Research on the Impact of Targeted Subsidies Within Open Defecation Free (ODF) Communities

This study evaluates targeted subsidies as a strategy to improve sanitation infrastructure and behaviours in communities that have reached Open Defecation Free (ODF) status after a Community-Led Total Sanitation (CLTS) program. The investigator's hypothesis is that sanitation subsidies targeted at the most vulnerable households within ODF communities will increase and help sustain latrine coverage, quality, and use amongst the targeted households, and through a spill-over effect, amongst the rest of the community. Half of participating communities will receive the targeted subsidy, while the other half will not receive any treatment.

Study Overview

• Status: Completed
• Conditions: Sanitation
• Intervention / Treatment: Behavioral: Targeted Subsidy

Detailed Description

Community-Led Total Sanitation (CLTS) is a widely used approach to eradicate open defecation in rural communities in developing countries. Using emotional triggers, CLTS promotes community self-help to build household latrines. In Ghana, where CLTS is part of the government's official sanitation strategy, a community is declared "Open Defecation Free" (ODF) when 80 percent of households own a latrine.

There is however evidence that open defecation persists in so-called "ODF" communities, especially as the most vulnerable households (the poorest of the poor) cannot afford to construct or maintain durable latrines. As a result, subsidies for these vulnerable households have been proposed as a strategy to promote the construction of durable latrines and help sustain safe sanitation behaviours in communities having received CLTS.

• Study Type: Interventional
• Enrollment (Actual): 5615
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Ghana
  • Tamale, Ghana
    • Districts of Tatale and Kpandai, Northern Region

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

This study is a cluster randomized controlled trial that will enroll entire communities. Within a community, only specific households will be selected to receive sanitation subsidy vouchers. Outcomes will be measured both for voucher recipients and for the rest of the community.

Inclusion Criteria (for Communities):

• Community was targeted by UNICEF's Community-Led Total Sanitation (CLTS) program in Tatale, Yendi, and Kpandai districts in Ghana.
• Community has Open Defecation Free (ODF) status according to local authorities.
• Community has more than 15 and less than 100 households.

Exclusion Criteria (for Communities):

• Community is located less than 2 kilometers away from a community in the opposite treatment arm.

Inclusion Criteria (for voucher recipients within study communities):

• Household is extremely poor, as identified through community consultation and/or the government's Livelihood Empowerment Against Poverty (LEAP) program.
• Household has at least one vulnerable person, i.e. who meets one of the following criteria: i) older than 65 years old, ii) person with a disability, iii) orphan or vulnerable child, iv) female head of household, v) widow(er), vi) terminally-ill persons, vii) unemployed, viii) outcast groups.

Exclusion Criteria (for voucher recipients within study communities):

• Household owns a functional, individual (non-shared) latrine with durable sub-structure.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Targeted Subsidy; In these communities, households identified as vulnerable receive a voucher for a free latrine sub-structure (slab + pit lining), redeemable with local sanitation suppliers.	Behavioral: Targeted Subsidy; Voucher
No Intervention: No subsidy; In these communities, no household receives a voucher.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of households owning an individual, functional latrine with full superstructure	Household ownership (yes/no) of a latrine that is i) not shared with other households ("individual"), ii) whose pit is not collapsed and not full ("functional"), and iii) with four walls (or circular walls) and a roof of any materials ("full superstructure").	Approximately 18 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of households reporting practicing open defecation	Self report by the respondent of not always using a toilet to defecate when at home.	Approximately 18 months
Percentage of households owning an individual, functional latrine with full superstructure and durable superstructure	Household ownership (yes/no) of a latrine that is i) not shared with other households ("individual"), ii) whose pit is not collapsed and not full ("functional"), iii) with four walls (or circular walls) and a roof of any materials ("full superstructure"), iv) with a concrete/plastic slab and pit lining with plastic/rocks/bricks/concrete ("durable substructure").	Approximately 18 months
Percentage of households reporting satisfaction with latrine	Self report by the respondent of being satisfied with the latrine (s)he uses for defecation.	Approximately 18 months

Collaborators and Investigators

• Sponsor: The Aquaya Institute
• Collaborators: United States Agency for International Development (USAID); Tetratech
• Investigators: Principal Investigator: Rachel Peletz, PhD, The Aquaya Institute

Study record dates

Study Major Dates

• Study Start (Actual): February 18, 2019
• Primary Completion (Actual): March 31, 2021
• Study Completion (Actual): March 31, 2021

Study Registration Dates

• First Submitted: January 25, 2019
• First Submitted That Met QC Criteria: January 28, 2019
• First Posted (Actual): January 30, 2019

Study Record Updates

• Last Update Posted (Actual): October 4, 2021
• Last Update Submitted That Met QC Criteria: October 1, 2021
• Last Verified: October 1, 2021

More Information

Terms related to this study

• Other Study ID Numbers: WASHPaLS Subsidy Study

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data for the primary and all secondary outcome measures as well as key confounders (demographics, wealth index, community characteristics) will be made available.
• IPD Sharing Time Frame: Data will be available within 9 months of study completion.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No