expanding reach into sanitation market through behavior change

WATER AND SANITATION PROGRAM: LEARNING NOTE

Expanding Reach into Sanitation Market through Behavior Change CommunicationsLessons from Rural Cambodia

September 2015

Key findings•Expandinglatrinesalesrequiresunderstandingconsumermotivationsforchange.ForruralCambodians,thedesireforstatus,fearof“losingface”andconveniencewerekeyreasonstoinvestinalatrine.

• Integratingareferralmechanismwithinthebehaviorchangecommunications(BCC)sessionsprovidesinterestedhouseholdswithjust-in-timeproductinformationandlinkstolocalbusinessesofferingsanitationservices.

•EngagingmembersoftheCommuneCommitteeforWomenandChildren2asfrontlineworkersprovidesanadditionalchanneltoreachhouseholdsthatmayotherwisenothavebeenreachedbytheprivatesectorsalesactivities.

•FindingsfromanevaluationsuggestthatanincreaseinlatrineuptakeandimprovedsanitationcoverageafteradditionalBCCinterventionsmayhaveoccurred,althoughtheresultswerenotstatisticallysignificant.

•Timeseriesdatafrom2012and2013showanincreaseinlatrinesalesaroundthetimeoftheBCCinterventionsuggestingthattheinterventionmayhavetriggeredsalesthatotherwisewouldnothavehappened.

IntRoduCtIonInCambodia,onlyoneinthreepeoplehas access to improved sanitationfacilities, reflecting one of the lowestsanitation coverage rates of anycountry in the Southeast Asian andPacific region.1 To accelerate accessto rural sanitation, the Water andSanitation Program (WSP) of theWorld Bank’s Water Global Practicehas supported Cambodia’s Ministryof Rural Development (MRD) in its

effortstointroduceandtest innovativesanitation marketing initiatives. In2009, in collaboration with iDE, anon-profit organization,MRD togetherwith WSP launched a sanitationmarketinginitiativeinKandalandSvayRieng provinces. This resulted in thedevelopmentofalow-cost,aspirationallatrine product that included ahygienicsubstructurebutnoshelterorinstallation costs. In addition, capacity

1UNICEFandWHO,ProgressonSanitationandDrinkingWater-2015updateandMDGassessment,20152CommuneCommitteeforWomenandChildrenexistsineverycommuneinCambodia;itsmission,amongotheraims,istoraiseawarenessoflawsandrightsforwomenandchildrenandtopromotehealth,education,andchildrendevelopment,includingregistrationofnewbornbabiesandchildren.

2 Expanding Reach into Sanitation Market through Behavior Change Communications

www.wsp.org

oflatrineproducerstomanufactureandinstallthelatrineswasbuilt,andsalesandpromotionalstrategieswere introducedtostimulateconsumerdemand.3Withintwoyears,morethan10,000latrineshadbeensoldinthetwoprovinces.4FurtherdetailscanbefoundintheWSPfieldnotetitled,“SanitationMarketingLessonsfromCambodia”.

PRoBLEM StatEMEntAnanalysisofthegeographicdistributionofsalesfromtheear-lysanitationmarketinginitiative indicatedthatsalesagents inCambodiaweresuccessfulatmarketinglatrinestohouseholdsalready interested in sanitation improvements. However, theprivatesectordidnothavesufficientincentivetoexpandsalesactivitiestohouseholdsnotyetreadytopurchasetoiletsattheinitialsalesevent.4Astrategytogeneratedemandforsanitationimprovementswasneededtocomplementtheprivatesector’sexistingeffortstoreachgreaternumbersofhouseholds.

In2011,WSPpartneredwithiDEand17Triggers,acreativeagency that specializes in behavior change communication(BCC), to revamp the social marketing and sales strategybeforeexpandingsanitationmarketingactivities toall com-munesintheKandalandSvayRiengprovinces.Oneofthemajor improvements to the strategy included the develop-ment of an evidence-based BCC campaign that could beusedbytheCommuneCommitteeforWomenandChildren(CCWC)tocomplementthemarketingactivities.CCWCsex-istineverycommuneinCambodiawithamissionto,amongothers, raise awareness of laws and rights forwomen andchildren, and tomobilize communities in health, educationandchildren’sdevelopment,includingregistrationofnewbornbabiesandchildren.

