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The effects of a comprehensive water and sanitation program in small rural communities in Bolivia
Last registered on June 08, 2017

Pre-Trial

Trial Information
General Information
Title
The effects of a comprehensive water and sanitation program in small rural communities in Bolivia
RCT ID
AEARCTR-0002262
Initial registration date
June 08, 2017
Last updated
June 08, 2017 6:10 PM EDT
Location(s)
Primary Investigator
Affiliation
IADB
Other Primary Investigator(s)
PI Affiliation
Inter-American Development Bank
PI Affiliation
Inter-American Development Bank
Additional Trial Information
Status
On going
Start date
2012-11-01
End date
2017-12-31
Secondary IDs
Abstract
Universal access to safe drinking water and sanitation continues to be a major development challenge in several countries in Latin America and The Caribbean, and even more so in the rural areas. In fact, eight of every ten people without access to an improved drinking water source, and nine of every ten people without an improved sanitation facility, live in rural areas (WHO/UNICEF, Joint Monitoring Programme, 2015).

Household access to safe water and improved sanitation are considered development goals in their own right, but in addition, lack of water and basic sanitation contribute toward higher prevalence of disease, anemia, malnutrition and poor child development. Children under five years of age are particularly vulnerable, as bad sanitation conditions and use of unimproved water sources expose them to parasites and fecal bacteria that causes infection (Kremer and Zwane, 2007; Ngure et.al. 2013; Burger and Esrey, 1995). Recent research also makes the link between poor water, sanitation and hygiene conditions of the environment and early cognitive and socioemotional development in small children (Ngure, 2014).

The Bolivia’s Ministry of Environment and Water has launched a water and sanitation program in rural areas of the departments of La Paz, Cochabamba, Chuquisaca and Potosi. The program’s objective is to increase access to safe water and improved sanitation by expanding water and sanitation infrastructure in small rural communities with low coverage levels. The program targets small communities with less than 500 people.

The program includes an experimental impact evaluation design where eligible communities are randomly assigned to treatment and control groups. After almost one year of the end of the intervention, the evaluation will estimate the effects of the program on intermediate indicators of utilization of improved water and sanitation facilities, and hygiene practices. The study will also evaluate the impact of the intervention on prevalence of water-related diseases such as diarrhea, and the use of time. Impact
External Link(s)
Registration Citation
Citation
Martinez, Sebastian, German Sturzenegger and Cecilia Vidal. 2017. "The effects of a comprehensive water and sanitation program in small rural communities in Bolivia." AEA RCT Registry. June 08. https://doi.org/10.1257/rct.2262-1.0.
Former Citation
Martinez, Sebastian et al. 2017. "The effects of a comprehensive water and sanitation program in small rural communities in Bolivia." AEA RCT Registry. June 08. http://www.socialscienceregistry.org/trials/2262/history/18442.
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Experimental Details
Interventions
Intervention(s)
The program was designed to reduce deficits in water and sanitation infrastructure in rural areas of the departments of La Paz, Cochabamba, Potosí and Chuquisaca. It was targeted to rural communities with less than 500 people with the following objective:
• Increase coverage of improved water and sanitation facilities
• Reduce open defecation
• Reduce the risk of water-borne diseases and diseases of environmental origin in children less than 5 years
• Increase labor productivity by reducing time used in water fetching activities

The intervention encompasses two main components financed by a loan from the Inter-American Development Bank (IADB) and donation funds from the Spanish Fund for Water and Sanitation. The first component finances the design and construction of communal drinking water systems and individual sanitation facilities (infrastructure component). The second component fosters the creation and strengthening of community-based organizations, and the organization and establishment of Water and Sanitation Committees for the administration, operation and maintenance of water systems (community development component “DESCOM”). As part of the DESCOM, the program comprises educational and behavioral change activities in the areas of hygiene and adequate use of water sources and sanitation infrastructure.

Within departments, 24 eligible program municipalities were identified using an indicator of areas for sanitation investments (IARIS) as well as accessibility and cost-effectiveness criteria. The IARIS is a formula that considers levels of poverty and water and sanitation coverage. From the 24 municipalities, 17, which had sufficient number of communities to introduce treatment variation, were selected for the experimental design and evaluation. In each of them, 369 communities with less than 500 inhabitants and coverage levels below 20% were randomly assigned to the treatment and control groups.

