Scaling up rural sanitation: Findings from the impact evaluation baseline survey in Madhya Pradesh

This report is a part of a series of papers that analysed the baseline data from all countries where the program was implemented.The goal of Global Scaling Up Rural Sanitation is to reduce the risk of diarrhoea and thus increase household productivity by stimulating demand for sanitation in the lives of people in India, Indonesia, and Tanzania.The program approach demands:

• Involvement from communities, local government, and the private sector.
• It aims to trigger the desire for an open-defecation free (ODF) community by raising collective awareness of the open defecation problem.
• It seeks to stimulate the supply of appropriate sanitation program and services by conducting market research and training local artisans to build the relevant facilities.

In India, WSP’s Global Scaling Up Rural Sanitation Program is supporting the Government of India’s (GoI) Total Sanitation Campaign (TSC) in the states of Himachal Pradesh and Madhya Pradesh. As of 19 November 2010, 54 percent of the households in MP have toilets, while more than 3 million households still lack basic sanitation facilities (DDWS 2010).

The IE study in MP employed a community-randomized controlled design to measure the causal effects of TSC on a broad range of health, social, economic, and welfare impacts. Two districts,Dhar and Khargone were selected for this IE. In each district, 80 Gram Panchayats were selected and randomised into two groups: 1) treatment group (to receive TSC immediately following the baseline survey) or 2) control group (to receive TSC after follow-up data collection). Approximately, 1,000 households (HHs) were sampled in each district to achieve a total sample size of 2,000 HHs for the IE in MP.

The study found that the surveyed population had significantly lower access to improved sanitation than families from the state and nation (87% reported sharing a toilet vs. 13% of MP at large and 17% of India, respectively). Results indicated a population very much in need of effective sanitation and health improvements. It was found that:

• The majority of households, 80% practised open defecation and many lacked access to improved sanitation (i.e., access ranged from 35% of households in the highest income quartile to only 5% of those in the lowest).
• More than half (54%) of households had to walk more than 10 minutes to their toilet/open defection site.
• In almost all the households (97%), drinking-water sources were contaminated with E. coli and similar levels of contamination were found in community sources (94%). 
• About 15% of children under five years age had symptoms of diarrhea within two weeks of the baseline interview, 16% suffered from some type of parasitosis. Twelve percent had symptoms of acute lower respiratory infections

Data indicated that there was a substantial need for improvements in sanitation and sanitation-related behaviors in MP. Emerging trends indicate that gains in improved sanitation, likely to be brought about by TSC, can have positive impacts on the health and welfare of rural families, especially young children.