CBA framework for Total Sanitation Campaign in India.

1. Curious Case of Missing Latrines Cost-Benefit framework for rural implementation of Total Sanitation Campaign in India By – Nolan Hendon, Thanh Cong Gian and Kartik Trivedi

2. Outline Introduction Background Stakeholders Costs Benefits Conclusion

3. Introduction Analytical framework for sanitation program in rural India Evaluating the resource allocation for the program Development of Cost-Benefit framework to compare individual household latrines (IHHL) and community latrines (CL) Impact on various stakes holders

4. Background 4% of global disease burden is because of sanitation related problems Major cause of child mortality and morbidity Great loss to efficiency Requires massive scale intervention Intervention needs to be community centric Should involve informing and motivating Our focus is on its rural implementation

5. Sanitation program in India is known as ‘Total Sanitation Campaign’ (TSC) TSC was launched in 1986 By turn of the century it’s roles were finalized as – Support the construction of Individual household latrines Conversion of dry latrines to water-flush latrines Construction of sanitary complex for women Construct community and institutional latrines Development of sanitary marts

6. Stakeholders Government of India State Government Gram Panchayat Constructors Beneficiaries Public

7. Processes under TSC Information Education and Communication (IEC) Construction Maintenance

8. Cost Construction costs as transfers 3 level of government + beneficiaries give and constructors receives IEC costs are borne by Government Maintenance costs are borne by Gram Panchayat and Beneficiaries Operational costs are borne by beneficiaries Different cost sharing ratios for people below and above poverty line

9. Cost Sharing

10. More on Costs… Framework developed to evaluate costs and benefits at individual level Least burden on beneficiary in case of CL, very little or no operational or maintenance cost We didn’t include institutional latrines Only considering manufacturing of new latrines Monitoring and auditing costs to be borne by state government

11. Benefits Direct Economic Benefits of Avoided Incidents of Diarrhea Indirect Economic Benefits of Avoided Incidents of Diarrhea Non-Health Benefits All benefits assume reduction in diarrheal diseases of 22% to 36% with TSC implementation.

12. Direct Economic Benefits of Avoided Incidents of Diarrhea Reduced visits to medical treatment centers. WHO figure estimates 30% of diarrhea sufferers will seek treatment. 8.2% of these 30% will be hospitalized for an average of 5 days. Benefits the Indian public. Universal health care. Below poverty line families receive free health care.

13. Indirect Economic Benefits of Avoided Incidents of Diarrhea Increased productivity from less morbidity and deaths. Each case assumes (WHO estimates): 2 days missed work, age 15 and older. 3 days missed school, age 3 to 14. 5 days ill, age 0 to 4. Uses average wage for given village as opportunity cost, about 67 Rupees (not national GNI). Discount rates of both 3% and 7% for deaths.

14. Non-Health Benefits Time savings Closer latrines Less time waiting for public latrines WHO estimates that this time savings is 30 minutes per person per day, and values their time at 100% of average wage. Sensitivity analysis with 15 minutes saved, valued at 50% wage.

15. Difficulties in Assessing Benefits All depend on being able to forecast reduction in diarrhea from TSC campaign. All use numbers which are extremely difficult to attain Time savings Percent sick who visit a treatment center Reduction in disease from campaign implementation.

16. Conclusion Intangible benefits Tangible costs Transfers as burden for beneficiaries Helps in evaluating balanced approach between IHHL and CL Thin demarcation between beneficiary and public Gram Panchayats are yet to evolve completely as data managing agencies, therefore lack of local data Framework helps in providing financial proof of benefits Can be used as communication tool to motivate beneficiaries

17. Thank you