Open defecation is one of the most complex social and health challenges that India faces. Despite serious health repercussions there are approximately 525 million people in India who are still defecating in the open, the majority of whom are living in rural areas.
In Water Insecurity and Sanitation in Asia, co-edited by Dr Eduardo Araral, Associate Professor and Director at Lee Kuan Yew School of Public Policy – Chapter 13 by Ankur Gautam reviews the gaps in India's sanitation policies. In particular, it illuminates the lack of institutional understanding of the complexity of behaviour change.
Rural sanitation policies in India
Information, education and communication (IEC) methods form the most common ways of promoting toilet use in India, and they often come together with subsidies.
A subset of this is the CLTS (community-led total sanitation) approach, which emphasises "shame" and "disgust" to elicit behavioural changes, resting on the belief that people would stop defecating in the open once these negative emotions are triggered.
The practice of offering subsidies to promote toilet construction and usage lies on the premise that rural communities would like to have toilets but lack the resources to build them. However studies have shown that even with latrines, people in rural communities still do not have the habit of using them, signalling how the issue of open defecation is much more than the lack of available latrines. Without targeted behaviour change approaches, open defecation continues.
Launched in 1999, the Total Sanitation Campaign (TSC) was the Indian government's renewed attempt at eradicating open defecation. Moving away from subsidies, the TSC aimed to be community-led, people-centred, demand-driven, and incentive-based. Yet, it was a policy failure. According to the 2011 census data, sanitation coverage barely improved, standing at only 31% in total. There was even an increase of 8.3 million households without latrines being reported.
Photo; M. Asokan - PM launches Swachh Bharat Abhiyaan
On 2 October 2014, the government relaunched the TSC as the Swachh Bharat Mission (SBM), with the intention of providing basic toilets to every household and completely eliminating open defecation by 2019. For each toilet constructed, an incentive is provided to a Below Poverty Line (BPL) family.
Leaning towards the CLTS approach, SBM guidelines focus heavily on triggering communities to achieve collective behaviour change towards toilet use. Emphasis is also placed on interpersonal communication, by triggering demand and use of toilets through social and behaviour change communication and house-to-house interventions.
Challenges & policy gaps
Among the numerous implementation challenges, one of the biggest was that supply was at times insufficient to meet demand. Even when communities have indicated an interest in moving towards better sanitation after being triggered, supply was unavailable and there was no choice but for the people to give up on having proper sanitation infrastructure.
The CLTS programme was poorly delivered, due to a lack of manpower to educate the communities about proper hygiene and sanitation practices and to engage in continued monitoring efforts.
There is also a concern regarding the timing of the incentive payment. If given before the toilets are constructed, the communities might end up using the money for other purposes. But, if the payment only comes after the toilets are built, there is no real incentive or means for them to construct the toilets in the first place either.
Loopholes in declaration and verification
To be verified as ODF (Open Defecation Free), there has to be a termination of faecal-oral transmission, defined by:
a) no visible faeces found in the environment/village; and
b) every household as well as public/community institutions using safe technology options for the disposal of faeces.
According to India's Ministry of Drinking Water and Sanitation, "safe technology" refers to no contamination of surface soil, ground water, or surface water; excreta inaccessible to flies or animals; no handling of fresh excreta; and freedom from odour and unsightly condition.
However, nowhere in this definition of ODF does it specify that the communities actually need to use a toilet as an alternative to open defecation.
These loopholes in definition of ODF can be attributed to the subjective nature of how individuals perceive latrines in rural India, according to Associate Professor Leong Ching of Lee Kuan Yew School of Public Policy. "Rural Indians have been found to have varying social and psychological perceptions of ODF, with some studies finding OD to more pleasurable, desirable and a viable means to a healthy, wholesome life. The perception that open defecation provides greater amounts of satisfaction and autonomy compared to an indoor latrine experience explains why some rural Indians choose to openly defecate rather than use latrines. These perceptions of OD being more "natural" and "healthy" are related to cultural and social norms of behaviour, conventions and self-imposed codes of conduct in rural India."
Moreover, long term behavioural change is not a linear path, meaning people can and will fall back on old habits of open defecation even as their communities try to break free from it.
Despite this, once a village is verified to be ODF, they will not lose this status even if the inhabitants do go back to open defecation. This poses a great challenge in affecting any sustained change, since there is no reason for the people to continually keep their own behaviour in check, if there is no threat of having their ODF status revoked.
Evaluation of policy management
So, why did India not manage to pull off the campaign successfully? "Although a lot of resources were poured into the campaign," says Professor Leong, "there seems to be insufficient efforts placed into understanding the underlying cause behind the continual practice of OD — which we identified to be the behavioural norms of OD tied to intrinsic cultural and social norms or values."
"The resources that were used in implementing the subsidies to increase the construction of individual household latrines, as well as the campaign, ultimately did not directly address the need for a change in OD attitudes and behaviour," she says.
In that case, is the incentive payment even a good idea, considering how it fails to elicit meaningful change despite its hefty price tag?
For Professor Leong, the answer is no, as it ultimately does not address the underlying cause behind OD behaviour.
"Through quantitatively surveying the residents of Andhra Pradesh, we found that people still cite a lack of financial resources as a constraint, even if they were given generous subsidies."
She continues, "This implies that traditional cost-benefit analysis may fail when we conceive of sanitation behaviour as part of an environmental identity. Instead, the comparison made here is between the cost-free option of OD, which is tied to one's intrinsic identity, and a costly one involving the use of latrines which requires additional investments and a change in one's environmental identities and values. Additionally, we also found that the use of OD is more satisfying to certain rural Indians, compared to the stifling indoor latrine experience. Therefore, incentive-based policies that aim to increase the preference for latrines are less likely to be effective, given that the preference is already clear."
Since residents who display OD behaviour are also likely to revert back to the practice once the incentives are gone, instead of a short-lived incentive-based policy, Professor Leong suggests implementing policies that advocate for a more sustainable shift in behavioural practices and identities instead.
She explains, "Incentive payment, however, can be introduced as alongside policies that stimulate behavioural change, such as motivating groups that display OD behaviour to interact with groups that do not. If implemented as the sole policy, however, it is likely to be ineffective, or prohibitively costly, in motivating a complete behavioural change."
Possible alternative solutions
According to Professor Leong, one way to achieve long-term behavioural change would be to encourage a continual mixing and exposure of social groups of people who favour open defecation to other groups who are similarly attuned to environmental issues.
"Studies have found that people outside a group change their behaviour in order to suit a group's identity over time, so as to adopt a new social status and identity for themselves."
Professor Leong continues, "This could have an overall positive impact in sharpening the environmental identities of the first group of individuals, and encourage them to take on the behavioural traits and attitudes of the second group, so that they gradually move towards adopting toilets as an alternative to OD. Additionally, latrine use can be promoted in campaigns as being part of the green identity as it is comfortable and ecologically less stressful for the environment."
Learn more on Professor Leong's study: Narratives of Sanitation: Motivating Toilet Use in India.
(Photo credit: juggadery)