India accounts for 33 percent of the global population without access to safe water and adequate sanitation. At the same time, few Indians have health insurance and therefore pay for most health care out of their pockets. Researchers will examine the link between improved health status and reduced health expenditures in poor, rural India by evaluating the effects of a community-based healthcare program and a sanitation program that provides access to credit to construct safe sanitation systems.
Good sanitation is indispensable for reducing many diseases and improving overall public health. There are also important economic consequences – the World Bank’s Water and Sanitation Program estimates that developing countries lose between one and seven percent of GDP annually due to poor sanitation. But improvements and investments in sanitation haven’t kept up with need in urban or rural areas. Experts in this field are still working to understand what mix of informational campaigns, credits and sanitation infrastructure can work to improve demand and usage. This evaluation will improve our understanding of what works by looking at the effect of combining better access to health insurance with informational campaigns and credit for constructing improved sanitation facilities. Researchers will also be building evidence on the links and interactions between safe sanitation and the availability of health insurance.
|India is home to 594 million people defecating in the open; over 50 per cent of the population. (Unicef)|
Research area: Early Childhood Nutrition, Development, and Health
Evaluation Sample: Project 1: 120 Gram Panchayat (a local governing institution that usually covers one or two villages) in rural India, Project 2: Three Gram Panchayat in rural India
Timeline: 2012 - 2017
Intervention: Informational campaigns, micro loans, low-cost health insurance
Researchers: Orazio Attanasio, University College London; Manish Kumar, World Bank; Sonali Andrea David, World Bank; Britta Augsburg, Institute of Fiscal Studies, University College London; Bansi Malde, Institute of Fiscal Studies, University College London
Partners: Grameen Financial Services India; SAS Poorna Arogya Health Care Pvt. Ltd., Mysore; University College London; EDePo at the Institute for Fiscal Studies; FINISH (Financial Inclusion Improves Sanitation and Health) Society; YASHDA, Pune, India
The Indian Government has worked to improve sanitation through its Nirmal Bharat Abhiyan policy (formerly known as the Total Sanitation Campaign), but safe sanitation uptake and usage remains low. The 2011 Indian census reported that almost 50 percent of Indian households do not have access to a private or public latrine, meaning that over half a billion people still defecate in the open. At the same time, the Indian Government has been expanding access to health insurance through its Rashtriya Swayam Bima Yojana health insurance program for the poor (http://www.rsby.gov.in/about rsby.aspx). The expansion of health insurance makes it possible to look more closely at the links and interactions between improved sanitation and health insurance.