Nudging people towards latrines

Nice article today on the WorldBank and its behavioural change aims - my favourite piece was this:

Toilets, for example. Nowhere is open defecation more prominent than in India, where more than 600 million people have no access to a toilet. But even where proper sanitation has been installed, “people tend not to want to use latrines,” says Gauri. It is a difficult habit to break, exacerbated by issues such as India’s caste system.

The team at Gini will be helping the Indian government work out how to meet its target to eliminate open defecation by 2019, measuring the success of certain interventions, such as asking people to commit to using toilets, and “no toilet, no bride” – an initiative that asks parents to ensure their daughters are not married to men whose villages have no toilet.

It's a similar result (although a better intervention) to the work we did with IRC and BRAC in Bangladesh back in 2012/2013 - and credit to the teams at both BRAC and WorldBank for their emergent approach to look at what does influence behaviour, rather than just what they thought influenced behaviour.

Back in 2012, we were planning the SenseMaker® project which was going to collect people's broad experiences about hygiene and latrines into a signification framework that allows us to explore quantitative patterns underpinned with qualitative material. As we built the framework, there was one piece of specific academic literature we built into the framework - the research that said (I'm paraphrasing) "you sell latrines to people by emphasising that they reduce risk, illness and disgust". So that was designed in - a clear hypothesis up front that we put into the framework.

A couple of months later, the remarkable BRAC team had gathered over 500 experiences into the framework and a group of us had gathered to make sense of the results in the Hague - project managers, subject matter experts, BRAC team members, experts on Bangladesh and myself (the naïve one).  The team made clear that they needed to know how to make installation, use and maintenance of hygienic latrines desirable to people in rural communities on their terms.  The expectation was that one of the three core messages would work more strongly with particular groups than the others - so should we be emphasising the risk, the disgust or the illness message?

From the signification data - the patterns that we could statistically analyse without ever looking at the stories themselves - it was clear that the answer was "None of the above".  There was, it has to be said, a palpable sense of disappointment in the room, mingled with confusion - "well what does work then, if it's not what the academics said would"

At this point, the stories came into their own - we identified a cluster of stories in which people did regard a latrine as being desirable, as being valuable. And then we asked the team back in Dhaka to translate those stories overnight and send them back to us the next morning.

Nineteen stories in all - and as we read them, already knowing that they illustrated desirable examples in which latrines played a role, a theme emerged quite quickly:

Installing a hygienic latrine gives you a better chance of a good quality marriage

It's one of those glorious conclusions that makes complete sense in retrospect but that it came out of the data and the words of people in the field gave it a validity that we couldn't have got elsewhere.

Even better - we had similarly themed examples told by different age groups:

• For young men, there was the story of the man who got married, his new wife moved to the new house and discovered there was no latrine. Two weeks later, on going to visit his new in-laws, he was subjected to two hours of nagging from his mother-in-law about how her daughter deserved a house with a latrine and how disrespectful she thought he was being.
• For parents of young children, there were other specific examples

We changed the direction of the communications programme as a result, and equipped field officers with specific, easily-recalled examples of stories to tell in the villages.

Like I said, the WorldBank idea of asking parents to ensure their daughters are not married to men whose villages have no toilet is even better. But brilliant all the same - recognising that behavioural change and nudging means looking at how people live their lives and where they are pre-disposed to do something - and then creating interventions based on that.  It's a more ethical, more effective way of helping populations - by allowing them an authentic voice first, then helping policy- and decision-makers (and in most cases, people from the communities themselves) amplify the positive behaviours themselves.

And, just for good measure, here's an example of one of the stories, translated from the original Bangla, that helped us to reach our conclusion:

Lots of families in Keutgao village did not have latrines. Many of the girls from the families living in this village were of appropriate age for marriage, and therefore were receiving proposals from nearby villages.
There was such a case where a man and his family from a nearby village came over to this village to meet a girl who was a prospective match for him.
After some conversation and dinner, one of the guests asked to use the latrine. The girl’s father showed him the way to some bushes and informed him that they all use the bushes as a toilet.
The man’s family then left the girl’s house and informed her family that they would not be able to form a new relationship with a family that did not have a latrine.
Seeing how the lack of a latrine prevented their daughter from being able to get married, the family decided to install a proper, sanitary latrine in their home. Eventually, the family gained social acceptance and the girl got married. Not only did this family acquire a latrine of their own, but they inspired others to do the same as well.