Swachhta Doot 2.0: Notes from the sidelines of Satyagraha to Swachhgraha

Bihar has witnessed unprecedented congregation at East Champaran yesterday. 20, 000 Swachhgrahis coming from various states of India and Bihar worked across villages in Bihar for a week during 2-9th and then reached Motihari for the commemoration ceremony. Experts working in sanitation for many decades lauded the efforts of the govt. to bring swachhgrahis out of MIS and registers on the ground.

The sector anecdotes are replete with stories of non existent swachhgrahis terming them Swachhta Boot (Swachhta Ghost) like many other voluteering efforts across many walks of life in India. Under SBM, Swachhta Doot was loosely rechristened as Swachhgrahis and listed.

Everyone talked about them being utilized for sanitation campaingn, but few ever got them going on the ground. The general template for implantation was enrolling, training and getting motivators from among the community with promised incentives, which was tied with toile construction. Interesting contrast- while swachhagarhis were ideally enrolled for changing behaviour their services were utilizsed for accelerating constructions and once construction completed project imagination ends.

“Satyagrah se Swachhgrah” for the first time compelled the system to make those faceless, coded names in website and registers resurrect and walk on the earth with flesh and blood in action. It took a lot of efforts from all state governments to actually see them visiting government offices and rebooting them before they were ready to march to Bihar and in case of Bihar on the ground.

And that also brought the biggest fear which establishment always had have with enrolling any front line workers. Would the worker eventually protest and demand for contractual services or be made permanent? They raised slogans for making their services permanent. If not all, a large section did and their voices could be heard loud from the front row.

PM did not buzz or stop addressing the group despite the demand growing louder and louder. His speech was as inspirational as possible, but left many questions unanswered. Could sanitation would have front line workers as entrenched as we have for ICDS and Health? Could government doesn’t fear the protests of these workers as they have not been for many protests in this country?

Disclaimer: Views expressed in blogs are personal and no way represents views of the organizations that I work with or worked with in the past. 

Toilet Technology and Temporary Contraceptive in India: Striking Analogy

Earlier efforts of rural sanitation programmes in India could still be sighted as tiny graveyards of sanitation built without any public participation and mostly by toilet contractors. I could recollect the similar sights of children blowing balloons and quite clearly efforts of family planning in India, which was dumping millions of condoms to health sub centres. It did not take much of googling efforts to get the representative pictures of both toilet graveyards and blowing balloons, which is pasted there. 

Though googling also thrown quite a beautiful toilets recently being built and also beautiful models/celebrities and others blowing condoms as part of HIV/AIDS campaign and some condom Adv. Surprisingly google scholar also produced academic references of Nirodh- brand name of condoms supplied by the government been blown by children. "Nirodh is used for balloon and children buy them for play" write B B Mandal in his book "Child and Action Plan for Development" in 1990. 

Children playing with Condom Ballooon

Random picture of toilet

Children blowing balloons in Chitrakoot

History of family planning and sanitation in India have very interesting trajectory. Both are mostly incentivised, political class have always been talking about it in different decades with some or the other names. The orientation of the programme and programme implementation changed over decades with increased focus on inter personal communication and use of IEC. I had fortune of being association with both programmes across few laggard state in India particularly Bihar and Uttar Pradesh. I shall be trying to talk about similarity and what sanitation programme in India could learn from family planning. 

Issue at hand: Choice of use of family planning methods and toilet at home are inherently person choice which people make. But this personal choice have many dimensions constantly operating or rather mediating it. These are larger ecosystem such as family, caste, religious belief, broader economic and social standing, which often determine the probability of making one particular choice over others. 

India has been pioneer and lauded for its efforts of being the first county in the world to have started family planning under the government immediately after independence. Similarly, persistence of successive Indian governments in making rural India open defecation free is noteworthy. Though rural sanitation was almost 3 decade behind in terms of initiation.

Family planning space has witnessed various phases of programme implementation. Being merely outreach programme to phase of intense coercion in 70s and 80s and then having taken development orientation. The language have also changed from family planning to family welfare and so on.

Rural Sanitation have also witnessed its own growth and changing optics from being support programme to total sanitation, nirmal bharat and now swachh bharat. Perhaps in some sense what rural sanitation is witnessing today is repeat of 70s and 80s of what family planning programme in India had witnessed. Therefore, programme wise it is good to look at achievements of family planning in India and implementation of sanitation programme to draw lessons for better programme outcomes. 

Comparing the coverage: Current coverage of family planning at India level and in Bihar & UP looks strikingly similar to that of Sanitation. The following data is picked from NFHS 4 and today's MIS for family planning and sanitation. Higher coverage on sanitation could be attributed in data term to its coverage indicators and not use as the case for contraceptives. Adjusting with the usages, my crude case is it would either go to contraceptive way or even lower.

