Explaining the outcomes of the 'Clean India' campaign: institutional behaviour and sanitation transformation in India

Abstract

IntroductionMany less developed countries are struggling to provide universal access to safe sanitation, but in the past 5 years India has almost reached its target of eliminating open defaecation.ObjectiveTo understand how the Indian government effected this sanitation transformation.MethodsThe study employed interviews with 17 actors in the government’s ‘Clean India’ programme across the national capital and four states, which were analysed using a theory of change grounded in Behaviour Centred Design.ResultsThe Swachh Bharat Mission (Gramin) claims to have improved the coverage of toilets in rural India from 39% to over 95% of households between 2014 and mid-2019. From interviews with relevant actors we constructed a theory of change for the programme, in which high-level political support and disruptive leadership changed environments in districts, which led to psychological changes in district officials. This, in turn, led to changed behaviour for sanitation programming. The prime minister set an ambitious goal of eliminating open defaecation by the 150th birthday of Mahatma Gandhi (October 2019). This galvanised government bureaucracy, while early success in 100 flagship districts reduced the scepticism of government employees, a cadre of 500 young professionals placed in districts imparted new ideas and energy, social and mass media were used to inform and motivate the public, and new norms of ethical behaviour were demonstrated by leaders. As a result, district officials became emotionally involved in the programme and felt pride at their achievement in ridding villages of open defaecation.ConclusionsThough many challenges remain, governments seeking to achieve the sustainable development goal of universal access to safe sanitation can emulate the success of India’s Swachh Bharat Mission.

Evaluating the declarations of open defecation free status under the Swachh Bharat (‘Clean India’) Mission: repeated cross-sectional surveys in Rajasthan, India

“…This percentage decreased over the four rounds to 18.4% of households in July 2018. Effort has been made by SBM to support behaviour change through mass training programs and local innovation 36. Despite the progress, these toilet usage rates have stagnated similarly to previous sanitation campaigns.…”

Cluster-randomised trial to test the effect of a behaviour change intervention on toilet use in rural India: results and methodological considerations

“…In 2014, through the launch of Swachh Bharat Mission-Gramin (SBM-G), the pace of toilet construction has increased [9]. Current strategies include a decentralised approach to improving sanitation coverage and use, by augmenting the capacity of state governments to undertake behaviour change activities and incentivizing government performance [10]. SBM-G focuses on mass media campaigns and village level events to address people's toilet use behaviour [9].…”

How to set up government-led national hygiene communication campaigns to combat COVID-19: a strategic blueprint

“…Here, we set out 10 essential steps in the development of a national communications strategy (box 1) to aid rapid, but strategic, thinking on designing pandemic communication campaigns. In providing this guidance, we draw on the experience of multiple national campaigns on hygiene in domestic settings in low-income countries [4][5][6][7] and a widely used framework for understanding and changing behaviour known as behaviour-centred design (BCD). BCD provides a generic but theory-based process for designing behaviour change programming.…”

“…An example is the Swaach Bharat Mission which successfully transformed sanitation provision across India by using a task-force, results-oriented, approach; co-opting young, energetic staff to mobilise activity within the bureaucracy of a busy line Ministry. 6 Step 2. Mobilise resources, including from the private sector Financial and human resources are being mobilised globally towards COVID-19 prevention.…”

“…The chosen national focal person will need technical experience in communications, marketing, cross-sectoral coordination and public health, and combine this with personal qualities of energy, persistence, open-mindedness, a problem-solving focus, communications and networking skills and motivational leadership. 6 Her/his role is to assure a joined-up approach to national communications across all channels and by all partners (as far as is possible in an emergency). He or she may be seated in the Ministry of Health (MoH) but must coordinate across the full range of ministries and cabinet offices that contribute to the response.…”