Exploring the change in communication in sanitation: An Arghyam consultation held on 1 August 2012

Arghyam consultation to address issues related to behaviour change communications, information education communication and to understand sanitation.

Arghyam, which works in the areas of domestic water and sanitation, has decided to look more closely at the sanitation space to identify certain areas where it can work towards attaining total sanitation in rural areas of India. In this context, with behaviour change being identified as one of the critical issues, Arghyam aims to specifically delve into the issues of individual households and the reasons behind poor usage of toilets in these households. 

The objectives of conducting this consultation were to shed light on issues with Behaviour Change Communication (BCC) and Information Education Communication (IEC) and to gain a deeper understanding of current efforts to address behaviour change in the Total Sanitation Campaign (now renamed Nirmal Bharat Abhiyan). Arghyam also aims to understand why and how some communication initiatives have worked; what the geographical and cultural diversities are that communication needs to address; why communication has not gained scale or in some cases neglected. This consultation showcased examples of communication successes in other development areas, as well as the BCC efforts undertaken by some state governments.

Unpacking the Information, Education and Communication (IEC) component in the Total Sanitation Campaign (TSC)

1. Presentation by Dr. Tapan Das, GoI

Several policy changes have taken place in the Total Sanitation Campaign, which has now been renamed as the Nirmal Bharat Abhiyan (NBA). Dr. Das’ presentation covered the salient points of Information, Education and Communication (IEC) within the TSC.

An important question raised in this presentation was how much of the 15% IEC allocation was actually being used by states. Chattisgarh, Jharkhand, Assam and Bihar are clearly lagging, while states like Kerala and Sikkim which are successful in TSC use anywhere between 1-20% of their IEC allocation. Kerala achieved the highest success in TSC, with all districts showing good sanitation coverage. Kerala’s IEC usage was high in the latest census figures. The TSC guidelines state that IEC funds are to be ensured at the Block and GP levels, for effective dissemination of IEC materials. It is an entirely different matter that funds don’t reach the Block and GP levels in reality.

Another very valid point was that funds for IEC can only be used properly if the Gram Sabha is empowered. This is something that comes up in many development issues, and is not exclusive to sanitation. While NGOs have asserted this point time and again, it is good to see that the government also agrees with this. Dr. Das went on to assert that the communication plan should be at the village and GP level, and that capacity building of groups at the grassroot level is a very important component of the strategy.

Dr. Das also pointed out that the leaders in influencing behaviour change in the community were usually Village Water and Sanitation Committee members, government representatives and ASHA workers. Women’s groups have been the biggest influencers and change agents, and this should be kept in mind while planning a BCC strategy. 

The TSC guidelines state that mass media should be taken up only at the national level and at the state level. National level mass media campaigns have, however not been adapted very well at the state level which was evident from ensuing presentations by the 3 states that were represented at the consultation. This was also made clear in the presentation on the Sholay campaign done by UNICEF and GoI in collaboration with Ogilvy & Mather in 2004. Tarvinderjit Singh said that the reason the campaign did not achieve what it was supposed to was because it was not followed up by any supporting communication. This indicates a clear gap in the current communication strategy being implemented both, within the TSC and in external efforts like the Sholay campaign.

Dr. Das suggested that the group of people present at the consultation could come up with a strategy for IEC fund division for pre-Nirmal and post Nirmal stages of the NBA, because this is where people are still practicing OD even after construction of toilets. He requested the group and Arghyam to lead in providing feedback on the Draft Communication Strategy recently released by the Ministry of Drinking Water and Sanitation. This is a potential area where the gap can be filled, by building the capacity of CCDU’s to adapt a national level communication strategy at the state level.

An important (and expected) question from the audience to Dr. Das, was where the money was going in the TSC. Census coverage figures are very different from TSC figures, which indicated that money was obviously being siphoned. Dr. Das responded that he has also pointed this out. An interim solution to this is that all states have been asked to do a baseline data survey to address this gap and ascertain where the money is disappearing. The baseline data survey is supposed to find out how many toilets there are and how many toilets need to be built in each GP within the state.