Program activities started in May 2015 and ended in August 2016.
Intervention Start Date
2015-05-01
Intervention End Date
2016-08-31
Primary Outcomes
Primary Outcomes (end points)
The purpose of this study is to assess the impact of the program on a variety of short- and medium-term outcomes:

Key short-term outcomes
• Access and use of improved drinking water sources
• Access and use of improved sanitation facilities
• Improved hygiene practices
• Improved water quality
• Reduction in time spent in water-fetching activities
Key medium-term outcomes
• Prevalence of water-borne diseases, including diarrhea, parasites and skin diseases
• Reallocation of time
Primary Outcomes (explanation)
Baseline Survey:

For experimental validity and balance purposes, a baseline survey was carried out between October and December of 2013 (phase 1), and March and May of 2014 (phase 2) . We collected information from 344 communities (170 treatment and 174 controls). We surveyed all eligible households with at least one child under 5 years of age, with an average of 6.3 eligible households per community. The survey collected information on demographic composition, socio-economic and household characteristics, water and sanitation facilities, time use, health information for children under 5, agricultural activities and observational information from the dwelling and its surroundings. In one random household per community we also measured water quality by evaluating the presence of fecal coliforms. The total sample size at baseline is 2,185 households. The baseline data analysis provided a comprehensive overview of the situation of pre-program indicators in the population under study. It also showed no significant differences in observable characteristics between treatment and control groups (Gertner et al. 2016).

Follow-up Survey:

The first follow up survey will take place between May 2017 and July 2017. Due to financial constraints, the survey will collect information from a sample of 100 communities (50 treatment and 50 controls) in rural areas of two of the four program departments (La Paz and Cochabamba). For each primary sampling unit (community), 12 randomly selected households will be interviewed.

The survey instrument will be designed to collect data on:
- Sociodemographic characteristics of household members
- Education
- Self-reported Health for all household members
- Use of time
- Household characteristics, assets and access to services
- Main and secondary drinking water sources and water sources for other purposes
- Water collection
- Sanitation facilities
- Hygiene practices
- Community participation

In addition, for a subsample of households, the survey will collect water quality indicators measured at the source and in the household, as well as a community questionnaire (Rural Water and Sanitation Information System - SIASAR by its Spanish acronym). All survey instruments will be used with adequate adaptation for the application in the local context.

A second follow-up on an expanded sample will be planned for approximately 2019 to measure long term health effects.

Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
Random assignment to treatment and control groups:

The impact evaluation will be based on the design of a Randomized Controlled Trial (RCT). Within each program municipality, eligible communities were classified in two groups: with population size from 50 to 200 and from 200 to 500. In each group, communities were randomly assigned an order of entrance to the program and listed accordingly. Communities at the top of the list were assigned to the intervention group (182) leaving the communities at the bottom of the list as controls (187). The number of communities that were offered the treatment was based on program resources available. All households in treatment communities would benefit from the program.

The randomization process was carried out in November 2012 through public lotteries witnessed by national and local authorities to ensure transparency and legitimacy. Lottery protocols were designed in coordination between the Ministry of Environment and Water, the National Service for the Sustainability of Basic Sanitation and the IADB.

Was the treatment clustered?
Yes, within each municipality treatment was assigned at the community level. Treatment assignment was stratified by municipality and population size.

Planned number of clusters: 100 communities (50 treatment and 50 control)

Planned number of observations: 1,200 households
- Treatment: 600 households
- Control: 600 households
Experimental Design Details
Randomization Method
Public lottery
Randomization Unit
Community
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
Planned number of clusters: 100 communities (50 treatment and 50 control)
Sample size: planned number of observations
Planned number of observations: 1,200 households
Sample size (or number of clusters) by treatment arms
- Treatment: 600 households
- Control: 600 households
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
A long-run follow up with 140 treatment and 140 control communities, with a population sample of 10 children per community, will permit a minimum detectable effect on diarrhea prevalence of between 6 and 7 percentage points assuming power = 0.8 and significance =0.05
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
IRB Approval Date
IRB Approval Number
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
No
Is data collection complete?
Data Publication
Data Publication
Is public data available?
No
Program Files
Program Files
Reports, Papers & Other Materials
Relevant Paper(s)
REPORTS & OTHER MATERIALS