Evaluation of the Total Sanitation Program in Maharashtra

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Evaluation of the Total Sanitation Program in
Maharashtra

• Nazmul Chaudhury

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Total Sanitation

• Failure of Supply-Driven Sanitation
• Behavior that Matters not Infrastructure
• Innovative Approach from Bangladesh
• Diffusion of TS Approach
• South Asia and Beyond
• Local/International NGOs
• Local/National Governments
• Lots of Money

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Randomized Evaluation Design

• A sub-set of communities are Randomly selected to
  receive the TSP Intervention
• Baseline survey in both Treatment and Control
  villages before any intervention
• Try doing this with local governments

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The Evaluation in 2 Parts

• (1) Program Effects on Hygiene and Behavior
• (2) Hygiene and Behavior Effects on Health
  Outcomes

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Why Would the Program Effect Hygiene ?

• What variables would we need to collect to answer
  this ?
• Community Accepts the Program Effective
  Implementation, Education, Income, Social
  Cohesion, Effective Local Leadership

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Why Should Hygiene Effect Child Health ?

• What variables would we need to collect to answer
  this ?
• Open Defecation, Handling of Childs Feces, Water
  Use, Soap Use, Income, Education, Genetics, Food
  Intake
• Measures of Child Health (Diarrhea, Height)
• Externalities is 100 necessary ?

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Sample

• 3 Districts
• Ahmednagar
• Nanded
• Nandurbar
• 180 Communities (60 per district)
• 10,748 Households
• 59,616 Individuals

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What do we Know from the Baseline Surveys ?

• Baseline conducted in February 2004
• Intervention in Ahmednagar takes place in April
  2004
• Follow-up Surveys conducted in August 2004 and
  August 2005
• Nothing much happens in other districts

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Treatment and Control

• 30 communities in each district were randomly
  selected to receive the TSP campaign
• Close Matched for the most part

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Correlates of Open Defecation

• Toilet Ownership
• Wealth
• Education
• Ethnicity
• Exposure to Sanitation Knowledge

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Correlates of Child Height

• Lots of Background Variables
• Mothers Height
• Water Quality (River)
• Open Defecation Not Toilet Ownership

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Correlates of Child Diarrhea

• Mothers Weight
• Wealth
• Whether or not Mother Washes Hand After Cleaning
  Childs Stool

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Follow-up Survey from Ahmednagar

• 30 Control Villages
• 30 Villages are Targeted for Intervention

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Growth in Child Height

• Growth in Child Height (standardized z scores) is
  significantly higher in treatment communities
• Before going any further we have to make sure
  what really happened .

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ConclusionThis stuff is hard to do

• Behavior Matters
• Behavior is much harder to measure than
  infrastructure
• Need to put a lot of effort on systematic
  monitoring of verifiable indicators
• Randomization and Political Commitment