Creating demand in public health

Social & behaviour change communication case study: open defecation in India

  • Public health programmes and interventions often focus on the supply side, such as providing equipment and infrastructure
  • To achieve sustainable improvements in health outcomes, we must also create demand for the new services
  • Open defecation in India as an important case study. Investment in building toilets has not significantly reduced the practice
  • Social and behaviour change communication can effectively increase demand for sanitation

This report demonstrates how behaviour change communications is key to improving public health in developing countries. Whilst building infrastructure and services is critical, there is also a need to change social and behavioural norms to create the demand for public health services.

In the case of open defecation in India, the supply-led approach of building latrines has failed to significantly reduce the practice. In October 2014, the Prime Minister of India launched a new Clean India Mission to focus on social and behaviour change to increase demand for and use of these latrines, alongside improving sanitation infrastructure.

Taking open defecation in India as a case study, this report is based on field work and qualitative research as well as desk research, and illustrates how behaviour change communications approaches can be used to tackle an ingrained public health challenge. The structure is inspired by both UNICEF’s guidelines on writing a communications strategy for development programmes and the proprietary tools used by Thompson Social | J. Walter Thompson for strategy development.

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