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Hygiene Cost Effectivenessstudy in GhanaDr. Kwabena Nyarko/ KNUSTPaa kwesi Woode, Kwabena B Nyarko and Bismark Dwumfour-AsareKwame Nkrumah University of Science and technology, Kumasi, Ghana

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Title, speakerOutline • 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

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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

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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

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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

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Title, speaker Hygiene Service levelEffective- Faecal Hand washing with Drinking water source andness containment soap/ Managementlevels and latrine use SubstituteHighlyimprovedImprovedBasicLimited Extra textNoneExtra text Monitoring Sustainable WASH Service Delivery Symposium

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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

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Fecal Containment and Latrine UseTitle, speaker Service LevelsService Levels Pre-Intervention Post-InterventionHighly Improved 0% 1%Improved 0% 0%Basic 0% 0%Limited 99% 98% Extra text Extra textNo service 1% 1% Monitoring Sustainable WASH Service Delivery Symposium

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

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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

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

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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

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Title, speaker Cost effectivenessIndicator % 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 4Containmentand LatrineUseHand washing 4 73,976 18,494 49 10with soapDrinking 18 87,961 4,887 13 3WaterManagement Monitoring Sustainable WASH Service Delivery Symposium

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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