SBM since its launch has got a lot of political support. Ministry of Drinking Water and Sanitation (MDWS) in its full capacity is trying to achieve the goal of making entire India OD free. There are currently 687 districts in India and MDWS has adopted the strategy of phasing districts till 2019. Till date only 16 districts have become OD free. To make all the remaining 661 districts OD free by 2019 is a herculean task.

At India Sanitation Coalition, a key exercise is to garner experiences of various stakeholders to create a solution driven approach. From the lessons learned, I feel that a shift of focus from a district to a gram panchayat level would be a fruitful approach. This would help in creating a manageable administrative unit. Further, in order to make the entire nation ODF by 2019, it is imperative that we work with community-level leaders. Thus, as we move forward, we must re-think our strategy, outlook and perspective around SBM.

This is the first time that the government’s sanitation programme guidelines have included sustainability as part of the project lifecycle. In earlier programmes, action stopped after facility construction with the assumption that people will use and maintain toilets. Recognizing this, the Swacch Bharat Mission’s guidelines were amended to include several steps on sustainability.

As has emerged there is a role for behaviour change and scale in sustainability. You cannot leave out 10 per cent of households in a village, block or district and expect sanitation services to be sustainable. Everybody everywhere needs to have and use a toilet, which is possible only if scale and behaviour change go together.

In order to ensure sustainability of ODF initiatives, we need to stratify the country based on three categories: identify districts where we have done badly as a priority to be accorded special attention. Second, identify the districts that have an average performance, and lastly the districts which have done well. There is a need to arrange a series of exposure visits to these places, for developing practical solutions to solve existing problems.

There also has to be a plan to tackle the issue of slip back of ODF habitations in times of drought. This has been seen in the last summer season, where newly ODF communities in states like Jharkhand etc., had slipped back to due the decrease in the availability of water. In fact Water for Sanitation, is a topic that needs attention of the planners and adminsitartors.

Further, members have noted that dedicated motivators/NGOs are a must to guide change. Funds are never a constraint if people decide to have a toilet. Technology choices and options to build safe sanitary toilets need to be made available and accessible. For example, in rocky terrain, water-logged areas, places with water scarcity, etc., toilet options need to match the local conditions.

A middle ground needs to be found in SBM, where the government can engage an NGO or agency capable of working at scale to run behaviour change campaigns, preceding and succeeding its construction drive. IEC funds can be used for paying the expenses incurred in both phases. NGOs/agency can also subsequently be engaged for monitoring, separating the roles of the implementing and monitoring agency. Involving school students, local youth and women’s engagement as ‘change makers’ in their community, is another strategy for spreading awareness, information, education and communication, and for behavior change in their respective areas of influence.

A greater focus is required on issues arising post toilet construction and its usage as stipulated. There are families who have single-pit toilets, which will usually get filled in 4 to 5 years – even quicker in the high water table areas. Hence, faecal sludge management and pit life extension are the two crucial factors to ensure the maintenance of ODF Status. It is essential that the householder is made aware of the issue of pits getting filled in future, at the time of initial construction Thus there is a need to adopt sustainable sanitation service initiatives so that there toilet usage is sustained by everyone in a family.

An issue that people often raise but that has not come up here is the lack of water for ablutions. I find this a facetious argument and, as Arti Dogra, a former collector of Bikaner in Rajasthan credited with making the district ODF put it, people fetch tens of litres of water for drinking, cooking and bathing; adding 2 litres to that load will not be a big deal. They carry a litre with them when they go to defecate outside to the extra water needed is only a litre a person. In other words, a shortage of water is not an argument for not using a toilet. This is echoed by district project coordinators in other states, some of whom have not heard Dogra. This issue obviously evokes debate, but my view is that it should not be used as an excuse of not promoting toilet use. It should be part of the behaviour change communication strategy and inputs.

Behaviour change is not a one-time or one-dimensional activity and hence requires intense investments in terms of time, money and human resources. Even if the focus shifts to behavior change and a large mass of people are influenced to change their behaviours, there will remain a group of people for whom it may not be a matter of behaviour, but who may have different reasons/barriers to building and using a toilet. The reasons could range from lack of funds or lack of space, to rocky terrain, high water table, living in a rented space etc. These situations will require case by case evaluation and problem resolving, in order to attain 100% toilet access and the subsequent ODF goal.

