Despite freshly-constructed functioning toilets in their homes, a group of old men in a village in Daniyawan block, about 30 km southeast of Patna city, continued to go out in the fields to defecate. Asked by sanitation workers why they were not using the toilets, one of the seniors is said to have replied, “How can we go to the toilet that is also being used by our daughters-in-law?”. In a nearby village of the same block, a lady had spent Rs 35,000 on getting a toilet with tiled flooring constructed in her house. The five members of her household, however, continued to go out to defecate. The ‘beautiful’ toilet had been locked by the lady apparently because she did not want it to get dirty or spoiled.
Those working on India’s sanitation programme, the Swachh Bharat Mission (SBM), narrate several such instances of people not adopting toilets despite having got access to one. The reasons are varied — personal, traditional, cultural. Some even say that the morning cleansing in the open is a time for socialising. For many it is just a habit that they have grown up with, and access to a new toilet is not a compelling reason to change that habit. As India tries to make itself completely open defecation free by the year 2019, the biggest stumbling blocks are not the lack of enough toilets, or accessories like water and electricity connections, but the difficulty in convincing people to start using toilets.
“It is not surprising. We observe this kind of behaviour all the time. Just because a foot over-bridge gets constructed does not mean that people start using it. They still prefer to cross the road despite speeding traffic. Don’t we still see people running on railway tracks to get to another platform? The physical infrastructure does not necessarily induce change in behaviour. Adoption of toilets face a similar problem,” said Madhu Krishna who works with the Bill and Melinda Gates Foundation and has been associated with the India Sanitation Coalition which brings together stakeholders working on sanitation.
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The realisation that making India open defecation free is much more than just building toilets is not new. There have been efforts in the past as well to encourage behaviour changes, sometimes by offering incentives and at others by running mass campaigns. A recognisable television and radio campaign by leading actress Vidya Balan has been running for five years now. However, the core of the sanitation programme has always been achievement of targets on construction of toilets.
That has changed now, assures Parmeswaran Iyer, secretary of the Ministry of Drinking Water and Sanitation which runs the Swachh Bharat Mission. “Our main aim is not to construct more and more toilets. Rather, we are focusing on usage of toilets, making villages Open Defecation Free (ODF) and then keeping them as such. Of course, this can’t happen if there are no toilets in a village. Infrastructure has to be built. But our work doesn’t end there. A lot of our effort is going into ensuring that villages that have become ODF do not slide back into old habits. And that requires our continued engagement,” Iyer said.
Several initiatives reflect this change in focus. To start with, ODF has been given a new definition that emphasises on usage rather than construction of toilets. It means that even a village or district with 100 per cent individual household toilets will not be called ODF till all the inhabitants start using them. A new protocol is being developed to monitor the villages that have been declared as ODF in order to ensure that they remain so.
In addition, the ministry has recently started virtual classrooms for training volunteers on how to encourage people to adopt toilets. The idea is to create an army of ‘champions’ at the local level.
The ministry, in the meanwhile, has also been seeking expert advice from scholars like Val Curtis, director of the Environmental Health Group at the London School of Hygiene and Tropical Medicine, who has worked extensively on this subject across the world. Curtis says the first big step in making people change their behaviour with regard to toilets has already been taken by initiating a conversation around it.
“One probable reason why sanitation campaign got so delayed in India is that nobody wants to talk about toilets. It is not part of conversations in the villages. And when nobody wants to talk about it, the problem becomes invisible. It is good that it is being talked about now. It is extremely heartening that the Prime Minister himself is engaging with this conversation. It is a huge step forward,” she said in a conversation with The Indian Express.
She said her main job was to identify the motivations that guide people’s adoption of toilets, and then work on those motivations through a campaign. “There are no more than 15 motivations for human behaviour. These include fundamental motivations like love, hunger or fear. Others include justice, and even hoarding of objects. We need to know what all motivations work for people in India to adopt toilets. We need to screen all these different motives and see which of these levers gets the best results,” she said, adding that that it would be good idea to refresh the television and radio campaign on sanitation, like the one involving Vidya Balan, in order to tap people who have not been influenced by the original message.
“We will also keep giving something new periodically, appealing to different motivations of people. Newer campaigns will be more powerful, more shocking, more surprising. It needs to be developed into a mass national campaign that everyone can recognise and identify oneself with,” she said.
Officials say the idea is to repeat and reinforce the messages through all means, including the use of newsletters that are planned to be delivered to each gram sabha and cartoon books. The first newsletter the Swachh Bharat Mission is due to be out this week itself.
The Ministry is also roping in postmen to trigger the sanitation messages. The postmen have first-hand access to the communities and are generally trusted by people in the villages. They can act as very good ‘champions’ at the local level for the sanitation campaign.
Curtis says the initial part of any behaviour change campaign requires a lot of effort and messaging. Eventually, once the behaviour change has been adopted by a critical mass of people, it becomes self-sustaining.
“People, in general, are conformists. They do not want to be outliers. They would like to fit in with the rest of the community. Right now a large number of people do not have access to toilets. So it seems acceptable to everyone. But as we get more and more people to adopt toilets, we will soon reach a critical mass after which the excluded ones would themselves want to have toilets. We do not notice this but this is a fundamental human behaviour. This will explain why, with 16 ODF districts out of 677, the growth may seem slow in the initial months and years. But once that critical mass is achieved, there will be no looking back and the ODF movement will scale up at extremely rapid rates.”