Microcredit and willingness to pay for environmental quality: Evidence from a randomized-controlled trial of finance for sanitation in rural Cambodia

Financial incentives for sanitation take-up: A randomized control trial in rural Vietnam

This study assesses the impact of financial incentives on hygienic latrine ownership by poor/near-poor households in Vietnam. Rural communes were randomly assigned to a control group and three treatment arm groups: (T1) a rebate for households that installed a hygienic latrine; (T2) a financial reward for commune governments if the proportion of hygienic latrines in their commune increased by 30 percentage points; (T3) both a household rebate and a commune reward. We find a strong and positive effect from the household rebate (treatment arms 1 and 3) but an insignificant effect from the commune reward (treatment arm 2) on household ownership of a septic tank latrine. Our analysis provides suggestive evidence that microcredit is a channel through which a rebate encourages the installation of septic tank latrines. We also find that treatment arm 3 increases people's knowledge regarding sanitation and the availability of water and soap for handwashing within households.

The state of reporting context and implementation in peer-reviewed evaluations of water, sanitation, and hygiene interventions: A scoping review

INTRODUCTION

To accurately assess evidence from environmental and public health field trials, context and implementation details of the intervention must be weighed with trial results; yet these details are under and inconsistently reported for water, sanitation, and hygiene (WASH), limiting the external validity of the evidence.

METHODS

To quantify the level of reporting of context and implementation in WASH evaluations, we conducted a scoping review of the 40 most cited evaluations of WASH interventions published in the last 10 years (2012-2022). We applied criteria derived from a review of existing reporting guidance from other sectors including healthcare and implementation science. We subsequently reviewed main articles, supplements, protocols, and other associated resources to assess thoroughness of context and implementation reporting.

RESULTS

Of the final 25 reporting items we searched for, four-intervention name, approach, location, and temporality-were reported by all studies. Five items-theory, implementer qualifications, dose intensity, targeting, and measured fidelity-were not reported in over a third of reviewed articles. Only two studies (5%) reported all items in our checklist. Only 74% of items were found in the main article, while the rest were found in separate papers (7%) or not at all (19%).

DISCUSSION

Inconsistent reporting of WASH implementation illustrates a major challenge in the sector. It is difficult to know what interventions are actually being evaluated and how to compare evaluation results. This inconsistent and incomplete implementation reporting limits the ability of programmers and policy makers to apply the available evidence to their contexts. Standardized reporting guidelines would improve the application of the evidence for WASH field evaluations.

Social and financial incentives for overcoming a collective action problem

Addressing public health externalities often requires community-level collective action. Due to social norms, each person's sanitation investment decisions may depend on the decisions of neighbors. We report on a cluster randomized controlled trial conducted with 19,000 households in rural Bangladesh where we grouped neighboring households and introduced (either financial or social recognition) rewards with a joint liability component for the group, or asked each group member to make a private or public pledge to maintain a hygienic latrine. The group financial reward has the strongest impact in the short term (3 months), inducing a 7.5-12.5 percentage point increase in hygienic latrine ownership, but this effect dissipates in the medium term (15 months). In contrast, the public commitment induced a 4.2-6.3 percentage point increase in hygienic latrine ownership in the short term, but this effect persists in the medium term. Non-financial social recognition or a private pledge has no detectable effect on sanitation investments.

Community matters: Heterogeneous impacts of a sanitation intervention

Sanitation is at the heart of public health policies in most of the developing world, where around 85% of the population still lack access to safe sanitation. We study the effectiveness of a widely adopted participatory community-level information intervention aimed at improving sanitation. Results from a randomized controlled trial, implemented at scale in rural Nigeria, reveal stark heterogeneity in impacts: the intervention has immediate, strong and lasting effects on sanitation practices in less wealthy communities, realized through increased sanitation investments. In contrast, we find no evidence of impacts among wealthier communities. This suggests that a targeted implementation of CLTS may increase its effectiveness in improving sanitation. Our findings can be replicated in other contexts, using microdata from evaluations of similar interventions.

