Consumer Study: Study of Sanitation Users in Madhya Pradesh

Inception Report

Submitted to The World Bank, New Delhi

By

Pragna Research & Consultancy Services Hyderabad

October 2008

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

1. Introduction

1.1. Water and Sanitation Program (WSP) in Madhya Pradesh: A brief overview

The Water and Sanitation Program (WSP) is an international partnership, administered by the World Bank, to help the poor gain sustained access to improved water supply and sanitation services. WSP works in partnership with country client governments, external support agencies, water sector professionals, civil society and private organizations to improve various institutional, technical, economic, financial, and legal aspects of service delivery options and to promote large-scale programs to accelerate service provision to the poor. It identifies and analyses key sector problems, identifies solutions, documents and shares lessons from the field and disseminates information and knowledge at local, national, regional and global levels. Administered through the World Bank, WSP is supported by over 15 different funding partners from around the world. WSP has regional programs in Africa, East Asia & Pacific, Latin America & the Caribbean, and South Asia. In South Asia, the WSP program, known as WSP-SA, is based in New Delhi, India and has offices in Bangladesh and Pakistan. WSP contributes to Millennium Development Goals in halving the proportion of people without access to safe drinking water and adequate sanitation by 2015.

To meet the sanitation goals of MDG, the Government of India has set an

ambitious target of constructing a latrine in every house in all villages by 2012.

However, it is to be mentioned that earlier goals set up by Gal during successive

Five Year Plans has fallen short of targets. While pursuing Total Sanitation

Campaign (TSC), no doubt, the emphasis has been laid on a participatory and

demand driven approach. In line with its goals and with similar objectives, since 2006, WSP has been implementing the Gates Foundation funded 'Total

Sanitation and Sanitation Marketing: New Approaches to Stimulate and Scale up

Sanitation Demand and Supply Project'. The Gates Foundation project has the

aim of scaling up sanitation activities by learning about efficient and effective

interventions to improve health of rural masses. Madhya Pradesh is one of the partner states under the project.

Promotion of sanitation practices is not new to Madhya Pradesh (MP). Water Aid and UNICEF are already active in the state. The Total Sanitation Campaign

2

(TSC) is under implementation all across the state. Even historically, Madhya Pradesh has taken few initiatives to encourage sanitation in villages. According to Clause 36 of the MP Panchayat Raj and Gram Swaraj Act, 1993, if elected representatives at the grassroots level fail to install toilets within a year of being elected, they would be disqualified. It is learnt that this has been implemented by GoMP. More recently, GoMP has agreed to initiate and implement Community Led Total Sanitation (CL TS). WSP is also extending its support to orient and motivate key stakeholders in the implementation of CLTS.

1.2. Background and Context of the Study

The TSSM programme of Gates Foundation has the aim of scaling up sanitation activities by incorporating learning on the interventions to improve the health of rural masses.

The Program has been conceived to meet the basic sanitation needs of rural poor by developing practical knowledge for designing sanitation and hygiene programs that are effective at improving health in a sustainable way. Further, the project plans to test proven and/or promising approaches to create demand for sanitation including the use of marketing techniques.

Amongst various factors in the extension of sanitation in rural areas, consumer behavior emerges as one of the most important factors. Consumer behavior is governed by various determinants as social, cultural and economic background of the people as well as education, media exposure, health awareness, access to resources, and incentives. In view of this, the current Study has been initiated to assess the consumer behavior to better streamline Total Sanitation and Sanitation Marketing (TSSM) Prgramme in Madhya Pradesh.

1. The Specific Objective of the Study

One of the central objectives of the Gates Foundation project is to improve sanitation at a scale sufficient to meet the MDG sanitation targets in the state of Madhya Pradesh. In this context, the study has been initiated with the basic purpose of gathering baseline information that can be used to design a program to better streamline TSSM in Madhya Pradesh.

The specific objective, as stated in the ToR, is to identify key household motivations and barriers (perceived and actual) for safe and hygienic sanitation practices, and preferences for latrine facilities that can be used to develop communication strategy and effective supply mechanisms in the state of Madhya Pradesh.

3

3. Description of Tasks

The study comprises three major activities. While the first two activities are taken form the ToR, the third activity has been proposed at the review meetings with the WB team.

• Activity 1: Study of consumer behavior in relation to defecation practices. It aims to assess the motivational factors for adopting and barriers for not adopting safer and hygienic defecation practices.

The Study would explore into the consumer behavior (with socio­economic, ethnic, gender and age differentials). This information would be then combined with efficacy of the current communication strategies (based on qualitative information from key informants and press/media and feedback from CCDU/government officials). An analytical consolidation of this data would provide the base to develop better communication strategies for the future.

