Shame or subsidy revisited: social mobilization for sanitation in Orissa, India

• Published in: Bulletin of the World Health Organization 2009-08, Vol.87 (8), p.580-587
• Main Authors: Pattanayak, Subhrendu K, Yang, Jui-Chen, Dickinson, Katherine L, Poulos, Christine, Patil, Sumeet R, Mallick, Ranjan K, Blitstein, Jonathan L, Praharaj, Purujit
• Format: Article
• Language: Portuguese
• Subjects: Health Policy & Services
• ISSN: 0042-9686
• DOI: 10.1590/S0042-96862009000800013

OBJECTIVE: To determine the effectiveness of a sanitation campaign that combines "shaming" (i.e. emotional motivators) with subsidies for poor households in rural Orissa, an Indian state with a disproportionately high share of India's child mortality. METHODS: Using a cluster-randomized design, we selected 20 treatment and 20 control villages in the coastal district of Bhadrak, rural Orissa, for a total sample of 1050 households. We collected sanitation and health data before and after a community-led sanitation project, and we used a difference-in-difference estimator to determine the extent to which the campaign influenced the number of households building and using a latrine. FINDINGS: Latrine ownership did not increase in control villages, but in treatment villages it rose from 6% to 32% in the overall sample, from 5% to 36% in households below the poverty line (eligible for a government subsidy) and from 7% to 26% in households above the poverty line (not eligible for a government subsidy). CONCLUSION: Subsidies can overcome serious budget constraints but are not necessary to spur action, for shaming can be very effective by harnessing the power of social pressure and peer monitoring. Through a combination of shaming and subsidies, social marketing can improve sanitation worldwide.