[Show abstract][Hide abstract] ABSTRACT: Like commercial marketing, social marketing uses the 4 "Ps" and seeks exchange of value between the marketer and consumer. Behaviors such as handwashing, and products such as those for oral rehydration treatment (ORT), can be marketed like commercial products in developing countries. Although social marketing in these areas is growing, there has been no systematic review of the current state of practice, research and evaluation. We searched the literature for published peer-reviewed studies available through major online publication databases. We identified manuscripts in the health, social science, and business literature on social marketing that used at least one of the 4 Ps of marketing and had a behavioral objective targeting the behaviors or products related to improving water and sanitation. We developed formalized decision rules and applied them in identifying articles for review. We initially identified 117 articles and reviewed a final set of 32 that met our criteria. Social marketing is a widespread strategy. Marketing efforts have created high levels of awareness of health threats and solutions, including behavior change and socially marketed products. There is widespread use of the 4 Ps of marketing, with price interventions being the least common. Evaluations show consistent improvements in behavioral mediators but mixed results in behavior change. Interventions have successfully used social marketing following widely recommended strategies. Future evaluations need to focus on mediators that explain successful behavior change in order to identify best practices and improve future programs. More rigorous evaluations including quasi-experimental designs and randomized trials are needed. More consistent reporting of evaluation results that permits meta-analysis of effects is needed.
Social Science [?] Medicine 03/2014; 110C:18-25. · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Environmental health problems such as malaria, respiratory infections, diarrhoea and malnutrition pose very high burdens on the poor rural people in much of the tropics. Recent research on key interventions-the adoption and use of relatively cheap and effective environmental health technologies-has focused primarily on the influence of demand-side household-level drivers. Relatively few studies of the promotion and use of these technologies have considered the role of contextual factors such as governance, the enabling environment and national policies because of the challenges of cross-country comparisons. We exploit a natural experimental setting by comparing household adoption across the Benin-Togo national border that splits the Tamberma Valley in West Africa. Households across the border share the same culture, ethnicity, weather, physiographic features, livelihoods and infrastructure; however, they are located in countries at virtually opposite ends of the institutional spectrum of democratic elections, voice and accountability, effective governance and corruption. Binary choice models and rigorous non-parametric matching estimators confirm that households in Benin are more likely than households in Togo to plant soybeans, build improved cookstoves and purchase mosquito nets, ceteris paribus. Although we cannot identify the exact mechanism for the large and significant national-level differences in technology adoption, our findings suggest that contextual institutional factors can be more important than household characteristics for technology adoption.
Health Policy and Planning 01/2014; · 2.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Improved cook stoves (ICS) have been widely touted for their potential to deliver the triple benefits of improved household health and time savings, reduced deforestation and local environmental degradation, and reduced emissions of black carbon, a significant short-term contributor to global climate change. Yet diffusion of ICS technologies among potential users in many low-income settings, including India, remains slow, despite decades of promotion. This paper explores the variation in perceptions of and preferences for ICS in Uttar Pradesh and Uttarakhand, as revealed through a series of semi-structured focus groups and interviews from 11 rural villages or hamlets. We find cautious interest in new ICS technologies, and observe that preferences for ICS are positively related to perceptions of health and time savings. Other respondent and community characteristics, e.g., gender, education, prior experience with clean stoves and institutions promoting similar technologies, and social norms as perceived through the actions of neighbours, also appear important. Though they cannot be considered representative, our results suggest that efforts to increase adoption and use of ICS in rural India will likely require a combination of supply-chain improvements and carefully designed social marketing and promotion campaigns, and possibly incentives, to reduce the up-front cost of stoves.
International Journal of Environmental Research and Public Health 01/2014; 11(2):1341-58. · 2.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Like commercial marketing, social marketing uses the 4 “Ps” and seeks exchange of value between the marketer and consumer. Behaviors such as handwashing, and products such as those for oral rehydration treatment (ORT), can be marketed like commercial products in developing countries. Although social marketing in these areas is growing, there has been no systematic review of the current state of practice, research and evaluation.