• Activity 2: Survey of existing latrine technology options along with their cost, affordability and acceptability. This shall encompass different designs of latrines available/communicated to the community and constructed, and the household perceptions (positive and negatives) of the same with regard to cost, ease of cleaning/management when pits are full etc.

• Activity 3: Assessment of Supply mechanisms: This shall explore into the perceptions of households/consumers on available supply chain mechanisms for construction materials including Rural Sanitary Marts. The perceptions shall include features like cost, convenience, quality, awareness, breakage in transportation etc. In addition, information on availability of trained masons and their skill sets (competencies to construct different designs) shall be explored. The assessment shall also review other supply chain models in practice in non-sample districts and their advantages and limitations as recorded. Overall, advantages and limitations of both centralized (single point availability of all materials required for construction of toilets) and decentralized models (materials are available at different shops/locations i.e. shop for toilet pans, shop for cement) besides their location, or a combination of above, shall be examined in the field from the perspective of consumers, so that a strategy for sanitation marketing could be developed.

4

4. Approach and Methodology

4.1. Approach

Participatory and interactive approach is employed for collection of data. As regards the method of data collection, both qualitative and quantitative methods would be employed.

The prime focus of the Study is the behavior of rural population in relation to sanitation practices, which is influenced by tradition, caste, ethnicity, religion, income, education, media exposure, health awareness, age, gender, peer prE!ssure, etc. It is expected that the study would assess the degree and extent of the influence such variables on the behavior of the different segments of population towards sanitation practices vis-a-vis the adoption or rejection of improved facilities. Such an analytical understanding would help in designing the content and media for effective communication.

In accordance with the above questions, the sampling, methodology and the tools for data collection are developed.

The study will be carried out in the selected districts of Madhya Pradesh, i.e., in Khandwa, Jabalpur and Chhattarpur. These districts have been selected by The World Bank based on the performance of Total Sanitation Campaign as well as to represent different socio-economic strata. In each of these districts, in consultation with the district authorities and CCDU officials, 5 villages will be selected based on their present sanitation status as a result of TSC campaign.

The composition of these 5 sample villages will be based on the following criteria: • One NGP village • One village -which was earlier an NGP village but had partly abandoned

the use of toilets • One non-TSC village • One village where TSC has made little impact. • The fifth village shall be selected either from Non-TSC I little TSC giving

adequate representation to the status of TSC and geographical distribution.

5

4.2. The sources for collecting data

4.2.1 Secondary sources

A thorough literature review would be taken up. The details are given under the heading '4.3. Desk research'

4.2.2. Primary Sources

1. Sample Population form the target population.

1. Male : open defecators 11. Women: open defecators iii. Community members (men and women) -who have toilets

and procured sanitary materials and masons

Under qualitative information, process of decision making within families and communities, influence of children and others in decision making, impact of peer pressure etc. shall be understood. This information would be correlated with other variables as caste, ethnicity, religion, income, education, media exposure, health awareness, age and gender.

To ensure this analysis, stratified random sampling is employed to capture

the influence of the different variables mentioned in the above paragraph.

11. Key informants

1. Masons

11. Elected representatives (Sarpanch, Panch, Ward Members)

etc.

111. Press/media at district level iv. Government officials at the village/Block/District level (CCDU

officials, TSC worker, Aanganwadi worker etc.) v. Opinion-makers of the village (Big landlord, Priests,

traditional leaders, school teacher etc) - interaction shall be held with only those, who command considerable influence

on the village community or a specific group in the village. v1. Office bearers of CBOs, SHGs and other informal groups in

the community

6

4.3. Desk Research

To understand the intricacies of the background and the sanitation scenario especially in Madhya Pradesh (MP), it is most appropriate to conduct a desk research, i.e. to carry out the review of the available literature. The literature shall be collected from various sources like WSP, UNICEF, Water Aid as well as other literature available on the web. While reviewing the literature, focus will be on sanitation scenario in MP, activities and performance of Total Sanitation Campaign (TSC), Technological options, existing Supply Chain Mechanism and its advantages and limitations, cultural and ethnic variations in sanitation behavior (including for tribal), besides the institutional structure, legal and policy support to sanitation improvements in the state. While reviewing the activities under TSC, secondary data/information shall be specifically collected about village wise activities, year wise NGP villages (Nirmal Gram Purushkar- which is awarded on achieving 1 00% sanitation) and about the villages-which have lost their status as NGP villages.

