Rethinking Behavioural Change for “Total Sanitation” in India

After 50% of households in the state of Jharkhand constructed toilets, all households were classified as manushya(human), billi(cat), and suwar(pig) based on their defecation behaviours and their status is made publicly visible at a prominent place by the members of the community. Children are made to stand in separate lines as a punishment in the schools of Maharashtra if they do not have toilets at home. At a recent consultation session organized by Arghyam to discuss behavioural change in the context of the Total Sanitation Campaign, I was astounded to learn that most state governments in India are resorting to or supporting strategies of public shame and fear to motivate people to construct toilets.

Most state governments realize that while the shortage of funds and land stand in the way of building toilets, they may not be the only roadblocks. Even if people have adequate funds and land, they are not motivated to build toilets, and public shame and fear become fool proof strategies to bring about this behavioural change in the short order. While different Indian state governments are evaluating the success of the Total Sanitation Campaign based on the number of toilets constructed, Arghyam, a public charitable foundation working in sanitation and water sector, has realized that building toilets does not necessarily ensure usage, which is critical for achieving “Total Sanitation.” The foundation’s main objective behind organizing the consultation session was to understand current efforts related to Behaviour Change Communication (BCC) and Information Education Communication (IEC) and the reasons why certain communication strategies have worked and the others have not been proven to be effective or scaled up.

Many participants at the session felt that the process of communicating a clear message through a key influencer in the community is critical for bringing the desired behavioural change. On the other hand, some expressed that toilet usage cannot happen through communication and needs to be enforced. A select few believed that “awareness is overrated,” and while it can play a huge role to address the prevailing myths and misconceptions it may not be effective to solve such “wicked problems.” Illustrating this argument, a participant mentioned that it is very difficult to motivate an old man habituated to open defecation for 60 years to suddenly start using toilets only through communication. A simple intuitive design, for instance “toilets with open roofs planted in the fields,” can bring about the desired behavioural change.

While this dilemma that whether design of new toilets or communication strategies would be more effective in the sanitation context was not resolved during the session, it was quite clear that enforcing toilet usage or resorting to strategies of fear or public shame may be effective to achieve short term behavioural change, but cannot sustain it as a cultural practice. Based on an understanding of cultural dynamics, different strategies may be required to motivate different types of people to use toilets. Central to the right of sanitation is the right of dignity, which is why women may be more motivated to build and use toilets as compared to men. Likewise, it would be harder to motivate older men to use toilets as they have been resorting to open defecation practice for many years. Also, a strategy which may work in the context of one Indian state may not be effective in the other considering the varying economics and other socio-cultural factors. Many communication strategies that have proved to be effective to bring behaviour change in other contexts, such as Polio health drive, may also fail in the context of sanitation as using toilets is not equivalent to saving lives.

After spending many hours listening to arguments around how to make the Total Sanitation Campaign more effective, it did become evident to me that, be it design of new toilets or communication strategies, leveraging cultural context is absolutely essential to arrive at an appropriate strategy which achieves more than an attitudinal shift. Along with designing appropriate strategies to achieve behavioural change, the type of change desired needs to be given equal emphasis for the effectiveness of the campaign. Simply using toilets may not ensure good hygiene. In order to achieve “Total Sanitation,” the campaign should not be only limited to changing open defecation behaviours and promoting toilet usage, but should also focus on promoting behaviours that emphasize on hygiene and health, such as using soap and water.