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Trials and Tribulations

This chapter introduces the WASH (Water Sanitation and Health) sector’s conversations about randomized intervention studies and draws lessons for development policy, more generally. Sanitation is a valuable case because, on the one hand, improving sanitation is widely recognized as a critical part of the development process, but, on the other hand, WASH interventions are often less well suited for randomized intervention evidence than other topics in health science or development economics. The chapter discusses a recent set of randomized trials which, far from definitively settling the important questions of rural sanitation policy, have renewed confusion and debate in the sector. Because even flawlessly designed and implemented sanitation interventions are likely to have different effects from one another and in different contexts, facts and theories from non-RCT sources are necessary (in addition to RCTs) to provide full and timely answers to sanitation policy questions. Finally, a case is made for the increased use of RCTs in the WASH sector where they might be more likely to help: to answer questions about behavior, rather than about health.