Current affiliation: Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC 27599, USA.
Water 2018, 10(6), 744; https://doi.org/10.3390/w10060744
Received: 23 April 2018 / Revised: 24 May 2018 / Accepted: 5 June 2018 / Published: 7 June 2018
Sustainable access to safe drinking water protects against infectious disease and promotes overall health. Despite considerable progress toward increasing water access, safe water quality and reliable service delivery remain a challenge. Traditional financing strategies pay implementers based on inputs and activities, with minimal incentives for water quality monitoring and sustained service operation. Pay-for-performance offers an alternative financing strategy that delivers all or a portion of payment based on performance indicators of desired outputs or outcomes. A pay-for-performance approach in the water sector could quantify and incentivize health impact. Averted disability-adjusted life years (ADALYs) have been used as a performance indicator to measure the burden of disease averted due to environmental health interventions. Water-related disease burden can be measured for application as an ADALYs performance indicator following either comparative risk assessment or quantitative microbial risk assessment. Comparative risk assessment models disease burden using water source type as a proxy indicator of microbial water quality, while quantitative microbial risk assessment models disease burden using concentrations of indicator pathogens. This paper compares these risk assessment methodologies, and summarizes the limitations of applying these approaches toward quantifying ADALYs as a performance indicator for water quality interventions. View Full-Text
Keywords: water quality; disease burden; ADALYs; pay for performance; results based financing; monitoring water quality; disease burden; ADALYs; pay for performance; results based financing; monitoring
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MDPI and ACS Style

Anderson, D.M.; Thomas, E.A.; Clasen, T.F. Quantifying Averted Disability-Adjusted Life Years as a Performance Indicator for Water Quality Interventions: A Review of Current Methodologies and Challenges. Water 2018, 10, 744.

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