Changing Behaviour and Convergence for Total Sanitation: Mobilising Communities and addressing deep seated social norms against open defecation. (A case study from Sarguja district, Chhattisgarh, India).
Shaheen Nilofer
Background
Total Sanitation Campaign (TSC) is a comprehensive national flagships program by Government of
India (GOI) that ensures sanitation facilities in rural areas with the broader goal to eradicate the practice of open defecation by 2012. TSC as a part of reform principles was initiated in 1999 and making it demand driven and people centered. The following case study is about adaptations and innovations brought in to make meaningful interventions in challenging social norms with regards to open defecation and changing social practices to motivate communities/individuals to adopt toilets at household level. This is an unique experiment where in legal or governmental commitment or legal norms so to say, initially in conflict with social norms leading to supporting the shift in mind set for collectives to change push for implementing social change. Hence, appreciates the role of various stakeholders in coming together to bring about a change.
District profile/Problem analysis:
TSC in Surguja District was started in 2006. In 2007 District administration took TSC as a priority programme component. A multi-sectoral approach with community involvement formed the basis.
Refreshingly new approach were utilized to overcome bottlenecks in supply of materials, involvement of community, overcoming initial resistance from the community to shun open defecation and coming forward to construct and use of household toilets, involvement of panchayat representatives (local self governance) and community, provision of water to sanitation facilities, and ensuring active participation of line departments. There is a strong belief that this is a unique model, which can ensure coverage, use and maintenance of toilets and hygiene measures and this model could be replicated within the district, other districts in Chhattisgarh as well as other states in India.
Sarguja district has more than half, about 55 per cent of the district population belongs to tribal community. These communities and panchayats are characterized by scattered hamlets ( para ), low literacy level, and widespread practice of open defecation. A large majority of households expressed poverty as a key reason for not having toilets. Prevalence of disease water borne, skin disease, and cases of malnutrition were also substantially high. Arrival of monsoon was most times followed with outbreak of epidemic and increased prevalence of diarrhoea, malaria, and other water borne diseases. Health department was always stretched for time and human resources considering the geographical spread of the district as well as inaccessibility of villages due to rains.
In addition, Group interviews were conducted with PRI functionaries, frontline functionaries,, Village
Motivator, and Community members (12 villages). Focus group discussions were also conducted with men and women in 11 villages. Visual documentation of individual household level toilets, School toilets, Anganwadi toilets, hand pumps to assess current condition were undertaken.

Concept applied:
This very programme is premised on Human Rights based Approach and explains through the greater involvement & leadership of the District Administration, the duty bearer’s perspective.
Notwithstanding the fact that, it also underlines the entitlement and rights holder’s approach to address the issue as we examined the active role played by the community institutions and individuals in supporting the initiative. It is quite evident how this particular case study has taken into consideration the need to undergo causal analysis and capacity gap assessment under the leadership of the District Collector (DC) before strategising the coordination system and implementation plan in place. Thus, information collection and dissemination/knowledge was used to its best as an evidence to convince people. The realisation of the fact that adopting household toilets by people is a major shift that calls for big social change/transformation and one that can only be better achieved by collective action backed by mutual expectations. This is what was demonstrated in the case study.
Why Convergence?
Convergence brings synergy between different programmes/schemes in term of planning, process, and implementation of programmes/schemes. The district administration envisaged sanitation services as an entry point for strengthening institutions and ensuring health benefits for the community. A thorough understanding of sanitation issues at village level and components that constitute total sanitation was essential and pre requisite for initiating activities under convergence.
Identifying Stakeholders for Convergence
Once it was clear that sanitation services would serve as an entry point for connecting to rural population, the first step was to list the stakeholders and ensure clarity in roles and responsibilities for effective convergence. It is important to highlight that convergence was visualized and implemented at department, programme, and executing staff level. The stakeholders both government, NGOs,
Community Institutions were all brought together as envisaged to ensure convergence of sanitation needs at the village level. The NGOs were specifically assigned the task of motivating villages to use the toilets that were constructed.
Advantage of sanitation as entry point for convergence
District administration team ensured following advantages by using sanitation as an entry point for convergence:

