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Stunting in Rural Uttar Pradesh

Jacqueline Upp, Victoria Lewis, Sarahanne Davidson, Lauren Osburn, Sean McMahon, Shannon Butler

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Introduction

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Solution Overview: Three Components

Small Business OpportunityLocal Partner: Sakshi NGO Fertilizer

Biodegradable Self-Sanitizing BagsLocal Partner: ESI Ecological Sanitation

EducationLocal Partner: HEEALS Activity Based Curriculum

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Solution Overview: Goals

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Education Campaign

Objective: Facilitate peer educators’ dissemination of health

consequences related to OD, how to eliminate those consequences, and entrepreneurial skills

Strategy: Three modules of an activity based curriculum

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Education Campaign: Implementation• Module 1: Health Consequences of Open Defecation

• Local Partner: Health, Education, Environment, and Livelihood Society (HEEALS)• Example Activities: Feces calculation, visual representation of feces in food/water

• Module 2: How to Eliminate Health Consequences of Open Defecation• Local Partner: Environmental Sanitation Institute• Example Activities: Integrating BioBags into your everyday routine

• Module 3: How to Grow Your Own Small Business• Local Partner: Sakshi NGO• Activities: Entrepreneurial skills, creating fertilizer, community development

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Goals for Peer Educators

• A pilot program will target 7 villages in rural Uttar Pradesh• We will train 15 peer educators in each village • Each educator will host two workshops for 30 people within

their social network• 1 peer educator will reach 60 people in his or her social network• 105 peer educators will reach 6,300 adults in 7 villages

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Our NGO + Partners

Village Peer Educator

Social Network

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Family Member

s

Social Network

30

Family Member

s

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Biodegradable Self Sanitizing Bags

BioBag vs. Pit Latrine  BioBag Pit LatrineContainment of Feces Yes YesRemoves Pathogens Yes NoEcological Yes NoConvenient Yes NoCultural Integration Yes NoSustainable Yes NoCost-Effective Yes NoScalable Yes No

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What to do with all these bags…The waste is converted to a valuable resource – fertilizer!

For Entrepreneurs• Small business opportunity• Local partner Sakshi NGO would

assist with educating entrepreneurs on a viable business plan to market their fertilizer product

For Farmers• Supplement to existing crops• Burying the BioBags in a garden

or field would enrich the soil• Farmers would grow better crops

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Biodegradable Self-Sanitizing Bags

Distribution

Utilization Donation Cultivation

Transaction

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Timeline: Big Picture

Cultural Integration

Year 1Implementation

Year 2Scaling Up

Year 3

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• Establish rapport with community

• Establish local partnerships

• Collect baseline data

0-6months

•Identify peer educators•Train local community leaders

6-12months

• Peer educators lead implementation

12-24Months

Timeline

• Troubleshoot problems

• Data collection• Evaluation

24 months

• Ensure sustainability

• Ensure scalability

24-36 months

• Data collection• Evaluation

36 months

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Scalability: Diffusion of Innovations Model

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Sustainability

• Government will move from paying for latrines to paying for BioBags• Government will save money on health care• Potential for citizens to purchase bags• Potential for Indian BioBag manufacturing facility

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Costs Associated with Open Defecation

Premature mortality: $29,052 million (Rs. 1,317 billion) Productivity loss: $4,787 million (Rs. 217 billion)+ Health care: $4,677 million (Rs. 212 billioin)

Total: $38.5 billion (Rs. 1.75 trillion)

• Per person: $30.75 (Rs. 1908.01)• Savings from Pilot Program: $322,875 (Rs. 20 million)

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Monitoring and Evaluation

Baseline Data • Ammonia levels in

common defecation areas

• Incidence of diarrheal disease in children

• Access to proper sanitation

Mid-Evaluation• Ammonia levels in

common defecation areas• Incidence of diarrheal

disease in children• Access to proper sanitation• Workshop attendance

numbers• Number of small business

entrepreneurs• Troubleshoot challenges• Recommendations for

scaling up

End Evaluation• Ammonia levels in

common defecation areas• Incidence of diarrheal

disease in children• Access to proper

sanitation• Workshop attendance

numbers• Number of small business

entrepreneurs• Recommendations for

sustainability

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Potential Challenges and Mitigation

• Risk of program disappearing as political leadership changes• Ensure smooth transition between NGOs and government with easy to

understand training manuals• Risk of losing participants between modules

• Peer educators responsible for reaching out to social network to ensure continued participation

• Cultural barriers• Strong partnerships with local NGOs

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Budget

• The 7 village pilot program will reach 10,500 people for $228,900• Costs included:

• Biodegradable product• Workshop Supplies• Training Materials

• At the end of year two, our remaining budget would allow us to potentially scale up to 30 more villages• See Appendix for budget details on additional costs associated with

personnel and contingency

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Solution Overview: Three Components

Practical Considerations

EcologicalFecal to Oral Transmission

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Conclusion Statement

An educational campaign paired with Biodegradable Self-Sanitizing Bags is the most effective and culturally appropriate solution given the resources of our NGO and the current state of infrastructure in

rural Uttar Pradesh.