We searched the literature for published peer-reviewed studies available through major online publication databases. We identified manuscripts in the health, social science, and business literature on social marketing that used at least one of the 4 Ps of marketing and had a behavioral objective targeting the behaviors or products related to improving water and sanitation. We developed formalized decision rules and applied them in identifying articles for review. We initially identified 117 articles and reviewed a final set of 32 that met our criteria.
Social marketing is a widespread strategy. Marketing efforts have created high levels of awareness of health threats and solutions, including behavior change and socially marketed products. There is widespread use of the 4 Ps of marketing, with price interventions being the least common. Evaluations show consistent improvements in behavioral mediators but mixed results in behavior change.
Interventions have successfully used social marketing following widely recommended strategies. Future evaluations need to focus on mediators that explain successful behavior change in order to identify best practices and improve future programs. More rigorous evaluations including quasi-experimental designs and randomized trials are needed. More consistent reporting of evaluation results that permits meta-analysis of effects is needed.
[Show abstract][Hide abstract] ABSTRACT: National parks and other protected areas are at the forefront of global efforts to protect biodiversity and ecosystem services. However, not all protection is equal. Some areas are assigned strict legal protection that permits few extractive human uses. Other protected area designations permit a wider range of uses. Whether strictly protected areas are more effective in achieving environmental objectives is an empirical question: although strictly protected areas legally permit less anthropogenic disturbance, the social conflicts associated with assigning strict protection may lead politicians to assign strict protection to less-threatened areas and may lead citizens or enforcement agents to ignore the strict legal restrictions. We contrast the impacts of strictly and less strictly protected areas in four countries using IUCN designations to measure de jure strictness, data on deforestation to measure outcomes, and a quasi-experimental design to estimate impacts. On average, stricter protection reduced deforestation rates more than less strict protection, but the additional impact was not always large and sometimes arose because of where stricter protection was assigned rather than regulatory strictness per se. We also show that, in protected area studies contrasting y management regimes, there are y2 policy-relevant impacts, rather than only y, as earlier studies have implied.
Environmental Research Letters 04/2013; 8(2):025011. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: How does specific information about contamination in a household's drinking water affect water handling behavior? We randomly split a sample of households in rural Andhra Pradesh, India. The treatment group observed a contamination test of the drinking water in their own household storage vessel; while they were waiting for their results, they were also provided with a list of actions that they could take to remedy contamination if they tested positive. The control group received no test or guidance. The drinking water of nearly 90% of tested households showed evidence of contamination by fecal bacteria. They reacted by purchasing more of their water from commercial sources but not by making more time-intensive adjustments. Providing salient evidence of risk increases demand for commercial clean water.
The American journal of tropical medicine and hygiene 07/2012; 87(1):18-22. · 2.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Over 5 billion people worldwide are exposed to unsafe water. Given the obstacles to ensuring sustainable improvements in water supply infrastructure and the unhygienic handling of water after collection, household water treatment and storage (HWTS) products have been viewed as important mechanisms for increasing access to safe water. Although studies have shown that HWTS technologies can reduce the likelihood of diarrheal illness by about 30%, levels of adoption and continued use remain low. An understanding of household preferences for HWTS products can be used to create demand through effective product positioning and social marketing, and ultimately improve and ensure commercial sustainability and scalability of these products. However, there has been little systematic research on consumer preferences for HWTS products. This paper reports the results of the first state-of-the-art conjoint analysis study of HWTS products. In 2008, we conducted a conjoint analysis survey of a representative sample of households in Andhra Pradesh (AP), India to elicit and quantify household preferences for commercial HWTS products. Controlling for attribute non-attendance in an error components mixed logit model, the study results indicate that the most important features to respondents, in terms of the effect on utility, were the type of product, followed by the extent to which the product removes pathogens, the retail outlet and, the time required to treat 10 L. Holding all other product attributes constant, filters were preferred to combination products and chemical additives. Department stores and weekly markets were the most favorable sales outlets, followed by mobile salespeople. In general, households do not prefer to purchase HWTS products at local shops. Our results can inform the types of products and sales outlets that are likely to be successful in commercial HWTS markets in AP, as well as the influence of different pricing and financing strategies on product demand and uptake.
