Bhubaneswar: A multi-stakeholder initiative on safe Child Faeces Management (CFM) in rural Odisha has led to 21 per cent increase in latrine use by children aged 24 to 35 months.
An evaluation of the initiative showed promising behaviour change among caregivers and infants. The results showed safe disposal of faeces by caregivers rose by 15 per cent for infants aged 12 to 17 months and 29 per cent for infants aged 8 to 11 months.
Gram Vikas and Emory University collaborated in June 2019 to design a behaviour change intervention and hardware to promote safe CFM practices among caregivers and infants.
Supported by USAID and Tetra Tech’s WASHPaLS initiative, they implemented the drive across 37 villages in Ganjam and Gajapati districts. The programme involved five behaviour change activities and designing a new CFM hardware.
The intervention addressed risks, attitudes, norms, abilities, and self-regulation for mothers and family members to adopt CFM. Simultaneously, through user-centred design sessions, the team engaged mothers and stakeholders to design a new CFM hardware and trained them in its use.
Speaking on the importance of the intervention, Executive Director of Gram Vikas Liby Johson said they found that more than 75-80% of the people use toilets in their partner villages. “Proper disposal of child faeces has now emerged as an area of concern. We must work on attitudes and behaviours among caregivers and children to ensure improper disposal of child faeces does not create new problems. The work on CFM is a vital aspect of deepening and integrating Gram Vikas’ work in Water, Sanitation and Hygiene to achieve better health and nutrition outcomes,” Johnson said.
The programme built action knowledge on latrine use, safe faeces disposal, and caregivers’ confidence in adopting the behaviour. It helped them to develop strategies to overcome barriers, gave a goal tracker to monitor adherence, and fostered support from fathers and grandparents. Caregiver support group meetings provided social support and encouragement.
On the programme’s significance for India, intervention lead from Gram Vikas, Dr Apurva Ghugey said though families consider child faeces as harmless, it is more harmful because children have underdeveloped immune systems for the first five years of their lives.
“About 25 million children are born in India every year. We must focus on developing programmes that move beyond infrastructure to address safe sanitation and health outcomes for children of a younger age,” Ghugey said.
The team rolled out the evaluation in 37 intervention and 37 control villages from December 2020 to March 2021. The 74 villages in the two districts are Gram Vikas programme villages with a combined water and sanitation programme.
The endline survey reached 662 primary caregivers and 841 children less than five years who received the intervention and 631 caregivers and 785 children in control villages. Overall, the study found a 12% higher safe child faeces disposal and 7% more child latrine use in the intervention villages compared to the control. The evaluation noted substantial improvements among children less than three years. Latrine use among children between 24 to 35 months increased by 21% in intervention villages.
Access to water and sanitation facilities improved the adoption of safe child faeces disposal behaviour among caregivers, noted the study. Bill & Melinda Gates Foundation supported the evaluation.
“We are excited by the dramatic increase of about 20% in caregiver disposal of faeces. The findings reveal that the study made a difference among younger children and facilitated young children’s latrine use,” Research Programme Manager from Emory University, shared her surprise, Gloria Sclar said.
Gram Vikas convened a workshop in Bhubaneshwar recently, bringing together 77 government officials, institutions, practitioners, policymakers and NGOs to share the results and promote cross learning. The participants discussed the accomplishments and challenges of the CFM trial’s design and key findings from the process evaluation.
