Event Information
Presented by : Sumeet Patil, The Colford Research Group, UC Berkeley,NEERMAN (Mumbai)
Abstract :
Poor sanitation is thought to be a major cause of enteric infections and malnutrition among young children. However, can large scale sanitation programs indeed deliver the hypothesized health benefits? We answer this question in the context of India’s Total Sanitation Campaign (TSC) using cluster-randomized, controlled trials in Odisha (2005-06) and Madhya Pradesh (MP; 2009-2011). In both sites, the interventions consisted of Community Led Total Sanitation (CLTS) based behaviour change approaches and subsidies for toilet construction but the intensity and mechanism of the programs differed. We randomized 40 and 80 villages to treatment and control arms equally in Odisha (n~1086 households) and MP (n~3029 households), respectively, and estimated differences in the outcomes between the two groups in an intention-to-treat analysis.
In both trials, the interventions increased percentage of households with IHL in a village (by 19% in MP and by 25% in Odisha) and decreased OD among adults (by ~10% in MP and by ~17% in Odisha). However, the intervention in MP did not improve child health based on multiple outcomes (diarrhoea, HCGI, helminth infections, anaemia, growth). In Odisha, the height of children under 5 years of age in the intervention group was 1.49 cm larger than that in the control group (85.56 cm). We also find evidence of effect on child arm circumference, but not on weight and diarrhoea prevalence. We also find that the level of OD in the village is strongly correlated with height and arm circumference and the reduction in OD is associated with both subsidies for toilet construction and behaviour change interventions.
The collective evidence suggests that the future refinements of the TSC may immensely benefit by strengthening both the behaviour change and subsidy delivery aspects of the program. However, available evidence also cautions us that that the effect of improved sanitation may depend on other non-sanitation factors (WASH, public health, environmental, etc.). Therefore, contrary to the current approach, program refinements to the TSC ought to be proved in small-scale and short-term pilots across different regions of India before scaling up to the national level.