Cameron Lisa, Gertler Paul, Shah Manisha, Alzua Maria Laura, Martinez Sebastian, Patil Sumeet
University of Melbourne, Australia.
University of California Berkeley and NBER, USA.
J Dev Econ. 2022 Nov;159:102990. doi: 10.1016/j.jdeveco.2022.102990.
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.
我们在印度、印度尼西亚、马里和坦桑尼亚这四个国家开展的大规模随机实地实验中，考察了一项旨在消除露天排便的卫生项目的影响。这些项目——均为广泛使用的社区主导全面卫生（CLTS）方法的变体——使所有四个地区的村庄私人卫生设施覆盖率提高了7至39个百分点。我们利用实验诱导的卫生设施获取差异，来确定村庄卫生设施覆盖率与儿童身高之间的因果关系。我们发现了阈值效应的证据，即一旦村庄卫生设施覆盖率达到50%至75%，儿童健康状况会提高0.3个标准差。超过这个阈值似乎不会有进一步的改善。这些结果表明，实现远低于CLTS运动所推动的100%覆盖率的水平，会带来巨大的健康益处。通过改善私人卫生设施获取情况，所有国家的露天排便现象都有所减少，在实施了最密集行为改变干预措施的马里，还通过增加卫生设施的使用实现了这一目标。
