Few rural sanitation programmes have documented large increases in sanitation coverage or have assessed whether interventions equitably increase sanitation coverage for vulnerable groups.
This article reports results of a study of the impact of the Sustainable Sanitation and Hygiene for All (SSH4A) approach on key water, sanitation and hygiene (WASH) indicators. The study also assessed if increases in WASH coverage were equitably reaching vulnerable and non-vulnerable groups.
The SSH4A approach was administered in 12 programme areas in 11 countries, including Bhutan, Ethiopia, Ghana, Indonesia, Kenya, Mozambique, Nepal, South Sudan, Tanzania, Uganda, and Zambia. Repeated cross-sectional household surveys were administered over four annual follow-up rounds, from 2014 to 2018. Surveys were conducted in 21,411 households (on average) at each round of data collection.
Overall, sanitation coverage increased by 53 percentage points between baseline and endline (95 per cent CI: 52 per cent, 54 per cent). We estimate that 4.8 million people gained access to basic sanitation in these areas during the project period. Most countries also demonstrated movement up the sanitation ladder, as well as increases in handwashing stations and safe disposal of child faeces.
When assessing equity — if sanitation coverage levels were similar between vulnerable and non-vulnerable groups — we observed that increases in coverage over time were generally comparable between the two. However, the increase in sanitation coverage was slightly higher for wealthier households compared to less well-off households.
Results from this study revealed a successful model of rural sanitation service delivery. However, further work is needed to explore the specific mechanisms that led to success of the intervention.