Social Science [?] Medicine 05/2012; 75(4):738-46. · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The global focus on improved cookstoves (ICSs) and clean fuels has increased because of their potential for delivering triple dividends: household health, local environmental quality, and regional climate benefits. However, ICS and clean fuel dissemination programs have met with low rates of adoption.
We reviewed empirical studies on ICSs and fuel choice to describe the literature, examine determinants of fuel and stove choice, and identify knowledge gaps.
We conducted a systematic review of the literature on the adoption of ICSs or cleaner fuels by households in developing countries. Results are synthesized through a simple vote-counting meta-analysis.
We identified 32 research studies that reported 146 separate regression analyses of ICS adoption (11 analyses) or fuel choice (135 analyses) from Asia (60%), Africa (27%), and Latin America (19%). Most studies apply multivariate regression methods to consider 7-13 determinants of choice. Income, education, and urban location were positively associated with adoption in most but not all studies. However, the influence of fuel availability and prices, household size and composition, and sex is unclear. Potentially important drivers such as credit, supply-chain strengthening, and social marketing have been ignored.
Adoption studies of ICSs or clean energy are scarce, scattered, and of differential quality, even though global distribution programs are quickly expanding. Future research should examine an expanded set of contextual variables to improve implementation of stove programs that can realize the "win-win-win" of health, local environmental quality, and climate associated with these technologies.
Environmental Health Perspectives 02/2012; 120(5):637-45. · 7.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Payments for environmental services (PES) are popular despite little empirical evidence of their effectiveness. We estimate the impact of PES on forest cover in a region known for exemplary implementation of one of the best-known and longest-lived PES programs. Our evaluation design combines sampling that incorporates prematching, data from remote sensing and household surveys, and empirical methods that include partial identification with weak assumptions, difference-in-differences matching estimators, and tests of sensitivity to unobservable heterogeneity. PES in our study site increased participating farm forest cover by about 11% to 17% of the mean area under PES contract over eight years.
Land Economics 01/2012; 88(2). · 1.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We review the evidence on the economic values of forest ecosystem services in developing nations and the effectiveness of policies aimed at protecting these services. We conclude that, despite a plethora of publications, the literature is thin, with few well-designed studies that can provide a coherent picture of ecosystem values or policy effectiveness. Although ecologists coined the term ecosystem services and have led much of the recent research, ecosystem services is fundamentally an economic concept. This offers economists a unique and important opportunity to contribute to the emerging literature on ecosystem valuation and policy effectiveness. Most importantly, we conclude that the most fruitful path for future inquiry is to more tightly integrate policy and research by conducting studies that combine nonmarket valuation and impact evaluation (i.e., valuation estimates based on observed impacts in the context of real-world programs). We believe that investing scarce research funds in such an integrated approach will increase the likelihood that future research on ecosystem services will yield high-quality evidence of practical use to policymakers. Copyright 2012, Oxford University Press.
[Show abstract][Hide abstract] ABSTRACT: We review and confirm the claim that credible evaluations of common conservation instruments continue to be rare. The limited set of rigorous studies suggests that protected areas cause modest reductions in deforestation; however, the evidence base for payments for ecosystem services, decentralization policies and other interventions is much weaker. Thus, we renew our urgent call for more evaluations from many more biodiversity-relevant locations. Specifically, we call for a programme of research—Conservation Evaluation 2.0—that seeks to measure how programme impacts vary by socio-political and bio-physical context, to track economic and environmental impacts jointly, to identify spatial spillover effects to untargeted areas, and to use theories of change to characterize causal mechanisms that can guide the collection of data and the interpretation of results. Only then can we usefully contribute to the debate over how to protect biodiversity in developing countries.
