Benefits and Costs of a Community-Led Total Sanitation Intervention in Rural Ethiopia—A Trial-Based Ex Post Economic Evaluation

Seungman Cha, Sunghoon Jung, Dawit Belew Bizuneh, Tadesse Abera, Young-Ah Doh, Jieun Seong and Ian Ross
Additional contact information
Seungman Cha: Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
Sunghoon Jung: Good Neighbors International, Mozambique, Maputo, Mozambique
Dawit Belew Bizuneh: Independent Consultant, Addis Ababa, Ethiopia
Tadesse Abera: Public Health Institute, Addis Ababa, Ethiopia
Young-Ah Doh: Korea International Cooperation Agency, Seongnam 13449, Korea
Jieun Seong: Korea International Cooperation Agency, Seongnam 13449, Korea

IJERPH, 2020, vol. 17, issue 14, 1-21

Abstract: We estimated the costs and benefits of a community-led total sanitation (CLTS) intervention using the empirical results from a cluster-randomized controlled trial in rural Ethiopia. We modelled benefits and costs of the intervention over 10 years, as compared to an existing local government program. Health benefits were estimated as the value of averted mortality due to diarrheal disease and the cost of illness arising from averted diarrheal morbidity. We also estimated the value of time savings from avoided open defecation and use of neighbours’ latrines. Intervention delivery costs were estimated top-down based on financial records, while recurrent costs were estimated bottom-up from trial data. We explored methodological and parameter uncertainty using one-way and probabilistic sensitivity analyses. Avoided mortality accounted for 58% of total benefits, followed by time savings from increased access to household latrines. The base case benefit–cost ratio was 3.7 (95% CI: 1.9–5.4) and the net present value was Int’l $1,193,786 (95% CI: 406,017–1,977,960). The sources of the largest uncertainty in one-way sensitivity analyses were the effect of the CLTS intervention and the assumed lifespan of an improved latrine. Our results suggest that CLTS interventions can yield favourable economic returns, particularly if follow-up after the triggering is implemented intensively and uptake of improved latrines is achieved (as opposed to unimproved).

Keywords: cost–benefit analysis; community-led total sanitation; Ethiopia; sanitation improvements; household latrine (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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