the challenge of sanitation in india1485220/...department of thematic studies environmental change...

of 61/61
Department of Thematic Studies Environmental Change MSc Thesis (30 ECTS credits) Science for Sustainable development Sara Versano The Challenge of Sanitation in India An assessment of Clean India Mission in the Gram Panchayat of Badkulla I and II, West Bengal, India Linköpings universitet, SE-581 83 Linköping, Sweden

Post on 09-Nov-2020

0 views

Category:

Documents

0 download

Embed Size (px)

TRANSCRIPT

  • Department of Thematic Studies

    Environmental Change

    MSc Thesis (30 ECTS credits) Science for Sustainable development

    Sara Versano

    The Challenge of Sanitation in India

    An assessment of Clean India Mission in the Gram Panchayat of Badkulla I and II, West Bengal, India

    Linköpings universitet, SE-581 83 Linköping, Sweden

  • ii

    Copyright The publishers will keep this document online on the Internet – or its possible replacement – for a period of 25 years starting from the date of publication barring exceptional circumstances.

    The online availability of the document implies permanent permission for anyone to read, to download, or to print out single copies for his/hers own use and to use it unchanged for non-commercial research and educational purpose. Subsequent transfers of copyright cannot revoke this permission. All other uses of the document are conditional upon the consent of the copyright owner. The publisher has taken technical and administrative measures to assure authenticity, security and accessibility.

    According to intellectual property law the author has the right to be mentioned when his/her work is accessed as described above and to be protected against infringement.

    For additional information about the Linköping University Electronic Press and its procedures for publication and for assurance of document integrity, please refer to its www home page: http://www.ep.liu.se/.

    © Sara Versano

  • iii

  • iv

    Table of contents Abstract ...................................................................................................................................... 1 List of abbreviations .................................................................................................................. 2 1. Introduction ............................................................................................................................ 3

    1.1 The importance of sanitation ........................................................................................... 3 1.2 The path towards Clean India Mission ............................................................................ 4 1.3 Clean India Mission ......................................................................................................... 5 1.4 Aims and research questions ............................................................................................ 7

    2. Background ............................................................................................................................ 9 2.1 The Community-Led Total Sanitation (CLTS) approach ................................................ 9 2.2 Assessment of CLTS campaigns ................................................................................... 10

    2.2.1 Assessment criteria of other CLTS campaigns ....................................................... 10 2.2.2 Assessment criteria of SBA .................................................................................... 11 2.2.3 Assessment criteria for this thesis ........................................................................... 12

    2.3 The assessment theoretical framework .......................................................................... 16 3. Method ................................................................................................................................. 17

    3.1 Study area ....................................................................................................................... 17 3.2 Study Population ............................................................................................................ 18

    3.2.1 The Gram Panchayat ............................................................................................... 18 3.2.2 The Households ...................................................................................................... 18

    3.3 Data collection and analysis ........................................................................................... 19 3.4 Ethics statement ............................................................................................................. 20 3.5 Limitations of the study ................................................................................................. 20

    4. Results .................................................................................................................................. 22 4.1 The Gram Panchayat perspective ................................................................................... 22

    4.1.1 SBA implementation ............................................................................................... 22 4.1.2 The role of GP ......................................................................................................... 24 4.1.3 Improvement in quality of life and behavioral change ........................................... 24 4.1.4 SBA sustainability .................................................................................................. 25 4.1.5 Suggestions for a future campaign .......................................................................... 26

    4.2 The Household perspective ............................................................................................ 27 4.2.1 Households size and duration of the staying in the area ......................................... 27 4.2.2 Latrine availability and open defecation status ....................................................... 27 4.2.3 SBA implementation ............................................................................................... 28 4.2.4 SBA sustainability .................................................................................................. 29 4.2.5 Improvement in quality of life and behavioral change ........................................... 31

  • v

    4.2.6 Suggestions for a future campaign .......................................................................... 33 5. Discussion ............................................................................................................................ 34

    5.1 Accordance to the SBA guidelines ................................................................................ 34 5.1.1 Toilets construction and financing implementation and efficiency ........................ 34 5.1.2 IEC activities implementation and efficiency ......................................................... 35 5.1.3 Considerations on SBA sustainability .................................................................... 36

    5.2 SBA and the CLTS principles ........................................................................................ 38 5.2.1 Capacity of triggering a behavioral change and to improve the quality of life ...... 38 5.2.2 The activity of the facilitators (GP) and community’s freedom of action .............. 39

    5.3 Contributes and obstacles towards the achievement of the SBA objectives ................. 41 5.3.1 The role of the actors .............................................................................................. 41 5.3.2 The role of the context ............................................................................................ 43

    5.4 Priorities and challenges for a future campaign ............................................................. 44 6. Conclusion ........................................................................................................................... 46 Acknowledgements .................................................................................................................. 48 Resources ................................................................................................................................. 49 Appendix I – Consent form ...................................................................................................... 54

    1. English version ................................................................................................................. 54 2. Bengali version ................................................................................................................ 54

    Appendix II – Interviews questionnaires ................................................................................. 55

  • 1

    Abstract

    Sanitation continues to represent one of the most significant problems threatening the world population. In this scenario, India still encounters several difficulties in guaranteeing generalized access to adequate sanitation and, for this reason, in 2014, Clean India Mission was launched. In order to provide an assessment of the campaign, semi-qualitative interviews were carried out with two different target groups – Gram Panchayat representatives and household heads – in the rural area surrounding the Gram Panchayat of Badkulla I and II. The analysis of the data collected reported that the Gram Panchayat representatives had a central and active role in the promotion, realization and monitoring of the guidelines of Swachh Bharat Abhiyan program. However, the SBA implementation did not wholly follow the campaign guidelines, and it did not appear totally in line with what suggested by the community-led approach. Moreover, the different initiatives included in the campaign presented some problematics, such as difficulties in accessing the campaign incentives, low-quality construction of the latrines, uneven spread of the communication activities and low sustainability of the campaign results. At the same time, the community members seemed more aware of the importance of better sanitation standards but generally unsatisfied with the campaign performance. The assessment of the campaign highlighted the significant influence that context and actors involved played in the campaign realization and how the missing focus on critical aspects, such as prioritizing the numbers of toilets over their quality, profoundly affected the campaign results and sustainability over time. A future sanitation campaign should be focusing on addressing the shortcomings of Swachh Bharat Abhiyan by also taking into consideration the potential challenges represented by financial constraints, continuous change in households’ structure, local social norms and climatic conditions.

  • 2

    List of abbreviations CLTS Community-Led Total Sanitation CRSP Central Rural Sanitation Program DHS Demographic and Health Survey GAMA Greater Accra Metropolitan Assembly GP Gram Panchayat GS Gram Sansad ICDS Integrated Child Development Services IEC Information, Education and Communication IHL Individual Household Latrines OD Open Defecation ODF Open Defecation Free PRA Participatory Rural Appraisal RQ Research Question SBA Swachh Bharat Abhiyan TSC Total Sanitation Campaign VHSNC Village Health Sanitation Nutrition Committee WASH Water, Sanitation and Hygiene

  • 3

    1. Introduction

    1.1 The importance of sanitation

    Sanitation is more important than political independence – Mahatma Gandhi.

    The term sanitation generally stands for the supplying of services and facilities for the safe management and disposal of human excreta and sewage, and, more generally, solid and animal waste (Singh, 2014). Unfortunately, even in 2020, sanitation continues to represent one of the most severe and significant problems threatening the world population. As reported by the 2018 Sustainable Development Report, in 2015, 2.3 billion people still lacked access to basic sanitation, while 892 million people kept practicing open defecation (OD) on a regular basis (Jangra et al., 2016; UN, 2018; Mukherjee et al., 2019). In particular, Africa and South Asia represent the regions where this absence of basic standards of hygiene is felt the most, with consequent issues for their general socio-economic development (Mukherjee et al., 2019).

