From new evidence to better practice: finding the sanitation sweet spot

Jan Willem Rosenboom; Radu Ban

doi:10.3362/1756-3488.17-00011

From new evidence to better practice: finding the sanitation sweet spot

A growing body of evidence shows that there is a strong causal link between exposure to poor sanitation and detrimental health, human capital, and economic outcomes. At the same time a number of recent impact evaluations of specific sanitation interventions show mixed results. This heterogeneity in findings raises the questions of whether and how the demonstrated benefits of improved sanitation can be consistently achieved through regular project implementation. This paper attempts to show that the benefits of improved sanitation can be consistently achieved through investing in interventions that address the drivers of latrine use and by divesting from interventions that do not address the drivers of latrine use.

Alzua, M.L., Cardenas, J.C. and Djebbari, H. (2014) ‘Community mobilization around social dilemmas: evidence from lab experiments in rural Mali’, CEDLAS Working Paper No. 160 [online], SSRN <https://ssrn.com/abstract=2438914> [accessed 2 October 2017].

Bateman, O.M. and Smith, S. (1991) A comparison of the health effects of water supply and sanitation in urban and rural Guatemala, in Proceedings of the Demographic and Health Surveys World Conference, August 5-7, 1991, Washington, DC, Volume II, pp. 1505–24, Columbia, Maryland: Institute for Resource Development/Macro International, Inc.

Boisson, S., Sosai, P., Ray, S., Routray, P., Torondel, B., Schmidt, W.-P., Bhanja, B. and Clasen, T. (2014) ‘Promoting latrine construction and use in rural villages practicing open defecation: process evaluation in connection with a randomised controlled trial in Orissa, India’, BMC Research Notes 7: 486.

Clasen, T., Boisson, S., Routray, P., Torondel, B., Bell, M., Cumming, O., Ensink, J., Freeman, M., Jenkins, M., Odagiri, M., Ray, S., Sinha, A., Suar, M. and Schmidt, W-P. (2014) Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial. The Lancet Global Health 2: e645–53 <http://dx.doi.org/10.1016/S2214-109X(14)70307-9>.

Coffey, D. and Geruso, M. (2017) ‘Sanitation, disease externalities, and anemia: evidence from Nepal’, The Economic Journal [online] <http://dx.doi.org/10.1111/ecoj.12491>.

Cutler, D.M. and Miller, G. (2005) ‘The role of public health improvements in health advances: the twentieth-century United States’, Demography 42: 1–22.

Dangour, A.D., Watson, L., Cumming, O., Boisson, S., Che, Y., Velleman, Y., Cavill, S., Allen, E. and Uauy, R. (2013) ‘Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children’, Cochrane Database of Systematic Reviews 8, CD009382 <http://dx.doi.org/10.1002/14651858.CD009382.pub2>.

Dickinson, K.L., Sumeet, R., Patil, S., Pattanayak, K., Poulos, C. and Yang, J-H. (2015) ‘Nature’s call: impacts of sanitation choices in Orissa, India’, Economic Development and Cultural Change 64: 1–29 <https://doi.org/10.1086/682958>.

Esrey, S.A., Potash, J.B., Roberts, L. and Shiff, C. (1991) ‘Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma’, Bulletin of the World Health Organization 69: 609–21.

Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. Jr (2005) ‘Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, The Lancet Infectious Diseases 5: 42–52 <https://doi.org/10.1016/S1473-3099(04)01253-8>.

Gertler, P., Shah, M., Alzua, M-L., Cameron, L., Martinez, S. and Patil, S. (2015) How Does Health Promotion Work? Evidence From The Dirty Business of Eliminating Open Defecation, Working Paper 20997, Cambridge, MA: National Bureau of Economic Research.

Geruso, M. and Spears, D. (2017) ‘Neighborhood sanitation and infant mortality’, American Economic Journal: Applied Economics, forthcoming.

Guiteras, R., Levinsohn, J. and Mobarak, A.M. (2015) ‘Encouraging sanitation investment in the developing world: a cluster-randomized trial’, Science 348: 903–6 <http://dx.doi.org/10.1126/science.aaa0491>.

Gupta, A., Spears, D., Coffey, D., Khurana, N., Srivastav, N., Hathi, P. and Vyas, S. (2014) ‘Revealed preference for open defecation: evidence from a new survey in rural North India’, Economic and Political Weekly 49: 43–55.

Gupta, A., Coffey, D. and Spears, D. (2016) ‘Purity, pollution, and untouchability: challenges affecting the adoption, use, and sustainability of sanitation programmes in rural India’, in P. Bongartz, N. Vernon and J. Fox (eds), Sustainable Sanitation For All: Experiences, Challenges and Innovations, pp. 283–98, Rugby, UK: Practical Action Publishing.

Haddad, L. and Spears, D. (2015) ‘The power of WASH: why sanitation matters for nutrition’, in 2014–2015 Global Food Policy Report, pp. 19–24, Washington, DC: International Food Policy Research Institute.

