Theory-driven formative research to inform the design of a national sanitation campaign in Tanzania

Czerniewska, Alexandra; Muangi, Winnie C.; Aunger, Robert; Massa, Khalid; Curtis, Val

doi:10.1371/journal.pone.0221445

Cited by 16 publications

(20 citation statements)

References 43 publications

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“…India is one country among many in which modernisation is proceeding rapidly. Tusting et al show that housing is improving across sub-Saharan Africa,58 and our research in Tanzania suggests that toilet promotion can be linked to this process of modernisation 59. India is also one of many countries in the global south with political leaders with ambitions for transformation, as was demonstrated when 53 government delegations attended a summit on SBM held in Delhi in October 2018.…”

Section: Discussionmentioning

confidence: 50%

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

Curtis

2019

BMJ Glob Health

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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.

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Section: Discussionmentioning

confidence: 50%

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

Curtis

2019

BMJ Glob Health

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“…Looking at the context in which SBM achieved what it did, it may be asked how far is India a special case, and how transferable are the results to other countries? India is one among many countries in which modernisation is proceeding rapidly, Tusting et al show that housing is improving across sub-Saharan Africa 58 , and our research in Tanzania suggests that toilet promotion can be linked to this process of modernisation 59 . India is also one of many countries in the Global South with political leaders with transformative ambitions, as was demonstrated when 53 government delegations attended a summit on SBM held in Delhi in October of 2018.…”

Section: Discussionmentioning

confidence: 54%

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

Curtis

2019

Preprint

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Introduction: Whilst many less developed countries are struggling to provide universal access to safe sanitation, in the last five years India has almost reached its target of eliminating open defaecation. The object of this study was to understand how the Indian Government effected this sanitation transformation. Methods: The study employed interviews with 17 actors in the Governments Clean India programme across the national capital and four states which were analysed using a theory of change grounded in Behaviour Centred Design. Results: The 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, which, in turn, led to changed behaviour concerning sanitation programming. The Prime Ministers setting of the ambitious goal to eliminate open defecation by the 150th birthday of Mahatma Gandhi (October 2019) 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 was used to engage and motivate the public and key players, and new norms of ethical behaviour were demonstrated by leaders. As a result, district officials engaged emotionally with the programme and felt pride at their achievements in ridding villages of open defecation. Conclusions: Though many challenges remain, Governments seeking to achieve the Sustainable Development Goal of universal access to safe sanitation can emulate the success of Indias Swachh Bharat Mission.

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“…Rural laborers usually work in more developed cities and have experience using flush toilets in cities, which gives them more willingness to use flush toilets after returning to rural areas. Existing research has confirmed that visiting better latrines elsewhere was a commonly reported reason for improving latrines 27 . In addition, we also included some characteristics that reflect the role of individual demonstration, such as whether the interviewees are village cadres.…”

Section: Variable Selectionmentioning

confidence: 96%

Correlation between general health knowledge and sanitation improvements: evidence from rural China

2021

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A lack of access to sanitation not only has negative effects on the environment but also results in increased prevalence of disease and adversely affects health outcomes. This paper uses data from a survey in Liaoning Province in China to examine the relationship between general health knowledge and improved sanitation facility access. It also explores the effects of work experience and government subsidies on toilet renovation. Using Logit Regression and Duration Analysis, our results show that general health knowledge had a significant positive correlation with flush toilet use and a significant negative correlation with the average duration of traditional latrine pits use. The results of heterogeneity analysis show that work experience in cities can expand farmers’ horizons, which increases their general health knowledge. However, per capita government subsidies are insufficient and result in no significant impact on general health knowledge. This paper also discusses certain restrictions that prevent general health knowledge from having an effect on toilet renovation. The article finally proposes policy recommendations for rural areas in China to better promote the rural toilet revolution and our results can also provide useful guidelines for drawing up relevant policies in other developing countries.

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Theory-driven formative research to inform the design of a national sanitation campaign in Tanzania

Cited by 16 publications

References 43 publications

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

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

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

Correlation between general health knowledge and sanitation improvements: evidence from rural China

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