Tag Archives: UNC Water Institute

The true costs of participatory sanitation

Plan International USA and The Water Institute at UNC have conducted the first study to present comprehensive, accurate, disaggregated costs of a WaSH behaviour-change programme.  The study calculated programme costs, and local investments for four community-led total sanitation (CLTS) interventions in Ghana and Ethiopia.

CLTS cost study highlights.jpg

Jonny Crocker, Darren Saywell, Katherine F. Shields, Pete Kolsky, Jamie Bartram, The true costs of participatory sanitation : evidence from community-led total sanitation studies in Ghana and Ethiopia. Science of The Total Environment, vol. 601–602, 1 Dec 2017, pp: 1075-1083. DOI: 10.1016/j.scitotenv.2017.05.279 [Open access]


Evidence on sanitation and hygiene program costs is used for many purposes. The few studies that report costs use top-down costing methods that are inaccurate and inappropriate. Community-led total sanitation (CLTS) is a participatory behaviour-change approach that presents difficulties for cost analysis. We used implementation tracking and bottom-up, activity-based costing to assess the process, program costs, and local investments for four CLTS interventions in Ghana and Ethiopia. Data collection included implementation checklists, surveys, and financial records review. Financial costs and value-of-time spent on CLTS by different actors were assessed. Results are disaggregated by intervention, cost category, actor, geographic area, and project month. The average household size was 4.0 people in Ghana, and 5.8 people in Ethiopia. The program cost of CLTS was $30.34–$81.56 per household targeted in Ghana, and $14.15–$19.21 in Ethiopia. Most program costs were from training for three of four interventions. Local investments ranged from $7.93–$22.36 per household targeted in Ghana, and $2.35–$3.41 in Ethiopia. This is the first study to present comprehensive, disaggregated costs of a sanitation and hygiene behaviour-change intervention. The findings can be used to inform policy and finance decisions, plan program scale-up, perform cost-effectiveness and benefit studies, and compare different interventions. The costing method is applicable to other public health behaviour-change programs.

UNC Water Institute WASH Research Policy Digests

These useful UNC research digests discuss a key article and include literature reviews on the selected topic:

Issue #1, July 2015: Sanitation Subsidies
Our first Digest deals with the difficult issue of when and how to use subsidies for on-site sanitation.

Issue #2, October 2015: WaSH in Healthcare Facilities
Issue two of the WasH Policy Research Digest digs in to the critical issue of WaSH in health care facilities, including a detailed review of WHO and UNICEF’s 2015 report on the topic and a synthesis of literature and solutions to address its impact on infection, mortality, maternal and neonatal health.

Issue #3, March 2016: Handpump Functionality Monitoring
The third issue of the WaSH Policy Research Digest focuses on handpump functionality monitoring. This issue of the Digest explores recent literature on this topic, focusing on policy implications, recommendations, and a call for standardized functionality measurements.

Issue #4, August 2016: Sanitation and Nutrition
Our fourth digest addresses sanitation and nutrition. This issue explores recent literature and the emerging evidence base on the connection between sanitation, nutritional outcomes, and child stunting.

Plan International and the Water Institute at UNC Findings on CLTS

Plan International USA and the Water Institute at the University of North Carolina at Chapel Hill (UNC) have released new findings and results about rural sanitation behavior change processes using the Community-led Total Sanitation (CLTS) approach. Entitled CLTS Learning Series: Lessons from CLTS Implementation in Seven Countries, the research report identifies implications for practice and delivers policy recommendations based on a rigorous review of seven country case studies and their approach to CLTS implementation.

Covering experiences from Haiti, Uganda, Niger, Cambodia, Lao PDR, Nepal, and Indonesia, long-form, individual country reports are complemented by a meta-analysis of all case studies, as well as a shorter, executive summary style briefing paper for rapid review. plan_unc

The reports present common features to CLTS implementation, identifies consistent bottlenecks and enabling conditions, and shares lessons relevant to scaling-up CLTS.

Copies of all reports from this work are available at the project website: https://waterinstitute.unc.edu/clts/

New Video Offers Five Lessons for Sanitation Policy and Practice

A new video from Plan International and the Water Institute at UNC offers a preview of five exciting lessons on sanitation policy and practice, based on findings from operational research on community-led total sanitation (CLTS). These lessons relate to CLTS planning at the national and local levels, its place in national sanitation systems, and the importance of involving local actors. In particular, government officials, teachers, and natural leaders can play important roles in improving access to basic sanitation, and their involvement can ensure sustainable outcomes over time.