Strengthen participatory process and leadership at the panchayat level (Local self governance)

A low resource intensive entry that focuses on software component

A wide range of sanitation services in different institutions can be addressed which otherwise would have required concerted efforts and prioritizing at three departments

Ensure improvement in health indicators by reducing practice of open defecation

Increase in physical and social capital at the panchayat


Link provision of sanitation services with positive reinforcement by linking it with Central
Government Scheme of Nirmal Gram Panchayat (An award instituted by GOI for qualifying criteria on sanitation standards)

Improvement in development indicators- literacy, health, financial inclusion,
Framework for Convergence
Convergence framework that facilitated access and provision for sanitation services was envisaged at three levels in the districts:
1. Institutions - PRI, Community, and District Administration
2. Issues - Sanitation linked with health, education, dignity and safety of women
3. Resources – Human, Financial, and Programmes
- The first level of convergence envisaged was at key institutions in the district involving Panchayat
Raj functionaries, Gram Sabha (Village Council), and Administration were thus three key institutions that develop a collective goal and joined hands to achieve the goal of total sanitation and improved health scenario in the district.
- Second level of convergence was enhanced ability of stakeholders to go beyond the issue of sanitation and address or link activities with other socio-economic and development issues. It was interesting to see how at each level, institutions visualized and linked the outcomes of improved sanitation with issues of health, education, economic status, social capital at panchayat level, and collective benefit for all.
- This synergy at GP level engaged individuals, grass root level functionaries, and PRI in prioritizing sanitation and contributing in the form of labour, materials, and ensuring the complex task of elimination of open defecation.
Following elements were integrated for ensuring effective convergence

Enable Gram Panchayats to identify sanitation services as a priority in the context of health and well being

Identification and engagement of change agents/influencers at gram panchayat – school students, women, adolescent girls, elders, village motivators, sarpanch, and other PRI functionaries


Orientation and sensitizing of stakeholders for convergence of human and financial resources
On going capacity building of all stakeholders including teachers, anganwadi workers and helpers, mitanins , village motivators resulting in strengthening service delivery

Develop mechanism to close supply gap for construction

A robust three tier monitoring mechanism to monitor progress and track health benefits
Concepts applied:
The above explanation clearly establishes how the `Script ’ was outlined based on a thorough understanding of social conventions, norms (social, legal and moral) and practice in putting together the campaign to promote household level toilets. Individual and social expectations (benefits of having

and using toilets and helped them understand the consequences of open defecation) were clarified and it helped in coordinated effort to mount pressure in a more persuasive and convincing manner.
The importance of understanding the problem, social practice and norms and foreseeing the strategies for change was admirable. The richness of the planning led to successfully motivating the large number of communities to participate in giving up the deep-rooted practice of open defecation.
The need to analyse both the empirical and normative expectations were strongly felt in the case study both before and during the campaign was underway. This case study therefore perfectly aligns with the theoretical underpinnings of the concept that emphasises the need for alignment or linking with the a) rights of the people, b) community values (concept of im/purity) and practices and c) in ensuring the Convergence for Total Sanitation Campaign becomes a reality.
Strategies adopted
Various strategies (innovative as well as those that are tried and tested) were adopted for effective planning and execution. Listed below are brief glimpses of these strategies:

Rationalized determination of scale for intervention - -based on review of resources available, terrain, spread of panchayats, and human resources, available number of panchayats were selected for intervention. Another factor in selection of panchayats was recognition of need to have one demonstration site in each block which can start domino effect.

Decentralization It was a conscious decision and effort that “we will not do everything” by district administration. District administration thus played a catalytic role in implementation by linking programmes, resources- human and financial, and monitoring support.

Community as stakeholder and taking ownership Functionaries at all levels provided information and created opportunities that helped community understand linkages between open defecation and prevalence of disease. This helped them understand ill effects of open defecation. Micro planning by village motivators was an important step in facilitating this understanding. Another aspect that facilitated this was visit by District Collector in all the panchayats. These visits were an opportunity for District Administration to address issues of priority- BPL card, PDS, NREGA (all social safety net programmes), resolve them at panchayat level, and then enquire about health status of villagers in the panchayat.

