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Sanitation, financial incentives and health spillovers: A cluster randomised trial

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  • Cameron, Lisa
  • Santos, Paulo
  • Thomas, Milan
  • Albert, Jeff

Abstract

Poor sanitation and its consequent negative health outcomes continue to plague the developing world. Drawing on the finding that financial subsidies have changed behaviour in other health contexts, we conducted a clustered randomised trial in 160 villages in Lao PDR to evaluate the effectiveness of combining financial incentives with Community-Led Total Sanitation (CLTS), a widely-conducted behaviour change program. Villages were randomly allocated to four groups, all of which received CLTS but differed in the type of subsidy offered (none, household, village or both). Using data from a random sample of households with young children and village administrative data, we show that household incentives increased sanitation take-up among the poor, whereas a village incentive increased take-up primarily among the non-poor. Improved sanitation produced positive health spillovers - a 10 percentage point increase in village sanitation coverage decreased the probability of childhood stunting by 3 percentage points.

Suggested Citation

  • 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).
    • Handle: RePEc:eee:jhecon:v:77:y:2021:i:c:s0167629621000412
    DOI: 10.1016/j.jhealeco.2021.102456
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    Cited by:

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    2. Hiroyuki Yamada & Tien Manh Vu, 2024. "Do Toilets Save Young Children�fs Lives? Evidence from Cambodia," Keio-IES Discussion Paper Series 2024-007, Institute for Economics Studies, Keio University.
    3. Pakhtigian, Emily L. & Dickinson, Katherine L. & Orgill-Meyer, Jennifer & Pattanayak, Subhrendu K., 2022. "Sustaining latrine use: Peers, policies, and sanitation behaviors," Journal of Economic Behavior & Organization, Elsevier, vol. 200(C), pages 223-242.
    4. 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).
    5. 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).
    6. Lopes, Adrian A. & Tasneem, Dina & Viriyavipart, Ajalavat, 2023. "Nudges and compensation: Evaluating experimental evidence on controlling rice straw burning," Ecological Economics, Elsevier, vol. 204(PB).
    7. 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.
    8. Wang, Dongqin & Shen, Yanni, 2022. "Sanitation and work time: Evidence from the toilet revolution in rural China," World Development, Elsevier, vol. 158(C).

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    More about this item

    Keywords

    Sanitation; WASH; Health behaviour; Financial incentives; Height; Stunting;
    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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