The Dirty Business of Reducing Open Defecation: Lessons from a Sanitation Intervention

This paper uses a randomized experimental design to evaluate a sanitation intervention that was piloted at scale across rural East Java. The program, known as Total Sanitation and Sanitation Marketing (TSSM) relies on facilitated sessions that trigger a sense of disgust at open defecation to stimulate collective action to solve current sanitation problems. Its lack of financial assistance to communities differentiates it from many previous programs that have subsidized sanitation materials. Anecdotal evidence from several countries suggests cost-effective, positive results and has led to the program being adopted in many different contexts. We find that the program significantly increased toilet construction, resulted in behavioural change amongst households with no private toilets, and had consequent sizeable impacts on child health. By decomposing the program impact we are able to show that the program worked predominantly through behavioural change. Toilet construction is however more effective at reducing open defecation than behavioural change but was hindered by the lack of financial assistance. Toilet construction was concentrated mainly among less poor households, with most of the health benefits also accruing to these households.