The role of social identification for achieving an open-defecation free environment: A cluster-randomized, controlled trial of Community-Led Total Sanitation in Ghana

Miriam Harter,Nadja Contzen,Jennifer Inauen

doi:10.1016/j.jenvp.2019.101360

Abstract

Unsafe sanitation practices are a major source of environmental pollution and are a leading cause of death in countries of the Global South. One of the most successful campaigns to eradicate open defecation is “Community-Led Total Sanitation” (CLTS). It aims at shifting social norms towards safe sanitation practices. However, the effectiveness of CLTS is heterogeneous. Based on social identity theory, we expect CLTS to be most effective in communities with stronger social identification, because in these communities individuals should rather follow social norms. We conducted a cluster-randomized controlled trial with 3,216 households in 132 communities in Ghana, comparing CLTS to a control arm. Self-reported open defecation rates and social identification were assessed pre-post. Generalized Estimating Equations showed that CLTS achieved lower open defecation rates compared to controls. This effect was significantly stronger for communities with stronger average social identification. The results confirm the assumptions of social identity theory. They imply that pre-existing social identification needs to be considered for planning CLTS, and strengthened beforehand if needed.

Highlights

Nine million people die due to environmental pollution (Landrigan et al, 2017)
The facilitators motivated community members to draw a map of their community on the ground and to indicate their houses as well as the spots they used for open defecation on the map
This study reports the success of CommunityLed Total Sanitation” (CLTS) on reducing open defecation rates and highlights the relevance of including social conditions into planning of sanitation campaigns, such as CLTS

Summary

Introduction

Nine million people die due to environmental pollution (Landrigan et al, 2017). In 2015, 892 million people still practiced open defecation, with rates being highest in Sub-Saharan Africa (WHO & UNICEF, 2017). In Ghana, where this study is located, 31% of the rural population practiced open defecation in 2015 (WHO & UNICEF, 2017). A single individual or household, by stopping open defecation, can only marginally reduce their diarrheal risk related to a fecal polluted environment (Jung, Hum, Lou, & Cheng, 2017). Research has shown that at least 75% of all households must stop open defecation to achieve a hygienically safe environment that benefits all (Clasen, Boisson et al, 2014; Jung et al, 2017; Wolf, Hunter et al, 2018)

Methods

Results

Discussion

Conclusion