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Scaling Up Sanitation: Evidence from an RCT in Indonesia

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  • Cameron, Lisa A.

    (University of Melbourne)

  • Shah, Manisha

    (University of California, Los Angeles)

Abstract

This paper evaluates the effectiveness of a widely used sanitation intervention, Community-Led Total Sanitation (CLTS), using a randomized controlled trial. The intervention was implemented at scale across rural East Java in Indonesia. CLTS increases toilet construction, reduces roundworm infestations, and decreases community tolerance of open defecation. Financial constraints faced by poorer households limit their ability to improve sanitation. We also examine the program's scale up process which included local governments taking over implementation of CLTS from professional resource agencies. The results suggest that all of the sanitation and health benefits accrue from villages where resource agencies implemented the program, while local government implementation produced no discernible benefits.

Suggested Citation

  • Cameron, Lisa A. & Shah, Manisha, 2017. "Scaling Up Sanitation: Evidence from an RCT in Indonesia," IZA Discussion Papers 10619, Institute of Labor Economics (IZA).
  • Handle: RePEc:iza:izadps:dp10619
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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. 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 Oct 2023.
    3. Abramovsky, Laura & Augsburg, Britta & Lührmann, Melanie & Oteiza, Francisco & Rud, Juan Pablo, 2023. "Community matters: Heterogeneous impacts of a sanitation intervention," World Development, Elsevier, vol. 165(C).
    4. 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.
    5. 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.
    6. Augsburg, Britta & Caeyers, Bet & Giunti, Sara & Malde, Bansi & Smets, Susanna, 2023. "Labeled loans and human capital investments," Journal of Development Economics, Elsevier, vol. 162(C).
    7. 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).
    8. 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.
    9. Bakhtiar, M. Mehrab & Guiteras, Raymond P. & Levinsohn, James & Mobarak, Ahmed Mushfiq, 2023. "Social and financial incentives for overcoming a collective action problem," Journal of Development Economics, Elsevier, vol. 162(C).
    10. Agostinelli, Francesco & Avitabile, Ciro & Bobba, Matteo, 2021. "Enhancing Human Capital at Scale," IZA Discussion Papers 14192, Institute of Labor Economics (IZA).
    11. 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).
    12. Vikram Dayal & Anand Murugesan & Tauhidur Rahman, 2022. "Drain on your health: Sanitation externalities from dirty drains in India," Review of Development Economics, Wiley Blackwell, vol. 26(4), pages 2251-2273, November.
    13. 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.
    14. 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.
    15. 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.
    16. 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.
    17. 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.
    18. 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.
    19. Wang, Dongqin & Shen, Yanni, 2022. "Sanitation and work time: Evidence from the toilet revolution in rural China," World Development, Elsevier, vol. 158(C).
    20. 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).
    21. 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).
    22. 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).
    23. 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).
    24. 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).
    25. 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

    development; scale up; sanitation; impact evaluation; health;
    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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