WSP Global Scaling up Handwashing Behavior Impact Evaluation 2009-2011, Baseline and Endline Surveys
Baseline and Endline Surveys
Other Household Health Survey [hh/hea]
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?
Hygiene information and practices play a critical role in preventing diseases, particularly among children. Hygiene behaviors practiced in the household have been linked to development outcomes such as socio-emotional skills. The WSP Global Scaling up Handwashing Behavior Impact Evaluation (WSPIE) 2009-2011 was conducted in Senegal, where the randomized design suffered from contamination between comparison groups. The variations in exposure and intensity to hygiene information campaigns captured in the surveys were used to understand contamination biases. Such variations were interacted with the presence of household communication assets to explore potential effects on children’s socio-emotional scores. In the presence of contamination biases, the study exploited the longitudinal sample of children in the surveys to reduce time-dependent biases. For robustness, statistical matching was applied between the impact evaluation surveys and Demographic and Health Surveys conducted in 2008 and 2011. Socio-emotional outcomes were the imputed into Demographic and Health surveys to expand sample sizes. By applying matching techniques and imputing outcomes into a larger sample, impacts were non-negligible. Double-difference estimates showed that children’s socio-emotional scores were higher when intervention status was interacted with the presence of communication assets within households. Without the presence of communication assets in the households the impacts were close to zero. Evaluating the effect of hygiene campaigns on children’s socio-emotional skills is challenging because of the biases from contamination that exist when information flows between comparison groups. Targeted hygiene information to the poorest households is relevant for reducing risks of recurrent infections and enables better conditions for socio-emotional development of children.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
Child (under 5 and under 2)
Version 1.0: The study includes information on the baseline and endline surveys.
The survey results provide information on the characteristics of household members, access to handwashing facilities, handwashing behavior, prevalence of child diseases such as diarrhea and respiratory infection, and child growth and development. In addition, community questionnaires were conducted with key informants at the village level in all sample locations to gather information on community access to transportation; commerce; health and education facilities, and other relevant infrastructure; contemporaneous health and development interventions; and environmental and health shocks.
The survey was undertaken in the commune (clusters). But as this is an impact evaluation, this is not a nationally representative statistic.
Producers and sponsors
Inter-American Development Bank
Water and Sanitation Program
National Institute of Hygiene and Epidemiology
Implemented the baseline survey
Data reduction endline
Bill & Melinda Gates Foundation
Primary funding source for the impact evaluation
The sampling framework included three stages. In the first stage, the collectivités locales (urban and rural communes) were selected. The selection of collectivités locales was drawn from the universe of urban communes and communautés rurales included in the four selected regions. Two collectivités locales-Commune de Thiès and Touba Mosquée-were excluded from the sampling universe for being larger than the rest (Touba Mosquée was close to 500,000 residents and Commune de Thiès was around 250,000 residents; the population of the next seven largest cities was between 171,000 and 113,000); from the remaining list there was a random selection from the largest collectivités locales. The second stage involved sample cluster selection. The selection of clusters or Census Districts was drawn from the universe of clusters. The last stage of the sampling framework involved household selection. The selection of households was randomly drawn among all households within the selected clusters that had at least one child less than two years of age, and was proportional to the number of households per cluster.
The randomized assignment of comunes was done at the locality level, and it included 110 urban and rural (cluster) villages randomly selected (55 for treatment and 55 for control) among eligible localites distributed across 7 of the 11 regions of Senegal. The evaluation design objective was to test whether handwashing behavior can be improved among the poor through the use of promotional strategies, and assess the effectiveness of the program at improving the health of the population at risk of diarrhea, and incidence of sanitation-related diseases. The program targeted a population of mothers and other caregivers between the ages of 19-49 and infants up to 13 years of age, living in urban and rural areas of the country, with the main objective of delivering the information campaign and hygiene promotion contents to the "stewards" of child health within the household.
While the intervention was designed to improve the health and hygiene practices of the treatment population, the intervention also collected data on children's health and mental development. Taking this information, children's mental development was analyzed using the data collected during the program. Hygiene practices within the household may impact child's mental development through different channels, such as nutrition, health, and high-quality supportive environments. The last channel includes mothers' behavior on health and nutrition, as these factors make mothers more responsive with the child's environment and his/her cognitive and socio-emotional development.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
The data were gathered through three different stages: a baseline survey, a longitudinal survey, and a post -intervention survey, all of which were collected from a representative sample of the target population living in the four regions designated for the study. The baseline survey was collected before the intervention and conducted from June through August 2009. The data was finally collected from about 1,150 households in 110 clusters within eligible urban and rural communautés. This survey consisted of household, health, and community questionnaires, structured observations, and stool samples. The longitudinal surveys were collected in three time periods before the intervention, and in three times, as a monitoring survey, after the intervention started. The post-intervention follow up survey was conducted in early 2011, and it collected, in great part, the outcomes collected in the baseline survey.
The National Institute of Hygiene and Epidemiology (Baseline Survey)
Centre de Recherché pour le Developpement Humain
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.
Estimates of Sampling Error
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
Water and Sanitation Program
Inter-American Development Bank
Access authority is defined in a policy document entitled: WSP Data Access Policy. This document is attached. However, the following is provided from the data access policy:
To access data, team members must complete a Data Access Request Form (attached). Although team members may already have physical access to a particular dataset, they are expected to complete a Data Access Request Form (attached) if they intend to conduct a new analysis and/or prepare a new abstract, conference presentation, or manuscript.
All Data Access Request Forms should be submitted to Bertha Briceno (firstname.lastname@example.org). In the event that Bertha is unavailable, the data access request form should be submitted to Alex Orsola-Vidal (email@example.com).
Once the data access request form is submitted and approved, Bertha or Alex will facilitate the team member's access to the necessary data. WSP will strive to centralize storage of the latest datasets for analysis by all team members. Until WSP centralizes data storage, the individual Country PIs will be able to distribute the latest datasets for their respective countries.
The responsible team member must ensure that data are not distributed to anyone other than researchers listed on the Data Access Request Form.
The following team members will have access to data upon request and approval of the Data Access Request Form (attached).
• Country PIs
• Global experts
• WSP team
• Students or trainees of country PIs, global experts, or WSP team members will have access to data only after the supervising PI, global expert, or WSP team member complies with the process described here, including submitting the student's signed request for data access and agreement to comply with authorship and publication guidelines described. It is the supervising team member's responsibility to ensure that the student comply with all guidelines contained within this document.
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. Senegal WSP Global Scaling up Handwashing Behavior Impact Evaluation, Baseline and Endline Surveys 2009-2011. Ref. SEN_2009-2011_WSPIE_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.
DDI Document ID
Compiled the DDI
Water and Sanitation Project
Reviewed content of the DDI
Date of Metadata Production
DDI Document version
Version 02 (July 2012). Edited version based on Version 01 DDI (DDI-WSP-SNM-IE2009-2011) that was done by Kimetrica International and reviewed by Water and Sanitation Project.