The issue: Creating a new Social Norm – Open Defecation Free Communities
Therese Dooley – WASH Section, UNICEF, New York
I.
Description of the challenge
Poor access to adequate sanitation, resulting in the practice of widespread open defecation, has
negative health, economic and social impacts on communities. In many developing countries children
suffer frequent bouts of diarrheal disease, owing primarily to inadequate sanitation and hygiene.
Repeated diarrheal episodes have been identified as a significant underlying cause for malnutrition, in
turn leading to weakened immune systems and impaired growth and development.1 Billions of annual
diarrhoea episodes continue to exact a heavy toll on the well-being and future potential of the children
of the world’s poor. Elimination of open defecation results in significant reduction in diarrheal
morbidity and mortality.
Open defecation is the last recourse for those without any form of sanitation – those at the bottom of
the sanitation ladder who endure the daily indignity of defecating in the open. In communities where
some members defecate in the open, the whole community is at increased risk of illnesses such as
diarrheal diseases and worm infestations. Furthermore, open defecation can create a vicious cycle of
illness, high expenditure on health care, lost work hours and poverty.2
Those who suffer most from lack of toilets, privacy and hygiene are women, adolescent girls, children
and infants. Sanitation provides women, primary caregivers, greater privacy and support for
maintaining children’s health and domestic cleanliness. Menstruating girls are reluctant to attend
schools without toilets, and their parents are reluctant to send them. Women and girls often become
“prisoners of daylight” as they must wait until the cover of darkness before going to the bush or fields
to relive themselves.
So why does this situation continue in so many communities around the world? Currently 1.2 Billion
people globally practice open defecation the majority being in South Asia and Sub-Saharan Africa.
The reasons are many and varied and indeed context specific to individual communities but include
lack of knowledge, traditional and cultural practices and economic constraints. As people become
aware and understand more about sanitation improvements and the various negative implications of
defecating in the open they find themselves in a habitual practice which poses a real social dilemma
and change is difficult as there is no empirical expectation for them to change.
1
2
'Hand washing for preventing diarrhea (Review)' Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA (Cochrane Review).
http://www.ids.ac.uk/go/news/191108shit
It is important to clarify between the programming reasons for encouraging such change (Health,
social and economic benefits, privacy, dignity, etc) and what drives change within individuals and
communities. Programmatically, we are driven by evidence on the impact of poor sanitation practices
on children and thus traditionally we have assumed that similar information will stimulate community
change – “You must build a latrines to stop your child getting diarrhoea” without contextualizing
such information into the overall schema as to why the community practices open defection.
The reality being that in many communities there is no empirical expectations on individuals and
families to change “everyone is doing it”. If we put this into context we will see that the existing
situation determines that the “best” practice from a personal perspective of an individual is generally
to practice open defecation which can be illustrated as follows:
Others
Use Toilet
Defecate in the Open
(1)
(2)
S
B
Use Toilet
S
W
Me
(3)
W
(4)
T
Defecate in the
open
B
T
B = Best, S = Second, T = Third, W = Worst
Red = Me, Green = Others
( ) Refers to box code used in explanation below
Table 1.
Existing Social Dilemma on Toilet use in a community
Using the above example:
For me as an individual in the community my current best option is described in box number (3)
where I practice open defecation and everyone else in the community uses a toilet. The reason for this
while context specific3 in many communities are: If everyone else uses a toilet I am less likely to get
sick, I don’t have to pay for a toilet and I don’t have to go against the tradition of not sharing a toilet
with men/women.
The worst scenario for me is described in box number (2) where I build and use a toilet and everyone
else defecates in the open. The main reason for this is that my children and I will continue to get sick
as the whole community environment is contaminated by everyone else, economically I am worse off
as I have invested in a toilet and I may be subject to ridicule for wasting money or going against the
tradition of sharing a toilet.
So what should I do? It is a real dilemma should I remain defecating in the open like everyone else (3)
or build a toilet? In order for me to change and gain from such a change I need to know that the entire
community will change and that they expect me to change along with them. For all of us as an entire
community to benefit the best scenario is described in box (1) where we all build and use toilets and
have empirical and normative expectations around toilet use in our community. So how do we address
this social dilemma and create a new social norm of open defecation free communities.
II.
Critical Evaluation of the work so far.
Various efforts and approaches to improve sanitation coverage have been taken over the years.
