Cost effectiveness of hygiene interventions: a methodology

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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, …

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.

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  • 1. Supporting water sanitation and hygiene services for life 1st June, 2014 2014 WASH Sustainability forum Cost-effectiveness of hygiene interventions A methodology Amélie Dubé Mélanie Carrasco
  • 2. Outline 1. Objectives and scope 2. Methodological aspects • Costs • Behaviour changes • Data collection 3. Practical example COST EFFECTIVENESS OF HYGIENE INTERVENTIONS
  • 3. 1. Objectives and scope
  • 4. 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
  • 5. What do we mean by measuring effectiveness? COST EFFECTIVENESS OF HYGIENE INTERVENTIONS Time Year 1 Year X Scope of the methodology Good Acceptable Bad Behaviour Intervention Intervention Intervention HEALTH IMPACTS
  • 6. – 2. The methodology The costs The behaviours The data The limitations
  • 7. The costs
  • 8. 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
  • 9. Costs components COST EFFECTIVENESS OF HYGIENE INTERVENTIONS
  • 10. 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
  • 11. The behaviour changes
  • 12. 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
  • 13. 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
  • 14. What do we mean by measuring effectiveness? COST EFFECTIVENESS OF HYGIENE INTERVENTIONS Year 1 Year 2 Year 3 Year X Time Intervention Intervention Intervention HEALTH IMPACTS Good Acceptable Bad Behaviour Improved Basic Limited Not Effective BehaviourEffectiveness levels
  • 15. 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 Uneffective Handwashing station is not available and household members do not wash their hands. Behaviour 2 Hand washing with soap at critical times
  • 16. Hand washing with soap at critical times
  • 17. 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 Limited Drinking 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)
  • 18. Domestic water management (from source to consumption)
  • 19. 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
  • 20. Feacal containment and latrine use Not effective Improved
  • 21. 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
  • 22. Data collection and limitations
  • 23. Data collection COST-EFFECTIVENESS OF HYGIENE INTERVENTIONS • 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
  • 24. 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
  • 25. 3. Practical example Results from Ouahabou in Burkina Faso Sustainability and ways forward
  • 26. The example of Ouahabou, Burkina Faso Burkina 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
  • 27. Data collection roll-out November 2011 February 2012 November 2012May 2012 Stagesofthe intervention Data collected  Household costs and behaviours data  Intervention (implementing NGO) costs Baseline Survey CLTS workshop 1 CLTS workshop 2 Hygienic campaign in each HH Mid-termSurvey (continuing)  Household costs and behaviours data
  • 28. Looking at the implementer’s costs USD 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$/month Support costs NA NA Cost of capital NA NA
  • 29. EXAMPLE PRESENTATION TITLE HH costs of hand-washing with soap Before the intervention (Nov 2011) After the intervention (Nov 2012) Average cost of soap/HH 4.07 4.38 Average cost of soap but without a latrine/HH 3.18 3.67 Average cost of soap and with a latrine/HH 4.81 5.03 HH cost of latrine building and maintenance Nb new latrines built since Nov 2011 69 Avrage CapEX /HH 22.38 OpEx /month /HH 0.39 Looking at household costs USD 2012
  • 30. Flow chart analysis An example from Burkina Faso Sensibilisation on the type of HW « facility » and on the need for sufficient water made a diffrence here
  • 31. Hand washing with soap 89% 9% 2% 1% 69% 25% 4% 2% 0% 20% 40% 60% 80% 100% Not effective Limited Basic Improved Population in Ouahabou (%) Intervention After Before
  • 32. Changes in fecal containment and latrine use 100% 0% 0% 0% 94% 1% 1% 4% 0% 20% 40% 60% 80% 100% Not effective Limited Basic Improved Population in Ouahabou (%) Intervention After Before
  • 33. Domestic water source and management 24% 59% 3% 13% 31% 50% 5% 14% 0% 20% 40% 60% 80% 100% Not effective Limited Basic Improved Population in Ouahabou (%) Intervention After Before
  • 34. Such changes…. for these costs? Costs components (USD, 2012) Implementer’s cost /HH HH cost (average) CapEx (S and H) 0,34$/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.
  • 35. 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…
  • 36. 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? EXAMPLE PRESENTATION TITLE
  • 37. Visiting address Bezuidenhoutseweg 2 2594 AV The Hague The Netherlands Postal address P.O. Box 82327 2508 EH The Hague The Netherlands T +31 70 3044000 info@ircwash.org www.ircwash.org Supporting water sanitation and hygiene services for life Thank you!