	Modern Contraceptive Use	Sanitation Coverage
Bihar	24	39
UP	46	57
India	54	77

 

Unmet Needs: Both family planning and sanitation have clearly recognised unmet needs. Current data of NFHS-4 estimates unmet needs for family planning at 13%. We don't have credible or such elaborate survey instrument to gauge the unmet needs for sanitation. However, the proximate indicators which I could possibly recall is one of the formative research in Bihar done by the Water and Sanitation Programme women and men put sanitation at their priority number 4th and 5th respectively. Therefore, it does indicate that there is latent unmet need for sanitation though slightly lower in the priority.

Temporary/spacing Vs permanent/ limiting instruments: Family planning claims to provide  age appropriate methods depending on the need of the couple to either space or limit their family. Various methods from tradition ones- withdrawal, rhythm to condom, pills, injectables, IUD to terminals methods of tubectomy to vasectomy. 

In the similar way, classically sanitation talks about whole sanitation ladder from unimproved dug pit to improved one of leach pit/septic tank/with toilet attached to sewerage line.

However, India landscape for both family planning and toilet technology use is very different. Field observations in both cases clearly favours use of terminal methods specially tubectomy as most preferred methods of family planning. Quite strikingly, among all toilet technology people have preference for septic tank toilet over the predominantly promoted or rather built two leach pit technology.

Septic tank is treated as permanent method or terminal solution to the toilet needs, if two leach pit is built under the government promotion at best it is treated as temporary method. Again, the data looks very interesting. I have taken all India figure for contraceptive technology and one survey from one of the districts in Bihar. This is for data point comparisons only. One can argue it as case of comparing apple and oranges but it has great programmatic significance. Please mark the numbers for Female Sterilisation and Septic tank toilets. 

  

Preference for contraceptive & toilet technology 

Discontinuation of Modern Spacing Method and leach pit toilet: The following graph gives interesting comparison about discontinuation of temporary contraceptive methods and leach pit toilet. The first graph is from NFHS-4, which puts discontinuation rate for all temporary methods at 44% where as in the second graph which is taken from the Nirmal Gram Sustainability study done by the Ministry of Drinking Water and Sanitation. This is to highlight under almost all toilets constructed under NBA/TSC were leach pit and study clearly found discontinuation of toilet use by all members in the family were more than 30%. 

What government programme has been doing: Both these programmes provides useful insights into how government had been doing business. Both talks about providing the client with basket of choice specially in terms of technology. However, they end of promoting terminal methods. This is to highlight here that tubectomy is incentivised. 

Guidelines of various rural sanitation programme in the similar fashion talks about giving household rights to build their toilets thereby choosing technology of their choice. However, leach pit is the technology which is promoted almost universally and incentivised. 

Disclaimer: Views expressed in blogs are personal and no way represents views of the organizations that I work with or worked with in the past. 

  

References: 

1. A photograph of children in Chitrakoot playing with all the free condoms. Credit: Khabar

2. https://books.google.co.in/books?id=qktDh5ytSUYC&pg=PA85&lpg=PA85&dq=nirodh+balloon&source=bl&ots=pFhc42ioLg&sig=6cY4RHxyOH8O9w0YJVemeLGar14&hl=en&sa=X&ved=0ahUKEwiojqXfxYLZAhUK448KHSXvA8wQ6AEIKzAA#v=onepage&q=nirodh%20balloon&f=false

Can we do elite modeling of two leach pit toilets in villages?

In last few weeks, I have been traveling to western Uttar Pradesh. Met officials right from the District Magistrates to panchayat secretaries. Have also got chance to interact with villagers in general and elected representatives. Some great young minds recruited through Tata-GoI collaborations. The most recent activity that we did is training masons on two leach pit technology toilets. Have been reflecting on some key questions which people often poses in sanitation.

1. Subsidy has done disservice to the cause of sanitation

This is typical question asked prominently by CLTS practitioners. Officials in higher bureaucracy specially has picked this question and don't miss a chance to ask anyone who interacts with them. I have also been interacting with CLTS practitioners - would rather call them trainers. They have pretty pragmatic take on this whole issue. They clearly highlighted current CLTS has limited imagination and hit dead end at triggering.  Their experience in community mobilization post triggering indicated, people can't sustain their changed new behaviour of stopping open dedication in the absence of proper toilet. Proper toilet costs money.

2. Can community do without subsidy?

Actual community mobilization ought to start once community is triggered. Govt. has huge deficiency there. Govt. has mobilized grass root functionaries with limited success and the entire energy is channelized towards constructing the toilets. Once construction of toilet starts there lies real challenge. Can community be mobilized to construct the toilets at large scale on their own. The answer is emphatic NO with the current engagement arrangements. 5 days of community triggering and thereafter leaving the community one with one messenger mostly a lower rung govt. worker is too much to ask for. They along with Sarpanch/Pradhan ends up facilitating construction mainly of two leach pit toilets. As experiences suggest that is not aspiration toilet for the community and the one they want costs way beyond their financial capacity. Therefore, sporadic engagement only during campaign period and forcing cheap toilet choices is bound to fail.

