Impact Evaluation of a Large-scale Rural Sanitation Project in Indonesia
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World Bank, Washington, DC
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Lack of sanitation and poor hygiene
behavior cause a tremendous disease burden among the poor.
This paper evaluates the impact of the Total Sanitation and
Sanitation Marketing project in Indonesia, where about 11
percent of children have diarrhea in any two-week period and
more than 33,000 children die each year from diarrhea. The
evaluation utilizes a randomized controlled trial but is
unusual in that the program was evaluated when implemented
at scale across the province of rural East Java in a way
that was designed to strengthen the enabling environment and
so be sustainable. One hundred and sixty communities across
eight rural districts participated, and approximately 2,100
households were interviewed before and after the
intervention. The authors found that the project increased
toilet construction by approximately 3 percentage points (a
31 percent increase in the rate of toilet construction). The
changes were primarily among non-poor households that did
not have access to sanitation at baseline. Open defecation
among these households decreased by 6 percentage points (or
17 percent). Diarrhea prevalence was 30 percent lower in
treatment communities than in control communities at endline
(3.3 versus 4.6 percent). The analysis cannot rule out that
the differences in drinking water and handwashing behavior
drove the decline in diarrhea. Reductions in parasitic
infestations and improvements in height and weight were
found for the non-poor sample with no sanitation at baseline.
Palabras clave
ABDOMINAL PAIN, ACUTE RESPIRATORY INFECTION, ACUTE RESPIRATORY INFECTIONS, AGE GROUPS, AGED, AGING, ANCYLOSTOMA, ANCYLOSTOMA DUODENALE, ANEMIA, ARI, ASCARIS LUMBRICOIDES, ATTITUDINAL CHANGE, BEHAVIOR CHANGE, BEHAVIORAL CHANGE, BEHAVIORAL CHANGES, BETTER HYGIENE, BOREHOLES, BREASTFEEDING, BURDEN OF DISEASE, CAREGIVERS, CAUSES OF DEATH, CHEMOTHERAPY, CHILD DEVELOPMENT, CHILD GROWTH, CHILD HEALTH, CHILD HEALTH OUTCOMES, COMMUNITIES, COMMUNITY HEALTH, DEFECATION, DESCRIPTION, DIAGNOSIS, DIARRHEA, DIARRHEAL DISEASES, DISABILITY, DISEASE BURDEN, DISEASE RISK, DISTRICTS, DRINKING WATER, DWELLING, EPIDEMIOLOGY, FECUNDITY, FEMALE, GENDER, HANDWASHING, HAZARD, HEALTH EFFECTS, HEALTH OUTCOMES, HELMINTHES, HELMINTHIASIS, HOOKWORM, HOOKWORMS, HOUSEHOLDS, HYGIENE, HYGIENE BEHAVIOR, HYGIENE HABITS, HYGIENE ISSUES, HYGIENE PRACTICE, HYGIENE PRACTICES, ILLNESSES, IMMUNE DEFICIENCY, IMPROVEMENTS IN HEALTH, INADEQUATE SANITATION, INADEQUATE WATER, INADEQUATE WATER SUPPLY, INFANTS, INFECTION, INFECTIONS, INFECTIOUS DISEASE, INTERVENTION, INTERVENTIONS, IRON, LATRINE CONSTRUCTION, LATRINES, MALNUTRITION, MARKETING, MATERNAL HEALTH, MOBILITY, MORTALITY, NASAL CONGESTION, NECATOR, NECATOR AMERICANUS, NUTRITION, NUTRITIONAL STATUS, PARASITOLOGY, PATHOGENS, PEDIATRICS, PHYSICAL ACTIVITY, PHYSICAL FITNESS, PHYSICAL GROWTH, POLLUTION, POOR HYGIENE, PREVALENCE, PREVENTABLE DISEASES, PUBLIC HEALTH, RANDOMIZED CONTROLLED TRIALS, RISK FACTORS, RURAL AREAS, RURAL COMMUNITIES, SANITATION, SANITATION FACILITIES, SANITATION PRACTICES, SANITATION SERVICES, SANITATION SITUATION, SCHISTOSOMA, SCHISTOSOMIASIS, SOAP, SOCIAL MARKETING, SOURCES OF WATER, STD, STUNTING, SYMPTOMS, TENANCY, TOILETS, TREATMENT, TROPICAL DISEASES, TROPICAL MEDICINE, TYPHOID, VACCINES, VILLAGE LEVEL, VILLAGES, WASHING HANDS, WASTE, WASTING, WATER QUALITY, WATER SOURCE