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Encouraging sanitation investment in the developing world: A cluster-randomized trial

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Science  22 May 2015:
Vol. 348, Issue 6237, pp. 903-906
DOI: 10.1126/science.aaa0491

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Helping the poor invest in sanitation

Almost a third of the world's people do not have access to hygienic latrines. Improving access to and increasing the use of latrines would reduce deaths and poor health caused by diarrheal disease. Guiteras et al. tested the relative benefits of supplying health information, offering a financial subsidy to purchasers of hygienic latrines, or increasing the availability of latrines for purchase. Providing the subsidy worked best: Nonsubsidized households were more likely to purchase latrines when other households in their village were subsidized.

Science, this issue p. 903

Abstract

Poor sanitation contributes to morbidity and mortality in the developing world, but there is disagreement on what policies can increase sanitation coverage. To measure the effects of alternative policies on investment in hygienic latrines, we assigned 380 communities in rural Bangladesh to different marketing treatments—community motivation and information; subsidies; a supply-side market access intervention; and a control—in a cluster-randomized trial. Community motivation alone did not increase hygienic latrine ownership (+1.6 percentage points, P = 0.43), nor did the supply-side intervention (+0.3 percentage points, P = 0.90). Subsidies to the majority of the landless poor increased ownership among subsidized households (+22.0 percentage points, P < 0.001) and their unsubsidized neighbors (+8.5 percentage points, P = 0.001), which suggests that investment decisions are interlinked across neighbors. Subsidies also reduced open defecation by 14 percentage points (P < 0.001).

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