Total Sanitation and Sanitation Marketing (TSSM) is the Indonesian component of World Bank Water and Sanitation Program's Scaling Up Rural Sanitation initiative. The approach consists of raising awareness of the problems of open defecation; marketing sanitation products; and supporting policies, financing, training, and regulations that are conducive to these efforts. Therefore, desired outcomes of the program include changes in perception of the consequences of poor sanitation, toilet construction and access to improved sanitation, reduction in open defecation, and child health outcomes. This impact evaluation assesses these results using a randomized controlled trial (RCT), and unlike many RCTs that are carried out on pilot programs, it looks at an intervention that has been implemented at scale and led by the government under real-world conditions, providing more reliable estimates. TSSM is associated with sanitation improvements overall, particularly among wealthier households that had no sanitation prior to the intervention.
- Kind of study: randomized controlled trial
- Sample size: 2,100 households in 160 communities across eight districts
- Timing of study: August 2008 - February 2011
- Among households that previously had no sanitation, the intervention caused a significant decrease in open defecation and increase in improved sanitation and disposal of children's feces.
- As there were no significant behavior changes among households who already had sanitation, it appears that behavioral changes were driven by toilet construction.
- The main obstacle reported to constructing a toilet was cost.
- "Poor" households, defined as those in the bottom quintile by value of non-land assets, did not show a significant increase in building toilets. Providing credit or subsidies to this group could increase the impact of the project.
- Diarrhea prevalence was lower in treatment communities as compared to controls by approximately 1.3 percentage points. This translates into about a 30% reduction in the chance that an individual would report having had diarrhea in the past 7 days. This result was also driven by households that had no sanitation at baseline.
- Among households that didn't have sanitation at baseline, diarrhea prevalence actually dropped more for poor households, despite the fact that they were less likely to have constructed toilets. This may be because the wealthier households are protected from diarrhea by other aspects of their environments.