Flushing out Barriers to Sewerage Connections: Results from a Cluster Randomized Trial in El Alto, Bolivia

Low levels of household sewerage connectivity constitute a pervasive challenge in low-income, peri-urban settings, limiting the potential benefits of sanitation systems. The situation calls for better understanding of what drives households decisions to invest in sewerage connections. This paper tested a multi-component communication campaign that combined broadcast messaging, “edutainment” activities, and personalized outreach. The intensive 11-week campaign was randomly assigned to a subset of 31 neighborhoods in the city of El Alto, Bolivia. The effects on a sample of over 1,300 households that were not connected to the sewerage system at baseline were then measured. The intervention increased household sewerage connection rates by 11.2 percentage points over 16 months, a 26 percent improvement relative to the control group. Treated households also reported better-quality connections. These results underscore the potential effectiveness of behavioral change strategies delivered through communication and edutainment campaigns to influence sewerage connectivity.