Sumeet Patil

The effect of water quality testing on household behavior: evidence from an experiment in rural India.

How does specific information about contamination in a households drinking water affect water handling behavior? We randomly split a sample of households in rural Andhra Pradesh, India. The treatment group observed a contamination test of the drinking water in their own household storage vessel; while they were waiting for their results, they were also provided with a list of actions that they could take to remedy contamination if they tested positive. The control group received no test or guidance. The drinking water of nearly 90% of tested households showed evidence of contamination by fecal bacteria. They reacted by purchasing more of their water from commercial sources but not by making more time-intensive adjustments. Providing salient evidence of risk increases demand for commercial clean water.

Nature’s Call: Impacts of Sanitation Choices in Orissa, India

Worldwide, over 2.5 billion people lack access to basic sanitation, a situation that contributes to 2 million annual diarrhea-related child deaths and substantial morbidity. Yet rigorous evaluations of sanitation behaviors and their health and welfare impacts are rare. This article uses a randomized sanitation promotion campaign in Orissa, India, to evaluate child health and household welfare outcomes. The sanitation campaign increased households’ ownership and use of latrines and improved children’s mid-upper-arm circumference, height, and weight z-scores. Switching from open defecation to latrine use also saved time and increased satisfaction in sanitation conditions. We use our results to illustrate the cost-benefit calculus underlying this seemingly unglamorous and mundane household choice with potentially large environmental externalities.

Of taps and toilets: quasi-experimental protocol for evaluating community-demand-driven projects

Sustainable and equitable access to safe water and adequate sanitation are widely acknowledged as vital, yet neglected, development goals. Water supply and sanitation (WSS) policies are justified because of the usual efficiency criteria, but also major equity concerns. Yet, to date there are few scientific impact evaluations showing that WSS policies are effective in delivering social welfare outcomes. This lack of an evaluation culture is partly because WSS policies are characterized by diverse mechanisms, broad goals and the increasing importance of decentralized delivery, and partly because programme administrators are unaware of appropriate methods. We describe a protocol for a quasi-experimental evaluation of a community-demand-driven programme for water and sanitation in rural India, which addresses several evaluation challenges. After briefly reviewing policy and implementation issues in the sector, we describe key features of our protocol, including control group identification, pre-post measurement, programme theory, sample sufficiency and robust indicators. At its core, our protocol proposes to combine propensity score matching and difference-in-difference estimation. We conclude by briefly summarizing how quasi-experimental impact evaluations can address key issues in WSS policy design and when such evaluations are needed.

A randomized, controlled study of a rural sanitation behavior change program in Madhya Pradesh, India

Poor sanitation and open defecation are thought to be a major cause of diarrhea and intestinal parasite infections among young children. In 1999, India launched the Total Sanitation Campaign with the goal of achieving universal toilet coverage in rural India by 2012. This paper reports on a cluster-randomized, controlled trial that was conducted in 80 rural villages in Madhya Pradesh to measure the effect of the program on toilet access, sanitation behavior, and child health outcomes. The study analyzed a random sample of 3,039 households and 5,206 children under five years of age. Field staff collected baseline measures of sanitation conditions, behavior, and child health, and re-visited households 21 months later. The analysis finds that implementation of the program activities was slower than the original timeline (only 35 percent of villages were triggered more than six months before the follow-up survey). Nevertheless, the Total Sanitation Campaign successfully increased toilet coverage by 19 percent in intervention villages compared with control villages (41 percent v. 22 percent), while reported open defecation decreased by 10 percent among adults (74 percent v. 84 percent). The intervention also led to some improvements in water quality and protozoan infection, but consistent improvements were not observed across multiple child health outcomes (diarrhea, helminth infections, child growth). However, the exposure period was likely to have been too short to result in any benefit of the sanitation interventions on child health. Given the large improvements in toilet construction documented, an additional follow-up survey with a longer period of exposure would yield valuable information on the effects of improved sanitation conditions on health outcomes.

Explaining environmental health behaviors: Evidence from rural India on the influence of discount rates

The authors examine whether high personal discount rates help explain why and which households in developing countries under-invest in seemingly low-cost options to avert environmental health threats, including bednets, clean cooking fuels, individual household latrines, water treatment and handwashing. First, the authors elicit personal discount rates by combining a simple randomized experiment with detailed surveys of over 10,000 rural households in Maharashtra, India. Personal discount rates are lower for women, for better-off households, and for households who can access formal credit. Secondly, they show that the discount rate is negatively related to a suite of behaviors that mitigate environmental health threats, from very low-cost steps like washing hands to more significant investments like household latrines, even after controlling for socio-economic status, access to credit, public infrastructure and services, and relevant beliefs.