WSP Global Scaling up Handwashing Behavior Impact Evaluation, Baseline and Endline Surveys 2009-2011
In December 2006, in response to the preventable threats posed by poor sanitation and hygiene, the Water and Sanitation Program (WSP) launched Global Scaling Up Handwashing and Global Scaling Up Rural Sanitation1 to improve the health and welfare outcomes for millions of poor people. Local and national governments implement these large-scale projects with technical support from WSP. Handwashing with soap at critical times-such as after contact with feces and before handling food-has been shown to substantially reduce the incidence of diarrhea. It reduces health risks even when families do not have access to basic sanitation and water supply. Despite this benefit, rates of handwashing with soap at critical times are very low throughout the developing world. Global Scaling Up Handwashing aims to test whether handwashing with soap behavior can be generated and sustained among the poor and vulnerable using innovative promotional approaches. The goal of Global Scaling Up Handwashing is to reduce the risk of diarrhea and therefore increase household productivity by stimulating and sustaining the behavior of handwashing with soap at critical times in the lives of 5.4 million people in Peru, Senegal, Tanzania, and Vietnam, where the project has been implemented to date.
In an effort to induce improved handwashing behavior, the intervention borrows from both commercial and social marketing fields. This entails the design of communications campaigns and messages likely to bring about desired behavior changes and delivering them strategically so that the target audiences are “surrounded” by handwashing promotion via multiple channels. One of the handwashing project's global objectives is to learn about and document the long-term health and welfare impacts of the project intervention. To measure magnitude of these impacts, the project is implementing a randomized-controlled impact evaluation (IE) in each of the four countries to establish causal linkages between the intervention and key outcomes. The IE uses household surveys to gather data on characteristics of the population exposed to the intervention and to track changes in key outcomes that can be causally attributed to the intervention.
The objective of the IE is to assess the effects of the handwashing project on individual-level handwashing behavior and practices of caregivers. By introducing exogenous variation in handwashing promotion (through randomized exposure to the project), the IE will also address important issues related to the effect of intended behavioral change on child development outcomes. In particular, it will provide information on the extent to which improved handwashing behavior contributes to child health and welfare.
The primary hypothesis of the study is that improved handwashing behavior leads to reductions in disease incidence, and results in direct and indirect health, developmental, and economic benefits by breaking the fecal-oral transmission route. The IE aims to address the following research questions and associated hypotheses:
1. What is the effect of handwashing promotion on handwashing behavior?
2. What is the effect of improved handwashing behavior on health and welfare?
3. Which promotion strategies are more cost-effective in achieving desired outcomes?
(The above excerpt is taken from: Scaling Up Handwashing Behavior: Findings from the Impact Evaluation Baseline Survey in Vietnam Claire Chase and Quy-Toan Do November 2010)
The report is attached.
Kind of data
Sample survey data [ssd]
The study includes information on the baseline, longitudunal and endline surveys.
The survey was held in three provinces selected for their representative geographic location. These provinces are:
- Hun Yen (close to Hanoi)
- Tien Gan (South)
- Than Hoa (North)
From these provinces a total, 401 communes across 18 districts in the three project provinces were listed by the VWU as eligible to participate in the project. From this list a total of 210 communes across 15 districts in the three provinces were selected for the study.
The survey was undertaken in the commune (clusters). But as this is an impact evaluation, this is not a nationally representative statistic.
Unit of analysis
- Child (under 5 and under 2)
The Vietnam Scaling Up Handwashing IE baseline survey collected information from a representative sample of the population targeted by the intervention. The survey was conducted between September and November 2009 in a total of 3,150 households containing 3,751 children under the age of five.
Producers and sponsors
Water and Sanitation Program
National Institute of Hygiene and Epidemiology
Implemented the baseline survey
Implemented the endline survey
Data reduction endline
Bill & Melinda Gates Foundation
Primary funding source for the impact evaluation
The primary objective of the handwashing project is to improve the health and welfare of young children. Thus, a sufficient sample size was calculated to capture a minimum effect size of 20 percent on the key outcome indicator of diarrhea prevalence among children under two years old at the time of the baseline. By focusing on households with children under two, the evaluation aims to capture changes in outcomes for the age range during which children are most sensitive to changes in hygiene in the environment. Power calculations indicated that approximately 1,050 households per treatment arm would need to be surveyed in order to capture a 20 percent reduction in diarrhea prevalence, and in order to account for the possibility of household attrition during the project study phase. Therefore, since the evaluation consists of two treatment groups and one control group, the total sample incorporates 3,150 households, each of which has at least one child under two years of age at the time of the survey.