    India, as a developing country, has rapidly improved in many fronts either in food production, industry, or its buzzing economy. Poverty has declined, and there is a thriving middle class of nearly 600 million people in the country. Despite this, India stands as one of the countries which continue to encounter numerous difficulties in guaranteeing generalized access to adequate sanitation for millions of people. Indeed, in 2015 according to the Water, Sanitation, and Hygiene (WASH) Performance Index developed by the Water Institute of the University of North Carolina, India was reported as one of the bottom performers out of the 117 developing countries investigated (Jordanova et al., 2015). One of the principal factors contributing to this ranking is represented by the persistence of OD practice among the Indian population (WHO and UNICEF, 2017). Indeed, as reported by India’s most recent Demographic and Health Survey (DHS) – carried on between January 2015 and December 2016 – 54% of households in rural India still regularly practice OD (IIPS and ICF, 2017; WHO and UNICEF, 2017). Besides representing a manifestation of the cultural heritage of the Indian society, the persistence of OD is repeatedly reported as a clear symptom of an inadequate toilet coverage and insufficient community knowledge about proper sanitation behaviors (Jain et al., 2020). This harmful habit correlated with several other problematic issues such as poor hygiene, water scarcity and contamination, illiteracy, and rapid economic growth has strained living space in urban and semi-urban areas (Ghosh, 2017; Kumar et al., 2011; Nath, 2003).

    The importance of sanitation resides in its interconnection with numerous other problematics. Firstly, the lack of sanitation is considered to be the principal cause of the burden of water-related diseases. This is especially true in the case of children under five, with 30% of death due to inadequate access to water and sanitation (Kumar et al., 2011; OECD, 2011). At the same time, low sanitation and related health issues can significantly impact the education outcome of young students, by particularly affecting school attendance and rates of girls, especially after the start of menstruation. Secondly, poor sanitation has a direct effect on economic growth, and consequently, its improvement could lead to consistent savings in health care costs, reduced days lost at work, time saved from increased convenience and reduced lost income (Hutton et al., 2007; Ghosh and Cairncross, 2014; Ghosh, 2017). Thirdly, improvement of sanitation standards could result in a significant decrease in water pollution, and thereby, freshwater scarcity. Indeed, the inefficient or non-treatment of wastewater from domestic use can result in severe impacts on surface waters and the adjacent ecosystems by allowing the spread of different fecal contaminants besides nitrate and ammonia and the leaching of microbial and chemical wastes into surface and groundwater resources (Grimason et al., 2000;

  • 4

    Nath, 2003; ADB, 2009; OECD, 2011; Graham and Polizzotto, 2013; Patil et al., 2014; Templeton et al., 2015; Nath, 2017, Mukherjee et al., 2019). Hence, the provision of proper sanitation facilities and structured waste management systems could significantly contribute to the containment of noxious substances from spreading in the environment and to the proper disposal of wastewater. Thus, a dependable and systematic set of initiatives aimed to guarantee adequate sanitation standards would strengthen the protection of freshwater resources and avoid environmental pollution (Sinha et al., 2018). Based upon these considerations, improved sanitation appears as a fundamental prerequisite to reduce poor health, child mortality, lost income, and to improve human dignity and quality of life in India (ADB, 2009).

    Actively achieving and guarantee better sanitation standards would also contribute to meet the United Nations Sustainable Development Goals by 2030. Evidently, a significant improvement in the Indian sanitation standards would provide a considerable push towards the meeting of three specific targets included in the sixth SDG goal for clean water and sanitation: 1) achieving adequate and equitable sanitation and hygiene for all, 2) ending open defecation and 3) improving water quality by reducing the release of hazardous chemical and materials (WHO and UNICEF, 2017). Meeting the requirements for this goal would also contribute to several other sustainable goals, such as SDG3 for good health and well-being and SDG4 for quality education. Indeed, as explained above, reaching higher sanitation standards could limit the spread of stomach related diseases and improve education outcomes of young students (Mukherjee et al., 2019). To actually meet the SDG6 targets, in October 2014 the most recent Indian national sanitation campaign, the Swachh Bharat Abhiyan (SBA), also known as the Clean India Mission, was launched. On this matter, the following sub-sections will present the steps and progress achieved in the course of the centuries by the Indian Government in the field of sanitation to then move to describe in detail the main aspects included in the SBA program. This will provide a perspective on the path that led to SBA and on how this campaign differed or stayed in line with the previous ones.

    1.2 The path towards Clean India Mission Intending to significantly reduce open defecation and, more broadly, improving the sanitation status in the country by providing sanitation facilities, creating proper waste management infrastructures and educating about personal hygiene, over the decades, the Indian Government has implemented several national measures and campaigns. Efforts to improve sanitation see their start back to 5000 years ago when the first underground drainage system was implemented to facilitate wastewater conveyance (Jangra et al., 2016). Starting from that, the vision of continually improving sanitary practice was carried on across the reign of several subsequent dynasties – e.g. Mauruyas and Guptas. During the pre-independence period, sanitation did not represent a central concern. Only as late as 1898, the first Bombay Improvement Trust was implemented as a response to the outbreaks of cholera and plague related to poor sanitation among the British Army. After attaining national independence in 1947 from British colonialists, the First Five Year Plan of the Government of India was implemented in 1954. The program included the introduction of the National Water Supply and Sanitation Program in the health sector, and it aimed to provide safe water supply and adequate drainage facilities for the entire urban and rural population of the country (Jangra et al., 2016). During the 70s, the Government placed more focus on the rural context by introducing the Accelerated Rural Water Supply program with the aim of providing funds for villages in need. The next significant step was then made in 1986 when the Central Rural Sanitation Program (CRSP) was launched to improve the quality of life of rural people and provide privacy and dignity to women by creating proper sanitation facilities in rural areas (Singh et al., 2014). The program was structured around the provision of subsidies to the rural communities to construct

  • 5

    sanitation facilities. However, even if CRSP represented a push towards the achievement of toilet coverage for the rural communities, the program showed how facilities provision was not sufficient without a systematic action to raise awareness about sanitation and to create a proper waste management system. Indeed, OD continued to represent a common practice among rural communities, and the provision of toilets posed a whole new set of challenges to be faced, such as facilities maintenance and durability over time (DDWS, 2007). In 1999, the Total Sanitation Campaign (TSC) was launched, and it represented the first national sanitation campaign adopted in India based on the Community-Led Total Sanitation (CLTS) approach. With the scope of filling the gaps emerged from the implementation of CRSP, the campaign had the objective of eliminating the practice of OD by 2012 by expanding the concept of sanitation and including the consideration of other related problematics. In particular, TSC included the promotion of sustainable latrines, school sanitation and hygiene education, social mobilization, behavioral change activities and the creation of an award for open defecation free (ODF) and completely sanitized administrative subdivisions – i.e. Gram Panchayat (GP), Blocks, Districts and States – called “Nirmal Gram Puraskar” (Jangra et al., 2016). The campaign was able to scale up the national toilet coverage and to actively educate communities about the importance of higher sanitation standards. However, at the end of the TSC implementation, it emerged that more time was needed to achieve the ambitious objectives included in the program – i.e. completing toilet coverage and ending OD - and that the campaign itself presented some inefficiencies – i.e. low quality and sustainability of the facilities provided (WSP, 2010; Huseo and Bell 2013; Singh, 2013; Patil et al., 2014; PEO, 2015). Indeed, according to 2015 data, between 1990 to 2015 only 28 percent population of India obtained access to adequate sanitation and 44 percent of the Indian population still practiced open defecation (WHO and UNICEF, 2015). For this reason, the Indian Government decided to extend the adoption of the CLTS approach by creating a new campaign aimed to complete the objectives of the previous one and to refine the strategies and tools adopted to achieve these goals (WSP, 2010; Huseo and Bell 2013; Singh, 2013; Patil et al., 2014; PEO, 2015).

