A ‘Losing Prospect’ Argument for Changing Sanitation Behaviour

From World Bank blog:A ‘Losing Prospect' Argument for Changing Sanitation Behaviour

SUBMITTED BYNIDHI KHURANA ONMON, 01/13/2014

Fact #1: One in six people still defecate in the open.
Fact #2: Most of them are not entirely convinced that a toilet does any good.
Fact #3: Many of the recent toilet adopters still like to go in the open.[1]

I don't mean to be alarmist, but these signal a need for a shift in thinking about the complex problem of addressing behaviour change with respect to toilet adoption.

With a myriad missing links to sustainable sanitation uptake, I'll stick my neck out and say that the stickiest issue in sanitation today is not one of lack of investment, nor political commitment or markets. Clearly, the governments understand the wide-ranging impacts of sanitation on health, environment, and economy, and have committed billions of dollars to increasing sanitation coverage. Recently, the Government of India quadrupled its investment in rural sanitation in the current planning period (2012 - 2017) to US$ 6 billion[2]through its ambitious Nirmal Bharat Abhiyan program. Moreover, there seems to be robust enthusiasm in the private sector for the ‘ready for take-off' sanitation market in low-and-middle income countries with low coverage. The continually baffling dilemma is in some ways an age-old one - that of changing mindsets. How do we influence and change the entrenched behaviour of open defecation and create a compelling case for toilet use? What is the appropriate rationale for applying social and behavioural interventions to get people not just to build toilets but also to use them?

Behavioural economics' Prospect Theory that models real-world decisions as opposed to optimal decisions might have an answer. The theory posits that people hate losing much more than they like winning (loss aversion), and that the value function for potential losses is much steeper than that for gains (Figure 1). Further, people make decisions based on the potential value of gains and losses rather than the final outcome. This implies that they tend to take a more intense view of losses than gains, even when in effect they arrive at the same final outcome. Therefore, the reference point or the ‘frame' matters.

Now let's attempt to apply the theory to the problem of sanitation demand and uptake. The current approach to community-led total sanitation emphasizes creating what behavioural economists would call a ‘gain prospect' for potential adopters. The logic flows somewhat like this: "You should not defecate in the open, and build and use a toilet because it produces health, convenience, privacy, dignity and safety benefits for you and your community." The problem with this approach is that potential gains are valued much less than losses, not to mention that health benefits in particular are too far out in the future to influence a significant change in behaviour. It is hard for the consumers to grapple with long-term beneficial impacts of sanitation. Then, of course there is inertia to having done things a certain way. The failure of this approach in selected contexts in India has been confirmed by consumer research. According to a recent consumer survey on sanitation in rural Rajasthan[3], as many as 9 in 10 of respondents who had a toilet did not use it at all or used it sparingly .

Still staying with the Prospect Theory, the perceived value of toilet use might be increased at least two-fold[4]by presenting the normative practices of open defecation and not using the toilet as losing propositions. The ‘loss prospect' argues: "You stand to lose immensely by defecating in the open and not using your toilet. There are grave losses in terms of health, privacy, safety and convenience for you and your community. Ergo, you should not defecate in the open and build and use toilets." This shift in frame from gain utility of sanitation to loss utility of open defecation would likely have a stronger psychological draw for delivering impact on the intractable issue of behaviour change.

It is widely agreed that one of the main missing links in driving real demand for sanitation is the poor traction we have on behaviour change. It not only undermines huge investments but also thwarts excellent policy. Stepping outside the box to apply the insights of psychology to implementing behaviour change is an experiment worth trying. Professor Kahneman would agree!

As per World Bank Water and Sanitation Programme's consumer research survey in the three Indian states of Rajasthan, Bihar and Meghalaya. [2]http://www.thehindu.com/news/national/plan-panel-allocates-rs36000-cr-for-rural-sanitation/article3501404.ece[3]World Bank WSP carried out a rural sanitation survey to study sanitation behavior in the three Indian states of Rajasthan, Bihar and Meghalaya in 2012. [4]Daniel Kahneman argues that on average, potential losses are valued at two to three times the potential gains.

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Taxonomy

• Training
• Hygiene Education
• Sanitation & Hygiene
• Stakeholder Engagement

3 Comments

1. Stephanie: Thanks for posting my blog and offering your perspective. To answer your concern, the decision-making that I speak of here is at a normative, community level. My point was that IEC initiatives, which target the communities would do well to consider a loss aversion frame in their communication approach. The question is not what happens before the sensitization happens (clearly it is not a conscious decision in the absence of information) — the point of decision making with respect to changing behaviour with regard to open defecation occurs after the behaviour change communication happens. I surmise (and it is a surmise..) that the BCC might be more effective if it told people about how much they stand to lose, rather than how much they stand to gain from using toilets. Kahneman's experiments also dealt with preferences for certain gains and losses, of which certain losses were resisted much more than certain gains were valued.

2. Any idea who is working on this avenue? http://mentalfloss.com/article/55699/meet-raya-sanitation-muppet Pretty cute and possibly quite powerful (provided the right people even have access!). My perspective on the OP: We're seeing now the benefits of community education in the environmental sector after decades, as I suspect childhood education has been the real power behind changing the direction of a society. Environmental awareness education in mainstream media from the 1980's has produced a far more aware and active generation, myself included. We adopted 'environmentally aware' behaviours easily despite not having them modelled by surrounding adults (I remember lecturing adults to 'put litter in it's place') and we are now becoming influencers in the workplace and government. I guess my point is that sometimes with education, one strategy is to take a long term view, not to focus on modifying existing behaviour, but forming appropriate behaviours from scratch and waiting for them to take hold throughout the community.

   1 Comment reply

   1. @Merly Sesame Street is an educational NGO working for kids. Raya is a part of their small Sesame Street Muppet army, you can visit their website here http://www.sesameworkshop.org/ and read the different initiative they are undertaking these days globally.

      1 Comment reply

      1. Hi there, Yes - I know what Sesame Street is - I grew up watching it! I was just wondering if there was an NGO or research group working with them on it that anyone knew of, and whether there were plans to measure the program's effectiveness.

3. As much as I applaud Khurana's use of prospect theory in WASH behaviour change, I have to question whether or not we can really treat sanitation and hygiene practices as instances of decision-making. Kahneman's experiments were based on scenarios where people had to consciously decide between two clearly presented options: a risky gain or a certain loss. I'm not sure that people are making conscious decisions of the same nature when they openly defecate. Practices like open defecation are more subconscious and reflexive - the body has become habituated to doing certain things without needing a lot of thought put into it. There isn't really a clear moment of decision-making involved, and in fact simply getting people to stop and think about how they defecate right before they do it would be a huge feat. Where I think loss aversion would be effective in WASH is in getting people to install a toilet. That is a clear decision-making point where people stop and weigh possible gains and losses, unlike the actual practice of using a toilet which is more of a habit than a decision-making point.