How evidence informed new sanitation experiments in India
Context
Repeated episodes of diarrhoea and chronic infection in early childhood are a leading cause of child malnutrition and impair physical development and cognitive function. According to UNICEF data, almost 60 per cent of diarrhoeal deaths worldwide stem from unsafe drinking water, and poor sanitation and hygiene.
At a time when India was falling short of the 2015 Millennium Development Goals target for sanitation and child health, researchers from the London School of Hygiene & Tropical Medicine worked with WaterAid India, United Artists Association and their local non-governmental partners in Odisha’s Puri district to promote latrine construction and use for two years, and to evaluate whether and how it affected diarrhoea, soil-transmitted helminth infections and malnutrition amongst children.
In accordance with the Indian government’s Total Sanitation Campaign, the intervention involved mobilising communities and households in villages characterised by high levels of open defecation, childhood diarrhoea and helminth infections to build and use latrines, through information, education and communication activities. The intervention also included monetary support, and provision of local technology and hardware supplies for the construction of household and institutional latrines.
The 3ie-supported evaluation, a cluster randomised controlled trial conducted between May 2010 and December 2013, studied 4,586 households in 50 intervention villages and 4,894 households in 50 control villages.
Evidence
The intervention increased average village-level latrine coverage from 9 per cent to 63 per cent in the 50 villages where WaterAid India and its partners implemented the programme. By contrast, average village-level latrine coverage increased from 8 per cent to 12 per cent in the control villages where the partners did not implement the programme.
The evaluation found no evidence that mobilising households and promoting latrine construction and use reduced exposure to faecal contamination or prevented diarrhoea, soil-transmitted helminth infection or child malnutrition. This led the researchers to conclude that, to deliver genuine health gains, sanitation improvement approaches should incorporate approaches to improve latrine use.
Evidence impacts
Type of impact: Improve the culture of evidence use
When decision makers or implementers demonstrate positive attitudinal changes towards evidence use or towards information the research team provides. Examples include strengthening monitoring and evaluation systems, increasing understanding of evidence and openness to using it, integrating these systems more firmly into programming or commissioning another evaluation or review.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
Read our complete evidence impact typology and verification approach here.
Close windowThe evaluation finding that promoting latrine infrastructure could not be assumed to lead to health gains contributed to the evaluation of a different rural sanitation model that emphasised the use of improved facilities. The evaluation, described in a working paper titled ‘Toilets Can Work’, leveraged the researchers’ partnership with Gram Vikas, another Odisha-based organisation. Gram Vikas’ programme focuses on community-led integrated water and sanitation improvement. It uses water as an incentive to encourage all households in a village to commit to building and using sanitation infrastructure.
Type of impact: Inform the design of other programmes
Where findings from the evaluation or review inform the design of a programme(s) other than the one(s) evaluated.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
Read our complete evidence impact typology and verification approach here.
Close windowThe evaluation findings, alongside those from other studies, informed the design of an evidence programme to promote latrine use in rural India. The programme, which is managed by 3ie and supported by the Bill & Melinda Gates Foundation and the Research Institute for Compassionate Economics, focuses on identifying context-relevant interventions to promote the use of improved sanitation infrastructure.
‘We partnered on the evidence programme because…a series of evaluations, including Clasen and colleagues’ 2014 study in Odisha, gave us the picture that reducing open defecation in rural India is challenging and needs new ideas.’ — Radu Ban, senior program officer, evidence and measurement – water, sanitation and hygiene, Bill & Melinda Gates Foundation
Suggested citation
International Initiative for Impact Evaluation (3ie), 2019. How evidence informed new sanitation experiments in India [online summary], Evidence Impact Summaries. New Delhi: 3ie.
Evidence impact summaries aim to demonstrate and encourage the use of evidence to inform programming and policymaking. These reflect the information available to 3ie at the time of posting. Since several factors influence policymaking, the summaries highlight contributions of evidence rather than endorsing a policy or decision or claiming that it can be attributed solely to evidence. If you have any suggestions or updates to improve this summary, please write to influence@3ieimpact.org
Last updated on 11th November 2020