Combating Pediatric Stunting in the Saharanpur District of Uttar Pradesh

Lauren GistBeenish Kamran

Yashna KrishnamaniPrima Modi

Aarin Palomares 1

IndiaTotal Population: 1,236,344,631 (2nd largest)Infant Mortality Rate: 43.19 deaths / 1,000 live birthsReligion: Hinduism (80.1%) - traditional, deep rootsVulnerabilities:

- Poor Hygiene & Sanitation- Highly Dense Populated Areas

Uttar Pradesh DemographicsPopulation: 200,581,477 Religion: Hinduism (84%) Islam (18.4%)Literacy Rate: 68% Overall

Target Population: Saharanpur District of Uttar PradeshPopulation: 3,466,382 (2011)Literacy Rate: 70% Overall 2

Problem & Objective

Problem: Religion and lack of education constitute to a highprevalence 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

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Existing Initiatives/PoliciesTotal 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

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Methods

- 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

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Why Community Led Total Sanitation? - 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/communityledtotalsanitation.org/files/images/CLTSPosterirsp.jpg6

Retrieved from: http://www.mapc.org/sites/default/files/CDC%20impact%20table_2.JPG

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Year 1

Identifying, Educating and

Training Community

Latrinesand

Sustainability

Changing the Norms

Projected TimelineYear 2 Year 3

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Year 1Identifying, 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

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Year 1

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 stuntingProvide 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

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Year 2Changing 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

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Year 2

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

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Bharatanatyam in Temples/Community Centers

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https://sanitationupdates.files.wordpress.com/2013/09/tbc-nepal.jpg16

Year 2 (cont.)

Q3 (Months 7-9)

Continue ad campaignInnovation 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 campaignEvaluate Innovation Workshop

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Retrieved from: http://www.popcouncil.org/uploads/pdfs/2010India_PolicyBrief10.pdf18

Year 3Sustainability & 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

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Year 3

Q1 (Months 1-3)

Third community assessment/mappingHold 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 latrinesPropose to government to make our NGO a part of the Modi Green Campaign

Q2 (Months 4-6)

Raise support for anti-open defecation policyContinue searching for funds to build latrines

Q3 (Months 7-9)

Sustainability Workshop focused on training and expanding community engagementContinue lobbying the government to pass policy

Q4 (Months 10-12)

Expand community workshops district wide

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Finances

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Evaluation and Impact

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

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Sustainability

- 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

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Acknowledgements

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

References ● http://www.indiasanitationportal.org/ ● http://www.communityledtotalsanitation.org/country/india● http://www.popcouncil.org/uploads/pdfs/2010India_PolicyBrief10.pdf● http://riceinstitute.org/wordpress/2014/07/30/do-religious-leaders-talk-about-defecation-

in-india/● http://riceinstitute.org/blog/three-government-sanitaiton-programs-fail-to-improve-open-

defecation-in-one-switching-study-village/● http://www.gatesfoundation.org/What-We-Do/Global-Development/Reinvent-the-Toilet-

Challenge● http://personales.upv.es/anhuegon/latrines.html● http://www.endwaterpoverty.org/sites/endwaterpoverty.org/files/WTD%20Dossier.pdf● http://www.census2011.co.in/census/district/503-saharanpur.html● http://riceinstitute.org/wordpress/wp-content/uploads/2014/09/Open_Defecation.pdf

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TOILET COVERAGE AND SANITATION

PERFORMANCE IN INDIA BY STATES (2001-2011)

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What is CLTS?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

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Innovation WorkshopPhase 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

Saharanpur StatisticsUttar Pradesh Region Saharanpur District

Population200,581,477 3,466,382

Literacy Rate 68% 70%

% OD (highest)

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Fund our NGO!

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Success Story!

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