Recent studies from Bangladesh indicated open defecation free status could only be sustained where there was CLTS approach for brining awareness and subsidy working together. In the community where only CLTS was done without giving them subsidy had no real gain. That gives a compelling evidence, that CLTS+ Subsidy is best option in resource poor setting.

3. Choice of toilets

I have been working in the sector for over a decade. Have closely seen and read the basket of choice for family planning services under RCH programmes. In the name of choices govt. mostly ended promoting terminal tubectomy over all other methods. Choice of toilet technology is mostly guided by classic learning methods known in behavioural psychology - imitation. We initiate our peers and cultural traits are mostly transmitted from upper classes /strata to lower strata. Conceptual framework of westernization and sanskritization are case on point for most of our acquired behavioural traits. So, whom we normally imitate- rural imitates urban, poor imitates rich and we mostly mimic their behavioural traits both material and otherwise.

Predominantly all actors in toilet construction supply chain practice sanitation in very different way. The one who does actual construction (read Masons and labourers) don't have toilet at their home, the one whose house is centre of this great sanitation experiment have aspiration of something very different. The one who is managing the construction have different toilet at home. Therefore, all cues in their environment support a very different aspiration. Common aspirational toilet is spetic tank. Maximum incentive which govt. could leverage for each toilet is Rs.1200. The promise of the same is already under severe strain due to inability of central govt.to fund all toilets. This incentive money doesn't help in constructing toilet of their choice and that seriously undermine their participation in construction and thereafter it's use.

Some direction to move forward

• Modeling of two leach pit toilet use by rural elites

Taking cues from sociology and behavioural psychology, can government think of modeling two leach pit toilets by rural elites. Many districts did establish Sanitation Technology Park somewhat with the objective of showing the visitors live models of various toilet technology. However, it has limited use towards training masons or taking people for exposure.

If rural elites specially those who are involved in the supply chain of entire construction process start constructing and using this toilets, people at large would start using and adopting the technology.

• Using masons as messenger

Masons are the most effective messenger as far as the technology choice go.

Their words of assurance about the sustainability of two leach pit toilet go a long way in ensuring its use. In the recent training out of 20 masons not many were wholeheartedly convinced on the sustenance of this technology. Precise reason was they had never seen this technology working in their neighbourhood. In the semi- finished toilets only two masons- Ahsan and Sah Alam (In the photo) were involved intensely in learning nuances of construction by doing hands on. Other participants did participate but their level of participation was very low.

Engineers were all using different technology for use in their households and looked more like doing their job than having any aspirations for propagating the technology.

• Long term view of community mobilization for sustaining ODF

There needs a long term view of community mobilization for ODF than the currently practiced CLTS cycle. Triggering and follow up needs to be complemented with long term messaging with all possible mediums and contacts. The current ODF sustainability guideline talks about sustaining it for 6 months. However, behavior change demands much large intervention cycle. Evidence from other sectors specially health suggests need for continuous engagement at community level through incentivized volunteer worker like ASHA. There is already a provision for such workers in Sawachh Bharat Mission and their utility needs to be emphasized specially in post ODF sustainability phase.

Disclaimer: Views expressed in blogs are personal and no way represents views of the organizations that I work with or worked with in the past. 

Shades of pit emptying

A Sanitation Worker 

Swachh Bharat Mission has entered into year 3 of its implementation since its commencement on 2nd October 2014. The momentum has been unprecedented with 3 states and 95 districts already declared open defecation free. The current leadership has shown its resolve to finish the last miles and declaring those three states ODF.

Dry toilet, A Sanitation Worker

It looks like the administrative energy is converging well with political ambition of our Prime Minister. There is right buzz around the country fighting with this stigma of defecating in the open. Buzz is in right earnest and there is hardly any space which is not discussing this issue. Even joke factory is churning jokes around....." "खायेगा इंडिया तभी तो शौचालय जायेगा इंडिया" many more.

The year has also been noteworthy one of the Padma award going though posthumously to Mr. Mapuskar- one of the great sanitation worker who was also a doctor who truly believed in power of good sanitation contributing to good health. http://indianexpress.com/article/cities/pune/padma-shri-to-dr-mapuskar-swachhta-doot-from-dehu-village-4491728/

Mr. Iyer, Secretary, GoI, 2017

Last week has seen some dramatic visuals of sincerity coming to media for public consumption- the highest level of bureaucrats emptying filled pit. This would contribute towards fight stigma around handling manures from filled leach pits. This job has been traditionally considered impure and a certain section of society were engaged in doing so. This is still continuing and they are really living on the margins of the society. Despite the relative benefits of leach pit technology, the defining feature of Indian social system- caste system working on the binary of purity and pollution always came on the way of it. People preferred septic tank technology over this due to their inherent unwillingness not touching shit with their hands.