Strategic complements: Poverty-targeted subsidy programs show additive benefits on household toilet purchases in rural Cambodia when coupled with sanitation marketing

While poverty-targeted subsidies have shown promise as a means of reducing financial constraints on low-income populations to invest in new latrines, concerns have been raised about whether they may reduce demand for new latrines among non-eligible, non-poor populations, especially in geographically limited or closed markets. Using quasi experimental methods, we investigate the interaction effects of the "CHOBA" subsidy, a partial poverty-targeted monetary incentive to build a toilet, and a sanitation marketing program (SanMark) on new latrine uptake among households from different income segments in 110 rural villages across six Cambodian provinces. These programs were implemented either jointly with or independently. Overall, we find strong complementarity of the CHOBA subsidy with SanMark where the coupled implementation of the programs increased latrine uptake across all households as compared to exclusive deployment of the programs independently. Additionally, the CHOBA subsidy alone resulted in higher gains among the poor compared to SanMark suggesting that financial constraint is indeed a significant demand barrier for new latrines. The presence of the poverty-targeted subsidies did not reduce demand for new latrine purchases among ineligible households. Instead, we find some evidence for a positive spillover effect of subsidies on uptake of latrines among ineligible households in villages where both programs were implemented indicating that the presence of sanitation subsidies and the decision to purchase latrines among non-beneficiaries can be viewed as complements. We employ multivariate logistic regressions as well as further robustness checks to estimate the effects of the different interventions, with qualitatively consistent results.

Environmental and Economic Factors of Migration from Urban to Rural Areas: Evidence from Poland

The net migration rate is highly diversified and noticeable chiefly in municipalities directly adjacent to large cities. This trend is still maintained in Poland and is now becoming even more visible than previously. Most of the studies conducted to date have not focused on extracting economic and environmental factors or determining the role of individual factors in those decisions. Furthermore, they have not analysed the issue of differences in motives and directions of migration. Thus, the aim of the research was to establish the factors that determine contemporary migrations from the city to suburban areas and to outline the role of economic and environmental factors. For this purpose, 164 interviews were conducted with individuals who had migrated from the city to the countryside surrounding one of the most important urban centres in Central Europe—Wrocław. In the research, the multiple snowball sampling technique was used. It was found that the factors with the most significant impact on the decision to move from the city to the countryside were those of an environmental nature, whereas the selection of a specific location (village) was to a greater extent determined by economic factors. Compared to their previous place of residence, the respondents most positively rated the environmental benefits of living in the countryside, whereas economic factors, especially insufficient sewage and energy infrastructure, in addition to poor services and transport, were downvoted. The results therefore imply the need for better planning of suburban settlement patterns that takes account of the availability and development of the infrastructure network. The settlement dispersion, as shown through spatial studies, leads to higher unit costs, which generate higher public services costs and thus increasing local expenditures.

Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low- and middle-income countries: An evidence and gap map of effectiveness studies

Background

Lack of access to and use of water, sanitation and hygiene (WASH) cause 1.6 million deaths every year, of which 1.2 million are due to gastrointestinal illnesses like diarrhoea and acute respiratory infections like pneumonia. Poor WASH access and use also diminish nutrition and educational attainment, and cause danger and stress for vulnerable populations, especially for women and girls. The hardest hit regions are sub-Saharan Africa and South Asia. Sustainable Development Goal (SDG) 6 calls for the end of open defecation, and universal access to safely managed water and sanitation facilities, and basic hand hygiene, by 2030. WASH access and use also underpin progress in other areas such as SDG1 poverty targets, SDG3 health and SDG4 education targets. Meeting the SDG equity agenda to "leave none behind" will require WASH providers prioritise the hardest to reach including those living remotely and people who are disadvantaged.

Objectives

Decision makers need access to high-quality evidence on what works in WASH promotion in different contexts, and for different groups of people, to reach the most disadvantaged populations and thereby achieve universal targets. The WASH evidence map is envisioned as a tool for commissioners and researchers to identify existing studies to fill synthesis gaps, as well as helping to prioritise new studies where there are gaps in knowledge. It also supports policymakers and practitioners to navigate the evidence base, including presenting critically appraised findings from existing systematic reviews.

Methods

This evidence map presents impact evaluations and systematic reviews from the WASH sector, organised according to the types of intervention mechanisms, WASH technologies promoted, and outcomes measured. It is based on a framework of intervention mechanisms (e.g., behaviour change triggering or microloans) and outcomes along the causal pathway, specifically behavioural outcomes (e.g., handwashing and food hygiene practices), ill-health outcomes (e.g., diarrhoeal morbidity and mortality), nutrition and socioeconomic outcomes (e.g., school absenteeism and household income). The map also provides filters to examine the evidence for a particular WASH technology (e.g., latrines), place of use (e.g., home, school or health facility), location (e.g., global region, country, rural and urban) and group (e.g., people living with disability). Systematic searches for published and unpublished literature and trial registries were conducted of studies in low- and middle-income countries (LMICs). Searches were conducted in March 2018, and searches for completed trials were done in May 2020. Coding of information for the map was done by two authors working independently. Impact evaluations were critically appraised according to methods of conduct and reporting. Systematic reviews were critically appraised using a new approach to assess theory-based, mixed-methods evidence synthesis.

