Keystone III

KEYST NE A B I - M O N T H LY R E S E A R C H P U B L I C AT I O N F RO M WO R L D V I S I O N I N D I A

I S S U E N O. 3 | J U N E 2 0 1 7

TABLE OF CONTENTS EDITORIAL

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SEEDS OF CHANGE: VIDARBHA FARMERS LIVELIHOOD PROJECT (PROJECT REPORT)

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HOW SAFE DO OUR CHILDREN FEEL? (FACTSHEET)

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TACKLING INDOOR AIR POLLUTION: CASE STUDY FROM BARAN, RAJASTHAN (RESEARCH PAPER)

PAGE 12

PROMOTING LATRINE USE IN RURAL BIHAR: FORMATIVE STUDY REPORT (RESEARCH REPORT)

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EDITORIAL As the third issue of Keystone reaches you, I would like to express my joy in the manner Keystone has been received by all of you, and for the valuable feedback. Just like the last two issues, Keystone again brings to you some of our most significant content in the context of evidence and learning.

The ability of children to survive and thrive largely depends on the ability of their families to provide for their needs, which in turn depends on secure and sustainable livelihoods at the household level. The report on Vidarbha Farmers Livelihood project highlights how we have been able to impact farmers’ livelihood in one of India’s most vulnerable and droughtprone pockets.

We believe that sustainable well-being of children is impossible without sustainable, equitable access to clean water, dignified sanitation and appropriate hygiene behaviours. A formative paper on promoting latrine use in rural India, thus finds its place in this issue of Keystone – a product out of the partnership between Oxford Policy Management, Ideas42 and World Vision India.

Acute lower respiratory infection (ALRI) is a big threat to the health of children under five. There is consistent evidence that indoor air pollution causes ALRI. The paper on indoor air pollution in Baran in this issue of Keystone brings the environmental perspective to

good health of children below five.

We are happy to also present the first research product from our extensive baseline data. This issue of Keystone includes a factsheet on child protection – a representation of World Vision India’s very own primary data from our baseline.

Let me take this opportunity to request your constant and constructive feedback, which would help us in making this research communication more effective.

Happy reading!

Prasad Talluri, Head - Strategy & Research Management World Vision India

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Seeds of Change: Vidarbha Farmers Livelihood Project

PROJECT REPORT This report highlights the change brought about among the farmers in Vidarbha through World Vision India’s Vidarbha Farmers Livelihood Project (VFLP). Through our interventions from 2013

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to 2016,VFLP successfully improved farmers’ livelihood through integrated watershed management and conservation of natural resources. This is significant since the Vidarbha region has been infamous for

continuous droughts and the disturbingly high number of farmer suicides.

Authors: Paul Mathai, Bestin Samuel

WHY VIDARBHA Mahrashtra’s Vidarbha region occupies 31.6% of its total land area, and 21.3% of its total population. The region is marked by extreme vulnerability to droughts, untimely rainfall, adoption of new seeds and use of excessive fertilizers and pests leading to land degradation, economic backwardness and lack of agri based infrastructure.

The Vidarbha region witnessed 771 suicidal deaths during the years 2001-2007. Out of them, 60% of cases were reported from farmers possessing lands of 0-2.5 hectares, 67% of suicide deaths of those who availed loan upto Rs.25000 and 63% cases reported from the credit from District Cooperative Banks as the recovery system was not farmer friendly. Most of the

suicide death occurred from small and marginal farmers of Other Backward Castes (46%). Although the Prime Minister had announced Rs.3700 crore rehabilitation package for the Vidarbha region in 2006, the utilization was only 49%. These were the reasons that prompted World Vision India to work with the farmers in Vidarbha.

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WHERE WE WORKED World Vision India worked in Yavatmal district, within the larger Vidarbha region.

The Project Area comprised 15 villages from 10 Gram Panchayats (GPs) from Yavatmal Block, out of which 5 villages from 4 Gram Panchayats are from Watershed Area (WSA) and the rest 10 villages of 6 GPs from Non Watershed Area (NWA). One (Lasina GP)

falls in both WSA and NWA. Out of the 1818 families we reached, 33% are from WSA and 67% from NWA. Yavatmal district receives very poor rainfall, at an annual average of 800 mm.

Agriculture is the mainstay of the economy in the region, but only negligible land has irrigation facility. Compounded by poor soil and lack of

vegetation, agriculture suffers very badly. Cotton & Soya bean are the main cash crops and wheat, jowar (sorghum) and bajra (pearl millet) are the main food crops. For sowing cotton, farmers take loans and continuously for the past few years, the rainfall was below normal and the crops failed pushing farmers into debt.

WHO WE WORKED WITH Among the 15 villages we worked in, 6 villages were dominated by Scheduled Tribes (ST) population (100%) and the rest of 9 villages with more than 90% ST followed

by Scheduled Castes (7%) and also a Muslim (below 1%) minority. The tribal population mostly live in remote villages and are less privileged on many counts.

Thus, working with them will enable them to overcome the social inequalities they face.

Agriculture is the mainstay of the economy, but the sources of irrigation is very poor. Thus, many of them double up as agricultural labourers in farms where there is irrigation or migrate to nearby cities for labour during lean seasons.