The safe disposal of faeces is a second generation problem that needs to be addressed. The SBM guideline addresses this by recommending a twin pit design, but the fact is that in many places single pit toilets are being built and can sooner or later lead to overflowing pits, defunct toilets and even contamination of water sources. Improved training on appropriate technology/design for masons, education of users on this and better monitoring to prevent single pit toilets is the need of the hour. It is important that the household is aware of what they are building and the future possibilities. In many areas, Faecal Sludge Management continues to be a missing link in the sanitation value chain and creative solutions need to be developed for this.

If everything ends with ODF, sustainability will be at risk. Once ODF is achieved, practical measures should be taken to avoid slippage, including regulation to ensure every new house built (households separating, newcomers, etc.) in the GP comes with a latrine. There has to be clarity in government policy on whether these new households are eligible for Incentives. Campaigning and monitoring should continue for some time post ODF, and in the meantime investments should be made on solid and liquid waste issues. It has to be ensured schools, Anganwadis and health centres have sustained sanitation services, along with handwashing facilities and water supply. This will not just demonstrate government leadership in practice but also educate future generations in healthy habits. There has to be a coherence in the mass media campaigns). Cross-ministerial collaboration needs to be pushed at the state and national level to make sanitation a multi-sector effort, with health and education playing a key role.

Dear friends,

Thanks for this very interesting conversation.

I won’t repeat previous points, but just to quickly add:

- I agree with Madhavi on the need to strengthen human resource on the ground and take IEC seriously. As a supporting example, Indore became the first ODF district in Madhya Pradesh, partly because its expenditure of IEC budget was 6 times higher than any other district in the division.

- I also agree with Meena that better monitoring is crucial. I think that it is important to seize the opportunity provided by the World Bank 1.5 billion loan, which includes setting up a third party verification system. If it measures toilet use reliably, is truly independent and allows comparing performance across districts, I believe it can make a huge difference and strongly contribute to sustainability

Another thought I wanted to share is that sustainability requires changing social norms, and that needs in turn long term efforts to reach further milestones. If everything ends with ODF, sustainability will be at risk. I’d highlight 2:

- Once ODF is achieved, practical measures should be taken to avoid slippage, including regulation to ensure every new house built (households separating, newcomers, etc.) in the GP comes with a latrine. Campaigning and monitoring should continue for some time, and in the meantime investments should be made to progress on solid and liquid waste issues.

- Ensure schools, anganwdis and health centres have sustained sanitation services, along with handwashing facilities and water supply. This will not just demonstrate government leadership in practice but also educate future generations in healthy habits (and coherence will strengthen the mass media campaigns). This needs to be pushed at the state and national level, ensuring cross-ministerial collaboration to make sanitation a multi-sector effort, with health and education playing a key role.

Thanks and kind regards,

Andrés Hueso
Senior Policy Analyst - Sanitation
WaterAid

Single pit toilet is not allowed in the present SBM Guidelines. State government need to monitor it properly.
Double leach pit toilets should be discouraged for areas having high water table as there is chance of ground water pollution. Definition of Open Defecation by MoDWS should be followed. The definition includes criteria for a sanitary toilet. There are several technologies for on-site sanitation. A Handbook on Technological options for On-site sanitation, is in the process of release by the MoDWS very soon.
SBM Guidelines is silent on Septage Management. It is an important issue. The book on Technological options for solid and liquid waste management, released by the MDWS in 2015 mentions about Septage management also.

pawan

Here’s Arghyam’s view based on work we’ve supported on ground.

