Enhancing sanitation equity in Ethiopia

Decision-maker’s challenge

Only about 10% of households in rural Ethiopia have access to an “improved latrine” – one that separates waste from human contact and prevents water contamination. Improved, or even partially improved, latrines are associated with a significant reduction in the risk of diarrheal diseases and better health. 

Ethiopia’s government faces a tough decision: how can it best use limited funds to ensure the poorest families build and use improved latrines? How can market-based sanitation activities support area-wide coverage? Often, subsidy programs meant to help the poorest families end up benefiting those who are already better off, leaving the most vulnerable behind.

Impact opportunity

Effective sanitation subsidies can dramatically improve health and quality of life for millions. In Ethiopia alone, reaching the poorest families with improved toilets could significantly cut illness from preventable diseases like diarrhea, benefiting up to 20 million rural residents. 

In this project, we hope to influence the National Sanitation Subsidy Protocol in Ethiopia and share lessons with others in the WASH space.

Our approach

In partnership with iDE and engagement with the Federal Ministry of Health (FMoH), Regional Bureaus of Health, and local communities in Ethiopia, IDinsight designed a randomized controlled trial (RCT) to understand how smart, targeted subsidies influence the purchase, use, and sustained ownership of latrines in rural communities. The study will also examine whether there are market distortions as a result of subsidy implementation. 

The household listing and baseline analysis for the RCT was completed in January 2025 and subsidy implementation began in February 2025. We anticipate the RCT endline survey taking place in June 2026, which will include a household-level survey. 

Using household listing data, we compared multiple approaches to determine subsidy eligibility, balancing vulnerability and equity across dimensions. Additionally, during the subsidy rollout period, we conducted a survey that examined how household factors such as gender correlated with subsidy uptake patterns.

The results

• High impact for ultra-poor and women: Full subsidies increased latrine uptake to 93%, compared to only 75% when households had to pay partially. Women-led households, in particular, struggled to pay even small costs, highlighting the need for tailored support.
• Improved targeting strategies: Using multiple poverty-measurement tools, such as community-based health insurance (CBHI) exemption lists and the Poverty Probability Index (PPI), along with local verification and food security questions, significantly improved identifying the most vulnerable families.

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Note: The inception and household listing phases were funded as part of a USAID-funded consortium called WASHPALS#2. The eligibility targeting, uptake survey, and dissemination to stakeholders was funded by the Hewlett Foundation’s Gender grant.