Incentivizing Sanitation Uptake and Sustainable Usage through Micro Health Insurance, Impact Evaluation 2017 - India

Abstract
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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.

Geographic coverage
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120 Gram Panchayats in two Districts in Maharashtra, Nanded and Latur.

Analysis unit
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- Villages
- Households

Kind of data
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Sample survey data [ssd]

Sampling procedure
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This evaluation is based on a 'cluster randomized controlled trial'. The study started off by determining the set of 120 Gram Panchayats (GPs) to consider as part of the evaluation and then to randomly allocate each of these to the three different evaluation arms. The second step was the randomization of the 120 GPs to one of three evaluation arms. Randomization was stratified by branch and by size of the GP (size in terms of number of households). The study stratified not only at the GP-level randomization, but also when selecting the sample of survey respondents. Study households were stratified by (i) whether a client lived in the household and (ii) whether a child under the age of two years lived in the household. All client households interviewed at the baseline (around 1,800) were included in the endline sample of client survey, referred to as the `panel client household’.

To limit sample loss due to attrition for the endline survey from the baseline survey, the study tracked households if they moved (i) within the GP where they lived at baseline, and (ii) to another GP in the study area. 2,400 additional households were selected among clients already active at baseline and belonging to those lending groups (kendra) where at least one client household was interviewed for the baseline survey. Overall, they sampled around 75% of all 5,350 active at the time of the baseline survey.

As was the case with client households interviewed at baseline, they also revisited all non-client households interviewed at the baseline (around 1,800) for the endline survey. They supplemented the original non-client households with a sample of households living close to a random sample of client households (which we refer to as the index households). They surveyed around 8 - 9 index households per GPs according to the size of the client population in that GP, for a total of 1,000 index households and 5,000 neighbor households from the same 120 GPs.

As mentioned above, panel households were tracked within the GP and in other GPs within the study area to limit attrition. The attrition rate for the whole panel sample was on average 4% (2% and 6% among non-clients and clients respectively), between the baseline and endline surveys.

Mode of data collection
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Computer Assisted Personal Interview [capi]

Research instrument
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The data was collected using the following survey instruments:

- Client Questionnaire
- Community (Village) Questionnaire
- Household (Clients) Questionnaire
- Household (Non-Clients) Questionnaire
- Mason Questionnaire
- Non-Client (Neighbours) Questionnaire
- Non-Client Index (Neighbours) Questionnaire
- Swachh Bharat Mission (SBM) Village Questionnaire

The questionnaires are provided in English and are made available for download here.

摘要
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本研究旨在探讨提高安全卫生普及率和使用率的创新方法，并提供关于改善卫生与健康保险之间联系的证据。该研究通过研究两个相互关联但独立的项目来实现这一目标。
组件1通过由Grameen Koota在农村马哈拉施特拉邦提供的微型金融服务来促进改善卫生的采用。非政府组织Navya Disha将开展社会动员。这些干预措施旨在改善农村印度穷人的健康状况，降低他们的医疗保健成本，这可能在较低的健康保险索赔量中得到反映。
组件2提议探索向成为开放排泄自由（ODF）的社区提供的初级社区健康保险，条件是维持他们的ODF状态。如果这一举措成功，相关证据将成为强有力的宣传材料，以鼓励保险公司以低利率在印度推广类似产品，从而提高ODF的可持续性。
地理覆盖范围
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马哈拉施特拉邦的两个区，Nanded和Latur的120个乡村潘查亚特。
分析单位
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- 村庄
- 家庭
数据类型
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样本调查数据 [ssd]
抽样程序
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此次评估基于'集群随机对照试验'。研究首先确定了作为评估的一部分的120个乡村潘查亚特（GPs），然后将每个这些潘查亚特随机分配到三个不同的评估组中。第二步是将120个GPs随机分配到三个评估组中的一个。随机化按分支和GPs的大小（以家庭数量衡量）进行分层。研究不仅在GPs级别进行随机化，而且在选择调查受访者样本时也进行分层。研究家庭按（i）是否有客户居住在该家庭以及（ii）是否有两岁以下的儿童居住在该家庭进行分层。所有在基线（约1,800人）接受访谈的客户家庭都被包括在最终样本的客户调查中，被称为'面板客户家庭'。
为了限制由于流失导致的最终调查样本损失，研究跟踪了家庭如果他们（i）在基线居住的GPs内部迁移，以及（ii）迁移到研究区域内的另一个GPs。在基线活跃的客户中，从那些至少有一个客户家庭接受基线调查的贷款小组（kendra）中选择了2,400个额外的家庭。总的来说，他们从基线调查时的5,350个活跃家庭中抽取了大约75%的样本。
与在基线接受访谈的客户家庭一样，他们也重新访问了在基线接受访谈的所有非客户家庭（约1,800人），以进行最终调查。他们用靠近随机抽取的客户家庭样本的家庭（我们称之为索引家庭）补充了原始的非客户家庭。根据该GPs中客户人口的数量，每个GPs调查了约8-9个索引家庭，共1,000个索引家庭和5,000个来自同一120个GPs的邻近家庭。
如上所述，面板家庭在GPs内部和其他研究区域内的GPs中进行了跟踪，以限制流失。整个面板样本的流失率平均为4%（非客户和客户中分别为2%和6%），在基线和最终调查之间。
数据收集方式
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计算机辅助个人访谈 [capi]
研究工具
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数据收集使用以下调查工具进行:
- 客户问卷
- 社区（村庄）问卷
- 家庭（客户）问卷
- 家庭（非客户）问卷
- 石匠问卷
- 非客户（邻居）问卷
- 非客户索引（邻居）问卷
- 清洁印度行动（SBM）村庄问卷
问卷以英文提供，并在此处可供下载。