Sustained focus, behaviour change needed to make people use new toilets: study

The last five years have seen a sharp surge in toilet building, owing to the Centre’s Swachh Bharat Mission (SBM). But for people to reap benefits by actually using those toilets, a sustained focus and investment in behaviour change programme is needed, according to a recent study. 

Adding a behaviour change component to sanitation programmes can motivate and incentivise people to use toilets, the study conducted in rural Bihar, Gujarat, Karnataka and Odisha between 2017 and 2019, found. 

Four teams supported by International Initiative for Impact Evaluation (3ie) fanned out in these states with a set of interventions such as community action planning, toilet makeovers, household visits, motivational posters, folk dance performances, etc and divided groups into control areas and treatment areas (where intervention was done).

The intervention was designed to identify barriers to toilet use and was directed at correcting the underlying biases, thus promoting the development of intent to use; and including simple aids to help convert the positive intent to habitual use. 

For instance, in Karnataka, while there was a bump of a little over 20 per cent in people using toilets in groups where behavioural intervention was done, the increase was 15 per cent in control groups. 

The exercise emphasised that while physical barriers like poor toilet design or lack of water are important, the focus should also be on barriers amenable to correction using a behavioural intervention.

People’s reasons for not using toilets varied across states. For example, concerns about latrine pit emptying in these states meant that toilets are only partially used. Teams found anxiety among people around pit filling and emptying that led to low usage of toilets. 

However, after intervention, treatment areas showed an increase in knowledge on correct pit filling rates, and decomposition rates, as well as an increase in the perceived convenience of pit emptying. Most households, however, still reported relying on hiring someone for pit emptying and not always waiting till decomposition was complete. 

In most states, the preference for open defecation continues to be a common reason for not using the toilet, according to the findings. 

People reported feeling claustrophobic while using a toilet and said it was not a comfortable experience, said Kavita Chauhan from the London School of Hygiene and Tropical Medicine, who along with her team worked in Gujarat in 94 randomly-selected village clusters. 

“We asked a key question to ourselves about why those who have functional toilets are not using them,” said Shruti Viswanathan, governance specialist, Oxford Policy Management, who along with her colleagues conducted the intervention across six districts of rural Bihar. 

Some of the reasons the team found out ranged from no intent to conceptions around which gender is supposed to use the toilet, anxiety about toilet repairs, to no trigger or nudge to habitual use. 

After intervention, a significant increase in toilet use was observed. In the end line period, around 83 per cent of households in the study population reported that all adult members usually use the latrine, compared to 52.5 per cent in the baseline period.

Similarly, the share of households reporting that all members used the latrine the last time they defecated also increased from 67 per cent to 82.5 per cent. 

Similarly, in Karnataka, the study was carried out in northern Raichur district that has poor development indicators. 

The campaign aimed at changing the drivers and barriers of latrine use in the target population by using the risks, attitudes, norms, abilities and self-regulation or RANAS approach to tailor the interventions to the actual mind-set of the target population.

The campaign triggered a statistically significant increase in latrine use by approximately five per cent to almost 100 per cent at end line. 

In Gujarat, the team tried to break the idea of toilets being ‘disgusting’ by demonstrating to the public different toilet models around the world and asking them to rate their own toilets based on a five star rating system. 

In Odisha, latrine use behaviour changed in the research area overall, but increased 6.3 per cent more in the intervention area. 

“Since 2014, the Swachh Bharat Mission has made rapid strides in addressing this complex development challenge. Our studies show that while there is a lot for us to celebrate, there needs to be continued investment in behaviour change programmes that promote the consistent and sustained use of the toilet as well as the safe disposal of child faeces,” said Marie Gaarder, director, Evaluation Office and Global Director of Innovation and Country Engagement at 3ie.

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