2. Presentation by Nitin Mane, Dy. CEO, Zilla Panchayat, Kolhapur (State Govt. representative from Maharashtra)

The Maharashtra State Government has conducted NSS camps and trained Swacchata doots to spread awareness on the importance of sanitation. Mr. Mane’s presentation showcased the use of Gandhigiri for sanitation, where Gram Panchayats enforced fines for open defecation. Around 7200 people were fined in Maharashtra. Another punishment meted out at the village level was dhols being banged in front of households that were practicing open defecation. The names of families caught defecating in the open were displayed in the village to shame and embarrass them. Other punishments were withholding rations, going to the extent of turning off water and electricity connections and even using the police to track down people practicing open defecation.

Mr. Mane was of the view that IEC activities should include reward and punishment, so that there are consequences that people have to face for practicing open defecation. Maharashtra seems to have used much more forceful measures, but it has placed them in the position of being a successful state in the TSC. They’ve achieved the goal of getting people to use toilets by using stronger force, which raised many questions of ethics and lack of empathy from the NGO representatives at the consultation. Using force does not necessarily create demand for sanitation or toilets, and Dr. Mapuskar pointed this out at the end of the day when he rightly said that changing behaviour by using coercion and force will not guarantee sustained behaviour change in the long term. This point contradicted Mr. Mane’s presentation, which said that Maharashtra (and most state governments) are trying to create demand for sanitation. The NBA guidelines clearly state the demand driven approach put forth by the former TSC guidelines should be continued “with emphasis on awareness creation and demand generation for sanitary facilities in houses, schools and for cleaner environment”. Dr. Mapuskar’s point was that demand cannot be created by using force, coercion or shame. This is thus a major problem and paradox in any effort to generate demand, as put forth in the NBA guidelines.

Ravi Narayanan, (advisor to Arghyam) posed two interesting questions in the discussion that followed Mr. Mane’s presentation: (i) Is behaviour change the same as stopping open defecation or should it include hygiene? And (ii) Are these examples cited in the presentations specific to rural areas only?

Stalin K from Video Volunteers was quite vocal in his opposition to the methods adopted by the state governments, saying that there is no doubt that fear and shame were fool proof ways to affect change from a communication perspective. However, sanitation is not just an entitlement; living with dignity is a basic human right. Behaviour change is about initiation, popularisation and perpetuation; we have to see it through till it becomes a cultural phenomenon. Behaviour change is by definition pedantic, patronising and top down because it is ultimately one person or group saying “I know better than you”. Ending open defecation is not hard to achieve, but the larger issue in this debate on sanitation is public health. The problem is not open defecation; the real problem is health. The health issue thus needs to be demystified in communication efforts to improve sanitation in India. This point again addressed the question of the gap in the current communication efforts being adopted and implemented at the state level – that the issue of sanitation was being trivialised to mean simply ending open defecation.

Kalpana Sharma, a journalist who writes on development issues posed another question to Mr. Mane after his presentation: of the households whose water and electricity connections were cut as penalties for practicing open defecation, did the Government of Maharashtra survey if they were still practicing open defecation after imposing these punishments? She raised a very valid point, that the state government was making the lives of poor people even harder with these kinds of penalties, like cutting off basic services. Doling out punishments isn’t fair when the options being offered are so sub standard, and the very use of toilets is not understood or recognised by communities.

Joe Madiath from Gram Vikas was on the Sanitation Standing Committee which submitted recommendations to the Planning Commission for the 12th Five Year Plan. He said that the Ministry took most of the Committee’s recommendations very seriously. Even though Jairam Ramesh joined only towards the end of the series of meetings that were held, he reviewed their recommendations and took 99% of them to the Planning Commission. Some points were rejected by the Planning Commission, although Mihir Shah tried to fight for the recommendations . An example of this was that group recommended a subsidy for all people in rural areas that did not have a toilet, which was accepted by Jairam Ramesh and Mihir Shah. But when it went to the Planning Commission, they said all groups of people could get subsidy except big farmers. 

The issue of virtual toilets as far as TSC and non-TSC achievements are concerned was also raised by Mr. Madiath in this discussion. The Standing Committee strongly asserted that the wrong doers here were not the farmers or people living in rural areas who were supposed to have made the toilet. The real sinners are the technical people and the government bureaucracy at the block and GP level. Industry is being given a lot of leverage, which is why this is happening. The Planning Commission shot down the Standing Committee’s recommendation for a one time Rs. 3000 subsidy for every household.

