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Health and sanitation in developing countries

Over the last eight years, Researchers at the IFS have collaborated closely with several field implementation agencies in three countries across two continents (India, Nigeria and Pakistan), carrying out trials testing various innovative approaches to improving uptake and usage of low-cost safe sanitation.

The experience and data emerging from these collaborations put us in a unique position to test hypotheses that could potentially explain a puzzled that emerged in the field: Although sanitation – broadly defined as hygienic means of promoting health through prevention of human contact with the hazards of wastes, particularly human waste – has long been acknowledged as an indispensable element of disease prevention and primary health care programmes (Declaration of Alma-Ata, 1978), a large number of recent impact evaluation studies on sanitation interventions in low-income countries fail to find any health improvements. Clasen et al. (2014), for example, conduct a well-funded and rigorous impact evaluation study of a sanitation intervention in Eastern India, and, despite an increase in mean village-level sanitation of about 50 percentage points, no impacts on a number of health outcome measures could be established almost three years after the intervention.

Ongoing research at the IFS builds on these experiences and collaborations, and uses academically rigorous and innovative methods to analyse available detailed micro-data to speak to two overarching questions:

  • Is (low cost) sanitation on its own really as beneficial for health as postulated? Or are we possibly dealing with a more complex process for the formation of health (which economists refer to as a health production function), where sanitation interacts with other factors, particularly nutrition, in the production of health outcomes?
  • Independent of the health production function, are possible imperfections, frictions and constraints related to the uptake and usage of sanitation infrastructure restricting sanitation interventions from realising their potential for improving health and, through that, the productivity of developing countries?

Selected highlights

IFS Working Paper W19/11
We study the effectiveness of a community-level information intervention aimed at reducing open defecation (OD) and increasing sanitation investments in Nigeria. The results of a cluster-randomized control trial conducted in 247 communities between 2014 and 2018 suggest that average impacts are ...
Newspaper article
In November last year, Nigeria declared that its water supply, sanitation and hygiene sector was in crisis. A community-level intervention aims to reduce open defecation and improve toilet coverage. So why does it work in some places and not others?
Journal article
Our study contributes to the understanding of key drivers of stunted growth, a factor widely recognized as major impediment to human capital development.
Inadequate sanitation is a leading cause of poverty in developing countries, largely because it causes premature mortality. But policymakers in Nigeria still struggle to improve sanitation practices despite their importance to national health and poverty eradication strategies.


Contact IFS on 020 7291 4800 or [email protected]

Britta Augsburg
Associate Director
Sonya Krutikova
Deputy Research Director
Yani Tyskerud
Assistant Director
Antonella Bancalari
Research Associate