Forget hygiene education, market behaviour change

How do we create demand for household toilets, and ensure they are used appropriately and consistently? In the second of his blog series on how to get toilets to everyone in Ghana, Chaka Uzondu, Policy Manager at WaterAid Ghana, explores the challenge of demand creation for household toilets.

Just because you do not have access to a toilet, does not mean you want one. But for everyone, everywhere to be able to live healthy lives, the more than 1.2 million Ghanaian households that currently do not have access to a decent toilet need to gain access. And the sooner, the better. However, having a toilet but not using it every time, and/or not practising good hygiene at critical times, defeats the purpose of having a toilet in the first place – it’s not just having one that counts.

So, how do we create demand for household toilets, and ensure people use them appropriately and consistently?

Answering this question poses an opportunity for the Ministries of Sanitation and Water Resources, of Local Government and Rural Development, of Gender and Social Welfare, of Health, of Education, of Agriculture, of Finance, of Housing and the Office of the President. And the answer requires all of these ministries and their various departments to work together.

What makes people behave?

Back to the question: how do we create demand for household toilets? First, understand the current behaviour. Why do people defecate in the bush and on beaches? More often than not it is the easiest option.Why queue to use a so-called public toilet, which is likely to be poorly maintained and smelly, when the beach offers a scenic view and the relaxing sound of crashing waves?

Why rush to build a toilet in three months only to see it washed away during the rainy season? The cost–benefit analysis is rational – save limited resources for priority uses (a pair of shoes for your child), put your labour to better use (home repairs), and shit in some bushes, behind some rocks, or behind a big tree.

Forget about 'educating'

What do we do to change this behaviour? ‘Educate’ people? That is the first reaction and a common mistake. Hygiene education is more a failure than a success in changing behaviour. Research on behaviour change has shown that cognitive approaches are of limited usefulness.

So forget about ‘educating’. Think instead of appealing to other drivers of behaviour. No one teaches us to want what many Ghanaians refer to as ‘minerals’ – those carbonated drinks with high amounts of sugar and artificial flavours. Three things make these unhealthy drinks ubiquitous:

1. Heavy marketing, which appeals to emotions.

2. Unhealthily high levels of sugar, which are often addictive to our taste buds.

3. Cheap availability.

This formula, appropriately modified, can also help increase demand and access to household toilets and better hygiene practices.

1. It’s important to ‘market’ behaviour change. That is, the message should be surprising and appealing to the key target populations. It should get to them in an emotive way and hold their attention, and should get to them consistently and continuously, so it leads to a shift in feeling and thinking.

2. We also need to ‘add value’ to the desired behaviour change. The challenge is to make people believe that owning and using a decent household toilet adds value – in this case, social value. I know of one community in the Ghana’s Northern Region where women refused to marry men who did not have a toilet in their homes. Men (and women) desired the social status of being married; they both wanted the affiliations that come with marriage. However, women refused to surrender the convenience, dignity, and privacy afforded by a decent household toilet in exchange for marriage. The result? The men who wanted to get married built household toilets. The women of the community had added value to having a household toilet.

3. Make it easy. Make it easy to get a household latrine. We are back to the argument of my previous article. If people want a household latrine, it should be easy to get. Supply is linked to demand; if demand cannot be met effectively, then that demand is undermined. With the habit of open defecation being normal for many, the country cannot afford for failure of supply to undermine demand. We can make it a bit easier to own a household latrine by increasing the number of artisans who are trained to build them well. The Afram Plains Development Organizations (APDO) is one national NGO doing this. Other organizations are also making it easy to get toilets, for example the partnership between Global Communities and DuraPlast Ghana Ltd to develop Digni-Loo. In short, efforts are underway to make getting a decent toilet easier. But there is more to do.

Designing toilets so they are used properly

It is not enough to simply create demand for household toilets – we need to create a culture of consistent appropriate use. This is where user-centred design is so important. When designing and constructing toilets, a most important priority is making one that meets the user’s needs – a toilet that they truly like using. Giving the user a facility that suits them stops open defecation behaviours such as ‘flying toilets’ from being the preferred choice. By providing a better, preferable alternative, policy-makers, traditional authorities and other change agents can encourage demand for household toilets and sustained appropriate use.

Imagine this: all households without toilets now want to own toilets. Some, especially the most vulnerable among them, will need (financial) support. This is an opportunity the Government of Ghana can seize to transform sanitation. The Government could enable the financing so necessary for millions of households to gain access to decent toilets within the next three years.

How is this possible? I will share some ideas in my next article. In the meantime, let us 1) train latrine artisans, and 2) create massive demand for decent toilets.