Results

There has been an enormous growth in impact evaluations and systematic reviews of WASH interventions since the International Year of Sanitation, 2008. There are now at least 367 completed or ongoing rigorous impact evaluations in LMICs, nearly three-quarters of which have been conducted since 2008, plus 43 systematic reviews. Studies have been done in 83 LMICs, with a high concentration in Bangladesh, India, and Kenya. WASH sector programming has increasingly shifted in focus from what technology to supply (e.g., a handwashing station or child's potty), to the best way in which to do so to promote demand. Research also covers a broader set of intervention mechanisms. For example, there has been increased interest in behaviour change communication using psychosocial "triggering", such as social marketing and community-led total sanitation. These studies report primarily on behavioural outcomes. With the advent of large-scale funding, in particular by the Bill & Melinda Gates Foundation, there has been a substantial increase in the number of studies on sanitation technologies, particularly latrines. Sustaining behaviour is fundamental for sustaining health and other quality of life improvements. However, few studies have been done of intervention mechanisms for, or measuring outcomes on sustained adoption of latrines to stop open defaecation. There has also been some increase in the number of studies looking at outcomes and interventions that disproportionately affect women and girls, who quite literally carry most of the burden of poor water and sanitation access. However, most studies do not report sex disaggregated outcomes, let alone integrate gender analysis into their framework. Other vulnerable populations are even less addressed; no studies eligible for inclusion in the map were done of interventions targeting, or reporting on outcomes for, people living with disabilities. We were only able to find a single controlled evaluation of WASH interventions in a health care facility, in spite of the importance of WASH in health facilities in global policy debates. The quality of impact evaluations has improved, such as the use of controlled designs as standard, attention to addressing reporting biases, and adequate cluster sample size. However, there remain important concerns about quality of reporting. The quality and usefulness of systematic reviews for policy is also improving, which draw clearer distinctions between intervention mechanisms and synthesise the evidence on outcomes along the causal pathway. Adopting mixed-methods approaches also provides information for programmes on barriers and enablers affecting implementation.

Conclusion

Ensuring everyone has access to appropriate water, sanitation, and hygiene facilities is one of the most fundamental of challenges for poverty elimination. Researchers and funders need to consider carefully where there is the need for new primary evidence, and new syntheses of that evidence. This study suggests the following priority areas:Impact evaluations incorporating understudied outcomes, such as sustainability and slippage, of WASH provision in understudied places of use, such as health care facilities, and of interventions targeting, or presenting disaggregated data for, vulnerable populations, particularly over the life-course and for people living with a disability;Improved reporting in impact evaluations, including presentation of participant flow diagrams; andSynthesis studies and updates in areas with sufficient existing and planned impact evaluations, such as for diarrhoea mortality, ARIs, WASH in schools and decentralisation. These studies will preferably be conducted as mixed-methods systematic reviews that are able to answer questions about programme targeting, implementation, effectiveness and cost-effectiveness, and compare alternative intervention mechanisms to achieve and sustain outcomes in particular contexts, preferably using network meta-analysis.

Impact of Process Misconception in Becker-DeGroot-Marschak Single Response Value Elicitation Procedures: An Experimental Investigation in Consumer Behavior Using the IKEA Effect

Consumer researchers frequently employ valuation experiments to assess consumer opinions and test related hypotheses. One popular method used in many such experiments is the Becker- DeGroot-Marschak (BDM) single-response value elicitation procedure that initiates an incentive for the subjects to respond with their true valuation by utilizing a random bid to which the participants’ bid is compared. However, the “random bid” is not a straightforward concept, and the participants may not fully understand the mechanics of the bidding process. Therefore, they may incorrectly associate the bidding mechanism with a conventional auction bidding process in which the highest bidder wins, causing biased valuation outcomes. In this paper, we introduce a comprehension measurement step to eliminate the process comprehension bias in BDM valuation experiments. We also discuss the potential impact of the treatment of “zero” bidders in the BDM procedure. The present work shows that the size and statistical significance of past consumer research results are positively correlated with the participant comprehension of the valuation procedure. The results suggest that consumer research using a single-response value elicitation procedure, which initiates an incentive for the subjects to respond with their true valuation, may not be trusted if the comprehension level is not controlled.

