Creating Social Norms in Marketing Sanitation in China

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1 Creating Social Norms in Marketing Sanitation in China Zhenbo Yang, UNICEF China At UNICEF-U-Penn 011 training on advances in social norms Executive Summary I have given a brief introduction about the current situation of sanitation in China, the practices, the types of sanitation facilities and the coverage of the use of facilities. I concluded, based on the definition of social norms, which expectations (both empirical and normative) do not exist in China re the use of sanitary latrines. I further made a review of the current sanitation programs having been implemented in China trying to analyse the incentives offered by these programs for people to change their attitude and behaviour in defecation and use of latrines. It is believed that current programs do not render good strategies in promoting individual and social behaviour change in using sanitary latrines. To apply the game theory, the social dilemma ends up with a Nash Equilibrium that all households tend not to invest in improving their latrines. I propose that a social norm should be created through social and commercial marketing in order to promote sustainable development in sanitation. To create a social norm, tremendous efforts are needed in value deliberation about use of sanitary latrines among communities and the whole society, in organizing diffusion of common knowledge and behaviour, in harmonization of moral norms, social norms and legal norms. Networking is needed in both social and commercial marketing through building public private partnership. 1. Human waste disposal in China Two most important biological needs of human being are eating/drinking and defecating/urinating. The quality of drinks and food has been given a much greater attention as they are taken in. However, the quality of faeces and or faeces disposed products is not ensured before it is applied to field and is discharged into environment. It can be easily expected that due to the continued pollution including lack of disposal of human waste, the cost for quality insurance of drinks and food is getting higher and higher; and that people eat and drink what they themselves defecated is inevitable. China has a long history of depending on agriculture production; and it is still in order to provide drinks and food for its more than 1.3 billion population. In most of the areas, people especially rural farmers treasure human waste very much due to its value as manure. Therefore, most of the people do have a fixed place at home to defecate even if it could be

2 very simple, where faeces could be collected and be used for agricultural production of their own land. Most people in China especially in urban cities know that they may get sick if faeces get into mouth, but may not know how and why. In rural areas, people know less and care less. In the short history after the founding of People s Republic of China, several initiatives were conducted to promote the construction and use of latrine/toilets, which include the national campaigns to promote the use of latrines and the safe disposal of human excreta by composting it before applying to agriculture through the national patriotic health campaign in 1950s. Mao Zedong called people to Practice Hygiene and Prevent Diseases. Latrine upgrading was further promoted through primary health programme in early 1980s. These were effective interventions and contributed to the low open defecation rate in China. Further promotion for using latrines and upgrading the technologies happened since mid- 1990s with the support from international societies such as UNICEF. National Standards of Hygienic Latrines was established, and it was upgraded in 009 to regulate the quality of the construction to ensure that faeces are separated from human exposure and effluent from the household latrines is harmless. The government s statistics was changed to report the coverage of both sanitary latrines and latrines of harmless waste disposal since 006. Use of latrines/toilets in China including in rural China is popular with only 4% of the population defecated openly by the end of 008 (WHO/UNICEF JMP, 010). However, access to improved household latrines (MDG definition) arrived at only 55%, and that 41% of households using non-improved household latrines/toilet and public toilet. This was also accompanied with poor hygiene practices. An informative study done in Shaanxi Province in 007 found that out of almost 3,500 events observed, hands were washed with soap only 9% of the times (Baseline study in Shaanxi for the preparation of the Western Provinces Rural WASH Project supported by World Bank, DfID and UNICEF). Low access to improved latrines and poor personal hygiene will create risks for disease transmission, causing public health problem. This situation can be very serious because using human waste as manure is quite common in rural China. In addition, poorly constructed latrines can create environment problems that faecal matters get into field and groundwater and also surface water when latrines are flooded. This will cause wide spread environmental issues and make the provision of drinking water and environmental clean-up costly. This situation can be serious in southern and eastern China where rural farmers are economically better off, and flush toilet is preferred and used that they do not use human waste and public sewage system has not been put in place for centralized treatment. Therefore, the use of sanitary latrines by an individual and the construction of sanitary latrines is not just a simple behavioural regularity but carry social responsibility. However, the dilemma is rural farmers think a latrine is a dirty place and is not worthy of a big investment, and would not need spending effort to maintain it.. Current programs and strategies on sanitation and evaluation in China

