A cost analysis of hygiene promotion interventions in Mozambique : paper presented at the IRC symposium ‘ Pumps, Pipes and Promises: Costs, Financ...

Lack of access to safe drinking water, inadequate sanitation and poor hygiene causes 2.2 million deaths each year in the developing world, mostly children. Reduction in poverty and improved health can only be achieved if water and sanitation facilities are used hygienically by all. One of the methods that aim to achieve this goal is hygiene promotion.

There seems to be a knowledge gap in the WASH sector when it comes to the costs of hygiene promotion interventions. The purpose of undertaking this study was to increase knowledge on this subject by collecting, analysing and reporting the costs of several hygiene promotion interventions in Mozambique. An understanding of the costs of hygiene promotion is a first step towards assessing its cost-effectiveness, or “value for money”.

The main question this study answers is: what are the full life cycle costs per capita of hygiene promotion interventions in Mozambique? To answer this question requires performing a type of analysis which is often referred to as a cost analysis.

This cost analysis was carried out using a societal perspective covering the five year period from 2005 to 2010. Cost data was obtained from organisations involved in supporting and providing hygiene promotion interventions and households. Cost data was collected through various means including : publically available project reports, internal project reports, financial statements, key informant interviews, and focus group discussions. Cost data from households was obtained through household questionnaires.

The cost per capita for implementing four Community Education Programmes (Programa de Educação Communitaria-PEC) ranged from the equivalent of US$ 1 to US$ 15 per year, using a Purchasing-Power Parity (PPP) conversion. The average cost of these projects in 2008 US dollars was US$ 4. Large differences in costs were found among the four different approaches to community education implementation. Expenditure on direct support by supporting organisations was calculated to cost the equivalent of US$ 0.11 per capita per year. These support costs were on average 12% of the total implementation costs. Household costs of hygiene promotion, as time spent on hygiene promotion activities was US$ 0.31 per capita per year. These costs, did however, only apply to the 19.5% of the people who actually reported to have attended a hygiene promotion intervention in the past year. Other household investments related to hygiene practices were also determined. The average household investments on handwashing facilities was US$ 0.97 per capita, with an additional US$ 12.62 per capita per year spent on the purchase of soap. Current data does not permit direct allocation of these costs to a particular type of intervention, but they are considered relevant as they are potentially a direct consequence of hygiene promotion activities.

Cost analysis of the kind described in this paper will be especially valuable when combined  with studies to show the effectiveness of different approaches to hygiene education. [authors abstract]