Through these experiences much has been learnt, particularly in terms of engaging communities,
creating demand for sanitation, behavior change, developing appropriate technologies and fostering
sustainability of systems. While the learning curve has been steep, new approaches have evolved
which address sanitation from a social rather than a technical perspective and these are summarized in
Table 2.
Old Approaches
New Approaches
Building Toilets
Individual/family
Health Message Focused
Top – Down & Externally Driven
Didactic
Technologies predetermined
Subsidized
Don’t mention the S*** word
Personal responsibility - fear
Changing Social Norms
Social/Community
Economic, Social, Health, disgust,
Community led –Internal, demand driven
Participatory – natural & traditional leaders
Local technologies, community capacity
Rewards – PRIDE – celebration
Talk SHIT – faeces, Poo, Kaka,
HRBA – right holders/duty bearers
perspective
Table 2. Changes in sanitation programming approaches
3
Note for the purposes of this paper I am using general contexts and not specifics for individual communities
In the past sanitation was seen as a purely technical problem which would be solved by building
toilets. The types of toilets to be used were predetermined by “outside engineers” who felt they knew
what the best solution was from a technical perspective. Where families could not afford these
technologies various systems were established to subsidize or build these toilets for families. Many
projects were thus externally driven and while efforts were made to ensure community involvement,
the messaging was often health focussed and didactic. Even where more participatory approaches
were used the target was individual/family behaviour change without considering the broader context
of the social norms in the community. So while there were some “islands of success” there were few
open defecation free communities. Some members of the community did change and these were often
the early adaptors who saw the benefits of having a toilet for their families (Privacy, Health) or others
who were driven by the social status4 of being a toilet owner. In some instances toilets were
subsidized and built but never used by individuals or their families and while it was always
considered that the reason for this was lack of understanding or behaviour change – in hindsight – one
of the key reasons for this may have been that there was no empirical expectation for the family to use
the toilet and there is some anecdotal evidence of families being ridiculed by others when their child
gets diarrhoea or for defecating in the same place as their daughters-in-law, etc.
New approaches have shifted the focus to the creation of a new social norm where entire communities
become open defecation free. It is a community focussed approach which is internally led by the
community and demand driven. It is participatory by design and facilitates community led discussions
and interactions concerning open defecation - it’s economic, social and health implications for the
community, while also allowing for deeper discussions on more traditionally held beliefs about
sanitation (sharing toilets, defecating in a room, witchcraft, etc) that the community as a whole can
address themselves. It builds on established networks (schools, traditional leaders, religious elders,
women’s groups, etc) while also encouraging “natural leaders” who emerge from the various groups
during discussions. Disgust5 is a powerful emotive experience which is built upon during community
interactions and used in the triggering process with communities with the key reward being pride.
Technologies are locally developed and built requiring no external support, (once a new social norm
has been established local capacities can be developed and markets explored to ensure people have
access to enhanced technologies and services to better sustain the social norm) and no external
subsidies are provided to individual households but communities plan and decide themselves what
needs to be done to become open defecation free.
4
Globally the richest are five times more likely to have a toilet than the poorest and the disparity is much greater
in many developing countries
5
Also sometimes described as grossology
Why are we talking about CATS?
Community Approaches to Total Sanitation (CATS) are the articulation of the key principles
underlying a variety of people-centered approaches to community sanitation that UNICEF currently
employs globally. When we speak about CATS, we are essentially discussing a distillation of best
practice in community based sanitation that includes approaches such as Community Led Total
Sanitation (CLTS), School Led Total Sanitation (SLTS) and Total Sanitation Approach (TSA).6
CATS principles reflect what we have learnt and provide the minimum ‘ingredients’ for improving
community sanitation.
The nine essential elements7 of CATS were derived from commonalities in the various approaches
taken by UNICEF country offices around the world. They represent the most critical aspects of
community programming and considered to be non-negotiable in the sense that they are the minimum
elements for improved programming for sanitation and the elimination of open defecation.
Taking Community Led Total Sanitation (CLTS) as an example, a series of steps to facilitate
community wide discussions and deliberation is undertaken. These steps can briefly be described as
follows8:

