Evaluating the Impact of Community Led Total Sanitation in Mali. A Randomized Controlled Trial

The evaluation study described involves 121 communities in the Region of Koulikoro in rural Mali. The intervention works in the following manner: communities are facilitated (by means of government and NGOs staff) to conduct their own appraisal and analysis of open defecation (OD) and take their own action to become open defecation free (ODF).

In Mali, the Open Defecation Free (ODF) status has been defined as follows: "each family has a latrine equipped with a cover that limits the proliferation of flies from the pits; all members of the family exclusively use such latrine to defecate; each latrine is equipped with a hand washing device (water + soap / water + ash bucket)".

To estimate the causal effect of CLTS the researchers need to construct a valid counterfactual in order to calculate what would have happened in the absence of the intervention. Random allocation ensures that on average, treated and untreated communities share the same observables and unobservables. Random assignment to treatment also overcomes the main selection problem found in evaluations, where those who are selected to receive the program may have different attributes than those who were not selected in the first place. These differences can be caused by observable attributes, more wealthy communities, more engaged leaders, better weather, etc, may be more willing to engage in CLTS programs, or by unobservable dimensions too. What is more important is that such differences can be affecting the outcomes the investigators want to measure. Random assignment to the program eliminates selection bias because it ensures that on average, communities receiving the program are similar to the ones that do not receive it.

Although random assignment is at the community level, the basic units of analysis of this evaluation are households. The investigators are interested in health outcomes for children under five, because diarrhea is among the main causes of child mortality. Also, the researchers are interested at looking at morbidity and school attendance for school age children. Finally, improved sanitation is supposed to produce a redistribution in the use of time at the household level. In addition the researchers are very interested at looking at variables that are directly related to the success/failure of the intervention. In particular, the investigators will monitor latrine use, water quality, general hygiene. The team will be able to determine whether lack of impact on health outcomes is due to lack of latrine use despite their availability, or whether it is due to lack of hand hygiene despite use of latrines.

UNICEF has observed in areas where the program has already been implemented that migration is relatively low, so the researchers do not expect much attrition. This decrease in diarrhea can be expected even if the village does not become fully ODF, but take up levels are lower.