    1.3 Clean India Mission To meet the SDG6 targets and extend the path towards generalized access to proper

    sanitation, the Indian Government committed to ending OD and unsafe sanitation practices by 2019, in correspondence of the 150th anniversary of Mahatma Gandhi’s birth (Dandabathula, 2019). In October 2014, the SBA, also known as the Clean India Mission, was launched (Singh et al., 2014). The campaign aimed to achieve the following points:

    - improving the quality of life in rural areas by eliminating open defecation - accelerating sanitation coverage in rural areas - motivating communities and Panchayat institutions to implement sustainable sanitation

    practices and facilitate it through health education and sustainable sanitation

    - promoting proper and cost-effective technologies to guarantee ecologically safe and sustainable sanitation

    - developing community managed sanitation systems for waste management - creating a positive impact on gender equality and promoting social inclusion by

    improving sanitation in marginalized communities

  • 6

    In particular, the SBA planned to achieve these objectives by applying a three-phase strategy composed by: - the planning phase: designed with the objective of creating a five-year implementation strategy to be prepared by the district and GP institutional bodies and then consolidated in a State plan by the State Government. - the implementation Phase: designed with the intent of actively implementing the SBA plan by using three principal categories of tools – advocacy and communication, financing, and construction of toilets. - the sustainability Phase: designed with the aim of continuing hygiene promotion activities among communities, assisting communities with the maintenance of the campaign results and starting an SBA monitoring and evaluation system.

    By resuming the CTLS principles embodied in the TSC program, SBA based its three-phase strategy on the active creation of massive mass movement through engagement and behavioral change of communities. In this sense, ample space was reserved for the action of grassroots institutional bodies (i.e. GP) in informing the communities about the campaign and monitoring the results. Indeed, the aim of the campaign was to trigger a behavioral change through an intense activity of promotion of SBA and education on proper hygiene practices. The idea was that once provided with all the necessary information about the campaign and informed about the importance of proper sanitation practices the communities may have been triggered to modify their sanitation behaviors (MDWS, 2017).

    At the same time, with the aim of achieving the TSC uncompleted objective of eliminating the OD practice in the country, the SBA program placed even more stress on hygiene education and toilet provision for the communities. On this particular matter, SBA tried to overcome the complaints against the low quality and sustainability of the facilities provided by the previous campaign by establishing some minimum standards for toilet construction, while leaving free of choice to the communities in selecting the adequate toilet solution depending on their resources and needs. Indeed, according to the SBA program, a completed household sanitary latrine unit should have had been composed by 1) a sanitary structure able to safely confine human feces and eliminating the need for users to handling them before their complete decomposition, 2) a safe superstructure, 3) a handwashing unit for cleaning and handwashing. On the particular type of latrine to be constructed the program did not impose one specific option, but suggested, in the case of limited resources, the initial construction of a simple pit latrine to be updated, in a second time, to a twin pit latrine (MDWS, 2017) – see table 1 for summarized characteristics of the two different options.

    Table 1 Latrines Characteristics (PA, 2008)

    Simple Pit Latrine Twin Pit Latrine

    Unlined hand dug pit covered with a series of wooden logs strapped together allowing the user to defecate into the pit. It does not need a permanent superstructure. It can comport groundwater contamination if the pit is not completely unlined and if it is placed too close to water bodies.

    Addition of a second pit to allow the waste contained in the first pit to decompose while the second one gets filled up. It makes safer to collect the waste from the pit. It requires a permanent superstructure. It can comport groundwater contamination if the flow switch between the two pits is not

  • 7

    operated correctly (i.e. the waste did not have enough time to decompose) and if it is placed too close to water bodies.

    For what concerns the official outcomes of SBA, the data reported by the Department of

    Drinking Water and Sanitation describe the overall success of the campaign. Indeed, it has been reported that more than 102 million household toilets were built and that all the 28 states and 6 union territories are currently 100% ODF (MDWS, 2020). Thus, by considering the official data, it seems that the SBA was able to finalize the ambitious objective of ending OD practice in the country and accelerating toilet coverage in rural areas. Nevertheless, the official data did not report specific information about the campaign consistency with the program guidelines and with the principles embodied by the CLTS approach, as well as about the general quality and sustainability levels of the facilities provided. For these reasons, since SBA saw its conclusion in the year 2019, it seems necessary to consider and analyze how the campaign performed in these spheres during the last five years. In this context, an assessment of SBA may also provide additional information about the actual achievement of the ODF objective and the connected toilet coverage acceleration in the rural context. Finally, the information collected on these matters could provide a base for an analysis of what limited or contributed to the achievement of the campaign objectives by also elaborating some considerations on the possible future steps to be made in this field.

    1.4 Aims and research questions

    The aim of this study is to undertake a systematic analysis of the SBA implementation in two circumscribed areas represented by the Gram Panchayats (grassroots-level local administrative bodies) of Badkulla I and Badkulla II. In particular, the study aims to provide an assessment of SBA by using a semi-qualitative approach. The assessment covers four main aspects related to the campaign: its implementation, administrative efficiency, outcomes and sustainability over time. The analysis is carried out by focusing the attention on the accordance of the SBA implementation in the area considered to the campaign guidelines, on its conformity to the CLTS approach and the influences played by the actors involved and context. Moreover, based on the information collected through the assessment and analysis of the campaign implementation, the study provides some considerations around the potential priorities and problems connected to the realization of a future sanitation campaign in India. Specifically, the thesis project tries to answer the following research questions:

    • To what extent was SBA implemented by following the guidelines presented in its program? And, more generally, to what extent did SBA portrait the principles embodied by the CLTS approach?

    • How did the actors involved – GP representatives and community – influence the campaign performance?

    • In which measure the rural context did play a role in contributing/limiting the campaign realization?

    • What may be the priorities and challenges in the framework of the creation and implementation of a future national sanitation campaign?

  • 8

    To answer these questions and meet the aim of the study, the thesis project is structured as follows. The following section is dedicated to an analysis of the CLTS approach and a review of CLTS campaigns assessment produced by the current literature. The analysis has the scope of providing some criteria to assess the campaign implementation, and it also describes the scientific work which was produced so far in the evaluation of SBA. Moreover, the next section describes the analytical framework used to make an analysis of the factors that could have influenced the performance of the campaign. The following section describes in-depth the methodology used to collect and analyze the empirical data in the SBA assessment, and it explains the project’s limitations and ethical concerns. The subsequent part presents the results of interview sessions by providing an in-depth content analysis. The following section discusses to what extent the campaign stayed in line with the SBA program and the CLTS principles and how the actors involved and the context influenced the campaign’s outcomes, by also reflecting on the potential priorities and limitations of a future national campaign. The last part of the thesis serves as a summary of the main results and concepts that emerged throughout the whole study.

  • 9

    2. Background

    To create the theoretical and contextual background required to elaborate a systematic assessment of SBA, this section aims to provide an analysis of scientific literature concerning the assessment of CLTS campaigns for the improvement of national sanitation standards. In particular, the analysis first presents the common traits and characteristics of the CLTS campaign model to provide a clear understanding of this specific approach and to extrapolate its main principles. After that, the literature review covers the perspectives which have been used to assess different CLTS campaigns to select the criteria for evaluation of SBA proposed in this thesis. This analysis is carried out by considering how CLTS campaigns are commonly assessed, and then by posing the focus on the specific case of SBA. In this way, the literature review also meets the objective of providing a state-of-art about the SBA assessment in the scientific community. The information collected from the literature analysis is then used to select the criteria for this thesis, and the process is described in detail. Finally, this section also contains a description of the theoretical framework used for the analysis of the factors which influenced the campaign performance.

    2.1 The Community-Led Total Sanitation (CLTS) approach

    The CLTS approach originated in 1999 by Kamel Kar while working with the Village Education Resource Centre and was supported by Water Aid in a small community in Bangladesh (Kar and Chambers, 2008). After spreading within Bangladesh, the approach was introduced in many other countries in Asia and Africa (Kar, 2005). The CLTS approach involves the use of Participatory Rural Appraisal (PRA) methods to make local communities able to analyze their sanitation conditions and unitedly understand the sanitation impact of OD on public health and the environment. Indeed, the CLTS promoters state that when triggered systematically, this approach can provoke urgent collective local action to reach ODF status. In particular, the CLTS facilitation form includes, among other measures, the use of the crude local term for “shit” and visit to the dirtiest areas in a neighborhood to provoke shock, disgust, and shame among people. The assumption behind this approach is that no human being could stay unmoved once having learned that they are ingesting other people’s excreta. The goal is to help community members to see for themselves the consequences of OD to push them to take action. Thus, the CLTS approach places its attention on triggering a change in sanitation behavior instead of solely construction of toilets. This is accomplished through a process of social awakening stimulated by facilitators working within or outside the community. In particular, CLTS focuses on a whole community change rather than on individual behaviors. Indeed, the approach proposes that social solidarity and cooperation among households in the community are key elements for behavioral change. For this reason, CLTS encourages communities to take action and be responsible for their own campaign implementation. Among a broad series of actions, CLTS promotes, for instance, stopping OD, ensuring that every community member uses a hygienic toilet and encouraging everyone to wash their hands with soap before preparing food or eating (Kar and Chambers, 2008).