Transect walk – defecation areas

Community Mapping of defecation areas

Identifying the areas in the community with the most open defecation

Calculation of shit and medical expenses

Water, hair, shit – or fly in my soup – triggering disgust

Ignition or “aha” moment

Planning

Monitoring and evaluation

Open Defecation Free (ODF) declaration and celebration
These steps commonly referred to as the triggering process may be adapted depending on the
communities involved, but all have one commonality, if undertaken correctly they are led by the
community.
Community Approaches to Total Sanitation – Field Note UNICEF 2010
Annex 1
8
Handbook on Community-Led Total Sanitation, Kamal Kar, Robert Chambers
6
7
II.2 In what ways are these strategies already integrating social norms and social change:
To date the work undertaken has not been articulated in the language of social norms. However, from
the insights and discussion held during the course it is clear that the strategies being used are already
integrating social norms and social change.
Allowing for local and context dependent differences in the behavioural rules around sanitation CATS
aims to develop new a new social norm in a community whereby they become open defecation free
and the empirical and normative expectation in those communities are that the entire community
abandons open defecation.
Before commencing the process we try to interpret and understand the current situation in the
community and categorize it. What current sanitation methods does everyone use, have there been
previous external sanitation interventions in this community, how homogenous is the community,
what are the various groups and/or strata in the community (landless, women), etc.
Networks are often assessed in terms of who does what in a community, who are the local traditional
and natural leaders, what groups need to be involved in planning the process, which groups need
special attention so that they will not be excluded, who’s influential in the community, who are the
dormant leaders, who are the communicators, etc. Much of this information is obtained through the
local extension agents, religious, natural and traditional leaders.
Invoking a schema or script whereby beliefs, expectations, behavioural rules, roles and
responsibilities are better understood is currently inherent in the process itself. During the walk,
mapping and discussions the community discusses open defecation and all issues concerning it
including their belief and traditions, current and indeed past behavioural rules and their expectations
and hopes.
Disgust is a powerful trigger which is used during the triggering process and from a social norms
perspective this could be describes as the development and activation of a salient cue which in the
case of sanitation is an emotive reminder to many of the underlying reason for abandonment of open
defecation.
CATS uses deliberation to change the norms. Once the community has progressed through the
process which involves a lot of discussion and deliberation - they want to change, realize that others
want to change, commit to change and implement change - all of these are critical steps in the process.
Rewards in the form celebration and pride are the key incentives, however in some areas other
incentives are provided such as an ODF certificate or a village sign citing that the village is ODF.
To date the results are demonstrating that we have achieved open defecation free status in hundreds if
not thousands of communities and I believe that we have changed the social norm.
CLT S Pilot in Mali: After 3 months
100%
Initial coverage
Final coverage
Sanitation coverage
75%
Pilot targeted 15 villages
with a total population of
approximately 14,000. All
15 villages became ODF
within 3 months of
triggering. Approximately
300 latrines were
constructed, 100 latrines
rehabilitated, and all
latrines were equiped with
handwashing stations.
50%
Néguébabougou
Fadiéda
N’Fabougou
Boidégué
Korikabougou
Dossérébougou
Sido
Gouakoulou
Boro
Babougou
Gabacoro
Fabougou
Tiafina Est
Tiafina Ouest
0%
Somba
25%
Village Name
Others
Follow Norm Disobey Norm
Use Toilet
Defecate in the Open
(1)
(2)
B
T
Follow Norm
Use Toilet
B
W
Me
Disobey Norm
Defecate in the
open
(3)
T
W
(4)
S
B = Best, S = Second, T = Third, W = Worst
Red = Me, Green = Others
( ) Refers to box code used in explanation below
Table 3.
A new social norm – open defecation free community
S
Once the community agrees to abandon open defecation, takes action and declares itself ODF
a new social norm is established and it is best for me and others to follow the norm and use a
