Sector Wide Approach to Strengthening Health ( SWASTH )

Bihar Technical Assistance Support Team (BTAST)
Government of Bihar initiative supported by Department for International Development, UK


Making villages open defecation free in Bihar: A matter of effort and will

Even for a small village like Rampur in Bihar, which houses about 35 families, it takes multi-pronged efforts to achieve ODF status.

PARAS Nath Ojha wakes up as early as four in the morning to keep tight vigil in Rampur village, Buxar, along with a small contingent of villagers armed with whistles and torches. What they do in
the early mornings and also late evenings is very unusual. They stand vigil not against any law breakers, but against those who defecate in the open. Ojha heads the Nigrani Samiti (Vigilance Committee) in Rampur - a village that is populated by 35 families.
Prabhat Pheris or morning walkabouts by the Nigrani Samitis, rallies by school children and local people are being organised by Panchayats to impress upon local communities to stop defecating in the open and about the benefits of owning and using a toilet. Thanks to the active participation of the Nigrani Samiti, the Mukhiya (headman) of the village, the Gram Sabha and its several villagers, today Rampur is open defecation free (ODF). On the 21st of December the village panchayat assessed and declared itself as ODF, which is being verified by the district and state authorities.
Open defecation is widespread in Bihar as it is in many other Indian states. According to the 2011 Census, over 75% of the population in Bihar defecates in the open. The Community Led Total Sanitation (CLTS) approach encouraged by several non-governmental agencies, and supported by the Government of Bihar and most importantly adopted by Gram Panchayats  has now triggered a collective behaviour change in local communities. Many other villages like Rampur are progressing steadily to become ODF villages. 
The daunting task of making Rampur ODF was achieved through CLTS, wherein the community is at the centre of the sanitation campaign, and drives it to its success. Gram Panchayat leaders play a crucial role on a daily basis along with government officials in dissuading fellow villagers from defecating in the open. Out of a total of seven villages that comprise Umarpur Panchayat, Rampur is the third village that has become ODF as a result of the community actively taking responsibility for bringing about the change.
Rampur clearly is a good example of how diffusion of messages and positive deviance can encourage change. Shiv Mali, Up-Pradhan (Deputy Village Head) of Umarpur Panchayat, reports that residents of Rampur decided to make their village ODF, when they saw villages of Ahrauli Panchayat located close-by become ODF. In one of their Gram Sabha meetings, they undertook to achieve this status. “We made people swear in the name of sacred river Ganga to ensure that people collectively participate in the ODF process,” he says. 
Vijay Paswan, Mukhiya, confides that media reports on nearby villages being declared ODF came as a big boost in convincing the local people. “But addressing the issue of ‘missing toilets’ (i.e. those where incentives had been released but construction was never done) are still a challenge for us. Also many toilets constructed under previous schemes are not usable now. And unfortunately there is no provision of providing funding to people who own such toilets, to construct new ones.” he says.
The CLTS approach has encouraged neighbouring villages also to raise demand for toilets. Communities are now actively asking for toilets, instead of the government thrusting the construction of facilities on them. Brij Kishore Upadhyay, Mukhiya of the nearby Ahrauli Panchayat, who earned accolades for his efforts for making villages ODF villages, says, “Although people are now raising the demand for toilets, it is still not easy to change their behaviour.” This is the real challenge that most villages face as many in the past had continued with open defecation, despite having toilets at home.
Shri Niwas Ojha, a retired government servant and former Mukhiya, however, feels that the case of Rampur therefore is exemplary as it had the complete backing of the Panchayat members and several other villagers who were keen to see the change happen. He feels that the motivation for that was triggered through the CLTS approach, and the financial support from the government catalyzed the movement in the village. “It could not be achieved without active participation of all the villagers. If it were not for the community mobilisation, Swachh Bharat Mission-Gramin (SBM-G) would have failed to achieve the desired success. Many Panchayat members have visited individual families to counsel them and discourage open defecation. SBM-G was preceded by other ambitious schemes such as Central Rural Sanitation Programme (CRSP) and Total Sanitation Campaign (TSC), which was later renamed as Nirmal Bharat Abhiyan (NBA).
Despite these multiple efforts, the pace of the sanitation programme has remained sluggish in the state for a long time. DFID supported Bihar Technical Assistance Support Team (BTAST) in partnership with the Public Health and Engineering Department (PHED) and in agreement with the Bihar State Water & Sanitation Mission (BSWSM) signed a Memorandum of Understanding (MoU) with a non-profit organisation - Action for Community Empowerment (ACE) - to accelerate the implementation of SBM-G in project blocks through the use of participatory CLTS approach.
Despite these multiple efforts, the pace of the sanitation programme has remained sluggish in the state for a long time. DFID supported Bihar Technical Assistance Support Team (BTAST) in partnership with the Public Health and Engineering Department (PHED) and in agreement with the Bihar State Water & Sanitation Mission (BSWSM) signed a Memorandum of Understanding (MoU) with a non-profit organisation - Action for Community Empowerment (ACE) - to accelerate the implementation of SBM-G in project blocks through the use of participatory CLTS approach.
Krishna Kumar, Project Manager, ACE, Buxar, says that unlike other programmes the focus of SBM-G is on community sensitisation and mass mobilisation. He says, “Earlier, the focus was on construction of toilets but the supply-driven approach failed because very little attention was given to community awareness and preferences. He adds how ‘triggering’ – a tool used in the CLTS approach – almost shocks the community into taking appropriate action by demonstrating how flies contaminate food and how in effect people then eat each other’s waste. Other activities like the ‘walk of shame’ involve taking the community to areas where open defecation takes place frequently and encouraging a feeling of disgust amongst them about the practice. ODF status is said to have been achieved only when no visible human faeces are found on the ground anywhere in the community and its vicinity; and the community uses toilets on a regular basis. Kumar also elaborates that a community is made to acknowledge how toilets help to promote health and dignity of the community. “We highlight a toilet as a place where adults can go with dignity, and also a facility that ensures dignity and security of women,” he says.
Several villagers took an active role to ensure that no member of the community digresses from the community decision to make their village ODF. The local priest Narbadeshwar Pathak, for example, feels that given his position in the village, he had to set an example. “I started using toilet because unless I used it myself, I couldn’t ask other people to use it,” he says. He thinks toilets at homes have encouraged people to be conscious about cleanliness at homes.

