Can Leaders Promote Better Health Behavior? Learning from a Sanitation and Hygiene Communication Experiment in Rural Bangladesh

This study looks at the roles that local women leaders can play in addressing the important environmental health issue of sanitation and hand hygiene by improving access to quality sanitation and hygiene practices through information and education campaigns and promotions. Pathogens of fecal origins (coliforms and other bacteria in addition to helminthes) still pose an important public health hazard for poor households in Bangladesh and elsewhere, which impose a significant disease and mortality burden. We devise an experiment where we exogenously vary the leadership capacity of the women leaders and their involvement in the sanitation and hygiene campaigns. We find that, in the treatment areas, households report higher interaction with local women leaders and community women group members compared to the control areas. However, we neither find a reduction in the number of households engaged in the practice of open defecation (which was anyway already very low before the interventions) nor an increase in the number of latrine construction. We further look at objective hand hygiene outcomes as measured by bacteriological counts on the hands of very young children and their primary female caregivers. We find that interactions with the local women leaders have positive impacts on hand hygiene outcomes as suggested by a reduction in the microbial counts of total coliforms, fecal coliforms and E. coli in the hand samples of theyoung children though not for those from the mothers. We conclude that leadership capacity can be effective in improving sanitation and hygiene outcomes that are mainly behavioral in nature and do not involve substantial financial investment.