Family and social effects on adoption of preventative health measures

家庭和社会对采取预防性卫生措施的影响

• 批准号: ES/S01571X/1
• 负责人: Britta Augsburg
• 金额: $ 33.22万
• 依托单位: Institute for Fiscal Studies
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FS01571X%2F1
• 关键词: Family; social; effects; adoption; preventative

Sanitation - broadly defined as hygienic means of promoting health through prevention of human contact with the hazards of waste and in particular human waste - has long been acknowledged as an indispensable element of disease prevention and primary health care programmes (Declaration of Alma-Ata, 1978). An estimated 2.3 billion people do not have access to basic sanitation services, and 4.5 billion people do not have access to safely managed sanitation. Hence the scale of the problem is urgent, and improving sanitation is included in both the Millennium and Sustainable Development Goals (MDGs and SDGs). It is estimated that better sanitation could prevent the majority of diarrheal-related deaths of 361,000 children aged less than 5 years each year. Improved sanitation would also have substantial impacts on developing countries' economic growth: the Water and Sanitation Program of the World Bank estimates that India, the context of the proposed research, loses more than 6% of its annual GDP due to inadequate sanitation. Strategies to improve sanitation coverage across the developing world have focused predominantly on providing information and credit or subsidies to encourage the construction of private household toilets. However, a large number of recent impact evaluation studies on sanitation interventions in low-income countries find only modest impacts on toilet uptake and usage. It is crucial for the design and targeting of policies aimed at improving sanitation, and consequently health and productivity, to gain a deeper understanding of what imperfections and constraints are driving this observed failure of sanitation interventions to achieve their full potential. The proposed research aims to inform the design of effective sanitation interventions and policies by identifying the importance of social factors in explaining sanitation adoption decisions. In particular, our research will focus on understanding the role of dynamics within the household, such as between husband and wife who may value sanitation differently, and within peer groups, which are particularly important in interventions such as micro-credit which are delivered through groups within the community. We focus on the context of India, which contributes almost 60% of the close to one billion people who defecate in the open globally (WHO/UNICEF JMP, 2017). The Government of India is committed to achieving SDG 6 of clean water and sanitation for all by 2030, including via its ambitious Clean India Movement which aims to make India open-defecation-free by 2019. At the same time, India remains a patriarchal society, where women are often seen as subordinate to men, and a society with very strict norms governing social interactions within the community. Social factors, and in particular those related to gender and community, are therefore likely to pose particularly strong constraints on sanitation investments in India.We will seek to answer a number of important and related questions. First, we will ask whether women indeed bear higher costs of open defecation and place a higher valuation of toilets relative to men. Yet second, since women often have lower bargaining power within poor Indian households, we will investigate to what extent bargaining within the household over budget and mobility constrains their ability to invest in sanitation via building private latrines or using community toilets. Third, the effectiveness of encouraging individuals to invest in private latrines via microfinance lending is also likely to depend on the preferences and behaviour of key individuals within joint-liability microfinance groups. We will explore such intra-group dynamics and how leaders influence sanitation investment decisions. Finally, we will model and test whether investing in toilets allows grooms on the marriage market a better chance of attracting higher-quality brides (or any bride at all).

