Publication: Promoting Handwashing and Sanitation : Evidence from a Large-Scale Randomized Trial in Rural Tanzania
Loading...
Date
2015-01
ISSN
Published
2015-01
Author(s)
Abstract
The association between hygiene,
sanitation, and health is well documented, yet thousands of
children die each year from exposure to contaminated fecal
matter. At the same time, evidence on the effectiveness of
at-scale behavior change interventions to improve sanitation
and hygiene practices is limited. This paper presents the
results of two large-scale, government-led handwashing and
sanitation promotion campaigns in rural Tanzania. For the
campaign, 181 wards were randomly assigned to receive
sanitation promotion, handwashing promotion, both
interventions together, or neither. One year after the end
of the program, sanitation wards increased latrine
construction rates from 38.6 to 51 percent and reduced
regular open defecation from 23.1 to 11.1 percent.
Households in handwashing wards show marginal improvements
in handwashing behavior related to food preparation, but not
at other critical junctures. Limited interaction is observed
between handwashing and sanitation on intermediate outcomes:
wards that received both handwashing and sanitation
promotion are less likely to have feces visible around their
latrine and more likely to have a handwashing station close
to their latrine facility relative to individual treatment
groups. Final health effects on child health measured
through diarrhea, anemia, stunting, and wasting are absent
in the single-intervention groups. The combined-treatment
group produces statistically detectable, but biologically
insignificant and inconsistent, health impacts. The results
highlight the importance of focusing on intermediate
outcomes of take-up and behavior change as a critical first
step in large-scale programs before realizing the changes in
health that sanitation and hygiene interventions aim to deliver.
Link to Data Set
Citation
“Briceno, Bertha; Coville, Aidan; Martinez, Sebastian. 2015. Promoting Handwashing and Sanitation : Evidence from a Large-Scale Randomized Trial in Rural Tanzania. Policy Research working paper;no. WPS 7164; Policy Research Working Paper;No. 7164. © World Bank Group, Washington, DC. http://hdl.handle.net/10986/21383 License: CC BY 3.0 IGO.”
Other publications in this report series
Publication Right to Education(Washington, DC: World Bank, 2024-03-12)About a third of the 7.7 million Venezuelans who have left their country due to political and economic turmoil have settled in neighboring Colombia. The extent to which the Colombian schooling system can absorb the massive demand for education of Venezuelan children is key for their future trajectory of human capital accumulation, as well as that of Colombian students in receiving communities. This paper estimates the effect of Venezuelan migration on educational outcomes of children living in settlement municipalities in Colombia, distinguish between the effect of the migration shock on native and migrant students. Specifically, it estimates the effect of the migration shock on school enrollment, dropout/promotion rates and standardized test scores. The identification relies on a plausibly exogenous measure of the predicted migration shock faced by each Colombian municipality every year. The findings show that the migration shock increased the enrollment of Venezuelan students in both public and private schools and in all school grades, but also generated negative spillovers related to failing promotion rates and increasing dropout. This paper documents that these negative effects are explained by the differential enrollment capacity of schools, as well as by the deterioration of key school inputs.Publication Environmental Policy under Weak Institutions(Washington, DC: World Bank, 2024-03-11)Developing countries are facing mounting pressures to incorporate environmental concerns into their policy reform agendas. This paper finds that common environmental policies, such as levying taxes to reduce the excessive exploitation of natural assets, can be self-defeating when (i) institutions are weak and (ii) the general equilibrium effects of such policy actions are overlooked. This seemingly paradoxical result is driven by fundamental mechanisms in structural transformation frameworks, without the need for strong assumptions. It also carries a clear policy implication: environmental policies should be considered within a country’s broader development context, rather than in isolation.Publication The Quality and Price of Africa’s Imports of Digital Goods(Washington, DC: World Bank, 2024-03-08)Imported digital goods are critical for productivity growth in low-income countries. Using detailed data on international trade flows and tariffs, this paper finds that African nations tend to import relatively low quality, low price digital goods. It also finds that digital goods in Africa are subject to relatively higher tariffs, along with other factors that contribute to their higher cost in the domestic market compared to other regions, especially in some low-income countries. The findings show that the African Continental Free Trade Area will do little to reduce this tariff burden, as most digital goods are sourced from higher income nonmembers. In contrast, unilateral tariff liberalization toward all countries would significantly increase the imports of digital goods in Africa.Publication Reviewing Assessment Tools for Measuring Country Statistical Capacity(Washington, DC: World Bank, 2024-03-06)Country statistical capacity is increasingly recognized as crucial for development, but no academic study exists that reviews the available assessment tools. This paper offers the first review study that fills this gap, paying particular attention to data and practical measurement challenges. It compares the World Bank’s recently developed Statistical Performance Indicators and Index with other widely used indexes, such as the Open Data Inventory index, the Global Data Barometer index, and other regional and self-assessment tools. The findings show that each index brings advantages in data sources, number of indicators, measurement focus, coverage of countries and time periods, and correlation with common development indexes. The Open Data Inventory index covers the most countries, the Global Data Barometer index collects data through its surveys, and the Statistical Performance Indicators and Index offer a broader framework for assessing statistical systems. The paper offers further thoughts on the potential mechanisms through which these tools can bring positive impacts on economic activities and some political economy concerns, as well as future directions for development.Publication High Temperature and Learning Outcomes(Washington, DC: World Bank, 2024-03-05)This paper uses data from 2003–19 on 2.47 million test takers of a national high stakes university entrance exam in Ethiopia to study the impacts of temperature on learning outcomes. It finds that high temperatures during the school year leading up to the exam reduce test scores, controlling for temperatures when the exam is taken. The results suggest that the scores of female students are less impacted by higher temperatures compared to their male counterparts. Additionally, the analysis finds that the scores of students from schools located in hotter regions are less impacted by higher temperatures compared to their counterparts from cooler regions. The evidence suggests that the adverse effects of temperature are driven by impacts from within-classroom temperatures, rather than from indirect impacts on agriculture.