Hygiene Cost Effectiveness study in Ghana

Hygiene Cost Effectiveness study in GhanaDr. Kwabena Nyarko/ KNUST

Paa kwesi Woode, Kwabena B Nyarko and Bismark Dwumfour-AsareKwame Nkrumah University of Science and technology, Kumasi, Ghana

Outline• Introduction• Methodology• Results

– Change in Hygiene Service levels– Cost of hygiene intervention– Cost effectiveness of the hygiene

intervention

• Conclusion

Title, speaker

Monitoring Sustainable WASH Service Delivery Symposium

Hygiene Promotion Interventions (HPIs)• Hygiene promotion interventions are project

cycle-based activities aimed at changing hygiene behaviours in targeted populations within a particular time frame (Potter et al, 2011).

• Cost-effectiveness, the cost of a unit effect of an intervention, is largely unknown for HPIs etc.

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Objectives• To assess the cost-effectiveness of Hygiene

Promotion Interventions (HPIs)– Determine Hygiene Service levels before and after the

intervention– Find the total costs of the intervention (Households,

Intervention Implementers and Government)– Compare costs to change in Hygiene Service levels.

• This presentation is focused on the short terms effects, conducted immediately after the completion of the hygiene intervention

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Method• Hygiene Service levels determined by pre- and post

intervention household surveys (May 2012 and January 2013).

• Cost Data collected at all stages of intervention for all actors:– Household– Implementer– Government

• Hygiene Service levels assessed by the use of WASHCost Hygiene Service Levels.

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Hygiene Service levelTitle, speaker

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Effective-ness levels

Faecal containment and latrine use

Hand washing with soap/Substitute

Drinking water source andManagement

Highlyimproved

Improved

Basic

Limited

None

Description of Intervention• Modified Community Led Total Sanitation

(modified CLTS).

• Community triggering, education and construction of hand pump boreholes.

• Four (4) Selected rural communities in the Brong Ahafo Region, with total population of 1,870.

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Fecal Containment and Latrine Use Service Levels

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Service Levels Pre-Intervention Post-Intervention

Highly Improved 0% 1%

Improved 0% 0%

Basic 0% 0%

Limited 99% 98%

No service 1% 1%

Hand washing with Soap Service LevelsTitle, speaker


Service Levels Pre-Intervention Post-Intervention

Improved 3% 7%

Basic 0% 0%

Limited 23% 57%

No service 74% 36%

Drinking Water Management Service Levels

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Service Level Pre-Intervention Post Intervention

Highly Improved 1% 6%

Improved 33% 52%

Basic 16% 10%

Limited 22% 17%

Not Effective 28% 15%

Total Intervention costs prior to surveyTitle, speaker


Description (cost classification)

Total Cost for 4 communities(USD; 2012)

Cost per Household (USD; 2012)

Cost per Person (USD; 2012)

Household participation cost (CapEx Software)

3,961 11 2

Household Output (CapEx Hardware)

1,397 4 1

Household Expenditure on Soap (OpEx)

17,481 47 10

Implementer Cost (CapEx Software)

2,133 6 1

Government (ExpDS) 267 1 0.2

Water Supply Costs (CapEx)

81,600 218 44

Total 106,819 286 57HH expenditure on soap was for 6 months

Cost effectiveness• Fecal Indicator Cost

– HH participation + HH output (facilities) + implementer + government

• HWWS Cost – HH participation + HH OpEx + implementer +

government + water supply costs• Drinking Water Cost

– HH participation + implementer + government + water supply costs

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Cost effectivenessTitle, speaker


Indicator % Movement above Basic Service Level

Total Cost for 4 communities (USD; 2012)

Total Cost per % movement for 4 communities (USD; 2012)

Cost per % Change Per Household (USD; 2012)

Cost per % Change Per Person (USD; 2012)

Fecal Containment and Latrine Use

1 7,758 7,758 21 4

Hand washing with soap

4 73,976 18,494 49 10

Drinking Water Management

18 87,961 4,887 13 3

Conclusions• Drinking Water Management has highest cost-

effectiveness, followed by Fecal Containment and Latrine Use and then Hand washing with soap.• Drinking Water Management - Cost effectiveness value

of USD 3 per Percentage change per Person.• The cost effectiveness with regards to Faecal

Containment and Latrine Use and Hand Washing With Soap were USD 4 and 10 per Percentage change per Person respectively.

• Cost-effectiveness of hygiene service level indicators varies widely.

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Business

Hygiene Cost Effectiveness study in Ghana