The total number of direct beneficiaries of our project was 7500.

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The Chief Minister of Maharashtra, Devendra Fadnavis (3rd from left), visited Kita village in Yavatmal in June 2016, and was appreciative of World Vision India’s water conservation efforts.

FROM FIVE TO TWENTY-FIVE Yogesh Nagarao Dahane is a 28 year old farmer who has been working with World Vision and improving his farming methods for the past 8 years. Over this period he has managed to increase his yield from 5 quintals to 25 quintals of wheat and from 10 quintals to a mammoth 30 quintals of cotton, an increase of 400% and 200% respectively. This year he managed a profit of 3,00,000 rupees (more than 4600

USD). With World Vision’s help he deepened his well and installed motor pumps.

He also got aid to fence vulnerable parts of his land, thus preventing loss to wild animals. Over the past years, Yogesh has seen significant change in his village. The number of farmers who are using new irrigation facilities to harvest a third crop through the year has increased from 3-4 farmers to close to 50 farmers.

WHAT WE DID The VFLP (Vidarbha Farmers’ livelihood Project) worked in 15 villages providing immediate interventions like improving the farm land, diversifying livelihoods helping the people take-up value added services (like making dhal from pulses). However, our biggest intervention was aimed at addressing the scarcity of water for both drinking and irrigation.

Through the integrated watershed approach, the project promoted harvesting of rainwater that increased the ground water table. The integrated approach helped in conserving the environment necessary to sustain the

impact, besides providing employment opportunities during lean seasons thus reducing migration and also other livelihoods such as fisheries, animal husbandry, etc. The primary aim of our project was to sustain and improve farmers’ livelihoods through integrated watershed management and conservation of natural resources. The project and its different activities were also in line with policies, strategies and priorities of the Government.

Further, the project outcomes are in line with and also would contribute to attainment of the following Sustainable Development Goals:

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WHAT WE ACHIEVED The focus of World Vision India’s Vidarbha Farmers Livelihood Project was on the conservation of natural resources through watershed with a ‘Ridge to Valley’ approach, and the activities included promoting soil and water conservation measures, encouraging sustainable agricultural practices, and enhancing economic status through different livelihood opportunities. Implementation of physical and biological soil and water conserving measures revitalized and stabilized the natural environment in the watershed villages. Sporadic changes occurred in the NWAs where

the agricultural and irrigation infrastructure was supported.

Available water allows intensified production (double-cropping, vegetable cultivation), together with improved and diversified sustainable agricultural practices. Groundwater levels and vegetative cover have increased, thereby also improving the crop yield, availability of drinking water, fodder and wood. The crop production has improved considerably and more in WSA compared to NWA. Economic gains from the project are significant and have boosted the household

1 - 2 METRES

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income across the watersheds –both in respect of landed and landless community members. The self help approach improved the access of credit facilities through the SHGs savings, linkages with Government schemes, etc. The project initiatives have contributed to meet the overall objective of improved livelihood and food security, income level and check migration. One of the biggest impacts of the project was that there were zero cases of farmer suicide in the 15 villages where we worked since 2013.

Increase in groundwater levels in watershed areas

33% INCREASE

Overall cotton production

50% INCREASE

Overall Bajra production in watershed area

50% INCREASE

Overall soya bean production in nonwatershed area

25%

Farmers practice crop rotation in the project area

50% INCREASE

Number of food secure months in majority of the vulnerable community

70% INCREASE

Household income among landed and landless community members in WSA

235% INCREASE

Household income among landed and landless community members in NWA

METHODOLOGY The evaluation of World Vision India’s work through the Vidarbha Farmers Livelihood Project was done in five steps. Desk Review, Planning Meeting, Field Work and Synthesis, Debriefing and Feedback and Report Writing.

The data collection methods included indepth interviews (7), focus group discussions (7), household survey (221 respondents)

and field observations. A Development and Environment consultant P S Chandrasekhara Rao was employed to conducted the project evaluation, a highly experienced monitoring and evaluation expert who has worked both with the government and with agencies like UNICEF, UNDP and DFID.

WHAT WE LEARNED World Vision India’s work in Vidarbha was also an enriching experience of learning. We learned that more than addressing issues at a micro level, more focus could be given on institutional mechanisms and their functioning.

Despite the intentional target audience being only the farmers, our work had also resulted in

a positive impact on all vulnerable groups. We realised a participatory approach in beneficiary selection would give rich dividends. If amply supported, self help groups can build their capacities in achieving linkages with credit institutions.

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How safe do our children feel?

FACTSHEET This factsheet is unique in the sense that it derives its statistics purely from World Vision India’s baseline numbers. Using our own primary data collected using both the Youth Healthy

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Behaviour Survey (YHBS) tool and the Caregiver Survey tool, the factsheet gives a picture of what are the biggest fears of children in our communities and how adults see issues regarding child protection.

The survey covered 45,844 children in the age group of 12-18 years.

Prepared by: Francis Simon, Sarojitha Arokiaraj, Bestin Samuel

HOW SAFE DO OUR CHILDREN FEEL? World Vision India works among children in 6252 communities across 26 states in India.

