Date of Award

Spring 1-1-2013

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

First Advisor

Karl G. Linden

Second Advisor

Amy Javernick-Will

Third Advisor

JoAnn Silverstein

Fourth Advisor

Rita Klees

Fifth Advisor

Ned Breslin

Abstract

The continued maintenance of sanitation services post-implementation is a persistent challenge in less-developed countries that can often negate the anticipated health and economic impacts of sanitation investments. The school setting, in particular, may present an even greater test of service longevity due to the greater number and rapid turnover of stakeholders. In response, a number of drivers of well-maintained services have been posited in white and grey literature. However, there is a surfeit of factors and we lack evidence of which conditions are necessary and sufficient for continued service provision over time. This dissertation analyzes case schools in Peru, Belize, and Bangladesh to identify causal pathways to continued (and discontinued) maintenance of school sanitation services post-intervention. A novel method, Qualitative Comparative Analysis, facilitates the evaluation of collective influences and offers multiple models or a "roadmap" of conditions that provide high likelihood for continued maintenance of school sanitation.

Barriers and pathways to well-managed school sanitation are discussed for each study location specifically, followed by a multi-country cross-case fuzzy-set qualitative comparative analysis to provide more generalizable results. Based on case data from Peru, Belize and Bangladesh, two sufficient pathways to well-maintained school sanitation are identified as well as three pathways to poorly maintained services. Both pathways to well-maintained sanitation include high quality construction and local involvement in planning and construction, in combination with a local champion in one pathway and with financial support from the government and community in the second. All sufficient pathways to poorly maintained services include the absence of financial support from either the government, community or both, indicating the significance of reliable financial access to on-going maintenance and the negative impact that the absence of support for recurrent costs can have on capital investment.

This dissertation provides empirical evidence for multiple sufficient pathways to well-managed (and poorly managed) school sanitation in Peru, Belize and Bangladesh. The research methods and findings may have widespread implications for improving the reliability of sanitation and hygiene service provision in low-income schools, increasing potential for positive health and education impacts, as well as more effective resource utilization.

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