Creating Demand for Peri-Urban Sanitation

Reaching the Sustainable Development Goal (SDG) for sanitation (6.2) of “Access to safely managed sanitation for all” is estimated to cost about USD $1 Trillion from 2015-2030.  Most of this expenditure is for urban areas, where investments will largely go towards infrastructure.  Little user contribution to sanitation costs is expected, and many existing toilets are not of sufficient quality to be connected to any sewerage lines constructed.  Formative research has identified several promising possibilities for peri-urban sanitation quality improvement interventions, and observational evidence suggests that latent tenant demand communicated to landlords could lead to substantial gains in sanitation quality.  However, the lack of rigorous evidence prevents the implementation of such demand-creation interventions on a large scale, and so a trial is both necessary and has the opportunity to have a major impact on meeting the sanitation SDG.  We designed the SanDem trial to test the hypothesis that we could create demand for peri-urban sanitation and increase sanitation quality with no intervention on the supply side.

Recent popular press article summarizing the overall design and results:

“Talking Shit” Pays Off for Landlords and Tenants in Developing Cities

Papers from the trial:

1. Formative Research

Tidwell JB, Chipungu J, Chilengi R, Curtis V, Aunger R: Theory-driven formative research on on-site, shared sanitation quality improvement among landlords and tenants in peri-urban Lusaka, Zambia. International Journal of Environmental Health Research 2018:1-14.

2. Understanding Shared Sanitation from a Common-Pool Resource Lens

Chipungu J, Tidwell JB, Chilengi R, Curtis V, Aunger R: The social dynamics around shared sanitation in an informal settlement of Lusaka, Zambia. Journal of Water, Sanitation and Hygiene for Development 2018:washdev2018102-washdev2018102.

3. Intervention Development

Tidwell JB, Chipungu J, Chilengi R, Curtis V, Aunger R: Using a theory-driven creative process to design a peri-urban on-site sanitation quality improvement intervention. BMC Public Health 2019, 19:565.

4. Measuring Sanitation Quality

Tidwell JB, Chipungu J, Chilengi R, Aunger R: Assessing peri-urban sanitation quality using a theoretically derived composite measure in Lusaka, Zambia. Journal of Water, Sanitation and Hygiene for Development 2018.

5. Measuring Tenant Demand for Sanitation

Tidwell JB, Terris-Prestholt F, Quaife M, Aunger R: Understanding demand for higher quality sanitation in peri-urban Lusaka, Zambia through stated and revealed preference analysis. Social Science & Medicine 2019.

6. RCT Results

Tidwell JB, Chipungu J, Bosomprah S, Aunger R, Curtis V, Chilengi R: Effect of a behaviour change intervention on the quality of peri-urban sanitation in Lusaka, Zambia: a randomised controlled trial. The Lancet Planetary Health 2019, 3:e187-e196.

7. Process Evaluation (in preparation)

Other materials:

Trial Protocol

Intervention Manual

Intervention Secret Posters

Intervention Secret Monitoring Cards: (Card 1) (Card 2) (Card 3) (Card 4)

Indaba Rota Symbol Of Responsibility