Publication: India: How Many Toilets Does It Take to Improve Health?
Loading...
Files in English
628 downloads
Date
2015-03
ISSN
Published
2015-03
Author(s)
Editor(s)
Abstract
Access to proper sanitation helps keep children healthy, but millions of people in the developing world still practice open defecation, putting children at risk. Diarrhea, which can result from the spread of fecal material into food or mouths, kills around 800,000 children under the age of five every year and leaves millions more malnourished and stunted. Whats the best way to create lasting change? Previous efforts often focused on encouraging individuals to invest in toilets for their households, but gains are limited if not everyone in the village does the same. One reason may be that sanitation has a communal element because even if only one family in a neighborhood practices open defecation, all families may be at risk of ingesting fecal matter. Sanitation therefore presents a unique challenge: If an individual family invests in a toilet, but their neighbors dont, are there still positive benefits? What proportion of households need to have improved sanitation for benefits to be seen across the whole village? And whats the impact in a village that goes from zero toilet use to full coverage? The World Bank is committed to helping countries develop the necessary infrastructure and practices to improve sanitation, reducing barriers families may face in raising healthy children. To better understand the impact of a whole village using improved sanitation – such as private toilets or pit latrines – compared with just a few people in the village having access to toilets, World Bank researchers analyzed a national survey database on more than 200,000 children younger than four years old in rural India. More than two-thirds of the people in the rural areas defecate in the open. The study found that diarrhea prevalence halved when sanitation coverage at community level is fully achieved. The study says that these results are mostly due to the positive spillover effects on everyones health that occurs when all (or the overwhelming majority of) households have toilets. The findings can help governments and development practitioners understand the importance of taking a communal approach to the problem.
Link to Data Set
Citation
“World Bank. 2015. India: How Many Toilets Does It Take to Improve Health?. From Evidence to Policy;. © World Bank. http://hdl.handle.net/10986/22631 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Publication Kenya(Washington, DC, 2022-10)Before the COVID pandemic, more than half of children in low and middle-income countries suffered from learning poverty: they either were out of school or failed to learn to read with comprehension by age 10. At the same time, numerous studies have documented serious challenges related to the quality of education services, particularly for those serving poor students. In a country like Kenya, for example, teachers exhibit low levels of content and pedagogical knowledge. Previous research has shown that highly structured teaching guides could improve literacy, but scripted lessons are not without critics, who worry that teachers will not be able to adapt content to student’s needs. In places where teachers may be less prepared to tailor high quality lessons to their students, however, scripting may offer a way to standardize a minimum level of quality at scale.Publication Rwanda(World Bank, Washington, DC, 2021-11)Children need a safe, nurturing, healthy, and stimulating environment to thrive and reach their full potential. But millions of children living in poverty don’t receive enough stimulation or good nutrition in their first years of life, and poverty also makes them more likely to experience neglect and violence in the home. Domestic violence, however, is rarely addressed in programs promoting young children’s development, which also typically focus on mothers, with little attention on fathers. Previous research suggests home-based parenting programs can lead to positive improvements in children’s brain development. Can these programs be adapted to address family violence as well Can these services be effectively delivered through government social safety net programs which often target poor, vulnerable familiesPublication Rwanda(World Bank, Washington, DC, 2021-01)Performance pay for teachers generates debate. Proponents argue that many school systems have low levels of accountability and advocate incentivizing teachers by linking their pay to either their own efforts or their students’ learning. Critics, however, raise concerns that performance pay attracts people to the teaching workforce who are in it for the money and can diminish the intrinsic motivation to teach among teachers already in classrooms.Publication Armenia(World Bank, Washington, DC, 2021-04)More people around the world are dying from noncommunicable diseases than ever before. These diseases, which include cancer, chronic respiratory diseases, diabetes, and heart disease, prematurely kill more than 15 million people between ages 30 and 69 each year. Many of these health conditions also make individuals more susceptible to severe forms of other diseases like Coronavirus disease 2019 (COVID-19). This study targeted adults between the ages of 35 and 68 in Armenia who had not been screened in the preceding year. The baseline data suggests this population was not economically secure: half of participants responded that their income was sufficient for basic family needs, such as food, clothing, and utilities, but not enough for big purchases like a car, while 35 percent responded that their income is sufficient for everyday food but not for clothes and other basic needs. More than half of those in the study were unemployed. This research finds that conditional incentives and personalized invitations can substantially increase screening for diabetes and hypertension for those who haven’t been recently screened. Further research may be needed to evaluate these interventions at scale.Publication India(World Bank, Washington, DC, 2021-07)In the first years of life, all children need healthy food, a clean environment, and stimulation to thrive and reach their full developmental potential. However, poverty prevents millions of young children in low- and middle-income countries from receiving adequate nutrition and stimulation. As a result, many disadvantaged children’s brain development lags behind that of their well-off peers, which can have lifelong consequences. Previous research from low-income settings has found that encouraging parents to play and interact more with their children can improve children’s brain development, with impacts that can last into adulthood. Delivering these parenting programs at scale and in a cost-effective manner, however, has been a challenge, in part because some of the most successful programs have been delivered through intensive and relatively costly home-based programs.