Date of Award


Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)


Public Policy

First Advisor

Erin O'Brien

Second Advisor

Amit Patel

Third Advisor

Rosalyn Negrón


This study investigates why sanitation outcomes vary across urban poor communities in Delhi, India. Unequal access to quality sanitation has serious implications for the health, dignity, and economic well-being of the poor and public health in general due to risks of environmental contamination. For this multiple-case study, a sample of 15 communities is drawn from slums, public housing, homeless shelters, and the streets. The database comprises of direct observations of sanitation outcomes in these communities, interviews with 95 key policy informants, official documents of relevant government agencies, newspaper articles, and a perception-of-the-poor survey of 30 sanitation bureaucrats. Thematic analysis of government documents and interviews with officials reveals a laissez faire framework for governing sanitation where the state plays a limited role of building infrastructures. Broadly speaking, the poor are blamed for unsanitary conditions that arise due to limited government intervention, and are handed the responsibility of service management for sanitation improvement. To then understand why outcomes vary within this broader framework, the qualitative dataset is analyzed using process-tracing to uncover policy decisions across communities. Variations in social constructions of the poor by policymakers have a dominant influence in shaping policy decisions. Perceptions of unsanitary habits and incorrigible, irresponsible behaviors result in lack of government support and worse sanitation outcomes in “deviant” communities. Government support for better sanitation is justified as civic education of the communities perceived as needy “dependents”, and a reward for politically organized “contender” communities. A quantitative cultural consensus analysis of the survey shows that a majority of the bureaucrats share a strongly-held view of the poor on the dependent-deviant spectrum. This largely corroborates the qualitative findings. Clientelist politics is the other influential factor that shapes policy decisions. Poor communities access service improvements by exchanging votes with politicians and solidarity with service providers. The strength and longevity of these clientelistic exchanges influences the timing and provision of entitled sanitation services in client-communities. Findings show that inequitable sanitation outcomes are manufactured by biases that blame the poor for service deficits and make the provision of entitled benefits contingent on political mobilization of exhibiting “good citizenship.” This has serious implications for democratic accountability between the government and the very citizens that are most in need of public services to meet their sanitation needs.

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