Sanitation Policy Raymond Guiteras, Maryland James Levinsohn, Yale - - PowerPoint PPT Presentation

Sanitation Policy

Raymond Guiteras, Maryland James Levinsohn, Yale

• A. Mushfiq Mobarak, Yale

Implementation Partners: Innovations for Poverty Action Wateraid, Bangladesh VERC Grantor: The Bill and Melinda Gates Foundation

Sanitation

• One billion people, or about 15% of the world’s

population, currently practice open defecation.

• 2.5 billion do not have access to an improved

sanitation facility

• MDG goal of 75% coverage by 2015 will be missed

by close to one billion people.

• Poor sanitation is estimated to cause 280,000 deaths

per year

• May also be responsible for serious long-term

health conditions such as stunting or tropical enteropathy

Policy Interest

• In 2012 UNICEF spent $380 million on programs focused on

water, sanitation, and hygiene for children.

• The World Bank’s Water and Sanitation Program plans to direct

US $200 million to improve sanitation for 50 million people during the 2011-2015 period (World Bank WSP, 2013).

• In India, over half the population practices open defecation

(Census Organization of India, 2011)

• Prime Minister Narendra Modi’s pre-election campaign: “pehle

shauchalaya, phir devalaya” (“toilets first, temples later”)

• He has pledged to eliminate open defecation in India by 2019

Policy Debates in Sanitation Programming

• Is Demand Generation necessary or sufficient?
• Is a Supply-Side Push necessary or sufficient?
• Are Subsidies necessary? Are they helpful?
• Who should you subsidize? How should you

subsidize?

• Trying to bring some rigorous evidence to bear
• n these questions for rural Bangladesh

General Research Question: Interdependencies in Household Decisions

• Latrine adoption decisions may be interdependent

across households

– Epidemiological Complementarity – Social spillovers – learning/shame/status

• How important are these interdependencies?
• Which mechanisms are most important?
• If these interdependencies are significant, how can

we use them to improve interventions?

– e.g. what’s the threshold to push over to the “good equilibrium”?

Context

• Rural areas of Tanore district, Bangladesh

Context

• Rural areas of Tanore district, Bangladesh
• 32% open defecation (cf. 15% nationally)
• Increased coverage of basic latrines, but low

coverage of improved or hygienic latrines

– 19% used improved latrines in 2009 MICS

• Study Sample:

– 4 of 7 sub-districts (unions), 115 villages, 372 neighborhoods (paras), 18,000 households

Summary of Design: Key Aspects

2 x 2 Demand-Supply Interventions – Control – Supply – Demand – Demand + Supply

Supply Side Push None Demand Generation (CLTS or “LPP”) D+S Demand Only None Supply only Control

Summary of Design: Key Aspects

2 x 2 Demand-Supply Interventions – Control – Supply – [LPP+Subsidy] – [LPP+Subsidy] + Supply LPP= Latrine Promotion Program, a version of CLTS

Summary of Design: Key Aspects

2 x 2 Demand-Supply Interventions – Control – Supply – [LPP+Subsidy] – [LPP+Subsidy] + Supply – LPP only (Added this fifth group – LPP without subsidies – to separately identify information vs subsidy effects)

Design: Education / Motivation Latrine Promotion Program (LPP)

• First barrier may be that households simply are

not aware of the importance of sanitation

• With WaterAid and VERC, designed LPP, based
• n Community-Led Total Sanitation (CLTS)
• Transect walk, Open Defecation Mapping,

Community Discussion

• Not just individual benefits: inter-dependency

Design: Education / Motivation Latrine Promotion Program (LPP)

Design: Subsidy

• Identify “eligible” (poorer) households

– primarily based on land ownership

• Lottery for voucher, roughly 75% of cost
• Winners could choose from three models

– After-voucher price (approx.) USD 7.5, 10, 15 – All meet standard criteria for “hygienic”

• Independent lottery for superstructure (“tin”)

Design: Subsidy

Design: Supply

• Even if households are motivated and can afford

a latrine, there may be supply-side barriers

– Information about quality, installation, link to supply

• Latrine Supply Agent (LSA)

– Community member respected in technical matters – Provide information on where to purchase, how to assess quality, how to install and maintain – Linked to masons

