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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. Agostinelli, Francesco & Avitabile, Ciro & Bobba, Matteo, 2021. "Enhancing Human Capital at Scale," TSE Working Papers 21-1196, Toulouse School of Economics (TSE).
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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).
    8. 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).
    9. 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).
    10. 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.
    11. 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.
    12. 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.
    13. 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.
    14. 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.
    15. 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).
    16. 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).

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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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