Results from the Hygiene Cost Effectiveness study in Burkina Faso

Results from the Hygiene Cost Effectiveness study in Burkina FasoJuste Hermann Nansi IRC International Water and Sanitation Centre

Outline• Context• Limitations• Results• Next steps

Hygiene cost effectiveness study in Burkina Faso, Juste NANSI

Monitoring Sustainable WASH Service Delivery Symposium

Context of the HCE methodology application in Burkina Faso





SaniFaso• Four-year rural household sanitation programme running from

2010-2014• Application of National H&S strategy toward MDG in 12 districts• 3 millions Euros budget co-funded by EU• Aiming to improve H&S for 16 000 households by supporting

services management by local authorities, subsidising construction of improved latrines and hygiene promotion (combining CLTS and SARAR/PHAST)

• Implemented in consortium: Eau Vive, GIZ, Helvetas, IRC and WaterAid.

Hygiene Cost / Effectiveness evaluation within SaniFaso



HCE within SaniFaso



November 2011 February 2012 November 2012May 2012

Household costs Household behavioural data

Project costs Household costs Household behavioural data

CLTS workshop in

Ladiana

CLTS workshop 1 in

Ouahabou

CLTS workshop 2 in

Ouahabou

Home visits in Ladiana and Ouahabou Home visits (continuing)


Limitations of the HCE study



About some assumptions

• This study does not capture information about where hand washing water comes from (supposed to be clean while this is often not the case).

• Behaviour is dependent on specific equipment e.g. a family latrine is a necessary condition for hygienic HH sanitation. This approach rules out other scenarios that could be considered as hygienic behaviour: for example, burying faeces or using public latrines which are better than open defecation.



About collected data

• Data on household expenditures are very limited: do not take into account in kind expenditures or sums spent on accessing water from an improved source

• Data on external expenditures do not take into account expenditure for direct support which are very important in hygiene promotion activities e.g SaniFaso staff costs or support given by public health authorities that are involved in the promotion of hygienic behaviour



Result of the HCE study



Effectiveness of SaniFaso on faecal containment and latrine use in Ouahabou

• High effectiveness with 28 HH (from 1 in 2011 to 29 in 2012 owning and using an improved latrine)

• Basic effectiveness with 6 HH (from 0 to 6)• Limited effectiveness with 11 HH (from 0 to 11)• Slight but Positive change (822 HH), taking into account that:

– Not all households had already been covered by home visits of hygiene workers or given opportunity of subsidized latrine

– Most of those able to finance themselves an improved latrine need more than one year from decision to action.



Effectiveness of SaniFaso on domestic water management in Ouahabou• 35 additional HH always use improved water sources and collect

water with appropriate containers (from 446 to 481)

• High effectiveness with 10 HH (from 109 in 2011 to 119 in 2012 with adequate behavior of domestic water management i.e. previous criteria + appropriate drawn)

• Little but Positive change (822 HH), taking into account that:– Not all households have already been covered by home visits of

hygiene workers– All costs related to this behavior improvement are paid by HH, no

subsidies.



Effectiveness of SaniFaso on hand washing with soap at critical times in Ladiana

• All the HH already had hand washing facility in 2011, no change in 2012

• From 2% of HH with good behaviors in 2011 to 0% in 2012

• Surprising observations that need to be shared and discussed with local stakeholders for better understanding and appropriate adjustments in hygiene promotion activities



Costs of hygiene behaviour changes in Ladiana and Ouahabou from 2011 to 2012


Ouahabou (822 HH) Ladiana (271 HH)HH with good behaviour Nov. 2011 Nov. 2012 Nov. 2011 Nov. 2012

Faecal containment and latrine use 1 29 (+3.4%) 0 3 (+1.1%)

Hand washing 26 59 (+4%) 15 5 (-3.7%)

Domestic water management 109 119 (+1.2%) 4 8 (+1.5%)

SaniFaso hygiene promotion costs

841 USD1 USD per HH

1090 USD4 USD per HH

HH latrine CapEx Not available 23 USD / latrine Not available 5.11 USD /

latrine

HH latrine OpEx 1 USD/ latrine 0.75 USD / latrine Not available 0.75 USD /

latrine

HH hand washing OpEx

4.18 USD /month

4.5 USD / month

3 USD / month

2.55 USD / month


Some analysis around Costs and Hygiene behaviour changes• While the target groups of hygiene promotion activities are HH, the

observed expenditures per village are not proportional to the number of HH targeted

• But surprisingly comparing Ladiana to Ouahabou, higher external investment per HH doesn’t induce better effectiveness thus there is an urgent need to reflect on what happened in Ladiana

• Lack of external investment in water induce very limited improvement in domestic water management behavior

• Visibly, higher HH investments lead to better effectiveness of hygiene promotion activities

• Confirm necessity to track costs/effectiveness to improve hygiene interventions



Next steps…



From project evaluation to service monitoring

• Improving SaniFaso hygiene promotion activities based on the results of the HCE study

• Improving and adapting HCE methodology for local authority-led regular hygiene services monitoring to improve decisions/actions

• Enable the embedding of HCE methodology in national hygiene interventions monitoring framework


Barka!Juste Hermann NANSI / IRC

Results from the Hygiene Cost Effectiveness study in Burkina Faso

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