Rather than using simple random sampling, which is much more costly, the study randomly sampled households in clusters at the commune administrative level. Households were randomly selected from a sampling frame of 210 communes randomly selected from 15 districts in three provinces.
Data were collected using structured questionnaires in all 3,150 households and in each of the 210 commune (one per commune).
94.7 % of the households responded.
Approximately 87% of the persons interviewed in the baseline were re-interviewed in the endline.
Dates of collection
Mode of data collection
The baseline survey was conducted from September to December 2009 and included the following instruments:
• Household questionnaire: Th e household questionnaire was conducted in all 3,150 households collect data on household composition, education, labor, income, assets, spot-check observation of handwashing facilities, handwashing behavior, and handwashing determinants.
• Health questionnaire: Th e health questionnaire was conducted in all 3,150 households, to collect data on children’s diarrhea prevalence, acute lower respiratory infection (ALRI) and other health symptoms, child development, child growth, and anemia.
• Community questionnaire: Th e community questionnaire was conducted in 210 communes, to collect data on socio-demographics of the community, accessibility and connectivity, education and health facilities, water and sanitation related facilities and programs, and government assistance or programs related to health, education, cooperatives, agriculture, water, and other development schemes.
The National Institute of Hygiene and Epidemiology (Baseline Survey)
Baseline: The baseline survey was processed using the assistance of Sistemas Integrales in Chile. A manual for the data entry system is attached under the title of: Data Entry Manual:Baseline.
Endline: Kimetrica International was contracted to design the data reduction system to be used during the endline. The data entry system was designed in CSPro (Version 4.1) using the DHS file management system as a standard for file management. Details of the system can be found in the attached manual entitled: Data Entry Manual for the Endline Survey.
The data entry system was based on a full double data entry (independent verification) of the various questionnaires. CSPro supports both dependent and independent verification (double keying) to ensure the accuracy of the data entry operation. Using independent verification, operators can key data into separate data files and use CSPro utilities to compare them and produce a report that indicates discrepancies in data entry.
The DHS system uses a fully integrated tracking system to follow the stages in the data entry process. This includes the checking in of questionnaires; the programming of logic in what is known as a system controlled environment. System controlled applications generally place more restrictions on the data entry operator. This is typically used for complex survey applications. The behavior of these applications at data entry time has the following characteristics:
- Some special data entry keys are not active during data entry.
- CSEntry will keep track of the path.
- 'Not applicable' or blanks values will not be allowed. Missing values have to be coded.
- More appropriate to the heads up methodology of data capture.
- Logic in the application is strictly enforced; operator cannot bypass or override.
Files were processed using the unique cluster number and then concatenated after a final stage of editing and output to both SPSS and STATA.
Furthermore, attempts were made to respect the values and the naming conventions as provided in the baseline. This required using non-conventional values for “missing” such as -99. In most cases the same value sets were applied or during the questionnaire review process the WSP was alerted to such discrepancies.
The data files as they are output in CSPro follow the hierarchical structure as established in the data dictionary. These however may not be convenient for the analyst. The WSP requested that the files be integrated into various record level files. The files that are included in the final data base reflect this structure.
However, some analysts may still want the hierarchical level data available in its original record form (as it was during data entry). For that reason, these files are also zipped together and provided in the event that they are desired.
The final data files are provided in STATA format as requested by the WSP.
Although there was no formal or independent appraisal of the data, an appraisal was undertaken when the data files for: Peru, India and Vietnam were prepared for a WSP presentation in Mexico. These data were presented in a public forum and scrutinized by various analysts. There was a process of feeding back information which helped correct or format or revise the data.
Water and Sanitation Program (WSP)
- Licensed datasets, accessible under conditions
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
World Bank Water and Sanitation Program. Vietnam Multi-Country Impact Evaluation (IE) of WSP's Global Handwashing and Rural Sanitation Programs 2009-2011. Ref. VNM_2009_2011_WSP-IE_v01_M. Dataset downloaded from [website/source] on [date]
Disclaimer and copyrights
WSP is a multi-donor partnership created in 1978 and administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. WSP's donors include Australia, Austria, Canada, Denmark, Finland, France, the Bill & Melinda Gates Foundation, Ireland, Luxembourg, Netherlands, Norway, Sweden, Switzerland, United Kingdom, United States, and the World Bank. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the Water and Sanitation Program, the World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent.
Water and Sanitation Program (WSP)
Compiled the DDI
Water and Sanitation Project
Reviewed content of the DDI
Version 01: Adopted from "DDI_VNM_2009_2011_WSP-IE" DDI that was done by metadata producers mentioned in "Metadata Production" section.
Version 02: Bertha Briceno and Alex Orsola-Vida removed as access authorities and contacts since they left the World Bank and contact details are no longer valid.