Effect of a behaviour change intervention on the quality of peri-urban sanitation in Lusaka, Zambia: A randomised controlled trial

This paper by Tidwell et al. (2019) describes a randomised control trial carried out in Lusaka, Zambia, to determine the effect of a behaviour change intervention to motivate landlords to improve the quality of shared toilets on their plots in a peri-urban setting. The study was published in The Lancet Planetary Health. The intervention was developed using a Behaviour Centred Design approach and involved a series of group meetings designed to motivate sanitation quality improvement as a way to build wealth and reduce on-plot conflict. 1085 landlords were enrolled and no subsidies or materials were provided. Outcomes measured included having a rotational cleaning system (for hygiene), having a solid door on the toilet with an inside lock (for privacy), having an outside lock (for security) and having a sealed toilet (to reduce smell and contamination). Outcomes were measured 1 month before the intervention and 4 months after it ended. The intervention was associated with improvements in all of the outcomes, showing that it is possible to improve the structural quality and cleanliness of shared sanitation through behaviour change interventions and without provision of additional subsidies or materials.