BACKGROUND: The Indian Swachh Bharat Mission (SBM) was launched in 2014 with the goal to make India open defecation (OD) free by October 2019. Although it is known that the ambitious goal was not achieved, the nature of the sanitation change brought about by the SBM in different parts of India is poorly understood. One reason is a dearth of case studies that would shed light on the performance of the SBM simultaneously across its different domains. This article provides an example of such study. Employing a Process, Outcomes, Context approach, the objective is to understand the process and outcomes of the SBM-induced sanitation change in a specific context of rural Jharkhand. METHODS: The study utilizes data collected through field research conducted in the rural areas of Ranchi district, Jharkhand, a state in east-central India. This data was obtained via repeated cross-sectional household surveys conducted at the beginning and at the end of the SBM, supplemented by key informant interviews with SBM stakeholders. FINDINGS: We identified political support of SBM implementation and its acceptance amongst the population. Female community workers became key agents of SBM implementation at local level. The SBM increased toilet coverage in the study area from 15% to 85% and lowered the OD rate from 93% to 26%. It substantially reduced structural inequalities in access to toilets, furthered social sanitation norms, improved some of the attitudes towards toilet use, but impacted less on hygiene and sanitation knowledge. The implementation mainly concentrated on the construction of subsidized toilets but less on improving public understanding of safe sanitation practices. CONCLUSIONS: Although the SBM reduced sanitation inequalities in access to toilets in the study area, the behaviour change component was underplayed, focusing more on spreading normative sanitation messages and less on public education. Sustainability of the observed sanitation change remains a key question for the future. This article calls for more systematic production of geographically situated knowledge on the performance of sanitation interventions.

Department of Social Geography and Regional Development Faculty of Science Charles University Albertov 6 Prague Czechia

School of Geography University of Leeds Leeds UK

Xavier Institute of Social Service Purulia Road 834001 Ranchi Jharkhand India

Zobrazit více v PubMed

Prüss-Ustün A, Wolf J, Bartram J, Clasen T, Cumming O, Freeman MC, Johnston R. Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: an updated analysis with a focus on low-and middle-income countries. Int J Hyg Environ Health. 2019;222(5):765–77. doi: 10.1016/j.ijheh.2019.05.004. PubMed DOI PMC

Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abegaz KH, Abolhassani H, Aboyans V, Abreu LG, Abrigo MRM, Abualhasan A, Abu-Raddad LJ, Abushouk AI, Adabi M, Lim SS. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of Disease Study 2019. Lancet. 2020;396(10258):1223–49. doi: 10.1016/S0140-6736(20)30752-2. PubMed DOI PMC

Hammer J, Spears D. Village sanitation and child health: effects and external validity in a randomized field experiment in rural India. J Health Econ. 2016;48:135–48. doi: 10.1016/j.jhealeco.2016.03.003. PubMed DOI PMC

Augsburg B, Rodriguez-Lesmes PA. Sanitation and child health in India. World Dev. 2018;107:22–39. doi: 10.1016/j.worlddev.2018.02.005. DOI

WHO/UNICEF JMP. (2021), Progress on household drinking water, sanitation and hygiene 2000–2020: Five years into the SDGs.

Hueso A, Bell B. An untold story of policy failure: the total sanitation campaign in India. Water Policy. 2013;15:6. doi: 10.2166/wp.2013.032. DOI

Curtis V. (2019). Explaining the outcomes of the’Clean India’campaign: institutional behaviour and sanitation transformation in India. BMJ Global Health, 4(5), e001892. PubMed PMC

Mehrotra S. (2021). Monitoring India’s National Sanitation Campaign (2014–2020). Institute of Development Studies - https://opendocs.ids.ac.uk/opendocs/bitstream/handle/20.500.12413/16714/INDIA_case_study_FINAL_VERSION.pdf?sequence=5&isAllowed=y

