Changing the way we change the world

Sticky Toilet Use

By Kate Fogelberg, Springfield Centre

From Susan Davis: I’m thrilled to have a guest blog from Kate. We got to know each other when we both worked at Water For People. Kate is now a Senior Consultant with the Springfield Centre, an independent consulting, training, and research organization dedicated to improving the way development is done. Trained in economic development and health, she spent the last 10 years working in the WASH sector in Latin America, Africa, and India. Her favorite toilet is in the Cordillera Real of Bolivia; comfortable, private, and with amazing views of the Andes. 


Susan Davis (left, Improve International Executive Director) and Kate Fogelberg (right, Senior Consultant with the Springfield Centre) investigating toilets in Bolivia

Sticky toilet use sounds like something you’d do your best to avoid. But in the language of behavioral change, it simply means people stop shitting in the open and use a toilet instead. Put another way, a new behavior –whether it’s using a toilet, wearing a condom, or taking vitamins -“sticks” when it becomes a habit. Reading Sunstein and Thaler’s Nudge recently, I was struck by the potential that “nudging” offers to systemic change programs, especially as the approach expands into consumer services.

Implicit in achieving systemic change in any field is behavior change of market system actors. We talk of market systems ad nauseam, but these systems are made up of people, and it is these people whose practices, behaviors, and habits must change to improve wealth and health. Incentives can be aligned, and capacities can be built, but if behaviors don’t change, systemic change won’t stick.

Experts tell us that we make daily decisions using two types of thought processes-automatic and reflective. Most behavior change tactics rely on reflection, information, and motivation and tap into our reflective processing. But at the same time, the parallel automatic system is used when we engage in habitual behavior, relying on automation and environmental cues, such as wearing a seat belt or handwashing. Nudging uses slight environmental changes to adapt human behavior directed by the automatic system as opposed to rational, reflective messages that we may or may not act upon.

For example, if you’re reading this, you probably know you should wash your hands after going to the toilet.  99% of British people surveyed confirmed that they had washed their hands leaving a toilet. Yet electronic monitoring data revealed that only 32% of men and 64% of women actually washed their hands. So we don’t always actually what we say we do, which has important health implications, even more so in contexts beyond British gas stations.

Examples of successful nudges are plentiful, and range from selecting healthier lunch options in cafeterias to cleaner public toilets to increased savings.  An example from the energy sector highlights the importance of understanding root causes-a cornerstone of making markets work for the poor. British policymakers were trying to encourage people to adopt energy efficient insulation in their homes. Assuming that information and access to finance were the primary barriers to home insulation, they created an aggressive public awareness campaign and offered financial subsidies. Uptake was not what they expected, and a casual conversation among energy experts referenced the oft-cited complaint that people must clean out their attics before being able to insulate. This led to a re-framing of the insulation company’s offer to appeal to the actual constraint — cleaning out one’s attic — and enrollment increased five-fold.

Beyond the shores of a rainy island, several development organizations have recognized the potential of nudging for improved wealth and health. Poor Kenyans were nudged to save for insecticide-treated bednets (ITNs) with “mental accounting” by putting small amounts of cash in a locking box and writing down the amounts- leading to increased savings for ITNs.  USAID and primary schools in Bangladesh have been experimenting with nudging kids to wash their hands at school by painting footprints leading from toilets to colorfully painted handwashing stations, resulting in a 74% increase of handwashing. The World Bank has identified numerous ways for open defecators to be nudged onto toilets, including capitalizing on life changes-like marriage or the birth of a child-to insert toilet use promotion messages.

Reflecting on my own work in water and sanitation for a decade, some of the more successful interventions came not from new technologies or big subsidies, but slight shifts –nudges, you could say-to common problems. Communicating that “Most water committees have meters,” contributed to changing water payment norms in rural Bolivia. Relocating female toilets in Indian secondary schools so that they didn’t have to walk past groups of male teachers increased their use by girls. Emphasizing the shower component of a toilet attracted more interest from low-income consumers than only promoting the toilet itself.

Nudging has attracted a lot of buzz, but of course it would be naïve to think that people can be nudged out of poverty. Or that a strategically placed sticker can guide implementers towards more effective programs. There are as many critiques of nudging as any other strategy out there. It’s not the next silver bullet, but for systemic change to have the most impact in fields like health, sanitation, and water, individual behaviors must change for good.

More nudge resources:

UK’s nudge unit

World Bank’s nudge unit

Danish group that conducts behavioral science research and offers courses on nudging

Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in Bangladesh (paywall)

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