The role of social identity in improving access to Water, Sanitation and Hygiene (WASH) and health services: evidence from Nepal

Motivation: COVID-19 has revived focus on improving equitable access to water, sanitation and hygiene (WASH) and health services in developing countries. Most public programming tends to rely on economic indicators to identify and target vulnerable groups. Can expanded targeting criteria that include social status help to improve not only targeting, but also equity in access to WASH and health services? Purpose: This paper assesses the role of social identity in mediating access to WASH and health services, controlling for economic disadvantages such as household wealth, income sources and assets. Methods and approach: We use regression analysis applied to the 2016 Nepal Demographic and Health Survey (DHS) to estimate the relationships between social identity and access to WASH and health services, controlling for wealth (using wealth index quantiles), and remittances (using indicator variables for domestic and international remittances). Findings: We find that differences in access are mediated in large part by caste, and religious and ethnic identity, especially in rural areas; suggesting that the supply of such services is lower for historically disadvantaged communities. In addition, communities with lowest access are not necessarily the most economically disadvantaged, indicating that relying solely on traditional economic indicators to target programs and interventions may not be sufficient to improve equity in access to public health services. Policy implications: The results make a case for broadening indicators beyond the economic criteria for improving targeting of public funds for more inclusive development.