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Financing On-Site Sanitation for the Poor : A Six-Country Comparative Review and Analysis(World Bank, Washington, DC, 2010-01)The present study offers evidence on alternative financing approaches for on-site household sanitation from case studies in six countries: Bangladesh, Ecuador, India, Mozambique, Senegal, and Vietnam. This evidence can help identify the best-performing approaches and the relevant factors and issues to consider in designing a sanitation financing strategy. The study systematically compares alternative financing approaches based on a set of common indicators, including in terms of the effectiveness in the use of public funds and targeting. The team chose to focus on those projects recognized as successes to obtain a reasonable representation of the better practices in sanitation programs. The study identified a number of useful examples and tentative lessons about finance which should help to advance the design of sanitation finance at the outset of a project. Replicating such experiences will require a better understanding of what drives household investment and what the key constraints limiting such investment are, in both financial and non-financial terms. The sanitation challenge continues to grow with population, as does the cost of failing to meet it. This study is a worthwhile contribution to addressing the challenge of how to pay for sanitation.Publication Economic Impacts of Inadequate Sanitation in Bangladesh(World Bank, Washington, DC, 2012-01)This study estimates the nonmonetary, financial, and economic costs of poor sanitation in the areas of health, drinking water, and domestic water, as well as user preference and welfare. Financial costs refer to the direct financial expense paid in monetary terms by someone, such as changes in household and government spending and real income losses for households. Nonmonetary costs consist of both longer-term financial impacts (such as less educated children, fewer children, and loss of working people due to premature death or relevant morbidity), and nonfinancial implications, such as the value of loss of life, time-use of adults and children, and intangible impacts. Bangladesh has made inadequate progress toward the sanitation-related millennium development goal (MDG) target. The country's financial commitment and political priority for sanitation also has shown inadequate progress (Water-Aid, 2008). Therefore, to mitigate the adverse effects of poor sanitation and hygiene practices, intervention is necessary. The aim of this study is to provide concrete evidence of the impact poor sanitation has on the population and the environment and, consequently, on the economy. This study provides estimates of the current and long-term effects of poor sanitation, which cover not only the negative impacts of poor sanitation but also the potential gains that different sanitation interventions could achieve. Policy makers and water and sanitation advocacy organizations are the target audience of this study.Publication A Randomized, Controlled Study of a Rural Sanitation Behavior Change Program in Madhya Pradesh, India(World Bank, Washington, DC, 2013-11)Poor sanitation and open defecation are thought to be a major cause of diarrhea and intestinal parasite infections among young children. In 1999, India launched the Total Sanitation Campaign with the goal of achieving universal toilet coverage in rural India by 2012. This paper reports on a cluster-randomized, controlled trial that was conducted in 80 rural villages in Madhya Pradesh to measure the effect of the program on toilet access, sanitation behavior, and child health outcomes. The study analyzed a random sample of 3,039 households and 5,206 children under five years of age. Field staff collected baseline measures of sanitation conditions, behavior, and child health, and re-visited households 21 months later. The analysis finds that implementation of the program activities was slower than the original timeline (only 35 percent of villages were triggered more than six months before the follow-up survey). Nevertheless, the Total Sanitation Campaign successfully increased toilet coverage by 19 percent in intervention villages compared with control villages (41 percent v. 22 percent), while reported open defecation decreased by 10 percent among adults (74 percent v. 84 percent). The intervention also led to some improvements in water quality and protozoan infection, but consistent improvements were not observed across multiple child health outcomes (diarrhea, helminth infections, child growth). However, the exposure period was likely to have been too short to result in any benefit of the sanitation interventions on child health. Given the large improvements in toilet construction documented, an additional follow-up survey with a longer period of exposure would yield valuable information on the effects of improved sanitation conditions on health outcomes.Publication Scaling Up Rural Sanitation : Findings from the Impact Evaluation Baseline Survey in Madhya Pradesh, India(World Bank, Washington, DC, 2011-03)In India, Water and Sanitation Program's (WSP's) global scaling up rural sanitation program is supporting the Government of India's (GoI) Total Sanitation Campaign (TSC) in two states: Himachal Pradesh and Madhya Pradesh. TSC is an ambitious countrywide, scaled-up rural sanitation program launched by the GoI in 1999, which seeks to attain an Open Defecation Free (ODF) India by 2012. In contrast to earlier, hardware-centric supply approaches to rural sanitation, TSC aims to generate demand for and adoption of improved sanitation at the community level. The program focuses on creating ODF communities rather than bringing about incremental individual changes. The TSC aims not only to achieve ODF communities but also focuses on hygiene, waste management, and sanitation in schools and institutions. The main components of the intervention include: 1) community-led total sanitation, 2) social marketing of sanitation, 3) strengthening the enabling environment, and 4) nirmal gram puraskar awards. Although the data are limited in establishing causality, emerging trends indicate that gains in improved sanitation, likely to be brought about by TSC, could have positive impacts on the health and welfare of rural families, especially young children.Publication Maternal Health, Child Health and Nutrition in Lao PDR : Evidence from a Household Survey in Six Central and Southern Provinces(Washington, DC, 2013-06)Despite being on-track on the child- and maternal-health Millennium Development Goals (MDGs), Lao PDR continues to have some of the worst maternal and child health (MCH) and nutrition outcome indicators, both globally as well as in the East Asia and Pacific (EAP) region. This report presents results from a household, village, and facility survey on Maternal and Child Health (MCH) and nutrition in mostly rural areas of six central and southern provinces of Lao People's Democratic Republic (PDR). The information in this report localizes MCH and nutrition-related information that are typical for sampled catchment areas of selected health centers in six central and southern provinces of the country. In addition, the report summarizes data on service availability and readiness of health centers in terms of their ability to provide key MCH & nutrition-related services. The results from this survey thus shed light on what it would take to attain the health-related MDGs. In order to improve the level and equity of maternal and child health indicators, interventions would need to address numerous demand-side barriers, including physical access barriers, financial barriers, and cultural, linguistic, and educational barriers.