[Show abstract][Hide abstract] ABSTRACT: Current attention to improved cook stoves (ICS) focuses on the "triple benefits" they provide, in improved health and time savings for households, in preservation of forests and associated ecosystem services, and in reducing emissions that contribute to global climate change. Despite the purported economic benefits of such technologies, however, progress in achieving large-scale adoption and use has been remarkably slow. This paper uses Monte Carlo simulation analysis to evaluate the claim that households will always reap positive and large benefits from the use of such technologies. Our analysis allows for better understanding of the variability in economic costs and benefits of ICS use in developing countries, which depend on unknown combinations of numerous uncertain parameters. The model results suggest that the private net benefits of ICS will sometimes be negative, and in many instances highly so. Moreover, carbon financing and social subsidies may help enhance incentives to adopt, but will not always be appropriate. The costs and benefits of these technologies are most affected by their relative fuel costs, time and fuel use efficiencies, the incidence and cost-of-illness of acute respiratory illness, and the cost of household cooking time. Combining these results with the fact that households often find these technologies to be inconvenient or culturally inappropriate leads us to understand why uptake has been disappointing. Given the current attention to the scale up of ICS, this analysis is timely and important for highlighting some of the challenges for global efforts to promote ICS.
PLoS ONE 01/2012; 7(2):e30338. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This report reviews the literature on the links between energy access, welfare, and gender in order to provide evidence on where gender considerations in the energy sector matter and how they might be addressed. Prepared as a background document for the 2012 World Development Report on Gender Equality and Development, and part of the Social Development Department's ongoing work on gender and infrastructure, the report describes and evaluates the evidence on the links between gender and energy focusing on: increased access to woodfuel through planting of trees and forest management; improved cooking technologies; and access to electricity and motive energy. The report's main finding is that energy interventions can have significant gender benefits, which can be realized via careful design and targeting of interventions based on a context-specific understanding of energy scarcity and household decision-making, in particular how women's preferences, opportunity cost of time, and welfare are reflected in household energy decisions. The report focuses on the academic peer-reviewed literature and, although it applies fairly inclusive screening criteria when selecting the evidence to consider, finds that the evidence on many of the energy-gender linkages is often limited. There is thus a clear need for studies to evaluate interventions and identify key design elements for gender-sensitive project design.
[Show abstract][Hide abstract] ABSTRACT: This paper evaluates public investments in forest-based microenterprises as part of an integrated conservation and development project (ICDP) in the Brazilian Amazon. We combine matching with regression to quantify the effects of program participation on household income, wealth, and livelihoods. We find that participation increased cash and total income and asset accumulation, suggesting that the microenterprises contributed to the development goals of the ICDP. There is no clear evidence, however, that the microenterprise program helped achieve the ICDP’s conservation goals of shifting household livelihoods away from agriculture and into sustainable forest use.
Land Economics 01/2011; 87(4). · 1.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In remote areas of developing countries, people's health and livelihoods are closely intertwined with the condition of the natural environment. Unfortunately, claims regarding the role of ecosystem degradation on disease outcomes rest on a short list of rigorous empirical studies that consider social, cultural and economic factors that underpin both ecosystem disruptions and behaviors related to exposure, prevention and treatment of diseases such as malaria. As the human ecological tradition suggests, omitting behaviors can lead to erroneous interpretations regarding the nature of the relationship between ecological changes and disease. We specify and test the relationship between child malaria prevalence and forest conditions in a quasi-experimental setting of buffer zone villages around a protected area, which was established to conserve biodiversity on Flores, Indonesia. Multivariate probit regressions are used to examine this conservation and health hypothesis, controlling for several individual, family and community variables that could confound this hypothesized link. We find that the extent of primary (protected) forest is negatively associated with child malaria, while the extent of secondary (disturbed) forest cover is positively correlated with child malaria, all else equal. This finding emphasizes the natural insurance value of conservation because children are both especially vulnerable to changes in environmental risks and key players in the future growth and prosperity of a society.
