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Shame or subsidy revisited: Social mobilization for sanitation in Orissa, India

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. FINDINGS: 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). CONCLUSION: 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.


Pattanayak, S., Yang, J-C., Dickinson, KL., Poulos, C., Patil, S., Mallick, RK., ... Praharaj, P. (2009). Shame or subsidy revisited: Social mobilization for sanitation in Orissa, India. Bulletin of the World Health Organization, 87(8), 580-587. https://doi.org/10.2471/BLT.08.057422

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