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Child Health Indicator

Description

This composite indicator measures a government’s commitment to child health as measured by child mortality, the sound management of water resources and water systems, and proper sewage disposal and sanitary control.

Relationship to Economic Growth

Improving child health leads to a more productive and healthier workforce both presently and in the future. Inadequate water and sanitation is the second leading cause of child mortality; it kills more young children than AIDS, malaria, and measles combined.34 Improved sanitation and increased access to water have numerous economic benefits, including productivity savings in the form of fewer missed days of work or school due to illness from unclean water; the economic contribution of the lives saved from diarrheal disease; decreasing treatment expenditures for diarrheal disease at both the individual and government levels and time savings related to searching for facilities and water collection that would increase time for income-earning work.35 Women, children, handicapped individuals and the very poor are particularly affected by inadequate sanitation and water quality, meaning that improvement in these areas would help these groups the most.36 In children in particular, improved sanitation and water quality have been found to improve learning outcomes due to alleviating the burden of illness and helminthes (parasites) on cognitive development.37

Methodology

Indicator Institution Methodology38

This index is calculated as the average of three, equally weighted indicators:

  • Access to Improved Sanitation: Published by the World Bank, this indicator measures the percentage of the population with access to facilities that hygienically separate human excreta from human, animal, and insect contact. Facilities such as sewers or septic tanks, pour-flush latrines and simple pit or ventilated improved pit latrines are assumed to be adequate, provided that they are not public and not shared with other households. https://data.worldbank.org/indicator/SH.STA.BASS.ZS
  • Access to Improved Water: Published by the World Bank, this indicator measures the percentage of the population with access to at least 20 liters of water per person per day from an “improved” source (household connections, public standpipes, boreholes, protected dug wells, protected springs, and rainwater collection) within one kilometer of the user's dwelling and with collection times of no more than 30 minutes. https://data.worldbank.org/indicator/SH.H2O.BASW.ZS
  • Child Mortality (Ages 1-4): Produced by the Inter-agency Group for Child Mortality Estimation (IGME), this indicator measures the probability of dying between ages 1 and 4. https://childmortality.org

MCC Methodology

Child Health Score = [(Normalized Child Mortality) ÷ 3 ] + [(Normalized Access to Water ÷ 3 ] + [ (Normalized Access to Sanitation) ÷ 3 ]

This index draws on the 2025 Water and Sanitation data representing calendar year 2024 and the 2024 Child Mortality data representing calendar year 2023.39 Country scores are reported on the Scorecards as 2024 data. When some indicators are missing data, the others are used. Since the two sources of this index have different scales, MCC created a common scale for each of the indicators by normalizing them. Please see the equations below.

MCC Methodology to Normalize Water, Sanitation, and Child Mortality Data:

  • Normalized Child Mortality = (Number of countries scoring below Country X on Child Mortality raw data in the income group) ÷ (Number of Countries scoring equal to or greater than Country X on Child Mortality raw data in the income group + Number of countries scoring below Country X on Child Mortality raw data in the income group)
  • Normalized Access to Water = (Number of countries scoring below Country X on At Least Basic Water raw data in the income group) ÷ (Number of Countries scoring equal to or greater than Country X on At Least Basic Water raw data in the income group + Number of countries scoring below Country X on At Least Basic Water raw data in the income group)
  • Normalized Access to Sanitation = (Number of countries scoring below Country X on At Least Basic Sanitation raw data in the income group) ÷ (Number of Countries scoring equal to or greater than Country X on At Least Basic Sanitation raw data in the income group + Number of countries scoring below Country X on At Least Basic Sanitation raw data in the income group)

For example, to calculate a given country X’s score, MCC first finds the number of countries that score worse than that country in the income pool, and the number of countries that have the same or better score than country X on the sub-source.  MCC then divides the number of countries below by the sum of the number of countries below and the number of countries equal or above.  Missing values are not included in these calculations.  Finally, MCC averages the normalized values for each source together. If one source is missing, the average of the normalized scores for the other two is used.  If two sources are missing, the normalized score for the other is used. If all three are missing, the indicator is considered missing and assigned an “N/A”.

Footnotes
  • 34. UNICEF. 2009. Diarrhoea: Why children are still dying and what can be done. Access at:https://www.who.int/publications/i/item/9789241598415.
  • 35. Cumming, Oliver. 2008. Tackling the silent killer: The case for sanitation. London: Water Aid. Organization for Economic Cooperation and Development. 2011. Benefits of Investing in Water and Sanitation: An OECD Perspective. Paris: OECD Publishing. Hutton et al, UNDP (2006) ‘Economic and health effects of increasing coverage of low cost sanitation interventions,’ Human Development Report Office occasional paper Evans, Hutton and Haller (2004), “Closing the sanitation gap: the case for better public funding of sanitation and hygiene”, OECD Round Table on Sustainable Development 2004 UNDP (2006) Human Development Report: Beyond Scarcity: Power, Poverty, and the Global Water Crisis. New York: UNDP. World Bank (2008) Environmental Health and Child Survival: Epidemiology, Economics, and Experiences. Washington, D.C.: The World Bank. Haller L, Hutton G, and Bartram J. (2007). Estimating the costs and health benefits of water and sanitation improvements at global level. Journal of Water and Health 5:4, 476-480. Sijbesma, C. (2008). Sanitation and Hygiene in South Asia: Progress and Challenges. Chapter 25 from Beyond Construction Use by All. IRC, WaterAid and the WSSCC,Delft, Netherlands.
  • 36. Organization for Economic Cooperation and Development. 2011. Benefits of Investing in Water and Sanitation: An OECD Perspective. Paris: OECD Publishing. Evans, Hutton and Haller (2004), “Closing the sanitation gap: the case for better public funding of sanitation and hygiene”, OECD Round Table on Sustainable Development 2004 UNDP (2006) Human Development Report: Beyond Scarcity: Power, Poverty, and the Global Water Crisis. New York: UNDP. World Bank (2008) Environmental Health and Child Survival: Epidemiology, Economics, and Experiences. Washington, D.C.: The World Bank. Sijbesma, C. (2008). Sanitation and Hygiene in South Asia: Progress and Challenges. Chapter 25 from Beyond Construction Use by All. IRC, WaterAid and the WSSCC,Delft, Netherlands.
  • 37. Evans, Hutton and Haller (2004), “Closing the sanitation gap: the case for better public funding of sanitation and hygiene”, OECD Round Table on Sustainable Development 2004 UNDP (2006) Human Development Report: Beyond Scarcity: Power, Poverty, and the Global Water Crisis. New York: UNDP. World Bank (2008) Environmental Health and Child Survival: Epidemiology, Economics, and Experiences. Washington, D.C.: The World Bank. Bethony, Jeffrey, Simon Brokker, Marco Albonico, Stefan M. Geiger, Alex Loukas, David Diemert, and Peter J. Hortez. 2006. Soil-trasmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet, 367: 1521-32.
  • 38. Due to Kosovo's lack of recognition status with the United Nations, Kosovo's data is not included in many UN datasets. The UN still collects and processes these data in line with international standards, but they are published by the UN Kosovo Team (UNKT) on this website. UNKT uses identical collection and validation methods to the UN agencies that produce the underlying datasets.
  • 39. If there are lags in the posting of these data or refreshing of the API, MCC uses the most updated version of this dataset available online from the original data source at the time of scorecard printing.