An evaluation of rural sanitation in India
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One billion people practice open defecation globally resulting in approximately 900,000 deaths via contaminated water and contact with human excreta. India is home to 600 million of the individuals engaging in open defecation, and poor sanitation is estimated to cause over 400,000 deaths annually. The Swachh Bharat Mission, the Indian government's scheme to increase sanitation coverage across India, promotes toilet construction by subsidizing the costs. The program has produced limited uptake in hygienic behavior change, and toilet construction goals are not being met. This study evaluates the effectiveness of sanitation interventions in 22 studies in the rural setting. The review identifies successful sanitation interventions and highlights gaps in the existing literature. Three types of studies were evaluated: infrastructure interventions, education interventions, and interventions that employed a combination of the two methods; and the review of the studies found that interventions utilizing community mobilization and subsidies as a part of their outreach were more likely to increase toilet coverage in the rural environment. The review also provides recommendations for future interventions, research, and implementing organizations operating in the rural sanitation environment. The report was written to inform the work of Humanure Power, an NGO working to end open defecation in rural Bihar, India. The potential for conditional cash transfers and pit latrine volumes were explored as solutions to inducing behavioral change, and the report outlined an evaluation framework for the rural environment. This report provides a framework that tracks multiple indicators and incorporates local help to build a sustainable sanitation tracking system to account for the difficulties of program monitoring and evaluation in a resource-limited environment.