# Behaviour change interventions to promote household connectivity to sewer: a scoping review

## TL;DR

This study finds that combining financial help with community involvement is more effective than just behavior change campaigns for getting households connected to sewers in low-income areas.

## Contribution

The paper provides new evidence on the effectiveness of multi-component interventions combining financial subsidies and community engagement for promoting sewer connections.

## Key findings

- Multi-component interventions with financial subsidies and community engagement significantly improve sewer connection rates.
- Stand-alone behavior change campaigns without financial incentives have limited impact on sewer connection rates.

## Abstract

Households without access to a functioning and well-managed sanitation system produce untreated faecal waste. While connecting households to sewers is ideal in densely populated low-income areas, the connection rates often remain low. Most interventions to increase connectivity focused on addressing financial, social, and legal barriers; there is limited evidence on the effectiveness of behaviour change interventions in promoting sewer connections. Thus, we aim to understand the effectiveness of behaviour change interventions in increasing the uptake of sewer connections. We developed a review protocol with key search terms relating to households, sewers, behaviour change interventions, promotion, and effectiveness. We aimed to identify both the types of interventions deployed and their impact on increasing household sewer connections. Eleven articles met the eligibility criteria and were included in the review. Findings indicate that changes in rates of connection were associated with interventions that included a blend of indirect financial subsidy in the form of a free connection and community-engagement activities. There was limited evidence that behaviour change campaigns without financial incentives lead to changes in sewer connection rates. A multi-component package involving financial subsidies with community engagement is likely to improve the sewer connection rate.

Main findings: Behaviour change interventions combining financial subsidies with community engagement significantly improve household sewer connection rates, while stand-alone behaviour change campaigns have limited impact.Added knowledge: This study demonstrates the critical role of multi-component interventions, integrating financial incentives and community participation, in promoting sewer connections in low-income, densely populated areas.Global health impact for policy and action: Policymakers should prioritise implementing multi-component interventions that combine financial subsidies for sewer connections with community engagement strategies, tailoring approaches to local socio-economic and cultural contexts to maximise sanitation uptake and health benefits.

Main findings: Behaviour change interventions combining financial subsidies with community engagement significantly improve household sewer connection rates, while stand-alone behaviour change campaigns have limited impact.

Added knowledge: This study demonstrates the critical role of multi-component interventions, integrating financial incentives and community participation, in promoting sewer connections in low-income, densely populated areas.

Global health impact for policy and action: Policymakers should prioritise implementing multi-component interventions that combine financial subsidies for sewer connections with community engagement strategies, tailoring approaches to local socio-economic and cultural contexts to maximise sanitation uptake and health benefits.