Community Participation Drives Tap and Toilet Projects in Rural India
A recent World Bank-funded study in rural India sheds light on the need to examine how programs that promote community participation can help improve water and sanitation conditions and ultimately reduce diarrheal diseases.
The five-year study, Evaluation of the Health Outcomes of the Rural Water Supply, Sanitation, and Hygiene in Rural Maharashtra and Orissa, India, which ends in 2008, evaluated water supply, sanitation practices, and hygiene (WSH) behaviors. Results confirm that income, health literacy, privacy, and peer pressure are central elements of interventions related to improving WSH conditions. The study also reveals that community involvement, particularly the encouragement of social pressures, may influence WSH behaviors.
RTI led the study, which concentrated on communities taking responsibility for their water and sanitation conditions. Researchers used rigorous methods, including surveys of control and treatment communities before and after interventions were implemented in the treatment communities.
In Orissa, the study suggests that a social intervention—information, education, and communication (IEC) campaigns—combined with subsidies for the poor can influence WSH behaviors. Following an intensive IEC campaign in 20 villages, children's diarrhea rates fell by as much as 30%. “Toilet ownership and use in these villages increased from 6% to 32% in one year,” said Subhrendu K. Pattanayak of RTI, principal investigator of the study. In control villages, ownership and use of toilets was up about 13% throughout the study.
Diarrhea incidence in children under age five decreased in treatment and control villages in Orissa by about 30%, and the decline was statistically significant at 5% in the intervention villages by 2006. “The small impact could result from the second health measurement, which was made shortly after the construction of latrines,” Pattayanak said.
Data from the Government of Orissa suggest that these increases continued in the year after the IEC campaigns and final surveys. By 2007, 10 of the 20 treatment villages had achieved 100% latrine ownership and use.
In Maharashtra, communities conceived, planned, and implemented WSH improvements and are responsible for operations, under the World Bank-funded Jalswarajya program, which encourages the concept of water self-rule. Among the 80 communities participating in the program, tap use increased from 17% to 32%, and toilet use rose from 15% to 36% within three years of the program’s implementation. In control communities, tap use increased from 24% to 28% and toilet use increased by 13% to 21%.
Understanding Incentives: The Costs and Benefits of Behavior Change
The World Bank study aimed to determine whether WSH interventions in the Jalswarajya project in Maharashtra and a government social mobilization program in Orissa affect WSH outcomes and improve children’s health.
The study’s approach to WSH assumed that behavior change results from perceived costs and benefits, both individual and collective, related to health and social factors. For example, an individual benefit of toilet use is privacy; a cost is the time and money spent on building a toilet. Within a community, many people may bear the costs of a household’s WSH behaviors. For instance, a community may rely on drinking water that is microbiologically contaminated as a result of the poor WSH practices of a single household.
“It is critical to motivate entire communities to recognize these social costs and benefits, to commit to changing behaviors, and to sustain that commitment. Better communication about the private health benefits and awards for community cleanliness are some of the tools available to policy makers,” said Pattanayak.
In Maharashtra, 10,000 households were surveyed four times; and in Orissa, 1,000 households were surveyed twice, in dry and rainy seasons. The questionnaires included biological, socioeconomic, behavioral, cultural, and environmental indicators. Baseline data were collected from households in treatment and control villages. Data were also collected through water quality tests and qualitative assessments. After interventions were completed in the treatment villages, the survey was conducted again in the same households and month, to account for seasonal health impacts.
Orissa—Changing Community Norms
In Orissa, the World Bank study evaluated an intensive IEC campaign in Bhadrak District, under the Government of India’s Total Sanitation Campaign. This intervention concentrated on changing the community norm of open defecation to the use of individual household toilets.
The IEC campaign conveyed messages about the costs and benefits of toilet use, provided technical assistance about toilet engineering, and engaged in social mobilization with strong emotional overtones. For example, the campaign used unconventional approaches such as calculation of fecal materials in the village, walks around open defecation sites, and mapping of unsanitary environments. Subsidies in Orissa were provided only for very poor households.
“The IEC campaign harnessed the power of social norms on individuals to conform to accepted practices,” said Jui-Chen Yang, RTI Assistant Project Director. The IEC campaign in Orissa “was enhanced by increasing the supply of materials, along with the technical ability to construct toilets,” Yang noted.
Maharashtra—Communities Design Their Own WSH Programs
In Maharashtra, the Jalswarajya program aims to increase rural access to drinking water and sanitation services through delivery by local governments and community involvement.
Maharashtra’s village residents apply to district governments to take part in the state-run program, and participants organize to improve their water and sanitation systems based on methods that best meet their needs and capabilities. The government pays for facilities, and villages must improve WSH, end open defecation, and pay 100% of operation and maintenance costs for improvements. The program concentrates on interventions such as piped water, household toilets, health and hygiene training, and source water quality.
Communities that participated in Jalswarajya significantly improved tap and toilet use, water quantity, and health, including a decrease in diarrhea. Health improvements were also observed in the control villages, reflecting overall and socioeconomic development in the state. Jalswarajya households reduced time spent walking to and waiting at the main water source. In the dry season, out-of-pocket expenses for treatment of illness decreased significantly in Jalswarajya villages, compared to control villages.
“The World Bank study shows that community engagement and intensive IEC efforts, with government partnership, can spur social change that increases the use of latrines and taps and help prevent diarrhea in children. It also confirms that physical engineering solutions are not sufficient, and that catalyzing communities and decentralizing institutions are necessary to improve water and sanitation conditions in much of the world and to meet the Millennium Development Goals,” said Pattanayak.