Supporting water sanitationand hygiene services for life

1st June, 20142014 WASH Sustainability forum

Cost-effectiveness of hygiene interventions

A methodology

Amélie Dubé Mélanie Carrasco

Outline

1. Objectives and scope

2. Methodological aspects

• Costs

• Behaviour changes

• Data collection

3. Practical example

COST EFFECTIVENESS OF HYGIENE INTERVENTIONS

1. Objectives and scope

Objectives This methodology has been used to assess:

1. What is the behaviour outcome of hygiene interventions

2. How much does it cost to reach that outcome

By doing so, it aims at:

• Contributing to effective policy making and budgeting at all levels,

• Advocating for improved long-term investment in hygiene,

• Strengthening sector knowledge on the topic.

Ensure a sustainable behaviour change in population

Who should use this methodology ?

Project implementers

Service authorities

COST EFFECTIVENESS OF HYGIENE INTERVENTIONS

What do we mean by measuring effectiveness?

 

COST EFFECTIVENESS OF HYGIENE INTERVENTIONS

Time Year 1 Year X

Scope of the methodology

Good

Acceptable

Bad

Beh

avio

ur

Inte

rventi

on

Inte

rventi

on

Inte

rventi

on

HEALTHIMPACTS

– 2. The methodologyThe costsThe behavioursThe dataThe limitations

The costs

Looking at the costs

EXERCISE 1

You are planning and budgeting for an hygiene components to be effective and last for the next five years

1. What costs will you need to plan for and budget?

2. Write each cost on a post-it (one cost per card)

COST EFFECTIVENESS OF HYGIENE INTERVENTIONS

Costs componentsCOST EFFECTIVENESS OF HYGIENE INTERVENTIONS

Looking at the costs

EXERCICE 1 (cont’d)

Please categorise your identified costs according to the life-cycle cost components in the pie chart

Q&A

COST EFFECTIVENESS OF HYGIENE INTERVENTIONS

The behaviour changes

Behaviour indicators

EXERCICE 2

Buzz groups: if you could choose only two indicators to measure behaviour change, which ones would you choose?

COST EFFECTIVENESS OF HYGIENE INTERVENTIONS

Behaviour indicators chosen

We cannot look at all the behaviours…

Our pick:

• Hand-washing with soap (after defecation/before eating)

• Use of safe sanitation facilities

• Domestic water management (from source to consumption)

…by households members

COST EFFECTIVENESS OF HYGIENE INTERVENTIONS

What do we mean by measuring effectiveness?

 

COST EFFECTIVENESS OF HYGIENE INTERVENTIONS

Year 1 Year 2 Year 3 Year X Time

Inte

rventi

on

Inte

rventi

on

Inte

rventi

on

HEALTHIMPACTS

Good

Acceptable

Bad

Beh

avio

ur Improv

ed

Basic

Limited

Not Effective

Beh

avio

ur

Eff

ecti

ven

ess

levels

Handwashing with soap (or substitute) at critical times

Improved

A handwashing facility is available

Water for handwashing is not re-contaminated by handwashing

 Soap is available and used by household members for handwashing

All household members wash their hands at two critical times

Limited

Water for handwashing is not poured away after washing and is re-contaminated

 Soap is not available and/ or is not used by household members for handwashing

 Some household members wash their hands at least one of the two critical times

UneffectiveHandwashing station is not available and household members do not wash their hands.

Behaviour 2 Hand washing with soap at critical times

Hand washing with soap at critical times

Domestic water management from source to consumption

Improved

Domestic water always comes from an improved source The collection and storage vessels are covered Water is drawn using a vessel or tap

Basic

Domestic water always comes from an improved source The collection and storage vessels are not covered AND/OR Water is not drawn using a vessel or tap

LimitedDrinking water does not always come from an improved source 

Uneffective

Drinking water never comes from an improved source 

Behaviour 3

Domestic water management (from source to consumption)

Domestic water management (from source to consumption)

Faecal containment and latrine use

Improved

All household members use a latrine all the time

The latrine used separates users from fecal waste

Basic

All or some household members use a latrine some or most of the time The latrine used separates users from fecal waste

Limited

The latrine does not provide adequate separation between users and fecal waste All or some household members use a latrine some or most of the time 

Uneffective Open defecation

Behaviour 1

Fecal containment and latrine use

Feacal containment and latrine use

Not effective

Improved

Using the flow charts

EXERCICE 3 – per table:

1. Based on the example presented, fill-in the flowchart on your table with help of the effectiveness ladder

2. Q&A and discussion

Data collection and limitations

COST-EFFECTIVENESS OF HYGIENE INTERVENTIONS

Data collection

• Households survey : Comprehensive survey, f2f and observations on behaviours and costs data collection