In a survey conducted in 2016, we interviewed 45,844 children regarding child safety.

This is what we found.

1 in 4 children does not feel safe in their neighbourhood.

59% children are unaware of basic personal safety measures.

41% children do not know of services that can help if they face abuse.

1 in 4 children does not seek help because they are scared of what their family or friends would think.

44% families do not feel that their community is safe for children.

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48% children do not feel safe because of alcoholics and drug users in their neighbourhood.

74% children are unaware of sources of help when in danger.

1 in 3 children does not feel safe because their play spaces are unsafe.

1 in 4 families would not report a case of child abuse.

1 in 5 children does not feel safe because of fear of sexual abuse.

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METHODOLOGY The survey was conducted in 102 locations in the country in 2016 by World Vision India, covering 45,844 children aged 12-18 years. Data was collected using a two-stage

cluster sampling method with the Youth Healthy Behaviour Survey (YHBS) tool. For adults, data was collected from 18,600 households using a Caregiver Survey tool. Data

was collected by trained staff and volunteers using an Android-based app ensuring data quality.

WORLD VISION INDIA & CHILD PROTECTION World Vision India has been giving utmost priority to child protection. In the locations we work, we equip children to protect themselves, provide life skill education, form community based child protection units, build capacity of police personnel,

medical professionals to be child sensitive, sensitise communities and parents on preventing child sexual abuse. Through partner organisations, we provide support to children who have been abused. Through our campaign It Takes Every

Indian to End Child Sexual Abuse, World Vision India will raise awareness about child sexual abuse and strengthen implementation of child protection services in the locations we work.

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Tackling Indoor Air Pollution: Case study from Baran, Rajasthan

RESEARCH PAPER According to WHO, air pollution is the biggest killer of children under 5 years. The paper discusses particularly the issue of indoor air pollution caused from burning of solid biomass fuels used for cooking purposes in

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rural and tribal communities, along with the associated issues of environmental degradation and climate change. The findings & benefits of switching to clean cooking methods and cleaner fuels, at the household level, are

presented in this paper.

The application of these methods among vulnerable communities, can save precious lives - particularly children.

Author: Salmon Jacob

BACKGROUND Tackling Indoor Air Pollution in the rural households with energy efficient stoves and use of renewable energy – A case study from Sahariya tribe of Baran district in Rajasthan.

As the world looks at Delhi on the issue of air pollution, and as Delhi’s political class and scientific agencies grapple for solutions to this alarming situation, it is also important to realise that a large section of the rural households in India are regularly exposed to a similar situation – though largely ignored – due to indoor air pollution. Indoor Air Pollution caused by open fires in traditional chulas (stoves) using biomass fuels contribute significantly to the atmospheric concentrations of carbon particulates and greenhouse gases leading to issues of global warming, along with causing health concerns related to respiratory infections particularly among children under 5 years and women. The World Health Organization estimates that indoor air pollution contributes to nearly 4.3 million deaths annually.

According to the National Sample Survey Organization India in 2015, 85% of the rural households (121 million) still use firewood and chips as cooking fuel. The Lancet Respiratory Medicine Commission estimates that a million deaths occur annually in India due to Household air pollution. Nearly, 39% of early neonatal stillbirths

were attributed to cooking fumes (National Centre for Biotechnology Information).

Furthermore, open fires using biomass fuels contribute significantly to global greenhouse gas emissions due to incomplete combustion.

of breath, lung inflammation, decreased lung function, worsening of asthma and other respiratory diseases, cardiac arrhythmia, increased risk of heart disease, heart attacks, stroke and even cancer.

There is consistent evidence that indoor air pollution causes acute lower respiratory infections (ALRI) in children under five, particularly pneumonia, and chronic obstructive pulmonary disease (COPD), chronic bronchitis and lung cancer among adults. In additional to this, there is emerging evidence that links indoor air pollution to low birth weight and prenatal mortality among infants, due to carbon monoxide (CO) inhalation among pregnant women and young children, as well as ear and respiratory infections, tuberculosis, nasopharyngeal and laryngeal cancer, cataract (blindness) and cardiovascular disease.

Children generally absorb proportionally higher doses of smoke pollutants which makes them particularly vulnerable to damaging health effects. Smoke pollution can cause permanent impairment of children’s growing as well as organ and immune system development as documented

by David Dyjack et al in “Residential Environmental Risks for Reproductive Age Women in Developing Countries”, 2005. Thus, significant reductions of these diseases can be achieved, particularly among women and children, by reducing the indoor air pollution.

Similarly long term exposure to methane (CH4) and poly aromatic hydrocarbons (PAHs) also affects child development, including harm to the developing heart, brain and nervous system. It is also associated with episodes of headaches, coughs, shortness

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THE PROJECT Kishanganj block in Baran district of Rajasthan, historically had a good presence of forests, and over the years it is seen that the quality of the forests have dwindled due to various reasons. According to the Rajasthan state forest Reports in 2001, the dense forest area in Baran district was 226 sq. km. while in 2011 the data was differentiated into Very Dense Forest (VDF) and Moderate Dense Forest (MDF) area. As per the 2011 data, it is seen that there is 0 sq. km. of VDF and 149 sq.km of MDF. This is an indication of the forest degradation issue in the district.

