Sanitation and Externalities: Evidence from Early Childhood Health in Rural India

Abstract

The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent.

Clean water, sanitation and diarrhoea in Indonesia: Effects of household and community factors

“…Such a facility separates the human excreta from direct contact with humans and ensures a safe disposal of the faeces, thus reducing the risk of faecal contamination (Andres et al, 2014). However, as shown by a recent cluster-randomised trial in rural Odisha, India, proper sanitation facilities at the household level do not always improve health .…”

“…An even stronger spillover effect is expected with respect to the coverage of proper sanitation in the community (Alderman et al, 2003). Although an improved toilet increases the hygiene level of the owner, it cannot fully eliminate faecal contamination from the neighbourhood if other households lack such a facility (Andres et al, 2014;Clasen et al, 2014). Indirect effects at the community level might also be important.…”

“…Ideally, an analysis of the determinants of diarrhoea should take all relevant factors at both levels into account (Corsi et al, 2011;Fewtrell et al, 2005). Children from a household with good quality water and sanitation are still at risk for diarrhoea if they live in a community with open defaecation, due to the contamination of soil and water sources (Andres, Briceño, Chase, & Echenique, 2014;Corsi et al, 2011). By focusing the analysis only on factors at the household level, an incomplete picture is obtained and interventions might appear to be less effective than they truly are (Corsi et al, 2011).…”

Sanitation and child health in India

“…In our definition of disease environment we go beyond the imminent disease environment of the household, acknowledging that toilet ownership and usage provides a direct benefit as well as an external benefit, which is believed to be substantial (Duflo et al [2015a]; Gertler et al [2014], Geruso and Spears [2014], Andres et al [2014]). Using a toilet reduces own contact with faeces in addition to other private benefits a toilet might provide (time saving, privacy, etc).…”

“…Their suggested impact of a one standard deviation reduction in their constructed open defecation index would lead to an average increase of standard deviation in children's height. Finally, Andres et al [2014], use a simple cross-sectional approach, not attempting to account for endogeneity in their variables of interest, finding that 'a 47 percent reduction in diarrhoea prevalence between children living in a household without access to improved sanitation in a village without coverage of improved sanitation and children living in a household with access to improved sanitation in a village with complete coverage'.…”