Creating the Hygiene Culture: Impact of Dettol School Hygiene Program

COVID-19, the most severe public health crisis of our times, amplified our need for hygiene & sanitation. Governments, policy makers, health workers and civil society swiftly ramped up hygiene infrastructure and education in their drive for a disease-free world.

Following this trend Samhita & Collective Good Foundation partnered with Reckitt Benckiser to launched the Dettol School Hygiene Education Programme in the State of Andhra Pradesh in 2015 and extended the programme to Telangana by 2016 and to Tamil Nadu by 2018.

The programme builds knowledge, attitudes, practice and behaviour around hygiene in children by engaging children as collaborators, letting them drive the change. It builds their leadership and critical-thinking skills and enables them to solve hygiene problems in creative, sustainable ways, like solving the problem of access by setting up soap banks, ensuring hygiene through Child Parliaments and more.

In a boost to the programme, the curriculum was translated into several local languages, easing the path to adoption and engagement across South India. In another first, Collective Good Foundation introduced digital learning through government education portals. Andhra Pradesh was the first state to upload digital video episodes on their DISHA portals. These videos are accessible to all schools and teachers at the touch of a button and now reach 2.5 million students across 42,000 schools.

Click below to read the full report on how the Dettol School Hygiene Education Programme is developing a culture of hygiene in India’s children.

Why the health of sanitation workers needs to be our society’s concern?

“In a world without sanitation workers, business and daily life would come to a halt”.

It may seem too extreme to state but is nevertheless true. Without sanitation workers, the functioning of our ecosystem will halt as supply chains of products and services are adversely affected.

Samhita believes that it is essential to ensure preventive health care for our sanitation workers to not only ensure the smooth functioning of our society but also enable them to live a life of dignity. Our WASH platform and, more recently, our IPA platform aims to put money where our mouth is.

To know more about our approach, read this article written by Priya Naik, Ragini Menon and Tushar Carhavlo for CNBC-TV18.

Our Private Healthcare System’s COVID-19 response can make or break India’s future

India has a mixed healthcare system, with majority of healthcare services being provided by the private sector. This accentuates the importance of private health care enterprises to partake in providing smaller and district level health providers with the support to continue functioning during economic upheaval.

Public health and economic experts stressed the importance of organising and fortifying the private healthcare system’s response to the COVID-19 crisis. They unanimously believed that investing in streamlining and strengthening the public healthcare system today can prepare the country for the long haul.

Check the key insights from our webinar ‘Strengthening the public health system is in our enlightened self interest’ and Samhita’s take on it.

Are healthcare facilities accessible to India’s tribals?

“India no longer has the luxury of continuing to wait and watch as millions of its tribal peoples suffer and die from preventable causes.”

There is a much higher incidence of maternal and under-five mortality, stuntedness, tuberculosis, and cardiovascular diseases among India’s 104 million tribals compared with the larger population.

Piramal Swasthya and The Bridgespan Group map out the reasons for the lack of reduction of health challenges in tribal areas based on their field studies.

They outline factors such as barriers in access to healthcare and information, insufficient number of public health facilities, and lack of data.

They stress that for scalable and population-wide impact to be achieved, especially to meet India’s national aspirations of Sustainable Development goals of health and well being- a focused and collaborative approach between all stakeholders of society is the only way forward.

The key to COVID-19 prevention in slums

Slums across India have been disproportionately affected by the COVID-19 crisis. 42% of Mumbai’s population lives in slums and therefore they require carefully planned measures to ensure that preventative and primary care remain accessible.

The Bridgespan Group and WHO emphasise that community participation is the key to implement any COVID-19 preventive interventions in the slums.

This is as a model of care, designed while incorporating community participation is more likely to be accepted and effective in the long-term. To elaborate on the practicality of their recommendation, they describe activities where communities have been engaged and relay how this principle helped the programs in Mumbai slums.

WASH Platform | Wash Grand Challenge (2019)

The WASH Platform builds synergistic collaboration between multiple stakeholders from the Private Sector, Development Sector and the Government, to identify, implement and replicate high impact projects across the sanitation value chain, starting from the state of Maharashtra.

The platform is a joint initiative between Samhita Social Ventures and India Sanitation Coalition in partnership with The Government of Maharashtra, The Bill and Melinda Gates Foundation with UNICEF and CEPT University as knowledge partners.