First and foremost is to recognize that there is a value chain and that the first step is not construction of toilets. Sanitation has to be looked at holistically and hence proactive efforts in behavior change, both before and after toilet construction are equally crucial. While the Swachh Bharat programme is designed to be a demand driven one, little attention is paid to the ‘softer’ aspects of the programme. IEC plans often remain as lists of various activities with very generic messages for all and there is reluctance to spend the IEC budgets. Half-way through the FY 2016-17, only 5.24% of the IEC funds have been booked. (sbm.gov.in/sbmreport/Report/Monitoring/S...DAdmin_TarVsAch.aspx; viewed on 18 August 2016 at 4:00 pm), and this is not a new trend. A variety of reasons for non-use of toilets need to be addressed through different target groups and using various positive emotional motivations and information. This means that investments need to be made in understanding of behaviours, developing strategies suited to various contexts and then operationalising the strategy, complete with human and financial resources allocations.

Presently the focus of the programme personnel is usually on construction, achieving targets and updating the online data management systems. Instead this needs to shift to behavior change by addressing concerns that cause reluctance in using a toilet such as managing anxiety around toilet usage, making toilets a priority for all – men, women and children etc. Behaviour change activities when undertaken are usually found to be person driven rather than process/system driven. While it is good to have passionate leadership at the helm of the programme, the personnel responsible for the SBM programme at various levels often lack clarity about their roles and responsibilities and they are rarely equipped with strategic communication tools to promote toilet construction, usage and maintenance.

Behaviour change communication (BCC) is an intense exercise requiring dedicated time, people and financial resources. In a pilot that Arghyam did in 25 GPs in Davangere Karnataka, it took a professional communication agency about 8 months to carry out their research, develop a strategy and produce campaign collateral to create demand for household toilets. The pilot was rolled out by the district level Nirmal Bharat Abhiyan unit. The team structure comprised of - 4 people at the district level, 9 people at the block level and one dedicated Panchayat Development Officer and Swachhata Doot at every GP. At the GP line workers like ASHA, anganwadi workers and school teachers were also roped in. In addition, there were nine campaign teams of 4 people each, travelling from village to village and carrying out critical campaign events. With this team 119 villages of 25 GPS across 6 blocks of the district could be reached out to twice in a span of one month, with specific messages on building and using toilets. The campaign reached out to 93% targeted households. Arghyam supported the campaign design while the campaign was rolled out leveraging IEC fund under NBA.

While this was a pilot, the resources can all be optimized for a programme at scale. The SBM guidelines outline the human resource requirements for the implementation of the programme, but the States may or may not have this HR in place. This needs to be addressed. Once the HR is in place, capacity building will have to be done for the programme personnel at all levels - district, block or GP as well as any additional HR. A comprehensive training programme on various approaches to triggering, implementation of specific contextualized behavior change campaigns, the SBM scheme processes etc. will be needed to build capacities of various stakeholders. Investments will also be required to engage creative agencies to develop behavior change communication campaigns.

The point is that behavior change is not a one-time or one-dimensional activity and hence it will require intense investments in terms of time, money and human resources.
Even if the focus shifts to behavior change and a large mass of people are influenced to change their behaviours, there will remain a group of people for whom it may not be a matter of behaviour, but who may have different reasons/barriers to building and using a toilet. The reasons could range from lack of funds or lack of space, to rocky terrain, high water table, living in a rented space etc. These groups will require case by case stock taking and problem resolving in order to attain 100% toilet access and the subsequent ODF goal.

The safe disposal of feces is the second generation problem that will need to be addressed. The SBM guideline addresses this by recommending a twin pit design, but the fact is that in many places single pit toilets are being built and can sooner or later lead to overflowing pits, defunct toilets and even contamination of water sources. Improved training on appropriate technology/design for masons, education of users on this and better monitoring to prevent single pit toilets is the need of the hour. Fecal Sludge Management continues to be a missing link in the sanitation value chain and creative solutions need to be developed for this.


Madhavi
Sr. Manager, Programmes
Arghyam

We have a few thought provoking responses to the sustainability aspect of SBM. I might mention this is the first time sanitation programme guidelines have included a sustainability topic. In earlier programmes action stopped after construction with the assumption that people will use toilets. Recognizing this, the government's guidelines were amended to include several steps on sustainability.

As has emerged there is behaviour change and scale in sustainability. You cannot leave out 10 per cent of households in a village, block or district and expect sanitation to be sustainable. Everybody everywhere needs to have and use a toilet, possible only if scale and behaviour change go together.

