Health Policy and Planning Advance Access originally published online on August 24, 2009
Health Policy and Planning 2009 24(6):418-427; doi:10.1093/heapol/czp036
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The value of hygiene promotion: cost-effectiveness analysis of interventions in developing countries
1 Senior Programme Officer, IRC International Water and Sanitation Centre, The Netherlands.
2 Formerly Programme Officer, IRC International Water and Sanitation Centre, The Netherlands.
* Corresponding author. IRC International Water and Sanitation Centre, P.O. Box 2869, 2601 CW Delft, The Netherlands. Tel: +31-15–2192939/+31-343–457828. Fax +31-15–2190955. E-mail: sijbesma{at}irc.nl
Hygiene promotion can greatly improve the benefits of water and sanitation programmes in developing countries at relatively limited costs. There are, however, few studies with hard data on the costs and effectiveness of individual programmes and even fewer have compared the cost-effectiveness of different promotional approaches. This article argues that objectively measured reductions of key sanitation and hygiene risks are better than DALYs for evaluating hygiene and sanitation promotion programmes. It presents a framework for the cost-effectiveness analysis of such programmes, which is used to analyse six field programmes. At costs ranging from US$1.05 to US$1.74 per person per year in 1999 US$ values, they achieved (almost) complete abandonment of open defecation and considerable improvements in keeping toilets free from faecal soiling, safe disposal of child faeces, and/or washing hands with soap after defecation, before eating and after cleaning children's bottoms. However, only two studies used a quasi-experimental design (before and after studies in the intervention and – matched – control area) and only two measured costs and the degree to which results were sustained after the programme had ended. If the promotion of good sanitation and hygiene is to receive the political and managerial support it deserves, every water, sanitation and/or hygiene programme should give data on inputs, costs, processes and effects over time. More and better research that reflects the here-presented model is also needed to compare the cost-effectiveness of different promotional approaches.
Key Words: Hygiene promotion, behaviour change, costs, effectiveness, social research, public health policy, water sector policy, developing countries
Accepted for publication 29 May 2009.