Field Note F i ~~~~~ ~~~23773l March 2000 Water and Sanitation Program An international partnership to help the poor gain sustained Marketing Sanitation access to improved water supply and sanitation services In Rura IndIa ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~....... ....._ _,_... South Asia Region ? 2 SUMMARY WaterAid-India's rural sani- i' ; tation program was making slow progress in 1995-96. A lack __ - of demand from households I' meant that partner NGOs had constructed only 460 out of 1,100_ latrines planned for the 12-month -__ period. WaterAid-India decided that it was time to reformulate its _7 J -1 L - r L strategy and focus on marketing sanitation. As a result of this change in approach, by the first six months of 1997-98, partner 4 NGOs had achieved a dramatic _ turnaround in demand and 1U- - constructed 5,000 latrines but ! were still unable to meet the spiraling demand from rural* households in their project areas. . This case study examines how ',I I - WaterAid-india stimulated the . demand for sanitation through social marketing and hygiene promotion. I g,0EF' < ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~~~~9 PR,, 1 ) In India, the Water and Sanitation certain parts of the southern and central Hygiene and Program-South Asia is working States. An estimated 1,000,000 people towards the adoption of significant in rural India could potentially be bene- Sanitation in institutional and financial reforms, in fited by WaterAid-India's project activities order to ensure that the poor through projects with around 100 local Rural India are explicitly recognized as valid partner NGOs. customers and that they have increased access to self-sustained water and Personal hygiene includes behavior sanitation systems, across the country. The A latrine provides the 'primary such as hand-washing with soap or Program generates and disseminates ash after defecation and before contact knowledge in the sector through barrier' against the spread of with food, but at a wider level includes workshops, study tours, studies and fecal matter, the source of most safe water collection, storage and documenting innovative experiences. handling. There are many possible This case study, written by the Water diarrhoeal pathogens, in the definitions for sanitation. According to and Sanitation Program-South Asia, environment. This barrier is easily DFID (1998), sanitation refers to safe indicates the importance of effective social management of human excreta and marketing and hygiene promotion in breached by a dirty latrine or if includes both the "hardware" (for getting people to invest in sanitation hand-washing after use does not example, latrines) and the "software" (for improvements. It is based on the example, hygiene promotion) needed to experience of WaterAid, an independent become normal practice. reduce fecal-oral disease. Environmental charity working with people in 13 main Source: DFID (1998) sanitation is a broader term, which countries in Africa and Asia, to improve encompasses excreta disposal, solid waste their quality of life through lasting management, wastewater disposal, vector improvements to water, sanitation and control and drainage, in addition to the hygiene, using local skills and practical INDIA FACT FILE activities covered by the definition technologies. In India, WaterAid supports of sanitation. integrated water, sanitation and hygiene BASIC INDICATORS Sanitation coverage is usually defined promotion projects with NGO partners in Total population in terms of the percentage of households having access to a sanitary latrine. In 982,223,000 India, despite concerted attempts by the Case Study Population under15 central Government, total sanitation coverage stands at 14 per cent of rural Locations 115,615,000 households. However, research shows that many of these latrines are not being used MORTALITY for their intended purpose. Under-5 mortality rate rt Hand-washing with soap and 105 (per 1,000 live births) ,,-4 Annual no. of under-5 deaths water after contact with fecal \~~/ < {.2-S ~~,{4 Annual no. of under-5 deaths , '9 .~Jrq; _ s 2,590,000 material can reduce diarrhoeal INDIA W AN disease by 35 per cent or more. t ,> \ ~~~~~WATER AND SANITATION t1 Using a pit latrine and % of rural population with access disposing of children's feces in it to safe water: 79 \ 'J gAndhra Pradesh can reduce diarrhoea incidence \ \S4 Hamsanpalli % of rural population with access \ (< by 36 per cent or more. * 1 Tamil Nadu to safe sanitation: 14 \~ Tiruchchirapalli Source: http://www.uniceforg/stotis Source: Esrey et al. 1990 Obstacles Demand Creation widespread adoption of safe hygiene practices. This move from hygiene to Progress through Hygiene education to hygiene promotion required the following steps: Prom otion a identifying what the hygiene In 1996, WaterAid-lndia identified behavior problems were; J two major obstacles to increasing Many hygieneIeducationxprograms identifying behavior that brings sanitation in rural India: M h about the greatest improved health return, i lack of demand - people do not see ' focus on passing on health for example, life-saving behavior such as the need or feel a desire for sanitation; messages In the hope that just because hand-washing after defecation and before and people know about disease and the cause contact with food; a the Government's promotion