Hygiene effectiveness and costs in Samtse district, Bhutan - baseline report, June 2014

PHED, IRC and SNV, under the Sustainable Sanitation and Hygiene for All Programme (SSH4A), have designed a hygiene effectiveness study to assess whether the hygiene interventions in Bhutan are successful in encouraging safe hygiene practices and how much these cost. The methodology is applied and tested in Samtse district. The SSH4A programme is implemented over a four-year period across two districts. It began in Samtse in 2014 and was extended to Tashigang district in 2016. Why look at hygiene promotion cost effectiveness? Since hygiene, and more broadly behaviour change, is seen as a core component of the SSH4A programme, it seemed logical to take a deeper look into the hygiene activities, their costs and whether they are influencing behavioural change and thus resulting in better hygiene practices. We know that unless improved water and sanitation services are used and used hygienically, health and socio-economic benefits will not be realised. We don’t know much about financial benchmarks for water and sanitation improvements, and even less so for hygiene improvements.

This study aims to guide the programme, offer improvements and support decisions on where to adapt or refine hygiene interventions and where best to allocate financial resources. It also aims to support decision makers at the Ministry of Health by providing a greater insight on current costs and effectiveness of behaviour change communication interventions. The hygiene cost effectiveness study began by collecting hygiene effectiveness data at household level as part of the baseline data collection exercise of the SSH4A programme in Samtse in June 2014.