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Prepared by Dr. Kwabena Nyarko/ KNUST and others for the Monitoring Sustainable WASH Service Delivery Symposium, 9 - 11 April 2013, Addis Ababa, Ethiopia
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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.
Title, speaker
Monitoring Sustainable WASH Service Delivery Symposium
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
Title, speaker
Monitoring Sustainable WASH Service Delivery Symposium
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.
Title, speaker
Monitoring Sustainable WASH Service Delivery Symposium
Hygiene Service levelTitle, speaker
Extra textExtra text
Monitoring Sustainable WASH Service Delivery Symposium
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.
Title, speaker
Monitoring Sustainable WASH Service Delivery Symposium
Fecal Containment and Latrine Use Service Levels
Title, speaker
Extra textExtra text
Monitoring Sustainable WASH Service Delivery Symposium
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
Monitoring Sustainable WASH Service Delivery Symposium
Service Levels Pre-Intervention Post-Intervention
Improved 3% 7%
Basic 0% 0%
Limited 23% 57%
No service 74% 36%
Drinking Water Management Service Levels
Title, speaker
Monitoring Sustainable WASH Service Delivery Symposium
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
Monitoring Sustainable WASH Service Delivery Symposium
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
Title, speaker
Monitoring Sustainable WASH Service Delivery Symposium
Cost effectivenessTitle, speaker
Monitoring Sustainable WASH Service Delivery Symposium
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.
Title, speaker
Monitoring Sustainable WASH Service Delivery Symposium