The study evaluated the cost effectiveness of hygiene promotion programs in Mozambique. It analyzed data from a bilateral program conducted from 2007-2011 that included water supply, sanitation improvements through model latrines, and hygiene education. Baseline and endline data were collected in 30 and 20 communities respectively in targeted and non-targeted areas. The study found that an investment of $5 per person per year resulted in a 5% increase in basic latrine use, 28% increase in basic handwashing, and 57% increase in safe water management. However, the study had limitations as it used secondary data and many proxies due to the independent data collection.

1. Cost effectiveness of hygiene promotion in
Mozambique
Arjen Naafs,
WASHCost Country Coordinator

2. Specificities in Mozambique study
Cost and effectiveness of hygiene promotion components, WASHCost Mozambique, Alana Potter
Monitoring Sustainable WASH Service Delivery Symposium
3 – Methodology of the study
• Study conducted within the following programmes:
– Bilateral programme (2007-2011) with water supply
component and improvement of sanitation through
model latrines and hygiene education
– Baseline and endline data collected by two different
agencies:
• Baseline in 30 communities, incl. 15 in target area,
• Endline in 20 communities, incl. 10 in targeted area
Statistically representative at project level

3. Specificities in Mozambique study
Cost and effectiveness of hygiene promotion components, WASHCost Mozambique, Alana Potter
Monitoring Sustainable WASH Service Delivery Symposium
3 – Methodology of the study
• Flowcharts were adapted
to match the HH
questionnaire conducted
within the bilateral
programme
• Proxies were used for
missing data
• Costs data obtained from project reports and
contracts of bilateral programme

4. Specificities in study
Cost and effectiveness of hygiene promotion components, WASHCost Mozambique, Alana Potter
Monitoring Sustainable WASH Service Delivery Symposium
3 – Methodology of the study
• Cost data allocated by the WASHCost team on hygiene,
sanitation and water activities on project based
assumptions
• Part of the programme was conducted in schools: since
the study is at HH level only, the WASHCost team
allocated part of the costs for HH based on assumptions
• No control group, all changes assigned to the
intervention

5. Hygiene promotion costs
Cost and effectiveness of hygiene promotion components, WASHCost Mozambique, Alana Potter
Monitoring Sustainable WASH Service Delivery Symposium
4 – Results of the study
• Household and district costs were not collected
• Implementer costs:
- Within the range of costs obtained in previous study in
Mozambique for hygiene education programmes
- Results from van de Reep gave 4 USD/person/year (2008)

6. 6
Figure 3: Household expenditure on soap per month
1%1%
4%6%
24%
64%
0
200
400
600
800
1000
1200
number of respondents 1023 383 100 65 17 14
1 - 5 USD$ per
month
6 - 10 USD$ per
month
11 - 15 USD$
per month
16 - 20 USD$
per month
21 - 25 USD$
per month
>25 USD$ per
month
Average per capita per year: 12.62 US$
Data does not permit allocation to hygiene promotion
Comparison with household expenditure

7. Cost and effectiveness of hygiene promotion components, WASHCost Mozambique, Alana Potter
Hygiene behaviours effectiveness
4 – Results of the study

8. Cost-effectiveness of the intervention
Cost and effectiveness of hygiene promotion components, WASHCost Mozambique, Alana Potter
Monitoring Sustainable WASH Service Delivery Symposium
• An investment of 5 USD/ person/ year resulted in:
– 5% increase in basic latrine use (indicator 1):
• All or some household members use a latrine some or most of the time
• When there is no access to a latrine, faeces are generally buried
• Latrine separates users from faecal waste
– 28% increase in basic hand washing (indicator 2):
• Accessible designated handwashing facility
• sufficient water is available for handwashing
• water for handwashing is poured/ not re-contaminated by handwashing
• soap or substitute available and used
• All household members wash their hands with soap/ substitute at critical times
– 57% increase in safe water management (Indicator 3)
• protected water sources are always used
• Collection vessel (if necessary) is regularly cleaned with soap or substitute
• Water storage vessel (if necessary) is uncovered and/or water is not drawn in a safe
manner

9. Cost-effectiveness of the intervention
Cost and effectiveness of hygiene promotion components, WASHCost Mozambique, Alana Potter
Monitoring Sustainable WASH Service Delivery Symposium
4 – Results of the study
• Challenges:
– Only one cost of intervention calculated
(5USD/person/year) but there are 3 indicators,
– How to divide costs among the 3 indicators?
• Analysis is made by setting out % of change across
each key hygiene behaviours, to get a nuanced
understanding of where the change happened

10. Limitations
Cost and effectiveness of hygiene promotion components, WASHCost Mozambique, Alana Potter
Monitoring Sustainable WASH Service Delivery Symposium
• Limitations of the study:
– Secondary data used to test the methodology
– Difficult to distinguish costs between water, sanitation
and hygiene interventions
– Use of many proxy since the HH questionnaire was
developed and used independently from the WASHCost
study
– No household data collected
– Presence of school activities within the programme, not
covered by the WASHCost study
– Not known if additional interventions occurred