Impact of Indian Total Sanitation Campaign on latrine coverage and use: a cross-sectional study in Orissa three years following programme implementation

PLoS One. 2013 Aug 21;8(8):e71438. doi: 10.1371/journal.pone.0071438. eCollection 2013.

Abstract

Background: Faced with a massive shortfall in meeting sanitation targets, some governments have implemented campaigns that use subsidies focused on latrine construction to overcome income constraints and rapidly expand coverage. In settings like rural India where open defecation is common, this may result in sub-optimal compliance (use), thereby continuing to leave the population exposed to human excreta.

Methods: We conducted a cross-sectional study to investigate latrine coverage and use among 20 villages (447 households, 1933 individuals) in Orissa, India where the Government of India's Total Sanitation Campaign had been implemented at least three years previously. We defined coverage as the proportion of households that had a latrine; for use we identified the proportion of households with at least one reported user and among those, the extent of reported use by each member of the household.

Results: Mean latrine coverage among the villages was 72% (compared to <10% in comparable villages in the same district where the Total Sanitation Campaign had not yet been implemented), though three of the villages had less than 50% coverage. Among these households with latrines, more than a third (39%) were not being used by any member of the household. Well over a third (37%) of the members of households with latrines reported never defecating in their latrines. Less than half (47%) of the members of such households reported using their latrines at all times for defecation. Combined with the 28% of households that did not have latrines, it appears that most defecation events in these communities are still practiced in the open.

Conclusion: A large-scale campaign to implement sanitation has achieved substantial gains in latrine coverage in this population. Nevertheless, gaps in coverage and widespread continuation of open defecation will result in continued exposure to human excreta, reducing the potential for health gains.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude
  • Cross-Sectional Studies
  • Environment
  • Family Characteristics
  • Female
  • Health Promotion / methods*
  • Humans
  • India
  • Male
  • Multivariate Analysis
  • Public Health / methods*
  • Residence Characteristics
  • Rural Population
  • Sanitation / methods*
  • Surveys and Questionnaires
  • Toilet Facilities*

Grant support

This work was supported by the Bill & Melinda Gates Foundation; International Initiative for Impact Evaluation; SHARE Research Consortium. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.