Design: Summary

Control No intervention 65 Clusters Treatment 1 LPP Only 50 Clusters Treatment 2 LPP + Subsidy 110 Clusters Treatment 3 LPP + Subsidy + Supply (LSA) 110 Clusters Treatment 4 Supply Only (LSA) 35 Clusters

Effects on Open Defecation

Design: Refinements to Subsidy

• Form of subsidy

– Early adopter versus Fixed share

• Intensity: share of Eligibles receiving subsidy

– Divide subsidy clusters into Low, Medium and High intensity: 25%, 50% and 75% of eligibles receive a voucher

• Target “Highly Connected Individuals” (HCIs)

– In random subset of clusters, we weighted voucher winners towards those most highly connected

Effects of Proportion of Community Subsidized on Latrine Ownership

Ineligibles

• 25% of the population was ineligible for the

subsidy

– Based on landownership criteria

• What are the key constraints for the relatively

rich?

• Did neighbors getting subsidies affect their

behavior?

Measuring Social Network Effects

• Thought experiment:
• Similar HH A and B, one eligible contact each
• A’s contact wins, B’s does not (random)
• A’s contact is more likely to adopt
• Can use this random variation to estimate:

– Whether a household’s adoption decision is influenced by the decisions of their contacts – What type of contacts matter.

VARIABLES 0.579*** 0.564*** 0.710*** 0.711*** 0.270** 0.365*** 0.189** 0.110 (0.0852) (0.0950) (0.0723) (0.0841) (0.125) (0.112) (0.0811) (0.0931) Won Latrine only 0.0625*** 0.0686*** 0.0464*** 0.0485*** 0.0989*** 0.0634*** 0.111*** 0.0745*** (0.0158) (0.0187) (0.0128) (0.0145) (0.0179) (0.0191) (0.0194) (0.0197) Won Tin only

• 0.00631
• 0.00241
• 0.0263*
• 0.0268*

0.00733

• 0.0184

0.0209

• 0.0126

(0.0185) (0.0231) (0.0142) (0.0162) (0.0190) (0.0201) (0.0206) (0.0222) Won both 0.120*** 0.127*** 0.0923*** 0.0943*** 0.159*** 0.122*** 0.175*** 0.137*** (0.0171) (0.0194) (0.0136) (0.0147) (0.0177) (0.0191) (0.0199) (0.0224)

• 0.00122

0.00372

• 0.00286
• 0.0147

(0.00844) (0.00506) (0.0126) (0.0187)

• 0.00644
• 0.00722

0.0141 0.0270 (0.00850) (0.00502) (0.0147) (0.0214) 0.00205 0.000494 0.0148 0.0390** (0.00724) (0.00532) (0.0158) (0.0165) 0.00117 0.00202 0.0416*** 0.0336** (0.00714) (0.00554) (0.0126) (0.0155) 0.00259 0.00550 0.0433** 0.0325* (0.00796) (0.00567) (0.0172) (0.0168)

• 0.00867
• 0.00501

0.00610 0.0258 (0.00730) (0.00599) (0.0140) (0.0165)

Observations 7,930 7,930 13,607 13,607 13,445 13,445 11,438 11,438 Technical Access to Hygienic Latrine

Treatment: High Intensity & Fixed Subsidy Treatment: High Intensity & Early Adoption

Playmates Interact Conflict Resolve Access rate among social contacts

Treatment: Low Intensity & Fixed Subsidy Treatment: Low Intensity & Early Adoption Treatment: Medium Intensity & Fixed Subsidy Treatment: Medium Intensity & Early Adoption

Results

• We see very strong effects:
• If the share of your contacts with a hygienic latrine

increases by 10 pct. pts., your household’s probability of adoption increases by approximately 5 pct. Pts.

• Strongest effects from HH where your children

play, HH with which you frequently interact.

• Weaker effect from person whose opinion you

respect, person you would consult for technical advice.

Concluding Remarks

• Subsidies targeted to the poorer segments of the

community are a useful complement to CLTS-style programming (community motivation, joint commitment)

• Affects both ownership and use of latrines
• Strong inter-dependencies in decision-making:

– Interventions should target communities, not individuals

• The relatively rich benefit from supply-side help
• 1300 extra toilets got built in treatment areas

(relative to control) as a result of these interventions.