Department of Global Health, University of Washington, 325 9th Avenue (Box 359931), Seattle, WA, 98104, USA.
School of Earth, Ocean and Environment, University of South Carolina, Columbia, SC, USA.
Int J Hyg Environ Health. 2021 Mar;232:113682. doi: 10.1016/j.ijheh.2020.113682. Epub 2020 Dec 24.
We conducted cost effectiveness analyses of four different CLTS interventions implemented in Ethiopia and Ghana. In each country, a pilot approach in which additional local actors were trained in CLTS facilitation was compared to the conventional approach. Data were collected using bottom-up costing, household surveys, and observations. We assessed variability of cost effectiveness from a societal perspective for latrine ownership and latrine use outcomes in different contexts. Cost effectiveness ranged from $34-$1897 per household ($5.85-$563 per person) gaining access to a private latrine or stopping open defecation, depending on the intervention, context, and outcome considered. For three out of four interventions, CLTS appeared more cost effective at reducing open defecation than at increasing latrine ownership, although sensitivity analysis revealed considerable variation. The pilot approaches were more cost effective at reducing open defecation than conventional approaches in Ethiopia, but not in Ghana. CLTS has been promoted as a low-cost means of improving the ownership and use of sanitation facilities. In our study, the cost of CLTS per household gaining latrine access was slightly higher than in other studies, and the cost of CLTS per household stopping OD was slightly lower than in other studies. Our results show that aggregate measures mask considerable variability in costs and outcomes, and thus the importance of considering and reporting context and uncertainty in economic analysis of sanitation interventions.
我们对在埃塞俄比亚和加纳实施的四种不同 CLTS 干预措施进行了成本效益分析。在每个国家，我们都比较了培训更多当地行为者参与 CLTS 促进的试点方法与传统方法。使用自下而上的成本核算、家庭调查和观察收集数据。我们从社会角度评估了在不同背景下，拥有厕所和使用厕所的结果的成本效益的可变性。根据干预措施、背景和考虑的结果，获得私人厕所或停止露天排便的家庭成本效益范围从每户 34 美元到 1897 美元（每人 5.85 美元到 563 美元）。对于四种干预措施中的三种，CLTS 在减少露天排便方面比增加厕所拥有量更具成本效益，尽管敏感性分析显示存在很大差异。在埃塞俄比亚，试点方法在减少露天排便方面比传统方法更具成本效益，但在加纳并非如此。CLTS 一直被宣传为一种低成本手段，可提高卫生设施的拥有率和使用率。在我们的研究中，CLTS 使每户获得厕所使用权的成本略高于其他研究，而 CLTS 使每户停止露天排便的成本略低于其他研究。我们的研究结果表明，总体措施掩盖了成本和结果的巨大可变性，因此在对卫生干预措施进行经济分析时，必须考虑并报告背景和不确定性。