Behera MR, Pradhan HS, Behera D, Jena D, Satpathy SK. (2021). Achievements and challenges of India’s sanitation campaign under clean India mission: A commentary. J Educ Health Promotion, 10. PubMed PMC

Jain A, Wagner A, Snell-Rood C, Ray I. Understanding Open Defecation in the age of Swachh Bharat Abhiyan: Agency, accountability, and anger in Rural Bihar. Int J Environ Res Public Health. 2020;17(4):1384. doi: 10.3390/ijerph17041384. PubMed DOI PMC

Kedia M. (2022). Sanitation policy in India–designed to fail? Policy Design and Practice, 1–19.

Gupta A, Khalid N, Deshpande D, Hathi P, Kapur A, Srivastav N, Vyas S, Spears D, Coffey D. Revisiting Open Defecation evidence from a Panel Survey in Rural North India. Economic Political Wkly. 2020;55(21):2014–18. PubMed PMC

Ministry of Jal Shakti. (2021): Swachh Bharat Mission– Grameen. Factsheet posted on November 16, 2021, https://pib.gov.in/FactsheetDetails.aspx?Id=148579 Last accessed on January 2, 2023.

GoI. (2021): National Family Health Survey (NFHS-5) 2019-21. Compendium of fact sheets. Government of India, http://rchiips.org/nfhs/NFHS-5_FCTS/Final%20Compendium%20of%20fact%20sheets_India%20and%2014%20States_UTs%20(Phase-II).pdf Last accessed on January 2, 2023.

IIPS. (2017) National Family Health Survey (NFHS-4), 2015-16: India. International Institute for Population Sciences (IIPS) and ICF, Mumbai. https://dhsprogram.com/pubs/pdf/fr339/fr339.pdf Last accessed on January 2, 2023.

VerKuilen A, Sprouse L, Beardsley R, Lebu S, Salzberg A, Manga M. Effectiveness of the Swachh Bharat Mission and barriers to ending open defecation in India: a systematic review. Front Environ Sci. 2023;11:565. doi: 10.3389/fenvs.2023.1141825. DOI

GoI. (2020): National Annual Rural Sanitation Survey, Round-3 (2019-20). National Report. Ministry of Jal Shakti, Government of India https://jalshakti-ddws.gov.in/sites/default/files/NARSS_Round_3_2019_20_Report.pdf.

Seth P. The NFHS-5 Sanitation Story: case for moving from Access to Adoption. Indian Economic J. 2021;69(1):163–9. doi: 10.1177/00194662211015382. DOI

Mondal D. (2022). Access to Latrine Facilities and Associated factors in India: an empirical and spatial analysis. Indian J Hum Dev, 09737030221141248.

Prakash S, Kumar P, Dhillon P, Unisa S. (2022). Correlates of access to sanitation facilities and benefits received from the Swachh Bharat Mission in India: analysis of cross-sectional data from the 2018 National Sample Survey. BMJ Open, 12(7), e060118. PubMed PMC

Ghosh A, Cairncross S. The uneven progress of sanitation in India. J Water Sanitation Hygiene Dev. 2014;4(1):15–22. doi: 10.2166/washdev.2013.185. DOI

Chaudhuri S, Roy M. Rural-urban spatial inequality in water and sanitation facilities in India: a cross-sectional study from household to national level. Appl Geogr. 2017;85:27–38. doi: 10.1016/j.apgeog.2017.05.003. DOI

De Shay R, Comeau DL, Sclar GD, Routray P, Caruso BA. Community perceptions of a multilevel sanitation behavior change intervention in rural Odisha, India. Int J Environ Res Public Health. 2020;17(12):4472. doi: 10.3390/ijerph17124472. PubMed DOI PMC