Mr. Madiath went on to state that sanitation was not just about defecation; more importantly it was about dignity. The Standing Committee recommended a bathing room along with the toilet, with additional subsidy. This suggestion was shot down at the Ministry before it even went to the Planning Commission. Ravi Narayanan added to this, saying that poor people should not suffer differential standards. Mr. Madiath said that there is a predominant feeling among bureaucracy, media, donors and NGOs that poor people need poor solutions, and that the very poor need miserable solutions. Low cost does not have to be the most economical solution, and very often is not in reality. 

Another interesting point raised by Sopan Joshi was a permutation of the shame game being implemented in sanitation. Why don’t we shame urban populations into dumping their sewage into water bodies? Shouldn’t it be shameful to do this?

The session ended on the note that ending open defecation will not guarantee public health. The whole sector has been so engineering-led that BCC efforts have ignored the people who will benefit from improved sanitation.

3.Presentation by Shardendu Narayan, Dept. of Drinking Water and Sanitation, Jharkhand

Jharkhand is the worst performing state in sanitation as per the latest census. Mr. Narayan requested assistance in conducting a baseline data survey every 3 months to monitor toilet coverage and usage in the state, in an effort to improve Jharkhand’s sanitation indicators.

WSP supported the sanitation work in Dumka, one of Jharkhand’s most backward districts. The representative from WSP, Suseel Samuels said that from this experience, they learned that participatory learning was key to facilitating behaviour change. The community should come forward and the government agency should step aside and monitor.

The Jharkhand Drinking Water and Sanitation department adopted the Community Led Total Sanitation (CLTS) approach to create demand. Mr Narayan said that it is very difficult under the current system imposed by the government to change behaviour when every state is given targets that have to be met.

Jharkhand had no Panchayati Raj Institution (PRI) system for 32 years, which was one of the main reasons it failed on many counts in sanitation coverage. Now there is a PRI system, and the state government is empowering them to take charge because they also recognise that wherever there are strong PRIs, there is empowerment. 50% of seats in Jharkhand’s PRIs are reserved for women, which is fantastic for sanitation.

Mr. Narayan’s presentation showed that NGO members visited villages in Jharkhand to interact with community leaders. At first they were met with indifference and almost defensiveness by villagers, who did not see the need for any dialogue on sanitation. But after 3-4 meetings they warmed to the NGO members. Mr. Narayan said that winning the confidence of panchayat leaders and tribal chieftains was key to ensuring community participation.

Jharkhand’s villages are scattered over large forest areas, making many areas inaccessible. State government had to facilitate meetings with all the GPs even though they were so far flung and far away from each other. This was a major challenge in community mobilisation, and is the case with other states like Chattisgarh which have large forest areas and tribal populations. The intricacies of dealing with tribal populations had to be considered too in Jharkhand.

A common misperception in sanitation is that constructing toilets is an expensive affair. It doesn’t have to be, because there are low cost options, and moreover no cost options available, as Mr. Narayan showed in his presentation. The no cost options look very basic, but they were an enclosed space with walls and a roof.

An interesting point brought out in response to Mr. Narayan’s presentation on the sanitation situation in Jharkhand was that we should be careful with the way we approach this issue, and we should be careful of our body language. Government officials should not think that they are the “masters”, and should not preach or teach to beneficiaries. Talking down to people never works, even with poor people, and this is a fundamental principle adopted even in advertising and communication strategies. 

A question raised in the Q&A following Mr. Narayan’s presentation, was whether women took the lead in adopting new toilet technologies in Jharkhand.  The reason this question was asked was because women constantly face opposition in constructing toilets from the male members of their family. Men often don’t see the need to construct toilets because there’s no vested interest in it for them. When men are the primary decision makers in the conventional family structure, there is bound to be a clash of interests. Mr. Narayan’s response to this was that tribal women in Jharkhand play a dominant role in the societal structure. They are at the helm of affairs similar to many tribal societies even in North East India. Mr. Narayan and others said that it was actually surprising that women in Jharkhand had not stood up for their sanitation rights earlier.

