Nirmal Bharat Abhiyan

Scaling up and Sustaining Outcomes

Identifying the Goal

❧ Sanitation = habit ❧ Toilet construction is a means to an end ❧ Even if few use a toilet, all are at risk, unless

a community is ODF

Scaling up Behavior Change

Scaling up Rural Sanitation Outcomes

Toilet Construction is means to an

end

Coverage has scaled up rapidly….

Source: MDWS Online Monitoring, Jan 2013

3 states at 100%

10 states at 76-100%

12 states at 50-75%

5 states at <50%

National average is +70%

Scaling up equals Sustainability? Results from MDWS study of NGP sustainability….

All India average for 12 states

Below Average Performer

Average Performer

High Performer

Source: MDWS 2010

One Program, Different Outcomes

0

10

20

30

40

50

60

70

80

90

100

8.3 13

.6

14.8

15.3 18.6

20.1

22.9 26

.7

29.3

31.9

32.7

34.2

34.9 40

.4

41.7

44.2 48

.7 55 55.7

56.9

57.7 61

.5 67.5 71

.9

72.6 77

.7 84.6

85.1

87.1

87.7 94

.4

Perc

ent

5 states at 76-99%

3 states at 50-75%

22 states at <50%

Nil @ 100%

Source: Census 2011

What explains the difference in

performance?

Sustainability does not come after toilet construction is completed – it starts

with entry into a community

Quality of the process by which NBA is implemented at scale drives Outcomes

achieved and their sustainability

How to Measure Quality of Processes?Processes adopted by a district to implement TSC are grouped into 3 Components with scores to each process

Catalyzing

Strategy

Institutions

Finance

Delivering

Demand

Supply

Scale

Sustaining

Subsidy

Monitoring

Incentives

30

10

40

15

14

11

30

13

6

11

10

10

Results: Sample States Average Score on Quality of Processes = 56 on 100

Statistically strong +ve correlation found b/w quality of process and usage

❧ As quality of processes improves, hh toilet usage is found to increase in the sample of 56 districts

❧ Districts that implement TSC/NBA Guidelines in letter and spirit perform well

❧ Districts that implement program as a target driven construction drive perform poorly

High Performers have done this!

ODF Communities

Strategy => Collective behavior change

Strong political/administrative buy-in

Dedicated Institutional Arrangement

Build Capacity to facilitate BCC

Create demand for safe sanitation

Facilitate supply linkage

Ince

ntiv

es fo

r O

utco

mes

Mon

itor

Colle

ctiv

e O

utco

mes

HH invest own resources

Low performers have done this

Toilet Construction

Strategy => Meet Construction Targets

Weak political / administrative buy-in

Weak Institutional Arrangement

Weak CapacityAssume construction will lead to demand

Contractors engaged to accelerate

Upf

ront

h/w

su

bsid

y

Coun

ting

toile

ts

Technology fit to unit cost

Suggestions: Way Forward

+ve = Supply and Availability of Funding. However, need to focus on:

❧ Monitoring outcomes and reporting quality data

❧ Creating demand for sanitation through behavior change

❧ Delivery of subsidy as per NBA Guidelines, pay direct into beneficiary bank a/c after ODF habitation

❧ Competition to sustain NGP can help to ensure that NGP winners are not ‘forgotten’

Suggestions: Monitoring

❧ “what we monitor is what we get”

❧ Supplement existing data with six-monthly usage tracking through cross district verification

❧ Benchmarking of states/districts focusing on outcomes

❧ Potential to use ICT approaches

❧ Stronger alignment with periodic surveys

Suggestions: Demand Creation

Suggestions: Demand Creation

❧ Who will reach the communities / households….requires motivators

❧ Will they have capacity to do community led approaches

….need training

❧ Why should they do it….need outcome based incentives

Suggestions – Incentives

❧ Incentives to be released to bank a/c of hh after toilet construction and usage post ODF habitation

❧ Should not be given to third party (contractor, NGO) to construct toilets

❧ HH should be free to construct a toilet of their choice based on their affordability

❧ To release incentives, designated person can certify that toilet cost is more than incentive amount as the case may be and this is being used

Suggestions: NGP

❧ Sample surveys show slippage in NGP is a key concern

❧ MDWS Assessment (2010) found:– ~81% of HH have access to a toilet –

varies from 48% to 100% – 71% of persons report regular usage

– varies from 33% to 100%

❧ Currently NGP is a one-time award, winning PRI only ever verified once

❧ NGP may becomes an annual competition, PRI must sustain status to be eligible, “prestige” issue. Ex: Maharashtra, HP, Haryana, Karnataka

Nirmal Bharat?

201520222030

20502100

Thank you!Upneet SinghWater and Sanitation SpecialistWSP <usingh@worldbank.org>

Mathews Mullackal State Coordinator, Rajasthan

WSP <mmullackal@worldbank.org>

Results: Average Score (All India) on Quality of Processes = 56 on 100

Service Delivery Pathways: 2 States were Compared

High performerUsage ~90%

Poor Performer Usage <35%

Strategy Focus on collective behavior change

Focus on toilet construction

Institutions Dedicated staff and capacity at district and sub-district levels

Institutions are weak, with empty posts

Financing of toilets

Households motivated to invest own funds for construction

Construction depends on external subsidies

Service Delivery Pathways: 2 States were Compared

High performerUsage ~90%

Poor Performer Usage <35%

Demand creation

All BCC channels are used effectively, focus on behavior change

Toilets constructed without demand created

Supply Menu of technology options promoted household select based on options and need

Subsidy determine type of technology; Standard technology models promoted; household has no say

Scaling up Institutional structure, phasing adopted to scale up

Ad hoc implementation prevents scaling up

Service Delivery Pathways: 2 States were Compared contd

High performerUsage ~90%

Poor Performer Usage <35%

Subsidy Delivery

Given to community and household once 100% ODF is verified

Subsidy is used to pay upfront for construction of toilets without demand creation

Monitoring Focuses on outcomes and quality of data reported, NGP winners are periodically verified

Toilet numbers, no third party verification; NGP winners ‘forgotten’

Rewards Institute competition based awards to prioritize sanitation

No incentive other than meeting targets