The review shall include (but not limited to) consumer behavior in relation to health and hygiene, impact of legislative measures on sanitation movement, advantages and limitations of different marketing strategies adopted for sanitation materials, applicability of different designs of toilets in MP (and more specifically in selected districts considering soil type, water availability, ease of management, cost, socio-economic strata, human behavior etc.), performance of TSC, initiatives of UNICEF and WSP and their performance evaluation reports etc. The outcome of the review shall be a better understanding of the sanitation scenario in MP and the ways to support/improve the current research study.

As has been conveyed during the review meetings with the WB team, the literature review will be an ongoing process. It would serve the following purposes:

• Fine-tune data collection form the field • Ensure quality assurance: The information updates would provide us with

better knowledge-base in the analysis of data from the field. • Add to the content of the final report

4.3. Sampling of House holds/ Consumers for Data Collection

4.3.1. House hold survey

From each village, a sample of 30 households will be selected for Interviews by structured interview schedules.

7

Stratified random sampling method will be adapted to identify the households for the survey. The variables for sampling would be the following:

• Age • Gender • Caste/ethnicity • Education/Media exposure

These variables will be applied to the following three categories of population: • Male : open defecators • Women: open defecators • Community members (men and women) -who have toilets and procured

sanitary materials and masons

Voters' list will be the base document for identifying the respondents. Active assistance will be sought from the surpanch, ward members, angan wadi teacher/ school teacher and village elders.

With the forthcoming elections, this list should be easily available. In case of difficulties in acquiring such a list, right hand rule shall be used to select the number of sample houses. Even in such cases, care would be taken to ensure the inclusion of the various strata of population.

4.2~.2. Focus Group Discussions

4.3.2.1. Village level

• Masons • Open defecators- Men • Open defecators- Women • Elected Representatives and members of Panchayat Raj Institutions (PRI)

These FGDs would supplement and validate the data collected through the household survey. Deeper probe would be taken up at the FGD on the motivational and behavioral aspects.

4.3.2.2. District level

Press/media personnel: FGD would probe into their modus operandi of communication with rural communities and to assess the effectiveness in addressing health and sanitation issues in the villages.

8

5. Protocols for the Study

The protocols would refer to the code of conduct and the procedures for accomplishing the Study with quality and promptness in the different phases given below:

• Creation of enabling environment I Structural support for the smooth conduct of the Study

• Data Collection • Pre-test and finalization of tools for data collection • Recruitment and Training of Investigators • Data Analysis and Report writing

5:1. Creation of enabling environment

Kick-off meetings in Districts/ State level: At the outset of field work, State level officials will be contacted to gather basic information on the status of TSC, relevant Government Orders/ Circulars and seek their cooperation to inform the offilcials at village level to extend their cooperation in carrying out the study. CCDU and TSC officials at District level will be contacted to develop insights on the district, existing institutional structure and legal provisions, issues/constraints in !implementation (including communication) etc. Besides, a list showing present status of TSC in Gram Panchayats (GP)Nillage shall be collected. It would contain NGP villages, villages which has fallen back etc. Further, detailed discussions would be held on the process of selection of latrine technology for the district, community participation in the same and its suitability in local conditions. From GP level officials, household/voters list will be collected for selecting the sample households after local level validation.

5.2. Data Collection

5.2.1. Broad areas for Data Collection

The following broad areas would be covered while collecting the data from the various sources. All the tools would be geared towards these broad areas

• Consumer Behavior Study: This area of enquiry will focus on the attitudinal, motivational and behavioral variables in opting for a particular defecation practice and the degree of openness for change in opting for improved practices.

9

• Latrine Survey: This will cover the technology and its advantages and limitations including cost, affordability, management issues etc. While having discussions with CCDU officials, the reasons of selection of few I single latrine technology and the process to identify appropriate latrine technology for the area shall also be understood. Similarly, masons shall be able to provide pros and cons of these technologies for local conditions including soil, water table, construction, cost and repair considerations.

• Supply Assessment: Data from masons shall be collected on technology, availability of trained masons, their perceptions etc. as well as availability of sanitary materials and their views on sanitary marts. Discussions with local community (who has opted for toilets) and sanitary material suppliers shall also be conducted to understand the pros and cons of existing practices in marketing.

5.2.2. Tools for collection of Data

Interviews and Focus Group discussions would be employed for collecting data. The following tools would be administered:

• Structured Interview schedules for household survey • Semi-structured Interview Guides for collecting information from the key

informants • Checklist for FGDs

The data/information collected during the desk research shall be integrated into development of questionnaire and check list for FGDs.

The applicability and efficiency of the tools would be assessed through pretest. The feedback of the WB team would also be incorporated. Based on the pretest and with the feed back of the WB team, the tools would be finalized.

