title: Shame or subsidy revisited: social mobilization for sanitation in Orissa, India.
abstract: OBJECTIVE
  To determine the effectiveness of a sanitation campaign that combines 'shaming' (i.e. emotional motivators) with subsidies for poor households in rural Orissa, an Indian state with a disproportionately high share of India's child mortality.
  
  
  METHODS
  Using a cluster-randomized design, we selected 20 treatment and 20 control villages in the coastal district of Bhadrak, rural Orissa, for a total sample of 1050 households. We collected sanitation and health data before and after a community-led sanitation project, and we used a difference-in-difference estimator to determine the extent to which the campaign influenced the number of households building and using a latrine.
  
  
  RESULTS
  Latrine ownership did not increase in control villages, but in treatment villages it rose from 6% to 32% in the overall sample, from 5% to 36% in households below the poverty line (eligible for a government subsidy) and from 7% to 26% in households above the poverty line (not eligible for a government subsidy).
  
  
  CONCLUSIONS
  Subsidies can overcome serious budget constraints but are not necessary to spur action, for shaming can be very effective by harnessing the power of social pressure and peer monitoring. Through a combination of shaming and subsidies, social marketing can improve sanitation worldwide.
authors.affiliation: Sanford Institute of Public Policy and Nicholas School of the Environment, Duke University, Durham, NC, United States of America. subhrendu.pattanayak@duke.edu
authors.forename: Subhrendu K
authors.initials: SK
authors.lastname: Pattanayak
authors.forename: Jui-Chen
authors.initials: JC
authors.lastname: Yang
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Dickinson
authors.forename: Christine
authors.initials: C
authors.lastname: Poulos
authors.forename: Sumeet R
authors.initials: SR
authors.lastname: Patil
authors.forename: Ranjan K
authors.initials: RK
authors.lastname: Mallick
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Blitstein
authors.forename: Purujit
authors.initials: P
authors.lastname: Praharaj
mesh_terms: D000328:Adult; D003625:Data Collection; D005260:Female; D005380:Financing, Government; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007194:India; D008297:Male; D011203:Poverty; D012499:Sanitation; D012752:Shame
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