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. 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.

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. 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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Global Situation

Two and a half billion people live without access to improved sanitation and hygiene facilities resulting in 15% of the world population defecating in the open. Open defecation perpetuates a vicious cycle of disease and poverty making sanitation and hygiene among the most important drivers of health, social and economic environments.

Many countries have accomplished great progress in tackling the issue. Vietnam and Bangladesh virtually stamped out the practice entirely by 2012. This led to a decrease in the global number from 1.3 billion in 1990 to 1 billion today. 90% of people who live in rural areas still defecate in the open. The practice is on the rise in 26 countries in Sub-Saharan Africa, where open defecation has risen from 23 million in 1990 to 39 million in 2012.

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National Situation

India is the capital of open defecation, accounting for 59% of the practice in the world. The practice has been widely accepted for generations, becoming a well-established tradition deeply ingrained from early childhood and is almost an accepted part of the Indian landscape. OD is rampant in rural India where it is practiced by nearly 70% of the rural population.

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Explaining the Situation

India is considered an outlier with regards to open defecation, as common development indicators do not explain the widespread phenomenon:
  • Not Poverty/GDP
  • Not illiteracy
  • Not lack of water

There are many factors affecting rural sanitation behaviours, the most salient of which are social norms, customs and traditions around open defection. Other important factors include perceptions of latrine affordability, access and availability of functioning latrines, sanitation products and services.

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