The appropriateness and effectiveness of different policy instruments in fostering improved sanitation and hygiene practices in different contexts is debated. ‘Sermons’ inform on recommended behaviours, ‘carrots’ initiate behaviours, and ‘sticks’ restrict, deter, and punish undesirable behaviours. Through the lens of ‘carrots’ ‘sticks’, and ‘sermons’, this article analyses two approaches to sanitation promotion as they have been implemented in Rwanda and Uganda. The Community Health Clubs (CHCs) approach is the policy choice in Rwanda whereas Community-Led Total Sanitation (CLTS) is predominantly promoted in Uganda. Building on a survey of 1173 households in both countries, this article contributes to the ongoing debate with insights on how target populations perceive the options promoted by the different approaches in influencing behaviour change outcomes, or not.  

This study reveals significant differences regarding observed latrines, handwashing facilities, soap and water at the handwashing facility, and reported handwashing with soap and water between most of the study sites with CHC and CLTS intervention and those with no CHC and CLTS intervention. The observed differences are indications of the effectiveness of the interventions in changing behaviours. Similar differences are observed between best performing CLTS (ODF declared) and poor performing CLTS (ODF not yet declared), which underlines the importance of proper implementation. The study suggests support for using a combination of ‘carrots’, ‘sticks’, and ‘sermons’ which are all perceived as effective but for different reasons. Incentives for good sanitation practices and proper hygiene behaviour are perceived by respondents as a source of commitment and competition. Health messages are generally preferred for raising community awareness. However, the application of educational appeals - which are perceived as the most legitimate instruments and predominantly used in CHC and CLTS interventions – is insufficient for achieving universal compliance in the short-term. Other instruments can trigger short-term desired changes but may not be legitimate. This is the case with fines and naming and shaming which are perceived as effective but may compromise social relations and values. Findings also reveal that there is a common understanding among respondents that the responsibility for providing resources for construction and maintenance of sanitation facilities is a shared one. However, respondents’ ability to fulfil this responsibility is partly hampered by poverty and water availability related constraints.