From the comments, I have culled the following: In order to ensure sustainability of ODF initiatives we need to stratify the country based on three categories: identify districts where we have done badly as a priority to be accorded special attention. Second to the medium type districts and lastly the districts which has done well. There is a need to arrange a series of exposure visits to these places for coming out with practical solutions to solve the problems identified during such exposure visits by people themselves.

Further members noted that dedicated motivators/NGOs to guide change is a must. Funds are never a constraint if people decide to have a toilet. Technology choices and options to build safe sanitary toilets need to be made available. For example, in rocky terrain, water-logged areas, places with water scarcity, etc., toilet options need to match the local conditions.

A middle ground needs to be found in SBM where the government engages an NGO capable of working at scale to run behaviour change campaigns preceding and succeeding its construction drive. IEC funds can be used for paying the expenses incurred in both phases. NGOs can subsequently be engaged for monitoring, separating the roles of the implementing and monitoring agency. School students, local youth and women’s engagement as ‘changemakers’ in their community, is another strategy for awareness, information, education and communication, and for behavior change in their respective areas of influence.

A greater focus is required on issues arising post toilet construction and its usage as stipulated. There are families who have single-pit toilets which will usually get filled in 4 to 5 years – even quicker in the high water table areas. Hence, fecal sludge management and pit life extension are the two crucial factors to ensure the maintenance of ODF Status. The state governments need to adopt the sustainable sanitation service initiatives so that there is sustained toilet usage by everyone in a family.

An issue that people often raise but that has not come up here is the lack of water for ablutions. I find this a facetious argument and, as Arti Dogra, a former collector of Bikaner in Rajasthan credited with making the district ODF put it, people fetch tens of litres of water for drinking, cooking and bathing; adding 2 litres to that load will not be a big deal. They carry a litre with them when they go to defecate outside to the extra water needed is only a litre a person. In other words, a shortage of water is not an argument for not using a toilet. This aspect could be part of the behaviour change communications.

Dear members,

(The opinions expressed here are mine and do not reflect that of the organisation I am associated with.)

In order to ensure sustainability, on one hand, there is a need to understand the series of factors that have acted as barriers and de-motivated households, thus contributing to their decisions to abandon their toilets and revert to OD. Efforts to address these will assist with bringing this group back to ODF status and prevent households reverting to OD in the future.

On the other hand, there are those factors that have motivated or enabled households to maintain their toilets, either through initial levels of investment in a toilet that has lasted, or circumstances – both internal or external – that have led to them being prepared or able to invest in repairs and rebuilding. Building on or enhancing these factors is likely to strengthen this resolve and increase the likelihood that these households continue to maintain their toilets into the future and possibly even improve them.

Of the four most commonly mentioned factors motivating ODF households to maintain their toilets, only health potentially encompasses hand washing and other improved hygiene behaviours. The other three – shame/disgust/pride, privacy/security and convenience/comfort – are all met by simply having a toilet which perhaps goes some way to explaining the disparity between the figures for toilet retention and construction and/or retention of hand washing facilities.

A range of explanations are possible for the emphasis households placed on health. Health promotion during, or in parallel with, CLTS programming, etc. may create an understanding that toilet use creates health. Health messages may have continued to influence household thinking even years after ODF status had been achieved. Rather than through education, however, some households may have been persuaded through their own experience that toilets improve health. In turn, these households may have been reporting real improvements in health or on their perception that health had improved. It would be feasible to test this through further investigations with households, comparing the incidence of WASH-related illness (either self-reported or through local health records) and the average expenditure of households on health care in non-ODF and ODF villages.

Implications for practice depend on what is revealed through further investigation of the role health plays in motivating households. If it is largely a response to the efficacy of education, then it suggests that health messaging in conjunction with CLTS, etc. promotion is important and that strong efforts in this area are worthwhile. This might involve strengthening or prolonging the CLTS follow up stage to allow for more health awareness messaging or linking in with other hygiene promotion programmes, such as long-term government public health activities. Alternatively, if it is household experience of better health from long-term toilet use, either real or perceived, then the focus should be on other factors that drive households to sustain their toilets. In doing so, that will automatically strengthen households’ perceptions of being healthier. There may also be value in considering a combination of these approaches, with the emphasis on health and non-health motivators varying over time.

