cost effectiveness of hygiene interventions: a methodology
DESCRIPTION
Presentation of a methodology IRC is using for assessing cost effectiveness of hygiene interventions. By Amélie Dubé and Mélanie Carrasco for the hygiene track of the 2014 WASH Sustainability Forum, RAI, Amsterdam, The Netherlands. 30 June - 1 July 2014.TRANSCRIPT
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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Postal addressP.O. Box 823272508 EH The HagueThe Netherlands
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