Processes and challenges of community mobilisation for latrine promotion under Nirmal Bharat Abhiyan in rural Odisha, India

Parimita Routray, Belen Torondel, Marion W Jenkins, Thomas Clasen, Wolf-Peter Schmidt, Parimita Routray, Belen Torondel, Marion W Jenkins, Thomas Clasen, Wolf-Peter Schmidt

Abstract

Background: Despite efforts to eradicate it, open defecation remains widely practiced in India, especially in rural areas. Between 2013 and 2014, 50 villages in one district of Odisha, India, received a sanitation programme under the Nirmal Bharat Abhiyan (NBA - "Clean India Campaign"), the successor of India's Total Sanitation Campaign. This paper documents the strategies and processes of NBA community mobilisation for latrine promotion in these villages and assesses the strengths and limitations of the mobilisation activities.

Methods: NBA's community mobilisation activities were observed and assessed against the programme's theory of change in 10 randomly selected programme villages from start to finish. Additional data was collected through review of documents, individual interviews (n = 80) and focus group discussions (n = 26) with staff of the implementing NGOs and community members.

Results: Our study revealed the lack of a consistent implementation strategy, lack of capacities and facilitation skills of NGO staff to implement sanitation programmes, political interference, challenges in accessing government financial incentives for latrine construction, and lack of clarity on the roles and responsibilities among government and NGO staff, leading to failure in translating government policies into sustainable actions. Social divisions and village dynamics related to gender and caste further constrained the effectiveness of mobilisation activities. Meetings were often dominated by male members of upper caste households, and excluded low caste community members and views of women. Community discussions revolved largely around the government's cash incentive for latrines. Activities aimed at creating demand for sanitation and use of latrines often resonated poorly with community members. An assessment by the implementers, 1 year after community mobilisation found 19% of households had a completed latrine across the 50 villages, a marginal increase of 7 percentage points over baseline.

Conclusions: In this setting, the Government of India's NBA programme to increase rural sanitation coverage and use is hampered by political, programmatic, logistical and socio-structural constraints. Sanitation demand generation was difficult for local implementing NGOs as village populations had lost trust in organisations due to previous indications of fraud. Agencies or organisations implementing sanitation campaigns and conducting sanitation promotions need to enhance their staff's knowledge and build capacity in order to address important social heterogeneity within villages. This trial's registration number is NCT01214785 (October 4, 2010).

Keywords: Caste and power dynamics; Community mobilisation; Nirmal Bharat Abhiyan; Sanitation promotion.

Figures

Fig. 1
Fig. 1
Theory of change: Community mobilisation results in raising demand, acquisition, and use of latrines among rural households of Puri District
Fig. 2
Fig. 2
Wall painting in a study village

