Prepared by Dr. Kwabena Nyarko/ KNUST and others for the Monitoring Sustainable WASH Service Delivery Symposium, 9 - 11 April 2013, Addis Ababa, Ethiopia

1. Hygiene Cost Effectiveness
study in Ghana
Dr. Kwabena Nyarko/ KNUST
Paa kwesi Woode, Kwabena B Nyarko and Bismark Dwumfour-Asare
Kwame Nkrumah University of Science and technology, Kumasi, Ghana

2. Title, speaker
Outline
• Introduction
• Methodology
• Results
– Change in Hygiene Service levels
– Cost of hygiene intervention
– Cost effectiveness of the hygiene
intervention
• Conclusion
Monitoring Sustainable WASH Service Delivery Symposium

3. Title, speaker
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.
Monitoring Sustainable WASH Service Delivery Symposium

4. Title, speaker
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
Monitoring Sustainable WASH Service Delivery Symposium

5. Title, speaker
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.
Monitoring Sustainable WASH Service Delivery Symposium

6. Title, speaker
Hygiene Service level
Effective- Faecal Hand washing with Drinking water source and
ness containment soap/ Management
levels and latrine use Substitute
Highly
improved
Improved
Basic
Limited
Extra text
NoneExtra text
Monitoring Sustainable WASH Service Delivery Symposium

7. Title, speaker
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.
Monitoring Sustainable WASH Service Delivery Symposium

8. Fecal Containment and Latrine Use
Title, speaker
Service Levels
Service Levels Pre-Intervention Post-Intervention
Highly Improved 0% 1%
Improved 0% 0%
Basic 0% 0%
Limited 99% 98%
Extra text
Extra text
No service 1% 1%
Monitoring Sustainable WASH Service Delivery Symposium

9. Title, speaker
Hand washing with Soap Service Levels
Service Levels Pre-Intervention Post-Intervention
Improved 3% 7%
Basic 0% 0%
Limited 23% 57%
No service 74% 36%
Monitoring Sustainable WASH Service Delivery Symposium

10. Title, speaker
Drinking Water Management
Service Levels
Service Level Pre-Intervention Post Intervention
Highly Improved 1% 6%
Improved 33% 52%
Basic 16% 10%
Limited 22% 17%
Not Effective 28% 15%
Monitoring Sustainable WASH Service Delivery Symposium

11. Title, speaker
Total Intervention costs prior to survey
Description (cost Total Cost for 4 Cost per Cost per
classification) communities Household Person
(USD; 2012) (USD; 2012) (USD; 2012)
Household participation 3,961 11 2
cost (CapEx Software)
Household Output 1,397 4 1
(CapEx Hardware)
Household Expenditure 17,481 47 10
on Soap (OpEx)
Implementer Cost 2,133 6 1
(CapEx Software)
Government (ExpDS) 267 1 0.2
Water Supply Costs 81,600 218 44
(CapEx)
Total 106,819 286 57
HH expenditure on soap was for 6 months
Monitoring Sustainable WASH Service Delivery Symposium

12. Title, speaker
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
Monitoring Sustainable WASH Service Delivery Symposium

13. Title, speaker
Cost effectiveness
Indicator % Total Cost for
Total Cost Cost per % Cost per %
Movement 4 per % Change Per Change Per
above Basic communities movement Household Person
Service (USD; 2012) for 4 (USD; 2012) (USD; 2012)
Level communities
(USD; 2012)
Fecal 1 7,758 7,758 21 4
Containment
and Latrine
Use
Hand washing 4 73,976 18,494 49 10
with soap
Drinking 18 87,961 4,887 13 3
Water
Management
Monitoring Sustainable WASH Service Delivery Symposium

14. Title, speaker
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.
Monitoring Sustainable WASH Service Delivery Symposium