Abstract
BackgroundFaced with a massive shortfall in meeting sanitation targets, some governments have implemented campaigns that use subsidies focused on latrine construction to overcome income constraints and rapidly expand coverage. In settings like rural India where open defecation is common, this may result in sub-optimal compliance (use), thereby continuing to leave the population exposed to human excreta.MethodsWe conducted a cross-sectional study to investigate latrine coverage and use among 20 villages (447 households, 1933 individuals) in Orissa, India where the Government of India’s Total Sanitation Campaign had been implemented at least three years previously. We defined coverage as the proportion of households that had a latrine; for use we identified the proportion of households with at least one reported user and among those, the extent of reported use by each member of the household.ResultsMean latrine coverage among the villages was 72% (compared to <10% in comparable villages in the same district where the Total Sanitation Campaign had not yet been implemented), though three of the villages had less than 50% coverage. Among these households with latrines, more than a third (39%) were not being used by any member of the household. Well over a third (37%) of the members of households with latrines reported never defecating in their latrines. Less than half (47%) of the members of such households reported using their latrines at all times for defecation. Combined with the 28% of households that did not have latrines, it appears that most defecation events in these communities are still practiced in the open.ConclusionA large-scale campaign to implement sanitation has achieved substantial gains in latrine coverage in this population. Nevertheless, gaps in coverage and widespread continuation of open defecation will result in continued exposure to human excreta, reducing the potential for health gains.
Highlights
Faced with a massive shortfall in meeting sanitation targets, some governments have implemented campaigns that use subsidies focused on latrine construction to overcome income constraints and rapidly expand coverage
Villages were eligible for inclusion in the study if the Total Sanitation Campaign (TSC) was undertaken by an implementing partner non-governmental organizations (NGOs) of WaterAid India at least three years prior to the study
Most (79%) households had heard of a program promoting latrine construction, though fewer (31%) had heard of Village Water and Sanitation Committee (VWSC) members or (20%) had heard of VWSC meetings
Summary
Faced with a massive shortfall in meeting sanitation targets, some governments have implemented campaigns that use subsidies focused on latrine construction to overcome income constraints and rapidly expand coverage. Projections make clear that current progress will fall short of meeting the MDG sanitation target to halve the portion of the population without access to improved sanitation by 2015 [1]. Faced with this challenge, governments, non-governmental organizations (NGOs) and others have undertaken large-scale efforts to expand sanitation coverage. The TSC is a low-subsidy regime that aims to generate household involvement and demand responsiveness for the building of individual household latrines in below poverty line (BPL) households [3] It uses information, education and communication strategy in rural areas designed to generate demand, elicit greater community involvement and encourage use of latrines [4]
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