The dirty business of eliminating open defecation: The effect of village sanitation on child height from field experiments in four countries

We examine the impacts of a sanitation program designed to eliminate open defecation in at-scale randomized field experiments in four countries: India, Indonesia, Mali, and Tanzania. The programs – all variants of the widely-used Community-Led Total Sanitation (CLTS) approach - increase village private sanitation coverage in all four locations by 7–39 percentage points. We use the experimentally-induced variation in access to sanitation to identify the causal relationship between village sanitation coverage and child height. We find evidence of threshold effects where increases in child health of 0.3 standard deviations are realized once village sanitation coverage reaches 50–75%. There do not appear to be further gains beyond this threshold. These results suggest that there are large health benefits to achieving coverage levels well below the 100% coverage pushed by the CLTS movement. Open defecation decreased in all countries through improved access to private sanitation facilities, and additionally through increased use of sanitation facilities in Mali who implemented the most intensive behavior change intervention.