Aquaya Institute, Nairobi, Kenya.
Aquaya Institute, San Anselmo, California, USA.
Environ Health Perspect. 2022 Jun;130(6):67004. doi: 10.1289/EHP10443. Epub 2022 Jun 8.
According to the World Health Organization/United Nations International Children's Fund Joint Monitoring Program, people practice open defecation globally. After achieving open defecation-free (ODF) status through efforts such as Community-Led Total Sanitation (CLTS), communities (particularly vulnerable households) may revert to open defecation, especially when toilet collapse is common and durable toilets are unaffordable. Accordingly, there is increasing interest in pro-poor sanitation subsidies.
This study determined the impacts of a pro-poor sanitation subsidy program on sanitation conditions among the most vulnerable households and others in the community.
In 109 post-ODF communities in Northern Ghana, we conducted a cluster randomized controlled trial to evaluate a pro-poor subsidy program that identified the most vulnerable households through community consultation to receive vouchers for durable toilet substructures. We surveyed households to assess toilet coverage, quality, and use before and after the intervention and tracked program costs.
Overall, sanitation conditions deteriorated substantially from baseline to endline (average of 21 months). In control communities (not receiving the pro-poor subsidy), open defecation increased from 25% (baseline) to 69% (endline). The subsidy intervention attenuated this deterioration (open defecation increased from 25% to only 54% in subsidy communities), with the greatest impacts among voucher-eligible households. Noneligible households in compounds with subsidized toilets also exhibited lower open defecation levels owing to in-compound sharing (common in this context). CLTS followed by the subsidy program would benefit more households than CLTS alone but would cost 21-37% more per household that no longer practiced open defecation or upgraded to a durable toilet.
Sanitation declines, often due to toilet collapse, suggest a need for approaches beyond CLTS alone. This subsidy program attenuated declines, but durable toilets likely remained unaffordable for noneligible households. Targeting criteria more closely aligned with sanitation inequities, such as household heads who are female or did not complete primary education, may help to generate greater and more sustainable impacts in Northern Ghana and, potentially, other contexts facing toilet collapse and limited market access. https://doi.org/10.1289/EHP10443.
根据世界卫生组织/联合国儿童基金会联合监测规划，全球仍有人在露天排便。通过社区主导的整体环境卫生（CLTS）等方式实现无露天排便（ODF）后，社区（尤其是弱势家庭）可能会重新开始露天排便，尤其是在厕所倒塌普遍且耐用厕所无法负担的情况下。因此，人们对有利于穷人的卫生补贴越来越感兴趣。
本研究旨在确定有利于穷人的卫生补贴计划对最弱势群体和社区其他成员的卫生条件的影响。
在加纳北部的 109 个 ODF 后社区中，我们进行了一项整群随机对照试验，以评估一项有利于穷人的补贴计划，该计划通过社区协商确定最弱势群体，为他们提供耐用厕所基础结构的代金券。我们在干预前后对家庭进行了调查，以评估厕所的覆盖率、质量和使用情况，并跟踪了项目成本。
总体而言，卫生条件从基线到终线都大幅恶化（平均 21 个月）。在对照组社区（未获得有利于穷人的补贴），露天排便率从 25%（基线）上升到 69%（终线）。补贴干预减轻了这种恶化（补贴社区的露天排便率从 25%上升到 54%），对符合条件的家庭影响最大。在有补贴厕所的大院中，不符合条件的家庭也由于共用（在这种情况下很常见）而露天排便的比例较低。在 CLTS 之后实施补贴计划将使更多的家庭受益，而不仅仅是 CLTS 本身，但对于不再露天排便或升级为耐用厕所的家庭，每个家庭的成本将增加 21-37%。
卫生条件的下降，通常是由于厕所倒塌，表明需要采取 CLTS 之外的方法。该补贴计划减轻了下降，但耐用厕所可能仍然对不符合条件的家庭来说负担不起。更紧密地针对卫生不平等的目标，例如女性户主或未完成小学教育的户主，可能有助于在加纳北部和其他可能面临厕所倒塌和有限市场准入的情况下产生更大和更可持续的影响。