VIACOM18 | How to impact through the media lens

In a time where majority stakeholders were concentrating on building infrastructure to achieve the mission of Swachh Bharat Abhiyan, Viacom18 utilized the weapon they knew best – storytelling to create lasting impact in a society that has long been captured by the screen.

The Viacom18 story

With the launch of Swachh Bharat Mission, availability and access to toilets had improved tremendously. But social and behavioural change communication were far from implementation questioning the long-term adoption of infrastructure usage. Lack of sanitation has many rippling effects. 

The economic deprivation increases manifold when healthcare expenses and the cost of lost potential due to sickness arising from inadequate sanitation is added.

With the belief that sustained change in behaviour is at the helm of creating long term impact, Viacom18 worked with Samhita to design an intervention that aimed to address the issue of Open Defecation in Mumbai’s slums and inadequate sanitation in schools.

How did we impact 8,000+ lives

Samhita designed and implemented a community sanitation program with a focus on strong behaviour change in addition to providing basic infrastructure. Our theory of change centered around changing behavior, beliefs, and myths around toilets as a key to ensuring sustained open defecation free status in all communities and schools. The idea was to design visual messaging at key locations in slum areas, followed with awareness campaigns that brought together a social message with Viacom’s unique panache for storytelling.

Our vision of multiplying the impact by evolving the approach from infrastructure to behavioral change was distributed in 3 stages.

Geography

Impact

Kimberly Clark | Making lives better through purpose driven brands

The global effort to achieve sanitation and water for all by 2030 is extending beyond the household to include institutional settings such as separate washrooms in schools and workspaces. 

About 94% of women are employed in the informal sectors, according to the National Women’s Commission. Such informal sectors lack basic sanitation facilities including toilets. Public toilets, even if available, are often unsanitary and poorly maintained. Without access to toilets, women and girls develop coping strategies like drinking less water that in turn increases the risk for women’s health problems and their well-being, especially in times of menstruation. The extent of the problem is large in the school ecosystem across India

With the mission to create better workplaces that are healthier, safer and more productive, KCP in partnership with Samhita, designed two projects- 

  • Provide improved sanitation infrastructure in rural schools in Maharashtra and nudge children to adopt better sanitation habits
  • Provide increased access to better sanitation facilities for women working in informal markets

How did we impact 2000+ women and children’s lives

Project 1- The project aimed at solving two key challenges-

  • Poor usage of toilets by children in schools, and
  • Absence of hand washing facilities at critical junctures

We collaborated with the Swachh Maharashtra Grand Challenge, a first-of-its-kind open innovation platform, in partnership with the government, corporate & social sector to address the key challenges in the sanitation ecosystem; by identifying and piloting innovative programme models across sanitation value chain. We identified 4 major components under this setup-

How to address the school sanitation ecosystem

Project 1 – The project aimed at solving two key challenges –

  • Poor usage of toilets by children in schools, and
  • Absence of hand washing facilities at critical junctures

We received 50+ innovative solutions from across the country. A thorough review of the applications led us to select the most innovative and sustainable programs that would help build an impactful ecosystem in school sanitation. KCP and Samhita together set the journey from selection to knowledge dissemination for the selected programs:

  • Providing grants to selected pilot programmes
  • Coaching & mentoring
  • Project monitoring & evaluation, and
  • Knowledge dissemination.

The project impacted 2000+ children of Chandrapur, Maharashtra.

How to help women access sanitation in informal markets

The second project aimed at addressing the need for safe sanitation facilities for women working in informal markets. We shortlisted GARV TOILETS and CORO as implementation partners. The project provides sanitation facilities with following features:

To provide holistic, effective and sustainable sanitation impact, four components were designed:

  • Localised Behaviour Change Communication
  • Menstrual Hygiene Management
  • Operations & Maintenance
  • Waste Management

To support the end-to-end implementation of the project, Samhita leveraged their in-house expertise through the following stages- providing operational plans, developing standard operating procedures, monitoring and evaluation progress and outcomes and providing capacity building support for the implementation partners.

The project impacted 2000+ women in Kurla, Mumbai, Maharashtra.

Geographies

Project 1: Chandrapur Maharashtra

Project 2: Kurla, Mumbai, Maharashtra

Impact Numbers

4000+ Lives Touched

The need for sustainable sanitation solutions

The Prime Minister’s call for a Swachh Bharat Abhiyan in 2014 has reactivated the demand to provide better health and hygiene to communities. The mission became one of the first big priorities of CSR, after the law came into force, with several companies, foundations and individuals pledging their support to the cause of sanitation. While providing infrastructure and other resources is critical, it is also equally important to practice a holistic approach to implementing such programs.