The local perception of the reasons for the dwindling of the forests, were estimated based on the response from 300 households from the operational villages, wherein the major reasons for the forest depletion observed were timber merchants, clearing of forests for agriculture, firewood etc. It is interesting to note, that the people feel that one of the major reason for the degradation of the forest, is the felling of trees for local construction needs as well as firewood requirements.

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World Vision India, implemented a 3 year climate change project during the period 2013 to 2016, covering about 35 villages of Kishanganj block in Baran district of Rajasthan. These villages are remotely located and predominantly inhabited by Sahariya tribes. About 99% of the households from these communities were dependent on firewood & cowdung cakes, to meet their cooking energy needs.

Through this project, about 4326 households were facilitated to switch from traditional chulas (firewood stoves) to fuel efficient woodstoves and biogas stoves.

The fuel efficient woodstoves are designed to improve the combustion efficiency and thereby significantly reduce the firewood requirement as well reduce the smoke emitted from these woodstoves. These stoves require only dry twigs, which usually fall off from trees, as against the bigger blocks of wood used in the traditional open stoves.

In case of the biogas users, there is absolutely no requirement of firewood and almost no smoke emission from the stoves. In this case

however, the household needs to have cattle in their homes to meet the raw material requirement for the biogas digestors.

The process involved active engagement the women groups at the village level, regarding the proper use of these stoves and necessary handholding, to ensure appropriate behaviour changes. These handholding support was provided by the technical persons as well as the field staff of World Vision India.

In addition to the cleaner cooking practices, the project also focused on sensitising the children in the operational villages, on the importance of protecting and conserving the trees & forests, through various children’s club programmes – which included sensitisation workshops and use of activity books on trees & plants. The children also planted about 10,000 tree saplings which included fruit trees as well as shade giving trees. These were mostly planted in the backyards of their respective homes and also on common lands. It was observed, that about 85% of the saplings have survived and have started bearing fruits.

METHODOLOGY & RESULTS Percentage of Households on usefulness of Fuel Efficient Woodstoves

People’s Perception of the Percent Reduction in Firewood Requirement by using Fuel Efficient Woodstove

5% No 40

38% 29% 29%

30

20

10

95% Yes

04% 0 50%

The effectiveness of the project interventions were studied, with the help of a household survey comprising of 300 households as respondents and secondly indoor air quality from 8 operational villages were tested through independent NABL accredited labs, before and after the introduction of the clean cookstoves in the operational villages.

The survey was focused to find out whether the households have benefitted from these stoves, and the results of the survey are shown in the graph below: According the above graphs, it is observed that 95% of the users of the fuel efficient stoves have found it beneficial

in terms of the reduced smoke emissions, reduced firewood requirement and the comfort of cooking. About 67% of the households felt that the firewood requirement for a day’s cooking reduced by 50% - 60% as shown in the graph above.

The indoor air quality levels were tested for PM10, PM2.5, CO, CH4, and PAHs from 8 of the operational villages before and after the introduction of the improved stoves & biogas on various parameters, and the results are as shown in the adjacent graphs: It was observed, that the indoor concentrations of PM2.5 and PM10 levels inside the house were found to have reduced much below the

60%

40%

No difference

prescribed indoor air quality standards, through the use of cleaner cooking practices.

Similarly, the concentrations of carbon monoxide (CO), methane (CH4) and poly aromatic hydrocarbons (PAHs) were also found to have reduced well within permissible limits, in most of the samples tested except for a couple of cases.

In India, as there is no separate standards for the indoor air quality, the results of the air quality observed are compared with the ambient air quality standards prescribed by the Central Pollution Control Board of India. The standard limits for PM10 is 100 µg/m3 and PM2.5 is 60 µg/m3.

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Indoor PM10 concentrations before & after clean cookstove intervention in Project villages of Baran district in Rajasthan

The emission of methane gas from the traditional chulas though in low levels also contribute to the outdoor air pollution and has a high potential in contributing to global warming issues. The graph above indicates, that the use of clean cookstoves has decreased the methane concentrations in the indoor air, in comparison to the air quality while using the traditional open chulas.

Polycyclic aromatic hydrocarbons (PAHs) are a large group of organic compounds with two or more fused aromatic rings.

There are several hundred PAHs; the best known are benzo[a]pyrene (BaP), Anthracene, Coronene etc.

In the household context, PAHs are formed during incomplete combustion of fire wood, cowdung cakes and other biomass burning.

These are carcinogenic in nature and in combination with higher particulate matter concentrations, they further increase the cancer risk and other respiratory illness .

Though there is no prescribed standard available, for PAH exposure levels, the above comparative graph shows that the use of fuel efficient cookstoves have reduced the indoor PAH levels, thereby reducing the vulnerability of the household to health issues.

