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Measuring and valuing broader impacts in public health: Development of a sanitation‐related quality of life instrument in Maputo, Mozambique

Ian Ross, Giulia Greco, Charles Opondo, Zaida Adriano, Rassul Nala, Joe Brown, Robert Dreibelbis and Oliver Cumming

Health Economics, 2022, vol. 31, issue 3, 466-480

Abstract: Two billion people globally lack access to a basic toilet. While improving sanitation reduces infectious disease, toilet users often identify privacy, safety and dignity as more important. However, these outcomes have not been incorporated in sanitation‐related economic evaluations. This illustrates the general challenge of outcome measurement and valuation in the economic evaluation of public health interventions, and risks misallocating the US$ 20 billion invested in sanitation in low‐ and middle‐income countries every year. In this study in urban Mozambique, we develop an instrument to measure sanitation‐related quality of life (SanQoL). Applying methods from health economics and the capability approach, we develop a descriptive system to measure five attributes identified in prior qualitative research: disgust, health, shame, safety and privacy. Sampling individuals from the intervention and control groups of a sanitation intervention trial, we elicit attribute ranks to value a SanQoL index and assess its validity and reliability. In combination with a measure of time using a sanitation service, SanQoL can quantify incremental benefits in a sanitation‐focused cost‐effectiveness analysis. After monetary valuation based on willingness to pay, QoL benefits could be summed with health gains in cost‐benefit analysis, the most common method in sanitation economic evaluations.

Date: 2022
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