Caruso BA, Sclar GD, Routray P, Nagel CL, Majorin F, Sola S, Koehne WJ, Clasen T. Effect of a low-cost, behaviour-change intervention on latrine use and safe disposal of child faeces in rural Odisha, India: a cluster-randomised controlled trial. Lancet Planet Health. 2022;6(2):e110–21. doi: 10.1016/S2542-5196(21)00324-7. PubMed DOI PMC

Pakhtigian EL, Dickinson KL, Orgill-Meyer J, Pattanayak SK. Sustaining latrine use: peers, policies, and sanitation behaviors. J Econ Behav Organ. 2022;200:223–42. doi: 10.1016/j.jebo.2022.05.024. DOI

Sclar GD, Routray P, Majorin F, Udaipuria S, Portela G, Koehne WJ, Nagel CL, Sola S, Caruso BA. Mixed methods process evaluation of a sanitation behavior change intervention in rural Odisha, India. Global Implement Res Appl. 2022;2(1):67–84. doi: 10.1007/s43477-022-00035-6. DOI

Friedrich M, Balasundaram T, Muralidharan A, Raman VR, Mosler HJ. Increasing latrine use in rural Karnataka, India using the risks, attitudes, norms, abilities, and self-regulation approach: a cluster-randomized controlled trial. Sci Total Environ. 2020;707:135366. doi: 10.1016/j.scitotenv.2019.135366. PubMed DOI

Viswanathan S, Saith R, Chakraborty A, Purty N, Malhotra N, Singh P, Mitra P, Padmanabhan V, Datta S, Harris J, Gidwani S, Williams R, Florence E, Daniel S. Improving households’ attitudes and behaviours to increase Toilet Use (HABIT) in Bihar, India. 3ie impact evaluation report 118. New Delhi, International Initiative for Impact Evaluation; 2020. 10.23846/TW14IE118.

Chauhan K, Schmidt WP, Aunger R, Gopalan B, Saxena D, Yashobant S, Patwardhan V, Bhavsar P, Mavalankar D, Curtis V. 5 star toilet campaign-improving-toilet-use-rural India. (2019). https://www.3ieimpact.org/evidence-hub/publications/impact-evaluations/5-star-toilet-campaign-improving-toilet-use-rural.

Schmidt W.P., Chauhan K., Bhavsar P., Yasobant S., Patwardhan V., Aunger R., Curtis V. Cluster-randomised trial to test the effect of a behaviour change intervention on toilet use in rural India: results and methodological considerations. BMC public health. 2020;20(1):1–16. doi: 10.1186/s12889-020-09501-y. PubMed DOI PMC

Andrés LA, Deb S, Joseph G, Larenas MI, Zabludovsky G. J. (2020). A Multiple-Arm, Cluster-Randomized Impact Evaluation Of the Clean India (Swachh Bharat) Mission Program in Rural Punjab, India. World Bank Policy Research Working Paper, (9249).

Exum NG, Gorin EM, Sadhu G, Khanna A, Schwab KJ. (2020). Evaluating the declarations of open defecation free status under the Swachh Bharat (‘Clean India’) mission: repeated cross-sectional surveys in Rajasthan, India. BMJ Global Health, 5(3), e002277.

Dreibelbis R, O’Reilly K, Bhat S, Kulkarni S, Goel A, Grover E, Rao N, Cumming O. (2019) The evaluation of a sanitation intervention on sanitation-related emotional and psychological well-being among women and girls in Bihar, 3ie Grantee Final Report. New Delhi: International Initiative for Impact Evaluation (3ie).

Koonan S. Sanitation interventions in India: gender myopia and implications for gender equality. Indian J Gend Stud. 2019;26(1–2):40–58. doi: 10.1177/0971521518812114. DOI

Khandelwal S, Tamboli P, Madhup S, Dandabathula G. Assessment of Swachh Bharat Mission-Clean India Campaign’s contribution in combating violence against women. Int J Gend Women’s Stud. 2020;8(2):143–54.

Basnet​ S, Hoque MM. Critical analysis of the implementation of Clean India Mission in the rural areas: a gender perspective. Journal of Women, Politics & Policy; 2022. pp. 1–20.

