The value of hygiene promotion: cost-effectiveness analysis of interventions in developing countries

Authors: Christine Sijbesma, Trea Christoffers

Summary:

Promoting good hygiene can greatly improve the impact of water and sanitation programs in developing countries at a low cost. However, there are few studies with solid data on the costs and effectiveness of specific programs, and even fewer that compare different methods of hygiene promotion.

This article suggests that measuring actual reductions in key sanitation and hygiene risks is a better way to evaluate these programs than using DALYs (a common health measurement). It introduces a framework for analyzing cost-effectiveness, which is applied to six real-world programs. These programs, costing between $1.05 and $1.74 per person per year (in 1999 dollars), led to major improvements. These included almost completely stopping open defecation, keeping toilets clean, safely disposing of children's feces, and washing hands with soap at key times.

However, only two studies used a strong research method (comparing before and after results in both intervention and control areas), and only two tracked costs and long-term effects after the programs ended. To gain the necessary political and management support, all water, sanitation, and hygiene programs should provide data on inputs, costs, processes, and long-term impact. More high-quality research, based on this model, is needed to compare the effectiveness of different hygiene promotion methods.