Clinical trial NCT03822611: Research on the Impact of Targeted Subsidies Within Open Defecation Free (ODF) Communities
Official title: Research on the Impact of Targeted Subsidies Within Open Defecation Free (ODF) Communities
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Sanitation
Lead sponsor: The Aquaya Institute
Sponsor class: OTHER
Collaborators: name: United States Agency for International Development (USAID)
name: Tetratech
First posted: 2019-01-30
Enrollment: 5615
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: cluster Randomized controlled trial (c-RCT)
Primary purpose: OTHER

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.

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.

Primary outcomes:
measure: Percentage of households owning an individual, functional latrine with full superstructure
timeFrame: Approximately 18 months
Secondary outcomes:
measure: Percentage of households reporting practicing open defecation
timeFrame: Approximately 18 months
measure: Percentage of households owning an individual, functional latrine with full superstructure and durable superstructure
timeFrame: Approximately 18 months
measure: Percentage of households reporting satisfaction with latrine
timeFrame: Approximately 18 months
Other outcomes:
Locations:
city: Tamale
country: Ghana
facility: Districts of Tatale and Kpandai, Northern Region
Study officials:
affiliation: The Aquaya Institute
name: Rachel Peletz, PhD
role: PRINCIPAL_INVESTIGATOR
References: