India Swachh Bharat Mission — Open Defecation Free
World Bank / Research Institute for Compassionate Economics · India · 2018
Summary
The Swachh Bharat Mission is one of the largest public health infrastructure programs in history, and its evaluation illustrates the difference between changing physical infrastructure and changing behavior. The RICE Institute evaluation found that toilet construction increased substantially in program villages — but actual open defecation practice among adults declined much less than official statistics claimed. The discrepancy arose because many newly built toilets were unused. Behavior change lagged infrastructure construction. The finding is consistent with a broader literature on sanitation interventions: building latrines is necessary but not sufficient; sustained behavior change requires additional mechanisms including social norm change, enforcement, and convenience. Child health outcomes showed no statistically significant improvement in the first evaluation period.
Research question
"Does a government-led campaign combining toilet construction subsidies with behavior change communication produce sustained open defecation-free communities?"
Methodology
Intervention
Villages received subsidy for household toilet construction plus community mobilization (village-level meetings, social norm messaging, monitoring of open defecation); national program with geographic rollout creating comparison areas
Assignment
Difference-in-differences with matched control villages (quasi-experimental)
Sample size
Approximately 25,000 households across 280 villages (primary RICE evaluation); broader administrative data covering millions
Primary outcome
Toilet construction rate; open defecation practice rate; child diarrhea and stunting
Effect estimate
Toilet construction: +24 pp in program villages; open defecation practice: no significant reduction among adults (behavior gap); child diarrhea or stunting: no statistically significant reduction
Decision
National programme continued with target of 100 million toilets; subsequent phases added stronger social enforcement; UNICEF and WHO documented gaps between infrastructure claims and behavioral outcomes
Result
Mixed
Toilet construction: +24 pp in program villages; open defecation practice: no significant reduction among adults (behavior gap); child diarrhea or stunting: no statistically significant reduction
Evidence strength
Moderate
Quasi-experimental design; causal interpretation requires care.
Replication status
Partially replicated
Institution
World Bank / Research Institute for Compassionate Economics
Location
India
Year
2018
Policy area
Public Health
Mechanism
Community engagement