Next Article in Journal
Shale Gas Development and Community Distress: Evidence from England
Previous Article in Journal
Reclaiming ʻĀina Health in Waimānalo
Open AccessArticle

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

1
Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
2
Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang 37554, Korea
3
Good Neighbors International, Mozambique, Maputo, Mozambique
4
Independent Consultant, Addis Ababa, Ethiopia
5
Public Health Institute, Addis Ababa, Ethiopia
6
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)
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 cost–benefit analysis; community-led total sanitation; Ethiopia; sanitation improvements; household latrine
Show Figures

Figure 1

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.

Show more citation formats Show less citations formats
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Search more from Scilit
 
Search
Back to TopTop