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Assessing the Impact and Equity of an Integrated Rural Sanitation Approach: A Longitudinal Evaluation in 11 Sub-Saharan Africa and Asian Countries

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  • Paschal A. Apanga

    (School of Community Health Sciences, University of Nevada, Reno, NV 89557, USA
    These authors contributed equally to this work.)

  • Joshua V. Garn

    (School of Community Health Sciences, University of Nevada, Reno, NV 89557, USA
    These authors contributed equally to this work.)

  • Zoe Sakas

    (Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA)

  • Matthew C. Freeman

    (Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA)

Abstract

Few rural sanitation programs have documented large increases in sanitation coverage or have assessed if interventions equitably increase sanitation coverage for vulnerable groups. We characterize the impact of the Sustainable Sanitation and Hygiene for All (SSH4A) approach on key program WASH (water, sanitation, and hygiene) indicators, and also assess if these increases in WASH coverage are equitably reaching vulnerable groups. The SSH4A approach was administered in 12 program areas in 11 countries, including Bhutan, Ethiopia, Ghana, Indonesia, Kenya, Mozambique, Nepal, South Sudan, Tanzania, Uganda, and Zambia. Repeated cross-sectional household surveys were administered over four rounds at annual follow-up rounds from 2014 to 2018. Surveys were conducted in an average of 21,411 households at each round of data collection. Overall, sanitation coverage increased by 53 percentage points between baseline and the final round of data collection (95% CI: 52%, 54%). We estimate that 4.8 million people gained access to basic sanitation in these areas during the project period. Most countries also demonstrated movement up the sanitation ladder, in addition to increases in handwashing stations and safe disposal of child feces. When assessing equity—if sanitation coverage levels were similar comparing vulnerable and non-vulnerable groups—we observed that increases in coverage over time were generally comparable between vulnerable groups and non-vulnerable groups. However, the increase in sanitation coverage was slightly higher for higher wealth households compared to lower wealth households. Results from this study revealed a successful model of rural sanitation service delivery. However, further work should be done to explore the specific mechanisms that led to success of the intervention.

Suggested Citation

  • Paschal A. Apanga & Joshua V. Garn & Zoe Sakas & Matthew C. Freeman, 2020. "Assessing the Impact and Equity of an Integrated Rural Sanitation Approach: A Longitudinal Evaluation in 11 Sub-Saharan Africa and Asian Countries," IJERPH, MDPI, vol. 17(5), pages 1-23, March.
  • Handle: RePEc:gam:jijerp:v:17:y:2020:i:5:p:1808-:d:330899
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    References listed on IDEAS

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    1. World Bank, 2011. "Water Supply and Sanitation in South Africa : Turning Finance into Services for 2015 and Beyond," World Bank Publications - Reports 17752, The World Bank Group.
    2. World Bank, 2011. "Water Supply and Sanitation in Senegal : Turning Finance into Services for 2015 and Beyond," World Bank Publications - Reports 17759, The World Bank Group.
    3. World Bank, 2011. "Water Supply and Sanitation in Mauritania : Turning Finance into Services for 2015 and Beyond," World Bank Publications - Reports 17766, The World Bank Group.
    4. Aime Tsinda & Pamela Abbott & Steve Pedley & Katrina Charles & Jane Adogo & Kenan Okurut & Jonathan Chenoweth, 2013. "Challenges to Achieving Sustainable Sanitation in Informal Settlements of Kigali, Rwanda," IJERPH, MDPI, vol. 10(12), pages 1-16, December.
    5. Carolini, G.Y., 2012. "Framing water, sanitation, and hygiene needs among female-headed households in Periurban Maputo, Mozambique," American Journal of Public Health, American Public Health Association, vol. 102(2), pages 256-261.
    6. World Bank, 2011. "Water Supply and Sanitation in Kenya : Turning Finance into Services for 2015 and Beyond," World Bank Publications - Reports 12890, The World Bank Group.
    7. World Bank, 2011. "Water Supply and Sanitation in Benin : Turning Finance into Services for 2015 and Beyond," World Bank Publications - Reports 17763, The World Bank Group.
    8. World Bank, 2011. "Water Supply and Sanitation in Ghana : Turning Finance into Services for 2015 and Beyond," World Bank Publications - Reports 17758, The World Bank Group.
    9. World Bank, 2011. "Water Supply and Sanitation in Angola : Turning Finance into Services for 2015 and Beyond," World Bank Publications - Reports 17755, The World Bank Group.
    10. World Bank, 2011. "Water Supply and Sanitation in Liberia : Turning Finance into Services for 2015 and Beyond," World Bank Publications - Reports 17765, The World Bank Group.
    11. World Bank, 2011. "Water Supply and Sanitation in The Gambia : Turning Finance into Services for 2015 and Beyond," World Bank Publications - Reports 17764, The World Bank Group.
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    Cited by:

    1. Takele, Habtamu & Alemayehu, Mekuriaw & Geberu, Demiss Mulatu, 2023. "Outcome evaluation of WASH intervention in rural households at Jawi district, Northwest Ethiopia: Mixed method design, goal based evaluation," Evaluation and Program Planning, Elsevier, vol. 98(C).

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