    The CLTS approach was implemented in India for the first time in 1999, with the realization of India’s TSC. The same campaign model was then readopted and adjusted in the creation of the SBA. Indeed, it is possible to find in the SBA campaign that the main characteristics emerged from the definition and description of the CLTS approach are still present. SBA mainly focuses on the achievement of a behavioral change at the community level by giving great flexibility to the community members and GP in the implementation and

  • 10

    achievement of the campaign’s objectives. As in CLTS, SBA places its main attention on the community rather than individuals, and it promotes the acceleration of the ending of OD through education about the benefits of using toilets and promotion of personal hygiene. Moreover, by giving a central role to the GP institutional bodies, SBA seems to adopt the concept of using facilitators working within the community to contribute to the achievement of a social awakening process. Since SBA follows the principles embodied in the CLTS approach, the selection of criteria to assess the campaign will have to keep in consideration the approach’s central concepts presented in this section. More specifically, the selection of criteria will take into consideration the capacity of the campaign of triggering a behavioral change, the level of independence of the community’s members throughout the campaign realization and the role played by the facilitators (i.e. GP). Finally, what collected from the assessment will be used to discuss the consistency of SBA implementation with what stated by the CLTS approach.

    2.2 Assessment of CLTS campaigns 2.2.1 Assessment criteria of other CLTS campaigns

    After having identified and presented the main characteristics and features of the CLTS campaign format, this section has the scope of analyzing and describing the criteria mostly used to assess CLTS campaigns. In this sense, Table 2 provides a summary of the criteria emerged from the literature analysis. Table 2 Literature Review Summary

    Author Campaign Country Criteria WSP (2010) TSC India Objectives realization

    Influencing variables Hueso and Bell (2013) TSC India Objectives Realization

    Influencing variables Singh (2013) TSC India Human rights

    Health improvements Patil et al. (2014) TSC India Defecation behavior

    Child health improvements Toilet coverage

    PEO (2015) TSC India Objectives Realization Sustainability

    Cameron et al. (2013) Scaling Up Rural Sanitation Indonesia Health improvements Sanitation improvements

    Basiru et al. (2015) The National Sanitation Day Ghana Influencing variables Sustainability

    Abalo et al. (2017) The National Sanitation Day Ghana Objectives Realization Mwakitelima et al. (2018) National Sanitation

    Campaign Tanzania Toilet coverage

    Toilets type Handwashing facilities coverage Sanitation improvements Influencing variables

    CLTS Approach

    Principles

    Use of PRA methods Provoking community action Promoting behavioral change

    Using facilitators Leaving freedom of action to communities

    Figure 1 CLTS Approach Principles

  • 11

    The most common criteria of evaluation been adopted by the literature considered is represented by the overall capacity of a campaign of implementing its objectives (PEO, 2013). The analysis is usually structured around identification of the main goals of a campaign to detect if they were achieved and consequently if the campaign was successful (WSP, 2010; PEO, 2013; Hueso and Bell, 2015; Abalo et al., 2017). In the particular case of a study conducted on India’s Total Sanitation Campaign (TSC) by the Water and Sanitation Program (2010), the focus was on a comparison between the inputs provided by the Indian Government and the following outputs and outcomes that emerged in different states. By adopting this kind of perspective, this specific analysis was able to underline and describe the process embodied by the TSC. At the same time, different studies focused their investigations either on the overall capacity of a campaign to improve the sanitation standards of a certain area or region (Cameron et al., 2013; Mwakitelima et al., 2018) or on the specific ability of the facilities realized under a campaign of achieving its particular objectives (Singh, 2013). In numerous studies, this perspective was then linked to an analysis of the potential factors and variables which could have influenced the successful or failed achievement of a campaign’s goals (WB, 2010; PEO, 2013).

    In particular, in the examined literature the focus seems to be placed on the detection of challenges that were faced throughout the implementation of a certain campaign, by trying to understand which variables were affecting the final result (Basiru et al., 2019; Heuso and Bell, 2015; Abalo et al., 2017). In this particular context, toilet coverage, and correlated defecation behaviors are usually considered as a precise detector of a sanitation campaign’s performance (Cameron et al., 2013; Patil et al., 2014; Mwakitelima et al., 2018). Evaluation of the causes behind the non-usage of household toilets and their presence or absence in different socio-economic contexts is commonly deemed as a reliable representation of a sanitation campaign’s accomplishment (Sinha et al., 2018). In some studies, this was also complemented with an investigation of the type of toilets provided and the availability of handwashing facilities (Mwakitelima et al., 2018). Another related topic widely explored is the issue of health conditions, with a specific focus on the impacts that campaigns were able to have on child health (Cameron et al., 2014; Patil et al., 2014). Indeed, the study of the correlation between a sanitation campaign’s achievement and the occurrence of water-related diseases appears to provide relevant information about the performance of the sanitation measures implemented (Singh, 2013; Dandabathula et al., 2019). Finally, one last recurring aspect taken into consideration by the literature reviewed is the theme of the campaign’s sustainability in both their implementation and year after their conclusion (WB, 2010; Basiru et al., 2019). Thus, by considering what emerged by the literature analysis, it appears that the scientific community mainly focused on the following assessment criteria: campaign objectives realization, health improvements, defecation behaviors, toilets coverage, sustainability and sanitation improvements.

    2.2.2 Assessment criteria of SBA

    In the specific case of SBA, the literature which has been published by the scientific community is limited, and this is probably due to the fact that the campaign concluded recently,

    CLTS Assessment Criteria

    Common Criteria

    Objectives Realization Health improvements Defecation behavior

    Toilet coverage Sustainability

    Sanitation improvements

    Figure 2 CLTS Assessment Most Common Criteria

  • 12

    and such assessments are in the pipeline. Nevertheless, it was possible to identify some relevant evaluations and scientific assessments on the topic, and table 3 presents a summary of the used criteria.

    Table 3 Literature Review Summary

    Author Campaign Country Criteria Wadhwa nee Dabas (2017) SBA India Environmental awareness among

    children Dandabathula et al. (2019) SBA India Health improvements Sinha et al. (2018) SBA India Households toilet usage patterns

    Toilet coverage Dandabathula et al. (2019) conducted a systematic assessment of SBA by studying the correlation between the campaign’s implementation and the trend of severe diarrheal disease outbreaks over a 9-year period by also considering the change related to toilets construction promoted by SBA. Another specific assessment has then been offered by Sinha et al. (2018) who have conducted detailed research on the usage pattern of household toilets in tribal populations under SBA implementation. Finally, original research was carried on by Dabas (2017), who analyzed the impact of SBA on the development of environmental awareness among children. Thus, by considering the literature produced to assess the SBA implementation, it appears that at the present moment, the scientific community has mostly conducted studies focusing on one or more specific aspects related to the campaign’s implementation – i.e. toilet usage pattern, health conditions and environmental awareness among children. Thus, there is a lack of knowledge at the present moment for what concerns the overall SBA implementation. Indeed, no study was found investigating the comprehensive achievements and implementation of SBA at the community level by taking as reference points its theoretical objectives and systematically investigating the campaign's practical results.