Hammer, J. and Spears, D. (2016) ‘Village sanitation and child health: effects and external validity in a randomized field experiment in rural India’, Journal of Health Economics 48: 135–48 <https://dx.doi.org/10.1016%2Fj.jhealeco.2016.03.003>.

Hathi, P., Haque, S., Pant, L., Coffey, D. and Spears, D. (2017) ‘Place and child health: the interaction of population density and sanitation in developing countries’, Demography 54: 337 <https://dx.doi.org/10.1007/s13524-016-0538-y>.

Hatton, T.J. (2013) ‘How have Europeans grown so tall?’ Oxford Economic Papers 66(2): 349–72 <https://dx.doi.org/10.1093/oep/gpt030>.

Henrich, J., Boyd, R., Bowles, S., Camerer, C., Fehr, E. and Gintis, H. (2004) Foundations of Human Sociality: Economic Experiments and Ethnographic Evidence from Fifteen Small-Scale Societies, Oxford, UK: Oxford University Press.

Lawson, N. and Spears, D. (2016) ‘What doesn’t kill you makes you poorer: adult wages and the early-life disease environment in India’, Economics and Human Biology 21: 1–16 <https://doi.org/10.1016/j.ehb.2015.11.006>.

Luby, S. (2015) Is targeting access to sanitation enough? The Lancet Global Health 2: e619–20 <http://dx.doi.org/10.1016/S2214-109X(14)70326-2>.

Patil, S.R., Arnold, B., Arnold, B.F., Salvatore, A.L., Briceno, B., Ganguly, S., Colford, J.M. Jr. and Gertler, P.J. (2014) ‘The effect of India’s Total Sanitation Campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial’, PLoS Med 11: e1001709 <https://doi.org/10.1371/journal.pmed.1001709>.

Pickering, A.J., Djebbari, H., Lopez, C., Coulibaly, M. and Alzua, M.L. (2015) ‘Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial’, The Lancet Global Health 3: e701–11 <http://dx.doi.org/10.1016/S2214-109X(15)00144-8>.

Quicksand Design Studios (2011) The Potty Project: Understanding User Experience of Sanitation for the Urban Poor [pdf], <www.pottyproject.in/content_exec%20summary.pdf> [accessed 2 October 2017].

Routray, P., Schmidt, W-P., Boisson, S., Clasen, T. and Jenkins, M.W. (2015) ‘Socio-cultural and behavioural factors constraining latrine adoption in rural coastal Odisha: an exploratory qualitative study’, BMC Public Health 15: 880 <http://dx.doi.org/10.1186/s12889-015-2206-3>.

Schmidt, W.-P. (2014) ‘The elusive effect of water and sanitation on the global burden of disease’, Tropical Medicine and International Health 19: 522–7 <http://dx.doi.org/10.1111/tmi.12286>.

Singh, A., Thathachari, J., Agarwal, R. and Karamchandani, A. (2013) A Market Led, Evidence Based, Approach to Rural Sanitation [pdf], Monitor Deloitte <www.psi.org/wp-content/uploads/2014/09/Sanitation_Whitepaper_-market_led_evidence_based_approach_to_rural_sanitation.pdf> [accessed 2 October 2017].

Spears, D. (2012) Effects of Rural Sanitation on Infant Mortality and Human Capital: Evidence from India`s Total Sanitation Campaign, Working Paper, Research Institute for Compassionate Economics.

Spears, D. (2013) The Nutritional Value of Toilets: How Much International Variation in Child Height Can Sanitation Explain? Working Paper, Research Institute for Compassionate Economics.

Spears, D. and Lamba, S. (2015) ‘Effects of early-life exposure to sanitation on childhood cognitive skills: evidence from India’s Total Sanitation Campaign’, Journal of Human Resources 51(2): 298–327 <http://dx.doi.org/10.3368/jhr.51.2.0712-5051R1>.

Tremolet, S. and Binder, D. (2013) Evaluating the Effectiveness of Public Finance for Household Sanitation in the State of Bihar, India [pdf], London: Wateraid <www.wateraid.org/~/media/Publications/Bihar-sanitation-report.ashx> [accessed 2 October 2017].

Vyas, S., Kov, P., Smets, S. and Spears, D. (2016) ‘Disease externalities and net nutrition: evidence from changes in sanitation and child height in Cambodia, 2005–2010’, Economics & Human Biology 23: 235–45 <https://doi.org/10.1016/j.ehb.2016.10.002>.

Water and Sanitation for the Urban Poor (WSUP) (2011) Clean Team, A Human-Centred Approach to Sanitation: Initial Trials in Ghana [pdf], WSUP <www.wsup.com/wp-content/uploads/2013/05/015-PN008-CleanTeam.pdf> [accessed 2 October 2017].

Watson, T. (2006) ‘Public health investments and the infant mortality gap: evidence from federal sanitation interventions on U.S. Indian reservations’, Journal of Public Economics 90: 1537–60 <http://dx.doi.org/10.1016/j.jpubeco.2005.10.002>.