• Before • After

Indoor PM2.5 concentrations before & after clean cookstove intervention in Project villages of Baran district in Rajasthan

• Before • After

Indoor CH4 concentrations before & after clean cookstove intervention in Project villages of Baran district in Rajasthan

• Before • After

Indoor PAHs concentrations before & after clean cookstove intervention in Project villages of Baran district in Rajasthan

• Before • After

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CONCLUSION A large section of the rural communities in India, still depend on firewood, as their source of cooking energy – exposing themselves (particularly the children) to carbon particulates and other polluting gases coming from the smoke emitted from the chulas, leading to various health issues and also putting stress on the adjoining forest resources. In this context, it is important to look at pragmatic solutions to tackle these challenges, to ensure an environmentally sustainable and equitable development approach.

The Government of India, as part of its initiatives to tackle this issue, has launched the ‘Pradhan Mantri Ujjwala Yojana’, in May 2016, which provides free LPG connections to BPL families in India. It is expected to

spread the reach of LPG as cooking energy across the country. Considering the Indian context, where the remote villages of the country still struggle access to these LPG distribution systems and issues of affordability of the LPG cylinders (minus the subsidy), we need to wait to see the success of this programme.

A case discussed here in this paper, about the Sahariya tribe and their dependence on the forest resources – particularly with reference to the cooking energy needs, as well as their vulnerability to various health issues due to exposure to smoke from the traditional chulas, demonstrates a pragmatic & environmentally sustainable solution.

regarding the use of fuel efficient cook stoves & biogas energy for rural households, shows a very positive way forward in terms of tackling not only indoor air pollution [in terms of particulate matter concentrations (PM2.5, PM10), CO, CH4, PAHs] and associated health concerns, but also positively contributing towards addressing the issues of global warming and climate change.

The associated interventions of community sensitisation and tree plantations further ensure the sustainability of these practices and instil the sense of community ownership towards protection and conservation of the natural environment.

The results observed from the World Vision India project,

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Promoting Latrine Use in Rural Bihar: Formative Study Report

RESEARCH REPORT Promoting Latrine Use in Rural India Thematic Windowis a 3ie initiative jointly supported by Bill and Melinda Gates Foundation and r.i.c.e. (research institute for compassionate economics).

This formative study report (Phase 1 of thematic window)

is jointly done by Oxford Policy Management, ideas42 and World Vision India on improving latrine use in rural Bihar by increasing the intention to use the latrine among male household members and increasing habit formation among male

household members.

Authors: Oxford Policy Management, Ideas 42 and World Vision India Contact: sherin_daniel@wvi.org

EXECUTIVE SUMMARY Formative research and design work was structured around ideas42’s “define, diagnose, and design� methodology.

During the problem definition phase, we reviewed literature and carried out structured conversations with WVI to narrow the problem of focus to the following: 1. Increasing the intention to use the latrine among male household members; 2. Increasing habit formation among male household members.

During the diagnosis phase, ideas42 conducted behavioural mapping to generate hypotheses around barriers driving both problems. WVI carried out in-depth interviews, focus groups, and latrine

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observations in five villages in Nalanda. This process surfaced the following behavioural barriers to intention formation: ambiguity around pit emptying options, a strong aversion to self-emptying, and overestimation of pit filling rates. In combination, these created a strong belief that the latrine is a limited resource. The key barriers to habit formation were deeply embedded cultural rituals surrounding open defecation and lack of immediate rewards for latrine use. ideas42 carried out two structured design sessions to design intervention concepts that would target the behavioural barriers identified. OPM, ideas42, and WVI then worked collaboratively to revise and prioritize design concepts based on several team-wide

discussions.

After OPM conducted user testing to assess feasibility and effectiveness, we prioritized solutions to overcome barriers to intention formation, given that barriers to intention formation seem to be most relevant for households with latrines constructed through SBM. We continue to refine and explore two designs: a hypothetical technology (i.e. plastic pit liner) that would facilitate easier pit emptying and a card game to correct mental models around how quickly latrine pits fill.

Initial user testing highlights opportunities and challenges in taking these to scale.

CONTEXT All fieldwork for the formative study was conducted in Nalanda district of Bihar.

The district has a population of over 2.8 million persons with nearly 89% of the population residing in rural areas. Qualitative fieldwork was conducted in 5 villages: Sikandra, Rusaspur, Adampur, Tarokhar, Garedia Bigha.

We purposefully selected these villages based on toilet coverage, caste distribution, and exposure to the CLTS programme using maximum variation sampling.

Most government-constructed toilets in the villages were double-pit latrines. Those constructed by a contractor adhered to the standard pit-design under the SBM.

Most persons interviewed were unable to identify the SBM programme or its key objectives. Households had an inflated sense of the costs incurred to build a toilet and remained sceptical of receiving a subsidy from the government. In most villages, a contractor built toilets for the households and applied for the subsidy. These toilets did not have individual features that the household may have wanted to include in the toilet design.

Most persons interviewed express interest in owning and using a toilet, but were dissatisfied with the current design of the toilet. Toilets were used mostly by younger women in the household, with others referring to it as an “Emergency Toilet� to be used

at night time and in cases of ill health only. We found that the main reasons for toilet non-use were socialisation during open defecation, dissatisfaction with the toilet design, and fear of pit filling.

