Graduation Year


Document Type




Degree Name

MS in Environmental Engr. (M.S.E.V.)

Degree Granting Department


Major Professor

James Mihelcic, Ph.D.

Committee Member

Mingyang Li, Ph.D.

Committee Member

Mahmooda Pasha, Ph.D.


behavior change, female participation, market-based sanitation, SATO, Sub-Saharan Africa


Uganda aims to reach universal access to basic sanitation under Sustainable Development Goal #6, but achieving this target by 2030 would require doubling the annual rate of progress. Women are disproportionately affected by poor sanitation due to their health needs and risk of facing violence, but they have historically been excluded from sanitation planning. Low household demand and poor service delivery have stalled progress in Uganda. Market-based sanitation (MBS) is a novel method of developing a sanitation market through stimulating demand and supporting a competitive atmosphere for product and service providers. This research studies the sanitation marketing activities implemented by the Uganda Sanitation for Health Activity (USHA), a five-year MBS program established in 2018 by USAID. The activities include village-level trigger sessions, where demand is stimulated, sales pitches, and the use of USHA-trained masons. Gender effects on preferences, sanitation outcomes, and participation in household decisions and the sanitation marketing activities were studied.

Male and female preferences for sanitation products were analyzed, as well as households’ challenges and influencing factors during the process of sanitation improvement. Female-headed households had lower involvement in sanitation marketing activities and decision-making in the household, though they were 6.7% more likely to reach improved sanitation than male-headed households. Female-headed households faced challenges with access to sanitation financing and the work of pit diggers, and all households were faced with challenges related to financing and problems during the construction process.

The relationships between household head gender, sanitation outcomes, and participation in sanitation marketing activities and household decision-making were analyzed. A significant positive relationship between female inclusion during sanitation marketing activities and female decision-making in the home was identified. Female participation in household decisions increased by 6.0% where at least one-third of trigger session attendees were women and by 4.7% where men and women were seated in socially equal positions. Gender matching between salespeople and customers was shown to increase the likelihood of a household reaching improved sanitation by up to 10%, depending on gender and the household’s existing sanitation status. Community use of both USHA-trained and other professional masons was increased significantly when a household member or the mason attended a trigger session, signifying an impact of sanitation marketing activities on the broader service delivery market. Altogether, this research presents a novel outlook on the relationships between gender, participation, and sanitation outcomes.