A shift from Supply-Driven to Deman

A shift from Supply-Driven to Demand-Driven Development
Despite decades of donor and government financed infrastructure to improve water and sanitation conditions, many rural households in developing countries lack adequate coverage. Some have concluded that ownership and investment (i.e., demand) by the local population is needed if a program is to be sustainable. This sustainability factor has long been overlooked in development because supply-driven interventions have tended to measure success in terms of program outputs (e.g., latrines built), rather than in terms of project impact (e.g., reduction in open defecation) [Kar 2003].
Accordingly, reform efforts in water and sanitation policy have attempted to remedy coverage and sustainability problems by promoting bottom-up, demand-driven programs. Unlike the previous generation of development projects, demand-driven efforts are based on the assumption that the keys to increasing program coverage include effective behavior change strategies to increase program adoption and community empowerment efforts to increase sustainability. These campaigns have been effectively employed in developing countries (Quick 2003, Rowland et al. 2002, Mong et al. 2001) and offer economic advantages in increasing coverage of government sponsored public health initiatives to economically and geographically marginalized populations (Kikumbih et al. 2005, Kar 2003), for example, describes a community-led total sanitation effort in Bangladesh that employed children as change agents and used recognized diffusions principles (Barker 2004, Oldenburg et al. 1997, Dearing 2004) to increase coverage and acceptance of key program goals. Quick (2003) reports on water treatment efforts in three African nations; these efforts included individual behavior change and community mobilization and resulted in meaningful improvements in safe water handling practices.
The Theory of Household Behaviors
Demand-driven programs recognize that health behaviors are driven by value expectancy (Strecher 1997). They include components designed to influence household demand by altering the structure of costs and benefits from the perspective of the end user. If local stakeholders and community members do not recognize the benefits of improving basic water safety and hygiene, if they do not perceive themselves as capable of executing the intended behavior, or if they view costs and barriers as too high, they will be less likely to embrace program activities. In order for this explanation to have any practical meaning or predictive power, we need a better understanding of the “benefits” and “costs” that households consider. Thus, this study is guided by a generalizable theory of health- and sanitation-related behavior change, which is grounded in economic theory (utility maximization subject to constraints) and informed by psychological theories of behavior change (non market aspects of sanitation improvements, including dignity, privacy, and security). Appendix A presents a detailed exposition of this theory. Based on this theory and its predictions regarding the factors that affect the perceived costs and benefits of adopting an IHL (as well as hygiene behaviors), we hypothesize that the demand for IHL will increase where:
1. inputs to IHL construction, including time and materials, are subsidized
2. village residents’ technical knowledge regarding IHL construction is enhanced to improve the quality of IHL
3. non-health aspects of IHLs such as dignity, privacy, and security are perceived by village residents
4. health impacts of IHL are well understood by village residents
5. economic benefits of improved health are well understood by village residents (e.g., fewer lost work days and lost wages due to illness or caregiving responsibilities, increases in expected earnings for children)
6. village residents' expectations about the behavior change of others in the community
The theory also guides the data collection strategy by identifying and describing how the intervention is expected to affect household preferences. While the theory predicts that the health benefits will be borne largely by children, it predicts that the non-health benefits will be borne largely by women. The Government of India’s Total Sanitation Campaign The Government of India developed the Total Sanitation Campaign (TSC) in response to studies indicating that obtaining a private latrines was associated with an individuals’ attitudes regarding the value of ownership (Ministry of Rural Development 2004). The TSC was developed to be a demandresponsive, ‘community led’ and ‘people centered’ reform program that would be implemented by state governments such as the Government of Orissa (GoO). This approach has an empowerment focus that acknowledges the importance of individuals and communities in selecting and achieving goals. The strategy addresses all sections of the rural population, includes a wide range of community partners, and provides economic incentives to meet program and community needs. Current program efforts emphasize the development of information, education, and communication (IEC) activities to impact attitudes andknowledge relating sanitation, safe water, and hygiene to health. According to the logic of the program, increasing awareness of the connection among these health-related factors will lead to increased demand for sanitary facilities. TSC also acknowledges the role of small subsidies, particularly to the poorer segments of the population, in encouraging adoption of behaviors (e.g., construction and use of IHLs).
For example, the typical cost of construction for the type of latrine (off-pit) promoted under this campaign was Rs. 1500 (about US$30), of which households below the poverty line (BPL) were only required to pay Rs. 300 (about US$6).
GoO has a particular interest in the potential for TSC efforts to encourage the uptake of IHL and to reduce open defecation practices (UNICEF 2004, GoO 2004). It is believed that the success of the TSC and the increase in IHL coverage will lead to substantial reductions in the infant mortality rate related to diarrhea. To help it plan, the government piloted a version of the Total Sanitation Campaign of the Government of India in the 20 rural villages in the district of Bhadrak which is our intervention or treatment.