The key objectives of phase 1 fieldwork were to: 1. Verify findings from previous research on trends related to latrine use amongst households owning SBM-constructed toilets; 2. Gain an understanding of barriers related to pit filling and emptying; 3. Gain an understanding of current decisions and actions related to the processes of latrine use and open defecation.

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TABLE 1: DESCRIPTION OF ROUND 1 QUALITATIVE RESEARCH ACTIVITIES

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Number per village

Total number completed

IDIs

4; 2 male and 2 female

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FGDs

2; 1 male and 1 female (~6 persons in each)

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Latrine Observation

4

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INTERVENTION IDENTIFICATION Describe the methodology for identifying the intervention(s).

Intervention identification was carried out through behavioural diagnosis and design. a) Diagnosis: ideas42 team members carried out behavioural mapping, which consisted of charting the decisions and actions points around toilet use and hypothesizing behavioural/ psychological barriers to use. This mapping informed ideas42’s creation of qualitative research tools that were used by OPM in user testing.

Qualitative research activities, including in-depth interviews (IDIs), focus group discussions (FGDs), and structured latrine observations, were conducted

by OPM and are described in Table 1. The objective of this research was to understand behavioural bottlenecks to latrine use.

In preparation for individual interviews, OPM mapped each village to understand the communities that lived in various sections of the village.

In an effort to interview people across age and caste, they used maximum diversity sampling. OPM used snowball sampling to identify respondents for the FGDs. OPM also had discussions with the WVI block and village-level staff to better understand programming and SBM implementation in the area.

FGDs and IDIs were primarily conducted by contracted researchers with prior qualitative experience. Two consultants from OPM conducted training and were present for monitoring.

Researchers were trained for two days on sanitation research, the qualitative research guides, and the key objectives of the fieldwork.

All IDIs and FGDs were recorded, transcribed, and translated to English. b) Design: ideas42 carried out two creative brainstorming sessions to identify solutions to overcome barriers to intention formation and habit formation. Where possible, ideas42 reviewed studies on the effectiveness of similar interventions (those with analogous behavioural mechanisms) from other sectors to prioritize designs based on proven effectiveness.

Interventions proposed included household-based and community-based activities to shift mental models of pit filling rates, community-level competitions and rewards for latrine use, rituals and scheduling around latrine use, visual reminders of disgust around open defecation sites, and modifications to make latrine use more rewarding.

these designs were discussed, prioritized, and refined to identify feasible and impactful interventions. Each solution was tested for alignment with existing implementation models, compatibility with a rural Indian context, and adherence to behavioural science principles.

Design ideas that were prioritized for user testing included: • A plastic pit-liner for selfemptying of pits • A pit filling counting mechanism to address misperception of pit filling rates • A card game to correct mental models of pit filling rates • A game in the toilet for entertainment

Members of ideas42, OPM, and WVI joined for a design workshop to discuss and iterate on the solutions.

Over several days, each of

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INTERVENTION DESCRIPTION AND THEORY OF CHANGE. Barriers to intention formation centered around perceptions that latrines are a limited resource that should be conserved by restricting use to certain times of day, circumstances, and subsets of the household.

A perceived hierarchy of needs for privacy, safety, etc. within the household led to particular limits on use. In IDIs and FGDs, individuals referred to governmentconstructed toilets as “emergency toilets” only to be used during emergencies rather than for daily use.

They also stated that they constructed the latrine for young women or the elderly, limiting use by males. We also found that aversion to emptying pits oneself, hassles to emptying, and ambiguity about external means of pit emptying combined with misperceptions of pit filling rates generated a belief that latrines are a limited resource.

Currently, at the time of construction, options for pit emptying are not discussed and households are instructed to empty their own pits.

However, as documented by r.i.c.e. research and our qualitative fieldwork, there are strong cultural and religious barriers to self-emptying.

Design 1: A plastic pit liner to facilitate self-emptying. The pit liner would be porous to allow for decomposition and could be removed, covered, and transported to the site of disposal. With this solution,

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physically handling feces could be avoided. If designed properly, this design has the potential to significantly reduces hassles, cost, and ambiguity related to pit emptying and is expected to be more culturally-acceptable than other methods of selfemptying.

THEORY OF CHANGE: • Inputs: Pit liner. Note that this technology does not currently exist; would have to be engineered, manufactured and distributed in study communities.

size and a pit size and latrine type (single, double, etc.). The back of each card would have an estimate of how long it would take for the pit to fill.

Individuals would predict how long it would take for the pit to fill and flip the card over to see the actual estimated time. This intervention draws on research that suggests that we learn best on our own and through repetition.

The gamified aspect of the intervention increases the likelihood of participation.