– Paper based or via mobile technology (app)

• Cost survey : To be submitted to implementing agencies (NGOs, local/national health and WASH authorities) involved in the intervention

– Paper based/Excel

• Other information on the intervention and on other present and

past intervention taking place in the intervention area

Limitations

• This approach rules out scenarios that could also be considered as hygienic behaviour (e.g. burying feces or using public latrines which are better than open defecation)

• Economic costs for HH (sums spent on accessing water from an improved source, time spent building latrines etc..) are not taken into account

• It doesn’t take into account “interferences” from other past or present overlapping interventions

3. Practical exampleResults from Ouahabou in Burkina FasoSustainability and ways forward

The example of Ouahabou, Burkina FasoBurkina Faso :

• Human Development Index : 183/187 in 2012 (UNDP, 2013)

• Improved sanitation coverage in rural areas: 0,8 %; Water access in rural areas : 60% (Gov BKF, 2011)

The intervention (2011-2014) :

• Sanitation and hygiene programme, in 12 rural communes

• CLTS like approach + subsidies for the poorest

• HH promotion campaigns for hygienic practices

Ouahabou village:

• 6,000 inhab; 822 HH surveyed

Data collection roll-out

November 2011

February 2012

November 2012

May 2012

Sta

ges o

f th

e

inte

rven

tion

Data

collecte d

Household costs and behaviours data

Intervention (implementing NGO) costs

Base

line

Surv

ey

CLTS workshop

1

CLTS workshop

2

Hygienic campaign in each HH Mid

-term

Su

rvey

(continuing)

Household costs and behaviours data

Looking at the implementer’s costsUSD 2012

Costs components NGO Cost for the village of Ouahabou cost/household

Capital expenditure (software) CapExS 239$ /year 0.29$ /year

Capital expenditure (hardware) CapExH 43$ /year 0.05$/year

Recurrent expenditure OpEx 54$/month 0.07$/month

Support costs NA NA

Cost of capital NA NA

EXAMPLE PRESENTATION TITLE

HH costs of hand-washing with soap

Before the intervention (Nov 2011)

After the intervention (Nov 2012)

Average cost of soap/HH 4.07 4.38Average cost of soap but without a latrine/HH 3.18 3.67Average cost of soap and with a latrine/HH 4.81 5.03

HH cost of latrine building and maintenance

Nb new latrines built since Nov 2011 69

Avrage CapEX /HH 22.38

OpEx /month /HH 0.39

Looking at household costsUSD 2012

Flow chart analysisAn example from Burkina Faso

Sensibilisation on the type of HW « facility » and on the need for sufficient water made a diffrence here

Hand washing with soap

Not effective

Limited

Basic

Improved

0% 20% 40% 60% 80% 100%

89%

9%

2%

1%

69%

25%

4%

2% After

Before

Population in Ouahabou (%)

Inte

rven

tion

Changes in fecal containment and latrine use

Not effective

Limited

Basic

Improved

0% 20% 40% 60% 80% 100%

100%

0%

0%

0%

94%

1%

1%

4% After

Before

Population in Ouahabou (%)

Inte

rven

tion

Domestic water source and management

Not effective

Limited

Basic

Improved

0% 20% 40% 60% 80% 100%

24%

59%

3%

13%

31%

50%

5%

14% After

Before

Population in Ouahabou (%)

Inte

rven

tion

Such changes…. for these costs?

Costs components(USD, 2012) Implementer’

s cost /HHHH cost

(average)

CapEx (S and H) 0,34$/HH 22,38$/HH

OpEx 0,07$/month/HH 5$/month/HH

• Conclusion: Low investment on facilities (CapEx) shows little effect on behaviour change.

• For a latrine, HH spent 65 times more than the implementing NGO!!

• On average HH spend 5$/month to maintain their “good” behaviours, ie : to buy soap and maintain their latrines.

The added value of this methodology

• It provides a good indication of whether an intervention is successful or not,

• It identifies where the bottle necks are in the sequencing of behaviour changes,

• It indicates not only the costs involved to obtain such a change, as it looks at the sources of financing.

Currently being used and further developed in Bhutan, Bangladesh, Ethiopia, Uganda, Sierra Leone and Burkina Faso…

EXAMPLE PRESENTATION TITLE

How about sustainability?

Given the opportunity, the methodology can indicate (un)sustainable behaviour changes and its associated costs

…but it doesn’t solve the bigger issues such as :

• How to ensure the regularity of hygiene interventions for sustainable changes in populations?

• Who should finance and implement them?

• What is (should) be the role of public health, health and education authorities in WASH-related hygiene interventions?

• How to (better) support populations (households) in maintaining these behaviours?

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T +31 70 3044000info@ircwash.org www.ircwash.org

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