toilet. In some instances following the declaration communities have created local bye-laws
to prevent open defecation in their village and such systems may be important to monitor,
regulate and sustain the social norm as it indicates to all including new comers to the
community that the normative expectation in that community is that people use toilets.
III Change in Practices:
A greater understanding and knowledge of social norm theory is vital for planners, managers and
implementers of CATS. What has to date been seen as a behaviour/social change initiative would
benefit greatly from a better understanding of social norms. As CATS is expanding as such a fast rate
it is vital that there is an appreciation of the importance of all the components, categorization,
development of a script, the importance and role of normative and empirical expectations, etc. and
that we can incorporate this understanding in our trainers, facilitators and leaders. For me this is
urgent as I can see that some of the issues which have arisen in the process to date have been due to a
lack of understanding of the role expectations and norms play in the process.
Some specific issues which we will try to strengthen as a result of the training is in the area of
incentives. In some cases financial and/or material incentives have been provided to communities to
become ODF. This may be in the form of a cash grant, a material benefit such as a water system or an
incentive to a leader or extension agent. This could be an example of Crowding Out Effect whereby
individuals perceive the intervention to be controlling their intrinsic motivation. While in some cases
these incentives have resulted in communities and leaders trying to bypass the process in order to reap
the reward. So a deeper understanding of rewards and incentives is needed to ensure that they are
supportive and motivating.
It will also be important to enhance our social network analysis to ensure it is actually undertaken in a
strategic way and looks at diffusion strategies for replication of ODF to other communities. As CATS
is expanding at such a rapid rate we have no control on diffusion, neighbouring communities to those
triggered are declaring themselves ODF and changing their social norms. While traditional leaders
such as Chiefs are working with elders from the same clans and ethnic groups to ensure the norm
spreads throughout their “kingdom”. This is currently happening in an ad-hoc manner and could
benefit greatly from a more organized approach which looks at networks and diffusion mechanisms.
Annex 1 CATS – essential elements
CATS: 9 essential elements
1. The goal of CATS is ‘total sanitation’, that is, achieving open-defecation free communities
through the use of safe, affordable and user-friendly solutions/technologies. The emphasis of
CATS is the sustainable use of sanitation facilities - as opposed to the construction of
infrastructure. Safe disposal of human excreta includes the management of infants and young
children’s feces.
2. The definition of ‘communities’ includes households, schools, health centers and
traditional leadership structures in addition to women and girls, children and men. Working
with communities inclusively is an integral aspect of CATS.
3. Communities lead the change process and use their capacities to attain their envisioned
objectives. They play a central role in planning with special consideration to the needs of
vulnerable groups, women and girls and in respect of the community calendar.
4. Subsidies - in the form of funds, hardware, or otherwise - are not given directly to
households. Community rewards, subsidies and incentives are acceptable only where they
encourage collective action and total sanitation, and where used to attain sustainable use of
sanitation facilities (as opposed to the construction of hardware).
5. Households will not have externally imposed standards for choice of sanitation
infrastructure. Technologies developed by local artisans from locally available materials are
encouraged. External agencies provide guidance as opposed to regulation. Where viable,
involvement/instigation of a local market with its local entrepreneurs is encouraged.
6. Local capacity building, including the training of community facilitators and local artisans,
is an integral part of CATS.
7. Government participation and cross-fertilization of experiences are essential for scaling up.
8. CATS integrate hygiene promotion effectively into program design; the definition, scope
and sequencing of hygiene components are contextual.
9. Sanitation is an entry point for greater social change and community mobilization.