Bulletin of the World Health Organization

Long-term impact of a community-led sanitation campaign in India, 2005–2016

Jennifer Orgill-Meyer, Subhrendu K Pattanayak, Namrata Chindarkar, Katherine L Dickinson, Upendra Panda, Shailesh Rai, Barendra Sahoo, Ashok Singha & Marc Jeuland


To evaluate the long-term impact of a community-led total sanitation campaign in rural India.


Local organizations in Odisha state, India worked with researchers to evaluate a community-led total sanitation campaign, which aimed to increase the demand for household latrines by raising awareness of the social costs of poor sanitation. The intervention ran from February to March 2006 in 20 randomly-selected villages and 20 control villages. Within sampled villages, we surveyed a random subset of households (around 28 households per village) at baseline in 2005 and over the subsequent 10-year period. We analysed changes in latrine ownership, latrine functionality and open defecation among approximately 1000 households. We estimated linear probability models that examined differences between households in intervention and control villages in 2006, 2010 and 2016.


In 2010, 4 years after the intervention, ownership of latrines was significantly higher (29.3 percentage points; 95% confidence interval, CI: 17.5 to 41.2) and open defecation was significantly lower (−6.8 percentage points; 95% CI: −13.1 to −1.0) among households in intervention villages, relative to controls. In 2016, intervention households continued to have higher rates of ever owning a latrine (26.3 percentage points; 95% CI: 20.9 to 31.8). However, latrine functionality and open defecation were no longer different across groups, due to both acquisition of latrines by control households and abandonment and deterioration of latrines in intervention homes.


Future research should investigate how to maintain and rehabilitate latrines and how to sustain long-term behaviour change.