This Learning Note documents the process and lessonslearnedwhiledesigningandimplementingtheBCCactivitiesandengaginglocalgovernment,aswellasthetop-linefind-ings fromanevaluation thatwasconducted tomeasure itsadditionalimpact.6

aCtIonTodevelopanevidence-basedBCCcampaign,theteamhasconducted consumer research; developed campaign com-municationobjectives,messagesandactivities; trainedandmonitored frontline workers; and evaluated the impact ofBCCactivitiesonlatrineuptakethroughaquasi-experimentaldesign.

Consumer research:Inearly2011,researchwasconductedtounderstandthemotivationaldifferencesbetweenadoptersandnon-adoptersoflatrines,mapthedecision-makingpro-cessforhouseholds,andidentifykeyinfluencesateachstepofthepurchasingprocess.7FindingswereanalyzedusingtheSaniFOAM8frameworktounderstandwhatfactorsmayinflu-encehouseholds’opportunity,ability,andmotivationtoinvestinapour-flushlatrine,thepredominanttoiletpreferenceofru-ralhouseholdsinCambodia.AdditionalstudiesconductedbyWaterSHEDAsiawerealsousedtoinformthedevelopmentoftheBCCcampaign.9,10,11ThefindingsfromthestudiesaresummarizedinTable1belowaccordingtobehavioraldeter-minantsbasedontheSaniFOAMframework.

3DaniellePedi,PhyrumKov,andSusannaSmets,“SanitationMarketingLessonsfromCambodia:AMarket-BasedApproachtoDeliveringSanitation,”WaterandSanitationProgram,WorldBank,2012.4Ibid.5Ibid.6ClaireChase,VirginiaZiulu,PriyaLall,PhyrumKov,SusannaSmets,VirakChan,YengLun,“Addressingthebehavioralconstraintstolatrineuptake:EffectivenessofabehaviorchangecampaigninruralCam-bodia,”PaperacceptedforpublicationinWaterlinesJournal,(forthcoming).7PowerPointavailableuponrequest.8JacquelineDevineandYolandeCoombs,“IntroducingSaniFOAM:AFrameworktoAnalyzeSanitationBehaviorstoDesignEffectiveSanitationPrograms,”WaterandSanitationProgram,WorldBank,October2009.9“UnderstandingHouseholdConsumersintheEmergingSanitationMarketinCambodia,”WaterSHEDAsia,2010.10MimiJenkins,“CambodiaSanitationConsumerDemandBehaviorQualitativeStudy:HighlightsofKeyFindings,”WaterSHEDAsia,2010.11DaniellePedi,SophanaMel,SopheaPouvandMarionJenkins,“RuralConsumerSanitationAdoptionStudy,”WaterSHED,October2014

Expanding Reach into Sanitation Market through Behavior Change Communications 3

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Communication objectives and messages: Based onanalysisoftheresearchfindings,knowledgeandsocial/phys-icaldrivers—inparticularconvenience—werechosenasthekey behavioral determinants to address in the campaign,translatingintothefollowingcommunicationobjectives:

• Provideknowledgeofthetruepriceoflow-costlatrineoptions(knowledge)

• Highlight the shameand loss of face associatedwithnothavingatoilet(socialdriver)

• Stress the inconvenienceofhaving todefecate in theopen(physicaldriver)

Thecampaign’scalltoactionof“BuyorBuildaToilet”includ-edtwokeymessages:

• “Havingalatrinehelpsyousaveface”• “Life without a latrine is full of inconvenience andshame”

Channels and activities: While behavior change com-munications campaigns can deploy a suite of instruments,inter-personal communication (IPC) was chosen as thesole channel for reaching households formultiple reasons:1) results from the initial pilot revealed limited audiencerecall of messages delivered via mass-media channels;

table 1: Key research findings according to behavioral determinants

Focus Target population • Ruralhouseholdswithoutimprovedlatrines

Desired behavior • Buyorbuildalatrine

opportunity Access to water • AsmostruralCambodiansdesireapour-flushlatrine,accesstowaterisimportant.Gen-erally,wateraccessisnotconsideredaproblem,eveninthedryseasonformosthouse-holds.

Product attributes • RuralCambodianswanttoiletsthatlookgood,areodorfree,areeasytoclean,durableanddonotrequirefrequentemptying,ifatall.