of a of disease, they will do something about a developing key messages that single high specification design with a it. As WaterAid's understanding of the discourage poor practices and encourage high construction subsidy. subject developed through experience, it good practices; To tackle these problems, WaterAid- decided that education alone was clearly a developing effective techniques of India and its partners developed an not enough. WaterAid-India and its delivering these messages to the right approach focused on demand creation, partners decided to move to health target audience; social marketing, providing access to promotion which is defined by Curtis and a supporting these key messages with credit and developing a reliable supply Kanki (1998) as a planned approach to social and structural changes, for of sanitation goods and services. preventing diarrhoeal disease through the example, promoting latrine construction A Convinced Child; A Committed Advocate v w e~ The Society for Community Organization and People's r Education (SCOPE) generates demand faster and provides greater latrine coverage in villages with a school health education program compared to villages where there is no such program in the local village school. Al. SCOPE runs school health programs in 30 village schools in Tamil Nadu State and has plans to extend this to another 20 schools by the end of 2000. Their experience L%P has been that "a convinced child is a committed _ t w ~~~~~~~~~~~advocate" of improved sanitation behavior. The impact of the school hygiene education program is not limited to the school children, but affects the wider community as well, because children influence the hygiene behavior _f t --, of their families, peers and neighbors. 'I ' /^ N . = ' Mahalaxmi, a 1 0-year-old student in the fifth grade, tried , / } | - 'ti . . E to convince her parents to construct a latrine after learning about the fecal-oral transmission route at school. Surprisingly, her mother was the hardest to convince out of her whole family. But once she had the support of her older brothers, the family decided to construct a latrine. I I E X ^Now the whole family has changed from their previous proctice of open defecation in the fields and uses the 2 - --< ], X family latrine. in schools to reinforce the use of latrines by school children (see Case Study 1). a promoting the use of existing Creating Demand by Highlighting latrines for their intended purpose; and m drawing on the lessons learned to the Benefits of Sanitation continually innovate and develop the program, for example, an evaluation showed that in one particular area with Research in Environment, Education and Development Society (REEDS), 100 per cent latrine coverage, only 37 an NGO working in the Mahabubnagar district in Andhra Pradesh, per cent of men were using household latrines. This prompted the development started receiving support from WaterAid-India in May 1997. of a more gender-balanced approach to group formation and health promotion. REEDS appointed female health workers to work in six villages in the In addition, WaterAid-India provided district.These health workers identified the hygiene behavior problems the necessary resources, in terms of staff, skillecesand funding es, n partner staff, and disseminated key messages to their target groups to discourage skills and funding, to NGO partner staff to implement hygiene promotion activities. poor practices and encourage good practices. They also assisted the WaterAid-India also believes that it is women in these villages to organize themselves into self-help groups. very important to motivate people to chane ipoortantto hygien te practs by Two women from each of these self-help groups represented the group change poor hygiene practices by providing the proper incentives and at a village-level network of self-help groups. In turn, two representatives products. This can be done through from the village-level network shared information about the marketing the "non-health" benefits of sanitation and providing products across development activities in the village, including the problems and a range of prices. solutions with a cluster of villages, grouped together both for development and revenue purposes, called a Mandal. This Mandal network provided a forum from which to disseminate key life-saving messages from professionals, for example, doctors, community health supervisors, midwives, etc. These messages filtered down to the village- level networks and further down to self-help group level. * Z - - has approximately 14 per cent coverage. There were previously no latrines in either of these villages. * ; -, *r Social M arketing production centers. Small non-profit a Safety - encounters with snakes, independent retail operations were also insects, vehicles and vegetation are set up to take orders for latrines from common. Examples include the death of Partner NGO staff and WaterAid- customers and promote other sanitation a 1 2-year-old girl from snakebite and a India decided to borrow from goods(seeCaseStudy3).Working latrine 48-year-old man killed by a bus while commercial marketing strategies to models were also constructed and used defecating by the roadside; increase latrine uptake among rural by village health motivators to n Status/Prestige - a household households. This involved giving careful demonstrate