208536 Market-based approaches to improve sanitation access in Bolivia: Studying demand and developing supply

Sunday, November 8, 2009

William E. Oswald, MHS , Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, GA
Monique Hennink, PhD , Rollins School of Public Health, Emory University, Atlanta, GA
Jennifer Warpinski , Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, GA
Holly Dentz , Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, GA
Oscar Suntura , Fundacion Sumaj Huasi, La Paz, Bolivia
Juan Carlos Suntura , Fundacion Sumaj Huasi, La Paz, Bolivia
Raul Silveti , Fundacion Sumaj Huasi, La Paz, Bolivia
Christine L. Moe, PhD , Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, GA
In Bolivia, 47% of the population lack access to improved sanitation, and only 22% of rural inhabitants have sanitation. Few efforts to improve sanitation coverage and use have been successful, indicating the need for innovative delivery mechanisms and a better understanding of consumer demand. The objectives of this study were to: 1) examine consumer demand, preferences and willingness to pay for sanitation, 2) develop local sanitation microenterprises to provide appropriate products and services, and 3) evaluate the impact of sanitation microenterprises and social marketing on sanitation access in two study sites in Bolivia.

Household interviews were conducted in 12 communities with sanitation interventions by 5 NGOs in three ecological zones to examine consumer attitudes and preferences for sanitation and why certain interventions were successful or not. Two sanitation microenterprises were trained and established; one in a rural, agricultural highland community, and one in a periurban community in the tropical lowlands. Focus groups were conducted to investigate consumer demand for sanitation, willingness to pay, access to microcredit, and local communication channels to develop a sanitation marketing campaign. Various microcredit approaches were provided to stimulate demand and enable household sanitation purchases.

Initial findings indicate strong demand for sanitation, willingness to pay, and interest in microcredit for sanitation. We are monitoring sanitation sales and awareness in the study sites and testing scaling-up sanitation provision through replicate “franchise” enterprises, centralized production of sanitation “kits,” and various microcredit strategies. Further research is needed to reduce the costs of household sanitation and refine financing mechanisms.

Learning Objectives:
1) Identify the use of qualitative research methods to collect information to guide sanitation interventions; 2) Describe the complexities of consumer attitudes towards sanitation; 3) Discuss the role of market-based approaches to provide public health goods and services.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Christine Moe is the Eugene J. Gangarosa Professor of Safe Water and Sanitation and the Director of the Center for Global Safe Water at Emory University. Her primary appointment is in the Hubert Department of Global Health at the Rollins School of Public Health of Emory University, and she holds joint appointments in the Department of Environmental and Occupational Health and the Department of Epidemiology. She received her Bachelor's degree in biology from Swarthmore College and her MS and Ph.D. from the Department of Environmental Sciences and Engineering at the UNC School of Public Health. She was a post-doctoral fellow in the Division of Viral Diseases at the CDC, and later returned to UNC-Chapel Hill as an assistant professor in the Department of Epidemiology. She moved to Emory University in 2000. Dr. Moe’s research focuses primarily on the environmental transmission of infectious agents - particularly foodborne and waterborne disease. She works on international water, sanitation and health issues and has conducted research in the Philippines, El Salvador, Bolivia and Kenya. Her laboratory research program focuses on noroviruses and includes human challenge studies to examine dose response and determinants of host susceptibility and resistance, studies of viral persistence in the environment, methods to concentrate and detect enteric viruses in water and wastewater and evaluations of the efficacy of disinfectants and handwash agents against noroviruses. Her field research includes studies of dry sanitation systems, assessing determinants of water quality in distribution systems and identifying risk factors for environmental contamination of vegetable crops. Dr. Moe currently serves on the Health and Scientific Advisory Board for the Institute for Public Health and Water Research. She has been a consultant for WHO and the Bill and Melinda Gates Foundation on several projects related to water, sanitation and health. She was also a member of the Water Science and Technology Board of the National Research Council, the USEPA Science Advisory Board for Drinking Water and the Research Advisory Council for the American Water Works Research Foundation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.