[Show abstract][Hide abstract] ABSTRACT: Purpose – The purpose of this paper is to investigate whether mining can serve as a pathway for economic development despite the environmental externalities. The extensive literature on the “resource curse” phenomenon at the national level generally finds that economic dependence on mineral resources is associated with lower levels of economic growth. This paper shows that further insight can be obtained by studying micro-level resource curse because of heterogeneity in institutions, natural resources and economic behaviors. Design/methodology/approach – The paper empirically tests the resource curse hypothesis with data from a stratified random sample of 600 households in 20 villages in the mining district of Keonjhar, Orissa. Household surveys were used to collect data on demography, forest dependence, health and household economics. Using geographical information system (GIS), the household data were integrated with secondary spatial data on land cover and location of mines to construct multiple measures of exposure to iron ore mines. Findings – Microeconometric models demonstrate the multi-faceted nature of the relationships between mine exposure, forest resources and human welfare. Households closer to mines experience higher incidences of many illnesses, rank lower on indicators of human development and own fewer production assets. They also derive fewer forest benefits because forests are more degraded and less accessible in villages closer to mines. Originality/value – This analysis remains timely because of on-going violent conflicts and concern over negative impacts on the welfare of rural populations in the mining areas of India, which is consistent with the notion of a resource curse. The paper's findings on the magnitude of negative impacts can inform the policy discourse (e.g. benefits sharing schemes) related to mining-led growth.
Indian Growth and Development Review 09/2010; 3(October):166-185.
[Show abstract][Hide abstract] ABSTRACT: Despite the potential for economic growth, extractive mineral industries can impose negative health externalities in mining communities. We estimate the size of these externalities by combining household interviews with mine location and estimating statistical functions of respiratory illness and malaria among villagers living along a gradient of proximity to iron-ore mines in rural India. Two-stage regression modeling with cluster corrections suggests that villagers living closer to mines had higher respiratory illness and malaria-related workday loss, but the evidence for mine workers is mixed. These findings contribute to the thin empirical literature on environmental justice and public health in developing countries.
[Show abstract][Hide abstract] ABSTRACT: To evaluate and quantify the economic benefits attributable to improvements in water supply and sanitation in rural India.
We combined propensity-score "pre-matching" and rich pre-post panel data on 9500 households in 242 villages located in four geographically different districts to estimate the economic benefits of a large-scale community demand-driven water supply programme in Maharashtra, India. We calculated coping costs and cost of illness by adding across several elements of coping and illness and then estimated causal impacts using a difference-in-difference strategy on the pre-matched sample. The pre-post design allowed us to use a difference-in-difference estimator to measure "treatment effect" by comparing treatment and control villages during both periods. We compared average household costs with respect to out-of-pocket medical expenses, patients' lost income, caregiving costs, time spent on collecting water, time spent on sanitation, and water treatment costs due to filtration, boiling, chemical use and storage.
Three years after programme initiation, the number of households using piped water and private pit latrines had increased by 10% on average, but no changes in hygiene-related behaviour had occurred. The behavioural changes observed suggest that the average household in a programme community could save as much as 7 United States dollars per month (or 5% of monthly household cash expenditures) in coping costs, but would not reduce illness costs. Poorer, socially marginalized households benefited more, in alignment with programme objectives.
Given the renewed interest in water, sanitation and hygiene outcomes, evaluating the economic benefits of environmental interventions by means of causal research is important for understanding the true value of such interventions.
