Evidence-based sanitation advocacy in India to promote latrine use (r.i.c.e. India)
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Evidence-based sanitation advocacy in India to promote latrine use (r.i.c.e. India) 22 Aug 2014 11:16 #9850

  • SangitaVyas
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Dear all,

Today I would like to tell you about a sanitation grant by the Bill & Melinda Gates Foundation that I am involved with at the r.i.c.e. (Research Institute for Compassionate Economics):

Title of grant: SQUAT (Sanitation Quality, Use, Access, and Trends): Evidence based sanitation advocacy for India
Subtitle (more descriptive title): To promote evidence-based sanitation policy-making in India that can reduce open defecation and improve children’s health by promoting latrine use
Name of lead organization: Research Institute for Compassionate Economics (r.i.c.e.)
Primary contact at lead organization: Sangita Vyas
Grantee location: Amston, CT (Connecticut, USA)
Developing country where the research is being or will be tested: India
Start and end date: February 2013 – July 2015
Grant type: Global Development (e.g. Global Challenges Explorations, Reinvent the Toilet Challenge, Other)
Grant size in USD: $262,340 (as per grant database: www.gatesfoundation.org/How-We-Work/Quic...n%2C%20and%20Hygiene)

Short description of the project:

Open defecation imposes enormous costs on children’s health and human capital, and is exceptionally widespread in India. We believe that there is convincing evidence of the benefits for health and human capital of safe latrine use. What is needed now is (1) to convince policy-makers of this, and (2) a better understanding of the local political economy, social forces, and economic factors that constrain or promote latrine use.

Ultimately, our goal is to influence Indian policy, such that the government – at its various levels – might better pursue an end to open defecation, especially in rural India, which is r.i.c.e.’s focus. We note that we can only be a small part of this large process. However, many policy-makers still do not recognize sanitation as a top priority; others are missing opportunities to make programs more effective; and nobody fully understands, including we ourselves, how rural communities can be best encouraged to use latrines. Thus, there is a need for basic persuasion of the urgency of safe excreta disposal; for advocacy of more effective policies, based on latrine use, not construction; and for research into the social, institutional, and political mechanisms that might successfully promote latrine use.

Goal(s):

Policy advocacy goals:

1. Sanitation as a policy priority. Although the Total Sanitation Campaign (TSC) has been a “flagship program” of the Indian government, there is still much scope for increasing the prominence of sanitation as a policy priority. A key part of this will be emphasizing the link between sanitation and stunting, commonly called “malnutrition.” Many activists who worry about children’s health advocate a “right to food;” others seek to promote medical care, or even access to water (rather than safe excreta disposal in particular); none of these promote the crucial public good of ending open defecation. Among those who do, there is debate over whether negative externalities imply that eradication of open defecation is necessary for a locality to see health effects.

2. Focus on latrine use, not construction. Too much of the policy discussion centers on building latrines, however building latrines has not significantly reduced open defecation over the past 15 years in India. Information, education, and latrine use promotion need to be the cornerstones of any successful program to end open defecation.

3. Central measurement of latrine use. Recognizing that any goal that is not measured is not achieved, the government should establish an independent, accountable mechanism of monitoring latrine use, not latrine construction.

4. Latrine use requires a ground staff. Rural sanitation teams at the block and district level require a new, dedicated staff responsible only for behavior change and promotion of latrine use, not for latrine construction.

Objectives:
o Conducting a new survey on sanitation attitudes and behaviors in rural north India
• SQUAT report based on findings
• Short contributions from many stakeholders
• “Launch party” conferences in Delhi and two state capitals (probably UP and Bihar, or maybe MP, three very poor Indian states where we have experience and connections)

o Conference jointly produced with the Delhi School of Economics and World Bank Water and Sanitation Programme about stunting of Indian children
o Newspaper articles authored by and not authored by rice staff, in English and Hindi press
o Continuing to meet with policy-makers in Delhi to advocate policy goals and report findings
o Meeting with 15-25 District Magistrates or District Panchayati Raj Officers (or similar local officers) note that this will work towards both research and advocacy goals
o Meeting with relevant state officials in at least two states
o Presentation at LBNAA (IAS academy)
o Encouraging other advocates (e.g. World Bank WSP, UNICEF) to cite our research and to promote our messages
o Offering to help the government design systems for useful monitoring data collection

Research or implementation partners: Delhi School of Economics

Links, further readings – results to date:

