Evidence on sanitation and hygiene program costs is used for many purposes. The few studies that report costs
use top-down costing methods that are inaccurate and inappropriate. Community-led total sanitation (CLTS) is
a participatory behavior-change approach that presents difficulties for cost analysis. We used implementation
tracking and bottom-up, activity-based costing to assess the process, program costs, and local investments for
four CLTS interventions in Ghana and Ethiopia. Data collection included implementation checklists, surveys,
and financial records review. Financial costs and value-of-time spent on CLTS by different actors were assessed.
Results are disaggregated by intervention, cost category, actor, geographic area, and project month. The average
household sizewas 4.0 people in Ghana, and 5.8 people in Ethiopia. The program cost of CLTSwas $30.34–$81.56
per household targeted in Ghana, and $14.15–$19.21 in Ethiopia. Most program costs were from training for
three of four interventions. Local investments ranged from $7.93–$22.36 per household targeted in Ghana, and
$2.35–$3.41 in Ethiopia. This is the first study to present comprehensive, disaggregated costs of a sanitation
and hygiene behavior-change intervention. The findings can be used to inform policy and finance decisions,
plan program scale-up, perform cost-effectiveness and benefit studies, and compare different interventions.
The costing method is applicable to other public health behavior-change programs.