Milan Thomas :
In rural areas, lack of familiarity with new technologies is often compounded by financial constraints, making unhealthy or inefficient practices persistent – even when it comes to toilets. Upgrading to a more sanitary toilet would improve the health of many households, along with their neighbors’. But new hardware is expensive, and the social cost of continuing to use a less sanitary toilet is not often fully understood.
How can healthy changes in rural sanitation be encouraged? A recent successful effort in Viet Nam suggests that involving women is the key.
In Viet Nam’s Mekong Delta, residents face an additional sanitation hurdle. Frequent flooding means that even some modern devices, such as pour-flush toilets, can pose a threat to public health. Plastic septic tanks are a safe alternative, but their advantages are not widely understood. Also, purchasing the tank and building a superstructure requires an equivalent of nearly two months’ income for the average farming household.
To promote the use of more hygienic toilets, our partners at East Meets West (a nonprofit that promotes sanitation in Southeast Asia) work with local chapters of the Viet Nam Women’s Union (a civil society organization with over 14 million members) to conduct door-to-door campaigns and provide sanitation information at village meetings. Engaging the Union members makes it easier to share knowledge of healthy sanitation practices with women, whose involvement in household decision-making is critical for affecting intergenerational change, according to many studies.
In April 2017, the two groups launched a 12-month campaign to promote plastic septic tanks in 25 communes of Ben Tre Province. We surveyed 1,250 households that did not use a septic tank as the campaign began. At the time, 60% of them practiced open defecation, while the rest used non-hygienic means such as pit latrines. We followed up with those households in May 2019 to learn which of them installed a septic tank – and why. By then, 44% of the surveyed households had switched to using a septic tank.
First, we investigated the basic premise of the campaign. Were women who interacted with a Women’s Union promoter more likely to participate in their household’s decision to purchase a septic tank? The answer was yes-in fact, they were about one third more likely to do so as a result.
Next we identified the drivers of septic tank adoption. Economic factors were indeed critical, as wealthier households were much more likely to invest in a septic tank. But we also uncovered predictors that underscore the key role of social factors.
For instance, purchasing a septic tank was 24% more likely for households in which a woman leads home construction decisions. Households were 38% more likely to buy a septic tank if a close friend had recommended one prior to the campaign. And they were 24% more likely to buy one if they were familiar with their local Women’s Union promoter prior to the campaign.
Exposure to sanitation information was also strongly predictive. Purchase of a septic tank was 17% more likely in villages where a demonstration of one took place. Meanwhile, respondents with awareness of the environmental hazards of open defecation were 13% more likely to buy a septic tank.
To gain more insight on what made the campaign resonate with some households, we surveyed Women’s Union promoters who marketed septic tanks door-to-door and in village meetings. The average promoter facilitated 38 septic tank sales during the campaign, but sales performance varied substantially. Older, more educated promoters sold more tanks, while those knowledgable on their benefits – and locally available financing options – sold an average of 20 additional tanks.
Taken together, the evidence is encouraging. Positioning women as advocates is key when encouraging households to make the leap with an unfamiliar hardware, along with other essential investments along the sanitation service chain. For households already linked to civil society, familiar faces and trusted resources are effective campaigners for healthy behavioral change. And for households less plugged into local networks, strengthening women’s participation in key decisions through demonstration and information-sharing is critical for making villages healthier places for all.
(Milan Thomas is Young Professional (Economist), Economic Research and Regional Cooperation Department, ADB).
