Measuring Willingness-to-Pay for Water and Sanitation by People Living with HIV and AIDs in South Africa

Ephias M. Makaudze (PhD)

Department of Economics

University of Western Cape, South Africa

The ill-provision of water and sanitation services poses the greatest risk to people living with HIV and AIDS in South Africa - a majority who resides in slum settlements. People living with HIV and AIDS (PLWHA) die after succumbing to opportunistic infections especially water-borne diseases (e.g. diarrhea, cholera).  Currently, about 3.6 million people live in slum settlements across South Africa (AIDs Foundation 2010). With a high rural-to-urban migration rate estimated as 3.5% per year (Barry & Ruther 2005), the population of slum dwellers is expected to double by 2020. Further, it is estimated that a third of this population will be infected with HIV and AIDs (Shisana et al. 2014).

However, one severe challenge faced by local municipalities is the burden of providing clean water and safe sanitation to the rapidly rising urban slum population. Many municipalities are currently struggling to provide efficient water and sanitation delivery services to their citizens, especially in urban slums. Frequent protests by urban residents against poor service delivery (water and sanitation in particular) bear evidence of the severe challenges that many local municipalities across the country are facing. The recent violent protests in Cape Town by slum dwellers in Khayelitsha – in what are often dubbed the ‘toilet wars’ – provides a case in point.

The objective of this study was to assess the willingness-to-pay (WTP) for improvements in water and sanitation by people living with HIV and AIDs (PLWHA) in South Africa. Since the government has declared access to clean water and safe sanitation a basic human right, upholding this fundamental right to PLWHA deserves more priority.  Ensuring adequate access to clean water and safe sanitation is vital as this is likely to prolong the livelihoods as well as enhancing the dignity of PLWHA.

This study was based on 485 HIV and AIDs individuals drawn from three types of settlements (rural, peri-urban and urban slums) and sampled from three selected provincial districts of Khayelitsha (Western Cape Province), Ukhahlamba (Eastern Cape) and Groblersdal (Limpopo). The results show PLWHA having higher WTP for sanitation at ZAR448.40/month compared to water (ZAR428.60).  Those living in urban slum settlements show the highest WTP for sanitation (ZAR552.70), followed by counterparts living in rural areas (ZAR500.24). The results underscore some important implications: PLWHA face greater sanitation challenges relative to water; those in slum settlements endure the worst sanitation hardships compared to counterparts living in other settlement types; Higher WTP for sanitation implies that PLWHA will derive greater benefits from improvements in sanitation relative to water. To conclude, it is imperative for municipal authorities to prioritize the provision of improved sanitation facilities to PLWHA especially in urban slums as part of the “pro-poor service delivery” campaigns.  


Dr Makaudze's full paper is published in Journal of Water, Sanitation and Hygiene for Development, Mar 2016, 6 (1), 161-169; DOI:10.2166/washdev.2016.102

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