Evaluations - Water and Sanitation

October 6, 2016





Improved water supply and sanitation are critical for health and development, especially of young children, by reducing the transmission of disease. Toilets and easily accessible water supply systems provide women and children with security and dignity. They also can help raise school attendance, reduce healthcare costs and ultimately, strengthen productivity. For too many, this is still out of reach: More than 2.5 billion people don’t have access to basic sanitation, 1.1 billion people still defecate in the open, and more than 780 million people do not have regular access to clean drinking water. Improving water and sanitation makes good business sense as well, because poor sanitation and its effects depresses a country’s economic potential. SIEF-supported researchers are evaluating what mix of informational campaigns, financial instruments and incentives, and provision of sanitation infrastructure can successfully boost sustained access and usage. The evidence collected will give governments powerful evidence for making policy decisions that will ultimately bring tangible improvements in people’s well-being. Read more about water and sanitation and impact evaluation in our Cluster Note.





Bangladesh: Impact of Low-Cost In-Line Chlorination Systems in Urban Dhaka on Water Quality and Child Health

  • Principal investigators: Stephen Luby, Stanford University
  • Timeline: Completed
  • Evaluation: In Bangladesh, limited water supply and poor sanitation infrastructure in dense slums is associated with high rates of child diarrhea and stunting. Central treatment and delivery of water supply is prohibitively expensive for municipal governments to implement in low-income areas. An in-line chlorination system was used to deliver the right dose to dispensed water at existing handpumps in Dhaka. Researchers sought to determine the effectiveness of using automated chlorination at public water dispensing stations to improve water quality and child health outcomes.


Ethiopia: The Impact of Enhanced, Demand-Side Sanitation and Hygiene Promotion on Sustained Behavior Change and Health in Ethiopia

  • Principal investigator: Matthew Freeman, Emory University
  • Timeline: 2017-2019
  • Evaluation: Neglected tropical diseases (NTDs) are a diverse group of parasitic, bacterial, and viral diseases affecting more than one billion people around the world, primarily those in poor regions without adequate sanitation. Some of the diseases, namely soil-transmitted helminthiasis, schistosomiasis, and trachoma, can be controlled with preventive chemotherapy, but reinfection can rapidly occur. Long-term drug provision is not a sustainable solution, and eliminating these conditions as public health concerns will not occur without adequate provision of water, sanitation and hygiene infrastructure and changing related behaviors. Millions of people in Ethiopia are at risk of neglected tropical diseases, and the Government of Ethiopia has made control and elimination a priority. Researchers will study the impact of an intervention that integrates specific sanitation and hygiene behavior change components into current government supported programming to encourage improved personal hygiene and sanitation practices and reduce the spread of neglected tropical diseases. Resulting evidence will help the Government of Ethiopia decide on next steps for the prevention and control of neglected tropical diseases and promotion of better sanitation and hygiene.  


India: Incentivizing Sanitation Uptake and Sustainable Usage through Microfinance

  • Principal investigators: Orazio Attanasio, University College London
  • Timeline: Completed
  • Evaluation: India accounts for 33 percent of the global population without access to safe water and adequate sanitation. Experts are still working to understand what the barriers are to take up for improved sanitation, and they’re testing what mix of informational campaigns, credits and sanitation infrastructure might work to improve demand and usage. This evaluation will improve our understanding of the possible obstacles by looking at the effect of offering households microfinance loans for sanitation improvement, and the effect of combining this with an awareness campaign.


India: A Multiple-Arm, Cluster-Randomized Impact Evaluation of the Clean India (Swachh Bharat) Mission Program in Rural Punjab, India

  • Principal investigators: Luis Andres, World Bank; Saubhik Deb; George Joseph, World Bank; Maria Isabel Larenas, Inter-American Development Bank; Jonathan Grabinsky Zabludovsky, World Bank
  • Timeline: 2014 - 2019
  • Evaluation: This study reports impacts of a large-scale, multiple-arm, cluster-randomized control study carried out in rural Punjab, India, to assess the impact of a flagship sanitation program of the Government of India. The program, the Clean India Mission for Villages, was implemented between October 2014 and October 2019 and aimed to encourage the construction of toilets, eliminate the practice of open defecation, and improve the awareness and practice of good hygiene across rural India. It utilized a combination of behavioral change campaigns, centered on the community-led total sanitation approach, and financial incentives for eligible households. The study also evaluates the incremental effects of intensive hygiene awareness campaigns in selected schools and follow-up initiatives in selected communities.


Kenya: Turning Pipe Dreams into Reality: Improving access to water and sanitation services in a Nairobi Slum

  • Principal investigators: Sebastian Galiani, University of Maryland; Paul Gertler, University of California, Berkeley
  • Timeline: Ongoing
  • Evaluation: As part of World Bank infrastructure project to extend services to poor households in Kenya’s fast growing urban slums, the Nairobi City Water and Sewerage Company has provided water and sewer services to more than 8300 customers. These are generally landlords who rent out rooms in compounds in informal settlements in Nairobi. The water and sewage company is concerned that the landlords, most of whom already have outstanding bills for water services, won’t pay for the upgrades as agreed, making it impossible for the water authority to repay the money it borrowed to connect the compounds. The study tests the effect of increased enforcement through disconnection warnings to landlords and bottom-up accountability through the provision of billing information to tenants.


Nicaragua Sustainable Water and Sanitation Sector Project

  • Principal Investigator: Christian Borja-Vega, Pavel Luengas-Sierra, and Jonathan Grabinsky
  • Timeline: 2014 - 2019
  • Evaluation: Poverty in Nicaragua is concentrated in rural areas, where more than 40 percent of the population lives. Over a third of people in rural areas lack piped in water and access to adequate sanitation. With the Government of Nicaragua, the World Bank supported a rural water supply sanitation project, known as PROSASR, to improve water and sanitation for the rural poor. An impact evaluation, conducted with the government, tested the impacts of building the capacity of local water and sanitation committees on the financial stability and maintenance of the water system as well as use of improved sanitation in households.


The Philippines Pantawid Pamilya CCT Sanitation Impact Evaluation

  • Principal Investigators: Paul J. Gertler, University of California, Berkeley; Joshua Gruber, University of California, Berkeley
  • Timeline: Ongoing 
  • Evaluation: Access to basic sanitation is still one of the largest development challenges in the Philippines. About a quarter of the population don’t have access to latrines and other improved sanitation facilities, putting especially children at risk of diarrheal illnesses that can stunt growth, harm health and make it hard for them to reach their potential. The Government of the Philippines, working with the World Bank, is implementing and evaluating a new program that will twin subsidies or loans with promotional campaigns to convince households to acquire and use toilets. The results of the evaluation will help the government decide what is the best approach for ending open defecation.