The Q&A in this session ended with a discussion on the unethical nature of the CLTS approach. Many participants, particularly from NGOs questioned how state governments could endorse CLTS, an approach which strips people of their dignity. Moreover, who decides what the ceiling or limit is for shame in the CLTS approach? What qualifies as too much? How can you put a picture of a pig that eats excreta on the door of a household that still practices open defecation? Mr. Narayan's response was that it was left to the community to decide to do these things, and that the Jharkhand government did not have the mandate nor the right to resort to such measures. It was the community’s decision to use insults to shame other members into using toilets. But isn’t the state government using CLTS as a BCC tool in the implementation of TSC? There should be other tools available for state governments to use in training communities, other than CLTS which have shown some if not greater measures of success. Currently this seems to be the only successful method, which is why it is being adopted by states like Jharkhand. Mr. Narayan concluded with the point that if CLTS is not supported by the provision of a sanitary toilet, then it is a failed approach.

4.Presentation by Vikramjit, Programme Officer, HP Voluntary Health Association (HPVHA)

Himachal Pradesh has re-verified its 100% OD-free status in each GP after it was declared an ODF state. They started re-verifying GPs because they realised that villages that had been declared OD-free were no longer targeted or focussed on in communication efforts. There are so many factors that contribute to sustained use of toilets, one being that family sizes increase so there are more people in the household and thus more users for a single toilet. The more users, the greater the chances of behaviour regressing back to OD. Vikramjit said that there has to be some monitoring and continued intervention even after declaring the village OD-free.

Himachal Pradesh also works through the demand driven approach, as promoted by Dr. Mapuskar, but they too used CLTS supported by WSP. Tools available in CLTS have shown results in many GPs in the state. 

In a shift from the other State Government presentations, the HP state government decided that the subsidy would be given to the community, and not to only BPL families as per the TSC guidelines. This meant that the HP state government provides funds to the GP, and the GP gets to decide what they want to do with it. HPVHA also trained masons on low cost and appropriate technologies for rural areas, and trained Swacchata doots in each GP in the state.

IEC was implemented using interpersonal communication through Mahila Mandals, SHGs and religious leaders. These groups were trained to promote sanitation in their communities. Doordarshan, cable TV and radio were mass media channels used to publicise success stories in the state, in an effort to inspire others to follow their example. Vikramjit also said that water testing kits were a very effective IEC tool, and that the media played a big role in covering success stories.

HP also involved all line departments within the state government, like Education, Health, Welfare, IPH and PWDs in their communication efforts. This was essential to the success of the TSC in HP. HP is third after Kerala and Rajasthan in TSC coverage, although usage was not mentioned.

While the NGP award is 5 crores, GPs in HP have used only 2 crores of this for IEC. The Chief Minister of HP is very pro-sanitation and regularly video conferences with secretaries and other bureaucrats. This shows that political will is essential to make a state successful in sanitation coverage.

The presentation was followed by a comment from Vishwanath (advisor to Arghyam) that continued IEC efforts in HP will ensure no slippage from their achievements in TSC. Dr. Mapuskar also commented that a 2 pit latrine can ensure sustainability in usage. HPVHA’s response to this comment was that they did not agree with the supply approach promoted by the TSC initially, where too much focus was on the actual toilet structure. They wanted to adopt a demand driven approach, and have made some progress in making the toilets low cost so they are more sustainable.

Subsidies were given to panchayats as a sanitation fund by GoI. A question posed to Vikramjit was what GPs had done with that money – did they use it for community mobilisation, since they did not agree with the TSC guidelines which said it should only be given to BPL families? HPVHA leaves it to the GP to decide what to do with it. The GP has to submit a list of beneficiaries to the state government, which is then uploaded to an online database.

WSP was associated with the sanitation work in HP, and Suseel Samuels from WSP pointed out that a crucial factor for success in HP was the many champions in the administration, bureaucracy and political leadership for sanitation. HP also down played the subsidy, and focussed on the achievements of GPs that had become OD-free. Also the poverty level in HP is quite low so it was easier to convince people of the need to construct toilets. Capacity building by support organisations and through exposure visits to other states also contributed to HP’s success.

