Plain English Summary
Background and study aims
Access to basic sanitation remains one of the largest development challenges in the Philippines as 26% of the total population is without access to improved sanitation facilities. In rural areas alone, access to improved sanitation is less than 70% or about 9.5 million people, with 5.7 million of them defecating in the open and 3.7 million using unimproved toilets. Household latrines provide substantial health and other welfare benefits to users as well as positive development outcomes to others in the community, yet ownership of sanitary household latrines is uncommon among the poor. This study aims to address a key knowledge gap: what is the best mechanism to address the financial constraints of households to improving their sanitation situation – savings, subsidy, or a combination of the two?
Who can participate?
All people living in the participating barangays (villages)
What does the study involve?
Participating barangays are randomly allocated to one of the three intervention groups or the control group. All groups receive sanitation promotion through Family Development Sessions (FDS) and a Community Led Total Sanitation (CLTS) campaign. The control group receive no further interventions apart from this. Intervention group 1 receive access to funding through national and municipal programs to subsidize the purchase and construction of household latrines. Intervention group 2 have access to a 25% microfinance institution (MFI) grant for purchase of a latrine and make regular savings contributions to repay the remaining 75%. Intervention group 3 have access to a 50% MFI grant for purchase of a latrine and make regular savings contributions to repay the remaining 50%. Household take-up of improved sanitation is measured through surveys at the start and end of the study.
What are the possible benefits and risks of participating?
Participants in the three intervention groups are eligible to receive subsidies or savings grants that help subsidize the construction of household latrines. All participants are exposed to national sanitation promotional campaigns. There is some risk for participants that enroll in savings grants programs will not be able to repay their portion of latrine costs. Study and MFI protocols include protections to ensure households that do not meet appropriate income levels will not be offered savings grants, thereby minimizing this risk. Otherwise, participation in the study does not represent risks to participants beyond what would be expected otherwise.
Where is the study run from?
The study takes place in the Philippines and includes 17 municipalities in the provinces of Negros Oriental, Cebu and Bohol and Leyte and Eastern Samar
When is the study starting and how long is it expected to run for?
September 2015 to December 2015
Who is funding the study?
World Bank Strategic Impact Evaluation Fund (SIEF)
Who is the main contact?
1. Claire Chase (scientific)
cchase@worldbank.org
2. Edkarl M. Galing (public)
egaling@worldbank.org
Study website
Contact information
Type
Public
Contact name
Mr Edkarl Galing
ORCID ID
Contact details
World Bank
1818 H Street
Washington DC
20433
United States of America
+1 (0)2023440207
egaling@worldbank.org
Type
Scientific
Contact name
Ms Claire Chase
ORCID ID
Contact details
World Bank
1818 H Street
Washington DC
20433
United States of America
+1 (0)2024734111
cchase@worldbank.org
Additional identifiers
EudraCT/CTIS number
IRAS number
ClinicalTrials.gov number
Protocol/serial number
N/A
Study information
Scientific title
Increasing access to improved sanitation for poor households in the Philippines through financial savings and subsidies: a cluster randomized controlled trial
Acronym
Study hypothesis
The primary hypothesis being tested in the study is that addressing the financial constraints of poor rural households, in combination with promotional activities, will increase the proportion of households that adopt and use improved sanitation.
Ethics approval(s)
University of the Philippines Manila Research Ethics Board, 02/11/2015, ref: RGAO-2015-0034
Study design
Experimental multi-arm parallel-assignment unmasked multi-center cluster randomized control trial with an active control group
Primary study design
Interventional
Secondary study design
Cluster randomised trial
Study setting(s)
Community
Study type
Other
Patient information sheet
Not available in web format, please use the contact details to request a patient information sheet
Condition
Sanitation
Intervention
The evaluation is a four-arm cluster randomized controlled trial, where treatment is randomly assigned at the cluster (village / barangay) level. Barangays were randomized within municipality to one of the three treatment arms, or control (stratified randomization within municipality). Random assignment was accomplished through standard practices using STATA.