• Theoverwhelmingmajoritypreferapour-flushmodeloverdrypit.Theyalsopreferatoiletthatallowsforanalcleansingandbathing.

ability Knowledge • 60%ofruralhouseholdswithoutalatrinedonothaveaccurateinformationofhowmuchalowcostlatrinecancost,includingthetruemarketpriceforsanitationmaterials.ManyhouseholdscitethatthecostoflatrineswouldrangefromUS$100-300.

• Mosthouseholdsareunawareofthefinancingoptionsavailabletothem.

Motivation Social drivers • StatusamongpeersandneighborsisanimportantdriverforruralCambodianstobuildtoilets.Theywouldliketohavewhattheirneighborshaveandalatrineisawaytogainstatusforfamilies.

• Householdsthatpracticeopendefecationarelookeddownuponbyneighbors,andthelackofatoiletforvisitorsisshameful.

• Familieswithadolescentdaughtersarealsomotivatedtoinvestinlatrinetoavoidhavingtheirdaughterbeseendefecatinginpublic,whichbringsshametothefamily.

Physical drivers • Havingtowalkafardistancethroughfieldslitteredwithfecesaredescribedasinconve-nientanddisgusting.

• Manyhouseholdsavoidedopendefecationatnightforfearofanimalbites,evilspiritsandrape.

Attitude • Individualsfeelthatopendefecationisacceptableaslongastheyarehidden.

Competing priorities • Householdsciteneedingmoneyforschool,medicalbillsandpurchasingfarmanimalsoverpurchasingalatrine.

Willingness to pay • Somehouseholds,alreadyindebt,arereluctanttoborrowmoneyforfearofnotbeingabletopayitback.


www.wsp.org

2) airing of mass media would be too expensive for localgovernmentbudgettosustain;and3)theBCCactivitiesaimtoinfluencehouseholdintentionstobuyorbuildalatrine,aprocess that requiredmultiplemessages thatwouldbe toocomplicatedtocoverinconventionaltelevisioncommercials.Thus,IPCactivitiesweredevelopedforimplementationintwophases,eachconsistingofanhour-longgroupmeetingledbyCCWCtobeconductedaroundlunchtimewhenmosthouse-holdmembersweremostlikelytobeathome.Sessionsweretargetedatthosehouseholdsthatdidnotyethavealatrine,whileonpurposeseverallatrineownerswouldalsobeinvit-edtoprovidetestimonyasneeded.Thegroupmeetinggavespaceforparticipantstointeractwithoneanotherandtogetinvolvedwiththewholelearningprocess.

During the first meeting, CCWCs encouraged participantstodiscusstheshameofbeingunabletoprovideatoiletforout-of-townguestsandembarrassmentofhavingtheirado-lescentdaughtersbeseendefecating in theopen.CCWCstheninvitedparticipantstoplayapricinggametohelpthem

understand the actual cost of dry-pit andpour-flush latrinemodelsandpositionlow-cost,naturalsheltersasbetterop-tionsthandefecatingintheopen.

In thesecondmeeting, targetedhouseholdswereexposedthroughaGalleryWalktopostersdepictingsituationswhereit is inconvenientorshameful todefecate in theopen.Par-ticipantswerealsoaskedwhy theyhadyet tobuildorbuya latrine—the facilitatorsbeingequippedwith visuals to re-spond to themost commonobjections and rebuttals suchas“nothavingenoughmoney,savingforatoiletwithacon-creteshelter,waitingforanNGOtoprovideoneforfree,”etc.Thesecondsessionconcludedwiththesamecalltoactionasthefirst:householdsinterestedinpitlatrineswereprovid-edwithsimple instructionsonhowtobuildone;andthoseinterestedinpour-flushlatrinesweregivenreferralcardswithcontact informationof localsalesagentsor latrinebusinessowners.BCCmaterialsusedinfirstandsecondmeetingscanbefoundintheSanitationMarketingToolkitCambodiasec-tionatwww.wsp.org/toolkit/cambodia.


www.wsp.org

training and monitoring: Tools developed included a fa-cilitator guide and training curriculum, a banner, puzzles,fansandposters, forusebyCCWCs(orother facilitatorsofIPC sessions in the community). Training focused on bothtechnicalandattitudinalaspectsofconductingIPCactivities.During implementation,CCWCswere shadowed byDistrictCommitteeforWomenandChildrenforanaverageoffiveses-sions andwereprovidedwith feedbackon their applicationofIPCmethodsandtools,usingachecklistthatwouldscoretheir“mind-set”,“skill-set”anduseofthe“tool-set”.Reflectionworkshopswereheldaftereachphase todiscussareas forimprovement,andmaterialswereadjustedaccordingly.

