Cost-effectiveness analysis of the various CLTS implementation modalities used in Mozambique

This technical paper evaluates the cost-effectiveness of various Community-Led Total Sanitation (CLTS) implementation modalities in Mozambique, supported by UNICEF since 2009. The study compares Provincial Community Participation and Education (PEC), Decentralized and District PEC, District-driven Team (DDT), and District Sanitation Fund (DSF) modalities. It finds that PEC modalities are more effective and cost-efficient than DDT and DSF, with higher conversion rates to Open Defecation Free (ODF) status and lower unit costs per ODF community. Decentralized PEC is identified as the most cost-effective, with significant potential for local ownership and sustainability. The paper highlights the need for improved planning, budgeting, and payment mechanisms tailored to results, enhanced capacity building for government actors, and a clear segregation of functions among stakeholders to ensure accountability and sustainability. The recommendations aim to guide future CLTS implementations towards greater cost-effectiveness and sustainability in Mozambique. [author abstract]