THEORY OF CHANGE:

• Activities: WVI or Bihar Rural Livelihoods Association installs pit liner at time of construction; WVI explains pit liner and how it can be used for self-emptying

• Inputs: Card game

• Outputs: Households have pit liners in latrines; households understand how to use pit liners for selfemptying

• Intermediate outcomes: Households have correct understanding of filling rates; pit perceived as less scarce than previously thought

• Intermediate outcomes: Households believe they can empty their own pits; households view latrine as renewable resource; latrine use is not restricted

• Impact: All households members use latrine regularly; community-level shift in perceptions of pit filling rates

• Impact: All households members use latrine regularly; households use pit liner for self-emptying; other households see pit liner emptying process and also use liner to empty pits

The pit liner intervention could immediately lead to behaviour change amongst households receiving the liner if they immediately perceive self-emptying as a viable option. The pit filling exercise could also quickly lead to a change in behaviour but would need to be accompanied by an intervention to overcome barriers to self-emptying.

Design 2: A card game to correct mental models of pit filling rates. The front of each card would portray a family

• Activities: WVI team member plays game with households • Outputs: Household members have played game

PILOT OF THE INTERVENTION(S) The following designs were tested through user testing fieldwork: 1. A plastic pit-liner for selfemptying of pits [intention] 2. A wire and ring pit filling counter to address misperception of pit filling rates [intention] 3. A card game to correct mental models of pit filling rates [intention] 4. A game in the toilet for entertainment [habit formation] The key objectives of the user testing were to: • Test if design assumptions were correct; • Collect feedback from users on the intervention to refine the designs; • Observe how people interacted with the designs (when possible) to assess whether the design was achieving its purpose; • Identify feasibility of design implementation User testing entailed bringing low-cost, simple prototypes of the interventions to the field and carrying out activities with the prototypes and community members.

After these activities and demonstrations, the OPM researchers conducted brief interviews to collect participants’ feedback on the activities and prototypes. The plastic pit liner was tested with a plastic bag during the

first day, but this prototype caused confusion about the final days and in subsequent user testing was explained without a physical prototype.

The wire and ring pit filling counter was tested with a wire and a small number of metal rings. The card game was tested with quickly designed cards printed on paper. The game in the toilet was tested with a prototype of the loop and hook game.

User testing guides are in the appendix for reference.

Rapid user testing was done in a total of five villages over three days. All designs were tested during the first two days. Due to lack of acceptability and appropriateness, designs two and four were de-prioritized and not tested on day three.

We had initially planned to return to the villages in Giriak block where we conducted our initial interviews, but after the first 2 days of user testing we learned that a Block Development Officer had recently been promoting latrine use in the block. On the last day we visited two villages in Rajgir block to gather views from villages that had not been exposed to recent latrine promotion.

status. We visited a total of 25 households, 3-4 in each village. We interviewed an equal number of men and women during the testing.

In addition, we interviewed the Block Development Officer to understand the implementation of SBM, and specifically what, if any, promotional activities were being conducted.

A team of three consultants from OPM, two male and one female, carried out the user testing. All of them have experience conducting qualitative and process assessments and were wellversed with the project design.

At the end of each day, they held an hour-long call with ideas42 and other members of OPM to discuss the findings from the field, prioritize and modify design ideas. The team from WVI was continuously involved in the design and testing process and their inputs informed feasibility concerns. We only collected qualitative data.

Latrine use was not measured during user testing as the key objectives were to assess compatibility of designs and refine of designs.

We used maximum variation sampling. We focused on villages with higher toilet coverage and only visited homes with a toilet. We attempted to visit household with varying caste and wealth

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FINDINGS FROM THE PILOT We discarded both the wire and ring latrine filling meter and the latrine game during user testing. Given feedback during user testing, both interventions seem unlikely to be used. Their potential to be effective would rely heavily on whether or not they are used.

Further, the wire and ring filling meter could have unintended effects as it could make a filling pit more salient and thus discourage use.

Additional research needs to be leveraged to determine the logistical and financial feasibility of the latrine pit liner. We plan to discuss engineering of this design with product developers working both in the US and in India in the coming weeks. The card game intervention would be very low cost to create (less than 1 USD per household) and could be implemented by World Vision team members with minimal training or supplementary materials.

We received mixed feedback on the latrine pit liner intervention. Many community members insisted that they would not empty their own latrines even with this pit liner.

There were a few community members who were more open to the idea of using the liner to empty their own pits.

Further user-testing with a more representative prototype would be needed to validate or disprove our assumption that the pit liner would facilitate emptying one’s own pit.

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In the case of this design solution, we would define success as increasing consistent latrine use and reducing the perception of latrine pits as a limited resource.

We retain concerns on the feasibility of this solution achieving its objectives.

Success would depend on 1) proper engineering, manufacturing, distribution of the pit liners at the time of latrine construction and 2) the pit liners being perceived as a socially acceptable way to empty ones’ pit. Further investigation is needed to determine the feasibility of implementation and potential for effectiveness of this intervention.

We received generally positive feedback on the card game intervention. Community members were surprised by the numbers on the back of the cards, appeared to be learning the trends and patters in latrine filling times, and genuinely seemed to enjoy the game. We would define success of the card game as 1) effectively changing perceptions about pit filling rates and 2) increasing latrine use by making the latrine pit seem like a less scarce limited resource. Success of the card game would depend on proper implementation, and would likely need to be paired with another intervention to either make pit emptying more socially acceptable or to make the time to pit filling (~10 years) seem as far away as it is.