Prof. Robert Chambers in India 2015

Mr. Navrekar, Maharashtra, 2016

There has been earlier instances of demonstrating pit emptying by other sanitation champions notably Mr. Shrikant Navrekar and many others. This act by officials and champions looks like working straight on recommendations in the text book.

Not long ago, writing on the occasion of 1st anniversary week of SBM campaign Dr. Robert Chambers called for two thrusts--- making a spectacles of emptying filled leach pits by politicians, officials, spiritual leaders and other important members in the society to dispel myths around handling shit. / http://indianexpress.com/article/opinion/columns/whose-campaign/ He did demonstrated the same a year ago or so during his visit to India, but that didn't had the same media space. 

However, one very critical group which was recommended- politicians are hardly been in the frame. In the first few months of SBM, politicians with broom was the daily soap opera. Media had stories and counter stories around those being photo ops. Looks like politicians are to still muster the courage to do so. However, if they decide to do so, this could be game changer.

Mr. Bala,  Mission Director for Bihar, 2017

Most of these examples were coming from states in south or western India. In Uttar Pradesh and Bihar, while the traditional system has stronger roots but there are very limited space for such demonstration. Leach pit toilets which was considered "Sarkari toilets" hardly had any acceptance and use by people. Therefore, getting a filled, well manured pit is hard to find.  

 * Pictures are randomly picked from internet. No permission requested.

Disclaimer: Views expressed in blogs are personal and no way represents views of the organizations that I work with or worked with in the past. 

Engagement begins.......

Many of my friends have been blogging for quite sometime and I always thought.....what to write. Then I found myself for last two years dealing with pile of shit both personally and professionally. And hence decided to write blog over "shit"

Most of my friend is aware that I am father of a cute daughter who is going to complete two in coming few weeks. She came to our life in November 2013 and thats when my active engagement with shit happened first. 

No way I am going to tell, that before that I was not defecating or was living in such sterile environment that I had no contact with shit....what I mean to highlight that your "Voluntary engagement" starts once you have the kid. When one cleans once own shit...its involuntary as you mostly don't have a choice...do you?

And then in September 2014, I started working on sanitation issues....and that qualified me to engage with shit professionally. And thats how this blog. I intend to chronicle my professional and personal engagements with shit. 

And it was black: The very first shit that child does is called Meconium. It is black and Unlike later feces, meconium is composed of materials ingested during the time the infant spends in the uterus: intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile, and water. Meconium, unlike later feces, is viscous and sticky like tar, its color usually being a very dark olive green; it is almost odorless. When diluted in amniotic fluid, it may appear in various shades of green, brown, or yellow. It should be completely passed by the end of the first few days after birth, with the stools progressing toward yellow (digested milk). Please read Wiki in case you want to know more about it.. https://en.wikipedia.org/wiki/Meconium 

And the engagement grows:  So, as Wiki said shit progressively turns yellow.....and thats where the story unfolds....till baby was getting her meconium coming out from stomach...there were people around (family) and so you hardly have to worry much. Once the shit turns yellow.....and Baby start having frequent stools....you find yourself amidst pile of shit.

So, thats how I brought my baby to home. It was winter......Old School thought was telling me.....all previous generation was raised on baby wrapped in cotton cloths....or rather any cloths available in the house...so we started with old school and soon realized every one including my baby were having sleepless nights......(Shall be dealing with sleepless nights in another blog later)

Then we figured out....baby was getting wet as my public health training was telling baby needed to be breastfed and if she was getting enough of it....6-7 times urination was indication.....and you could easily imagine long winter nights.....and baby wrapped in cloths.....

And then we got this magic pants...."diaper"

My wife and I put diaper as one of the biggest invention of 20th century possibly and are unison in case voting by us---parents of millions of babies all over world win Nobel prize for someone who has discovered better invented this diaper. (Disclaimer: We don't really know who has invented it and rather lazy to google it at this hour).

But, hey I found this damn costly.....over two years...I realized quite a substantial chunk of produce of my "Professional engagement of shit" was going to cover for my personal engagement of shit. On an average one bout of baby shit costs roughly about INR 15 rupees. (this is inclusive of wet wipes....which is so costly).

And other day I found a friend of mine was complaining about the quality of diapers by pampers. Rightly so, their quality has gone down. 

Thats where I stop for the introduction. I intend to deal with my professional engagement in upcoming posts....when I would deal with what I professionally do and explain. In addition, I intend to invite my friends working on sanitation to write on this space.

Disclaimer: Views expressed in blogs are personal and no way represents views of the organizations that I work with or worked with in the past.