References

    1. Clasen TF, Bostoen K, Schmidt WP, Boisson S, Fung IC, Jenkins MW, Scott B, Sugden S, Cairncross S. Interventions to improve disposal of human excreta for preventing diarrhoea. Cochrane Database Syst Rev. 2010;(6):CD007180. doi:10.1002/14651858.CD007180.pub2.
    1. Acharya DR, Bell JS, Simkhada P, Van Teijlingen ER, Regmi PR. Women's autonomy in household decision-making: a demographic study in Nepal. Reprod Health. 2010;7(1):15. doi: 10.1186/1742-4755-7-15.
    1. Stocks ME, Ogden S, Haddad D, Addiss DG, McGuire C, Freeman MC. Effect of water, sanitation, and hygiene on the prevention of trachoma: a systematic review and meta-analysis. PLoS Med. 2014;11(2):e1001605. doi: 10.1371/journal.pmed.1001605.
    1. World Health Organization, UNICEF. Progress on sanitation and drinking water–2015 update and MDG assessment. World Health Organization. 2015. . Accessed 15 Jan 2016.
    1. Government of India. Census of India, 2011 : Availability and type of latrine facility - 2001-2011. . Accessed 17 Dec 2014.
    1. Spears D, Ghosh A, Cumming O. Open defecation and childhood stunting in India: an ecological analysis of new data from 112 districts. Plos One. 2013;8(9):e73784. doi: 10.1371/journal.pone.0073784.
    1. Cairncross S, Hunt C, Boisson S, Bostoen K, Curtis V, Fung IC, Schmidt WP. Water, sanitation and hygiene for the prevention of diarrhoea. Int J Epidemiol. 2010;39(suppl 1):i193–i205. doi: 10.1093/ije/dyq035.
    1. Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis. 2005;5(1):42–52. doi: 10.1016/S1473-3099(04)01253-8.
    1. Water and Sanitation Program. World Bank. A Decade of the Total Sanitation Campaign: Rapid Assessment of Processes and Outcomes. 2010. . Accessed 13 Feb 2013.
    1. Government of India Guidelines : Total Sanitation Campaign in India. 2010 .. Accessed 15 Sept 2015.
    1. WaterAid. Feeling the Pulse - A study of the Total Sanitation Campaign in five states of India. 2008. . Accessed 10 May 2012.
    1. Planning Commission. Evaluation study on total sanitation campaign. Programme Evaluation Organisation, Government of India. 2013. . Accessed 13 Oct 2015.
    1. Routray P, Schmidt WP, Boisson S, Clasen T, Jenkins MW. Socio-cultural and behavioural factors constraining latrine adoption in rural coastal Odisha: an exploratory qualitative study. BMC Public Health. 2015;15(1):880. doi: 10.1186/s12889-015-2206-3.
    1. Coffey D, Gupta A, Hathi P, Khurana N, Spears D, Srivastav N, Vyas S. Revealed preference for open defecation. Econ Polit Wkly. 2014;49(38):43.
    1. Barnard S, Routray P, Majorin F, Peletz R, Boisson S, Sinha A, Clasen T. Impact of Indian Total sanitation campaign on latrine coverage and use: a cross-sectional study in Orissa 3 years following programme implementation. Plos One. 2013;8(8):e71438. doi: 10.1371/journal.pone.0071438.
    1. Patil SR, Arnold BF, Salvatore AL, Briceno B, Ganguly S, Colford JM, Jr, Gertler PJ. The effect of India's total sanitation campaign on defecation behaviors and child health in rural Madhya Pradesh: a cluster randomized controlled trial. Plos Med. 2014;11(8):e1001709. doi: 10.1371/journal.pmed.1001709.
    1. Government of India. Nirmal Bharat Abhiyan - Guidelines. 2012. . Accessed 21 Sep 2015.
    1. Government of India. Swachh Bharat Mission(Gramin). 2014. . Accessed 10 May 2017.
    1. Cops M. Guide to community mobilization programming. . Accessed 6 Apr 2016].
    1. WHO, UNDP, and World Bank, The PHAST initiative - A new approach to working with communities. 2000. . Accessed 30 Jun 2016.
    1. SARAR Methodology - Factsheet. . Accessed 14 Nov 2014.
    1. Chambers R. Going to scale with community-led Total sanitation: reflections on experience, issues and ways forward. IDS Pract Papers. 2009;2009(1):01–50. doi: 10.1111/j.2040-0225.2009.00001_2.x.
    1. Kar K, Chambers R. Handbook on community-led total sanitation. London: Plan UK; 2008 Apr.
    1. Waterkeyn J, Cairncross S. Creating demand for sanitation and hygiene through community health clubs: a cost-effective intervention in two districts in Zimbabwe. Soc Sci Med. 2005;61(9):1958–1970. doi: 10.1016/j.socscimed.2005.04.012.
    1. O'loughlin R, Fentie G, Flannery B, Emerson PM. Follow-up of a low cost latrine promotion programme in one district of Amhara, Ethiopia: characteristics of early adopters and non-adopters. Tropical Med Int Health. 2006;11(9):1406–1415. doi: 10.1111/j.1365-3156.2006.01689.x.
    1. Government of India, World Bank. From Dreams to Reality : Compendium of Best Practices in Rural Sanitation in India. 2010. . Accessed 1 Apr 2016.
    1. Pattanayak SK, Yang JC, Dickinson KL, Poulos C, Patil SR, Mallick RK, Blitstein JL, Praharaj P. Shame or subsidy revisited: social mobilisation for sanitation in Orissa, India. Bull World Health Organ. 2009;87(8):580–587. doi: 10.2471/BLT.08.057422.
    1. Clasen T, Boisson S, Routray P, Torondel B, Bell M, Cumming O, Ensink J, Freeman M, Jenkins M, Odagiri M, Ray S. Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: a cluster-randomised trial. Lancet Glob Health. 2014;2(11):e645–e653. doi: 10.1016/S2214-109X(14)70307-9.
    1. Boisson S, Sosai P, Ray S, Routray P, Torondel B, Schmidt WP, Bhanja B, Clasen T. Promoting latrine construction and use in rural villages practicing open defecation: process evaluation in connection with a randomised controlled trial in Orissa, India. BMC Res Notes. 2014;7(1):486. doi: 10.1186/1756-0500-7-486.
    1. Wagner E, Lanoix JN. Excreta disposal for rural areas and small communities. WHO monograph series no 39. Geneva: World Health Organisation; 1958.
    1. DFID, Sutra Consulting. Rapid Appraisal of WASH sector in Odisha : A Community Report. . Accessed 12 Apr 2016.
    1. Hueso A, Bell B. An untold story of policy failure: the Total sanitation campaign in India. Water Policy. 2013;15(6):1001–1017. doi: 10.2166/wp.2013.032.
    1. Government of India, UNICEF. Sanitation and Hygiene Advocacy and Communication Strategy Framework 2012–2017. . Accessed 10 May 2017.
    1. O’Reilly K, Louis E. The toilet tripod: understanding successful sanitation in rural India. Health Place. 2014;29:43–51. doi: 10.1016/j.healthplace.2014.05.007.
    1. Water Supply and Sanitation Collaborative Council, World Health Organisation. Sanitation and Hygiene Promotion - Programming Guidance. 2005. . Accessed 12 Feb 2015.
    1. Mehrotra N, Patnaik SM. Culture versus Coercion: Other Side of Nirmal Gram Yojana. Econ Polit Wkly. 2008;43(43). . Accessed 8 Sept 2016.
    1. Government of India. Census Data. Toilet Coverage and Sanitation Performance in India By States (2001–2011). . Accessed 14 Sept 2015.
    1. Kumar A. Sanitation in rural India: an analysis of households’ latrine facility. J Stud Dyn Chang (JSDC)-ISSN: 2348–7038. 2014 Oct 16;1(6):231-246.
    1. Pardeshi G, Shirke A, Jagtap M. SWOT analysis of total sanitation campaign in Yavatmal district of Maharashtra. Indian J Community Med. 2008;33(4):255. doi: 10.4103/0970-0218.43233.
    1. Kraemer P, Sinha S. Capacity building-a tool for up-scaling decentralised sanitation infrastructure provision. Water Pract Technol. 2010;5(4):wpt2010116. doi: 10.2166/wpt.2010.116.
    1. Kurup KB, Abdulla KA, Kurien CO, Remadevi OT, Mathew T. The community-managed sanitation programme in Kerala: learning from experience. . Accessed 2 Feb 2014.
    1. Movik S, Mehta L. The Dynamics and Sustainability Of Community -led Total Sanitation Mapping Challenges And Pathways. . Accessed 21 Mar 2016.

Source: PubMed

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