This study evaluates the impact of a behaviourally-informed intervention in increasing the intent and habit of toilet use amongst toilet-owning households in rural Bihar.
Despite the large-scale sanitation subsidy programmes of the last two decades, rates of open defecation (OD) in India remain high compared to other countries with similar socioeconomic characteristics. As of 2015, 52.1 per cent of the Indian rural population was still defecating in the open (Swacchta Status Report 2015). Bihar has among the highest rates of OD, with 70 per cent of people in rural Bihar defecating in the open (Swacchta Status Report 2015). Furthermore, the SQUAT report finds that at least one member continues to openly defecate in 44% of households with a latrine. Given Bihar’s status as the country’s second-most populous state, these figures suggest firstly that progress on eliminating OD in India depends critically on progress made in Bihar, and secondly that progress in Bihar (as elsewhere) will involve bridging the gap between latrine ownership and latrine use.
Developing scalable, cost-effective interventions to bridge this gap by increasing rates of latrine use in rural Bihar therefore emerges as a key input into the success of India’s drive to eliminate OD, and is likely to be influential in informing both state and national government strategy in this area.
The evaluated intervention involved community meetings and follow-up household visits. It used a set of inter-related activities and tools to create and activate intentions to use latrines. The lessons from this study are important in developing solutions to increase the rate of toilet use in rural Bihar, and consequently important in improving sanitation outcomes across the country.
The main outcome of interest of this impact evaluation was toilet use at the individual and household levels. The evaluation also tests the impact of the intervention on knowledge of pit-filling rates, attitude towards, and knowledge about, pit emptying.
The intervention aimed at changing behaviour at both the household and community levels by shifting norms related to the acceptability of open defecation.
The community meeting targeted behavioural barriers such as: overestimation of pit filling rates, unclear rewards to latrine use, and ambiguity around pit decomposition and emptying. The community meetings were supplemented and reinforced by a set of nudges, commitments and pledges during ongoing household-level visits.
Theory of change
This study posits that key barriers to reduced toilet use in rural Bihar revolve around incorrect perceptions around pit filling and anxiety about pit cleaning (tied to caste prejudices). In targeted community meetings and household visits, the team designed behavioural games which aimed at:
- Correct mental models about pit filling.
- Address reasons for latrine aversion.
- Address anxiety about pit emptying.
- Create commitment to use latrine.
The intervention designs assumes implementation fidelity, i.e, ability of the implementing agency to deliver the intervention as planned. The intervention also does not tackle supply side barriers to toilet use (i.e, toilet design, water table, etc). The assumption in the theory of change was that these ‘nudges’ would be sufficient to overcome other barriers to toilet use.
The eligible population for the study were households that have functional latrines (defined by having a twin-pit, pan, and pipe connecting the two). The team found this targeting strategy to be appropriate because it focused on a target population likely to be affected by the intervention but who (as owners of twin-pit latrines) were broadly representative of the broader population among whom this intervention would need to be scaled.
The study was conducted in six districts in Bihar where WVI operates.
The study found significantly high improvements in toilet use. At baseline, around 48 per cent of households in the survey sample were open defecation free. At endline, this figure increased to over 80 per cent. While at baseline over 60 per cent of individuals in the sample were usually using a toilet, this increased to over 90 per cent at the endline. This increase was largely similar across intervention and control areas, suggesting that the increase was not the result of the intervention.
Despite the significant increases in toilet use, the study found limited change in intermediate outcomes i.e knowledge and attitudes around pit-filling and pit emptying. A majority of households continued to mis-estimate rates of pit filling; and perceived pit emptying as inconvenient. However, that households in the intervention areas were six percentage points more likely to correctly estimate the pit-filling rate than their control counterparts. Additionally, while the number of people underestimating the amount of time taken for pits to fill increased in control areas, this number fell substantially in the intervention areas from 43 to 23 per cent.
The study findings suggest that the Swattch Bharat Mission (SBM) and a range of other activities related to behaviour change in Bihar have significantly increased the use of twin-pit toilets, constructed under the SBM. Despite this, sustainability of toilet use is a concern, given the persisting underlying misconceptions around pit filling, and a lack of awareness about the process of decomposition – outcomes which the intervention was able to influence to a certain extent.
Implications for implementers, policy and practice: Construction of toilet pits and inconsistency in type and size presents a challenge for implementers, making it difficult to tailor standardised messaging around pit filling. Providing adequate information to ensure conversion of faecal matter to non-pathogenic decomposed matter and framing the sanitation issues around social attitudes and behaviours would be necessary to promote self-emptying and to avoid further entrenchment of caste-based pit emptying.
Implications for further research: This study provides support to the evidence around aversion to pit-emptying and deeply entrenched notions of caste, purity and pollution. This highlights the importance of treating sanitation as a social issue, and not merely as one related to access and toilet use behaviours.
As part of this study, the team held a state-level workshop to discuss future themes for sanitation attended by government officials, practitioners and researchers. These discussions will help influence the conversation on upcoming sanitation programming and policy.
Presentation on the endline findings will be uploaded on the project web page once the final report is approved