Cost and effectiveness of water, sanitation and hygiene promotion intervention in Ghana: the case of four communities in the Brong Ahafo region

Paa Kwesi Woode,Bismark Dwumfour-Asare,Kwabena Biritwum Nyarko,Eugene Appiah-Effah

doi:10.1016/j.heliyon.2018.e00841

Abstract

Knowledge of cost and effectiveness of Ghana's main hygiene promotion intervention (HPI), Community-Led Total Sanitation (CLTS), is critical for policy direction. Cost and resultant effect of HPI is examined using a case study of four communities. Surveys were conducted with 300 households, CLTS implementers and relevant agencies during the study period (May 2012 to February 2014). The HPI produced marginal but statistically significant effect (8%, p < 0.001). Improvement in hygiene behaviour was statistically associated with both government investments (p < 0.001) and household investments (p < 0.001). Actual HPI cost is US$ 90 per household: US$ 51 and 39 from government and households respectively. Cost-effectiveness of the HPI is US$ 106.42 per capita of improved hygiene behaviour.

Highlights

Hygiene practices are invaluable in improving public health (Kemeny, 2007; PrussUstun et al, 2014). Pruss-Ustun et al (2014) estimate that in 2012 over 1 million deaths were attributable to inadequate and poor sanitation, drinking water and hand hygiene
It is asserted that supply-led sanitation provision in the form of infrastructure subsidies or direct investment may not be effective at reducing diarrheal diseases risk if good hygiene behaviours are not promoted (Potter et al, 2011; Rheinlander et al, 2010)
Upon realization of the critical role hygiene plays in achieving significant positive impact from water and sanitation interventions, several approaches have arisen to promote hygiene as an integral part of any WASH intervention

Summary

Introduction

Hygiene practices are invaluable in improving public health (Kemeny, 2007; PrussUstun et al, 2014). Pruss-Ustun et al (2014) estimate that in 2012 over 1 million deaths were attributable to inadequate and poor sanitation, drinking water and hand hygiene. There is significant incremental effect of hygiene intervention to water and sanitation (Mahon and Fernandes, 2010; Mason et al, 2013; Lawan et al, 2010). Community-Led Total Sanitation (CLTS) is an example of such hygiene promotion approaches that is aimed at changing behaviours positively towards sanitation and hygiene (Kar and Chambers, 2008). CLTS is a participatory community-centred approach to improving sanitation coverage by increasing hygiene awareness through the use of shame (Kar and Chambers, 2008). CLTS aims to raise community consciousness and to stimulate improved hygiene behaviour and sanitation practices (Kar and Milward, 2011; Chambers, 2009)

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Results

Conclusion