Users also downloaded
Showing related downloaded files
Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.Publication World Development Report 2006(Washington, DC, 2005)This year’s Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a person’s chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The report’s main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005‹an appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.Publication Lebanon Economic Monitor, Fall 2022(Washington, DC, 2022-11)The economy continues to contract, albeit at a somewhat slower pace. Public finances improved in 2021, but only because spending collapsed faster than revenue generation. Testament to the continued atrophy of Lebanon’s economy, the Lebanese Pound continues to depreciate sharply. The sharp deterioration in the currency continues to drive surging inflation, in triple digits since July 2020, impacting the poor and vulnerable the most. An unprecedented institutional vacuum will likely further delay any agreement on crisis resolution and much needed reforms; this includes prior actions as part of the April 2022 International Monetary Fund (IMF) staff-level agreement (SLA). Divergent views among key stakeholders on how to distribute the financial losses remains the main bottleneck for reaching an agreement on a comprehensive reform agenda. Lebanon needs to urgently adopt a domestic, equitable, and comprehensive solution that is predicated on: (i) addressing upfront the balance sheet impairments, (ii) restoring liquidity, and (iii) adhering to sound global practices of bail-in solutions based on a hierarchy of creditors (starting with banks’ shareholders) that protects small depositors.Publication The Journey Ahead(Washington, DC: World Bank, 2024-10-31)The Journey Ahead: Supporting Successful Migration in Europe and Central Asia provides an in-depth analysis of international migration in Europe and Central Asia (ECA) and the implications for policy making. By identifying challenges and opportunities associated with migration in the region, it aims to inform a more nuanced, evidencebased debate on the costs and benefits of cross-border mobility. Using data-driven insights and new analysis, the report shows that migration has been an engine of prosperity and has helped address some of ECA’s demographic and socioeconomic disparities. Yet, migration’s full economic potential remains untapped. The report identifies multiple barriers keeping migration from achieving its full potential. Crucially, it argues that policies in both origin and destination countries can help maximize the development impacts of migration and effectively manage the economic, social, and political costs. Drawing from a wide range of literature, country experiences, and novel analysis, The Journey Ahead presents actionable policy options to enhance the benefits of migration for destination and origin countries and migrants themselves. Some measures can be taken unilaterally by countries, whereas others require close bilateral or regional coordination. The recommendations are tailored to different types of migration— forced displacement as well as high-skilled and low-skilled economic migration—and from the perspectives of both sending and receiving countries. This report serves as a comprehensive resource for governments, development partners, and other stakeholders throughout Europe and Central Asia, where the richness and diversity of migration experiences provide valuable insights for policy makers in other regions of the world.Publication Argentina Country Climate and Development Report(World Bank, Washington, DC, 2022-11)The Argentina Country Climate and Development Report (CCDR) explores opportunities and identifies trade-offs for aligning Argentina’s growth and poverty reduction policies with its commitments on, and its ability to withstand, climate change. It assesses how the country can: reduce its vulnerability to climate shocks through targeted public and private investments and adequation of social protection. The report also shows how Argentina can seize the benefits of a global decarbonization path to sustain a more robust economic growth through further development of Argentina’s potential for renewable energy, energy efficiency actions, the lithium value chain, as well as climate-smart agriculture (and land use) options. Given Argentina’s context, this CCDR focuses on win-win policies and investments, which have large co-benefits or can contribute to raising the country’s growth while helping to adapt the economy, also considering how human capital actions can accompany a just transition.