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

Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang 37554, Korea

Good Neighbors International, Mozambique, Maputo, Mozambique

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Independent Consultant, Addis Ababa, Ethiopia

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Public Health Institute, Addis Ababa, Ethiopia

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Korea International Cooperation Agency, Seongnam 13449, Korea

Author to whom correspondence should be addressed.

Int. J. Environ. Res. Public Health 2020, 17(14), 5068; https://doi.org/10.3390/ijerph17145068

Received: 7 June 2020 / Revised: 27 June 2020 / Accepted: 2 July 2020 / Published: 14 July 2020

(This article belongs to the Section Global Health)

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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). View Full-Text

Keywords: cost–benefit analysis; community-led total sanitation; Ethiopia; sanitation improvements; household latrine

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MDPI and ACS Style

Cha, S.; Jung, S.; Belew Bizuneh, D.; Abera, T.; Doh, Y.-A.; Seong, J.; Ross, I. Benefits and Costs of a Community-Led Total Sanitation Intervention in Rural Ethiopia—A Trial-Based Ex Post Economic Evaluation. Int. J. Environ. Res. Public Health 2020, 17, 5068. https://doi.org/10.3390/ijerph17145068

AMA Style

Cha S, Jung S, Belew Bizuneh D, Abera T, Doh Y-A, Seong J, Ross I. Benefits and Costs of a Community-Led Total Sanitation Intervention in Rural Ethiopia—A Trial-Based Ex Post Economic Evaluation. International Journal of Environmental Research and Public Health. 2020; 17(14):5068. https://doi.org/10.3390/ijerph17145068

Chicago/Turabian Style

Cha, Seungman, Sunghoon Jung, Dawit Belew Bizuneh, Tadesse Abera, Young-Ah Doh, Jieun Seong, and Ian Ross. 2020. "Benefits and Costs of a Community-Led Total Sanitation Intervention in Rural Ethiopia—A Trial-Based Ex Post Economic Evaluation" International Journal of Environmental Research and Public Health 17, no. 14: 5068. https://doi.org/10.3390/ijerph17145068

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

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