    2.2.3 Assessment criteria for this thesis

    Figure 4 illustrates the different steps taken to identify the assessment criteria for this thesis. The selection was made by considering 1) the principles embodied by the CLTS approach, 2) the common assessment criteria used to evaluate CLTS campaigns, 3) the criteria used at the present moment to assess the SBA implementation and 4) the thesis research questions. The first step of the criteria selection consisted of taking into consideration what was already had been analyzed by the literature assessing the SBA implementation to find a possible knowledge gap. In particular, as explained above, it emerged that at the present moment there are mainly studies assessing specific aspects of the campaign and there is a lack of studies providing an overall assessment of the SBA implementation. From that, the second step consisted in taking into account the principles embodied by the CLTS approach and the most common criteria used by literature to assess CLTS campaigns. This step served as a tool to understand when CLTS campaigns implementation is evaluated as successful and according to which criteria. Then, the third step consisted of filtering these principles and criteria through the thesis research questions with the scope of selecting the most relevant ones to help answering them both directly and

    SBA Assessment Criteria

    Criteria Used So Far

    Toilet usage pattern Health conditions

    Environmental awareness among children

    Figure 3 SBA Assessment Criteria

  • 13

    indirectly. Indeed, while RQ1 and RQ4 can be more directly answered by the evaluation of the SBA implementation through the selected criteria, RQ2 and RQ3 require an elaboration of the information obtained from the first analysis of SBA by integrating them with the theoretical framework which will be presented in the next section. Finally, the fourth step resulted in the definition of this thesis criteria by transforming the CLTS principles in measurable criteria and reporting the criteria selected from the literature assessing CLTS campaigns. In particular, the criteria selected for this thesis are:

    • From CLTS Principles - Capacity of triggering a behavioral change - Role of the facilitators (GP) - Community’s freedom of action

    • From Literature Criteria

    - Realization of the campaign objectives - Health improvements - Defecation behaviors - Toilets coverage - Sanitation improvements - Sustainability

    Moreover, the fourth step consisted also in the selection of the most relevant aspects of the campaign to be assessed on the basis of the chosen criteria. Thus, in light of the program’s objectives listed above, three out of six were chosen as part of this analysis. Specifically, they are:

    - The improvement of the quality of life in rural areas by eliminating open defecation - The acceleration of the sanitation coverage in rural areas - The development of communities and Panchayati Raj Institutions’ motivation to

    implement sustainable sanitation practices and facilities through health education and sustainable sanitation

    These objectives were selected based on the will of investigating SBA implementation by focusing on its coherency with the CLTS principles and its capacity of achieving better sanitation standards in the community, reducing OD and improving health conditions and toilet coverage through sustainable solutions. On the base of this reasoning, the more specific goals concerning gender equality, technology innovation and the development of community-managed sanitation systems for waste management were not included in the analysis. The campaign’s strategy – i.e. creating a mass massive movement and giving a central role to GP – has also been object of the study’s investigation. Finally, concerning the different phases which composed SBA – Planning, Implementation and Sustainability Phase – the latter two were the main focus of the analysis. In particular, in the case of the Implementation phase the assessment was divided into three main sections, campaign’s promotion, realization - with a specific focus on the campaign’s tools (advocacy and communication, financing and toilets construction) efficiency – and monitoring. On the other side, the analysis of the sustainability phase was focused on the capacity of maintaining the results obtained and being environmentally sustainable.

  • 1

    STEP 4

    STEP 3 STEP 2 STEP 1

    Criteria from Literature on SBA

    Toilet usage pattern Health conditions

    Environmental awareness among children

    CLTS Principles

    Use of PRA methods Provoking community action Promoting behavioral change

    Using Facilitators Leaving freedom of action to

    communities

    Research Questions RQ1: To what extent was SBA implemented by following the guidelines presented in its program? And, more generally, to what extent did SBA portrait the principles embodied by the CLTS approach?

    RQ2: How did the actors involved – GP representatives and community – influence the campaign performance?

    RQ3: In which measure the rural context did play a role in contributing/limiting the campaign realization?

    RQ4: What may be the priorities and challenges in the framework of the creation and implementation of a future national sanitation campaign?

    Knowledge Gap

    Overall Assessment of the SBA Implementation

    Criteria from Literature on CLTS Campaigns

    Objectives Realization Health improvements Defecation behavior

    Toilet coverage Sustainability

    Sanitation improvements

    Assessment Criteria of this Thesis

    From CLTS Principles - Capacity of triggering a behavioral

    change - Role of the facilitators (GP) - Community’s freedom of action

    From Literature Criteria

    - Realization of the campaign objectives - Health improvements - Defecation behaviors - Toilets coverage - Sanitation improvements - Sustainability

    SBA Aspects Assessed

    I) Objectives (3 out of 6) II) Strategy

    1. Creating a mass massive movement 2. Central role to GP

    II) Strategy Phases

    1. Implementation Phase Promotion Realization (Tools) Monitoring

    2. Sustainability Phase Results Maintenance Environmental Sustainability

    Figure 4 Selection Process for the Thesis Criteria

  • 16

    2.3 The assessment theoretical framework

    With the scope of creating a theoretical framework to analyze the factors which influenced the campaign implementation a review of the relevant assessment theories was systematically conducted. From the literature analysis, two specific theories have stood out among the others (e.g. Theory of Reasoned Action by Fishbein & Ajzen, (1975) – more centered on human behaviors – or the Extended Parallel Process Model by Witte, (1992) – focused on people reaction to campaigns communication strategies) that are 1) the Realistic Evaluation Theory designed by Pawson and Tilley (1997) and 2) the Contextual Interaction Theory developed by Bressers (2009). With regard to the latter, this theory aims to explain the dynamic interactions which elapsed between different actors with the scope of providing an empirically tested framework for identifying possible obstacles in policy implementation (Bressers, 2009; Spratt, 2009; Salaj, 2017). In this scheme, the theory establishes motivation, cognizance, and power of actors as the critical variables with an influence on policy implementation. Thus, motivation represents the driver of actors' actions, cognizance the information and knowledge that defines the actors' interpretations of reality and power capacity of actors to use the available resources to facilitate the implementation of policies (de Boer and Bresser, 2011; Hueso and Bell, 2013). Thus, in this vision, the results of a policy or campaign depend on actors' "core characteristics" which are their objectives, information, and power. At the same time, external circumstances – i.e. availability of recourses – can also produce an influence on the policy or campaign results due to their capacity of affecting the "core characteristics" of the actors involved (Bressers, 2009; Salaj, 2017).

    On the other side, the Realistic Evaluation Theory offers another interesting perspective on the assessment practice. The theory bases itself on the epistemological foundations of critical realism, and consequently, it assumes that knowledge is a social and historical construction. In this perspective, the analysis of a policy should always consider the social context where the policy itself was implemented. Moreover, by recognizing that there are many variables operating at the different levels in society, this evaluation method appears as a functional theoretical framework for complex social interventions, such as sanitation campaigns. In particular, this evaluation theory supports the concept by which intervention program do not necessarily work for everyone, and this is because individuals are different, and they are placed in different contexts. Thus, Pawns and Tilley (1997) suggest that the outcomes of a program should always be analyzed by focusing specifically on the context (i.e. location, rules, and social norms) and undergoing mechanisms (i.e. negative behavior removal and people change triggering) which contributed to the realization or failure of the program's outcomes.

    Thus, it can be stated that both the theories offer numerous relevant concepts and criteria to be used in the analysis of the specific SBA campaign. By considering the general aim of providing an assessment of the SBA implementation, it was possible to identify some additional useful elements to be considered in the evaluation of the campaign. Indeed, the assessment of the SBA will take into consideration not only the campaign's direct outcomes but also the influence that the actors involved – community and GP representatives – and the context played in the SBA performance. This will be done by particularly analyzing if the actors had the motivation and information necessary to implement the campaign and if they were able to use the resources required to achieve the campaign's successful implementation. Finally, SBA's assessment will take into consideration the role of the context, both from a social and environmental perspective and in terms of resource availability.

  • 17

    3. Method

    As described above, the main objective of the thesis was to provide an assessment of SBA in the Gram Panchayat of Badkulla I and II by evaluating its implementation, administrative efficiency, outcomes and sustainability over time and by investigating its coherency with the campaign guidelines and CLTS principles and how the actors and context involved influenced its performance. Hence, selection of qualitative interviews as the tool for the empirical data collection was made by closely following these goals. The chance of talking directly with the users and officials involved in the implementation of SBA provided critical and relevant insight into the campaign implementation from two distinct perspectives. This section will provide an in-depth description of the research method by specifically presenting the study area and population, data collection and analysis, ethical issues, and limitations of this study.