3 The healthy city/town strategy In 1993, the National Patriotic Health Campaign committee Office started a program called health city/town program. The program has in general generated a strong enthusiasm for local government to improve the general sanitation situation. When the city/town is granted a title of healthy city/town, the incentives are many including overall environmental improvement for investors to build industries, to attract real estate development and to attract tourist. In the end, the local economy has been boosted. The local government officials who are responsible for the improvement and getting the title for the city/town got visibility and promotion. The granting process and the monitoring and evaluation guarantee the effort is almost maintained. People are always proud of being a citizen of a healthy city/town. People will feel it a shame not to contribute in maintaining the environment. By the end of 010, there has been around 60 cities/towns awarded Health City/Town. The program is led by local government and coordinated by Patriotic Health Campaign Committee Office designated by the local government and efforts come from all related departments. Although the program is in general successful, it is restricted to urban areas without extending to rural communities. The program does not provide any financial incentive. The subsidized household latrine construction in the Health Sector Reform Program Since 009, the government launched a health sector reform program, which is holistic including also water supply and environmental sanitation. The central government allocates RMB1.6 billion per year as subsides with matching subsides from local government to help household latrine construction. As the government developed national standards for household latrines with even the models provided, the subsidy is only enough for the substructure of the latrines. Households need to contribute by providing labour and materials for the super-structure. This program provides financial incentives for building latrines; it also creates problems such as that local people would like to wait for the program to come instead of building/improving their own latrines by themselves. And, it does not promote positive attitude and behaviour change. In some areas, latrines were built in inappropriate places and people do not maintain the latrines well. There are also occasions that extra latrines were built and people still use the original ones and the new ones are used as storeroom etc. In addition, this program has also created disparities between the poor and the rich. The subsidy strategy in its current way of distribution provides incentives for negative social norm creation all waiting for government funds to come. Integrated rural sanitation improvement action plan This program was started in 010 with an aim to support the new socialist rural village construction. It covers such aspects as safe drinking water supply, household latrine, solid waste management, wastewater management and others. The program is a government program and led by local government and coordinated by Patriotic Health Campaign Committee Office with joint effort from health, construction, environment, agriculture and other sectors. This program was implemented in almost the same way as the healthy

4 City/town program, but with a strong monitoring component that includes baselines of key indicators and annual inspection and supervision by 8 key ministries from the central government. It is expected that targets can be achieved in its 3 years implementation time span. 3. Creating social norms for household latrine construction, use and maintenance With the background of people using latrines and using human waste as fertilizers and the impact of current practices in causing public health and environmental problems and economic cost; and with the current on-going government programs which do not necessarily create best practices and behaviour change. It is proposed that social norms should be created. The social dilemma analysis It is not known what the exact reasons are for the groups of people who are still practicing open defecation. In addition, a large group of people in the eastern and southern provinces are no longer using human waste as fertilizer as they are better off and they are no longer working in agriculture. It is foreseen that some more farmers will become city residents or working in industrial and commercial services sectors and use fancy toilet and also dump their own waste. In all these situations, both individual and collective interest will be jeopardized. And, the gain for not constructing latrine (saving of cost) is in long run limited. However, the cost for getting clean water and environment, for treating health problem and others can be very big. However, the social dilemma is that without interventions people would not realize these gains and lost. Every individual believes that I should not waste my money to build and use a latrine which does not benefit oneself. Figure 1 Dilemma of use and not use sanitary latrines Rest of Community Construct latrine Individual Construct Only construction cost (- ) is considered; so that no individual and all the rest want to construct, use and maintain latrines in a clean condition.

