This document outlines a 3-year plan to combat pediatric stunting in the Saharanpur district of Uttar Pradesh, India through improving sanitation and eliminating open defecation. The plan involves using a community-led total sanitation approach to change social norms around open defecation through education campaigns and latrine installation. Key activities include training local leaders, conducting workshops, launching media campaigns incorporating local culture, designing affordable latrines through community input, and advocating for government policies against open defecation. The goal is to replicate this model throughout Uttar Pradesh to help reduce stunting and related health issues.
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An opportunity analysis of the sanitary issues in the Indian educational context.
Project Goal:
Identify opportunity spaces for improving sanitation within the educational sector in India.
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Statistics and Programme Implementation (MosPI), for his significant inputs that helped define
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2015 team 1
1. Combating Pediatric Stunting in the
Saharanpur District of Uttar Pradesh
Lauren Gist
Beenish Kamran
Yashna Krishnamani
Prima Modi
Aarin Palomares
2. Total Population: 1,236,344,631 (2nd largest)
Infant Mortality Rate: 43.19 deaths / 1,000 live births
Religion: Hinduism (80.1%) - traditional, deep roots
Vulnerabilities:
- Poor Hygiene & Sanitation
- Highly Dense Populated Areas
Uttar Pradesh Demographics
Population: 200,581,477
Religion: Hinduism (84%) Islam (18.4%)
Literacy Rate: 68% Overall
Target Population: Saharanpur District of Uttar Pradesh
Population: 3,466,382 (2011)
Literacy Rate: 70% Overall 2
3. Problem: Religion and lack of education constitute to a high
prevalence in open defecation in rural areas of Northern India
- Largest factor of pediatric stunting
- Causes gastrointestinal diseases
- Pollutes the environment
Household Latrine Statistics for Rural Saharanpur
Objective: Provide effective strategies to combat pediatric stunting in the
Saharanpur district of Uttar Pradesh
3
4. Total Sanitation Campaign (TSC): Comprehensive program that ensures
sanitation facilities in rural defecation with goal to eradicate open defecation
Prime Minister Modi’s Initiative
- Pledge of 11 million toilets
Bill and Melinda Gates Foundation
- Reinvent toilet campaign
4
5. - Aligning with Community-Led Total Sanitation Approach
- Gearing interventions based on community assessments
- Developing appropriate technology
- Lobbying the local government to pass a No Defecating Policy in the Saharanpur
A Multifaceted Approach with Focus on Community-Led Total
Sanitation and Collective Behavioral Change
5
6. - Community Led Total Sanitation (CLTS) is already
being used in 16 of the 35 states in India.
- An estimate of around 5 million people have gained
access to safe sanitation across rural India due to
CLTS.
- In regions such as Himachal Pradesh and Haryana,
there has been a 60-70% increase in sanitation
coverage.
- In Bihar, where they use subsidies instead of CTLS,
they have only had a 20% increase in sanitation
coverage.
http://www.communityledtotalsanitation.org/sites/communityledtot
alsanitation.org/files/images/CLTSPosterirsp.jpg 6
9. Year 1
Identifying, Educating and Training Community
Goal: To gain trust within the community, identify possible partners in initiative,
reach out and educate community leaders to address open defecation, and
launch initial media campaign
- Community Assessment
- Build Relationships
- Educate and train community leaders
9
10. Q1
(Months 1-3)
Initial community assessment/mapping
Build relationships and gain trust from community members
Q2
(Months 4-6)
Identify community leaders through community assessment/mapping
Educate the community members of the issue by conducting a transect walk
Reach out to current community stakeholders (other NGOs, UN, Bill and Melinda Gates Foundation)
Obtain governmental support by contacting officials in district
Q3
(Months 7-9)
Community
Workshops: 1-2
times a month
Train local community leaders to advocate against dangers of open defecation
Educate community members about how OD leads to stunting
Provide resources/materials to educate and promote latrine usage
Gain media and ad campaign support
Q4
(Months 10-12)
Evaluate training and education program for next year
Refocus community workshops based on evaluation
10
11. Year 2
Changing the Norms
Goal: To establish a collective behavioral approach, changing the attitudes on
open defecation through a mass media campaign that takes into account
culture
- Focus scope of ad campaign to include cultural influence and familiarize locals
with the dangers of open defecation
- Lobby local government to enforce ‘No Open Defecation in Saharanpur’ policy
11
12. Q1
(Months 1-3)
Second annual
community
assessment/mapping
Expand efforts to include more villages
utilizing temples as community centers
Bharatanatyam
Launch mass media campaign
Execute reformed community workshops
Q2
(Months 4-6)
Incorporate a
holistic
advertisement
campaign
Refocus campaign to include popular
Bollywood culture and influence
Focus on mother’s involvement as a