Kết quả (Việt) 1:

Một sự thay đổi từ lái xe cung cấp để phát triển Demand-Driven Mặc dù nhiều thập kỷ của nhà tài trợ và chính phủ tài trợ cơ sở hạ tầng để cải thiện điều kiện nước và vệ sinh môi trường, nhiều hộ gia đình nông thôn ở các nước đang phát triển thiếu bảo hiểm đầy đủ. Một số đã kết luận rằng quyền sở hữu và đầu tư (tức là, nhu cầu) bởi người dân địa phương là cần thiết nếu một chương trình là để được bền vững. Yếu tố này phát triển bền vững đã lâu bị bỏ qua trong phát triển, bởi vì theo định hướng cung cấp biện pháp can thiệp có xu hướng để đo sự thành công trong điều khoản của chương trình đầu ra (ví dụ như, nhà vệ sinh xây dựng), chứ không phải là trong điều khoản của dự án tác động (ví dụ như, giảm mở đại tiện) [Kar 2003].Accordingly, reform efforts in water and sanitation policy have attempted to remedy coverage and sustainability problems by promoting bottom-up, demand-driven programs. Unlike the previous generation of development projects, demand-driven efforts are based on the assumption that the keys to increasing program coverage include effective behavior change strategies to increase program adoption and community empowerment efforts to increase sustainability. These campaigns have been effectively employed in developing countries (Quick 2003, Rowland et al. 2002, Mong et al. 2001) and offer economic advantages in increasing coverage of government sponsored public health initiatives to economically and geographically marginalized populations (Kikumbih et al. 2005, Kar 2003), for example, describes a community-led total sanitation effort in Bangladesh that employed children as change agents and used recognized diffusions principles (Barker 2004, Oldenburg et al. 1997, Dearing 2004) to increase coverage and acceptance of key program goals. Quick (2003) reports on water treatment efforts in three African nations; these efforts included individual behavior change and community mobilization and resulted in meaningful improvements in safe water handling practices.The Theory of Household BehaviorsNhu cầu-driven chương trình nhận ra rằng hành vi sức khỏe được thúc đẩy bởi giá trị kỳ vọng (Strecher năm 1997). Chúng bao gồm các thành phần được thiết kế để ảnh hưởng đến các hộ gia đình nhu cầu bằng cách thay đổi cấu trúc của các chi phí và lợi ích từ quan điểm của người dùng cuối. Nếu bên liên quan địa phương và các thành viên cộng đồng không nhận ra những lợi ích của việc cải thiện an toàn cơ bản nước và vệ sinh, nếu họ không nhận thức bản thân như có khả năng thực hiện hành vi dự định, hoặc nếu họ xem chi phí và rào cản là quá cao, họ sẽ ít có khả năng nắm lấy chương trình hoạt động. Để cho điều này giải thích để có bất kỳ ý nghĩa thực tế hoặc kiểu sức mạnh, chúng ta cần một sự hiểu biết tốt hơn của các "lợi ích" và "chi phí" mà xem xét các hộ gia đình. Do đó, nghiên cứu này hướng dẫn bởi một lý thuyết generalizable của sức khỏe và vệ sinh môi trường liên quan thay đổi hành vi, đó là căn cứ trong lý thuyết kinh tế (tối đa hóa tiện ích tùy thuộc vào giới hạn) và thông báo của các lý thuyết tâm lý của sự thay đổi hành vi (thị trường phòng không khía cạnh của cải thiện vệ sinh môi trường, trong đó có nhân phẩm, quyền riêng tư và bảo mật). Phụ lục A trình bày một trình bày chi tiết của lý thuyết này. Dựa trên lý thuyết này và dự đoán của nó liên quan đến các yếu tố ảnh hưởng đến nhận thức chi phí và lợi ích của việc áp dụng một IHL (cũng như hành vi vệ sinh), chúng tôi đưa ra giả thuyết rằng nhu cầu về IHL sẽ tăng nơi:1. đầu vào để xây dựng IHL, bao gồm cả thời gian và tài liệu, được hỗ trợ2. village residents’ technical knowledge regarding IHL construction is enhanced to improve the quality of IHL3. non-health aspects of IHLs such as dignity, privacy, and security are perceived by village residents4. health impacts of IHL are well understood by village residents5. economic benefits of improved health are well understood by village residents (e.g., fewer lost work days and lost wages due to illness or caregiving responsibilities, increases in expected earnings for children)6. village residents' expectations about the behavior change of others in the community The theory also guides the data collection strategy by identifying and describing how the intervention is expected to affect household preferences. While the theory predicts that the health benefits will be borne largely by children, it predicts that the non-health benefits will be borne largely by women. The Government of India’s Total Sanitation Campaign The Government of India developed the Total Sanitation Campaign (TSC) in response to studies indicating that obtaining a private latrines was associated with an individuals’ attitudes regarding the value of ownership (Ministry of Rural Development 2004). The TSC was developed to be a demandresponsive, ‘community led’ and ‘people centered’ reform program that would be implemented by state governments such as the Government of Orissa (GoO). This approach has an empowerment focus that acknowledges the importance of individuals and communities in selecting and achieving goals. The strategy addresses all sections of the rural population, includes a wide range of community partners, and provides economic incentives to meet program and community needs. Current program efforts emphasize the development of information, education, and communication (IEC) activities to impact attitudes andknowledge relating sanitation, safe water, and hygiene to health. According to the logic of the program, increasing awareness of the connection among these health-related factors will lead to increased demand for sanitary facilities. TSC also acknowledges the role of small subsidies, particularly to the poorer segments of the population, in encouraging adoption of behaviors (e.g., construction and use of IHLs).For example, the typical cost of construction for the type of latrine (off-pit) promoted under this campaign was Rs. 1500 (about US$30), of which households below the poverty line (BPL) were only required to pay Rs. 300 (about US$6).GoO has a particular interest in the potential for TSC efforts to encourage the uptake of IHL and to reduce open defecation practices (UNICEF 2004, GoO 2004). It is believed that the success of the TSC and the increase in IHL coverage will lead to substantial reductions in the infant mortality rate related to diarrhea. To help it plan, the government piloted a version of the Total Sanitation Campaign of the Government of India in the 20 rural villages in the district of Bhadrak which is our intervention or treatment.