Shame or subsidy revisited: social mobilization for sanitation in Orissa, India (pdf, full-text). IN: Bulletin of the World Health Organization; forthcoming article
Subhrendu K; et al.
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 (those eligible for a government subsidy) and from 7% to 26% in households above the poverty line (those 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.
Sanitation Updates 
I really enjoyed this article — great work! We need more research like this in other regions — most notably Sub-Saharan Africa. I’ve found a lot of resistance to the idea of community-led total sanitation in Africa, and we need more evidence of how (or if) the process can be adapted in other regions.
My only criticism of the article is that CLTS is boiled down to the word shame. There are other important components: empowerment (as the article describes), identification of champions, as well as promotion of critical thinking. These aspects of CLTS should be more carefully considered.