In my previous blog,
I described the prevalence and predicaments of open defecation (OD) in India. For
my PhD thesis, I am working with GDS to make villages open defecation free
(ODF) by investing in construction of toilets as well as bringing about a
behavior change and estimating the impact on the adoption of toilets, child
health and basic sanitation practices. Our recently completed census baseline
survey gives us imperative insights to do the same.
In this blog, I’ll share early findings from these field
interventions and discuss how these insights help us to analyze existing and
prevalent public policies.
Lack of toilets or behavior change? Or both?
Nearly 95% of the households in our survey do not own a toilet
and only 4% use a community
toilet. Government interventions are yet to reach Eastern U.P. When
asked “Why do you go out for OD?”,* a staggering 48.90% of the respondents
(representative women of the households) acknowledge the practice of OD as
“tradition or habit or have always done so”, essentially revealing a preference
for open defecation. Following closely,
48.71% of the respondents identify the lack of toilets as their reason for OD. This result makes a strong case for an intervention that incorporates both
behavior change and toilet construction. This means that we are on the right
[*Note: “Why do you go out for OD?” was a multi-response question and the enumerators
were trained not to prompt the respondents.]
Proud owners of toilets. Only 5% of the households in our project
area own a toilet. (Photo credit: Payal Seth)
viral contamination, resulting in anemia, diarrheal disease, and acute
respiratory infection, end the lives of nearly three million children per year
and contribute to the severe stunting of millions more. Handwashing with soap
is widely regarded as “the most cost-effective vaccine” against such deaths
(World Bank 2005), as it decreases person-to-person transmission and protects
the last point of contact between the body and germs (WHO 2009). Unfortunately, however, only 10% of our
respondents wash their hands with soap after defecating. Because our intervention
includes awareness-raising and training with regards to handwashing practices,
this finding affirms our approach and raises our confidence that the
intervention design may make a significant difference in the health and
nutrition of the people.
A training session in practice: A representative woman or
man from each household in the intervention village was trained on how to use
the soap and pour water. They were encouraged to practice this handwashing
technique at critical moments in the fecal-oral transmission route. (Photo credit: Payal Seth)
Need for reassessing government policies
There is a stark digression between the current government
policies and the requisite changes in the field. In fact, while addressing the
group of scholar, academics, and scientists at the conference in National
Institute of Agricultural Economics and Policy Research (NIAP), TCI Director
Prabhu Pingali said, “a brick and mortar model of providing toilets under the
government’s Swach Bharat Abhiyan (SBA)** fails to identify the root of the problem: a need for behavior change to
successfully control open defecation”.
[**Note: Swachh Bharat Abhiyan (In English: Clean India
Mission) is a campaign by the Government of India to reduce or eliminate
open defecation through the construction of individual, cluster and community toilets by
2 October 2019, by constructing 12 million toilets in rural India, at a
projected cost of ₹1.96 lakh crore (US$30 billion).]
Even though there have been attempts to
include celebrities to propagate the use of toilets, SBA is heavily fixated on
the provision of hardware without complementary investments in behavior change software (as Dr. Pingali rightly pointed out).
Another disturbing trend in current public policy frame is
the abominable absence of handwashing messaging. There has been no broadcast
that encourages handwashing, let alone the correct methodology for the same.
The significance of handwashing has been unacceptably understated or completely
The experimental design for my PhD dissertation has been carefully
planned to account for these gaps and to provide an alternative approach as
well as robust evidence for achieving open defecation free villages and
improved child nutrition. Our behavior change intervention consists of
community led total sanitation (CLTS) (Click here for more details on the CLTS methodology.) along with proper training on handwashing. CLTS facilitates a community’s analysis of their own sanitation profile. Using
interactive activities and thought-provoking discussion, the community reflects
on their practices of defecation which leads to greater awareness of the
consequences of mass open defecation. The community then becomes motivated to
change, and leverages social pressure to get individuals to adopt toilet-use.
Meanwhile, our module on
handwashing discusses the proper way of washing hands ― using soap instead of
ash and mud, rubbing the hands with soap and then pouring water on it,
repeating the process not just after defecating but also before cooking food,
feeding the baby, etc.
These keen children
learn the proper way of handwashing as taught by Payal Seth (author).
Finally, I’ve seen first-hand the value of conducting a
rigorous baseline study. This is of utmost importance because it helps the
researcher validate the interventions in the field. It is only then that the next stage follows.
As we move ahead in our
study, we are interested in understanding the returns behavior change has on
the adoption of toilets and nutrition. Please look out for our new posts as we
continue to analyze interesting facts from our data!
By Payal Seth
Seth is a PhD Student and a Tata-Cornell Scholar in the Charles H. Dyson School of Applied
Economics and Management. Her research focuses on linkages between sanitation and