Engagement of local government: A challenge for localgovernmentduring thisprocesswas toallocate funds fromtheirlocalbudgettoimplementtheBCCactivities.Toaddressthis,anumberofworkshopswereheldwithdistrictandcom-muneofficialstoi)supporttheprioritizationofcommune-levelBCCactivities,andii)helpthemdevelopanadequateworkplanandbudget.Furthersupportwasprovidedtoboththedistrictandcommunestomonitorprogressofperformance.Withinthecontextofthegovernment’splanneddecentraliza-tionofruralsanitationfunctionstodistrictlevel,theseactivitieshavebeeninstrumentaltodemonstratehowcommunes-levelactorscantakeonamandateforsanitationservicedelivery.

Evaluation: In 2013, an evaluation of the BCC activitieswas conducted. The study compared communes inwhichonly sales activities took place—so called “nonBCCcom-munes”—with those in which sales activities were imple-mentedandcombinedwithBCCactivities—socalled“BCCcommunes”—tounderstand,primarily,theeffectivenessofanaddedBCCcomponentonlatrineuptake.12

RESuLtS• In total,more than20,000people (70%werewomen) in174villageswerereachedthroughtheBCCcampaignandanaverageof25peopleattendedeachIPCsession.

• The evaluation of the BCC intervention producedmixedresults.Asthesamplesizewasverysmall—only20com-muneswere selected for the intervention—itwasdifficulttogeneratestatisticallysignificantfindings.Availabledataseem tosuggestan increase in latrinepurchaseand im-provedsanitationcoverageafterBCCinterventions.

• Timeseriesdata from2012and2013 indicate thatwhilethe non-BCC communes have purchased more latrinesaroundtheagriculturalharvestperiod,theBCCinterventionseemstohavebeenabletoalsogeneratelatrinepurchaseoutsideofthatperiod.

12ThedetailedmethodologyandresultscanbefoundinClaireChase,VirginiaZiulu,PriyaLall,PhyrumKov,SusannaSmets,VirakChan,YengLun,“Addressingthebehavioralconstraintstolatrineuptake:EffectivenessofabehaviorchangecampaigninruralCambodia,”PaperacceptedforpublicationinWaterlinesJournal,(forthcoming).


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• In2014, followingthecompletionof theBCCactivities inthe20communes,fivedistrictsinKandalandSvayRiengprovinces agreed to scale up the IPC activities to morecommuneswithintheseprovinces.WSPprovidestrainingandmaterials,followingwhichthecommunescarryoutallIPCactivitieswiththeirownfunds.Theseeffortsarenowfurtherreplicatedaspartofagovernmentinitiativesupport-edbyWSPtotestthetransferofruralsanitationfunctionin10districtsintwoprovinces.

KEy LESSonSLessonsfromdesigningandimplementingtheBCCactivitiesincludethefollowing:

• Focus on motivations:Severalconsumerresearchstud-iesrevealedstatusandconveniencetobethekeydriversfor latrine adoption among rural Cambodians. Based onthis,BCCmaterialsfocusedontriggeringtheseemotionalandphysical drivers rather thandiscussingmore rationalbenefitstoimprovedsanitationsuchashealth.

• Latrine adoption becomes easier when solutions are provided in terms of supplier contacts, products and

prices: Theobjectiveof theBCCactivitieswas tomoti-vatehouseholdstowardsbuyingorbuildingalatrine.AttheconclusionoftheIPCsessions,CCWCsprovidedhouse-holdswithcontactinformationtorelevantenterprises,serv-ingasabridgebetween thehouseholdsand the sanita-tionproviderandeliminatingconsumerhurdlestoseekoutpurchasingoptions.Providingan immediatesolutionmaypartlyexplainwhylatrineadoptionratesweresignificantlyhigherthroughoutthedurationofthecampaign.

