Research on the Impact of Targeted Subsidies Within Open Defecation Free (ODF) Communities

Study Overview
=================
Brief Summary
-----------------
This study evaluates targeted subsidies as a strategy to improve sanitation infrastructure and behaviours in communities that have reached Open Defecation Free (ODF) status after a Community-Led Total Sanitation (CLTS) program. The investigator's hypothesis is that sanitation subsidies targeted at the most vulnerable households within ODF communities will increase and help sustain latrine coverage, quality, and use amongst the targeted households, and through a spill-over effect, amongst the rest of the community. Half of participating communities will receive the targeted subsidy, while the other half will not receive any treatment.

Detailed Description
-----------------
Community-Led Total Sanitation (CLTS) is a widely used approach to eradicate open defecation in rural communities in developing countries. Using emotional triggers, CLTS promotes community self-help to build household latrines. In Ghana, where CLTS is part of the government's official sanitation strategy, a community is declared Open Defecation Free (ODF) when 80 percent of households own a latrine. There is however evidence that open defecation persists in so-called ODF communities, especially as the most vulnerable households (the poorest of the poor) cannot afford to construct or maintain durable latrines. As a result, subsidies for these vulnerable households have been proposed as a strategy to promote the construction of durable latrines and help sustain safe sanitation behaviours in communities having received CLTS.

Official Title
-----------------
Research on the Impact of Targeted Subsidies Within Open Defecation Free (ODF) Communities

Conditions
-----------------
Sanitation

Intervention / Treatment
-----------------
* Behavioral: Targeted Subsidy


Participation Criteria
=================
Eligibility Criteria
-----------------
This study is a cluster randomized controlled trial that will enroll entire communities. Within a community, only specific households will be selected to receive sanitation subsidy vouchers. Outcomes will be measured both for voucher recipients and for the rest of the community. Inclusion Criteria (for Communities): Community was targeted by UNICEF's Community-Led Total Sanitation (CLTS) program in Tatale, Yendi, and Kpandai districts in Ghana. Community has Open Defecation Free (ODF) status according to local authorities. Community has more than 15 and less than 100 households. Exclusion Criteria (for Communities): Community is located less than 2 kilometers away from a community in the opposite treatment arm. Inclusion Criteria (for voucher recipients within study communities): Household is extremely poor, as identified through community consultation and/or the government's Livelihood Empowerment Against Poverty (LEAP) program. Household has at least one vulnerable person, i.e. who meets one of the following criteria: i) older than 65 years old, ii) person with a disability, iii) orphan or vulnerable child, iv) female head of household, v) widow(er), vi) terminally-ill persons, vii) unemployed, viii) outcast groups. Exclusion Criteria (for voucher recipients within study communities): Household owns a functional, individual (non-shared) latrine with durable sub-structure.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: cluster Randomized controlled trial (c-RCT)
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Targeted Subsidy<br>In these communities, households identified as vulnerable receive a voucher for a free latrine sub-structure (slab + pit lining), redeemable with local sanitation suppliers. | Behavioral: Targeted Subsidy<br>* Voucher<br>|
| No Intervention: No subsidy<br>In these communities, no household receives a voucher. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of households owning an individual, functional latrine with full superstructure | Household ownership (yes/no) of a latrine that is i) not shared with other households (individual), ii) whose pit is not collapsed and not full (functional), and iii) with four walls (or circular walls) and a roof of any materials (full superstructure). | Approximately 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of households reporting practicing open defecation | Self report by the respondent of not always using a toilet to defecate when at home. | Approximately 18 months | 
| Percentage of households owning an individual, functional latrine with full superstructure and durable superstructure | Household ownership (yes/no) of a latrine that is i) not shared with other households (individual), ii) whose pit is not collapsed and not full (functional), iii) with four walls (or circular walls) and a roof of any materials (full superstructure), iv) with a concrete/plastic slab and pit lining with plastic/rocks/bricks/concrete (durable substructure). | Approximately 18 months | 
| Percentage of households reporting satisfaction with latrine | Self report by the respondent of being satisfied with the latrine (s)he uses for defecation. | Approximately 18 months |