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Scaling up sanitation: Evidence from an RCT in Indonesia

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  • Cameron, Lisa
  • Olivia, Susan
  • Shah, Manisha

Abstract

We investigate the impacts of a widely used sanitation intervention, Community-Led Total Sanitation, which was implemented at scale across rural areas of Indonesia with a randomized controlled trial to evaluate its effectiveness. The program resulted in modest increases in toilet construction, decreased community tolerance of open defecation and reduced roundworm infestations in children. However, there was no impact on anemia, height or weight. We find important heterogeneity along three dimensions: (1) poverty—poorer households are limited in their ability to improve sanitation; (2) implementer identity—scale up involves local governments taking over implementation from World Bank contractors yet no sanitation and health benefits accrue in villages with local government implementation; and (3) initial levels of social capital—villages with high initial social capital built toilets whereas the community-led approach was counterproductive in low social capital villages with fewer toilets being built.

Suggested Citation

  • Cameron, Lisa & Olivia, Susan & Shah, Manisha, 2019. "Scaling up sanitation: Evidence from an RCT in Indonesia," Journal of Development Economics, Elsevier, vol. 138(C), pages 1-16.
    • Handle: RePEc:eee:deveco:v:138:y:2019:i:c:p:1-16
    DOI: 10.1016/j.jdeveco.2018.12.001
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    Cited by:

    1. Karen Setty & Ryan Cronk & Shannan George & Darcy Anderson & Għanja O’Flaherty & Jamie Bartram, 2019. "Adapting Translational Research Methods to Water, Sanitation, and Hygiene," IJERPH, MDPI, vol. 16(20), pages 1-31, October.
    2. Evan Plous Kresch & Molly Lipscomb & Laura Schechter, 2020. "Externalities and Spillovers from Sanitation and Waste Management in Urban and Rural Neighborhoods," Applied Economic Perspectives and Policy, John Wiley & Sons, vol. 42(3), pages 395-420, September.
    3. Agostinelli, Francesco & Avitabile, Ciro & Bobba, Matteo, 2021. "Enhancing Human Capital in Children: A Case Study on Scaling," TSE Working Papers 21-1196, Toulouse School of Economics (TSE), revised Aug 2022.
    4. Laura Abramovsky & Britta Augsburg & Melanie Lührmann & Francisco Oteiza & Juan Pablo Rud, 2018. "Community matters: heterogenous impacts of a sanitation intervention," IFS Working Papers W18/28, Institute for Fiscal Studies.
    5. Amanda Beatty & Evan Borkum & William Leith & Marisa Henry & Margo Berends & Clair Null & Nicholas Ingwersen, "undated". "MCC Indonesia Nutrition Project Impact Evaluation Final Report," Mathematica Policy Research Reports 177dad81487243d59a9fefbcf, Mathematica Policy Research.
    6. Jonathan Chapman, 2020. "Extension of the Franchise and Government Expenditure on Public Goods: Evidence from Nineteenth-Century England," Working Papers 20200045, New York University Abu Dhabi, Department of Social Science, revised Mar 2020.
    7. Zuin, Valentina & Delaire, Caroline & Peletz, Rachel & Cock-Esteb, Alicea & Khush, Ranjiv & Albert, Jeff, 2019. "Policy Diffusion in the Rural Sanitation Sector: Lessons from Community-Led Total Sanitation (CLTS)," World Development, Elsevier, vol. 124(C), pages 1-1.
    8. Britta Augsburg & Antonella Bancalari & Zara Durrani & Madhav Vaidyanathan & Zach White, 2021. "When nature calls back: sustaining behavioural change in rural Pakistan," IFS Working Papers W21/46, Institute for Fiscal Studies.
    9. Revilla, Ma. Laarni D. & Qu, Fangqi & Seetharam, K E & Rao, Bhanoji, 2021. "“Sanitation” in the Top Development Journals: A Review," ADBI Working Papers 1253, Asian Development Bank Institute.
    10. Jessica Tribbe & Valentina Zuin & Caroline Delaire & Ranjiv Khush & Rachel Peletz, 2021. "How Do Rural Communities Sustain Sanitation Gains? Qualitative Comparative Analyses of Community-Led Approaches in Cambodia and Ghana," Sustainability, MDPI, vol. 13(10), pages 1-23, May.
    11. Wang, Dongqin & Shen, Yanni, 2022. "Sanitation and work time: Evidence from the toilet revolution in rural China," World Development, Elsevier, vol. 158(C).
    12. Francesco Agostinelli & Ciro Avitable & Matteo Bobba, 2021. "Enhancing Human Capital at Scale," Working Papers 2021-012, Human Capital and Economic Opportunity Working Group.
    13. Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2020. "Reducing the Cost of Remoteness: Community-Based Health Interventions and Fertility Choices," Journal of Health Economics, Elsevier, vol. 73(C).
    14. Faraz Usmani & Marc Jeuland & Subhrendu Pattanayak, 2018. "NGOs and the effectiveness of interventions," WIDER Working Paper Series 59, World Institute for Development Economic Research (UNU-WIDER).
    15. Augsburg, Britta & Bancalari, Antonella & Durrani, Zara & Vaidyanathan, Madhav & White, Zach, 2022. "When nature calls back: Sustaining behavioral change in rural Pakistan," Journal of Development Economics, Elsevier, vol. 158(C).
    16. Cameron, Lisa & Santos, Paulo & Thomas, Milan & Albert, Jeff, 2021. "Sanitation, financial incentives and health spillovers: A cluster randomised trial," Journal of Health Economics, Elsevier, vol. 77(C).
    17. Faraz Usmani & Marc Jeuland & Subhrendu K. Pattanayak, 2018. "NGOs and the effectiveness of interventions," WIDER Working Paper Series wp-2018-59, World Institute for Development Economic Research (UNU-WIDER).
    18. Cameron, Lisa & Gertler, Paul & Shah, Manisha & Alzua, Maria Laura & Martinez, Sebastian & Patil, Sumeet, 2022. "The dirty business of eliminating open defecation: The effect of village sanitation on child height from field experiments in four countries," Journal of Development Economics, Elsevier, vol. 159(C).
    19. Camille Boudot‐Reddy & Anita Mukherjee, 2021. "Improving the adoption of household health products: A sales experiment with chlorine tablets," Health Economics, John Wiley & Sons, Ltd., vol. 30(3), pages 623-641, March.
    20. Cameron, Lisa & Chase, Claire & Haque, Sabrina & Joseph, George & Pinto, Rebekah & Wang, Qiao, 2021. "Childhood stunting and cognitive effects of water and sanitation in Indonesia," Economics & Human Biology, Elsevier, vol. 40(C).
    21. Cameron, Lisa & Olivia, Susan & Shah, Manisha, 2019. "Scaling up sanitation: Evidence from an RCT in Indonesia," Journal of Development Economics, Elsevier, vol. 138(C), pages 1-16.
    22. Aidan Coville & Sebastian Galiani & Paul Gertler & Susumu Yoshida, 2020. "Financing Municipal Water and Sanitation Services in Nairobi’s Informal Settlements," NBER Working Papers 27569, National Bureau of Economic Research, Inc.
    23. Artwell Kanda & Esper Jacobeth Ncube & Kuku Voyi, 2021. "Effect of Sanitation Interventions on Health Outcomes: A Systematic Review of Cluster-Randomized Controlled Trials in Rural Communities of Low- and Middle-Income Countries," IJERPH, MDPI, vol. 18(16), pages 1-16, August.

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    More about this item

    Keywords

    Sanitation; Impact evaluation; Health; Scale up; Social capital;
    All these keywords.

    JEL classification:

    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development

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