|Sanitation Promotion (SIDA - SDC - WSSCC - WHO, 1998, 292 p.)|
|Promotion through innovation|
1 Institute of Health Management, Pune, India.
Young community agents of change
Schoolchildren are a valuable community-based resource and can participate actively in improving sanitation systems. This case-study illustrates a number of mechanisms through which children can be mobilized to promote sanitation. It demonstrates the impact that Bal Sevaks (children who serve their communities) have had on handwashing after defecation in a rural area of Maharashtra, India. It describes a process of empowering children, and the community-wide effects of their activities. (See also Promoting sanitation through children.)
The villages of the drought-prone Marathwada area of Maharashtra, India, present a sanitation scenario similar to that of much of the rest of rural India - scant sanitation facilities, deeply-ingrained, inadequate hygiene habits and a low demand for improved sanitation systems. Furthermore, cultural inhibitions prevent village workers from addressing issues such as defecation hygiene because villagers are embarrassed to talk about defecation.
In 1990, the Institute of Health Management, Pachod (IHMP), a grass-roots NGO, faced an unusual dilemma. Although over 75 per cent of the village households where it was working had soap, less than 25 per cent washed their hands with it after defecation. In addition, the Institute's health workers expressed extreme reluctance to address the culturally sensitive defecation issue. This situation required an alternative approach, so the Institute embarked on a child-to-community programme. Children, called Bal Sevaks (children who serve their communities) were mobilized to change defecation hygiene behaviours in adults. Bal Sevaks work in pairs; each pair is responsible for 30 households.
The project's objectives were:
- to generate a demand for sanitation facilities in 186 villages in Maharashtra;
- to change hygiene-related defecation behaviours, specifically to increase handwashing with soap or ash after defecation, in these villages in Maharashtra;
- to develop leadership potential in children by establishing children's groups; and
- to encourage community initiatives for environmental cleanliness and sanitation.
Although the programme began with hygiene education, it now addresses sanitation demand, and maintenance and sustained use of latrines, leadership development among children, cleanliness and beautification of the environment.
The Institute's programme covers a total population of 150 000. The Bal Sevak Programme includes four primary activities:
- house-to-house visits by children;
- establishment of children's groups (Bal Sanghatans),
- Bal Shakti, a newsletter for rural children; and
- community organization involving environmental initiatives.
Children participate in the programme as volunteers. As an incentive for their participation, Bal Sevaks are provided with school books.
Home visits by Bal Sevaks
Since Bal Sevaks tackle the difficult challenge of habit-related behaviour change, they employ an intensive, interpersonal, persuasive strategy. A Bal Sevaks pair visits each household twice a month. The younger child (8-10 years old) holds posters as the older child (10-14 years old) speaks. The children focus on a specific number of behaviours as new topics are addressed. The Bal Sevaks also monitor the programme at a household level.
Bal Sevak house visit.
The Bal Sangathans simulate village councils, by which children prepare themselves for future leadership roles.
Monthly in-service meetings are held for the children. The school-teacher supervises the Bal Sevaks at the village level.
Children's groups (Bal Sangathans)
Children are organized into groups called Bal Sangathans that are formulated along the lines of village councils. The village council is the primary body involved in implementing village-level development programmes. Bal Sangathans have been formed in 25 villages. The children elect leaders who are then trained by the IHMP. The Sangathans meet regularly to plan specific village-level activities. By simulating village councils, children prepare themselves for future leadership roles.
Some of the activities and programmes that the Sangathans have undertaken include fund-raising at the village level for a children's park, voluntary labour for cleaning defecation sites and handpump surroundings, and children's parades for disseminating sanitation and health messages. The formation of local street theatre troupes, which began as a spontaneous initiative by one of the village Sangathans, is now being replicated in other programme villages.
Bal Shakti: children's newsletter on sanitation
Since the Bal Sevak Programme was expanded from 25 to 186 villages, a mechanism was required to keep children and school-teachers updated on programme issues and activities. The IHMP decided to produce a monthly newsletter for children that provides them with reading material outside of their school curriculum. A 1995 survey indicated that 98 per cent of 300 rural school children in the Bal Sevak villages had no access to reading material other than their school books.
Two workshops were held in 1995 with village school-teachers and children to finalize the content, format, and frequency of the newsletter. The children named the newsletter Bal Shakti (Bal means child; Shakti means power) and recommended that it be published monthly. An 11-member advisory committee was formed, comprised of village school-teachers, children, and the IHMP representatives.
The newsletter focuses on different aspects of health and sanitation. It is distributed to the 186 villages with one copy for every three households. Recent issues have included articles on selection and training of Bal Sevaks, gender issues, how to conduct a promotional sanitation campaign, and personal hygiene behaviours. The newsletter includes activity sheets.
Organizing the community for environmental initiatives
Intervention with children at household, school, and community level culminates with communities initiating projects the children identify. For example, the initiative of the Bal Sangathan in the Dabrul village resulted in a villager donating land for a recreational park adjacent to the school. The village council followed with a financial donation of 1000 Rupees. This recreational park has been planned as a garden of learning, with the goals of providing children with play facilities and demonstrating various elements of environmental sanitation.
Children are applying social pressure on adults to demand better sanitation systems and to work towards a cleaner environment. The children's enthusiasm has triggered activities that allow adults to make important sanitation-related decisions and actions at household and community levels. For example, children in the Harshi village wanted to put basalt around the platforms of seven handpumps in their village. They succeeded in persuading farmers to donate two bullock carts for this purpose, even though it was the middle of the peak harvest season.
