Cultural preferences for the methods and motivation of sanitation infrastructure development

Research has found that sanitation infrastructure is cultured, or is shaped by national level cultural preferences. This study expands on this past work to identify causal pathways showing combinations of cultural dimensions that explain sanitation infrastructure technology choice, including total access to improved sanitation facilities, sewerage connections and access to onsite treatment technologies. This analysis uses fuzzy-set qualitative comparative analysis to analyze all possible combinations of causal conditions which contribute to an outcome of interest. In doing so, pathways are discovered using Hofstede’s cultural dimensions as causal conditions and national-level sanitation data as outcomes. Findings show that the cultural dimensions of power distance, individualism versus collectivism, and uncertainty avoidance play a dominant role in sanitation technology choice. These cultural preferences are used to create an analytic framework thatmaps the cultural dimensions to the methods and motivations of common sanitation infrastructure delivery methods. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/). doi: 10.2166/washdev.2017.188 s://iwaponline.com/washdev/article-pdf/7/3/407/159089/washdev0070407.pdf Miriam E. Hacker (corresponding author) Jessica A. Kaminsky Department of Civil and Environmental Engineering, University of Washington, 201 More Hall, Seattle, WA 98195, USA E-mail: meh7@uw.edu


INTRODUCTION
The need to provide sanitation is motivated by the direct relationship between the use of improved water, hygiene and sanitation infrastructure and a decrease in the incidence of diarrheal disease (USAID ). This is a significant public health challenge; in 2013 diarrheal disease was listed as the second leading cause of death for children under the age of five (WHO ). While various approaches have been taken to understand this gap in sanitation infrastructure, this study focuses on the relationship between national cultural descriptors and sanitation outcomes (White ). We seek global trends that (1) rigorously describe cultural preferences and (2) link them to sanitation infrastructure; when leveraged locally, these may help the development community systematically design and deliver more culturally appropriate infrastructure. This will help researchers better understand how sanitation infrastructure embodies implicit cultural values, and will enable policy makers and engineers to adapt project design and delivery to better fit diverse cultural preferences.

POINT OF DEPARTURE: HOFSTEDE'S CULTURAL DIMENSIONS
Multiple tools for cross-national cultural assessments exist, including Hofstede's cultural dimensions, GLOBE and Trompenaars' model of national culture differences (Magnusson et al. ). Out of these assessments, Hofstede has been the most cited (Jones ) and is used as the basis for other cross-national cultural assessments because of its extensive dataset (Taras et al. ). Therefore, it was also selected for use in this study. Kaminsky , ).

Method vs. motivation
We explain the observed link between cultural dimensions and infrastructure technology type by proposing an analytic framework that maps a connection between culture and the methods and motivations by which sanitation projects are designed and constructed. Results of these analyses are discussed within the context of this framework.
According to the Merriam-Webster Dictionary, method is 'a careful or organized plan that controls the way some-

Fuzzy-set qualitative comparative analysis
This paper uses fuzzy-set qualitative comparative analysis (fsQCA), a set theoretic method used to find relationships between outcomes and sets of causal conditions. Using fsQCA provides the ability to analyze smaller datasets than conventional regression and reveals all possible combinations of factors (or pathways) which lead to the outcome (Ragin ). Each condition is measured by set membership on a calibrated scale. This calibration is important because it is frequently inaccurate to say that a case is at a place of absolute membership or lack thereof. For example, an individual typically does not have just two categories of food preferences (e.g. like vs. dislike) but rather varying categories of relative acceptability. Similarly, sanitation outcomes in this study have varying levels of membership. This is quantified on a 0 to 1 scale associated with the percentage of sanitation outcomes at the national level. Any There has been some debate as to whether individualism and collectivism exist as polar opposites rather than having overlapping qualities. For example, within religious organizations, both individualistic and collectivistic qualities, such as uniqueness and self-sacrifice, are encouraged (Schimmack et al. 2005). Regardless, studies have validated Hofstede's work to determine that IDV is adequate for comparison of culture (Schimmack et al. 2005). b The author contends that these traits can be attributed to both men and women within a society; this dimension more accurately describes the styles of socialization rather than gender roles. However, to maintain consistency with published literature, the existing nomenclature will remain intact for the present analysis.
given combination (or pathway) of causal conditions is considered to be significant if it has a raw consistency of 80% or greater (Ragin ). Consistency measures the degree to which the causal conditions and specific pathways are sub- However, in the analysis of total access to improved sanitation facilities, data were available for 30 developing countries, contributing to just below 50% of the dataset. In addition to availability of data, the scope of the survey was limited to IBM employees and as such was not taken from a statistically representative sample of national populations. The various combinations of available data considered in this paper are detailed in Table 4. The dataset includes all nations that had data for both the indicators and outcome; as described below, this number is different for the various runs. When analyzing change in sanitation, only countries with a change greater than 1% were included since we are interested in the difference and wanted to discard cases that have no change in outcome.

Data analysis
The data that were included in the analysis include national

RESULTS AND DISCUSSION
Fuzzy-set QCA identifies possible pathways which lead to specified outcomes. Comparable to a baking recipe, different combinations of the same ingredients can lead to many delicious outcomes. Similarly, resulting pathways are a combination of either high or low levels of membership in a cultural dimension, as shown in Table 2.  Table 3. The scope of analysis for each dominant pathway is presented in Table 4. For example, Pathway 1 encompasses membership from both developing and developed countries with a consistency ranging from 0.80 to 0.93 and a unique coverage from 0.23 to 0.84 (Table 3). This pathway was observed in five different runs (Table 4) with a maximum of 64 countries analyzed.
To reiterate, these pathways do not imply that cultural dimensions are exhibited in each individual project within

Total access to improved sanitation
Two pathways lead to increased total access to improved sanitation: PDI* ∼ IDV and PDI* ∼ IDV*MAS*UAI. One critical observation is both pathways include the combination of membership in power distance as well as collectivism, describing cultural preferences for strong hierarchical frameworks in combination with a collective mindset. Using the analytic framework proposed earlier,

Onsite treatment
The final dominant pathway relates to the coverage of onsite treatment facilities at a national level: PDI* ∼ IDV*UAI.

CONCLUSION AND POLICY IMPLICATIONS
The purpose of this study is twofold: to discover relation- The most general contribution of this work is the identification of analytically robust cultural descriptors from the academic literature that provide a structure for understanding how culture influences sanitation infrastructure around the globe. However, and as cogently noted by a reviewer, the national unit of analysis used here is less than ideal for either the description of culture or application to individual sanitation projects. Still, we claim the relationships that emerged from the data represent global trends that may be practically applied at the project level. The caveat, of course, is that local cultural preferences must be rigorously understood before the more generalized relationships discovered in this analysis will be usefulthese local preferences will often not be the same as the more aggregate, national preferences. For example, regardless of where a particular community falls on the spectrum of individualism vs. collectivism preferences, we now know that this is a cultural force that influences sanitation infrastructure and should be considered during project design and delivery.
To aid these endeavors, future project-level research should continue to map project delivery methods and technologies to the analytic framework proposed here. In addition, future research is needed to create new project delivery methods that better fit cultural preferences that are poorly served by current approaches.
Additional information to support the contents of this document is available online. This includes comprehensive results and a sample truth table for the fsQCA (Table S1).