Water, sanitation, and hygiene

Nelson Ekane’s chapter 31 in Part IV deepens the discussion of the interlinkages between water, sanitation, and hygiene. Specific emphasis is placed on the impact of water, sanitation, and hygiene services (or the lack thereof) at the household and community levels and strategies and approaches for sustainably changing sanitation practices and hygiene behaviours.

Eliminating open defecation, promoting proper and sustained use of toilet facilities, and instilling handwashing with soap at critical times are key for achieving SDG 6. Subsidy, technology, and supply-driven approaches have produced sub-optimal results in addressing these challenges. This is partly due to the fact that sanitation and the related health and hygiene behavioural aspects are largely influenced by context and culture which present multiple barriers to behaviour change. These barriers are related to cognition, attitudes and intentions to change. Drawing on applied behavioural sciences and policy implementation theories, this chapter examines what it takes to overcome such barriers. This is done through the lens of ‘carrots’, ‘sticks’, ‘sermons’, and ‘nudges’ which are instruments used to trigger and sustain behaviour change. The chapter emphasizes the need for practitioners and policy-makers in the WaSH sector to design and implement approaches that take into consideration the nature of what motivates people to act and the social, economic, and political pressures acting on them. Behaviour change for a wide variety of desired changes starts with diagnosing what actually encourages the behaviours and practices that are being discouraged, and what people are ready, willing, and able to do to change behaviours. Such insights are key for improving the implementation of approaches and hence sustainable behaviour change outcomes.