Informing interventions to improve WASH behaviours in Odisha, India
Under Swachh Bharat Abhiyan (Clean India Mission), launched by the Indian government in 2014, India has made rapid progress towards ending open defecation, with improvements in water, sanitation and hygiene (WASH) outcomes. However, some states still lag behind in providing access to latrines for all. India’s National Statistical Organisation’s data shows that in 2018, approximately 28.7 per cent of rural households still lacked access to any form of latrines. In Odisha alone, 50 per cent of rural households had no access to latrines. Further, as previous studies have shown, access to latrines does not automatically lead to latrine use and safe sanitation.
In 2017, researchers from Emory University collaborated with Rural Welfare Institute with support from 3ie to conduct a formative evaluation examining the challenges to latrine use in rural Odisha. The team identified six behavioural barriers responsible for non-use of latrines for defecation or disposal: non-functional latrines, lack of practical knowledge regarding latrine use, preference for open defecation, latrine use not prioritised and/or valued, unsuitable latrine design, and inaccessible water.
Using formative phase findings, the partners designed the Sundara Grama (beautiful village) intervention, which included community- and household-level activities in Puri district in Odisha. The community-level activities involved folk performances, transect walks, meetings and village map painting. At the household level, the implementers also conducted targeted visits and minor repairs. Another intervention component was the mothers’ group meeting, where implementers introduced mothers and caregivers to activities and CFM hardware, such as plastic potties and scoops, that can enable safe disposal of child faeces. This component was designed for qualitative analysis.
The evaluation used cluster randomisation with 33 intervention villages and 33 control villages and included mixed methods process evaluation. Additionally, qualitative research was conducted in six villages (three of which received the intervention).
The intervention led to a moderate 6.4 per cent increase in latrine use amongst individuals aged 5 years and older, in comparison to the control group. This increase was detected even after controlling for increased government efforts in both intervention and control villages as part of the push to declare India ‘open defecation free’. Analysis revealed larger treatment effects of latrine use amongst females as compared to males.
The evaluation found the intervention was associated with a 20.4 per cent increase in the reported safe disposal of child faeces. Enabling caregivers to understand the importance of disposing of child faeces was highlighted as the reason for the improvement of reported safe disposal.
In addition, the process evaluation showed that intervention aspects such as recruitment, reach, fidelity and satisfaction of each of the community activities could be improved to potentially achieve greater impact. For instance, the mothers’ group meetings were often attended by other caregivers, who might not have conveyed the importance of safe child faeces disposal to the mothers.
Type of impact: Inform the design of other programmes
Where findings from the evaluation or review inform the design of a programme(s) other than the one(s) evaluated.
This is one of 3ie’s seven types of evidence use. Impact types are based on what we find in the monitoring data for an evaluation or review. Due to the nature of evidence-informed decision-making and action, 3ie looks for verifiable contributions that our evidence makes, not attribution.
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The evaluation findings – particularly qualitative findings that related to the caregivers’ management of child faeces and their participation in Sundara Grama mothers’ group meetings – informed the intervention design process and theory of change for a new project led by the Odisha-based NGO, Gram Vikas. For instance, according to the project partners, the Sundara Grama evaluation’s findings helped them decide the hardware selection approach – user-centred design – to pilot test.
The new project focuses on safe CFM, and researchers from Emory University are working with Gram Vikas to design, implement and evaluate the intervention in 80 villages in Ganjam and Gajapati districts of Odisha. The project includes 4 phases over a 24-month period, during which the study team and implementing agency will develop and test novel CFM hardware; design and test behaviour change strategies for CFM; deliver the finalised intervention; and evaluate the effect of the intervention on CFM practices, faecal exposure pathways and gender.
International Initiative for Impact Evaluation (3ie), 2020. Informing interventions to improve WASH behaviours in Odisha, India [online summary], Evidence Impact Summaries. New Delhi: 3ie.
Evidence impact summaries aim to demonstrate and encourage the use of evidence to inform programming and policymaking. These reflect the information available to 3ie at the time of posting. Since several factors influence policymaking, the summaries highlight contributions of evidence rather than endorsing a policy or decision or claiming that it can be attributed solely to evidence. If you have any suggestions or updates to improve this summary, please write to email@example.com