Tag: Health

“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.

1. What CSR programs do you currently focus on in sanitation and the Swachh Bharat mission? How does this align with Reckitt Benckiser’s broader sustainability approach?

We have a broad responsibility towards Banega Swachh India (BSI). [RB’s ambitious program to address the sanitation and hygiene crisis in India] We work under 4 pillars. The first pillar is behaviour change communication, the second is mass reach, the third pillar is product access and fourth is infrastructure creation and maintenance. We give maximum weight to work around behaviour change communication because we find without BCC infrastructure created will remain only structures that will never be used. So our work is focused around the determinants of behaviour change. We are trying to understand through our work and processes why behaviours are such and what triggers non-behaviours into behaviours.“We give maximum weight to work around behaviour change communication because we find that without BCC infrastructure created…will never be used”

 2. Can you tell us about some activities that you have conducted in the area of behaviour change communication?

Under Banega Swachh India (BSI) we are developing school modules for very young children at the foundation stage which include early-learning goals like personal social and emotional development, knowledge and understanding, physical development. Typically what happens is that some hand washing programs are conducted for a session or two. They aren’t regular sessions, just awareness programs. We are trying introduce a program where there will be modules in place for school children, student work books, activity based learning kits and a school curriculum for the teachers amongst other things, so that there is a regularity in the messages that are disseminated.  We don’t only work on one aspect which is only hygiene or hand washing. We have elaborate modules that range from personal hygiene to hygiene at home, hygiene at school, hygiene during illness, hygiene in neighbourhoods etc. We are making strides at various levels and building a curriculum to implement good hygiene. In the coming months we will roll out a program with some very worthy partners that have been working with us since the launch of our BSI campaign, which is the Banega Swachh India campaign.

 Do you work with other communities as well?

We are starting with schools, but yes we do intend to work with natural leaders and community based leaders. We are also thinking about using a platform to create an enabling environment for the Banega Swachh India campaign to leads us towards the goal of the Swachh Bharat mission. We are currently in dialogue with certain organizations about this.

 3. Do you think that organizations are interpreting the Swachh Bharat campaign to mean “build toilets?” There are other aspects of WASH that are not receiving as much attention, why do you think this is so?

I feel that there are various partners so if someone is constructing toilets, it’s a very big part of the mission. To invest in creation of the infrastructure, a lot of capital is involved. But yes, we should leverage resources that everyone has – corporates, private foundations, international organisations, all have resources and it’s important to leverage these to shape the market.  One part is construction of toilets which is very important, but along with that, companies can come up with various things. Companies have brands and conduct campaigns and so we have experience in this area. We can do something to motivate people like bringing like-minded people together so that everyone contributes. It should not be a standalone thing – there needs to be a spirit of partnership on mutually agreed principles so that people work together and achieve the goal of making India open-defecation free.

4. What are the main issues that you think need intervention in sanitation and how does RB approach these issues?

What’s important here is to work as a consortium rather than alone, because organizations have different skill sets and different strengths, so if everyone comes together there’s a good chance things will happen. To take the example of Samhita and how you bring in multiple stakeholders for an issue – if we do that then we will know what TCS is doing, how someone else is contributing etc.  No organization or company can do this alone, we need to fit in with the overall vision of Swachh Bharat. We are currently exploring the best ways to do this.

5. At the Chicago Booth event, you mentioned an innovative approach that RB is implementing, can you tell us a little bit more about that?

Our work is of 2 kinds. One is hardcore execution on the field through intervention partners. We work on bringing partners together and we also bring some global people together so that the best can be achieved. Our second approach is working on something which is more on the policy level. Here we’re looking at how all this work can be integrated into the larger framework of sanitation.

6. What do see as the major obstacles or challenges to having a Swachh Bharat? What challenges has RB faced?

Let’s call it learnings, not challenges. We see opportunities for where we can do better, not just the challenges. I think we need to have more partnerships and more aligned thinking. It’s very important to have design thinking. We are continuously working on that – improving our design thinking.

7. What do you see as the key development issues in India? What is the role that companies can play?

You see, health, hygiene, sanitation they all go hand in hand. There are various things that need our urgent attention.  You must know that India has committed to the MDGs. The MDGs talk about the latest figures for under 5 mortality and morbidity arising out of diarrhoea. That’s one of the things which is very important. A lot of theories state that this is an unexplored space where companies can come forward to contribute. There are only a few foundations working in this area.