Closing Supply gap Guidelines for procurement and distribution were provided to all panchayats through Janpad meetings and district level meetings. This played a critical role in avoiding any supply deficiency.

Robust monitoring- Dedicated cadres of monitors at different layers were appointed to develop a feedback loop for progress, quality, and challenges. About 180 DLM (District Level Monitors),
Block level supervisors, and Community level monitoring team (Toka Taki team, students) constituted this cadre. This group visited fields/households/, met periodically and helped at each level to explore solutions for challenges coming forth.

Effective IEC- Communication had a vital role and far reaching effects on success of convergence efforts for provision of sanitation services. Importantly not a single print material in form of pamphlet, poster, or flyers was used during the entire implementation phase. Alternatively

emphasis was on interactive communication. Pictorial messages at key places, milestones along the road, wall paintings on the walls in the school and anganwadi premises were used.
Involvement of local kala jattas , photo exhibition by PR departments, door to door visits by village level workers formed elements of IEC activities at village level. Further Akashwani (Radio) also was actively engaged in programmes on sanitation to reach rural masses.

Community monitoring and collective pressureChhattisgarh Panchayat Raj Adhiniyam, 1993, (a
State Regulaton), along with other by laws lays penalty for acts/behaviour leading to un cleanliness in the village. Under this act, open defecations calls for fine of Rs 50. This was taken advantage of by “Toka Taki teams” formed in each panchayat. AWW, Mitanin, Village Motivator, men and women, children constituted this team. The team members paraded at sites of open defecation in morning and evening to identify people going for defecation. Though fine was only a token amount, the experience of being told by their own people about their wrong practice (of open defecation) put many people to shame and adopt desired behaviour.
Concept applied:
The section above on strategy clearly establishes the fact that a script was very much in place and it had taken into cognisance the existing practices and norms, legislation that sanctioned people practicing open defecation, hence violation of legal norm. However, the enforcement was left to the community who arrived at a consensus on how much penalty that they would levy on people who were found defecating in the open. Hence, it was not entirely an enforcement led by higher authority but very much appreciated by the community. This indeed also speaks of how the community was structured and wielded a strong social network and instead led the conversation and discussions on the various negotiations leading to everyone agreeing to adopt toilets at their homes. Therefore, the power of collective assertion for change was remarkable and a commitment to change in expectations, which is giving up open defecation, was pronounced. Hence, the strategy offered solutions to oft-repeated questions on sustainability of initiatives introduced that challenges deep rooted social norms such as this one? Here in this particular case under study, the burden of bringing about change as seen is shared equally by the community as the rights holders and the government as the duty bearers. It’s interesting to note here that the empirical evidences which were cited and when shared right at the beginning with the community on the high expenses made on the medical costs owing to diarrhoea and other water borne diseases, the drop outs of the school children, especially young girl’s in secondary and higher secondary schools were a concern as schools didn’t have toilets, loss of wages due to general sickness were all good enough reasons for the collective to make an affirmative commitment to bring about a change in the social norm. This section also aptly describes the concept of how dis/incentives work in `public good’ environment where rewards and punishment co-existed were applied in the case study. The award instituted by the GOI `Nirmal Gram
Puraskar’ was an re/award based incentive for the panchayat’s to compete with each other to be eligible for the award hence invested their energy and resources fully as if it was a matter of great honour and pride for the panchayat/village to have received the award. This presents an interesting corollary to the fact that while the reward for being the best defecation free panchayat/village is given

by the Government (India) the communities themselves devised a penalty system of levying fine for those who defaulted the agreement on open defecation. It’s worth mentioning here that individual families decided to put a name plate on their doors to declare that they own toilets just below their names. Over-all, it was clear that the notion of dis/approval was so significant as collectives/community and as individuals that the expectations today stands changed for the better.
Clearly, the intrinsic motivation for change and the dominant thinking on preserving dignity and honor became supreme over the material incentives of re/award & punishment and thus ensured commitment to conform.
Evidence of effective convergence and benefits for community
Following is a brief explanation on how the communities perceived `change ’ reported in the village that could be attributed to inputs and intense community involvement that evolved during TSC program.
Gram Sabhas (Meeting of the Village Council)

94 per cent of households in intervention villages report that gram sabhas are being held more regularly as compared to previous year.

