Scaling up sanitation: Evidence from an RCT in Indonesia

Lisa Cameron,Susan Olivia,Manisha Shah

doi:10.1016/j.jdeveco.2018.12.001

Abstract

We investigate the impacts of a widely used sanitation intervention, Community-Led Total Sanitation, which was implemented at scale across rural areas of Indonesia with a randomized controlled trial to evaluate its effectiveness. The program resulted in modest increases in toilet construction, decreased community tolerance of open defecation and reduced roundworm infestations in children. However, there was no impact on anemia, height or weight. We find important heterogeneity along three dimensions: (1) poverty—poorer households are limited in their ability to improve sanitation; (2) implementer identity—scale up involves local governments taking over implementation from World Bank contractors yet no sanitation and health benefits accrue in villages with local government implementation; and (3) initial levels of social capital—villages with high initial social capital built toilets whereas the community-led approach was counterproductive in low social capital villages with fewer toilets being built.

Highlights

It is estimated that about 1.1 billion people worldwide practice open defecation as a result of lack of access to sanitation facilities
In other work we find that program impacts on child height operate via village open defecation rates, suggesting that there might be a critical level of community sanitation that needs to be met before heights increase (see Gertler et al (2015); Cameron, Olivia and Shah (2015))
We find that CommunityLed Total Sanitation (CLTS) significantly increases the rate of toilet construction, reduces worm infestations, and reduces community tolerance of open defecation

Summary

Introduction

It is estimated that about 1.1 billion people worldwide practice open defecation as a result of lack of access to sanitation facilities. Millions of people contract fecal-borne diseases, most commonly diarrhea and intestinal worms, with an estimated 1.7 million people dying each year because of unsafe water, hygiene and sanitation practices (WHO/UNICEF, 2010). In Indonesia 110 million people lack access to proper sanitation and 63 million of them practice open defecation (WHO/UNICEF, 2012). Two of the four main causes of death for children under five in Indonesia (diarrhea and typhoid) are fecal-borne illnesses linked directly to inadequate water supply, sanitation, and hygiene issues (Ministry of Health, 2002). Inadequate sanitation and poor hygiene in Indonesia is estimated to cost approximately US$6.3 billion, or more than 2.4 percent of the country’s gross domestic product (GDP) (Napitupulu and Hutton, 2008)

Methods

Results

Conclusion