I also see that very simple things like hand-washing can reduce diarrhoea and pneumonia mortality and morbidity rates using very simple tools.

There are 3 aspects on which define your CSR strategy – one is the company’s mission the other is sustainability goal of the company and the third is seeing if there is a match between the two. I would also like to say that without partnerships no one can achieve anything. This is the time to work together to achieve Swatch Bharat Mission and make India Open Defecation Free.

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, ensuring Sustainable sanitation.

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 sanitation.

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 sanitation 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 sanitation 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

At a time when the entire country is raging over the oh-so-popular debate of toilets over temples, Outlook India (an English weekly news magazine), declared sanitation as India’s No. 2 problem (in more ways than one) (You can refer to the article here). 64% of Indians still do it in the open which is a global record in itself. In the background of such a situation, the Uttarakhand Bio-toilet initiative of a major Indian logistics company in partnership with Samhita is one step towards solving one of the oldest and large-scale problems of India.

To address this problem in a sustained manner, the company adopted sanitation as one of the top causes as part of its CSR policy. In pursuance of its CSR policy, it gave a go ahead to set-up environment friendly bio-toilets in and around its areas of operations to eliminate open defecation practice. These bio-toilets differ from the conventional toilets as all of the human waste is processed and converted into harmless water thus promoting environmental sustainability.

Just as it was approving the budget to go ahead with the installation of bio toilets at their Mumbai Port facilities, unfortunately, in Uttarakhand, thousands of people were killed/displaced due to devastating floods and landslides in the region. Being a socially responsible business that it is, the company decided to prioritize helping flood victims and encouraged employees to come forward and commit one day’s salary, which the company will match.

The company decided to undertake a more structured and holistic approach in order to ensure that the collected money is brought to an effective use and delivers the much-needed impact in the affected communities. So, in partnership with Samhita, a needs assessment was conducted in the flood affected villages to identify the imminent problems. It was identified that the villagers in the flood affected regions were left with very little sanitation facility due to floods; most of them going out in open spaces to defecate. Thus, there loomed a big danger of an epidemic breakout in the region. Community being an integral part of their operations, the company wanted to go beyond donations and overtake the execution of the relief project till the final stage until the affected people are not forced anymore to indulge in open defecation practice.

A local NGO Yusuf Meherally Centre (YMC) was identified for looking after the installation and maintenance of these toilets in the long run. The work began with Samhita and YMC teams getting together and conducting days of groundwork which included surveys and some social engineering to ensure only the needy and those who are severely affected by the disaster are selected as beneficiaries for toilets. Moreover, to make best use of capacity of bio-toilets, the beneficiaries were grouped together to use common toilets. This also ensured a sense of responsibility amongst the people to first build the toilets, and then use and maintain them collectively.

Impact

–  An amount equal to Rs. 7,22,760 was raised through the matching scheme with the employees

–  18 toilets would be built, spread out over six flood affected villages namely Dugadda, Shirwa, Durgapul, Bhumia ki Chaloti, Thatyur and Thapla. 15 were built for households and 3 were built for schools

–  More than 200 villagers and 325 children have been benefitted by getting access to toilets

–  Because of Uttarakhand Bio-toilet initiative around 45 villagers who worked as daily labourers received livelihood opportunities as construction workers of toilets

Role of Samhita

–  Identified sanitation as the major problem in alignment with the mandate of the corporate from a ground-level needs assessment in the villages of Uttarakhand

–  Recognized the right kind of social enterprise with its area of operation in and around Uttarakhand and as sanitation as the focus area. After a series of personal calls, market research and due diligence process, StoneIndia was identified as the partner social enterprise.

–  Carried out a door-to-door research and identified potential locations for setting up of bio-toilets where sanitation facilities were largely deficient. Feasibility studies and access issues were also carried out at this stage.

–  Helped in the setting up of bio toilets and supervised the working and functioning of bio-toilets. The NGO Yusuf Meherally Centre was identified and handed over the responsibility of installation and maintenance of these toilets in the long-run

–  Provided villages with a reporting and impact assessment framework to record the progress and sustainability of the project.

The leading logistics company has assured their commitment towards community development work in the long run and promised to stay closely associated with the local people to ensure sustainability of these efforts. The seriousness and commitment shown by the higher management ensured the project execution in a very small duration and brought a huge difference to the life of flood affected communities.