Gupta A, Khalid N, Hathi P, Srivastav N, Vyas S, Coffey D. (2019). Coercion, Construction, and ‘ODF paper pe’: Swachh Bharat According to Local Officials. https://osf.io/preprints/socarxiv/c3va8/ Last accessed on January 3, 2023.

Pawson R, Tilley N. An introduction to scientific realist evaluation. Evaluation 21st Century: Handb. 1997;1997:405–18. doi: 10.4135/9781483348896.n29. DOI

Pawson R. The science of evaluation: a realist manifesto. London: Sage; 2013.

Novotný J, Ficek F, Hill JK, Kumar A. Social determinants of environmental health: a case of sanitation in rural Jharkhand. Sci Total Environ. 2018;643:762–74. doi: 10.1016/j.scitotenv.2018.06.239. PubMed DOI

Harter M, Mosch S, Mosler HJ. How does Community-Led Total Sanitation (CLTS) affect latrine ownership? A quantitative case study from Mozambique. BMC Public Health. 2018;18:1–10. doi: 10.1186/s12889-018-5287-y. PubMed DOI PMC

Harter M, Inauen J, Mosler HJ. How does Community-Led Total Sanitation (CLTS) promote latrine construction, and can it be improved? A cluster-randomized controlled trial in Ghana. Volume 245. Social science & medicine; 2020. p. 112705. PubMed PMC

Basu I. The politics of Recognition and Redistribution: Development, Tribal Identity politics and Distributive Justice in India’s Jharkhand. Dev Change. 2012;43(6):1291–312. doi: 10.1111/j.1467-7660.2012.01803.x. DOI

Wahi N, Bhatia A. The legal regime and political economy of land rights of scheduled tribes in scheduled areas of India. Centre Policy Res. 2018 doi: 10.2139/ssrn.3759219. DOI

Jewitt S. Mothering earth? Gender and environmental protection in the Jharkhand, India. J Peasant Stud. 2000;27(2):94–131. doi: 10.1080/03066150008438733. DOI

Borde R, Novotný J. (2020). Art out of place? Toilets and tribal folk art in Jharkhand. J Adivasi Indigenous Stud, 10(2).

Novotný J, Hasman J, Lepič M. Contextual factors and motivations affecting rural community sanitation in low-and middle-income countries: a systematic review. Int J Hyg Environ Health. 2018;221(2):121–33. doi: 10.1016/j.ijheh.2017.10.018. PubMed DOI

Winter S, Dreibelbis R, Barchi F. Context matters: a multicountry analysis of individual-and neighbourhood‐level factors associated with women’s sanitation use in sub‐Saharan Africa. Tropical Med Int Health. 2018;23(2):173–92. doi: 10.1111/tmi.13016. PubMed DOI

Chakraborty S., Novotný J., Das J., Bardhan A., Mondal S., Pramanik S. Geography matters for sanitation! Spatial heterogeneity of the district-level correlates of open defecation in India. Singapore Journal of Tropical Geography. 2022;43(1):62–84. doi: 10.1111/sjtg.12402. DOI

Victora CG, Habicht JP, Bryce J. Evidence-based public health: moving beyond randomized trials. Am J Public Health. 2004;94(3):400–5. doi: 10.2105/AJPH.94.3.400. PubMed DOI PMC

Deaton A, Cartwright N. Understanding and misunderstanding randomized controlled trials. Soc Sci Med. 2018;210:2–21. doi: 10.1016/j.socscimed.2017.12.005. PubMed DOI PMC

Joyce KE, Cartwright N. Bridging the gap between research and practice: Predicting what will work locally. Am Educ Res J. 2020;57(3):1045–82. doi: 10.3102/0002831219866687. DOI

Reidpath, D. D., Allotey, P., Barker, S. F., Clasen, T., French, M., Leder, K.,... & Siri, J. (2022). Implementing “from here to there”: A case study of conceptual and practical challenges in implementation science. Social Science & Medicine, 114959. PubMed

Bharat G, Dkhar NB, Abraham M. (2020) Aligning India’s Sanitation Policies with the Sustainable Development Goals (SDGs). TERI Discussion Paper.