BCC cannot be done through government infrastructure; it has to be done through social organisations and NGOs. Most states are lagging in the TSC because of this systemic issue.

Vikramjit concluded by saying the subsidy was being given because of the TSC guidelines, even though beneficiaries didn’t want it in HP. This is true in richer states like HP.

Communication for Development: Experiences from other sectors

1.Analysis of the Pulse Polio campaign communication: Gitanjali Chaturvedi

Gitanjali talked about the learnings from the polio campaign that could be relevant to sanitation. Five years ago, the pulse polio campaign was doing very badly. The very need for eradicating polio was not clear and the campaign had to be justified at all levels. Building acceptance and demand in the community was much harder than convincing them of the need for polio drops. Poor people struggle for so many other basic things, so where did polio fit into their agenda? This made the challenge even greater.

The pulse polio campaign had to be community led with the government playing a strong role. Religious leaders were pivotal to the success of the campaign, which followed a 3 pronged strategy:

(i)Community engagement: a credible messenger had to spread the message in individual households. Village women who were respected and had some formal education were used as these messengers. This was the first form of interpersonal communication used in the campaign.

(ii)Getting Muslim sects to come on board was a challenge for the polio campaign, especially in UP and Bihar because GoI didn’t really deal with this community. The Rotary Club was brought in to facilitate this discussion with the Muslim community in UP and Bihar. They helped frame the messaging of the campaign, using religious and cultural connotations like sunnat. They talked about hygiene in the context of Islam, to make it more identifiable to the Muslim community.

(iii)Amitabh Bacchan: the polio campaign was the first in India to use a celebrity brand ambassador. People would listen to Amitabh Bacchan telling them they were stupid to not immunise their children – coming from him, it was palatable. Coming from the government, it would have sounded patronising. He is the biggest superstar, which is why there was no need for the polio campaign to even break the monotony of the same ad over and over again. They just ran it over and over again, reinforcing the message through repetition.

What works for the TSC is that it is a horizontal programme, so it can link to other programmes. The disadvantage with the TSC, according to Gitanjali is that there are so many messages in sanitation, when there should be one clear message. The Bacchan ads created awareness and moreover created a demand for polio. The message was strong and clear in the polio campaign, that it was important to immunise everyone.

The use of data for communication in the pulse polio campaign was instrumental to its success. They had very specific, focussed target areas, and it was also a communication intervention that could be measured. Also 99% of the communicators for the Pulse Polio campaign were women, which was a major enabler for the campaign’s success.

Gitanjali warned of the trap of programme fatigue, which was also faced by the pulse polio campaign. Programme fatigue is when people get fed up of a programme that isn’t working, and this seems to also be happening with the TSC. It has been in force since 1999 and it is now 2012. Many are wondering why it has taken so long, and why it still seems to be such an uphill struggle.

Another valid point brought out in this discussion was the number of things we are expecting from poor women. They are faced with many problems that come from poverty, so it is unfair to expect them to become change agents for an issue that they don’t think they really need.

Sustaining behaviour is also a problem. In this pulse polio campaign the NRHM came in at the right time and took the burden off the campaign. The programme created a lot of demand for polio eradication through its IEC efforts. 

Rohini Nilekani, Chairperson, Arghyam asked Gitanjali after the presentation if she thought that polio was easier as an issue than sanitation. Polio was not a political bomb, nor was it connected to so many different issues like poverty, gender, etc. as in the case of sanitation as an issue. Gitanjali did agree to a certain extent that polio was possibly an issue that had less layers of complexity than sanitation. She added that another reason for the success of the campaign was that volunteers all over the country were mobilised, and became a tremendous resource.

The discussion then moved to sanitation, where it was rightly pointed out by an audience member that the money allocated for capacity building in the TSC is underutilised and has been taken for granted by the state governments. The pulse polio campaign’s main differentiator was that the training was so holistic and the volunteers were mobilised so effectively.

A participant asked Gitanjali if coercion was used in any way in the pulse polio campaign. She responded that it was not because it was very clear that this was a people’s programme. They were also dealing with a religious minority so they could not possibly use force, fear or shame. They had to be convinced and persuaded using religious teaching, and the only reason it worked was by putting a friendly face before them.

