2011年-世界发展银行全球_Scaling_Up_Rural_Sanitation___Findings_from_the_Impact_Evaluation_Baseline_Survey_in_Madhya_Pradesh_India_80页_1mb

报告摘要

Summary of "Global Scaling Up Rural Sanitation: Findings from the Impact Evaluation Baseline Survey in Madhya Pradesh, India"

Core Content

The Global Scaling Up Rural Sanitation (GSRU) program is a World Bank initiative led by the Water and Sanitation Program (WSP) that aims to improve sanitation and hygiene in rural areas of India, Indonesia, and Tanzania. The program combines Community-Led Total Sanitation (CLTS), Behavior Change Communications (BCC), and Social Marketing of Sanitation to stimulate demand for improved sanitation and strengthen the supply of sanitation services, with the ultimate goal of reducing the risk of diarrhea and improving health outcomes for rural populations.

In Madhya Pradesh (MP), the program is implemented in collaboration with the Government of India, specifically through the Total Sanitation Campaign (TSC), which targets the creation of Open Defecation Free (ODF) communities. The program's approach involves community engagement, raising awareness, and supporting local initiatives to achieve sustainable sanitation improvements.

Main Components of the Program

Community-Led Total Sanitation (CLTS): A participatory approach that aims to trigger community-level behavior change by making people aware of the health risks associated with open defecation.
Behavior Change Communications (BCC): Aims to motivate individuals and households to adopt better hygiene and sanitation practices.
Social Marketing of Sanitation: Involves market research and training local artisans to build appropriate sanitation facilities and stimulate the supply side of the sanitation sector.
Nirmal Gram Puraskar (NGP) Awards: Recognize Gram Panchayats (village councils) that achieve ODF status and maintain environmental cleanliness and school sanitation.

Methodology

The Impact Evaluation (IE) study in MP uses a community-randomized controlled trial (RCT) design to measure the causal effects of the TSC program. The study includes:

A baseline survey conducted in 2009.
Monthly longitudinal surveys over an 18-month period.
An extensive follow-up survey planned for early 2011.

Two districts, Dhar and Khargone, were selected for the IE. In each district, 80 Gram Panchayats (GPs) were randomly assigned to either a treatment group (receiving TSC immediately) or a control group (receiving TSC after follow-up data collection). Approximately 2,000 households were surveyed in total.

Key Findings

Household Demographics

Average household size: 6.9 members, with 1.7 children under five per household.
HH heads had a mean age of 44.2 years, while other members were 18.5 years on average.
94% of HH heads were male, and 38% of other members were male.
51% of HHs had ever attended school, with primary school being the most common.
82% of HH heads and 59% of other members were employed in the week prior to the survey.
Average monthly per capita income: Rs 1617 (US$36).

Water, Sanitation, and Hygiene

97% of HHs used a water source outside their home or yard.
51% used tube wells, 24% used private piped water, and 13% used unprotected dug wells.
80% of HHs reported open defecation, with higher rates in poorer HHs (87% vs. 60% in richer HHs).
Pit latrines were the most common sanitation facility (10% of HHs).
54% of HHs had sanitation facilities more than 10 minutes away, and 27% had no designated place.
99.7% washed hands after using the toilet, and 96.6% washed hands before preparing food.
97% of HHs used a container for handwashing, while 24% used open water sources.
Richer HHs had better access to soap and safe water for handwashing.

Child Health and Development

16% of children under two had parasitic infections (Giardia, Ascaris, Entamoeba, hookworms).
8% of children under five had diarrhea symptoms in the last 48 hours.
13% had symptoms in the previous week, and 15% in the previous two weeks.
Diarrhea was more common in poorer HHs.
ALRI prevalence was slightly higher in unimproved sanitation and water households.
Anemia was widespread, with 80% of children under two being anemic, and no significant difference was found based on sanitation or hygiene conditions.

Child Care and Development

59% of children under five were found to have a clean environment.
38% had dirty hands, 52% had dirty fingernails, and 28% had unclean faces.
52% of children under two played with household objects.
15% of caregivers read books to children, and 11% told stories.
Child development was lower in HHs without improved sanitation, water, or handwashing facilities.
Wealthier HHs had better child development outcomes.

Community Survey Findings

On average, GPs included 2–3 villages, with 503 HHs and 2,770 persons.
65% of HHs belonged to SC/ST groups, recognized as marginalized.
46% of HHs were BPL (Below Poverty Line).
99% of GPs had access to primary schools, but 30% had access to higher secondary schools.
66% of GPs had public piped water systems.
21% had public taps, and 13% had unprotected dug wells.
50% of GPs buried or burned solid waste, and almost all had open drainage.
Only 15% of HHs had their own toilet facilities.

Conclusion

The baseline data from MP indicate a substantial need for improved sanitation and hygiene. While the study does not yet establish causality, it highlights that improved sanitation is strongly linked to better health outcomes, especially for young children. The TSC program has the potential to bring about positive changes in rural sanitation, but sustained behavior change and access to improved facilities require continued efforts in community engagement, behavior change communication, and market development.

The findings also suggest that sanitation-related behaviors are more prevalent in wealthier households, indicating the importance of economic conditions in shaping sanitation practices. The NGP awards and community-led approaches are critical in recognizing and motivating local efforts toward ODF status.

Key Takeaways

CLTS, BCC, and social marketing are essential in driving behavior change and improving sanitation access.
Poverty is strongly correlated with poor sanitation practices and health outcomes.
Improved sanitation and hygiene are linked to better child health and development.
Community engagement and local recognition (like NGP awards) are key to sustaining improvements.
Data collection methods include household surveys, biometric measurements, and community-level assessments.