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References

• Shakya, H. B., Christakis, N. A., & Fowler, J. H. (2014). Association Between Social Network Communities and Health Behavior: An Observational Sociocentric Network Study of Latrine Ownership in Rural India. American Journal of Public Health, 104(5).

• Biran, A., Schmidt, W. P., Varadharajan, K. S., Rajaraman, D., Kumar, R., Greenland, K., ... & Curtis, V. (2014). Effect of a behaviour-change intervention on handwashing with soap in India (SuperAmma): a cluster-randomised trial.The lancet global health, 2(3), e145-e154.

• Olx.in. 2015. Cars. Retrieved February 5, 2015 from: http://olx.in/uttarpradesh/cars/• Numbeo.com. 2015. Cost of Living in Mathura, Uttar Pradesh, India. Retrieved February 5, 2015

from: http://www.numbeo.com/cost-of-living/city_result.jsp?country=India&city=Mathura%2C+Uttar+Pradesh

• Health, Education, Environment, and Livelihood Society. 2013. http://heeals.org/• Environmental Sanitation Institute. 2014. http://www.esigujarat.org/• Sakshi Center for Information, Education, and Communication. http://www.sakshingo.org/• Water and Sanitation Program. The Economic Impacts of Inadequate Sanitation in India. Retrieved

February 6, 2015 from: http://www.wsp.org/sites/wsp.org/files/publications/wsp-esi-india.pdf

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References cont.

• Economist. 2014. The Final Frontier. The Economist Asia. Retrieved November 13, 2014 from: http://www.economist.com/news/asia/21607837-fixing-dreadfulsanitation-india-requires-not-just-building-lavatories-also-changing

• BPI. 2012. Standard EN 13432: Proof of compostability of plastic products. Retrieved February 6, 2015 from: http://www.bpiworld.org/page-190437

• UNICEF. 2011. The Situation of Children in India: A Profile. Retrieved February 6, 2015 from: http://www.unicef.org/india/The_Situation_of_Children_in_India_-__A_profile_20110630_.pdf

• National Family Health Survey Bulletin. 1996. Fertility and Contraceptive Use in Tamil Nadu, Andhra Pradesh, and Uttar Pradesh. Retrieved February 6, 2015 from: http://www.eastwestcenter.org/fileadmin/stored/pdfs/NFHSbull003.pdf

• UNDP. 2011. About Uttar Pradesh. Retrived February 5, 2015 from: http://www.in.undp.org/content/india/en/home/operations/about_undp/undp-in-Uttar-Pradesh/about-UP/

• Patil SR, Arnold BF, Salvatore AL, Briceno B, Ganguly S, Colford Jr JM, Gertler PJ. 2014. The Effect of India's Total Sanitation Campaign on Defecation Behaviors and Child Health in Rural Madhya Pradesh: A Cluster Randomized Controlled Trial. PLOS Medicine. DOI: 10.1371/journal.pmed.1001709

• Mehrotra K. 2014. India’s Toilet Race Failing as Villages don’t Use Them. Bloomberg. Retrieved February 6, 2015 from: http://www.bloomberg.com/news/2014-08-03/india-s-toilet-race-failing-asvillages-don-t-use-them.html

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Appendices - Budget

GHCC Budget

Year 1 Year 2 Remaining

Beginning Balance $2,000,000.00 $1,490,491.80 $1,254,339.60

PersonnelLodging $5,221.62 $5,221.62Utilites $2,030.58 $2,030.58Transportation $2,256.00

Personnel Total $9,508.20 $7,252.20

MaterialsBiodegradable Product $176,400.00Workshop Supplies $31,500.00Training Materials (Paper, ink, etc.) $21,000.00Materials Total $0.00 $228,900.00

Contingency FundsSet Aside for Emergencies $500,000.00

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Appendices - Budget

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Appendices - Bags• Dimensions

• Outer bag: 7x15in• Inner tube

• Circumference: 19• Length: 9

• Materials • Biodegradable plastics meeting EU Standard EN 13432:

Proof of composability of plastic products. BioBag disintegrates and is broken down into carbon dioxide, water, and biomass.

• Each BioBag will contain urea. When the urea comes into contact with urine or feces the pathogens will begin to be broken down. Furthermore, urea is the most common artificial fertilizer in the world.

• Production• A high speed production line will make half a million

BioBags can be manufactured each day.

Appendices – Training Materials

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