A policy brief summarizing the findings of the SQUAT Study can be found here: squatreport.in/wp-content/uploads/2014/0...UAT-policy-brief.pdf
SQUAT Study’s website: www.squatreport.in
r.i.c.e.’s website, the home of our blog: www.riceinstitute.org
NY Times article covering our research: www.nytimes.com/2014/07/15/world/asia/po...th-malnutrition.html
The Economist article covering our research: www.economist.com/news/asia/21607837-fix...tories-also-changing

Current state of affairs:

In August 2013, we organized a conference on stunting. Leading scholars of child height—economists, epidemiologists, nutritionists, and pediatricians—and government officials came together to discuss why children in India are so short? Height is an important indicator of overall health and human development because the same good health that helps a child grow tall can also help her grow smart. In presentation after presentation at the conference, sanitation stood out as an important part of this puzzle.

We have completed the data collection and entry for the SQUAT Study. Our working paper is available on the SQUAT Study’s website and is forthcoming in Economic and Political Weekly. The data was collected in villages in five states in India: Bihar, Haryana, Madhya Pradesh, Rajasthan, and Uttar Pradesh. We found that rural households do not build inexpensive latrines of the sort that commonly reduce open defecation and save lives in Bangladesh, Southeast Asia, and sub-Saharan Africa. Many survey respondents‘ behavior revealed a preference for open defecation: over 40% of households with a working latrine had at least one member who defecated in the open. In the sample from the four largest states, more than half of people in households which owned a government latrine defecated in the open. We applied a demographic model of latrine use which predicted that if the government were to build a latrine for every rural household that lacked one, without changing sanitation preferences, most people in our sample in these states would nevertheless defecate in the open. Further evidence supports a preference for open defecation: many survey respondents reported that open defecation is more pleasurable and desirable than latrine use. Among people who defecated in the open, a majority report that widespread open defecation would be at least as good for child health as latrine use by everyone in the village.

Numerous publications have covered our research including the New York Times, The Economist, The Hindu, among others. Additionally, numerous opinion pieces authored by us have appeared in a number of Indian newspapers.

In June and July of 2014, we sent the findings of our research and policy proposals to promote latrine use to 230 members of parliament, 377 ministry officials, and 389 district collectors by mail and email.

Biggest successes so far:

Sanitation has become a policy priority under the new government. We completed quantitative and qualitative research that explores sanitation attitudes and behaviors in north India perhaps more than any other study has. Our research and messages have been well-covered in the media.

Main challenges / frustration:

Convincing politicians who make policy decisions on sanitation to emphasize latrine use, rather than construction, in India’s sanitation policy.

We are happy to answer any questions you may have here on the forum.

Regards,
Sangita
Sangita Vyas
Associate Director
r.i.c.e.
Last Edit: 28 Aug 2014 10:29 by SangitaVyas.

Re: Evidence-based sanitation advocacy in India to promote latrine use 22 Aug 2014 16:10 #9852

  • ggalli
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  • Focus on governance and politics of sanitation. Exploring new opportunities in urban sanitation from Feb 2015
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Hi Sangita,
Thanks, for this. Had already followed your great work and the SQUAT report, and shared it internally within my organisation.

I have a question for you or your colleagues. The topic is named 'evidence-based sanitation advocacy' yet you end your post by saying that the biggest challenge is 'convincing politicians to emphasize latrine use, rather than construction'. Can you explain me what the reasons are why it is so difficult to convince politicians in India even though you have produced good evidence to back up your claim?

I am asking because more and more I am wondering whether we are wasting our time in generating more data and evidence. Political decisions are not made on basis of data, but on pressure, money and power. Maybe it is time to switch our strategy and start to get more 'dirty' (pun intended).
Giacomo Galli
Last Edit: 22 Aug 2014 16:11 by ggalli.
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Re: Evidence-based sanitation advocacy in India to promote latrine use 28 Aug 2014 10:28 #9915

  • SangitaVyas
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Hi Giacomo,

You pose an interesting question. The government doesn't focus on latrine use simply because all incentives point towards focusing on construction.

Local level bureaucrats prefer construction projects to behavior change campaigns because they are more profitable. It is easier to skim money off construction projects. Politicians prefer construction projects because they are very visible, and they can easily claim responsibility. Many local level politicians actually get their names written on the latrines that are built during their time in office. And to people who don't know much about sanitation in India, construction sounds like the obvious solution. Finally, construction is the status quo. And inertia gets in the way of changing it.