primary caregiver (trigger emotion)
Panchatantra: Open Defecation Edition
12
17. Q3
(Months 7-9)
Continue ad campaign
Innovation Workshop focused on addressing concerns of current latrines
and accommodate community preferred design
Begin lobbying to local government officials to enforce policy
(No Open Defecation in Saharanpur)
Q4
(Months 10-12)
Evaluate and refocus ad
campaign
Evaluate Innovation Workshop
17
19. Year 3
Sustainability & Latrines
Goal: To facilitate the design of a latrine that is more suitable to the comfort
level of the community and to ensure sustainability through additional
funding
- Conduct participatory community surveys about latrine design
- Continue advocating policy
- Compile data on effectiveness of initiative and propose partnership with Prime
Minister Modi’s “Clean India” Campaign and other organizations
19
20. Q1
(Months 1-3)
Third community assessment/mapping
Hold a community district innovation fair showcasing community-geared latrine design and conduct
a community participatory survey to evaluate which design would be most effective
Find external funding for the implementation of community preferred latrines
Propose to government to make our NGO a part of the Modi Green Campaign
Q2
(Months 4-6)
Raise support for anti-open defecation policy
Continue searching for funds to build latrines
Q3
(Months 7-9)
Sustainability Workshop focused on training and expanding community engagement
Continue lobbying the government to pass policy
Q4
(Months 10-12)
Expand community workshops district wide
20
23. Measurable Outcomes
• Annual Surveys
• Media Campaign Evaluations
Subjective: Annual Community Assessments
• We expect to greatly reduce open defecation in the Saharanpur district
• We aim to achieve similar results throughout the Uttar Pradesh region and spread across
India
We Plan to follow CDC’s Guide to Analyzing the Cost-Effectiveness of
Community Public Health Prevention Approaches
23
24. - Partner with Prime Minister Modi’s initiatives and ask for additional
funding in order to continue elimination campaign
- Our NGO will enact similar plans in surrounding districts and move
throughout in districts of Uttar Pradesh
- Progress monitored through routine annual community assessments
- Trained facilitators will continue mobilizing the community
24
25. Dr. Dale Dickinson for his mentorship
Dr. Daniel Chavez-Yenter for support throughout the week
Sparkman Center of Global Health
Fellow classmates for invaluable commentary, guidance and
discussions
Thank You! 25
28. Sample Workshop
Day 1- Introduction to CTLS
Groups discussed expectations on how to stop open defecation, how to motivate, how
to change thinking, and how to increase low cost toilets and develop effectiveness
Groups presented on projects that failed and addressed why they failed
Role Play- attitudes and behaviors of facilitators
Day 2- Triggering Tools
Rapport building, defecation mapping, calculation of fecal matter, calculation on
expenditure of diseases, low cost toilets, and commitment date (These are considered
tools)
Goal is to motivate participants to make changes
Day 3- Roles and Responsibilities
Groups demonstrated strategies and tools to villages
Day 4- Triggering Outcomes and Film Show
The groups presented on their outcomes in the villages and had follow-up visits
Day 5- Natural Leader Presentations
Overall Process
Pre-
Triggering
Triggering
Post
Triggering
Beyond
CLTS
28
29. Phase 1: Team Building
Teams consisting of builders, village health workers, and an Environmental Health
Officer
Identify root of issue
Identify advantages and disadvantages of current technology (latrines)
Phase 2: Discovery
Identify potential design options for latrines geared towards villagers’ needs
Brainstorm and mapout designs
Identify
Phase 3: Prototyping
Create small prototypes of designs
Gain feedback from villagers 29
All of us
We’d like start off by thanking you for allowing us to talk about a topic that continues to plague many rural populations of Northern India: Pediatric Stunting. Today we’re proposing a plan to combat this illness in the Saharanpur district of Uttar Pradesh. One of major causes is open defecation, which is still highly prevalent in many part of India, particularly in rural areas.
Literacy Rates
-Uttar Pradesh: 68% Overall (M: 77% & F: 51%)
-Saharanpur District: 70% Overall (M: 78% & F: 62%)
Child Stats:
“Muslim households are in better position, 50.79 per cent of them have in house toilet facility as compared to 45.62 per cent of total Hindu houses having in house toilet facility (Table-4.30).”
http://www.icssr.org/District%20Saharanpur%20-%20RC%20Tyagi.pdf
Heterogeneous community
Mostly rural (⅔)
Stats: http://knoema.com/IHBAOLF2011/indian-households-by-availability-of-type-of-latrine-facility?regionId=IN-UP-SA
Number of latrines is not correct- missing latrines
People aren’t using the latrines that are there
Cognitive
Educate population on the relationship between stunting and
open defecation
Affective
Acknowledge the consequences of open defecation pertaining to
children, environment, and overall health of community
Behavioral
Reevaluate behavioral practice in terms of open defecation
discuss why some of these efforts have failed
What has been useful?
