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‘Carrots’, ‘Sticks’, and ‘Sermons’: Household perspectives on sanitation and hygiene behaviours in Rwanda and Uganda
KTH, Skolan för arkitektur och samhällsbyggnad (ABE), Samhällsplanering och miljö, Urbana och regionala studier. KTH, Stockholm. (URS)ORCID-id: 0000-0002-9340-4391
KTH, Skolan för arkitektur och samhällsbyggnad (ABE), Fastigheter och byggande, Bygg- och fastighetsekonomi.
(engelsk)Manuskript (preprint) (Annet vitenskapelig)
Abstract [en]

The appropriateness and effectiveness of different policy instruments in fostering improved sanitation and hygiene practices in different contexts is debated. ‘Sermons’ inform on recommended behaviours, ‘carrots’ initiate behaviours, and ‘sticks’ restrict, deter, and punish undesirable behaviours. Through the lens of ‘carrots’ ‘sticks’, and ‘sermons’, this article analyses two approaches to sanitation promotion as they have been implemented in Rwanda and Uganda. The Community Health Clubs (CHCs) approach is the policy choice in Rwanda whereas Community-Led Total Sanitation (CLTS) is predominantly promoted in Uganda. Building on a survey of 1173 households in both countries, this article contributes to the ongoing debate with insights on how target populations perceive the options promoted by the different approaches in influencing behaviour change outcomes, or not.  

This study reveals significant differences regarding observed latrines, handwashing facilities, soap and water at the handwashing facility, and reported handwashing with soap and water between most of the study sites with CHC and CLTS intervention and those with no CHC and CLTS intervention. The observed differences are indications of the effectiveness of the interventions in changing behaviours. Similar differences are observed between best performing CLTS (ODF declared) and poor performing CLTS (ODF not yet declared), which underlines the importance of proper implementation. The study suggests support for using a combination of ‘carrots’, ‘sticks’, and ‘sermons’ which are all perceived as effective but for different reasons. Incentives for good sanitation practices and proper hygiene behaviour are perceived by respondents as a source of commitment and competition. Health messages are generally preferred for raising community awareness. However, the application of educational appeals - which are perceived as the most legitimate instruments and predominantly used in CHC and CLTS interventions – is insufficient for achieving universal compliance in the short-term. Other instruments can trigger short-term desired changes but may not be legitimate. This is the case with fines and naming and shaming which are perceived as effective but may compromise social relations and values. Findings also reveal that there is a common understanding among respondents that the responsibility for providing resources for construction and maintenance of sanitation facilities is a shared one. However, respondents’ ability to fulfil this responsibility is partly hampered by poverty and water availability related constraints.

Emneord [en]
Incentives, disincentives, educational messages, open defecation, hygiene, behaviour, perceptions, Community Health Clubs (CHCs), Community-Led Total Sanitation (CLTS)
HSV kategori
Forskningsprogram
Planering och beslutsanalys
Identifikatorer
URN: urn:nbn:se:kth:diva-224438OAI: oai:DiVA.org:kth-224438DiVA, id: diva2:1191281
Forskningsfinansiär
Swedish Research Council, 2013-6364
Merknad

QC 20180317

Tilgjengelig fra: 2018-03-16 Laget: 2018-03-16 Sist oppdatert: 2018-03-17bibliografisk kontrollert
Inngår i avhandling
1. ‘Making Sanitation Happen’: An Enquiry into Multi-Level Sanitation Governance
Åpne denne publikasjonen i ny fane eller vindu >>‘Making Sanitation Happen’: An Enquiry into Multi-Level Sanitation Governance
2018 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The importance of sanitation for human health and development is undisputed. Sanitation is now high on the international development agenda and has become a salient issue in most developing countries, Rwanda and Uganda being no exception. However, there are still shortcomings as regards ‘making sanitation happen’ on the ground. The basic institutional environment and the right governance structures are yet to be fully put in place. This is even more important in the new modes of governance wherein increasing numbers of public, private, and philanthropic actors at different levels of society are involved in sanitation provision and hygiene promotion driven largely by global goals and international development agendas. This has engendered top-down pressure to meet prescribed targets which in most cases miss the complexity of context, distort service priorities, and in some cases compromise sustainability.

This thesis disentangles how sanitation policies are articulated at multiple levels of governance and among various actors in the sector, and eventually translate into investment and behaviour change at the community and household levels. This is done by examining sanitation governance structures in Rwanda and Uganda. Specific emphasis is placed on the actors and actions at national, sub-national, community and household levels.

Drawing on multi-level governance as a conceptual framework, qualitative analysis of policy objectives and choices, and quantitative investigations of what motivates hygiene behaviour change at the community and individual levels, this cross-national comparative study is a novel attempt to decipher the complexity surrounding sanitation and to show ‘what makes sanitation happen’.

The insights of this research build on different strands of the literature but most importantly they contribute to the debate in the sanitation sector on what works on the ground, why and where.

 

sted, utgiver, år, opplag, sider
Stockholm: KTH Royal Institute of Technology, 2018. s. 95
Serie
TRITA-SOM, ISSN 1653-6126 ; 2018-3
Emneord
Sanitation, hygiene, behaviour, multi-level governance, institutions, policy, implementation
HSV kategori
Forskningsprogram
Planering och beslutsanalys
Identifikatorer
urn:nbn:se:kth:diva-224439 (URN)978-91-7729-686-7 (ISBN)
Disputas
2018-03-28, F3, Lindstedtsvägen 26, stockholm, 09:00 (engelsk)
Opponent
Veileder
Forskningsfinansiär
Swedish Research Council, 2013-6364
Merknad

QC 20180316

Tilgjengelig fra: 2018-03-16 Laget: 2018-03-16 Sist oppdatert: 2018-03-19bibliografisk kontrollert

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