2.Analysis of the communication campaigns for HIV/AIDS awareness and other development issues: Shankar Narayanan, Director of Programmes, Population Services International (PSI)

Shankar started off his presentation by saying that mass media works in India, and has been used by the public sector extensively. It has also been used successfully for health communication. Through PSI’s work in Behaviour Change Communication, they have learned that people change behaviours and adopt new ones. The Balbir Pasha campaign became a Harvard Business School case study, which Shankar went on to show the audience.

The campaign dealt with many taboo topics like commercial sex workers, sex and condoms. This is very similar to sanitation where the topic is shit and excrement, which nobody really wants to talk about. People do not discuss their daily toilet habits, nor do they appreciate other people telling them how to do it.

The Pulli Raja ads were pulled out of the media after running in Andhra Pradesh for 16 days. The recall was very high for these ads and directly correlated to behaviour change, with statistics showing increased and sustained condom use during a commercial sex act after the ads ran on TV. However they were taken off the air because of their controversial tone and subject matter.

Channels used in public health campaigns done by PSI include Inter Personal Communication, street theatre, outdoor and electronics. Mass media works best when combined with other forms of communication, demonstrating that the “through-the-line” approach should be used in devising a communication strategy for sanitation.

PSI poses several thought provoking questions in addressing behavioural issues. What are the barriers to behaviour? What is the cycle of use in a consumer’s life? It is very crucial to put a face to the beneficiaries the campaign is targeting, instead of randomly talking to anyone and everyone. Some demographic targeting and research should back up the primary and secondary target audience identification. Only after this can the message be crafted. An effective campaign needs a tight creative brief based on specific audience segmentation. The campaign needs to surprise consumers, give them solutions they want and can realistically do something with.

Shankar said that mass media is much more effective in developing countries, and that it can be cost effective. With TSC’s budget it can definitely afford it. Mass media gives the highest return on investment, and even the behavioural per unit cost can be analysed.

3.Sholay campaign: Tarvinderjit Singh

Repetition is key to making a message heard through mass media. The reason why TSC is facing this issue is because the Sholay campaign wasn’t reinforced with follow up communication. The campaign was done in 2004 and did not seem to run for very long because of various political factors. 

The biggest barrier faced was that they had no celebrity and no budget to work with. So they used Sholay, which research shows most Indians have heard of. It is an iconic Hindi movie.

Tarvinder made another valid point in the thinking behind the brief, that nobody likes to be told that they’re unhygienic. They couldn’t just go around telling people they’re being dirty by shitting in the open – it would not be appreciated nor would it go down well.

6 TV ads and 6 radio spots tackled 6 individual messages around sanitation in the Sholay campaign. They did not garble all the messages into one communication piece, using the same principles as the pulse polio campaign, which used a single, strong message. The story was told through series of ads, with one message leading to another.

Watch the Sholay ads here, here and here.

4.Presentation on Bombay Train campaign and Behavior Change as a Science: Ram Prasad, Final Mile

Ram Prasad runs a consulting company called Final Mile, which specialises in the science of Behaviour Change. It is a proven fact that people won’t change behaviour even if it’s a life or death situation. Also, 90% of products fail in private sector, so it’s not just government. Over 95% of behaviour is driven by our non-conscious minds. 

Context alters behaviour and decisions, as is evident in the TSC implementation in different states. The reason people were defecating on railway tracks or using them as short cuts in Mumbai was because the alternative was a very long walk. Railways called it trespassing; Mr. Prasad pointed out that this was a shocking lack of empathy for people who are only looking for ways to make their lives easier. The parallel that can be drawn in sanitation here is that open defecation is practiced because there is no better alternative (toilet), or they just don’t know better.

Awareness is essential but is usually overrated. The most claimed research when it comes to behaviour is “lies, honestly told”. We all say things that we don’t really mean. Behaviour is subject to many mental models and many biases that are hardwired – educating people out of bias is very difficult and not desirable. Behavioural science backs up interventions by understanding the behaviour and cause for it.