CLTS - triggers the community’s desire for collective change, propels people into action and encourages innovation, mutual support and appropriate local solutions, thus leading to greater ownership and sustainability.
Used in some states of India with proven success; however, approach has not reached parts of Uttar Pradesh
Pledge of 11 million toilets and an end to OD by 2019
Toilets before Temples
Reinvent the Toilet Campaign: Toilet Fair in New Delhi (2014)
**Focus on Hesitance & Stigma
Challenges:
Current cultural and societal norms
Social stigma (caste system status)
Hesitance toward latrines
discuss that the majority of ppl who do not use these toilets are hindus due to their ancient scriptures.
Obstacles for interventions:
Dependency on subsidies
Lack of sincerity
Lack of community participation
Corruption
No focus on the grassroots approach
Aligning with Community-Led Total Sanitation Approach to
Execute a behavioral change focused program
Low to no-subsidies to prevent subsidy dependence
Preventing missing toilets
Information, education, and communication
Gear interventions toward community members by incorporating strategies in
Cultural & religious practices
Popular media outlets
Introducing appropriate technology
Lobby the local government to enforce a No Defecating Policy in the District
**Add superscripts for references
we based our strategy on the CDC health impact pyramid. It helped us realize counseling and education will only provide a small impact within the region. Solely educating is not going to cause a permanent and lasting change. It is our goal to provide lasting interventions that will change the open defecation mentality. This change will provide a positive economic impact and stimulate the community to default into healthier decision making
**Find better pyramid graphic (color)
just shown sketch of broad timeline
Temple Leaders → Community Leaders → Interview
what is the community assessment
Start descriptions with:
Identifying...
Educating...
Training...
The natural leaders emerged when the defecation area was mapped out where initiallTargeted community leaders begin advocating against open defecation
Encourage leaders to start contemplating the possible solutions for open defecation
Launch media/ad campaign
Evaluate training program for next year ladies were participating slowly immediately intervened and took over the charge
What will community assessment look like?
Red: Not in powerpoint slide; verbally present information
Quarter 1:
Initial community assessment/mapping
gauge willingness to work together
Conduct interviews in communities to gain familiarity and understanding
Build relationships and gain trust from community members
Quarter 2:
Use community map to identify community leaders and build relationships as well as identify community assets (businessmen, engineers, teachers, etc…)
Reach out to current community stakeholders (other NGOs, UN, Bill and Melinda Gates Foundation)
Obtain governmental support by contacting officials in district (we want to do a grassroot approach and need to start deciphering local partners)
Quarter 3:
Community Training Workshops: 3-6 days, 1-2 times a month?
Invite community
make announcements in temples, community centers
Incentives
stepping stone for those interested in pursuing business/engineering/health
be able to train individuals in the future for pay
Objectives of Workshops
Training members to be community health workers
Educating families on the community health effects of open defecation
Women: How to prevent your kid from malnutrition/stunting due to GI disease
Children
Panchatantra: Open Defecation Edition
Quarter 4:
Targeted community leaders begin advocating against open defecation
Encourage leaders to start contemplating the possible solutions for open defecation
Launch media/ad campaign
Evaluate training program for next year
Mass Media Campaign
how will we enforce? what obstacles will we face to enforce?
Start descriptions with:
Identifying...
Educating...
Training...
The natural leaders emerged when the defecation area was mapped out where initiallTargeted community leaders begin advocating against open defecation
Encourage leaders to start contemplating the possible solutions for open defecation
Launch media/ad campaign
Evaluate training program for next year ladies were participating slowly immediately intervened and took over the charge
What will community assessment look like?
Red: Not in powerpoint slide; verbally present information
Quarter 1:
Initial community assessment/mapping
gauge willingness to work together
Conduct interviews in communities to gain familiarity and understanding
Build relationships and gain trust from community members
Quarter 2:
Use community map to identify community leaders and build relationships as well as identify community assets (businessmen, engineers, teachers, etc…)
Reach out to current community stakeholders (other NGOs, UN, Bill and Melinda Gates Foundation)
Obtain governmental support by contacting officials in district (we want to do a grassroot approach and need to start deciphering local partners)
Quarter 3:
Community Training Workshops: 3-6 days, 1-2 times a month?