    3.1 Study area

    This study was conducted in the farming town of Badkulla, situated in Nadia district in West Bengal, India. According to the data reported by the most recent census available from 2011, at that time, Badkulla had a total population of circa 18 thousand people (MHA, 2011). However, it can be supposed that from that year the population had significantly increased in number. Since SBA aimed to specifically improve the sanitation standards in rural India, the household interviews were collected in the rural area surrounding the town center.

    Figure 5 Study Area - Created by the researcher with the assistance of ArcGIS

    µ0 10 205 Kilometers

    STUDY AREA

    INDIA

    WEST BENGAL

    Nadia District

    West Bengal

    NADIA DISTRICT

    Ranaghat Block

    Badkulla

  • 18

    3.2 Study Population

    The inference was based on a limited survey of two target groups. The sample was composed of one representative from each of the two Gram Panchayat (GP; equivalent to the local municipality) Badkulla I and Badkulla II and eight households. These two target groups were chosen to offer a perspective on the SBA implementation, by presenting, at the same time, the point of view of the users and implementers.

    3.2.1 The Gram Panchayat

    The GP represents a grassroots-level self-governance system operating at village/small-towns. GP were introduced as village governments system in 1993 by the passage of the 73rd constitutional amendment. The main reason behind the 73rd amendment was the belief that local governments could have a better position, rather than centrally appointed bureaucrats, to detect and deal with villagers’ needs. At the same time, by having the GP working within the village reality, it would have been easier for the community members to monitor the GP work. Hence, since 1993, GP have been responsible for the maintenance of local infrastructures, such as village roads and drinking water facilities, as well as for the identification of beneficiaries for state financial aids. Moreover, GP cover the reasonability of promoting the community’s educational, economic, and social interests, while at the same time guaranteeing the community’s general well-being (Mathew, 2003; Besley, 2007).

    In the specific case of the SBA implementation, as explained above, GP were assigned with the role of promoters of the campaign and facilitators for its implementation, by at the same time, leaving free-of-action to the community members. In other words, their role consisted in primarily informing the community about the upcoming campaign realization in the village/town of competence to then move to their role of facilitators of the campaign implementation by assisting the progress of the community behavioral change process. In particular, they had the responsibility of promoting educational activities about personal hygiene and proper sanitation practices, giving information about the financial and toilet construction process, while at the same time organizing the provision of the IHL and monitoring the campaign realization (MDWS, 2017). In particular, their selection as one of the two target groups for the interview sessions had the scope of investigating if their role of facilitators actively influenced the achievement of the campaign’s objectives, if they actually had a role of facilitators in the community-led behavioral change process and if they generally followed the SBA program guidelines and the CLTS principles. From a logistic point of view, the GP in Badkulla I and II were selected in discussion with the local research mediators and facilitators by creating a network of contacts in the study area to facilitate the data collection process. 3.2.2 The Households

    For what concerns the campaign recipients’ perspective, eight households were randomly selected in the area surrounding the two GP. More specifically, households were selected by starting by the rural area surrounding the center of Badkulla to then gradually move away from the town center. This was done with the scope of detecting the reaching capacity of the campaign. Moreover, having obtained the campaign incentive was not a prerequisite to be part of the survey since one of the relevant information to be collected was to detect how many households had heard about SBA or benefited from it. Hence, the only eligibility criteria for the household representatives was that they had the primary responsibility of the family. Thus, the survey respondents were either household heads or elders. These criteria guaranteed that the respondents were able to provide detailed information about the household’s experience with the campaign. The decision of targeting households was based on the will of investigating

  • 19

    and portraying their direct experiences with the SBA implementation, and their opinions on sustainability and potential future improvements, while at the same time investigating their influence on the campaign results. Due to the limited number of household heads investigated, they partially represented the study area. At the same time, having all of them lived for an extended period of time in the area, they provided a relevant portrait of life in the area considered.

    3.3 Data collection and analysis

    The empirical data for the thesis were collected by conducting a series of interviews in the two GP of Badkulla I and II and the surrounding rural areas by using semi-qualitative questionnaires. The questionnaires were developed by considering the research questions of this thesis and, more specifically, the assessment criteria and theoretical framework presented in the previous section. In particular, the main themes covered were improvement in the quality of life, SBA implementation – with a specific focus on the campaign’s promotion, realization and monitoring - the role of GP, changes in sanitation habits, the SBA sustainability, and future sanitation campaigns/plans. Moreover, the questionnaires were developed by following a neo-positivist approach. Thus, the majority of the questions posed were open and generic with the scope of minimizing the researcher’s influence and avoiding leading the interviewee responses (Roulston, 2010).

    Different questionnaires were developed for the two distinct target groups that were selected. With regards to the questionnaire for the GP representatives, it was composed of 16 questions covering the assessment criteria with a particular focus on the role of the GP and their relationship with the district and state levels. In contrast, the household's questionnaire was structured around 14 questions that included the defined assessment criteria. In particular specific attention on the household’s personal experience with the campaign was sought. Both the questionnaires were organized by starting with an introduction section composed of some general questions to then move to a more in-depth discussion of the relevant assessment criteria (Mishler, 1991; Schostak, 2006). Moreover, the two questionnaires were composed both by open qualitative questions and multiple-choice quantitative questions. With specific regards to the methodology selected to conduct the interviews, the questioning process was based on a semi-structured approach with the scope of facilitating information sharing, without, at the same time, influencing the content and flow of the respondent’s narrative. Consequently, the interviewer played a semi-active role in the discussion by facilitating the development of the interview without manipulating the voluntary sharing of information. To facilitate dialogue, a pre-established series of questions were prepared with the option, if necessary, of posing additional questions during the interview to clarify specific issues or facilitate the respondent’s narrative (Wibeck et al., 2007; Roulston, 2010).

    All the interviews had a timeframe of 30-45 minutes to allow an in-depth discussion of the thematic background presented in the questionnaires by, at the same time, not making the session too long for the respondents. All the questions were first read out in English and then translated into Bengali to the respondents by an interpreter. During the questioning, different tools were adopted for the empirical data collection with the scope of catching not only the answers’ content but also the facial gesturing and the tone of voice of the interviewees. Specifically, all the interview sessions were audio and video recorded after having obtained the respondents’ informed consent in writing. Moreover, written notes were taken throughout the different sessions to follow more efficiently the respondents’ narrative (Lofland, 1971; Johnson, 1976; Briggs, 1986; Mishler, 1991).

    The transcription of the interviews was completed with the assistance of a mediator who translated the answers from Bengali to English. For what concerns the data analysis, it was

  • 20

    conducted by following a qualitative approach. Qualitative content analysis was selected with the scope of integrating the information collected through the interview sessions with theoretical explanations. Hence, based on the selected assessment criteria and theoretical framework elaborated in the background section, as well as research questions, analytical coding themes were defined before starting the analysis process. As a result, the assessment criteria, theoretical framework and research questions directed the analysis towards the investigation of the SBA performance, its consistency with the program guidelines and CLTS principles, the variables that influenced its implementation and on the potential lessons to be learnt in view of a future sanitation campaign. After having applied this theory-guided approach to the empirical data analysis, the interview transcripts were read over numerous additional times to investigate the possible additional themes brought up to the discussion by the respondents. Hence, the analytical themes for this study came from both an inductive approach – i.e. form the collected data – but especially from a deductive approach that referred to the researcher’s theoretical understanding of the studied phenomenon. Indeed, the relevant information was collected throughout the whole study through literature analysis, theoretical orientations and direct experiences collected during the interview sessions (Rian and Bernard, 2003; Roulston, 2010).