With regards to community participation in gram sabhas, 73 per cent respondents said that more men are attending gram sabhas and 13 per cent said that more women are attending gram sabha.

In intervention villages, greater number of respondents said that hygiene (75%) and sanitation
(25%) issues were discussed during gram sabhas. This percentage was lower in non intervention villages (56% -hygiene and 16% sanitation)
Awareness and benefits of social programs/schemes
One of the salient features of the district strategy was convergence of various department to maximize the reach of development programs and its benefits to the community. Its worth mentioning here that greater percentage of respondents in intervention villages report availing benefits of social sector programs (such as Janani Suraksha Yojana, Kishori Balika Aahar Yojana, Samajik Suraksha
Pension, Vruddha Awastha Pension, NREGP, PMGSY, and Mid day meal).
Responsiveness of government machinery and PRI
P eople’s perception about responsiveness of service delivery mechanism through government machinery and PRI representatives shows encouraging trend with, 54 per cent respondents report that responsiveness of government machinery has improved to a great extent which is 7 point percentage more than reported response in non intervention villages.
Similarly, responsiveness of PRI was rated to have improved to a great extent in intervention villages as compared to non intervention villages. This was 54 % and 44% in intervention and non intervention villages respectively.
Maintenance of hand pumps
A major shift in perception of community responsibility and their subsequent ownership for maintenance was visible and reported by households in intervention areas as compared to those in non intervention villages. Responsibility for maintenance of hand pumps was primarily shared by

households using hand pumps, VWSC, gram panchayat. Ongoing meetings (71%), visits by government functionaries (10%), and interaction with NGO staff were reasons listed for community taking greater responsibility.
Benefits at community level
Access to safe drinking water
About 92 per cent of households in intervention areas have access to drinking water within 500 mts and almost all household access water from safe sources. Importantly the practice of ensuring water safety is reported by significantly large majority of population. Majority (84%) shared that they have received messages on water storage and safety as opposed to 66 per cent in non intervention villages.
It is also important to note that prevalence of water borne disease was reported to have reduced as compared to last one year. About 31 per cent said that the members of the household sometimes suffered from water borne disease one year ago as opposed to only 18 per cent who said that currently members of the household suffer from water borne disease sometimes.
Reduced prevalence of disease
Intensive communication efforts coupled with community mobilization generated greater awareness about need to have clean surrounding, maintaining personal hygiene and cleanliness to avoid prevalence of skin disease, malaria, and water borne diseases. It also indicates that community perceives that prevalence of these diseases has reduced.
Participation in gram sabhas
Community in intervention areas perceived increased participation of men and women in their gram sabhas. About 86 per cent of respondents were of the view that there is a positive change in participation. Hygiene (75%) and Child health (45%) were most commonly cited issues discussed during these gram sabha meetings. Other issues discussed were alcoholism (34%), superstition
(17%), and sanitation (25%)
Provision of sanitation services for the community
Provision of sanitation services and access for community has substantially increased at all levels- individual household, school, and anganwadi.
Improved anganwadi services
Last one year has also seen a substantial improvement in anganwadi services for pre school children as well as pregnant and lactating mothers. Little less than half (48%) of the respondents said that they were seeking services from the anganwadi in their villages. Of those who were seeking services about 82 per cent reported increased regularity in provision of mid day meal. Importantly in non intervention areas only 55 per cent respondents report this.School Sanitation

