Moving from efficacy to effectiveness: using behavioural economics to improve the impact of WASH interventions
Biological plausibility and randomized controlled efficacy trials justify the importance of clean and accessible water, improved sanitation, and hygiene in reducing morbidity and mortality rates. However, most health impacts can only take place if people use the improved services and practise hygienic behaviour. Despite considerable efforts in increasing access to water and sanitation services and promoting hygiene practices, few people chlorinate their water, wash their hands, and connect to sanitation systems, limiting the potential health impacts of development programmes. This paper explores cognitive and behavioural constraints identified in the behavioural economics literature and how interventions have successfully accounted for these constraints in their design to increase demand for services and positive habit formation. We then provide stylized examples of using behavioural economics solutions when framing information in hygiene campaigns, using new technologies to remind individuals to wash their hands at critical junctures, automating water purification processes, and designing ‘smart’ sanitation subsidies as practical opportunities for practitioners to incorporate these insights into project design to achieve greater impact.