Many who were practising open defecation now acknowledge that this is a welcome change. Subhash Chand Yadav, a 52-year-old farmer, also a member of the village monitoring committee, who has been using a toilet for the past three months, agrees that it is an advantage for him during inclement weather like the rainy season.
Jagdish Prasad Kharwal, a 58-year-old retired teacher, says that regular usage of toilets has brought respect to the villagers, especially women. “Earlier, women would not have a full meal for fear of going out at odd hours to answer nature’s call. But with the provision of toilets at home, not only are women encouraged to eat properly which will have a positive impact on their health, but they are also within safe environs here,” he says.
Smita Kumari, a young college-going woman, agrees with this. Construction of a toilet at her home has come as a big relief to her and she says, “I would avoid going out at odd hours as I did not want to be noticed. I used to feel uncomfortable sitting in the open with men walking about in the same area.” Meera Devi, a 35-year-old mother also feels open defecation is inconvenient as well as unhealthy for women like her and her children. “It becomes really difficult during bad weather like the rainy and winter season, and it also makes our children sick.” she says.
The PHED plays an important role in disbursing funds to the Panchayats that have resolved to attain ODF status. Subodh Shankar, the Sub Divisional Officer, PHED, at Buxar, says that agencies such as BTAST and ACE help bridge the gap between the community and PHED. Talking about the importance of the CLTS approach, Mobin Ali Ansari, the Deputy Development Commissioner (DDC) of Buxar, says, “We are now demonstrating the hazards of open defecation. The community-centric approach has brought a behavioural change leading to a stage wherein people are racing towards making their village ODF.”
Making a village ODF is a daunting task. Manoj Kumar, Block Development Officer, Buxar, feels, “Only behavioural change will make the once attained ODF status long lasting.” There are several cultural reservations such the reluctance of a man in using the same toilet used by his daughter-law, which need to be addressed. The Panchayat in Rampur, through their counselling and monitoring as a part of the CLTS approach, has played an important role in this regard.
Examples like Rampur demonstrate that despite challenges, it is possible to make villages, Gram Panchayats and Bihar ODF. Concerted efforts from the Government and supporting agencies to catalyse action at the local level and the will of the local communities are the essential ingredients for success.
The Sector Wide Approach to Strengthening Health (SWASTH) programme aims to improve the health and nutritional status of people of Bihar by increasing access to better quality health, nutrition, and water and sanitation services, particularly for the underserved groups. The focus of this programme is to strengthen the systems through better planning, organisational strengthening and human resource management, decentralisation and convergence among key departments. The programme also uses community level processes to manage, demand and monitor services.
This story was written by Ashok Kumar at OneWorld Foundation India.
Disclaimer: SWASTH is supported by the Department for International Development (DFID)-UK and implemented by the Government of Bihar, in collaboration with the Bihar Technical Assistance Support Team. However, the views expressed in this report do not necessarily reflect either DFID’s or Govt. of Bihar’s official policies or views.