卫生设施——广义上是指通过防止人类接触废物，特别是人类废物的危害来促进健康的卫生手段——长期以来被认为是疾病预防和初级卫生保健计划中不可或缺的要素（《阿拉木图宣言》，1978年）。据估计，有 23 亿人无法获得基本的卫生服务，45 亿人无法获得安全管理的卫生设施。因此，该问题的规模十分紧迫，改善卫生设施已被纳入千年目标和可持续发展目标（MDG 和 SDG）。据估计，每年有 361,000 名 5 岁以下儿童因腹泻而死亡，改善卫生条件可以避免其中大部分死亡。改善卫生设施也会对发展中国家的经济增长产生重大影响：世界银行的水和卫生设施计划估计，拟议研究的背景下的印度由于卫生设施不足而损失了年国内生产总值的 6% 以上。提高发展中国家卫生设施覆盖率的战略主要侧重于提供信息和信贷或补贴，以鼓励建造私人家庭厕所。然而，最近对低收入国家卫生干预措施进行的大量影响评估研究发现，对厕所的普及和使用影响不大。对于旨在改善卫生、从而改善健康和生产力的政策的设计和目标定位至关重要，必须更深入地了解哪些缺陷和限制导致卫生干预措施未能充分发挥其潜力。拟议的研究旨在通过确定社会因素在解释卫生设施采用决策中的重要性，为有效的卫生干预措施和政策的设计提供信息。特别是，我们的研究将侧重于了解家庭内部动态的作用，例如对卫生设施的重视程度可能不同的丈夫和妻子之间，以及同侪群体内部，这对于通过社区内团体提供的小额信贷等干预措施尤为重要。我们重点关注印度的情况，全球近 10 亿露天排便人口中，印度占近 60%（世卫组织/联合国儿童基金会 JMP，2017 年）。印度政府致力于到 2030 年实现为所有人提供清洁水和卫生设施的可持续发展目标 6，包括通过其雄心勃勃的清洁印度运动，该运动旨在到 2019 年使印度不再随地大小便。与此同时，印度仍然是一个父权社会，妇女常常被视为从属于男性，并且对社区内的社会互动有非常严格的规范。因此，社会因素，特别是与性别和社区有关的因素，可能会对印度的卫生投资造成特别强烈的限制。我们将寻求回答一些重要的相关问题。首先，我们要问的是，女性是否确实比男性承受更高的露天排便成本，并对厕所给予更高的评价。其次，由于妇女在印度贫困家庭中的讨价还价能力往往较低，我们将调查家庭内部关于预算和流动性的讨价还价在多大程度上限制了她们通过建造私人厕所或使用社区厕所投资于卫生设施的能力。第三，鼓励个人通过小额信贷投资私人厕所的有效性也可能取决于连带责任小额信贷团体中关键个人的偏好和行为。我们将探讨这种集团内部的动态以及领导者如何影响卫生投资决策。最后，我们将建模并测试投资厕所是否能让婚姻市场上的新郎有更好的机会吸引更高质量的新娘（或任何新娘）。

项目成果

To invest or not to invest in sanitation: the role of intra-household gender differences in perceptions and bargaining power

投资还是不投资卫生设施：家庭内部性别差异在观念和议价能力方面的作用

• DOI: 10.1920/wp.ifs.2021.4521
• 作者: Wahhaj Z

Sanitation and marriage markets in India: Evidence from the Total Sanitation Campaign.

• DOI: 10.1016/j.jdeveco.2023.103092
• 发表时间: 2023-06
• 期刊: JOURNAL OF DEVELOPMENT ECONOMICS
• 影响因子: 5
• 作者: Augsburg, Britta;Baquero, Juan P.;Gautam, Sanghmitra;Rodriguez-Lesmes, Paul
• 通讯作者: Rodriguez-Lesmes, Paul

Increasing the adoption of safe sanitation infrastructure: Evidence from India

增加安全卫生基础设施的采用：来自印度的证据

• DOI: 10.1920/co.ifs.2023.0011
• 作者: Augsburg B

Coordination and the poor maintenance trap: an experiment on public infrastructure in India

协调与维护不善的陷阱：印度公共基础设施的实验

• DOI: 10.1920/wp.ifs.2021.1621
• 作者: Bancalari A

Sanitation and credit constraints - The role of labelled microcredit in India's Swacch Bharat Mission subsidy scheme

卫生和信贷限制——贴有标签的小额信贷在印度 Swacch Bharat Mission 补贴计划中的作用

• DOI: 10.1920/wp.ifs.2022.0922
• 作者: Malde B