• addressing affordability requires more than commu-nication: Accordingtoa2010NationalSanitationandHy-gieneKnowledge,Attitudes,andPracticesSurvey,53%ofCambodianhouseholdsbelieved,mistakenly,thatitwouldcost US$100 or more to build an acceptable latrine fortheir family.Thismisperceptionwasconfirmedby the ru-ralconsumersanitationadoptionstudy.13Toaddress thisknowledgegap,BCCactivities focusedon revealing thattheactualpriceofapour-flushlatrinebuiltwithalow-costsheltercouldbeas littleashalfof theperceivedprice. Italso positioned this price level “as achievable”, in com-parisonwithotheraspirationalconsumergoods,suchasmotorbikesandTVsets.Addressingaffordability,however,

13Ibid.


www.wsp.org

cannotberesolvedthroughcommunicationsalone.Low-erincomehouseholdsareoftenunabletopaytoup-frontcostsofalatrineandneedassistanceintheformofsmallloansorpaymentplanstofinancethepurchase.14

•Mentoring and supervision are critical to quality de-livery of BCC activities: CCWCsareoften selectedasfrontline workers because of their mandate to carry outoutreachactivitiesandtheirextensivegrassrootsnetwork,indispensable forgoingtoscalenationally.Aspartof thisinitiative, theywereprovidedwitha three-day trainingoncommunicationskillsatthestartoftheprogram.However,results frommonitoring activities revealed thatmentoringandclosesupervisionoftheCCWCswerestillnecessarytodeliverqualityBCCactivities.

•Commune leadership and implementation is fea-sible, with the right support structures: Other thantesting the implementation and effectiveness of using anevidence-basedBCCtoolkit, thispilotalsodemonstratedthecapacityandfeasibilityofcommune-ledsanitationpro-motionactivities.Adequatesupportstructuresfromdistrictandexternalmentorsarecriticalinsuchastart-upperiod.

What ELSE do WE nEEd to KnoW?Manyvaluablelessonshavebeenlearnedthroughoutthepro-cess.Therearestill,however,outstandingquestions:

• Sustaining momentum for IPC activities: Followingcompletionof IPCactivities in thecurrent20communes,someCCWCshavebeenabletocontinuetheIPCactivitiesusing their own resources.However, theextent towhichCCWCswill be able to sustain activities andwhat is re-quired tokeep themmotivated tocontinueneeds furtherlearning,whichwillbeapartoftheWSP-supporteddecen-tralizationpilotofsanitationfunctionsin10districts.

• targeting men in BCC activities: IPCactivitieswerede-signed to takeplaceduring lunchtimewhenat leastonehouseholdmemberwould be home.Monitoring data in-dicatethatthemajorityofparticipantsattheIPCsessionswerewomen15—butthenationalKAPsurveyindicates46%

ofhouseholds reported thathusbandandwife jointlyde-cideonalatrine.16Thus,itwouldbeworthwhiletounder-standwhetherpurchaseintentandsalesincrease,shouldIPCsessionsreachmoremen.

• addressing social norms: Formative research and im-plementation of BCC activities have revealed numerousinsights regarding behavioral determinants for householdadoptionoflatrines.Inaddition,Community-LedTotalSan-itation(CLTS)activitiesinCambodiahaveshownthatbuild-ingcollectivepeerpressureforlatrineadoptioncanbeveryeffective.AremainingchallengeishowtodevelopthenextgenerationofBCCmaterialstosustaincollectivepressurecreatedbyCLTSandwherebyhavingalatrineisthenewnorminruralCambodia.

RELatEd REadIngRogers,Everette.Diffusion of Innovations,5thed.,(NewYork:

FreePress,2003).

Devine,JacquelineandYolandeCoombs. Introducing San-iFOAM: A Framework to Analyze Sanitation Behaviors to Design Effective Sanitation Programs. Water andSanitationProgram,WorldBank,October2009.http://www.wsp.org/sites/wsp.org/files/publications/GSP_sanifoam.pdf

Ministry of rural Development.National Sanitation and Hy-giene Knowledge, Attitudes and Practices (KAP) Sur-vey.2010.

National Institute of Statistics. Cambodia Socio-Economic Survey, 2009.MinistryofPlanning,2010.

Water-SHEDAsia.Understanding Household Consumers in the Emerging Sanitation Market in Cambodia. 2010.http://www.watershedasia.org/sanitation-marketing-re-sources/

MimiJenkins.Cambodia Sanitation Consumer Demand Be-havior Qualitative Study: Highlights of Key Findings.Wa-terSHEDAsia,2010.

