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Assessing the impact of monetary incentives on open defecation: Experimental evidence from a CLTS program in rural Laos

Last registered on July 18, 2019

Pre-Trial

Trial Information

General Information

Title
Assessing the impact of monetary incentives on open defecation: Experimental evidence from a CLTS program in rural Laos
RCT ID
AEARCTR-0003408
Initial registration date
October 17, 2018

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
October 19, 2018, 6:19 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
July 18, 2019, 12:20 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Primary Investigator

Affiliation
University of Melbourne

Other Primary Investigator(s)

PI Affiliation
Monash University
PI Affiliation
East Meets West
PI Affiliation
Georgetown University

Additional Trial Information

Status
On going
Start date
2015-01-01
End date
2019-12-31
Secondary IDs
N/A
Abstract
Evidence on the effectiveness of Community-Led Total Sanitation programs (CLTS) and latrine subsidies in promoting hygiene practices has been documented in a number of studies, reviewed in Garn et al. (2016). Less is known about how collective and individual financial incentives can interact to improve sanitation for the poorest households. We investigate this question in two provinces of South Laos, where over half of our sample of 2,400 households practiced open defecation at the beginning of our study. We conduct a randomized controlled trial encompassing 160 villages. All households were exposed to CLTS. In treatment groups, we augmented CLTS with packages of financial incentives to test their impacts on hygiene. We are interested in how the incentives promote hygienic behavior across the wealth distribution. This study will provide evidence on the complementarity of small financial incentives to demand-triggering campaigns and their role in promoting equity in areas where sanitation coverage remains low.
External Link(s)

Registration Citation

Citation
Cameron, Lisa et al. 2019. "Assessing the impact of monetary incentives on open defecation: Experimental evidence from a CLTS program in rural Laos." AEA RCT Registry. July 18. https://doi.org/10.1257/rct.3408-2.0
Former Citation
Cameron, Lisa et al. 2019. "Assessing the impact of monetary incentives on open defecation: Experimental evidence from a CLTS program in rural Laos." AEA RCT Registry. July 18. https://www.socialscienceregistry.org/trials/3408/history/50221
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Experimental Details

Interventions

Intervention(s)
Between June 2014 and June 2015, a community-led total sanitation (CLTS) program was rolled out in 160 villages across 10 districts of rural Southern Laos by the health ministry (with technical support from the World Bank Water and Sanitation Program). Between February 2015 and June 2017, we complemented the CLTS program by providing packages of financial incentives designed to increase take-up of improved sanitation, especially in poor households.

The incentives offered were:

Village incentive: targeted at village administration, and delivered after verification of open defecation elimination by district health officials. The reward value was around USD 300-500, depending on village size, and could be used at the village head's discretion for any development project.

Promoter+household incentive: targeted at poor households, and delivered after verification of installation and use of pour-flush toilets. The reward value was around USD 20 (roughly equal to a 40% rebate on the cheapest poor flush toilet model without a superstructure). An accompanying reward was targeted at village sanitation promoters (part of village sanitation committee), and delivered upon verified installation of pour-flush toilets by poor households. The promoter reward value was around USD 3 per toilet.

To investigate how individual and community monetary incentives interact with the CLTS program to improve rural sanitation, we randomly assigned the interventions at the village level (see Experimental Design).
Intervention Start Date
2015-01-01
Intervention End Date
2018-06-01

Primary Outcomes

Primary Outcomes (end points)
Latrine construction, open defecation, caretaker reported diarrhea prevalence and diarrhea symptoms, children’s height- and weight-for-age.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Social cohesion.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
160 villages were randomly assigned to one of four equally-sized treatment groups. All groups received Community-Led Total Sanitation (CLTS). In Treatment Group 1, we also implemented smart subsidies targeted to the poorest 30% of households and provided promoter commissions. In Group 2, open defecation elimination rewards were offered to villages. Group 3 included all incentives in Groups 1 and 2. Group 4 is the control group, which received CLTS with no individual or community incentives.
Experimental Design Details
Randomization Method
Randomization by computer.
Randomization Unit
Village level randomization.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
160 villages.
Sample size: planned number of observations
2400 households.
Sample size (or number of clusters) by treatment arms
40 villages per treatment arm.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
National Ethics Committee For Health Research (Laos)
IRB Approval Date
2014-09-15
IRB Approval Number
039
Analysis Plan

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Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
June 01, 2018, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
July 25, 2018, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
159 villages.
Was attrition correlated with treatment status?
Yes
Final Sample Size: Total Number of Observations
2,398 villages.
Final Sample Size (or Number of Clusters) by Treatment Arms
600 households control, 600 households promoter+household incentive, 597 households village incentive, 601 households both treatments.
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
No
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials