Benefits and costs of rural sanitation interventions in Ghana

Abstract

Community-led total sanitation (CLTS) has triggered households around the world to adopt latrines, but evidence suggests that CLTS does not usually lead to universal latrine coverage. Additional interventions, such as subsidies for the poor, may be necessary to eliminate open defecation. While subsidies can improve sanitation-related outcomes, no prior studies have compared the net benefits of CLTS plus subsidies to CLTS-only. This paper presents a comparative analysis for rural Ghana, where efforts to reduce open defecation have had limited success. We analyze the costs and benefits of: (1) a CLTS-only intervention, as implemented in Ghana, and (2) a variant of CLTS that provides vouchers for latrines to the poorest households in high sanitation adoption communities. We find that CLTS-only fails a deterministic benefit-cost test and that only about 30% of 10,000 Monte Carlo trials produce positive net benefits. CLTS plus subsidies satisfy a benefit-cost criterion in the deterministic case, and in about 55% of the Monte Carlo trials. This more favorable outcome stems from the high adoption communities passing the threshold needed to generate positive health externalities due to improved community sanitation. The results suggest that a well-targeted CLTS plus subsidies intervention would be more effective in Ghana than CLTS-only.

Determinants of Open Defecation Among Rural Women in Ghana: Analysis of Demographic and Health Surveys

“…During these periods, notable interventions such as Community Led Total Sanitation (CLTS), National Community Water and Sanitation Programme (NCWSP) were implemented in rural communities and small towns to enhance access to safe water, sanitation and hygiene as way to improving living standards. However, these interventions failed to produce the anticipated outcomes due to financial constraints, weak sector coordination and collaboration, poor operations and maintenance culture, and inadequate hygiene education and sanitation 33 , 34 . The rates of OD observed in this study align with earlier studies carried out in Ghana 49.5%, 15 and Benin 53.9%.…”

The Impact of Pro-Poor Sanitation Subsidies in Open Defecation-Free Communities: A Randomized, Controlled Trial in Rural Ghana

“…Our cost-effectiveness analysis suggested that implementing this subsidy program after CLTS may contribute to maintaining and improving on the benefits of CLTS alone, although at a somewhat higher cost. A previous hypothetical benefit–cost study comparing these two scenarios 41 estimated the combination to be more cost effective than CLTS alone, although that study could not integrate actual program impacts or the overall sanitation decline, which were not yet known. In addition, that study focused on health benefits, including positive externalities associated with high levels of community sanitation coverage, 41 whereas we focused on benefits in sanitation outcomes.…”

“…A previous hypothetical benefit–cost study comparing these two scenarios 41 estimated the combination to be more cost effective than CLTS alone, although that study could not integrate actual program impacts or the overall sanitation decline, which were not yet known. In addition, that study focused on health benefits, including positive externalities associated with high levels of community sanitation coverage, 41 whereas we focused on benefits in sanitation outcomes. Notably, we included two categories of benefits in our analysis, representing households no longer practicing open defecation and those upgrading from nondurable to durable toilets.…”

“… 40 Recently, a hypothetical comparative benefit–cost analysis focused on Ghana suggested that CLTS combined with well-targeted subsidies could be more cost effective than CLTS alone. 41 The subsidy program we evaluate here (providing vouchers for durable latrine substructures in communities already declared ODF) acted as the model for the program considered in that benefit–cost analysis, but the program’s impacts were unknown at the time of that analysis.…”

Comprehensive Social Protection Programming: What is the Potential for Improving Sanitation Outcomes?

“…There is some evidence showing that monetary incentivesespecially when combined with existing behavioural interventionscan change sanitation behaviour and improve outcomes over and above impacts of behaviour change interventions alone. A study from Ghana shows that the provision of welltargeted subsidies, in the form of vouchers, to the poorest households can render community-oriented behaviour change approaches such as Community-Led Total Sanitation (CLTS) more effective (Radin et al 2020). When comparing costs and benefits associated with a 'traditional' CLTS-only intervention and a CLTS-plus intervention, authors found that net benefits of the plus variant are higher compared to the CLTS-only approach in reducing open defecation (ibid.…”