Ortenzi F, Marten R, Valentine NB, et al. Whole of government and whole of society approaches: call for further research to improve population health and health equity. BMJ Global Health. 2022;7:e009972. doi: 10.1136/bmjgh-2022-009972. PubMed DOI PMC

MDWS. (2017). Guidelines for Swachh Bharat Mission-Gramin. Ministry of Drinking Water and Sanitation http://swachhbharatmission.gov.in/sbmcms/writereaddata/images/pdf/Guidelines/Complete-set-guidelines.pdf.

Humňalová H, Ficek F. Sanitation strategies for reducing open defecation in rural areas of India and Ethiopia. AUC Geographica. AUC Geogr. 2023;58(1):51–63. doi: 10.14712/23361980.2023.5. DOI

Dash AK, Dash RK. Environmental and sustainability campaigns: a case study of India’s Swachh Bharat Abhiyan (2014–2019) J Communication Manage. 2021;25(4):385–400. doi: 10.1108/JCOM-07-2020-0072. DOI

O’Reilly K, Dhanju R, Goel A. Exploring the remote and the rural: open defecation and latrine use in Uttarakhand, India. World Dev. 2017;93:193–205. doi: 10.1016/j.worlddev.2016.12.022. DOI

Coffey D, Gupta A, Hathi P, Khurana N, Spears D, Srivastav N, Vyas S. (2014). Revealed preference for open defecation. Economic & Political Weekly, 49(38), p.43.

Routray P, Schmidt WP, Boisson S, Clasen T, Jenkins MW. Socio–cultural and behavioural factors constraining latrine adoption in rural coastal Odisha: an exploratory qualitative study. BMC Public Health. 2015;15(1):880. doi: 10.1186/s12889-015-2206-3. PubMed DOI PMC

Chakraborty S, Novotný J, Das J, Patel P, Maity I, Roy U. Spatial environment and open defecation: in pursuit of social valuation of sanitation ecosystem services. Prof Geogr. 2024 doi: 10.1080/00330124.2023.2287167. DOI

Kumar A. Beyond toilets and targets: sanitation mission in India. Dev Pract. 2017;27(3):408–13. doi: 10.1080/09614524.2017.1290050. DOI

MDWS. (2023): Jal Jeevan Mission - Har Ghar Jal. Dashboard of the Jal Jeevan Mission, Ministry of Drinking Water and Sanitation, https://ejalshakti.gov.in/jjmreport/.

Behera MR, Parida S, Pradhan HS, Priyabadini S, Dehury RK, Mishra B. Household sanitation and menstrual hygiene management among women: evidence from household survey under Swachh Bharat (Clean India) Mission in rural Odisha, India. J Family Med Prim Care. 2022;11(3):1100. doi: 10.4103/jfmpc.jfmpc_1593_21. PubMed DOI PMC

Sprouse L, Liles A, Cronk R, Bauza V, Tidwell JB, Manga M. Interventions to address unsafe child feces disposal practices in the Asia-Pacific region: a systematic review. H2Open J. 2022;5(4):583–602. doi: 10.2166/h2oj.2022.137. DOI

Williams RN, Sclar GD, Routray P, Majorin F, Blais L, Caruso BA. A qualitative assessment of mothers’ perceptions and behaviors in response to an intervention designed to encourage safe child feces management practices in rural Odisha, India. J Water Sanitation Hygiene Dev. 2022;12(4):375–86. doi: 10.2166/washdev.2022.011. DOI

Barriers to transition to resource-oriented sanitation in rural Ethiopia