Bulletin of the World Health Organisation 07/2010; 88(7):535-42. · 5.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nearly one billion people worldwide rely on unimproved sources of drinking water, which are not protected from outside contamination. Unhygienic handling of water after collection may further contaminate household drinking water. In recognition of these obstacles, usage of household water treatment and storage (HWTS) products (e.g., water filters, chlorine-based tablets or liquid) is regarded as a potentially important step in improving the microbiological quality of drinking water and reducing diarrheal illness in developing countries, such as India (UNICEF and WHO 2008, Clasen et al. 2006, WHO 2005, Harris 2005). Despite the demonstrated efficacy of HWTS technologies (Fewtrell et al. 2005, Clasen et al. 2006), levels of adoption and continued use remain low and commercial approaches to the promotion and distribution of these technologies have not significantly boosted adoption rates (Harris 2005). To date, there has been little systematic research on consumer preferences and willingness to pay for HWTS products that would inform more effective commercial initiatives.To increase the adoption of commercial HWTS products, new marketing and behavior change campaigns may be necessary. Toward this end, a conjoint analysis study was conducted to assess preferences for HWTS products and product attributes, and estimate predicted choice probabilities and willingness to pay by different potential consumer groups. Conjoint analysis is particularly valuable here because most of the population in developing countries does not use commercial HWTS products, and because a variety of commercial products are under development and are likely to be marketed in the near future, each with somewhat different features.We interviewed a representative sample of 500 households in the state of Andhra Pradesh, India in April and May 2008. The key attributes were type of product (consumable [e.g., chlorine tablets], durable [e.g., filter], or a combination of the two), safety of treated water, number of minutes required to treat 10 liters of water, location where new products are retailed, upfront costs of the product, and ongoing/operating costs of the product. Each respondent was presented with 6 choice tasks to measure preferences for commercial HWTS products. The surveys also collected detailed data on demographic and socioeconomic characteristics; water-related practices (including collection, transportation, storage, treatment, and handling); and water quality perceptions.We find that there is significant potential demand for commercial HWTS products -- 30 to 60% of households would purchase a commercial HWTS product, depending on its attributes. As expected, households preferred products that had lower prices, greater efficacy, and required less time to treat water. In general, households preferred durables to consumables and indicated that local community shops were the least desirable retail outlets compared to mobile salespeople, weekly markets, and department stores. Large increases in upfront costs of commercial HWTS products reduce the likelihood of product purchase more than small increases in monthly ongoing costs, which suggests that spreading payments for HWTS products over time may increase product uptake. Some of these preferences for HWTS products and their attributes vary across socioeconomic groups. These preferences can provide some evidence to inform selection of commercial HWTS products to promote, market segments to target, and possibly marketing strategies and messages. Qualitative research findings were consistent and provide additional context for these findings.
[Show abstract][Hide abstract] ABSTRACT: Many of the services supplied by nature are externalities. Economic theory suggests that some form of subsidy or contracting between the beneficiaries and the providers could result in an optimal supply of environmental services. Moreover, if the poor own resources that give them a comparative advantage in the supply of environmental services, then payments for environmental services (PES) can improve environmental and poverty outcomes. While the theory is relatively straightforward, the practice is not, particularly in developing countries where institutions are weak. This article reviews the empirical literature on PES additionality by asking, "Do payments deliver environmental services, everything else being equal, or, at least, the land-use changes believed to generate environmental services?" We examine both qualitative case studies and rigorous econometric quasi-experimental analyses. We find that government-coordinated PES have caused modest or no reversal of deforestation. Case studies of smaller-scale, user-financed PES schemes claim more substantial impacts, but few of these studies eliminate rival explanations for the positive effects. We conclude by discussing how the dearth of evidence about PES impacts, and unanswered questions about institutional preconditions and motivational "crowding out," limit the prospects for using international carbon payments to reduce emissions from deforestation and degradation. Copyright 2010, Oxford University Press.
Review of Environmental Economics and Policy 01/2010; 4(2):254-274. · 2.15 Impact Factor