Invite community
make announcements in temples, community centers
Incentives
stepping stone for those interested in pursuing business/engineering/health
be able to train individuals in the future for pay
Objectives of Workshops
Training members to be community health workers
Educating families on the community health effects of open defecation
Women: How to prevent your kid from malnutrition/stunting due to GI disease
Children
Panchatantra: Open Defecation Edition
Quarter 4:
Targeted community leaders begin advocating against open defecation
Encourage leaders to start contemplating the possible solutions for open defecation
Launch media/ad campaign
Evaluate training program for next year
*try to stay away from puns...
You are responsible for harming your child. Stop Open Defecation.
What percentage
Mural Women: http://opinionator.blogs.nytimes.com/2014/11/13/in-india-latrines-are-truly-lifesavers/?_r=0
Start descriptions with:
Identifying...
Educating...
Training...
The natural leaders emerged when the defecation area was mapped out where initiallTargeted community leaders begin advocating against open defecation
Encourage leaders to start contemplating the possible solutions for open defecation
Launch media/ad campaign
Evaluate training program for next year ladies were participating slowly immediately intervened and took over the charge
What will community assessment look like?
Red: Not in powerpoint slide; verbally present information
Quarter 1:
Initial community assessment/mapping
gauge willingness to work together
Conduct interviews in communities to gain familiarity and understanding
Build relationships and gain trust from community members
Quarter 2:
Use community map to identify community leaders and build relationships as well as identify community assets (businessmen, engineers, teachers, etc…)
Reach out to current community stakeholders (other NGOs, UN, Bill and Melinda Gates Foundation)
Obtain governmental support by contacting officials in district (we want to do a grassroot approach and need to start deciphering local partners)
Quarter 3:
Community Training Workshops: 3-6 days, 1-2 times a month?
Invite community
make announcements in temples, community centers
Incentives
stepping stone for those interested in pursuing business/engineering/health
be able to train individuals in the future for pay
Objectives of Workshops
Training members to be community health workers
Educating families on the community health effects of open defecation
Women: How to prevent your kid from malnutrition/stunting due to GI disease
Children
Panchatantra: Open Defecation Edition
Quarter 4:
Targeted community leaders begin advocating against open defecation
Encourage leaders to start contemplating the possible solutions for open defecation
Launch media/ad campaign
Evaluate training program for next year
Evaluating Outcomes
**Culturally, wouldn’t talk about their experience/be willing to give feedback in a group setting
Do surveys instead asking
Would you see lower rates of child stunting? No
Start descriptions with:
Identifying...
Educating...
Training...
The natural leaders emerged when the defecation area was mapped out where initiallTargeted community leaders begin advocating against open defecation
Encourage leaders to start contemplating the possible solutions for open defecation
Launch media/ad campaign
Evaluate training program for next year ladies were participating slowly immediately intervened and took over the charge
What will community assessment look like?
Red: Not in powerpoint slide; verbally present information
Quarter 1:
Initial community assessment/mapping
gauge willingness to work together
Conduct interviews in communities to gain familiarity and understanding
Build relationships and gain trust from community members
Quarter 2:
Use community map to identify community leaders and build relationships as well as identify community assets (businessmen, engineers, teachers, etc…)
Reach out to current community stakeholders (other NGOs, UN, Bill and Melinda Gates Foundation)
Obtain governmental support by contacting officials in district (we want to do a grassroot approach and need to start deciphering local partners)
Quarter 3:
Community Training Workshops: 3-6 days, 1-2 times a month?
Invite community
make announcements in temples, community centers
Incentives
stepping stone for those interested in pursuing business/engineering/health
be able to train individuals in the future for pay
Objectives of Workshops
Training members to be community health workers
Educating families on the community health effects of open defecation
Women: How to prevent your kid from malnutrition/stunting due to GI disease
Children
Panchatantra: Open Defecation Edition
Quarter 4:
Targeted community leaders begin advocating against open defecation
Encourage leaders to start contemplating the possible solutions for open defecation
Launch media/ad campaign
Evaluate training program for next year
use more money in years 2 and 3
****have milestones
http://aspe.hhs.gov/health/reports/06/cphpa/
also getting government to support it & making a bigger impact
Lobbying!
http://personales.upv.es/anhuegon/latrines.html
Can be role model for entire providence
Media has given full support
District Administration and Government officials has realized the effectiveness of community led approaches
Commitment of 35 participants to make villages ODF
Beenish do dis cuz idk statistics
Cognitive effect and changing their lives
The mural on the wall outside of Chandramani Jani’s home is more message than art. It depicts a sari-clad woman relieving herself behind a bush, looking worried as a man advances. A large thought bubble suggests the woman wishes for a toilet of her own, clean and complete with the privacy of a door