Incentivizing Sanitation Uptake and Sustainable Usage through Micro Health Insurance Impact Evaluation 2014

This study has been designed to investigate innovative ways of increasing the uptake and usage of safe sanitation and to provide evidence on the links between improved sanitation and health insurance. It does so by studying two distinct but linked projects.

Component 1 promotes the take up of improved sanitation with microfinance loans provided by Grameen Koota in rural Maharashtra. Social mobilization will be conducted by the NGO Navya Disha. These interventions aim to improve health and reduce health care costs of the poor in rural India, potentially reflected in lower health insurance claim volumes.

Component 2 proposes to explore primary community health insurance provided to communities that become open defecation free (ODF), conditional on sustaining their ODF status. If this is successful, the evidence will be strong advocacy material to encourage insurance companies to promote similar products at low rates throughout India, improving the sustainability of ODF.

A household listing exercise and a baseline survey were conducted from September 2014 to January 2015. Two main goals of the baseline data collection were to provide a snapshot of the study population, serving as a useful tool to understand the context in which the intervention is taking place, and to formally test whether there are any systematic differences between the treatment and control group prior to the intervention. The baseline survey collected information on socio-economic and welfare characteristics of household members, including access to sanitation facilities, self-reported open defecation, and prevalence of disease.

Random assignment of treatment and an endline survey are planned after the baseline survey. The endline survey will follows the same households sampled in baseline, and supplement additional to account for any potential attrition.