Regards,
Sunetra Lala,
Jaipur

Under the Swachh Bharat Mission (Gramin), a rapid progress has been observed throughout the country. The overall sanitation coverage has increased from 42.12% (October 02, 2014) to 54.03% (till date) (sbm.gov.in/sbmdashboard/Default.aspxHowever, usage is still a huge challenge. It is imperative that we should equally focus on factors inhibiting toilet usage, and behavior change is a significant impediment. Simultaneously addressing these factors is the way to ensure sustained success of SBM (G).
The effort of the government and all involved stakeholders towards achieving the Open Defecation Free (ODF) status is intensive. An exhaustive monitoring process is required to assess true progress made. Integrating improved data capture technologies is important. In this regard, Water For People captures the GPS coordinates of each toilet in its area to authenticate the monitoring data. In addition to toilets, Water For People has also undertaken the same for all its water points. A simple survey format on a mobile application is used to capture the data both at the community and school level.
School students, local youth and women’s engagement as ‘changemakers’ in their community, is another strategy for awareness, information, education and communication, and for behavior change in their respective areas of influence.
A greater focus is required on issues arising post toilet construction and its usage as stipulated. Fecal Sludge Management. There are families who have single-pit toilets which will usually get filled in 4 to 5 years – even quicker in the high water table areas. Hence, fecal sludge management and pit life extension are the two crucial factors to ensure the maintenance of ODF Status. The state governments need to adopt the sustainable sanitation service initiatives so that there is sustained toilet usage by everyone in a family.

There is a general understanding that behaviour change has to precede all other activities including construction. NGOs or community based organizations are best placed to do so and have been successfully engaged in this activity in the past with mixed results. They are excellent when working in their areas of strength but less effective when they are tasked to work outside their conventional project areas. Can we find a middle ground in SBM where the government engages an NGO capable of working at scale to run behaviour change campaigns preceding and succeeding its construction drive. IEC funds can be used for paying the expenses incurred in both phases. NGOs can subsequently be engaged for monitoring, separating the roles of the implementing and monitoring agencies.

I have had the experience of working with few NGOs operating in the water and sanitation sector, in Tamilnadu. As a Consultant to the action research programme in a water sanitation programme with a 3 year implementation cycle, I witnessed a gradual process of motivating the villagers for ODF villages. A resource NGO managed other local NGOs and capacitated them to run the show.
Initially they conducted a participatory mapping exercise in which people were taught to learn the actual situation. They mapped their villages, defecation sites, etc., and the NGO team collected the sanitation details of the village and guided them to draw the map. The information included how many people had toilets and how do not had it.
Then they selected women volunteers from among the villagers, trained them and a sanitation drive started. They had thrift-credit operations through SHGs who advanced funds to the women's groups and were repaid in installments (with interest).
Technology options and choices were given to them,local masons including women were trained, Watsan groups were formed locally to manage purchase of materials, etc. The NGO's technical officers ensured the best options of sanitation and supervised the construction works along with the Watsan groups. A lot of IEC material was developed and circulated. Village meetings, house visits, school health programmes, etc., were part of the show and there were targets for each to make villages ODF.
In the first round they covered people who were easily motivated to build latrines. These joined the motivators' teams to motivate others. Panchayats joined hands with the NGOs and subsidies were later released to families. Repayment of the loans taken was done without any problem and the peer group pressure was so intense that all in the village finally joined the stream to declare ODF villages.
They felt proud to have a toilet and their girl children were especially happy to have privacy. In the schools teachers did excellent motivation work so that children gradually became change agents.
I have documented this gradual process and gave advice for further steps and finally the result was 100% coverage and usage. Communities took up the lead and all age groups started using toilets. Even old people who prefer to go to the open changed their behaviour. Child friendly toilet boards were put on regular toilets for the use of small babies and this helped mothers toilet train their children from the age of 2 years.
Several sanitation hygiene practices were clubbed with this to achieve total sanitation and hygiene. And such sustainable practices helped to bring lasting changes in them.
Incidentally this programme was funded by Arghyam and they have the reports available with them, prepared in every 6 months. The gradual process of tuning a community will have several hurdles to cross initially. But dedicated NGOs can bring such change. So what I mean to say here is that it is not an easy task to achieve ODF and sustain behaviour unless the real participatory processes are used in combination.
Dedicated motivators/NGOs to guide change is a must. Funds are never a constraint if people decide to have a toilet. Technology choices and options to build safe sanitary toilets need to be made available. For example, in rocky terrain, water-logged areas, places with water scarcity, etc., toilet options need to match the local conditions. Even when NGOs withdrew from the scene completing the project, local volunteers continued to support the community.
Watsan committees and Gram panchayats led the show. Visits to such ODF villages will help others to copy what actually happened there. And I have learned that these NGOs are now involved with Swatch Bharath stream and is running several such shows in the nook and corner of the country.