We would like to do additional user testing to explore interventions that could be effectively paired with the card game intervention to reduce barriers to self-emptying.

Through user testing, we did not assess change in behaviour.

There was feedback that the pit liner could be used to simplify emptying one’s own pit, but it was unclear if the intervention would be used for self-emptying given that there was no physical prototype for user-testing. The card game did facilitate learning of estimated time until pits fill, specifically that pits fill more slowly than previously thought.

Through qualitative research, we noticed bottlenecks to intention formation and habit formation, as anticipated.

However, amongst this population, the majority of households faced barriers to intention formation. The only households that did have an intention to use the latrine regularly were those with privately built latrines. These latrines had either much larger pits or septic tanks and therefore were not viewed as a limited resource. ideas42, OPM and WVI did not assess outputs and outcomes through this pilot.

IMPLICATIONS OF FORMATIVE STUDY What are the implications for intervention design and implementation?

One notable implication of this formative research is that interventions to increase latrine use in rural Bihar must address the structural and cultural barriers to pit emptying.

Given the SBM policy to 1) avoid mentioning external means of pit emptying and 2) insist that households empty their own pits, in combination with deeply ingrained cultural barriers to self-emptying, latrines are correctly perceived as a limited resource. Any effective intervention to increase latrine use in this setting must overcome barriers to emptying. Among households

with government-constructed latrines, habit change interventions are not likely to be effective. ideas42, OPM and WVI have designed an intervention concept to address barriers to pit emptying, but the feasibility and acceptability of this intervention needs to be assessed through further fieldwork with more households. User testing was conducted with a physical prototype (mesh bags), but this prototype did not have many of the key features of the proposed plastic pit liner. ideas42, OPM and WVI propose creating more

representative prototypes for further user testing. OPM and ideas42 will also need to do research on engineering, manufacturing and delivery of the pit liners.

The project team has an improved understanding of the implementation strengths and difficulties inherent in this work, and thus propose testing interventions that do not require extensive explanation or adherence to lengthy protocols. We intend to refine the ideas, based on technical and field feedback, and assess their potential for another round of testing.

REFERENCES FOR INTERVENTION DEVELOPMENT: Katherine Milkman, John Beshears, James Choi, David Laibson, Brigitte Madrian. (2011). “Using implementation intentions prompts to enhance influenza vaccination rates.” http://www.pnas.org/content/108/26/10415.full Saugato Datta. (2015). “Risking it all for love? Resetting beliefs about HIV risk amongst low-income South African Teens.” Journal of Economic Behavior & Organization. http://www.ideas42.org/wp-content/uploads/2015/10/JEBO-ideas42-Paper.pdf

LITERATURE REVIEW: Princeton University Graduate Student Report. (2016) “Ending Open Defecation in India.”

David Neal, Jelena Vujcic, Rachel Burns, Wendy Wood, Jacqueline Devine. (2016). “Nudging and Habit Change for Open Defecation.” http://documents.worldbank.org/curated/en/905011467990970572/pdf/104328-WP-PUBLIC-OD-Habit-and-Nudging-CatalystBehavioral-Sciences-022916.pdf Florencia Devoto, Esther Duflo, Pascaline Dupas, William Pariente,Vincent Pons. (2011). “Happiness on Tap: Piped Water Adoption in Urban Morocco.” https://web.stanford.edu/~pdupas/MoroccoWaterConnections.pdf Diane Coffey, Aashish Gupta, Payal Hathi, Nidhi Khurana, Dean Spears, Nikhil Srivastav,and Sangita Vyas (2014). “Revealed preference for open defecation: Evidence from a new survey in rural north India.”

Diane Coffey, Aashish Gupta, Payal Hathi, Dean Spears, Nikhil Srivastav,and Sangita Vyas (2016). “Understanding open defecation in rural India:Untouchability, pollution, and latrine pits.”

Aashish Gupta, Diane Coffey, and Dean Spears. “Purity, pollution, and untouchability: challenges affecting the adoption, use, and sustainability of sanitation programmes in rural India.” Sustainable Sanitation for All: Chapter 17. http://dx.doi. org/10.3362/9781780449272.017 Diane Coffey, Aashish Gupta, Payal Hathi, Dean Spears, Nikhil Srivastav, and Sangita Vyas. (2015). “Culture and the health transition: Understanding sanitation behaviour in rural north India.”

Parimita Routray, Wolf-Peter Schmidt, Sophie Boisson, Thomas Clasen and Marion W. Jenkins (2015) “Socio-cultural and behavioural factors constraining latrine adoption in rural coastal Odisha: an exploratory qualitative study.” BMC Public Health. DOI 10.1186/ s12889-015-2206-3

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ABOUT US World Vision is one of the world’s leading child-focused humanitarian organisations.

Through development, relief and advocacy, we pursue fullness of life for every child by serving the poor and oppressed regardless of religion, race, ethnicity or gender as a demonstration of God’s unconditional love for all people. With nearly 65 years of experience in India, World Vision works in 191 districts impacting 26 lakh children and their families in over 6200 communities spread across 26 states of India.

Strategy and Research Management, World Vision India For feedback and queries, contact: bestin_samuel@wvi.org

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