A holistic approach with convergence of services at household, anganwadi centre and school has ensured a conducive environment for sustaining newly adopted behaviour. Respondents also reported an increase in hygiene monitoring in schools over last one year. About 84 per cent respondents concurred that there is an increase in hygiene monitoring in the schools over last one year as compared to 55 per cent in non intervention areas.
For instance, of school going children, 69 per cent said that they use toilets in the school for defecation while at school. The percentage of students using toilets at home was 63%. Students also report their involvement in activities related to maintenance and cleanliness of surrounding, storage of drinking water and cleanliness of its surrounding.
Behaviour Change
Behaviour discussed herein are those that are focus of TSC communication which includes personal hygiene, hand washing at critical times, defecation, and disposal of child faeces.
Water storage and handling
Hand pumps, public tap, and sanitary wells are the primary source of water for communities at large in both intervention and non intervention areas. In intervention area 72 per cent households report using a ladle for taking out drinking water whereas in non intervention areas, this was reported by 42 per cent about 30 point per cent less.
Hand washing
It was seen that percentage of respondents washing hands before eating, before feeding child, after defecation, and after coming from outside is high though not cent percent. Behaviour that needs further focus is washing of hands after disposal of child faeces, which was reported by less than one third of respondents. As presented there is a significant difference in hand washing practices among intervention and non intervention villages. Use of soap for washing hands before food and after defecation is substantially higher in intervention villages.
When asked about this change, 91 per cent in intervention areas agreed that their hand washing practices has changed to some extent or great extent in last one year. In non intervention villages, 71 opined that there was a change in their hand washing practices in last one year.
Personal Hygiene
Personal hygiene behaviour that was focused during program implementation included cutting nails, bathing, wearing clean clothes, and wearing chappals. Nail cutting habits improved as frequency of nail cutting was reported to increase. The challenge is to sustain the communication efforts and reinforce positive behaviour to sustain this change.
Other change reported was in habit of wearing slippers. About 75 per cent respondents in intervention area wore chappals while going out now. One year before 68 per cent of the same respondents wore chappals indicating a 7 point increase. In non intervention areas, one year before 66 per cent wore chappal which is now 63 per cent.

Defecation behaviour
The percentage of household having toilets significantly differs across intervention and non intervention villages.. In intervention village 98 per cent of households reported having individual household toilet where as in non intervention areas it was only 10 per cent.
Information was also sought to understand how open defecation has reduced.
Over all application of the Concepts in the case study :
Right holder’s/ Duty bearer’s perspectives : Good synergy between District administration and
Community participation/leadership.
Causal analysis/ Information collection / Knowledge dissemination: Community was made aware of the medical costs/ and other implications for not using toilets. Evidences were presented to the community prior to the designing of the campaign.
Schema/Script in place : The strategy was worked out based on the preliminary assessment on the current practice on open defecation. Clear strategy was laid out including who does what?
Motivation to change backed by credibility of info provided: There was clear trust and acceptance of the information provided to substantiate the need for social change.
Community empowerment / involvement : This was the very premise and community was heavily engaged right from the stage of conception, execution, supervision and monitoring of the initiative.
Empirical/Normative expectations clarified and matched : Conformity to an agreed decision and shared understanding of desirable change and sanctions respected.
Principles of dis/incentives led by community/government : The NGP award by GOI was a good incentive index for the panchayats/community to out-perform. Certain sense of competition was introdu ced to out do others. Hence, matter of `pride and honor’ and being felicitated at national/state capital was Big achievement. The sanctions/penalty decided by community to levy on defaulters was also associated by guilt/shame, hence no body preferred to be seen caught. Public pledges/declarations in the door of the house `that I own toilets’ was a huge shift in what people considered as `asset’ giving away the age old concept of `im/purity’.
Strong network : The community network was strong and powerf ul with `sarpanches’ taking lead and having explicit ties and nodes delivering clear roles and responsibilities of supportive supervision of the entire process.
Monitoring & Supportive supervision: At all levels, very well laid out monitoring and supportive supervision teams were set up. At Community level, the Toka-Taki team was the force behind social dis/approval of continuing practice of open defecation by some.
Pluralistic ignorance until the empirical evidences were presented to the community. Com munity’s perception of `change’ was driven when they saw the benefits of giving up Open defecation.
Network & Coordination theory helped in seeing the big picture in terms of trigger for change
(nodes/ties) The community network was strong and powerful wi th `sarpanches’ taking lead and having explicit ties and nodes delivering clear roles and responsibilities of supportive supervision of the entire process

Leadership (government) attempt to change citizen’s behaviour with citizen’s consent and cooperation was a sure shot success.



Shaheen Nilofer
Chief, State Office
UNICEF, Chhattisgarh State Office
India