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Marketing sanitation
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The unhygienic practice of open defecation leads to contamination of water sources and high incidence of disease. AVIK GHOSH reports on a successful mission in West Bengal that led villagers to adopt sanitary toilets.
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THE date of the wedding was settled and both parties looked pleased as the bride-to-be served tea. She whispers to her father. The father nods and puts a last question "Is there a sanitary toilet in your house?" The groom's father and the bridegroom look sheepish and shake their heads. The bride-to-be is pained and disappointed. The father of the groom hastens to give the assurance that the sanitary toilet will be constructed before the wedding.
Thus ends a TV spot put out by the Department of Panchayat and Rural Development, Government of West Bengal. Today, in rural West Bengal, the aspiration of a young bride to be married into a household with a sanitary toilet is not at all unrealistic. Thanks to the effort of the Government of West Bengal in collaboration with Unicef, the unhygienic practice of open defecation is gradually coming down and the toilet is a necessary feature of most households, even relatively poor ones. How did this dramatic change in accepted social behaviour come about?
Since the 1980s, there has been an accelerated effort to provide drinking water and sanitation facilities in rural areas. According to latest all-India figures over 87 per cent of rural habitations have access to a safe and clean drinking water source. However, coverage of rural household by sanitary toilets is less than 20 per cent. Consequently, incidence of sickness due to water-borne diseases remains high through contamination of drinking water sources due to open defecation, unsafe disposal of child's stools and poor water-handling practices. The initial efforts of the Government to introduce sanitary latrines in rural households, during mid-1980s and early 1990s, were characterised by certain limiting factors. The programme did not appropriately address the community's resistance to opt for toilets as an alternative to open defecation. The programme offered relatively expensive toilets with a pucca superstructure — heavily subsidised for the poorer families — and these were evidently out of place in the rural community. The government programme did not encourage others to build individual household latrines. In any event, except the well to do, very few had toilets at home and open defecation was the accepted social practice. There were also space constraints and apprehensions about pollution and odour within the home. The toilets supplied to the poorer households were not much used. The story goes that poor families would use the well-constructed toilet (probably the most secure structure in the home) as a store or a shelter for domestic animals!
The Government of West Bengal, supported by UNICEF, initiated the Rural Sanitation Programme (RSP) in Medinipur district in 1990. Medinipur is a large district with a population of about eight million (about one-eighth of West Bengal's population) and in 1991, only 4.74 per cent of the population had access to a sanitary toilet.
Working on the premise that there existed a demand for toilets, albeit latent, a demand responsive strategy was conceived to achieve the objectives. The key communication strategy was to ensure that latent desire for a toilet got converted to an expressed demand for an affordable product. A range of toilet models — from the least expensive ones with just one pit and squatting plate and water-seal to the more expensive ones complete with a brick-lined superstructure and roof — at differential rates was designed to cater to the users. Interestingly, the less expensive toilets could be upgraded at a later stage without much additional cost or difficulty.
The cornerstone of the programme has been the Rural Sanitary Mart (RSM) located at the block level. The RSM is a retail outlet located at the block level. It has a sale counter as well as a production centre where toilets are manufactured. The RSM is staffed by two Mart Managers, two Chief Motivators with a network of motivators located at the Gram Sansad (electoral booth) level (one for each Gram Sansad or about 100-150 households) and two or three Head masons with a group of masons. The sustenance of the RSM depends on its commercial performance. If that can be done, general health status and overall environmental condition of the villages in the area is expected to improve considerably.
The RSM is accessible to all Gram Panchayats in the block. If the households are not fully motivated to adopt a toilet they can be mobilised (through the network of motivators) to adopt a toilet. For every order placed on the RSM the motivator gets Rs. 20. This "social marketing" approach is the crucial significance of the RSM.
The Ramakrishna Mission Lok Shiksha Parishad (RKMLSP) a reputed non governmental organisation of the State was assigned the task of programme implementation. The RKMLSP supports the RSMs at the block level with the help of 16 Cluster Level Organisations (each managing 4-5 blocks or RSMs) and 1000 Youth Clubs at the village level. The Youth Clubs, according to their geographical locations, are affiliated to the respective Cluster Level Organisations and are entrusted to propagate the programme at the grassroots. The coverage of households by sanitary toilets in the district has increased to 45 per cent by 2001 (from 4.74 per cent in 1991).
The observations of Chandi Dey of RKMLSP, the key person spearheading the NGO support to the successful Medinipur Sanitation programme, are important. He explained that motivating villagers to build household latrines is done in two parts - one week of environment building activities throughout the district by means of various local/folk media and hoardings, "miking"', posters supported by the mass media (TV spots and others initiated by the State Government) and later personal contact through house to house visits by volunteer motivators or group meetings at Gram Sansad level. He also mentioned that social mobilisation is most successful when those who have installed latrines become motivators themselves. His experience has been, on an average, it takes about five house visits to get an order placement.
In March 2001, Nandigram II Block of Medinipur District claimed to have achieved full toilet coverage in the entire block. A team from the State Institute of Panchayat and Rural Development (SIPRD) conducted a random sample survey (drawn from seven Gram Panchayats) in September 2001 and 1,741 sample houses were visited and all houses had sanitary latrines. As a result of the successful implementation of the programme in Nandigram II block, the general cleanliness and overall environmental condition of the villages have improved considerably in comparison with neighbouring blocks. As a direct impact, since 1999, there has been no f diarrhoeal death in Nandigram II and the incidence of diarrhoea is also reducing gradually. While there were 415 cases of diarrhoea reported for out patient treatment in 1999, the figure had gone down to 264 by 2001.There are 91 primary schools in Nandigram II Block. Perhaps, it is the only block where every Primary School has a toilet block and tube wells constructed under the School Sanitation Programme. The surroundings of the school are no longer dirty with excreta and odour of urine.
In Medinipur district, over 4,00,000 individual household latrines have been built in the last decade and most districts in the State have adopted this very successful model of `social marketing' based on identifying a felt-need and an effective communication effort supported by efficient service delivery.
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