India accounts for 90% of the 692 million that practice open defecation in South Asia. The current state of affairs has caused the Government to recognize sanitation as a national priority through the Swachh Bharat campaign, which promises a “Clean India” by 2019. One of the key initiatives of the campaign is to provide rural India with more than 100 million toilets over the next five years. Many academics, policy planners and key stakeholders, however, point to the need for more holistic solutions and integrated approaches to address the issue of open defecation and its subsequent health outcomes.
The purpose of the Clean India: Stimulating Behavior Change and Usage convening hosted in Delhi on 17th April 2015 was to take stock of the Swachh Bharat campaign, identify gaps and suggest a way forward. The convening was hosted by The University of Chicago Center in Delhi, in conjunction with the University of Chicago, Booth School of Business’ Social Enterprise Initiative and non-profit Toilet Hackers and facilitated by resource partner Samhita Social Ventures.
The convening witnessed deep discussions with over 75 participants comprising of leading academicians, researchers, think tanks, foundations, companies, government officials and NGOs in India. Some of the key messages emerging from these discussions are captured below.
A nudge towards good behavioral practices
Professor Richard Thaler highlighted the application of behavioral economics to address the sanitation conundrum, focusing on the relevance and benefits of ‘nudges’ to influence behavior. The approach, called libertarian paternalism, indicates the possibility of influencing people’s behavior to opt out of specified arrangements, allowing them to make better choices. In order to capture attention and influence behavior, the nudges have to be – salient, easy, habit-inducing, fun, emotional and appealing to social norms.
Avoiding the great India infrastructure model – ‘Build, Neglect, Rebuild’
While the promises of the Clean India mission may be realized due to the concerted efforts of companies, foundations and the government, building toilets is clearly not enough to ensure an open-defecation free India. Diwyang Waghela of Tata Trusts raised concerns around whether the subsidy provided by the government (approximately Rs. 12,000 per household) is sufficient to create good quality and long-lasting toilets that people would want to use. Nitya Jacob of Water Aid raised concerns around the availability of skilled manpower to undertake this task.
Underpinning these concerns are the infrastructure-driven targets and commitments set by the government and other stakeholders, resulting in the monitoring of the number of toilets built, rather than the quality or usage or demand for toilets, Upneet Singh of WSP, pointed out.
Despite these constraints, the private sector has demonstrated a solid commitment to the execution of targets as shown by Vipin Arora of TCS, Vijay Chadda of Bharti Foundation and Praveen Aggarwal of Swades Foundation, who have already built hundreds of good quality toilets across India.
Collaborating with multiple partners
It was unanimously agreed by the speakers and reiterated by Kathryn Stevens of USAID that given the complex nature of the WASH challenge in India, its scale and resource requirements, partnerships between stakeholders hold the answers. Multi-stakeholder partnerships or coalitions between governments, foundations, companies, communities and NGOs are effective when individual partners share a common vision, collaborate early on in the process, engage in mutually reinforcing activities, and leverage core strengths.
The participants believed that the WASH ecosystem would have to evolve to enable multiple stakeholders to assume responsibility over a project life-cycle. As pointed out by Vaidyanathan Krishnamurthy of Samhita Social Ventures, enablers (such as collaborative platforms, technology, common tools for monitoring and evaluating, best practices etc.) help to build a conducive ecosystem. However some experts such as Manas Rath and Pratima Joshi of Shelter Associates drew attention to the time and support required to institutionalize such enablers.
Building capacity at all levels
An interactive group discussion revealed the imminent need for building and strengthening the capacity of stakeholders to deliver their individual commitments and to work together in an effective ecosystem. Capacity building can ensure that different stakeholders are provided with defined goals and targets and roadmaps to prioritise their work.
Investing in research to generate evidence on usage and behavior change in rural and urban contexts
There was a general agreement among speakers about the paucity of robust or reliable data on the usage of toilets and, as postulated by Dean Spears of r.i.c.e, on factors that affect behavior change.
Most of the evidence is anecdotal or, as expressed by Ram Prasad of Final Mile Consulting, there is a lot of ‘noise’ instead of concrete evidence on barriers that inhibit behavioral change at individual and community levels.
Sharon Barnhardt of IIM-A pointed out that the lack of evidence is particularly stark in the space of urban sanitation as very little is known about what products or strategies work to influence behaviors and entrench them as habits.
Encouraging community participation
There are many barriers to creating community-level demand and ownership in WASH. Ram Prasad of Final Mile Consulting thought that it was difficult to get communities to assume ownership of toilets owing to company branding, lack of personalization etc.
Similarly, Sumeet Patil of NEERMAN suggested that subsidies and vouchers as potential ‘nudges’ could encourage toilet usage at the community level but require high intensity nudging to ensure take-up. Some speakers also pointed out the negative outcomes that subsidies may create in terms of pushing a community towards toilet usage without adequately focusing on generating demand.
Others spoke of possible solutions – Sojan Thomas of Gram Vikas shared some interesting means followed by his NGO to ensure commitment from all the households in a community such as co-investment, constituting a democratic and representative body at the village level, creating a corpus fund etc. Similarly, Vijay Chadda spoke of a situation where children can be used as agents of change.
Developing relevant and appropriate communication
Mala Subramanian of Arghyam pointed out that most behavior change communication programs fail to develop a context specific strategy. Standardized messages are not effective owing to different urban locations and target audiences. There is a need for a professional approach to behavior change communication by planning communication activities based on key motivations and barriers of a particular community. Reflecting on this, Kishore Kumar from the Andhra Pradesh government pointed out that we need to progress from information, education and communication (IEC) to interpersonal communication (IPC) to affect change.
Focusing on the entire service chain
Madhu Krishna of Bill and Melinda Gates Foundation highlighted a key gap in the WASH sector- in the race to construct toilets; other aspects of the sanitation service chain such as fecal sludge management have not received much attention from stakeholders. These aspects of the service chain suffer from multiple limitations such as a lack of appropriate technologies, high costs, under developed markets etc. Such gaps could prevent the realization of overall public health outcomes associated with good sanitation practices.
Viewing design as a cross cutting capacity
Whether it is the design of toilets and technology, business models or operating models – design plays a critical role in prompting and supporting behavior change. As pointed out by Ayush Chauhan of Quicksand Designs, design needs to be integrated in the product (toilets), hardware, software, policy, financing and operating model. Gender, age, income and utility value by the user must be kept in mind for any design that is advocated for sanitation to prevent non-usage later. Anagha Mahajani of Ambuja Cement Foundation cautioned against the use of a one size fits all approach.
The intent of Swach Bharat or Clean India mission is laudable, but the move from intent to action needs to be facilitated. The convening was an attempt to bring together a variety of stakeholders and offer a platform for meaningful engagement with relevant elements of the sanitation challenges in India. It also presented an opportunity for debate on possible solutions and starting points for collaborations needed to address these issues.