Cover -- Contents -- Tables and Figures -- Tables -- 1 Households Using Different Types of Storage for Water Bought from Public Utilities Board, July 2013 -- 2 Water Sources Used in South Tarawa, July 2013 -- 3 Cases of Water- and Vector-Borne Diseases by Treatment Outlet in South Tarawa, July 2013 -- 4 Impact of Inadequate Water and Sanitation on Ecosystem Services That Humans Value, and Associated Common Valuation Approach -- 5 Sources of Data Used to Determine Health-Related Costs of Poor Water and Sanitation -- 6 Actual Expenditure by Cost Centers Attributable to Water-Borne Diseases in South Tarawa, 2012 -- 7 Number of Patients That Visited Clinics and Hospitals for Water-Borne Disease in South Tarawa by Age Group, 2012 -- 8 Assumptions on Patient Visits to Clinics and Hospitals for Treatment By Age Group, July 2013 -- 9 Opportunity Cost Scenarios to Estimate Loss in Economic Productivity Due to Water-Borne Illnesses and the Value of Caregiver's Time -- 10 Medicine Used to Treat Water- and Vector-Borne Diseases in Kiribati -- 11 Estimate of Water- and Vector-Borne Incidence Where Alternative Treatments May Have Been Sought in 2012 -- 12 Economic Burden of Water-Borne Diseases in South Tarawa Under Three Scenarios of Social Discount Rates, 2012 -- 13 National Base Data Used to Estimate the Economic Value of Lives Lost, 2010 and 2011 -- 14 Present Value of Loss of Lives Due to Poor Water and Sanitation Condition Under Three Scenarios of Social Discount Rates in South Tarawa, Average for 2010-2012 -- 15 Total Annual Economic Costs Associated with Poor Water, Sanitation, and Hygiene Conditions in South Tarawa -- Figures -- 1 Map of South Tarawa with the Insert of Kiribati In Relation with the Rest of the South Pacific -- 2 Sources of Water Used in South Tarawa, July 2013.

3 Households with Access to Improved and Unimproved Sanitation in South Tarawa, July 2013 -- 4 Use of Toilet Types by Households in South Tarawa, July 2013 -- 5 Households That Use Beach/Bush For Defecation, Even When They Have Access to Other Types of Toilets, July 2013 -- 6 Relationship Between the Prevalence of the Use of Beach and the Proportion of Traditional Houses in the Village, July 2013 -- 7 Households Using Different Combination of Water and Toilet System Types, July 2013 -- 8 Village Level Health Risk Due to the Use of Unsafe Water and/or Sanitation in South Tarawa Villages, July 2013 -- 9 Multiple Pathways Through Which the Effects of Inadequate Water and Sanitation Services Affect Changes in Ecosystem Goods and Services -- 10 Water-borne Diseases Over Time, 2010-2012, June 2013 -- 11 Average Mortality Caused by Diarrhea by Age Group, 2010-2012, August 2013 -- 12 Tourist and Total Visitor Arrivals to South Tarawa, 1993-2012 -- 13 Economic Burden of Inadequate Water and Sanitation -- 14 Key Components of a System-Based Intervention for Improvements in Water and Sanitation Services and Practices for Reduced Economic Burden -- Foreword -- Acknowledgments -- Abbreviations -- Executive Summary -- Introduction -- Research Methodology -- Analysis of the Water Supply and Sanitation Situation in South Tarawa -- Sanitation -- Combined Water and Sanitation Conditions -- Animal Wastes -- Population Growth and Poverty -- Impacts of Poor Water and Sanitation -- Overview -- Health Impacts -- Impact on the Tourism Industry -- Effect on Coastal Fisheries -- Economic Costs of Inadequate Water and Sanitation -- Valuation Method -- Human Health Costs -- Household Costs Associated with Alternative Treatment Outlets -- Results -- Economic Burden: Loss of Human Lives -- Result: Economic Value of Lives Lost -- Total Economic Burden of Poor Water and Sanitation.

Who Bears the Economic Burden of Poor Water and Sanitation? -- Household Level Costs -- Reducing Economic Burden of Poor Water and Sanitation -- Public Investment -- Improved Cost Recovery in Service Delivery -- Integrated Water, Sanitation, and Hygiene Improvements -- Conclusion -- References -- Annexes -- 1 ADB TA7359-KIR: Tarawa Sanitation Improvement Project - Assessment of the Economic Costs of Inadequate Water Supply and Sanitation Services in South Tarawa, Kiribati -- 2 Logit Regression Analysis of the Relationship Between House Type and Use of Beach -- 3 Relationship Between the Proportion of Household Members Suffering from Diarrhea and Dysentery and Villages in South Tarawa -- 4 Probability of Individuals Suffering from Diarrhea and Dysentery as a Function of Household and Village Characteristics -- 5 Relationship Between the Proportion of Household Members Suffering from Diarrhea and Dysentery (as a Continuous Variable) and Household and Village Level Characteristics -- 6 Willingness to Pay for Improved Water and Sanitation Services.