14AdamNewman,SusannaSmets,andPhyrumKov“Makingtoiletsmoreaffordableforthepoorthroughmicrofinance”WaterandSanitationProgram,WorldBank,2014.15iDE,“ScalingupSanitationMarketinginCambodia:GoingDeep,”BehaviorChangeCommunications:FinalReport,December2013.16Ibid.


WSP. Scaling Up Rural Sanitation: Findings and Recommendations.PowerPoint presentation. Cam-bodia. 2011. available upon re-quest.

DaniellePedi,PhyrumKov,andSusan-na Smets. Sanitation Marketing Lessons from Cambodia: A Mar-ket-Based Approach to Delivery Sanitation.WSP. 2012. Availableathttp://www.wsp.org/sites/wsp.org/files/publications/WSP-San-itation-marketing-lessons-Cam-bodia-Market-based-del iver-ing-Sanitation.pdf.

UNICEFandWHO.Progress on Drink-ing Water and Sanitation 2012 Update (2012).Availableathttp://www.unicef.org/media/files/JM-Preport2012.pdf

17 Triggers. iDE/CCWC Monitoring Workshop Report.2013.availableuponrequest.

TheWaterandSanitationProgramisamulti-donorpartnership,partoftheWorldBankGroup’sWaterGlobalPractice,supportingpoorpeopleinobtainingaffordable,safe,andsustainableaccesstowaterandsanitationservices.WSP’sdonorsincludeAustralia,Austria,Den-mark,Finland,France,theBill&MelindaGatesFoundation,Luxembourg,Netherlands,Norway,Sweden,Switzerland,UnitedKingdom,UnitedStates,andtheWorldBank.

Thefindings,interpretations,andconclusionsexpressedhereinareentirelythoseoftheauthorandshouldnotbeattributedtotheWorldBankoritsaffiliatedorganizations,ortomembersoftheBoardofExecutiveDirectorsoftheWorldBankorthegovernmentstheyrepresent.

©2015InternationalBankforReconstructionandDevelopment/TheWorldBank

AcknowledgmentsTheauthorswouldliketothankSusannaSmets,JacquelineDevine,EduardoPerez,EmilyChristensenRandandAlmudWeitzfortheircontributionstothisdocument.WewouldalsoliketoacknowledgestafffromiDE,17TriggersandWaterSHEDAsia,aswellasBorapichDanforhertechnicalguidanceinthedesignoftheBCCmaterials

About the programToday,2.5billionpeoplelivewithoutaccesstoimprovedsanitation.Ofthese,71percentliveinruralcommunities.Toaddressthischallenge,WSPisworkingwithgovernmentsandlocalprivatesectorstobuildcapacityandstrengthenperformancemonitoring,policy,financing,andothercomponentsneededtodevelopandinstitutionalizelargescale,sustainableruralsanitationprograms.Withafocusonbuildingarigorousevidencebasetosupportreplication,WSPcombinesCommunity-LedTotalSanitation,behaviorchangecommunication,andsanitationmarketingtogeneratesanitationdemandandstrengthenthesupplyofsanitationproductsandservices,leadingtoimprovedhealthforpeopleinruralareas.

Contact Us Formoreinformationpleaseemailwspeap@worldbank.orgorvisitwww.worldbank.org/waterorwww.wsp.org.

iDE. Scaling up Sanitation Marketing in Cambodia: Going Deep. Behavior Change Communications: Final Report. December 2013. avail-ableuponrequest.

WHOandUnicefJointMonitoringPro-gramforWaterSupplyandSani-tation.

Danielle Pedi, Sophana Mel, SopheaPouv and Marion Jenkins. Ru-ral Consumer Sanitation Adop-tion Study.WaterSHED.October2014.

ClaireChase, Virginia Ziulu, Priya Lall,Phyrum Kov, Susanna Smets,VirakChan, Yeng Lun.Address-ing the behavioral constraints to latrine uptake: Effectiveness of a behavior change campaign in ru-ral Cambodia.Paperacceptedforpublication inWaterlinesJournal,(forthcoming).

By Phyrum Kov, nga Kim nguyen and Virak Chan

expanding reach into sanitation market through behavior change

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