The effects of the Total Sanitation and Sanitation Marketing programme on gender and ethnic groups in Indonesia

Abstract

The Total Sanitation and Sanitation Marketing (TSSM) programme launched in the province of East Java, Indonesia in 2007. The TSSM promoted collective behaviour change moving from open defecation to more hygienic practices. This paper expands the analysis of a previous rigorous impact evaluation based on a cluster randomized controlled trial by studying programme differential impacts by female-headed households and three main ethnic groups. Because previous TSSM impacts found were relatively small, this led to small improvement in morbidity and child growth effects among poor households. This study examines two subgroups within the sample, female-headed households and ethnic populations (GEG), to explore whether the effects can be identified for both of these subgroups. The paper shows that female-headed TSSM households experienced a reduction of 5.8 per cent in diarrhoea prevalence of children under 5 years old. Ethnicities benefited differently from the programme: the Javanese ethnicity experienced no improvements in outcomes while the Madurese ethnic group showed significant improvements of one-sixth of one standard deviation (8.6 cm) of height-for-age in children (1.43 cm average) and one-fifth of a standard deviation (3.7 cm) increase in head circumference. Other ethnic groups showed a 20.6 per cent reduction in open defecation compared to non-exposed households. Because sanitation campaigns reach households and the intra-household responsibilities for sanitation practices depend partly on culture and social norms, certain components of TSSM can be mainstreamed to achieve behaviour change effectively towards gender and ethnic groups.