    3.4 Ethics statement

    From a general perspective, collecting empirical data through interviews can create some tensions between the aim of the study of providing new knowledge on the SBA implementation and the right of the participants to maintain their privacy. For this reason, throughout the whole study, the researcher took into consideration the ethical principles of anonymity, privacy, informed consent, and confidentiality. Official permissions to collect the data were obtained from the GP representatives and individual households through the signing of a written Informed Consent. The form was provided both in English and Bengali. All the participants were informed about the scope of the study, the methods used, the topics covered by the questionnaires, and the potential benefits of participating. Collaboration in the study was completely voluntary. The acceptance to participate in the study was discussed and negotiated with each informant. The willingness to participate was again attested through the signing of an Informed Consent form. The respondents were free to stop the interview at any moment in case they were feeling uncomfortable. Confidentiality was assured throughout the whole study. The identities of the interviewees were coded, and no names were used. Furthermore, questionnaires did not include questions that could have made possible to identify the participants, and transcripts were kept in a safe place until the data analysis was carried out and then destroyed (Swedish Research Council, 2017; Orb et al., 2001).

    3.5 Limitations of the study

    The limitations of this study include language barriers, limited information, and a short time frame to conduct all the interviews. The use of a translator for the interview and transcription led to an inevitable loss of meanings and information from both sides – interviewer and respondent. Indeed, most of the time informants did not know how to communicate in English, except for one GP representative. Thus, it was necessary to conduct all the interviews in Bengali and then translate everything into English. Consequently, during the post-interview phase, it was extremely challenging to identify and investigate the local communicative norms

  • 21

    necessary to elaborate on a constructionist analysis of the transcriptions. To compensate for the impossibility of conducting a systematic constructionist analysis, a second-level analysis was provided by creating a theoretical framework for the SBA implementation assessment by considering the different variables the influenced the campaign performance. The second limitation was represented by the difficulty to interview a large group of respondents. Indeed, the original plan was to conduct a bottom-up analysis starting from the collection of the households’ experiences to move then to interview representatives from the GP and the Public Health Engineering Department. Unfortunately, due to the current global health crisis on the coronavirus pandemic, data collection had to be interrupted before the expected time, and just a limited number of interviews were collected – i.e. only 8 households and 2 GP representatives. However, the available in-depth interviews carried out before the unexpected departure from the study area provided some perspectives on the SBA implementation and the different visions embodied by the administrative bodies and the campaign’s users. Consequently, a systematic analysis was conducted on the available empirical data to extrapolate the highest possible information. Another limitation was represented by the challenge of maintaining the interviews individually since there was the tendency of having external people – i.e. other GP representatives, other households’ members, households’ neighbors and friends – coming along to assist or comment on the interview session. Comments and external intermissions were limited by having just one selected person answering the interviewer’s questions. In the case of the GP, particular attention was posed on the consideration of the possible bias linked to the conflict of interest in reviewing the SBA implementation. Indeed, it may have been in the interest of the GP to positively review the campaign and hide some of its possible limitations. For this reason, the information provided by the GP representatives were integrated with the households’ direct experiences to have two distinct perspectives on the campaign.

    The combination of this different limiting factors undoubtedly influenced the representative potential of the collected empirical materials and the study’s capacity of providing a reliable assessment of the SBA implementation by only partially answering to the thesis research questions. Indeed, the limited data collected throughout the study are only able to give a circumscribed perspective on the campaign implementation by only describing the specific experience of the two GP of Badkulla I and II and the point of view of 8 households. Since India is a country composed of a high number of different cultural, socio-economic and geographical realities, a more expanded study would have been needed to provide a more representative evaluation of the SBA implementation.

  • 22

    4. Results

    This section contains the presentation and description of the results obtained from the interview sessions conducted with the selected target groups. The results were organized by dividing them between the information provided by the GP and the household representatives. For each of the two target groups, the empirical data were presented by referring to the principal themes that emerged from their responses. In particular, for the GP representatives, the covered topics were the SBA implementation, their role in the campaign process, their perception of the community’s change in sanitation habits and health conditions, the campaign sustainability, and suggestions for a possible future campaign. In the case of the household heads, the principal themes covered were their open defecation status, experience with the SBA implementation, the sustainability of the campaign, their perception of changes in quality of life, and suggestions for a possible future campaign. The information collected and reported in this section has the scope of providing relevant knowledge to answer this thesis research questions. In particular, by covering the aspects listed above the next subsections provide direct information about RQ1 (accordance to the campaign guidelines and the CLTS principles) and RQ4 (future priorities and challenges), while at the same time offering a relevant perspective on the role played by the actors interviewed and by the rural context where the interviews took place (RQ2 and RQ3).

    4.1 The Gram Panchayat perspective 4.1.1 SBA implementation

    For the campaign’s implementation, four main aspects were covered throughout the interview sessions, that are the SBA implementation’s promotion, monitoring, realization, and community’s response to the initiatives launched. With regard to the promotion of SBA across the community, the two GP representatives exposed different strategies and methods. For example, in Badkulla I, the campaign was presented to the community during the weekly/monthly meetings held by the Gram Sansad1 (GS) representatives. The informant explained that at least once a month, or when it was feasible, weekly, the GS updated the community about the government plans and opinions on different matters. Thus, these meetings were the perfect moment to inform households about the upcoming sanitation campaign. Moreover, SBA was promoted through posters, banners, and flyers spread across the whole area. With regard to the strategy implemented in Badkulla II, the GP adopted different methods to promote SBA. The respondent explained that they used to place loudspeakers on top of cars and drive around the area to provide information about the campaign. Then, to make the campaign’s promotion more effective and efficient, they conducted surveys in the area to identify the spots where OD was practiced the most. Starting from the data collected through the surveys, they mapped the area indicating the most affected locations. Consequently, on the base of these maps, GP and GS representatives and members of the Integrated Child Development Services2 (ICDS) went door to door talking about the campaign by principally focusing on the area where OD practice had been most prevalent.

    For the monitoring of the SBA implementation, the representative of Badkulla I responded by mainly focusing on the toilets’ construction objective and explained that they

    1 A body including all the voters of gram panchayat constituency, meeting at the behest of the head of the panchayat to discuss and implement local decisions – (Mathew, 2003) 2 A government program in India providing food, preschool education, primary healthcare, immunisation, health check-up and referral services to children below 6 years of age and their mothers – definition provided by the Ministry of Women & Child Development official website. Available at: https://icds-wcd.nic.in/icds.aspx

  • 23

    used to collect reports from three different sources. The first report was provided by the construction company hired to build the Individual Household Latrines (IHL) for the community members who applied for the campaign. They were regularly reporting on the number of toilets that were being constructed. The second report was then compiled by the GS representatives. Finally, the respondent referred that representatives from the district level offices came to Badkulla to check and record the SBA implementation in the area. In conjunction with this recording and reporting activity, the respondent explained that every fourth Saturday of the month, the GP members participated in a meeting with the ICDS staff and the health department personal. This group is called the Village Health Sanitation Nutrition Committee (VHSNC), and it usually discusses the requirements in terms of sanitation and toilet coverage and reports about detected cases of stomach related diseases and OD practices. The informant also wanted to emphasis the personal commitment of the GP secretary in the surveillance of the campaign implementation and performance. On the other side, the representative from Badkulla II mentioned only the reporting activity of the GS members who used to provide records of the number of IHL constructed and report on the new people requesting for IHL.

    The next elements covered concerning the campaign implementation were the efficiency and actual use of the tools foreseen by the SBA – advocacy and communication, also referred to as Information, Education and Communication (IEC) activities, financing, and construction of toilets. With regards to the IEC activities to create awareness among the community, the representative from Badkulla I explained that they used the already mentioned monthly/weekly meetings with the community to inform and educate them about proper sanitation habits. The informant also mentioned the school campaigns for the education of young members of the community. The representative from Badkulla II also talked about the realization of campaigns in the school accompanied by the door to door IEC activities. An additional activity reported by the informant from Badkulla II was the visit of the GP secretary or some representatives in the fields early in the morning to dissuade people from practicing OD by either using a whistle or shouting at them to stop. This method did not fall in the IEC activities presented in the SBA program, and it definitely seemed to be more related to a top-down kind of approach by including a form of imposition towards the community members. In any case, both the respondents reported a general high involvement of the community manifested by active participation to the weekly meetings and positive responses to the IEC door to door activities from the community members. In particular, the representative from Badkulla I indicated how the community truly craved for the implementation of a sanitation campaign in the area. On the other side, the informant from Badkulla II wanted to point out that the community members were already aware of the risks connected to OD, and only two areas were identified where practice of OD was still present. Concerning the financing and toilets provided for the community, more focused was posed on the possible difficulties encountered throughout the financial and construction processes. On this matter, no difficulties were reported by the Badkulla I representative. On the other hand, the respondent from Badkulla II underlined three central problems. Indeed, the respondent reported that households with financial constraints were not able to provide the initial installment to apply for IHL construction. As a consequence, these families were assisted only at a later time, and for this reason, they experienced a delay with the financing and toilet provision. The second problem was linked to toilet coverage. Indeed, the informants explained that a few decades ago, families used to stay united, while now they tend to separate themselves in more households. Thus, there is the necessity of building a higher number of toilets. Finally, the respondent mentioned the problem of people demanding for higher quality IHL, especially in terms of superstructure quality. On this matter, the informant expressed his point of view by explaining that to obtain higher quality toilets, the appliers should invest more money form their side.