5 Introduction of social norms The norm to be created is that rural households in the community all build and use sanitary latrines and maintain functional. According to Professor Cristina Bicchieri (lecture 011 at U Penn), to create a social norm, certain conditions need to be satisfied. In this case, the following conditions need to be in place. Empirical expectations: one believes that a sufficiently large number of the households in the community construct and use sanitary latrines and maintain well; normative expectations: one believes that a sufficiently large number of households in the community also expect him/her to construct and use sanitary latrines and maintain well; and if not, community sanctions will take effect. As analysed that there is currently a dilemma that people do not want to invest to build sanitary latrines. They believe that the investment is not worthy. Based on our knowledge, there are many incentives for constructing and using sanitary latrines. These includes dignity and safety; health benefit, economic benefit, environment and others. Community members may play the following social dilemma game (Figure ). The result indicates that building latrine and using it and maintaining is a Nash Equilibrium. Figure Gains for use and not use sanitary latrines Rest of Community Construct and Use latrine Individual Construct Construction cost = -; Health benefit = ; Environmental clean-up + water treatment + other benefit = 4; Waste as fertilizer = Sanitation marketing It is to use a combination of both social and commercial marketing to promote behavioural change in using latrines for the disposal and management of human waste that will improve

6 the health of both the family and community, and contribute to education and poverty reduction and others. The marketing approaches will make best use of the financing of both public and private sources to sustain that behaviour. As discussed, there are three typologies of situations, using no latrine (open defecation), unsanitary latrines and sanitary latrines. The three typologies will be addressed in different ways as illustrated below. Open defecation Simple un-sanitary latrines Sanitary latrines CLTS triggering method, value deliberation and making commitment Value deliberation and marketing of products/services/skills to assist upgrade sustainable latrines Value deliberation and sanitation marketing Knowing the most vulnerable Appropriate technological options via local supply chains groups Technical and social support for latrine construction through community work Financial support in construction and upgrading the systems through e.g. smart subsidies Skills development via training workshops support local masons in masonry and monitoring plus post construction maintenance and waste marketing Policy support to be given to private companies for them to grow up Measuring the practices and norms through UNICEF/Government pilot project KAP, baseline and others and government program e.g. the evaluation of the implementation of Health Sector Reform Program and regular monitoring program Awarding healthy household and healthy village/township through the government programs, e.g. Rural Integrated Sanitation Improvement Action Plan Social marketing This is to foster the formation of a social that people build and use a sanitary latrine and maintain it functional all the time. The following actions will be taken to achieve this. Breaking taboo, talking about shit loud through various media/occasions/internet using various opinion leaders. Community value deliberation Conversation/Dialogue is to analyse in a participatory way to the community members the benefits they can get through constructing and use sanitary latrines. These incentives of using improved latrines include safety, privacy, health, environment and economic benefits and probably clean energy if biogas septic tank is used. CLTS triggering transect walk, mapping shit, shit calculation/health care cost, water and bread games Participatory planning and making commitment Collective effort in implementation Community monitoring and evaluation and awarding of healthy households Authority verification for awarding healthy village according standards

7 Commercial marketing Government to give private sector policy for them to be involved, which should include the use of the patent, low taxing, use of land for production plant and others. Research and develop appropriate technologies which can be applied in different geological and climatic conditions and economical and social status. Provide product, training for installation and maintenance, post-service, etc. Research and monitoring the market and develop new marketing skills and modality Manage septic tanks, create enterprise for waste use Government to develop guidelines to keep private sectors involvement on track and standards to regulate the conduct in the provision of product, pricing and services. Harmonization of norms In the process, there is a need to harmonize the different norms therefore they are connected with each other. From the environmental protection point of view, there is an issue of morality. Community members are expected not to contaminate other s environment posing risks to others by constructing and using their own latrines. Internally they should feel guilty to do this. Some legal norms are in place, such as the National Standards for household Latrines and National Standard for Excreta Disposal. However, these norms are not implemented well. These norms should be well publicized and the monitoring of compliance should be in place in order to ensure the effectiveness. Measuring norms Identify social norms in relation to use of latrine by different population groups Monitor the use and maintenance of latrines and the use of waste product (KAPs etc.) Study the satisfaction of farmers about their latrines, the benefits and their happiness Monitor private sector s conduct as about the quality and price of latrine products and services to protect farmers interest Networking/organizing diffusion for sustainability/scaling up Engaging key opinion leaders including older revolutionist, retired and respectable heads of villages, elder teachers, health workers, economists and others. CBO plus local existing government funded structure Children as agent Inter-regional learning and exchange Exchange between groups of same folks Events including media/internet campaigning Good network of marketing process including Product, Price, Placement and Promotion to People in need.

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