Entire 80s to 2000s, sanitation program in India was hardware driven with few exceptions based on large subsidy element in to it. And also sanitation used to be a small component in largely water supply driven programs. The sanitation program was commonly referred as toilet construction program with no clear objective on coverage, use and sustainability of created facilities. These programs fails to deliver the intended objective due to poor take up rate, poor targeting and limited reach. The idea and concept of community participation, behavior change and sustainability was not even thought off during that period. Large scale non use of created facilities and poor sanitation conditions prompted review of the entire program policy, planning and delivery mechanism. Finally the government of India decided to take sanitation improvement in a campaign mode and CRSP 1986 rechristened in to Total Sanitation Campaign in 1999 with new approach and resolve to tackle the sanitation problem across India. The new ‘Total sanitation campaign’ policy provides thrust on community participation, behavior change and incentivizing panchayat for ODF status. The TSC has all attributes of a community led program but the delivery model fails to create the desired results and impacts. Many states like Maharashtra, Gujarat, and Tamilnadu did well in improving the overall status of sanitation but there are many states picking the speed very slowly. Bihar is among slow pickers state due to various reasons. The current sanitation coverage in Bihar is less than 25 % with usage percentage much lower. Open defecation is the most preferred option in villages of Bihar cutting across caste, gender and social status. Everybody take this easy but dangerous option to get reed off. Most of the rural household in Bihar is at the bottom of the sanitation ladder i.e. open defecation (OD).
In last two years some districts performed well to improve the sanitation condition which includes Vaishali, Muzaffarpur, Katihar etc but overall the situation is very poor. The challenge is to make Bihar open defecation free. The experience from other states shows that community participation is the key for sanitation improvement.
How to involve community to take charge of themselves to improve their sanitation?
Any sanitation program needs to work out a comprehensive approach for community intervention to address following objectives,
· Empower community , individuals with knowledge
· Enabling behavior change
· Creating sanitation demand and subsequent supply chain
· Improve planning, implementation of sanitation programs and maintenance of created facilities
The current scenario in Bihar is a compelling case for large scale community engagement for sanitation improvement with new reinvented community approach for seeking elimination of open defecation through ongoing TSC program and creating sanitation demands from migrating to next step of sanitation ladder by better utilization of TSC funds.
Many community wide sanitation approaches emerges in the last decade. These community led approaches are not entirely new but reinvented and more focused. Community wide approaches also called Total Sanitation approaches aim to achieve universal use of toilet for open defecation free communities. Total sanitation seeks to community behavior change rather than focusing on household behavior change. They promote collective decision making and local problem solving. Techniques used as mass social mobilization to focus attention and prioritize shared social problems- in this case open defecation. These community wide approaches primarily wok for demand creation for the elimination of open defecation. There are many variants of this approach but the overall goal of each approach is total sanitation. CLTS is among one of the approach tested on large scale in different settings with impressive initial success.
Community led total sanitation (CLTS):
CLTS aims to eliminate open defecation (OD) within a community, recognizing that individual hygiene behavior can affect the health of other community members. The approach encourages innovation and commitment within the community motivating them to build their own sanitation facilities without depending on external support.
CLTS aims and objectives complement the ongoing TSC program in Bihar by targeting community and households in rural areas for sustainable hygiene behavior change. It can be used as a facilitation technique for demand creation and scaling up the TSC program in Bihar.
CLTS raise awareness regarding risks of open defecation and subsequently raises natural sense of shame and disgust attached to OD. Community analyzes their own sanitation problem including OD, fecal –oral contamination route. The tools used in CLTS are:
· Focused group discussions
· Transect walks
· Mapping of open defecation sites
· Shit calculation
· Community planning for elimination of open defection
It generates a sense of disgust and shame among community members and encourages them to talk openly about the shit and its management. They collectively realize the terrible impact of open defecation on their lives that touches health, hygiene and nutrition. These revelations lead the entire community to an ignited realm to do something for themselves to improve their surroundings. This ignited state culminates into collective local action for improving sanitation within their community.
Evidence is emerging that CLTS is an effective approach to improve hygiene and sanitation behaviors where large scale open defecation is in practice. It can be also effective where usage is low and can be used as an entry tool for community mobilization for other community based program such as health, nutrition and education. It is not a top down directive approach and its major strength is to encourage hygiene behavior without any prescription. It also identifies and empowers natural community leaders and facilitators to spread the effect of collective action that can be immensely useful for other development projects.
In this context, CLTS can be an empowering approach in Bihar to seek open defection free communities, improving the usage of constructed toilets and creating demand for sanitation under ongoing TSC. Till date CLTS facilitation techniques has not been employed in Bihar. The best way forward is to take the ToT approach for CLTS introduction in Bihar by pooling out human resources from TSC, health, education and nutrition at district level and then these teams will train block level teams consisting of block level government functionaries, PRIs ,Anganvadi workers and women SHGs members. These blocks level teams will work at the village level. This will support the ongoing TSC program and also converge with health and nutrition interventions. CLTS will prove to be beneficial in all 38 districts of Bihar for creating demand for sanitation to achieve the MDG targets.