5.2.3. Transect walk

Before employing the structured interview schedule and FGDs in the selected vWages, and after meeting the Sarpanch/key persons in the village, a transect walk would be undertaken by field staff. This is meant to capture the general sanitation condition in the village, the behavior of the population and to find out the various groups as well as key informants who would be able to provide key information during the process of the Study.

10

During this, general information on soil type, availability of hard and soft strata, soil characteristics mainly from porosity considerations and type of latrine technologies used by various households shall be understood and recorded.

The transect walk would help in identifying the intermixing or otherwise of different social I ethnic groups and help in broadly understanding and assessing sanitation and hygiene behavior of different social groups. These observations shall be part of the qualitative information. They would also serve as the background information for making deeper probe during the interviews and the FGDs.

5.2.4. Household Survey

House hold survey would be done by employing structured interview schedules. The survey would capture information on the behavior of the sample population with regard to sanitation practices and would dwell on the motivating factors as well as the barriers for a particular behavior. The interview schedule would also elicit information on the socio-economic background, income levels, cultural norms, caste and ethnicity, education, defecation practices, their perceptions for acceptance/non-acceptance of toilets.

At the analysis stage, the correlation between a particular behavior and the corresponding socio-economic and psychological variables would be established.

It is expected that such a correlation would help in segmenting the target population for different communication packages.

The schedules would also capture data on technology adopted I not adopted, perceived I experienced pros and cons of these technologies etc. besides role of community groups/individuals in supporting TSC.

5.2.5. Focus Group Discussions (FGDs)

Checklists would be prepared for each of the groups mentioned under 4.3.2. The content, focus and the nature of the questions would vary for each group. Care would be taken to follow the norms and procedures for conducting FGDs.

Quality assurance will be ensured in the following areas:

• The constitution of and composition of groups • Initiation of the process of discussion

• Sequencing of questions

11

• Facilitation and moderation • Participation of the members • Recording of the discussions

As mentioned already, there would be separate groups of men and women open defecators.

After initiating the group into discussions, the facilitator would pose the points for enquiry before the group in a sequential order, starting with the simple and the apparently 'easy to respond' queries. The sensitive questions would be posed after the group members get into the mood and tempo of discussion. Starting with the peripheral level, the facilitator would probe deep into the motivational and behavioral variables. The tradition/ culture related queries as well as the community-based practices would be probed. When it comes to women groups, the special needs of women from a bio-psycho-social perspective would be covered.

The FGD with toilet adaptors shall seek its present status, advantages and limi!tations against what was conveyed during TSC campaigns, issues in procurement of sanitation materials as well as trained masons.

The FGD with press/media at district level shall address qualitative information on communication techniques employed for sanitation messages and their efficacy besides what could be done to improve awareness and knowledge levels in the specific field, for different target groups etc.

5.2:.6. Interview with Key informants

Non-structured Interview guides would be employed to collect information from the key informants listed under '(ii) 4.2.2- Primary Sources of data collection'. Separate interview guides would be employed to each of these groups depending on the nature of data to be collected.

5.2.6.1. Government. officials at the village/Block/District level (CCDU officials, TSC worker, Aanganwadi worker etc.):

To collect information on their experiences on consumer behavior, latrine technology - selection and process, pros and cons of present techniques of sanitation marketing as well as their general experience sharing in pursuing TSC.

12

5.2.6.2. Opinion-makers of the village (Sarpanch, ward members, Landlord, Priests, traditional leaders or any specific individual affecting opinions in the village - could be a school teacher):

To have their perceptions on health and hygiene, sanitation behavior and involvement of typical communities/social groups in TSC, ways to improve availability of materials for latrines (sanitation marketing) and efficacy of communication strategies (mass media, camps etc.) followed in the village etc ..

5.2 .. 6.3. Office bearers of CBOs, SHGs and other informal groups in the community:

To have their views on specific group (to which they belong) perceptions on health and hygiene, sanitation behavior of typical groups, involvement of community in TSC, ways to improve availability of materials for latrines (sanitation marketing) etc. and efficacy of communication (mass media, camps etc .. ) practices followed in the village etc.

5.2.6.4. Suppliers of Sanitary Materials at Local level:

To have their views on supply and demand at their shops, role of masons, elected representatives and CCDU officials in generating local demand, pros and cons of present marketing mechanism, issue of availability and demand of quality sanitary materials, in which marketing mechanism they would be interested in (centralized, decentralized or a combination etc.) and why.

