Abstract
Objectives
A total of 1.5 billion people live without basic sanitation. A 5-attribute index of sanitation-related quality of life (SanQoL-5) has been applied in 9 countries. SanQoL-5 attributes and their levels require weighting (valuation), with the resulting index ranging from 0 to 1. To date, SanQoL-5 valuation applied simple methods such as rank sum, not robust methods such as discrete choice experiment (DCE). We aimed to value SanQoL-5 using a DCE in urban Mozambique.
Methods
We enrolled 601 adults in the cities of Maputo and Dondo, sampling women and men equally. The DCE task was a choice of which was “better” among 2 combinations of SanQoL-5 attribute levels (always, sometimes, never). Each respondent completed 10 tasks and a dominance test. After fitting a mixed logit model, we rescaled coefficients to derive the index.
Results
The highest-valued attribute was disgust (“never feel disgusted while using the toilet”) at 0.25. The other attributes had similar values (ranging 0.18-0.19). People valued “sometimes” levels at approximately 60% of “never” levels. Therefore, moving from the middle level to the worst involves a larger decrement than moving from the best to the middle. Mean SanQoL-5 by toilet type followed a gradient with Sustainable Development Goal 6 categories: “open defecation” 0.30, “unimproved” 0.45, “limited” 0.60, and “at least basic” 0.70.
Conclusions
To our knowledge, this is the first DCE-based valuation of any index of sanitation-related quality of life, enabling SanQoL-5 to be used in economic evaluation. Identifying sanitation service transitions associated with the greatest quality of life gains could inform more efficient resource allocation.
Authors
Patrick V. Katana Neiva Banze Cremildo Manhiça Catildo Cubai Lucia Viera Edi Fulai Oliver Cumming Edna Viegas Igor Capitine Ian Ross