Only a politician or bureaucrat who really cares about eliminating open defecation would emphasize latrine use.
Sangita Vyas
Associate Director
r.i.c.e.
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Re: Evidence-based sanitation advocacy in India to promote latrine use 29 Aug 2014 04:29 #9922

  • pkjha
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  • Working for over 27 years in the fields of sanitation, biogas from human wastes, waste water treatment in rural as well as urban areas in India and other developing countries.
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Hi Sangeeta

As per the guidelines of NBA (earlier TSC) financial incentive will be provided after the construction and use of latrines. At policy level there is no problem in this regard. Main problem is almost complete lacking of monitoring (of construction and use of toilets) at the state and centre levels. Lack of awareness in rural areas is the most important issue. In such areas sanitation is not regarded as a felt need problem due to lack of knowledge, awareness and motivation. In some states like Haryana, in a short period, there has been appreciable sanitation coverage due to involvement of Women Self Help Groups. Many households constructed toilets without taking any financial support from the Government.
Lack of sanitation is mainly a social issue- not financial or technical. One can easily see several households having good houses and personal vehicles but without toilet. Increasing rate of cash subsidy of construction of toilets is also one of the deterrents of the programme. Such subsidy has made the program a supply driven approach. In 2011 rural sanitation coverage, as per the IMS data of the Ministry (as provided by the States) was over 70%. However, Census 2011 data showed only 31-32% coverage. Obviously there were considerable no. of missing/ unfinished construction/ wrongly located toilets, constructed under subsidy, not fit for use. Therefore, proper construction of toilets is equally important. Without having a toilet there is no question of its use. The IEC program of the Ministry needs to be monitored by the States with measurable deliverables.
pawan
Pawan Jha
Chairman
Foundation for Environment and Sanitation
Mahavir Enclave
New Delhi 110045, India
Web: www.foundation4es.org
Linked: linkedin.com/in/drpkjha

Re: Evidence-based sanitation advocacy in India to promote latrine use 29 Aug 2014 06:42 #9923

  • SangitaVyas
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Hi Pawan,

You are right. In India, very few people have inexpensive, simple latrines. These types of latrines are much more common to find in other parts of the developing world, even in South Asia. In Bangladesh, it's very common to find simple pit latrines, the kinds that UNICEF/WHO classifies as "unimproved." It's virtually impossible to find these in India. In India, people either build expensive latrines which often have septic tanks. And if they can't afford that, then they build nothing at all. There is no such thing as the sanitation ladder here.

Yes, there needs to be much more focus on IEC*. In the past financial year, very little of the IEC budget was spent. We need to be spending all of it.

Sangita


* IEC stands for Information, Education, Communication (note added by moderator)
Sangita Vyas
Associate Director
r.i.c.e.
Last Edit: 09 Oct 2014 22:48 by muench.

Re: Evidence-based sanitation advocacy in India to promote latrine use 09 Oct 2014 14:39 #10432

  • neilpw
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Pawan Jha wrote on 29 August: "Lack of awareness in rural areas is the most important issue. In such areas sanitation is not regarded as a felt need problem due to lack of knowledge, awareness and motivation."

Thank you for this comment. I would be interested to hear what works (and what doesn't) with regards to IEC*. Below are some possible methods, but I am not sure where and how they have been tried, and with what results:
- Community Health Workers (or ASHAs in India) explain importance of sanitation as part of routing health education (one-to-one, or in groups)
- Health education / sanitation posters (at health facilities and/or in public places)
- Health education / sanitation leaflets (at health facilities and/or in public places)
- SMS text messaging (health education "behavior change" messages)
- short videos on feature phones (basic mobile phones with SD cards)

Women's learning groups have been successful in reducing maternal and child mortality in many countries, through learning and preparedness for childbirth and child diseases. I am sure they have an important potential role in sanitation also.

Best wishes,
Neil Pakenham-Walsh, HIFA moderator (www.hifa.org)


* IEC stands for Information, Education, Communication (note added by moderator)
Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All) and co-director of the Global Healthcare Information Network. He is also currently chair of the Dgroups Foundation (www.dgroups.info), a partnership of 18 international development organisations promoting dialogue for international health and development. He started his career as a hospital doctor in the UK, and has clinical experience as an isolated health worker in rural Ecuador and Peru. For the last 20 years he has been committed to the global challenge of improving the availability and use of relevant, reliable healthcare information for health workers and citizens in low- and middle-income countries. He is also interested in the wider potential of inclusive, interdisciplinary communication platforms to help address global health and international development challenges. He has worked with the World Health Organization, the Wellcome Trust, Medicine Digest and INASP (International Network for the Availability of Scientific Publications). He is based near Oxford, UK. www.hifa2015.org neil.pakenham-walsh AT ghi-net.org
Last Edit: 09 Oct 2014 22:47 by muench.
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