5.3. Pre-test and finalization of tools for collection of data

All the research tools including Interview Schedules, FGD checklists and Interview Guides will be pre-tested in the nearby GPs of Bhopal. This shall be carried out in local language with due local sensitivity. Based on the feed back from the field, modifications will be made and fine-tuning of the tools will be done. The draft tools finalized at the level of Pragna will be then submitted to WB team for comments. Then the tools will be finalized by Pragna incorporating the comments of WB team.

5.4 .Recruitment and Training of Investigators

Field staff comprising Supervisors and Investigators shall be taken from a pool of qualified and experienced interviewers with the necessary linguistic skills and cultural sensitivity. Their knowledge about the selected districts, customs, knowledge of local dialects and experience in the field of health/sanitation etc.

13

shall be key points for consideration. One Supervisor and three Field investigators will be selected for each district. To address the gender issues and to ensure that women-FGDs are facilitated by women, a minimum of one female member will be part of the team.

A three day training program shall be conducted by the Pragna Team members.

During first day of the training, sessions would focus on • Water and sanitation practices, • Health and hygiene practices, • Issues in open defecation, • Objectives of the study, • Research process and methodologies and techniques to capture

sanitation • Social mapping of the village by transect walk.

On Second day would focus on:

• Tools for collecting data(lnterview Schedule, FGD Check lists and Non-structured Interview Guide)

• Interview techniques • Observation skills • Facilitation skills • Documentation and reporting

Ro,le plays and demonstration will also be employed.

On third day, actual field training shall take place by taking them to a village not too far from the place of training. The trainees shall be divided into two groups. In the evening, experience sharing shall be done between the two groups and corrective feed back will be given.

5.5. Data Analysis and Report Writing

5.5.1. Data Entry: Quantitative information will be analysed using computer packages like SPSS. Necessary codes would be developed prior to administering the questionnaire.

5.5.2. Data Cleaning: Before undertaking a quantitative analysis, data shall be scrutinized for missing (unanswered) questions and wrong answers. They shall be suitably modified I deleted using missing data techniques.

14

5.5.3. Data Analysis and Findings: The primary and secondary data collected from various sources will be consolidated and analyzed by employing appropriate statistical tools like SPSS. Regression analysis shall be done to assess correlations and variations among social groups. T-test and chi­square tests may be employed depending upon the exact needs.

The purpose of analysis shall be to determine the following:

• Consumer Behavior: This shall provide the motivational factors and barriers in adoption of improved sanitation practices.

• Technological Options: Assessment of technological options, assessment of soil type, availability of hard and soft strata, soil characteristics mainly from porosity considerations and type of latrine technologies used by various households. These data is expected from transect walk and Individual Interviews. This shall be supplemented with the data generated at the FGDs with masons, who would provide inputs on advantage and limitations of various technological options.

• Supply Chain Mechanism: While analyzing the supply chain mechanism for sanitary materials, efforts shall be made to define a village/local level model for supply of sanitary materials to facilitate construction of locally suitable toilets. This model could be either a centralized (all sanitary materials required for toilet construction, available at one location) or a de-centralized model (each shop specializes in specific sanitary materials) or a combination model, based on the experiences in the sample districts as well as in non­sample districts. The findings from non-sample districts have been proposed to be included to provide wider perspective of supply chain mechanism, which could be used for MP as a whole.

6. Preparation of Draft Report

Based on the analysis of the data form the Primary and Secondary sources, FGDs, transect walk, individual and personal observations (during transect walk

15

and later during survey), a draft report will be prepared and submitted to WSP team as per the agreed time schedule.

7. Submission of Final Report

After duly incorporating the suggestions/ comments made by the WSP team, the draft report will be modified and submitted.

8. Revised Action Plan

We look up to the advice of WSP team to work out a revised time line and action plan. We understand that there are two points to be considered in this regard:

• Revision of the Contract as mentioned in your communication • The elections in MP

Once we get the advice from you we would work out the revised plan.

9. Expected Outputs I Deliverables

• A report on the status and findings of consumer behavior, sanitation technologies and sanitation marketing practices in MP and data/information gaps (Review of literature would be a concurrent exercise) to be filled in these specific areas.

• Approach and Methodology for the Study and the Research Protocols which would define the purpose of study, research objectives, study populations, sampling procedures and sample size calculations, data collection methods, quality assurance (including training of interviewers, field supervision and spot-checks), pre-testing of instruments, analysis plan, data coding and cleaning of data set, etc.

• An assessment report of consumer sanitation behavior including motivations, barriers and preferences for sanitation

• A report of latrine technologies and options including cost estimates and • Assessment report of supply chain mechanism for sanitary materials

including a commentary on availability of quality sanitation materials, availability of trained masons etc.

• Draft and final protocols, transcripts, raw and clean datasets. • Photographs of FGDs/Discussions with key informants

16