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Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia
Last registered on September 29, 2016


Trial Information
General Information
Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia
Initial registration date
September 29, 2016
Last updated
September 29, 2016 9:36 AM EDT
Primary Investigator
Monash University
Other Primary Investigator(s)
PI Affiliation
University of California, Los Angeles
PI Affiliation
Monash University
Additional Trial Information
Start date
End date
Secondary IDs
Lack of sanitation and poor hygiene behavior cause a tremendous disease burden among the poor. This paper evaluates the impact of the Total Sanitation and Sanitation Marketing project in Indonesia, where about 11 percent of children have diarrhea in any two-week period and more than 33,000 children die each year from diarrhea. The evaluation utilizes a randomized controlled trial but is unusual in that the program was evaluated when implemented at scale across the province of rural East Java in a way that was designed to strengthen the enabling environment and so be sustainable. One hundred and sixty communities across eight rural districts participated, and approximately 2,100 households were interviewed before and after the intervention. The authors found that the project increased toilet construction by approximately 3 percentage points (a 31 percent increase in the rate of toilet construction). The changes were primarily among non-poor households that did not have access to sanitation at baseline. Open defecation among these households decreased by 6 percentage points (or 17 percent). Diarrhea prevalence was 30 percent lower in treatment communities than in control communities at endline (33 versus 46 percent). The analysis cannot rule out that the differences in drinking water and handwashing behavior drove the decline in diarrhea. Reductions in parasitic infestations and improvements in height and weight were found for the non-poor sample with no sanitation at baseline.

External Link(s)
Registration Citation
Cameron, Lisa, Susan Olivia and Manisha Shah. 2016. "Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia." AEA RCT Registry. September 29. https://doi.org/10.1257/rct.1636-1.0.
Former Citation
Cameron, Lisa et al. 2016. "Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia." AEA RCT Registry. September 29. http://www.socialscienceregistry.org/trials/1636/history/10908.
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Experimental Details
The study evaluates the impact of a rural sanitation project, known as the Total Sanitation and Sanitation Marketing (TSSM) project, which was launched by the Indonesian government to improve sanitation in rural communities of East Java. TSSM includes three main components: 1) Community-Led Total Sanitation (CLTS), 2) Social Marketing of Sanitation, and 3) Strengthening the Enabling Environment. In the CLTS component, external facilitators lead community discussions about sanitation and the potential affects of open defecation. Facilitators work with the community to draw a map of where defecation occurs, and then explain how defecation in particular areas may contaminate water and food. The community then builds an action plan to eliminate open defecation. Social Marketing focuses on marketing the increasing availability of sanitation-related products and services. And, the Strengthening the Enabling Environment component supports the development of policies and institutional practices that facilitate scaling up, program effectiveness, and sustainability.
Intervention Start Date
Intervention End Date
Primary Outcomes
Primary Outcomes (end points)
Open defecation, Toilet construction, Diarrhea prevalence, Child Height
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
The evaluation focused on eight rural districts and 160 sub-villages within East Java. Researchers worked with the local and national government, and the local private sector to implement the project. Treatment and control groups were randomly assigned at the village level.
Experimental Design Details
Randomization Method
In each of the eight districts, 10 treatment and 10 control villages were randomly selected by a random number generator in STATA.
Randomization Unit
Was the treatment clustered?
Experiment Characteristics
Sample size: planned number of clusters
160 villages
Sample size: planned number of observations
2,087 households
Sample size (or number of clusters) by treatment arms
80 treatment villages, 80 control villages
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB Name
IRB Approval Date
Details not available
IRB Approval Number
Details not available
Post Trial Information
Study Withdrawal
Is the intervention completed?
Intervention Completion Date
December 31, 2009, 12:00 AM +00:00
Is data collection complete?
Data Collection Completion Date
February 28, 2011, 12:00 AM +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
160 villages
Was attrition correlated with treatment status?
Final Sample Size: Total Number of Observations
The endline survey included 2,500 households; of which 1,908 were part of the initial baseline survey of 2,087 households.
Final Sample Size (or Number of Clusters) by Treatment Arms
Data Publication
Data Publication
Is public data available?
Program Files
Program Files
Reports, Papers & Other Materials
Relevant Paper(s)
World Bank Policy Research Working Paper 6360
Cameron, Lisa, Manisha Shah, Susan Olivia. "Impact Evaluation of a Large-Scale Rural Sanitation Project in Indonesia." World Bank Policy Research Working Paper No. 6360, February 2013.