The Bal Sevak approach rests on the belief that change is most effective when it emanates from the community. This approach demonstrates a productive application of an abundant and energetic human resource, often ignored by programme planners. It ensures sustainability, since it involves working today with tomorrow's adults. The programme promotes equity because the children involved come from the most marginalized families and special priority is given to girls. (See Paying attention to gender in sanitation programmes.) Finally, it is rooted in prevention with the goal of breaking the faecal-oral cycle of transmission.
The programme has had both intended and unintended outcomes. The intended impact has been in the area of hygiene behaviour. The unintended outcome has been the creation of a powerful force in the children themselves. As many Bal Sevaks enter young adulthood, they continue to retain a strong spirit of voluntary cooperation and commitment.
Personal hygiene behaviours
A community-based trial of the Bal Sevak intervention showed that women in the intervention group were four times more likely to wash their hands with soap than women in the non-intervention group, after controlling for literacy, occupation, and age (1).
Table 1. Women's soap use by number of reported Bal Sevak visits in past month (N=264)
Number of times women were visited in past month
Number of women
Number of women using soap for handwashing
Per cent using soap
In 1990, handwashing levels were 25-28 per cent in the intervention and control groups. Three years later, 66 per cent of the respondents reported washing hands with soap or ash in the intervention group, compared to 32 per cent in the control group. Table 1 indicates how soap use increased with the number of Bal Sevak visits in the intervention group.
An important goal of the programme is to reduce inequities. IHMP believes that encouraging gender sensitivity among children, especially boys, will address a deeply entrenched inequity in Indian society.
The Bal Sevak approach promotes equity because the children come from marginalised families, and special priority is given to girls.
The programme focuses on gender in two main ways: girls are recruited as Bal Sevaks, and the content and visuals of the newsletter promote gender equity. Additionally, a special issue on gender was published recently.
Bal Sevaks leadership development
Some of the Bal Sevaks who participated in the early phase of the programme are now young adults. They are demonstrating a strong inclination to continue their involvement in development work. Many want to continue living in their villages and serving their communities.
An example of this leadership development is demonstrated by Bal Sevak graduates, who, while still in their teens, started Bal Sevak programmes in neighbouring villages, helped prepare audiovisual materials for a sanitation campaign, and trained Bal Sevaks for the Institute's urban slum programme. Their greatest contribution is in serving as role models for younger children.
Box 1. Should a female Bal Sevak drop out of school to look after a sibling?
Children were asked in one issue of the monthly newsletter, Bal Shakti, to complete an unfinished story in which Mangal, an intelligent 10-year-old Bal Sevak girl, is forced to drop out of school to look after a younger sibling. Her brother, Raju, 8 years old, continues going to school. Children were asked to write responses to the question: Should Mangal drop out of school?
IHMP received more than 500 letters in response to this query. Most boys who sent letters stated the need for boys to participate more actively in household chores. Here are a few excerpts:
You're talking about one Mangal, I can show you a hundred such Mangals in our villages. Mangal's brother should help their mother with household chores and take over some of Mangal's household responsibilities. Mangal should go to school.
Vaidya Bhagwat, 13-year-old boy, Unchegaon village.
The Maharashtra government recently appointed IHMP as advisor to a large-scale rural sanitation campaign in four districts of Maharashtra. The government has accepted the premise that children are an optimal medium for reaching people in rural areas.
· Initially, parents were not willing to let their daughters be Bal Sevaks. This was resolved by asking school-teachers to motivate the girls' parents.
· Some Bal Sevaks were teased by village youth. This issue was addressed during an in-service training session. The children were told to report to their teacher or IHMP supervisor if the situation became difficult.
· Despite the children's intervention, some families did not change their handwashing behaviour. One successful alternative strategy was developed by two Bal Sevaks, who delegated the responsibility of persuasion to talkative and influential women.
· The topic of defecation causes embarrassment. The children had to overcome their own embarrassment before approaching their community.
· Establishing a viable and efficient distribution system for the newsletter has been difficult. The same has been true of other audiovisual materials used by Bal Sevaks.
· The frequent transfer of policy-makers at district and state levels created difficulties in influencing policy.
The key lessons learned from this programme are:
· Children are an abundant, energetic grass-roots resource.
· Children constitute an important pressure group with the potential to propel communities into action.
· Children's groups can be an effective tool for promoting better sanitation systems.
· Children can influence adult hygiene habits.
· Children are effective in applying group pressure on households.
· Change in habit-related hygiene behaviours requires intensive interpersonal contributions.
· To maintain behaviour change, additional contributions need to be incorporated into the programme planning process.
· Children's involvement generates change in two generations.
· The programme hinges on the support received from various community resources, such as village school-teachers and local groups. Sustaining the school-teachers' interest and motivation in the programme is key to its success.
· Community-based participatory approaches are essential for the creation, use, and sustainability of better sanitation systems.
Key institutions and responsible persons
Dr A. Dyalchand and Ms Manisha Khale
Institute of Health Management, Pachod
Dist Aurangabad 431121
Telephone: +91 2431 21382
Fax: +91 2431 21331
Dr N. Kapadia-Kundu
Institute of Health Management, Pachod
Bombay Sappers Society, Plot No. 13
Pune 411014, India
Telephone: +91 212 68546
Fax: +91 212 685462
(1) Kapadia-Kundu N. An empirical test of the Sadranikaran communication theory to defecation hygiene behaviour: evaluation of a child-to-community intervention in Maharashtra, India [Dissertation]. Baltimore, MD, Johns Hopkins School of Hygiene and Public Health, 1994.
© Nandita Kapadia-Kundu and Ashok Dyalchand, Institute of Health Management, Pune, India, edited by WHO with permission of Nandita Kapadia-Kundu and Ashok Dyalchand, 1997.
Prepared in association with SARAR TransformaciC.