Impact of Indian Total Sanitation Campaign on Latrine Coverage and Use: A Cross-Sectional Study in Orissa Three Years following Programme Implementation

Abstract

BackgroundFaced with a massive shortfall in meeting sanitation targets, some governments have implemented campaigns that use subsidies focused on latrine construction to overcome income constraints and rapidly expand coverage. In settings like rural India where open defecation is common, this may result in sub-optimal compliance (use), thereby continuing to leave the population exposed to human excreta.MethodsWe conducted a cross-sectional study to investigate latrine coverage and use among 20 villages (447 households, 1933 individuals) in Orissa, India where the Government of India’s Total Sanitation Campaign had been implemented at least three years previously. We defined coverage as the proportion of households that had a latrine; for use we identified the proportion of households with at least one reported user and among those, the extent of reported use by each member of the household.ResultsMean latrine coverage among the villages was 72% (compared to <10% in comparable villages in the same district where the Total Sanitation Campaign had not yet been implemented), though three of the villages had less than 50% coverage. Among these households with latrines, more than a third (39%) were not being used by any member of the household. Well over a third (37%) of the members of households with latrines reported never defecating in their latrines. Less than half (47%) of the members of such households reported using their latrines at all times for defecation. Combined with the 28% of households that did not have latrines, it appears that most defecation events in these communities are still practiced in the open.ConclusionA large-scale campaign to implement sanitation has achieved substantial gains in latrine coverage in this population. Nevertheless, gaps in coverage and widespread continuation of open defecation will result in continued exposure to human excreta, reducing the potential for health gains.

Beliefs, Behaviors, and Perceptions of Community-Led Total Sanitation and Their Relation to Improved Sanitation in Rural Zambia

“…Although one evaluation showed limited success in longterm impact, 13 the peer-reviewed 14 and gray [15][16][17][18][19][20] literature describe multiple examples of the success of the CLTS approach. In India, Barnard and others found that, although a major CLTS campaign was followed by dramatic uptake in latrine coverage in the population, the majority of defecation events were still in the open, exposing communities to human excreta.…”

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“…Epidemiological complementarities between water and sanitation interventions may arise because there are multiple pathways for transmission of water-borne disease (Clasen et al 2007, Waddington andSnilstveit 2009). A behavioral complementarity can occur if providing water encourages latrine use -1 without convenient access to water, it may be difficult to keep a latrine clean, and poor maintenance may discourage use (Barnard et al 2013). Furthermore, willingness to pay for the convenience of piped water in the home appears to be high (Devoto et al 2012), in contrast to a low willingness to pay for improvements in water quality by itself (Kremer et al 2011, Berry, Fischer, andGuiteras 2012) and latrines by themselves , Patil et al 2014.…”