Behaviour change interventions to promote household connectivity to sewer: a scoping review

Households without access to a functioning and well-managed sanitation system produce untreated faecal waste. While connecting households to sewers is ideal in densely populated low-income areas, the connection rates often remain low. Most interventions to increase connectivity focused on addressing financial, social, and legal barriers; there is limited evidence on the effectiveness of behaviour change interventions in promoting sewer connections. Thus, we aim to understand the effectiveness of behaviour change interventions in increasing the uptake of sewer connections. We developed a review protocol with key search terms relating to households, sewers, behaviour change interventions, promotion, and effectiveness. We aimed to identify both the types of interventions deployed and their impact on increasing household sewer connections. Eleven articles met the eligibility criteria and were included in the review. Findings indicate that changes in rates of connection were associated with interventions that included a blend of indirect financial subsidy in the form of a free connection and community-engagement activities. There was limited evidence that behaviour change campaigns without financial incentives lead to changes in sewer connection rates. A multi-component package involving financial subsidies with community engagement is likely to improve the sewer connection rate.