A point made by Stalin after Mr. Prasad’s presentation was that the OD-health link is invisible. I don’t see where my shit goes, but the dalit who cleans my gutter will probably die of ill health because he is doing that dirty work. So what total sanitation are we talking about? He also added that another way of looking at it is introducing a new behaviour, instead of saying the old one is wrong. We usually say “don’t do that, do this”. Maybe it can be Behaviour Communication – no change required. Another suggestion was to unlearn current behaviour and adopt new behaviour. This generally proves to be a tougher process.

Shankar Narayanan added that the problem in public health is that use is very low, whether of contraceptives or whatever preventive measure is being offered. In this case awareness plays a huge role, so it’s not entirely correct to make that statement broadly.

Rohini Nilekani asked Mr. Prasad what he thought sustained behaviour change. Is it opportunistic, is it habit or is it something else in the field of neuroscience? If there’s no reinforcement or reward it will fall back. Ram’s answer was that if there are any interventions at the point of action which people aren’t habituated to, then behaviour can be sustained. In the context of sanitation, this could mean the dedicated open area where people go to defecate is where messaging should be designed. 

Joe Madiath added that awareness cannot be spread through posters, leaflets, etc. Behaviour Change can only come about through pressure, because a dirty toilet is worse than no toilet. People in the villages where Gram Vikas works put school children on toilet monitoring committees, and fines were mandated by villages in Orissa. This is an example of an NGO using punishment to change behaviour.

Discussion facilitated by Rohini Nilekani, Kalpana Sharma and Ravi Narayanan

Rohini Nilekani summed up here impressions of the day by asking two questions in sanitation: how can we enable and empower dignity? What happens to the waste? It is quite clear that sanitation has moved up on the priority list. More people are talking about it due to positive (and some negative) externalities. The question of reward and punishment must be kept open, and the process of trying to achieve the end goal must be thought out. The end goal is dignity, not sanitation.

Kalpana Sharma's point of view stemmed from the key question of "why sanitation"? Because water and sanitation is often clubbed together, we don’t know why sanitation is important on its own because we have not thought it through very clearly. What does the Right to Sanitation mean? Dignity is intrinsic to this idea, and women are central to that. Sanitation is most importantly a gender concern, of which menstruation is as big as defecation and urination. Steps taken should not put people down or denigrate them; they should be respected as human beings, if we are to call ourselves a developing nation. Gender is a crucial issue in this debate, and must be the central focus. Not targeting women, but understanding how important it is to women and using them as change agents.

Ravi Narayanan added that there is a need to determine what Behaviour Change is before we think about the Communication that facilitates this. Does Behaviour Change in Sanitation = ending open defecation? Ending open defecation is the first step, but the scale of the problem in India is so huge that we have to take it one step at a time.

The discussion was then thrown open to the floor, and some key points were raised:

• Sanitation is not an activity but a way of life. Safe sanitation should be incorporated as a message/topic in school curriculum. Teachers repeatedly fail to teach children about this. If this is done, we will have a generation of young people who are already in the habit of using toilets. So the practice of open defecation will disappear with the next generation.

• Government will lead the programme implementation but must also collaborate with other stakeholder groups. Jharkhand has not targeted high school students, for example.

• Communication and Capacity Development Units (CCDU) units usually have 1-2 people with no experience in communication or IEC for that matter. The overall idea of the CCDU at the state level has not worked. The social mobilisation network in the polio campaign (literally thousands of people) was an indicator of how much manpower is required for communication of such issues. We are depending on such few people at the grassroot level to spread the sanitation message. In sanitation there is not enough mobilisation and not enough strong change agents. An area where Arghyam can help is thus building capacity of these CCDUs to empower them to implement a campaign of this scale.

• NBA shouldn’t become another missed opportunity. How do we sensitive government departments to effectively implement BCC initiatives?

• Hand washing translates to cleanliness, which in turn means good manners to mothers. Telling people to wash their hands with soap doesn’t mean they will.

• Dr. Mapuskar ended the day's discussions by saying that knowledge means nothing if it doesn’t lead to attitudinal change. Behaviour change can’t come from force. The entire sanitation lifestyle is necessary, and should be the larger aim. Force cannot be a motivational factor. The conversation has changed so much from the 1970s, and we should recognise that much at least. In schools for example, there is only construction of toilets in the school but no efforts or investment to make students use the toilets.