ReliefWeb

Summary

The Swachh Bharat Mission has given more impetus to improving sanitation in the country than ever before, with the explicit agenda of making India open defecation free by 2 October 2019. While the Mission has been very successful in boosting latrine coverage, actual latrine use remains low in many areas of the country. The aim of this study was to develop and rigorously evaluate low-cost and scalable behaviour change interventions to promote latrine use in rural India. ‘What works and why?’ best summarises the evaluation questions of this impact assessment.

The study was carried out in Raichur district, a district in Northern Karnataka that has poor development indicators (International Institute of Population Sciences and ICF 2017). We used the risks, attitudes, norms, abilities and self-regulation (RANAS) approach to tailor the interventions to the actual mindset of the target population. Thus, the campaign aimed at changing the precise drivers of and barriers to latrine use in the target population. We used a cluster-randomised trial (n = 1,945) with one intervention and one control group to rigorously evaluate the campaign.

Data were collected through standardised face-to-face interviews with household participants before the campaign (baseline survey) and after the campaign (endline survey). In addition to measuring latrine use through reports and spot-check observations, we also measured the behavioural factors potentially steering latrine use.
This meant we were also able to determine the mechanisms of actions through which the campaign achieved its impact.

Results indicated that, in both treatment and control arms, latrine use increased by more than 15 per cent. Also in both arms, the safe disposal of child faeces improved by approximately 30 per cent. This suggests that external factors had a strong influence on the project outcomes. Intensive government activities to promote and monitor latrine use were revealed by qualitative data collection, and our findings suggest that these had a substantial impact on latrine use and the safe disposal of child faeces, or the way in which people responded to the survey questions.

Our campaign resulted in an additional, statistically significant increase in latrine use, by approximately 5 per cent. Not only were significant changes reported in latrine use but also the spot-check observations corroborated these results. Insignificant effects on safe disposal of child faeces suggest that our campaign did not create an added value for this outcome.

Key recommendations for programme managers, policymakers, donors and researchers are as follows:

• Latrine use behaviour change to be positioned as an important component of the open defecation free sustainability agenda at all levels (from district to national). Behaviour change strategies to be positioned to promote latrine use behaviours, as well as to sustain latrine use behaviours over time in both open defecation declared districts and those that are yet to be declared. Further, sustained behaviour requires all community members to be engaged;

• Behaviour change strategies and activities identified as effective in this study and others (under this grant window) to be incorporated into ongoing campaigns by Swachh Bharat Mission on latrine use promotion, by building capacities of government functionaries, development partners and implementing organisations;

• Key behaviour change messages must be reinforced multiple times using different activities (that address different drivers); and

• Cultural and contextual sensitivities related to latrine use (e.g. overt and public display of campaign materials in households, water availability) must be taken into consideration and addressed, to implement a successful behaviour change intervention.