Long-term impact of a community-led sanitation campaign in India, 2005–2016

Abstract

Objective To evaluate the long-term impact of a community-led total sanitation campaign in rural India. Methods Local organizations in Odisha state, India worked with researchers to evaluate a community-led total sanitation campaign, which aimed to increase the demand for household latrines by raising awareness of the social costs of poor sanitation. The intervention ran from February to March 2006 in 20 randomly-selected villages and 20 control villages. Within sampled villages, we surveyed a random subset of households (around 28 households per village) at baseline in 2005 and over the subsequent 10-year period. We analysed changes in latrine ownership, latrine functionality and open defecation among approximately 1000 households. We estimated linear probability models that examined differences between households in intervention and control villages in 2006, 2010 and 2016. Findings In 2010, 4 years after the intervention, ownership of latrines was significantly higher (29.3 percentage points; 95% confidence interval, CI: 17.5 to 41.2) and open defecation was significantly lower (−6.8 percentage points; 95% CI: −13.1 to −1.0) among households in intervention villages, relative to controls. In 2016, intervention households continued to have higher rates of ever owning a latrine (26.3 percentage points; 95% CI: 20.9 to 31.8). However, latrine functionality and open defecation were no longer different across groups, due to both acquisition of latrines by control households and abandonment and deterioration of latrines in intervention homes. Conclusion Future research should investigate how to maintain and rehabilitate latrines and how to sustain long-term behaviour change.

Benefit–Cost Analysis of Community-Led Total Sanitation: Incorporating Results from Recent Evaluations

“…For example, several studies find that a relatively high fraction of households owning latrines have members that do not use them (Barnard et al, 2013;Cameron et al, 2013, Orgill-Meyer et al, 2019. Other studies report an increase over time in open defecation rates (Crocker et al, 2017a) and latrine abandonment (Orgill-Meyer et al, 2019). Based on these findings, our analysis assumes that all households that build a latrine use and maintain it for 5 years, and that a fixed percentage of households abandon their latrine in each of the subsequent 5 years.…”

“…Operations and maintenance costs depend on the extent to which members of households with latrines actually use them, which evidence suggests declines over time. For example, several studies find that a relatively high fraction of households owning latrines have members that do not use them (Barnard et al, 2013;Cameron et al, 2013, Orgill-Meyer et al, 2019. Other studies report an increase over time in open defecation rates (Crocker et al, 2017a) and latrine abandonment (Orgill-Meyer et al, 2019).…”

“…The recent popularity of CLTS has generated a large body of research designed to estimate its impacts. Over the past decade, numerous randomized controlled trials and field studies have been conducted to estimate the effects of CLTS on a range of outcomes, such as reduction in open defecation, increase in latrine ownership, and reduction in diarrhea prevalence (Pattanayak et al, 2009;Elbers et al, 2012;Cameron et al, 2013;Patil et al, 2014;Guiteras et al, 2015;Pickering et al, 2015;BDS-Center for Development Research, 2016;Hammer & Spears, 2016;Makotsi et al, 2016;Crocker et al, 2016a, b;Crocker et al, 2017a;Briceño et al, 2017;Orgill-Meyer et al, 2019). However, no benefit-cost analyses (BCAs) of CLTS interventions have incorporated the body of new evidence emerging from these studies.…”

Scenario-based life-cycle cost assessment to support sustainable investment in rural communal sanitation facilities: application to a school-based sanitation facility

“…Explanations for the poor performance of sanitation assert that sanitation has been a low priority for both donors and national policy-makers, resulting in low levels of investment and poor capacity in the sector. At the country level, evidence of these shortcomings is most evident in examples of toilet abandonment and reversion to open defecation (Hueso & Bell 2013;Improve International 2014;Orgill-Meyer et al 2019), what Kwiringira et al (2014) describe as 'descending the sanitation ladder'.…”

“…One notable exception to this is research in the state of Odisha in India, which revealed that despite a sustained sanitation behaviour change campaign and the availability of public funds for toilet construction, a huge number of toilets built under the Community-Led Total Sanitation Campaign were abandoned within a decade. The analysis of data from Odisha suggested that a lack of durable maintenance arrangements and a failure to stimulate and sustain demand resulted in only short-term reductions in open defecation (Orgill-Meyer et al 2019). Similarly, research in Uganda highlighted capacity and resources challenges for the maintenance and upkeep of communal sanitation facilities, leading to toilet misuse, abandonment, and the continuation of open defecation (Kwiringira et al 2014).…”