Community-led total sanitation (CLTS) has triggered households around the world to adopt latrines, but evidence suggests that CLTS does not usually lead to universal latrine coverage. Additional interventions, such as subsidies for the poor, may be necessary to eliminate open defecation. While subsidies can improve sanitation-related outcomes, no prior studies have compared the net benefits of CLTS plus subsidies to CLTS-only. This paper presents a comparative analysis for rural Ghana, where efforts to reduce open defecation have had limited success. We analyze the costs and benefits of: (1) a CLTS-only intervention, as implemented in Ghana, and (2) a variant of CLTS that provides vouchers for latrines to the poorest households in high sanitation adoption communities. We find that CLTS-only fails a deterministic benefit-cost test and that only about 30% of 10,000 Monte Carlo trials produce positive net benefits. CLTS plus subsidies satisfy a benefit-cost criterion in the deterministic case, and in about 55% of the Monte Carlo trials. This more favorable outcome stems from high adoption communities passing the threshold needed to generate positive health externalities due to improved community sanitation. The results suggest that a well-targeted CLTS plus subsidies intervention would be more effective in Ghana than CLTS alone.

社区主导的全面卫生（CLTS）促使世界各地的家庭采用厕所，但是有证据表明，CLTS通常不会导致厕所普及。为了消除露天排便，可能需要采取其他干预措施，例如为穷人提供补贴。尽管补贴可以改善与卫生有关的结果，但以前没有研究将CLTS加补贴的净收益与仅CLTS进行比较。本文对加纳农村地区进行了比较分析，该国减少露天排便的努力取得了有限的成功。我们分析以下方面的成本和收益：（1）加纳实施的仅限CLTS的干预措施，以及（2）CLTS的一种变体，为卫生条件较高的收养社区中最贫困的家庭提供厕所凭证。我们发现仅CLTS的服务无法通过确定性的利益成本测试，并且在10,000个蒙特卡洛试验中只有约30％产生了正的净利益。在确定性案例中，大约55％的蒙特卡洛试验中，CLTS加补贴满足了利益成本标准。这种更有利的结果是由于社区卫生条件得到改善，高收养率社区超过了产生积极的健康外部性所需的阈值。结果表明，针对目标明确的CLTS加补贴干预措施在加纳比单独使用CLTS更有效。这种更有利的结果是由于社区卫生条件得到改善，高收养率社区超过了产生积极的健康外部性所需的阈值。结果表明，针对目标明确的CLTS加补贴干预措施在加纳比单独使用CLTS更有效。这种更有利的结果是由于社区卫生条件得到改善，高收养率社区超过了产生积极的健康外部性所需的阈值。结果表明，针对目标明确的CLTS加补贴干预措施在加纳比单独使用CLTS更有效。