The true costs of participatory sanitation: Evidence from community-led total sanitation studies in Ghana and Ethiopia

Abstract

Evidence on sanitation and hygiene program costs is used for many purposes. The few studies that report costs use top-down costing methods that are inaccurate and inappropriate. Community-led total sanitation (CLTS) is a participatory behavior-change approach that presents difficulties for cost analysis. We used implementation tracking and bottom-up, activity-based costing to assess the process, program costs, and local investments for four CLTS interventions in Ghana and Ethiopia. Data collection included implementation checklists, surveys, and financial records review. Financial costs and value-of-time spent on CLTS by different actors were assessed. Results are disaggregated by intervention, cost category, actor, geographic area, and project month. The average household size was 4.0 people in Ghana, and 5.8 people in Ethiopia. The program cost of CLTS was $30.34–$81.56 per household targeted in Ghana, and $14.15–$19.21 in Ethiopia. Most program costs were from training for three of four interventions. Local investments ranged from $7.93–$22.36 per household targeted in Ghana, and $2.35–$3.41 in Ethiopia. This is the first study to present comprehensive, disaggregated costs of a sanitation and hygiene behavior-change intervention. The findings can be used to inform policy and finance decisions, plan program scale-up, perform cost-effectiveness and benefit studies, and compare different interventions. The costing method is applicable to other public health behavior-change programs.

Development and Application of Tools to Cost Delivery of Environmental Health Services in Healthcare Facilities: A Financial Analysis in Urban Malawi

“…While curricula for safety trainings covered all EHS simultaneously, we included the full training costs under each EHS, as each EHS required annual training and costs would not be substantially reduced by removing irrelevant curricula. Waste management had additional costs associated with consumables and capital maintenance for waste transport vehicles, which we estimated using established methods [37].…”

PROTOCOL: Community‐led total sanitation in rural areas of low‐ and middle‐income countries: a systematic review of evidence on effects and influencing factors

“…We can refer to the following "family" of four articles on CLTS in Ethiopia and Ghana (Crocker et al 2016a;2016b;2017a;2017b):…”

“…The fourth study byCrocker et al (2017b) once again considered the same interventions in Ethiopia and Ghana but reported on the costs of their implementation disaggregated by various parameters rather than on their results.…”

Budgeting for Environmental Health Services in Healthcare Facilities: A Ten-Step Model for Planning and Costing

“…Second-round revisions were informed by approximately 1000 hours of field experience across all authors in 12 countries in the World Bank regions for Latin America and the Caribbean, Middle East and North Africa, and Sub-Saharan Africa. For selected published examples, see [20][21][22][23].…”

“…We identified good practices of studies that scored highly in risk of bias assessments compared to studies with low scores (see [15] for details). Additionally, we reviewed selected guidelines for EHS delivery in HCFs [8,[24][25][26][27], costing studies of EHS from non-HCF contexts [23,28,29], guidelines for costing healthcare and HCFs [18,30], and reporting standards for costing [31,32].…”