Methodology for a Comprehensive Health Impact Assessment in Water Supply and Sanitation Programmes for Brazil

Debora C. Kligerman, Telma Abdalla de Oliveira Cardoso , Simone Cynamon Cohen , Déborah Chein Bueno de Azevedo , Graziella de Araújo Toledo, Ana Paula Chein Bueno de Azevedo, Sue Charlesworth

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Based on the broader concept of health proposed by the Pan-American Health Organization/World Health Organization (PAHO/ WHO), 2018, and the absence in the literature of indices that translate the causal relationship between sanitation and health, a methodology for assessing the health impact of a water and sanitation programmes, known as a Health Impact Assessment (HIA), was developed, specifically in the Brazilian context, and focused on a school in the northeast of the country. Through exploratory and descriptive evidence, and using documentary research as a method, a retrospective survey was carried out from 2000 to 2022 using documents proposing evaluation methodologies. A single document was found to fit the research objective, which was used to develop the proposed HIA methodology. Development of the methodology consisted of two stages: definition of the health dimensions and selection of the
indicators making up each dimension. The HIA methodology was then applied to a school in northeast Brazil to test its use, before a water-efficient management intervention was going to be used. The overall score of 46% indicated that there was room for improvement, which the new management approach could facilitate. This methodology is therefore proposed to be an instrument for the evaluation of public water and sanitation policies, thus assisting managers in the decision making process and in guiding sanitation programs and plans.
Original languageEnglish
Article number12776
Number of pages28
JournalInternational Journal of Environmental Research and Public Health
Issue number19
Publication statusPublished - 6 Oct 2022

Bibliographical note

This article is an open access article distributed under the terms and
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Funding Information: We would like to thank the Ministry of Science and Technology for the financial support that allowed us to carry out the research; the Israeli company that donated the water production equipment; and the local municipalities and education and health secretariats that helped us with information about the school. We also wish to thank the school management and employees who always received us with such affection and attention and the Presidency of Fiocruz and the direction of the National School of Public Health, the Head of the Department of Sanitation and Environmental Health and the area of communication of FIOCRUZ for the support given to our research. Funding Information: This research was funded by Ministry of Science and Technology and Information. The project funding number is: 14.0015.00/2019. Publisher Copyright: © 2022 by the authors.


  • health impact assessment
  • social determinants of health
  • sanitation
  • evaluation methodology


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