Improving the health of the rural population in India through bundling WASH practices.

Achieving access to clean and safe water, sanitation, and hygiene (WASH) for all is one of the Sustainable Development Goals. However, most efforts to improve access to clean and safe WASH focus on a single practice, resulting in a low adoption rate and limited impact. This study analyses data from 63,732 rural households from the 76th Round of the Indian National Sample Survey in 2018 to (i) identify the factors associated with the adoption of WASH practices using logit estimations, (ii) explore adoption disparities via the Blinder-Oaxaca decomposition method, and (iii) assess the health impacts of having one vs. a combination of several, i.e., bundles of practices, using the heteroskedasticity-based instrumental variable approach. The findings reveal that (i) the wealth status of rural households and education levels of household heads are significant factors associated with the adoption, (ii) female-headed households and those belonging to scheduled castes and tribes are disadvantaged in adoption, and (iii) bundling several practices is more effective in mitigating health problems compared to single-practice adoption. Therefore, prioritizing bundled practices for impoverished households, those with lower educational attainment, female-headed households, and scheduled castes and tribes is crucial for enhancing health outcomes and alleviating the disease burden in rural India.