Behavior Change in Water, Sanitation, and Hygiene: A 100-Year Perspective

The current methodological paradigm for addressing water, sanitation, and hygiene (WaSH) inaccessibility in rural sub-Saharan Africa is achieving insufficient progress. This essay evaluates WaSH-related policy, programming, and discourse from 1918 to 2021 to identify how this paradigm evolved and how it may reform. I argue that political–economic environments have strongly influenced existing sectoral praxis, shaping both programmatic methods and means. Colonial occupations generated rural–urban material inequalities, which were maintained and exacerbated during postwar reconstruction (1950–1970) and the proliferation of neoliberalism (1970–1990s). Meanwhile, modernization theory, a fundamental feature of colonial thought, has persisted discursively and practically. That is, rural resource limitations led WaSH practitioners to promote lower-cost appropriate technologies in the 1980s. Then, with challenges regarding technological disuse and misuse, behavior change–oriented methodologies responsively emerged in the 2000s and continue today. Yet, much like colonial predecessors, this latter turn presupposes that its programmatic benefactors must adapt to access WaSH services. Behavior change programs thus fail to critically consider the role of technological inadequacies and associated risk exposures in perpetuating existing inequities. Investigation of utility-style service models, where WaSH services adapt to the lives of its benefactors and behavioral persuasion is substituted for nonuser technological management, is recommended.