Intervention Arm 1 (Municipal Subsidy + Promotion):
Households will have access to funding through national and municipal programs to subsidize the purchase and construction of household latrines. Treatment will also include promotion through Community-led Total Sanitation (CLTS) and enhanced Family Development Sessions (FDS).
Intervention Arm 2 (MFI Savings + 25% Grant + Promotion):
Households will have access to a 25% MFI grant for purchase of latrine and will make regular savings contributions to repay the remaining 75%. Treatment will also include promotion through Community-led Total Sanitation (CLTS) and enhanced Family Development Sessions (FDS).
Intervention Arm 3 (MFI Savings + 50% Grant + Promotion):
Households will have access to a 50% MFI grant for purchase of latrine and will make regular savings contributions to repay the remaining 50%. Treatment will also include promotion through Community-led Total Sanitation (CLTS) and enhanced Family Development Sessions (FDS).
Control (Promotion):
Promotion through Community-led Total Sanitation (CLTS) and enhanced Family Development Sessions (FDS).
Intervention type
Other
Primary outcome measure
Household take-up of improved sanitation (proportion of sample that has access to improved sanitation at the endline); improved sanitation defined using WHO/UNICEF Joint Monitoring Committee (JMP) guidelines. Data collected through household and barangay level surveys in December 2015 and December 2017
The study is powered to detect differences in sanitation take-up both between each treatment arm and the control arm, as well as across treatment arms.
Secondary outcome measures
1. Open defecation habits (proportion of sample that practices open defecation). Data collected through household and barangay level surveys in December 2015 and December 2017
2. Childhood diarrhea (2-day, 7-day and 14-day diarrhea prevalence in children aged less than 5 years). Data collected through household and barangay level surveys in December 2015 and December 2017
Overall study start date
01/08/2015
Overall study end date
31/12/2017
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
Barangays (villages) were selected based on the following criteria:
1. Water, Sanitation and Hygiene (WASH) priority areas identified for WASH convergence
2. Participation in the national Zero Open Defecation Program
3. At least 20% of households in the barangay having no toilet (defecating in the open)
4. At least 40 households participating in the Pantawid Pamilya. Within each barangay, the NHTS was used as the sampling frame
The Pantawid Pamilya utilizes the National Household Targeting System for Poverty Reduction (NHTS-PR) to target beneficiaries. This is a national database of poor households, containing information on household eligibility and includes households’ access to sanitation. This targeting system identifies household eligibility and participation in Pantawid Pamilya, household composition, and proxy-means test.
There was no minimum/maximum age and both genders were included.
Participant type(s)
Other
Age group
All
Sex
Both
Target number of participants
A total of 4080 participants (households) from a total of 272 clusters (village/barangay level)
Participant exclusion criteria
Does not meet inclusion criteria
Recruitment start date
01/09/2015
Recruitment end date
01/12/2015
Locations
Countries of recruitment
Philippines
Study participating centre
N/A
N/A
Philippines
Sponsor information
Organisation
World Bank Strategic Impact Evaluation Fund (SIEF)
Sponsor details
1818 H Street
Washington DC
20433
United States of America
Sponsor type
Other
Website
http://www.worldbank.org/en/programs/sief-trust-fund
ROR
Funders
Funder type
Other
Funder name
World Bank Strategic Impact Evaluation Fund (SIEF)
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
The following additional documents will be available once the trial is over: study protocol and statistical analysis plan. Protocol is not currently published.
Planned publication of study results in a high-impact peer reviewed journal - date intended is one year after trial end date (around December 2019). A case study note and lessons learned report will also be prepared to be disseminated internally with key stakeholders within the World Bank and externally for knowledge sharing purposes (date intended is one year after trial end date - around December 2019).
Intention to publish date
31/12/2019
Individual participant data (IPD) sharing plan
The data will be stored in the World Bank repository. For access, Claire Chase (cchase@worldbank.org) should be contacted. The data will include household level surveys and the statistical data from baseline and endline evaluation.
IPD sharing plan summary
Stored in repository
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Funder report results | results in funder report | 12/11/2019 | 23/04/2021 | No | No |