that the technology was latrine is a symbol of progress and consideration to and making use of the simple and was not dirty and smelly as material wealth. WaterAid-India has "four Ps" of marketing - product, price, some people imagined. anecdotal evidence from its project areas place and promotion. to show that if the poorest households can Promotion be motivated to construct household Product WaterAid-India actively promoted the latrines, the more affluent households The product is a low-cost pour flush non-health benefits of owning a follow suit; pit latrine using material such as ferro- household latrine: rt Cost savings - the recurring cost cement, mud brick and prefabricated C Privacy - lack of privacy during to treat consistent poor health is a wall panels. open defecation is a major issue for considerable drain on household women. A household latrine means that resources. A latrine is a one-off cost that Price women do not have to wait for certain is offset, in the longer term, by the cost A series of latrine designs across a times of day, for example, dawn or dusk, savings on health bills; and range of prices, all of which are cheaper to relieve themselves; this also has health a Income generation - a latrine can than the high specification model implications; be built with a bath extension and the promoted by the centrally sponsored rural rx Convenience - latrines can be wastewater from bathing can be used to sanitation program. constructed next to the house, which is generate income from kitchen gardens. closer than traditional open defecation In one village, several women used the Place areas. Latrines can also be built with bath extra income to pay off the latrine Latrine modelswere puton permanent extension, increasing their utility for construction loan to the village self-help display at locally accessible technology/ women; group. _____- _ w Other promotion activities included -gh, X! i7f . ~~~~~~~~~~~~~~putting up billboards, painting promo- tional messages on the walls of houses and the use of a "sanitation roadshow" w i *;; z| 0 L - health workers touring local villages W^itE;tt\{ gS - *8 q. - in a bullock cart delivering hygiene 1\;8;\t2t; tt / , ,, ,_messages and selling sanitary wares. COST TO WATERAID -INDIA OF A SINGLE LATRINE -g " ;,,>, Item Cost (Rs)' 7 X__ ' i;. Construction subsidy up to 650 I j, . -i .Hygiene promotion 516 T -, r- -~ --I ' Marketing overheads 645 , i * -- and others - * - lotal cost 1,811 Income-generation from kitchen gardens using wastewater from bath extensions to latrines. 1 USS1 =Rs43 Providing W ; Access to Credit ) There is a wide range in the ability I i: to pay for a sanitary latrine even among the rural poor. WaterAid-India . believes that a flat rote subsidy is inappropriate as it fails to differentiate -_ between rich and poor households. It tries l ' to target the largest subsidy at the poorest households, that is, those that have the least ability to pay for a latrine. In contrast, I -P until April 1999, the Government low-cost * _ P. rural sanitation program offered a very high level of fixed rate subsidy. Experience .l i * i _ showed, however, that latrines constructed 1V - - - with high levels of subsidy, as the main - j motivating force, are often unused, converted to other purposes or neglected. WaterAid's partner NGOs work through village-level self-help groups, who are in the best position to know the a financial status of individual households, to provide support (through a mixture of A billboard with hygiene promotion messages. variable rate subsidies and microcredit sanitation projects with zero subsidy; can often be reduced. Microcredit loans schemes) to supplement household however, it recognizes that some financial (with low interest) can also assist contributions for latrine construction. In support is needed in the initial stages to householders with some of the costs. most cases, households utilize support for ensure demand is realized and latrines are Typically, the cost of a latrine and a bath construction to plinth level (that is, for the constructed to an adequate standard. extension (using hollow bricks) will total slab, pan, pit and pit lining). Hygiene promotion activities enjoy Rsl ,500, of which the household WaterAid aims to implement future economies of scale, therefore this line item contribution is Rs 100. Year Total Program % of budget Number of latrines Budget (in $s) Water Sanitation Health Marketing Total constructed promotion and others 1995-96 528,000 82 50 3 10 100 460 1996-97 738,000 67 1 1 8 14 100 1,710 1997-98 787,000 50 16 15 19 100 7,165 1998-99 1,040,000 40 20 21 19 100 9,793 ToW 3,093,000 19,098 Developing Supply Chains Supply Chains for Rural Sanitation Projects ) The effective and reliable supply of a range of goods and services from manufacturers, retailers and skilled The Society for Education, Village Action and Improvement (SEVAI) has created artisans and masons are vital in the rural reliable links between suppliers of raw materials, production centers, sanitary water and sanitation sector. marts, masons and householders in its project area close to Tiruchchirapalli in These goods and services reach the Tamil Nadu. customer through a chain of suppliers. Payments, in whatever form, travel along Rural Technology Center (RTC) the supply chain in the opposite direction. WaterAid-India has supported