In India, ending open defecation requires more than just behavior change

It’s been 10 months since India officially launched Swachh Bharat, a national cleanliness drive, which, among other things, aims to put an end to the practice of open defecation in the country by 2019.

To meet its target, some 30 million people need to be convinced to build and use toilets each year. But the $31 billion program has been criticized for cutting funding for education and communication intended to do the convincing. It has instead focused on subsidy-fueled construction, targeting more than 110 million toilets in five years.

Nongovernmental organizations are warning the mission will fail unless people are motivated to change habits. And they’re working alongside the government to try to make it happen —innovating behavior change techniques, leveraging technology and partnering with companies.

Designing behavior change programs is particularly difficult in India, according to Vinayak Chatterjee, chairman of Feedback Foundation, which runs several such endeavors funded by the World Bank. There are multiple languages, religions, castes and tribes, and no single method works for them all, he said.

“What might trigger a Hindu majority population, won’t work for Muslim,” he noted.

Community-led total sanitation is one of the most widely used methods to stop open defecation. Developed in Bangladesh, CLTS aims to generate demand for toilets in a community by triggering feelings of disgust. But this doesn’t work so well in India either.

“That trigger works well if you’re a tight-knit community,” a UNICEF official explained. “But in the nontribal areas there’s a divide: the caste system.”

When piloting CLTS, UNICEF found it effective in India’s tribal areas but saw it “does not work at all well” in general communities — which make up the majority of the population. So the agency is encouraging state governments to adopt it in tribal areas.

Targeted messaging

Simply stating the health risks is also not enough, according to those in field.

In a pilot sanitation program in rural Karnataka, philanthropic foundation Arghyam found many people were already well-aware of the risks and health benefits of having toilets.

The local women also wanted toilets, although they didn’t cite health reasons. Instead, they talked about the inconvenience of having to wait until dark so nobody saw them, humiliation from being caught and fear of getting attacked.

Why weren’t they building any?

Because the local “men didn’t feel the need,” explained Balalji Gopalan, from communications agency Center of Gravity. “And they’re also the decision-makers in this because it’s a financial decision, and in India men make the financial decisions.”

The mission does allow for 12,000 rupees ($187) as subsidy for each family, but it will only be paid after the toilet is built.

In partnership with Arghyam, Center of Gravity designed a campaign promoting the idea that building a toilet was a father’s “responsibility,” using films, posters and songs, and highlighting local fathers with toilets to inspire others. At the end of four months, 32 percent of families in the villages they were targeting had built a toilet. The state has asked Arghyam to repeat the program in other areas.

It was the first time the foundation engaged a for-profit company to design a communication program for development. Arghyam project manager Priya Desai said the decision was made largely because NGOs too often used generic communication that wasn’t tailored to the community — and so was less effective.

“Whereas an advertising or communication agency does a lot of research on the target audience,” she said.

Involving the entire community

For Swachh Bharat to succeed, local government workers need to be motivated as much as families, according to Feedback Foundation’s Chatterjee. They are responsible for making sure communication activities are carried out, but most of them do not have sanitation training.

“You have to excite them, you have to make them believe that total sanitation will bring about total development,” said Chatterjee, who oversees government training and capacity building for sanitation.

But Vaidyanathan Krishnamurthy, head of innovation at social sector consulting firm Samhita, believes behavior change can’t be left up to government workers.

Local authorities are juggling tasks for multiple government development programs and, “for them this is not something mandatory,” Krishnamurthy said. “If it was linked to promotions they might do it, but it’s not.”

Instead, Samhita is working with the private sector to promote sanitation across the country.

One example sees banks like Kotak Mahindra promoting toilet subsidies to farmers using their vast network of rural field officers, who visit villages to sell financial products.

“When they talk about agricultural products, they also talked about the toilet,” Krishnamurthy said. He said it had prompted 200 people to build toilets across five states.

Samhita is also working with fast-moving consumer goods companies that make soaps to run hand-washing demonstrations in villages, with free product samples.

To tackle the problem of toilets being built and falling into disrepair due to lack of maintenance, Samhita designed a model that taps the services of local “entrepreneurs” looking for more work. The philanthropy organization renovates or builds toilets, which families agree to pay a small monthly fee to use. These entrepreneurs then collect the monthly fees, part of which will be used to maintain the toilets “and the remaining money is their income,” Krishnamurthy said.

But one effort to stop open defecation has drawn more attention than any other in India.

Nadia, a district in West Bengal, officially ended the practice of open defection in March. This came after a 15-month program led by the district collector, who roped in the entire community: faith leaders, teachers, schoolchildren, hospital staff and ration centers, to encourage people to build and use toilets. An elaborate monitoring system was also set up, involving night watches and sanctions, to ensure the practice stopped.

“People really had no choice but to embrace this because it had become all-consuming in the district,” a UNICEF official said. “But is that sufficient to ensure that people carry on using the toilets? If we find out it is, we might have hit on something big.”

UNICEF is monitoring Nadia for the next two years to see if the change is lasting. Meanwhile, the search for a scalable method of changing behavior in India continues.

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