In response to my own pleas for full-cost accounting on interventions, I recently found an excellent report by WashCost (all of their stuff is usually excellent) but this is quite unlike anything I have seen before:

www.washcost.info/page/2909

They actual set out to answer the questions "how effective is (hygiene promotion) and how much does it cost".

The data are not perfect (when are they?) but they include the costs associated planning, training, implementation, etc. and then the economic (e.g. time-saving) costs of the intervention. Very nice stuff and some surprising results.

Ah-ha, I see. So you are looking for information regarding cost-benefit analysis of individual health-message programmes to compare with your experiment, is that right?

I know Sandy Cairncross has published some interesting stuff, but I think that is based on global numbers - you are right, it would be interesting to see the cost-benefit results of individual programmes.

Incidentally, my point a) above interests me. If it was possible to create a system in which the excreta (say both urine and faeces) had some monetary value, of which some returned to the user, which was enough to encourage them to use the facilities (and hopefully also pay for them..), that would be an almost perfect system. Which probably means it is impossible..

I've remembered where I heard about this (not saying how well it works), it was called Toilet plus. Details here .

Exaclty. We used small, constant payments to try and habituate a behaviour (we did test bigger, delayed payments, which were not as successful).

The question that you ask, that I am most interested in is b) "whether the amount paid makes using the toilet something worth doing compared to not using it" and that is exactly what our experiments were designed to determine. I have no comparable data about the cost-effectiveness of health-message campaigns, so please let me know if you come across any!

Liz

A while ago there was a company set up which collected faeces from users and paid them for it, I think in Bangladesh. I can't remember the details or where I heard about it.

I suppose the problem here is whether a) the costs paid to the users represents the value of the faeces b) whether the amount paid makes using the toilet something worth doing compared to not using it

I'm not an economist, but isn't there something about the attractiveness of something immediate-but-less-valuable compared to something delayed-but-valuable? Assuming that the objective is to try to persuade the user of the value of using the toilet (maybe I'm misunderstanding that aspect of the question..?) then perhaps a small token payment every time the toilet is used is actually more effective than explaining the long-term health benefits.

Hi Christoph,

I have never seen anything that examines the impacts of subsidies on actual long-term use, nor have I seen anything that evaluates the best way to spend money to get a toilet owner to become a consistent toilet user. If you have, I would be thrilled to know about it!

Your question is a good one, and I don’t know the answer. In other conditional cash transfer programs, the cash payments are ended when the goal is achieved, i.e. when the course of vaccinations is finished, or when the girl finishes highschool. When it comes to centralized sewer-based sanitation, the government never stops paying for those that are connected. I suspect that somewhere in between these two options would be appropriate if 100%, consistent usage rates of decentralized sanitation are to be achieved.

All the best,

Liz

Hi Liz,
very interesting way of expressing the ideas.

Reading your lines it came to me that the description is a bit as:
“Customer” acquisition cost – the question “do I go for marketing and media?” or “do I go for discounts or subsidized prices?”. This seems to be as a very typical business question. There should be lots of publications discussing ways of examining the best way to spend money to get a new customer and how to compare methods. I don´t have any idea about that – it was just an impression – which you probably are already exploring?

Really interesting as it never occurred to me that one could actually pay for a certain time to a person until the person has realized that a toilet is a good thing and therefore keeps on using (you do that with the price you pay for the urine I understand), might be much more effective than an awareness campaign.

But how do you stop later on to pay that person?

Well just some thoughts
Yours
Christoph

Hi all,

I wanted to reply to some comments that were posted in another topic, but decided that since we were getting a bit far away from the main thread, I would start a new topic "Monitoring and Evaluation". It's something I've very interested in, but haven't seen much of.

I will just start by replying to Dorothee, but if you are interested in seeing the conversation where this started, it is called "VUNA - Valorisation of Urine Nutrients in Africa (EAWAG, Switzerland, and South Africa)" which can be found by following the path: Innovative sanitation science and technology-->Resource recovery from excreta or faecal sludge (see here: forum.susana.org/forum/categories/98-res...mit=12&start=12#7350).

Very much hoping that others who have experience with quantifying impacts will comment and contribute to this thread!

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Hi Dorothee

Your point about monetary vs. non-monetary measures is an important one. In a lot of evaluation programs, or modeling exercises, non-monetary measures, like DALYs (Disability-adjusted life years) are calculated based on the reduced incidence of disease. However, in order to make the calculations comparable in an overall Cost-Benefit analyses, the measures must be converted into financial terms. This is usually done by assuming some sort of lifetime earning of the person in question, and calculating how much more they could earn if they weren’t sick or didn’t die.

Is this the best way? I don’t know. It does make the calculations easier, but certainly it requires a lot of assumptions.

This brings me to my second point: use. One of the biggest assumptions I see over and over again (in cost-benefit analysis, or program evaluations in general) is that the toilet OWNERS are also toilet USERS.

I have seen very little research about the incidence of toilet use. Indeed, big monitoring campaigns like the JMP count toilets- but how many of those toilets are being used?

Increasingly, I think it will be important to not only include alternative, non-financial metrics of success (e.g. USE), but also develop methods for measuring them.

You asked about my own calcuations: I am still crunching the numbers, but I will be looking at costs as well as use. I measure use by measuring the urine produced at the household level (i.e. are people peeing in the toilet). Is there a price you can put on use? Certainly, you can try to quantify the increased days of education, the reduced environmental pollution, reduced disease, etc. but again, these are based on assumptions.

Fundamentally, I am interested in knowing how much it costs to move a non-user to being a user.

As I mentioned before, I have been struggling to find literature or evidence about the costs of social-marketing, and the relative impacts they have. I have no doubt that social-market works, but how WELL does it work and what does it cost? Obviously, I am particularly interested in being able compare different methods of increasing use (e.g. social marketing vs. incentives).

I would be very happy if anyone knows anything about any such studies that quantify the costs and benefits, non-financial metrics or any other interesting work related to impact evaluation.

All the best,

Liz