Comparative economic analysis of urban sanitation interventions in low- and middle-income countries: a systematic review

This review assesses evaluative criteria for least-cost economic analyses of citywide inclusive sanitation (CWIS) interventions, focusing on their alignment with the practical needs for decision support in low- and middle-income countries. We examined the literature from 2003 to 2022 that compares the costs and benefits of urban sanitation interventions to analyse their capacity to select cost-efficient and equitable urban sanitation options. The analysis revealed that finer disaggregation of cost perspectives could better articulate the diverse demands for services. Furthermore, options for comparison should be framed in addition to the diverse service provision models already existing within a context to ensure these perspectives are included. Developing the capacity to forecast a context-specific without-project scenario, using locally derived cost data as a basis of comparison, will be essential for adhering to CWIS planning principles. In addition, involving marginalised users more effectively in decision-making processes within economic analyses is essential for advancing equitable service provision. Future comparative economic analysis studies should embrace the complexities of CWIS contexts by supplementing broad-scale comparisons with detailed, context-sensitive evaluations to support more inclusive urban sanitation planning.