Academic journal article Bulletin of the World Health Organization

Shame or Subsidy Revisited: Social Mobilization for Sanitation in Orissa, India/Sentiments De Honte et Subventions : Une Nouvelle Combinaison Pour Mobiliser la Societe En Faveur De L'assainissement Dans l'Etat d'Orissa, En Inde/Verguienza Y Subvenciones: Reanalisis De la Situacion En Un Caso De Movilizacion Social Para Mejorar El Saneamiento En Orissa, India

Academic journal article Bulletin of the World Health Organization

Shame or Subsidy Revisited: Social Mobilization for Sanitation in Orissa, India/Sentiments De Honte et Subventions : Une Nouvelle Combinaison Pour Mobiliser la Societe En Faveur De L'assainissement Dans l'Etat d'Orissa, En Inde/Verguienza Y Subvenciones: Reanalisis De la Situacion En Un Caso De Movilizacion Social Para Mejorar El Saneamiento En Orissa, India

Article excerpt

Introduction

An inadequate water and sanitation infrastructure and unhygienic practices facilitate the transmission of pathogens that cause diarrhoea, which accounts for 2 million child deaths annually in the world, about half of them in India. (1-3) In light of the strong interaction between sanitation and health, education, malnutrition and poverty, and of insufficient progress towards improving sanitation, 2008 was declared the International Year of Sanitation. (4-8)

Experts disagree as to whether improved access to sanitation and other health technologies is better achieved through monetary subsidies or shaming techniques (i.e. emotional motivators). Subsidy proponents contend that the poor face severe income constraints and need economic incentives to supply public goods that benefit everyone (e.g. a microbiologically safe environment). (9,10) Shaming proponents believe that lasting behavioural change requires strong intrinsic motivation and that people are more likely to use and value things they have had to pay for. (11) This paper contributes to the debate by providing evidence on the effectiveness of a social mobilization strategy that combines shaming with subsidies for poor households in rural Orissa, a state that bears a child mortality rate that is higher than the average for India (65 versus 57 per 1000 live births, respectively). (12)

The Government of India has a nationwide Total Sanitation Campaign that seeks to change attitudes about latrines in individual households. (13) The campaign is designed as a demand-driven community-led programme and is implemented by state governments. It targets all rural households, includes a range of community partners, provides economic incentives to meet programme objectives, and empowers individuals and communities to define and achieve their own goals. There is currently an emphasis on developing information, education and communication (IEC) activities to improve attitudes and knowledge about how sanitation, safe water and hygiene relate to health. The campaign also acknowledges the role of small subsidies in encouraging the poor to construct individual household latrines.

Despite the campaign, sanitation coverage remains low; less than a quarter of India's population and less than 10% of the population of Orissa state have access to safe water and good sanitation. (14,15) Thus, the government of Orissa has a particular interest in the Total Sanitation Campaign's potential to encourage individual household latrine uptake and reduce open defecation. (14)

This paper, which contributes to the "shame" versus "subsidy" debate, examines the effects in Orissa of an intensified version of the IEC campaign that draws on a promising but untested "community-led total sanitation" model initiated in Bangladesh and subsequently implemented in some Indian states. (11, 16) The resulting IEC campaign seeks to generate strong emotional responses at the community level that will culminate in a community-wide resolve to end open defecation. The study followed a cluster-randomized design, with villages randomly assigned to treatment or control groups.

Methods

Intervention

Development of the intensified IEC campaign was informed by in-depth interviews and focus groups made up of state and local government officials, village residents and key informants. The interviews revealed the importance of social marketing tools that go beyond merely providing "information" on health and that focus on education and communication about the need for a strong, sustained and widely-accepted commitment to improve sanitation. (17) Our discussions showed that it was critical to secure the support of district administrators, public health engineers and nongovernmental organizations (NGOs), as well as to train government civil engineers in social engineering. Interviews with key informants, local government officials and village focus groups suggested that any effective IEC effort must look beyond health to the privacy, dignity and safety benefits to women from using latrines. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.