  • 24

    Finally, for what concerns the general response of the community to the news of the SBA implementation in the area, both the respondents described the community members to be excited and curious about the campaign program and implementation process. Table 4 SBA Implementation

    SBA implementation’s Badkulla I Badkulla II Promotion Meetings

    Banners, posters, and flyers School campaign

    Loudspeakers Door to door Mapping of OD spots School campaign Early morning checks

    Monitoring Constructors’ report GS report District report VHSNC meetings GP secretary surveillance

    GS report

    Tools - IEC activities implemented

    School campaign Door to door High involvement

    Meetings School campaign

    - Problematics with financing and toilet provision

    No problematics Delay in toilet construction for households with money constraints Need for more toilets since families are separating themselves Requests for higher quality toilets

    - Community response to the campaign implementation

    Curiosity and excitement Curiosity and excitement

    4.1.2 The role of GP

    With regard to the role of the GP in the implementation of SBA, both the representatives underlined their total responsibility and autonomy in implementing the campaign. In particular, the representative from Badkulla II stressed the fact that the GP was the only body implementing the campaign and managing the funds coming from the government and district level and he underlined that these two levels could not interfere in the SBA implementation. In contrast, the representative from Badkulla I highlighted that they will have to follow up with the campaign’s results in the coming years. For this reason, during their regular GP meetings, they continue to keep track of the SBA implementation (i.e. the number of toilets built and their conditions).

    For what concerns the relationship between the GP and the other administrative levels, both the representatives described a positive collaboration. Only the representative from Badkulla II mentioned some delays in receiving the funds from the district headquarter. 4.1.3 Improvement in quality of life and behavioral change

    With regards to the general improvement in the quality of life in the area – including sanitation standards, sanitation behaviors, and health conditions – both the representatives were highly positive about these aspects. During the interviews, it was specified that the term sanitation standards referred to the safety of the toilets owned by the community members and to the level of knowledge about proper sanitation practices (optimal = extended possession among the community of completed household sanitary latrine units and of knowledge about proper sanitation practices; acceptable = partial possession among the community of completed household sanitary latrine unit and of knowledge about proper sanitation practices; poor = limited possession among the community of completed household sanitary latrine unit and of knowledge about proper sanitation practices). The variable sanitation behaviors stand for the

  • 25

    degree of variation in the practice of unsafe sanitation habits (significantly changed = the community members did not practice OD and regularly followed proper sanitary measures; slightly changed = the community members practiced OD and did not follow proper sanitary measures on certain occasions; not changed = the community members still practiced OD on a regular basis and did not follow proper sanitary measures). Finally, the variable health condition covered the level of change in the frequency of stomach related diseases among the community (significantly improved = rare cases of stomach related diseases among the community; slightly improved = occasional cases of stomach related diseases among the community; not improved = regular cases of stomach related diseases among the community). Based on the reports regularly collected by the GS members, both of them described the sanitation standards in the area as optimal and affirmed that SBA was able to significantly change the sanitation habits in the area – both the GP were declared ODF. Moreover, they stated that SBA was able to improve the health conditions in the area significantly. Table 5 Improvements in Quality of Life thanks to SBA

    Improvement in Badkulla I Badkulla II Sanitation standards

    Optimal

    Optimal

    Sanitation behaviors

    Significantly changed

    Significantly changed

    Health conditions

    Significantly improved

    Significantly improved

    To the question about the positive and negative results of the use of a community-led

    approach in improving sanitation and hygiene standards and triggering a behavioral change, the representative of Badkulla II answered that the community appreciated this initiative and people stopped practicing OD. Indeed, once they learnt about the health risks connected to OD, they acted to improve their sanitation standards and modified their sanitation habits by, for instance, starting to wash their hands properly. Moreover, the respondent wanted to stress again the importance of the campaigns conducted in schools, by underling how these activities made school children understand the importance of having the correct behavior towards sanitation practices. On the other side, the representative from Badkulla I described another type of approach for his area. They used the VHSNC meetings to discuss how to take action within the community, and then they reported their decisions during the monthly/weekly meetings with the community members. Neither of them mentioned any negative aspect related to the community-led approach. 4.1.4 SBA sustainability

    Another aspect covered throughout the interview sessions was how the GP were taking action to make SBA sustainable over time both in terms of maintenance and monitoring efficiency. The representative from Badkulla I explained that they had assigned a specific group of community members – called the foot-soldiers – to go around the area monitoring the conditions of the IHL built under SBA and checking if people were still practicing OD. The government paid the foot-soldiers – 1000 rupees per 5 months. Each member of the GS could hire three foot-soldiers to cover his/her particular sub-area. The representative from Badkulla II explained that the GS members monitored directly if the IHL built under SBA was correctly used and maintained since sometimes people used the toilets for other purposes, e.g. as storage rooms. Neither of the two representatives reported any difficulty in maintenance and monitoring of results obtained from SBA. Concerning toilet construction quality in terms of sustainability

  • 26

    over time the respondents from Badkulla II reported the problem of the low quality of the toilets constructed under the campaign but, as explained before, he stated that in order to obtain higher quality toilets there should be a higher investment from the households’ side. Finally, the same respondent reported a lack of funds for the maintenance of the toilets provided (e.g. tanks/pits cleaning, superstructure maintenance). 4.1.5 Suggestions for a future campaign

    The final aspects discussed with the two GP representatives were their perspectives on the overall strengths and weaknesses of SBA and their suggestions for a national sanitation campaign in future. Both the respondents indicated an overall shift in capacity and mindset by the campaign in changing the community’s habits and behavior. Indeed, both representatives emphasized the ODF status obtained by their respective areas. Moreover, the representative from Badkulla II specified that the health conditions had significantly improved and that the area can claim the presence of better than before sanitation standards (i.e. presence of proper infrastructures and knowledge about proper sanitation). With regard to the campaign’s weaknesses, the informant from Badkulla I reported a lack of funds for the maintenance of toilets (e.g. tanks/pits cleaning, superstructure maintenance), while the respondent from Badkulla II indicated the low quality of the toilets constructed under the campaign (i.e. unsafe superstructure and waste disposal management). He explained that most of the time, the constructors used only a metal sheet for the roof, and quite often, the walls were not thick enough. Table 6 SBA Strengths and Weaknesses

    GP representative SBA strengths SBA weaknesses Badkulla I

    Sanitation habits changed

    - No OD

    Lack of funds for maintenance of toilets

    Badkulla II

    Sanitation habits changed

    - No OD - Health conditions improved - Higher sanitation standards

    Low-quality toilets (i.e. unsafe superstructure and waste disposal management)

    When asked about possible suggestions for a future sanitation campaign, both the respondents mentioned the necessity for an increase in funds destined for the construction of more IHL. The representative from Badkulla I also suggested the construction of extra community toilets nearby the market and at bus stops. The respondent form Badkulla II stated that since families are getting more and more divided and the demand for new IHL is continuously increasing, the government should extend the campaign in the coming years. Another aspect suggested was the provision of more funds for the maintenance of toilets. In particular, the respondent from Badkulla II expressed the necessity for extra money and tools to m