The two-fold approach of emphasising the need to make habitations free from open defecation, and working at scale (usually the district), are welcome changes from the past. The difference from earlier sanitation campaigns are inclusion of sustainability in the SBM guidelines, so the project life-cycle includes post-construction activities to habituate the use of toilets. Their efficacy can be debated by having them in the official guidelines is a huge shift in thinking and recognizes the need to do things differently going beyond triggering and construction. More creative ways to improve these are welcome, in addition to doing the conventional inter-personal and mass media communication.

There have been district coordinators before, usually lone rangers trying to motivate poeple on the ground directly. The difference I see in districts where there is a change is the entire state machinery has become involved in mission mode to run the sanitation campaign. It is not only sanitation-related staff but people from other departments at all levels, from the district to the gram panchayat. The officers lead and others follow.

This last aspect can be improved or changed by encouraging the community to take charge instead of the officers leading. Using established empowerment techniques people can assume the leadership of sanitation work in their habitations and panchayats. Local leaders are most effective at the local level. The officials and elected representatives can facilitate and support and once the momentum is taken up by communities, they can withdraw.

Technology is one area where we face problems. The common twin leach pit toilet is universally promoted, regardless of suitability. There are many other options that are not taken up. I feel the reason is those charged with verifying toilets find it easiest to certify a twin leach pit toilet rather than bothering with eco-san toilets or even septic tanks that are well-made. The 1mX1m design of the leach pit makes it easy to measure and sanction for payments while all others are much harder to measure and approve. This can be dealt with by letting the panchayat's water and sanitation committee certify the usability and soundness of toilets rather than a government official.

The prompt payment of the incentive only to eligible families is also a powerful driver for both use and construction.

I feel this time the ingredients are right but the cooks also need to be trained to cook and serve the dish well.

Dear members,

I would like to bring to your kind attention that even 20 years back behavioral change strategy has been developed in our country and based on practical experience it has been published by IRC in 1996 based on the community based sanitation programme in Kerala. This was widely circulated to all officials in Government of India. Sorry to say that adequate exposure was not been given to such success stories because it was not been promoted by International agencies. In October 2005 the International Institute of Waste Management Bhopal has come out with a Hand book on Promotion of Sanitation and Hygiene in India for accelerating the implementation of Swachh Bharat programme in our country. Here step wise implementation strategy has been given based on the community based sanitation programmes.

What I have noticed that the so called experts and Govt. still interested in reinventing the wheel without addressing the problems at local level. We need to have locally specific approaches for addressing the issues. ODF is a good concept and we need to think beyond it. NO LATRINE SHOULD BE CONSTRUCTED BEFORE FULLY MOTIVATING THE USERS OR THE COMMUNITY. We need to learn from mistakes and experience from across the country.

I am extremely happy that a momentum has been created and we need to stratify the country based on three categories, identify districts where we have done bad as priority number one to given special attention. Second to the medium type districts. Lastly the districts who has done well. Arrange a series of exposure visits to these places for coming out practical solutions to solve the problems identified during such exposure visits by people by themselves. I am sure we can find sustainable solutions to address the social behavioral problem of sanitation practices within next five years.

Wishing you all a successful swachh bharat campaign with focus on social behavioural changes,

warmest regards,

Yours Sincerely,

Dr. K. Balachandra Kurup