Willingness to pay for improvements in rural sanitation: Evidence from a cross-sectional survey of three rural counties in Kenya

Poor sanitation worldwide leads to an annual loss of approximately $222.9 billion and is the second leading cause of Disability-Adjusted Life Years (DALY’s) lost due to diarrhoea. Yet in Kenya, the slow rate and levels at which the household’s access improved sanitation facilities remain a concern, and it is unknown if the cost of new technologies is a barrier to access. This study assessed the maximum willingness to pay (WTP) for SAFI and SATO sanitation products and identified those factors that affect the willingness to pay (WTP) valuation estimates by households in three counties in Kenya. It used quantitative economic evaluation research integrated within a cross-sectional survey. Contingent valuation method (CVM) was used to determine the maximum WTP for sanitation in households. We used the logistic regression model in data analysis. A total of 211 households were interviewed in each county, giving a total sample size of 633 households. The mean WTP for SAFI latrines was $153.39 per household, while the mean WTP for SATO pans and SATO stools was $11.49 and $14.77 respectively. For SAFI latrines, households in Kakamega were willing to pay $6.6 more than average while in Siaya, the households were willing to pay $5.1 less than the average. The main determinants of households WTP for the two sanitation products included household’s proximity to the toilet (p = 0.0001), household income (β = .2245741, p = 0.004), sanitation product (β = -2968.091; p = 0.004), socioeconomic status (β = -3305.728, p = 0.004) and a household’s satisfaction level with the current toilet (β = -4570.602; p = 0.0001). Increased proximity of households to the toilet, higher incomes, and providing loan facilities or subsidy to poor households could increase the demand for these sanitation technologies.

The Influence of Nontimber Forest Products Development on the Economic–Ecological Coordination—Evidence from Lin’an District, Zhejiang Province, China

The influence of the nontimber forest products (NTFPs) on the coordinated economic and ecological development has received considerable attention, where the results are mixed. This study took Lin’an District in Zhejiang Province of China as an example for analysis. Using long-term (more than 40 years) data, system coupling and autoregressive distributed lag models were combined to analyze the effect of NTFP development on coordinated economic–ecological development. The results show that large-scale commercial NTFP development positively affected coordinated economic–ecological development, and a long-term stable equilibrium relationship between them existed. The degree of regional economic–ecological coupling increased from 0.05 in 1978 to 0.98 in 2019, and both area and value of NTFP had a significant effect on the coupling degree at the 5% level. These findings indicate that NTFP development is an effective method to promote the coordinated development of the economy and ecological environment especially in mountain areas, and the government should encourage NTFP development by ecological management, strengthening policy guidance, and providing technological innovation support, etc.

Where Shared Sanitation is the Only Immediate Option: A Research Agenda for Shared Sanitation in Densely Populated Low-Income Urban Settings

Shared sanitation is not currently accepted within the international normative definitions of "basic" or "safely managed" sanitation. We argue that pro-poor government strategies and investment plans must include high-quality shared sanitation as an intermediate step in some densely populated urban areas. User experience must be considered in establishing the definition of high quality. We call for additional research on effective interventions to reach these quality standards and for the development of rigorous measures applicable to global monitoring.

Sanitation for Low-Income Regions: A Cross-Disciplinary Review

Sanitation research focuses primarily on containing human waste and preventing disease; thus, it has traditionally been dominated by the fields of environmental engineering and public health. Over the past 20 years, however, the field has grown broader in scope and deeper in complexity, spanning diverse disciplinary perspectives. In this article, we review the current literature in the range of disciplines engaged with sanitation research in low- and middle-income countries (LMICs). We find that perspectives on what sanitation is, and what sanitation policy should prioritize, vary widely. We show how these diverse perspectives augment the conventional sanitation service chain, a framework describing the flow of waste from capture to disposal. We review how these perspectives can inform progress toward equitable sanitation for all [i.e., Sustainable Development Goal (SDG) 6]. Our key message is that both material and nonmaterial flows-and both technological and social functions-make up a sanitation "system." The components of the sanitation service chain are embedded within the flows of finance, decision making, and labor that make material flows of waste possible. The functions of capture, storage, transport, treatment, reuse, and disposal are interlinked with those of ensuring equity and affordability. We find that a multilayered understanding of sanitation, with contributions from multiple disciplines, is necessary to facilitate inclusive and robust research toward the goal of sanitation for all.

Subsidies versus mental accounting nudges: Harnessing mobile payment systems to improve sanitation

The proliferation of mobile money across developing countries has led to an increase in availability of mobile payment systems. This decreases the organizational complexity of allowing more flexible payment terms for customers. We test whether subsidies, deposit requirements, and access to a mobile money savings vehicle increase the propensity of households to purchase an improved but more expensive sanitation service. While high subsidies increase purchases of the improved service, interventions inspired by mental accounting such as deposit requirements and earmarked savings accounts do not. The option to save in earmarked accounts using mobile money caused households to substitute away from purchasing the improved service in the general market and towards purchasing it through our providers, rather than substituting away from the unimproved service. We discuss implications for mental accounting-based policies compared to more traditional subsidies.