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The dirty business of eliminating open defecation: The effect of village sanitation on child height from field experiments in four countries

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  • Cameron, Lisa
  • Gertler, Paul
  • Shah, Manisha
  • Alzua, Maria Laura
  • Martinez, Sebastian
  • Patil, Sumeet

Abstract

We examine the impacts of a sanitation program designed to eliminate open defecation in at-scale randomized field experiments in four countries: India, Indonesia, Mali, and Tanzania. The programs – all variants of the widely-used Community-Led Total Sanitation (CLTS) approach - increase village private sanitation coverage in all four locations by 7–39 percentage points. We use the experimentally-induced variation in access to sanitation to identify the causal relationship between village sanitation coverage and child height. We find evidence of threshold effects where increases in child health of 0.3 standard deviations are realized once village sanitation coverage reaches 50–75%. There do not appear to be further gains beyond this threshold. These results suggest that there are large health benefits to achieving coverage levels well below the 100% coverage pushed by the CLTS movement. Open defecation decreased in all countries through improved access to private sanitation facilities, and additionally through increased use of sanitation facilities in Mali who implemented the most intensive behavior change intervention.

Suggested Citation

  • 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).
    • Handle: RePEc:eee:deveco:v:159:y:2022:i:c:s0304387822001328
    DOI: 10.1016/j.jdeveco.2022.102990
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    Cited by:

    1. Pakhtigian, Emily L. & Aziz, Sonia & Boyle, Kevin J. & Akanda, Ali S. & Hanifi, S.M.A., 2024. "Early warning systems, mobile technology, and cholera aversion: Evidence from rural Bangladesh," Journal of Environmental Economics and Management, Elsevier, vol. 125(C).
    2. Maria Laura Alzua & Juan-Camilo Cardenas & Habiba Djebbari, 2023. "Effective community mobilization: Evidence from Mali," French Stata Users' Group Meetings 2023 23, Stata Users Group.
    3. Pakhtigian, Emily L. & Pattanayak, Subhrendu K., 2024. "Social setting, gender, and preferences for improved sanitation: Evidence from experimental games in rural India," World Development, Elsevier, vol. 177(C).
    4. Kazuki Motohashi, 2023. "Unintended Consequences of Sanitation Investment: Negative Externalities on Water Quality and Health in India," ISER Discussion Paper 1210, Institute of Social and Economic Research, Osaka University.
    5. Gautam, Sanghmitra & Gechter, Michael & Guiteras, Raymond P. & Mobarak, Ahmed Mushfiq, 2024. "Encouraging Rural Sanitation Take-up: Insights from Experimental Evaluations of Interventions," CEnREP Working Papers 340057, North Carolina State University, Department of Agricultural and Resource Economics.

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    More about this item

    Keywords

    I12; I15; O15;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • O15 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Economic Development: Human Resources; Human Development; Income Distribution; Migration

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