partner The SEVAI Rural Technology Center is a local center of excellence for design, NGOs over the last four years to build a training and production of sanitation materials. Notable features include: very successful supply chain of raw material providers, small-scale production n procurement of raw materials from local suppliers; centers, retailers and skilled masons :t production center employing locally trained masons, some of whom based on the UNICEF model of Rural are women; Sanitation Marts. These marts are a non- ra a display of 10 low-cost latrine designs ranging from Rs 750* to Rs 2,300, profit independent retail operation that work in conjunction with a nearby including installation and transportation costs. People view the models and place production center. their order at the nearby rural sanitation mart; and Prices are very competitive compared a a fully equipped training facility that is used by WaterAid-India and to the rest of the sanitation goods and other NGOs. services market and the marts also provide customers with credit facilities. Rural Sanitation Mart (RSM) The marts also actively promote other hygiene behavior change by marketing a SEVAI also operates small retail outlets that take orders for latrines, that are wide range of complementary products such rasge soap, toothpasnte,an prot passed onto the technology/production center, and sell consumable materials such as soap, toothpaste, and other cleaning materials. needed in the construction of latrines or other sanitation facilities. Materials are The supply chain is particularly procured in bulk rates and sold cheaper than other retail outlets. But these marts successful because the economic and are not a subsidized service; they recover all their costs and make a small profit social benefits including employment, skill . generation and income, revolve in the target community. The community interest in maintaining a reliable chain of supplies Example Costs RSM Other sustains the program. suppliers Ceramic pan with attached footrest and waterseal Rs 275 Rs 325 For more information, contact the WSP-led global supply Ceramic pan with separate footrests and waterseal Rs 175 Rs 210 chain initiative that aims to Total turnover and profit of SEVAI RTC and RSM determine the nature of private Total turnover from Dec 1996 to Dec 1999 Rs 8,148,000 sector delivery of goods and services in RWSS. Total profit as on Dec 1 999 Rs 622,000 * US $1 = Rs 43 Water and Sanitation Program - South Asia 55 Lodi Estate -- e ; -.. New Delhi 110 003 *," _~= - , > India V s =~ . m Telephone: 011-4690488-89 Telefax: 011-4628250 E-mail: wspsa@worldbank.org Web site: www.wsp.org Other Publications in this Sanitation and Hygiene Safe water handling by school children. Promotion Seres: Co n clI usi ons and options to match household demand; 2. New Approaches to Promoting at installed demonstration models at Sanitation in Rural Bangladesh production centers to show the simplicity 3. Bringing Hygiene Promotion WaterAid-India was successful in and ease of construction; Up-to-date increasing demand for latrines ri provided householders with access among rural householders because it has: to credit for construction of latrines; and r( created an awareness of the cost- a built up reliable and effective links effectiveness of a one-time capital between suppliers, manufacturers investment cost of constructing a latrine and consumers. against the recurrent cost of water and sanitation-related diseases; Lessons for az allocated substantial resources in ,AL Pr je t terms of funds, staff and training into Other Projects hygiene promotion and marketing sanitation; Reduce This initiative was supported by the ' 13 Reduce ~~~~~and redirect subsidy from UK Department for International n realized that knowledge of the cause construction to hygiene promotion and Development (DFID) of disease does not necessarily cause marketing sanitation. people to change their behavior and rt Motivate target communities to adopt better hygiene practices; install latrines by marketing the non-health n stimulated demand among target benefits of sanitation. Water and Sanitation Program is an communities by marketing the "non- ri Provide users with a range of international partnership to help the health" benefits of sanitation; options rather than a single high price poor gain sustained access to improved at developed a range of latrine designs model for latrines. water supply and sanitation services. The Program's main funding partners References are the Governments of Australia, Curtis, V. and Kanki, B (1998). Hygienic, Healthy and Happy: How to set up a hygiene promotion Belgium, Canada, Denmark, Germany, programme. UNICEF, WHO, LSHTM and Ministere de la Sante du Burkina Faso Italy, Japan, Luxembourg, the Esrey, Potash, Roberts and Schiff (1990). Health benefits from improvements in water supply and Netherlands, Norway, Sweden, sanitation: Survey and analysis of the literature on selected diseases, WASH Technical Report No. 66, Switzerland, and the United Kingdom; Washington DC, USA the United Nations Development UK Department for International Development (DFID) (1998). Guidance Manual on Water Supply and Sanitation Programmes. Prepared by WELL, UK Programme, and The World Bank. Photographs by Ajay Paul Created by Write Media e-mail: writemedia@vsnl.com Printed af PS Press Services Pvt. Ltd.