A Community-Based Program Promotes Sanitation

Abstract

Basic sanitation facilities are still lacking in large parts of the developing world, engendering serious environmental health risks. Interventions commonly deliver in-kind or cash subsidies to promote private toilet ownership. In this paper, we assess an intervention that provides information and behavioral incentives to encourage villagers in rural Mali to build and use basic latrines. Using an experimental research design and carefully measured indicators of use, we find a sizeable impact from this intervention: latrine ownership and use almost doubled in intervention villages, and open defecation was reduced by half. Our results partially attribute these effects to increased knowledge about cheap and locally available sanitation solutions. They are also associated with shifts in the social norm governing sanitation. Taken together, our findings, unlike previous evidence from other contexts, suggest that a progressive approach that starts with ending open defecation and targets whole communities at a time can help meet the new Sustainable Development Goal of ending open defecation.

How community participation in water and sanitation interventions impacts human health, WASH infrastructure and service longevity in low-income and middle-income countries: a realist review

“…37 Celebration by village members and local media coverage of open defecation free status can reinforce the undesirable behaviour and shame of those not conforming to the social norm. 40 Effective leadership is an important enabler of reduced levels of open defecation in communities, as it helps reinforce changes in social norms. 10 65 68 80 High rates of latrine ownership and availability can indicate a change in social norms and the acceptance of the new behaviour.…”

“…45 46 The goal may also be resource preservation (safety and/or accessibility), so that water is available to be accessed as desired—eg, to check water samples for faecal or arsenic contamination 14 47–50 or to assess the level of groundwater available for agriculture throughout the year. 51 Internal monitoring can be conducted by a chief or village headman, 10 21 38 locally trained volunteers, 48 community members 40 51 or by the community’s health, water or community—total led sanitation committee. 37 39 41 45 46 48 50 External monitoring can be conducted by NGO facilitators, 40 44 health workers 39 43 52 or political leaders and council officials.…”

“… 51 Internal monitoring can be conducted by a chief or village headman, 10 21 38 locally trained volunteers, 48 community members 40 51 or by the community’s health, water or community—total led sanitation committee. 37 39 41 45 46 48 50 External monitoring can be conducted by NGO facilitators, 40 44 health workers 39 43 52 or political leaders and council officials. 37 …”

Achieving equitable uptake of handwashing and sanitation by addressing both supply and demand-based constraints: findings from a randomized controlled trial in rural Bangladesh

“…Scaled-up programs in the WASH sector, such as community-led total sanitation (CLTS) and social marketing are examples of strategies that have gained prominence in the recent decades and have emphasized demand-generation effort rather than alleviating supply constraints. CLTS programs place complete responsibility of construction of latrines on the community, and this demand-driven behavior promotion approach has achieved high levels of coverage in studies in Asia and Africa [ 25 – 27 ]. It may be effective on the whole, but it is not clear if this strategy is equitable.…”

Achieving Equitable Uptake of Handwashing and Sanitation by Addressing Both Supply and Demand-based Constraints: Findings From a Randomized Controlled Trial in Rural Bangladesh 

“…Scaled-up programs in the WASH sector, such as community-led total sanitation (CLTS) and social marketing are examples of strategies that have gained prominence in the recent decades and have emphasized demand-generation effort rather than alleviating supply constraints. CLTS programs place complete responsibility of construction of latrines on the community, and this demand-driven behavior promotion approach has achieved high levels of coverage in studies in Asia and Africa (25)(26)(27). It may be effective on the whole, but it is not clear if this strategy is equitable.…”