Impact of the Financial Inclusion Improves Sanitation and Health (FINISH) 2022- 2024 intervention. Protocol for a cluster - randomized controlled trial in Kenya’s Homa Bay County and Uganda’s Kamwenge District 

Abstract Background: Open defecation (OD) remains a rampant practice in Uganda and Kenya. Amref Health Africa, in collaboration with other partners, is implementing the Financial Inclusion for Sanitation and Health Initiative (FINISH) program in Kenya's Homabay and Uganda's Kamwenge regions. The initiative aims to enhance safely managed sanitation through the involvement of communities, governments, entrepreneurs, and financiers to improve government engagement, demand creation, market-based service delivery and products, and inclusive financing to businesses and households for sanitation. This evaluation will specifically determine the impact and cost-effectiveness of the FINISH intervention, as well as explore stakeholder views. Methods:This evaluation comprises a mixed methods approach. The quantitative design is a cluster-randomized controlled trial (cRCT). The intervention areas are Homa Bay County in Kenya and Kamwenge District in Uganda while the control areas are Siaya and Bushenyi in Kenya and Uganda respectively. With the village in both countries as the randomization unit, intervention and control households will be selected using multi-stage cluster random sampling. Change in diarrhea prevalence among children aged under five years is the main impact estimand. The sample sizes have been estimated at 1,090 households in Kenya (623 for Homa Bay and 467 for Siaya) and 649 households in Uganda (284 for Kamwenge and 365 for Bushenyi Districts). Ethics approvals and licenses were obtained from relevant institutions in Kenya and Uganda. Random assignment, instrumental variable (IV) techniques, and difference-in-difference will comprise the major impact assessment methods. Conclusion: This protocol is expected to lay ground for interrogation of the impacts of the FINISH model in relation to health and social outcomes in Kenya and Uganda. The study will propose strategy-level recommendations on how governments, communities, financial institutions, and entrepreneurs would work together to enhance safely managed sanitation in Kenya and Uganda.