 Sanitation, or WASH (Water, Sanitation and Hygiene) issues are divided into two broad categories of supply and demand. Supply side issues include building toilets, drainage systems and the availability of water and electricity. Issues that affect demand are to do with caste, location, environment, security, social prejudices, religious beliefs etc.

The government continues to restrict support to supply issues without adequately addressing demand barriers. It has capped the spending on Information, Education and Communication (IEC), to 15% of the budget signalling that it is secondary to creating infrastructure.

India is suffering from a serious sanitation crisis: we have the largest number of people practising open-defecation in the world. The situation is so bad that open defecation is more common in India than in poorer countries like Bangladesh, Pakistan, Kenya and Rwanda. To achieve the primary objective of Swachh Bharat and end open-defecation in India, it is critical that both aspects of WASH are addressed. In this context, it would be helpful to understand some of the ground level challenges, gaps and the scope for companies to provide sustainable and scalable support to the sanitation ecosystem.

Construction: The need for well-built toilets

Most companies have pledged to build toilets, which is desperately needed to combat the practice of open-defecation. India needs sanitation infrastructure for the more than 600 million people who do not have access to a toilet.

Construction is a cost-intensive activity and yet could be a half-baked solution if issues related to availability of water, electricity, land, manpower and appropriate toilet designs are not addressed upfront.

Companies need to rise to this challenge and focus on building good quality toilets. The one-size-fits-all approach cannot work because of vast differences between urban and rural spaces and variances in community practices and beliefs across geographies. Badly constructed toilets will also further discourage use.

What is needed is a concerted effort to build toilets that people will be encouraged to use, that keep in mind specific community needs, and also ear-mark resources for maintenance. There is also scope for funders to look at the renovation of existing toilets that have fallen into disrepair, reducing the need for cost-intensive construction projects.

To successfully tackle the problem of open-defecation we need to approach the issue holistically and encourage behaviour change rather than measuring our success by the number of toilets being built.

Critical WASH components that need support: maintenance, waste management and capacity building

A critical factor that is failing to receive adequate operational support is the maintenance of toilets. Hundreds of toilets lie unused due to the lack of proper maintenance systems – the total maintenance allocation for schools under the Sarv Shiksha Abhiyan (SSA), including cleanliness, consumables, and small repairs is a paltry Rs. 5000 a year. Providing a reasonable percentage of the budget to ensure proper maintenance – at least for some period of time after installation – can be a critical input for WASH programs.

Attention also needs to be paid to supplementary components like waste management, drainage systems, waste-water treatment, fecal sludge management and capacity building.

Companies also fail to strategize their exit from communities. Very few CSR efforts have exit plans that build in takeover by the community, which is essential to ensure longer-term sustainability of the initiative and durability of the intended outcomes. Another way of ensuring the sustainability of programs is through collaborative interventions, which provide a wider donor base for communities to draw upon. It is necessary for companies to support the sanitation ecosystem in a way that programs can be sustained after their exit.

Changing behaviour

Behaviour change communication is critical to ensure the usage of toilets. Messages need to be professionally developed and context-specific to account for the widely different reasons for open-defecation in urban and rural spaces. For example, rural areas are governed by socio-cultural practices, whereas the issue in urban areas is related to space, time and maintenance.

For FMCG companies, behaviour change campaigns also present an opportunity to strategically address the imperatives around WASH through cause-marketing campaigns, rather than be seen as pure CSR initiatives.

The need for sustainable solutions

The CSR mandate has motivated companies to participate in the Swachh Bharat campaign but in order to meet the goals of the campaign, CSR efforts need to be channelled towards interventions that are sustainable in the long-term.

Samhita strongly believes that in order to effectively address the problem of open-defecation companies need to fund end-to-end solutions that support the sanitation ecosystem. Programs should include the construction and maintenance of toilets, behavioral change communication, monitoring impact and sustainability. The program life-cycle should be designed such that all aspects of WASH are adequately covered.

We are not, however, suggesting that companies take on the entire responsibility at an individual level; companies could pool funds or create/join coalitions with other key stakeholders like Foundations, research bodies, social organizations to support specific interventions and drive collective impact.

2019 may be the year when India has a 100 million more toilets but unless the government, companies and other key stakeholders adopt a more holistic approach to sanitation, those toilets will lie abandoned and unused while people use the fields they find so pleasureable and convenient.

– Mr. Vaidyanathan Krishnamurthy