2015 team 1

1. Combating Pediatric Stunting in the
Saharanpur District of Uttar Pradesh
Lauren Gist
Beenish Kamran
Yashna Krishnamani
Prima Modi
Aarin Palomares

2. Total Population: 1,236,344,631 (2nd largest)
Infant Mortality Rate: 43.19 deaths / 1,000 live births
Religion: Hinduism (80.1%) - traditional, deep roots
Vulnerabilities:
- Poor Hygiene & Sanitation
- Highly Dense Populated Areas
Uttar Pradesh Demographics
Population: 200,581,477
Religion: Hinduism (84%) Islam (18.4%)
Literacy Rate: 68% Overall
Target Population: Saharanpur District of Uttar Pradesh
Population: 3,466,382 (2011)
Literacy Rate: 70% Overall 2

3. Problem: Religion and lack of education constitute to a high
prevalence in open defecation in rural areas of Northern India
- Largest factor of pediatric stunting
- Causes gastrointestinal diseases
- Pollutes the environment
Household Latrine Statistics for Rural Saharanpur
Objective: Provide effective strategies to combat pediatric stunting in the
Saharanpur district of Uttar Pradesh
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4. Total Sanitation Campaign (TSC): Comprehensive program that ensures
sanitation facilities in rural defecation with goal to eradicate open defecation
Prime Minister Modi’s Initiative
- Pledge of 11 million toilets
Bill and Melinda Gates Foundation
- Reinvent toilet campaign
4

5. - Aligning with Community-Led Total Sanitation Approach
- Gearing interventions based on community assessments
- Developing appropriate technology
- Lobbying the local government to pass a No Defecating Policy in the Saharanpur
A Multifaceted Approach with Focus on Community-Led Total
Sanitation and Collective Behavioral Change
5

6. - Community Led Total Sanitation (CLTS) is already
being used in 16 of the 35 states in India.
- An estimate of around 5 million people have gained
access to safe sanitation across rural India due to
CLTS.
- In regions such as Himachal Pradesh and Haryana,
there has been a 60-70% increase in sanitation
coverage.
- In Bihar, where they use subsidies instead of CTLS,
they have only had a 20% increase in sanitation
coverage.
http://www.communityledtotalsanitation.org/sites/communityledtot
alsanitation.org/files/images/CLTSPosterirsp.jpg 6

7. Retrieved from:
http://www.mapc.org/sites/default/files/CDC%20impact%20table_2.JPG
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8. Year 1
Identifying,
Educating and
Training
Community
Latrines
and
Sustainability
Changing the
Norms
Projected Timeline
Year 2 Year 3
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9. Year 1
Identifying, Educating and Training Community
Goal: To gain trust within the community, identify possible partners in initiative,
reach out and educate community leaders to address open defecation, and
launch initial media campaign
- Community Assessment
- Build Relationships
- Educate and train community leaders
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10. Q1
(Months 1-3)
Initial community assessment/mapping
Build relationships and gain trust from community members
Q2
(Months 4-6)
Identify community leaders through community assessment/mapping
Educate the community members of the issue by conducting a transect walk
Reach out to current community stakeholders (other NGOs, UN, Bill and Melinda Gates Foundation)
Obtain governmental support by contacting officials in district
Q3
(Months 7-9)
Community
Workshops: 1-2
times a month
Train local community leaders to advocate against dangers of open defecation
Educate community members about how OD leads to stunting
Provide resources/materials to educate and promote latrine usage
Gain media and ad campaign support
Q4
(Months 10-12)
Evaluate training and education program for next year
Refocus community workshops based on evaluation
10

11. Year 2
Changing the Norms
Goal: To establish a collective behavioral approach, changing the attitudes on
open defecation through a mass media campaign that takes into account
culture
- Focus scope of ad campaign to include cultural influence and familiarize locals
with the dangers of open defecation
- Lobby local government to enforce ‘No Open Defecation in Saharanpur’ policy
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12. Q1
(Months 1-3)
Second annual
community
assessment/mapping
Expand efforts to include more villages
utilizing temples as community centers
Bharatanatyam
Launch mass media campaign
Execute reformed community workshops
Q2
(Months 4-6)
Incorporate a
holistic
advertisement
campaign
Refocus campaign to include popular
Bollywood culture and influence
Focus on mother’s involvement as a
primary caregiver (trigger emotion)
Panchatantra: Open Defecation Edition
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13. 13

14. 14

15. 15

16. https://sanitationupdates.files.wordpress.com/2013/09/tbc-nepal.jpg
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17. Q3
(Months 7-9)
Continue ad campaign
Innovation Workshop focused on addressing concerns of current latrines
and accommodate community preferred design
Begin lobbying to local government officials to enforce policy
(No Open Defecation in Saharanpur)
Q4
(Months 10-12)
Evaluate and refocus ad
campaign
Evaluate Innovation Workshop
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18. Retrieved from: http://www.popcouncil.org/uploads/pdfs/2010India_PolicyBrief10.pdf
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19. Year 3
Sustainability & Latrines
Goal: To facilitate the design of a latrine that is more suitable to the comfort
level of the community and to ensure sustainability through additional
funding
- Conduct participatory community surveys about latrine design
- Continue advocating policy
- Compile data on effectiveness of initiative and propose partnership with Prime
Minister Modi’s “Clean India” Campaign and other organizations
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20. Q1
(Months 1-3)
Third community assessment/mapping
Hold a community district innovation fair showcasing community-geared latrine design and conduct
a community participatory survey to evaluate which design would be most effective
Find external funding for the implementation of community preferred latrines
Propose to government to make our NGO a part of the Modi Green Campaign
Q2
(Months 4-6)
Raise support for anti-open defecation policy
Continue searching for funds to build latrines
Q3
(Months 7-9)
Sustainability Workshop focused on training and expanding community engagement
Continue lobbying the government to pass policy
Q4
(Months 10-12)
Expand community workshops district wide
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22. 22

23. Measurable Outcomes
• Annual Surveys
• Media Campaign Evaluations
Subjective: Annual Community Assessments
• We expect to greatly reduce open defecation in the Saharanpur district
• We aim to achieve similar results throughout the Uttar Pradesh region and spread across
India
We Plan to follow CDC’s Guide to Analyzing the Cost-Effectiveness of
Community Public Health Prevention Approaches
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24. - Partner with Prime Minister Modi’s initiatives and ask for additional
funding in order to continue elimination campaign
- Our NGO will enact similar plans in surrounding districts and move
throughout in districts of Uttar Pradesh
- Progress monitored through routine annual community assessments
- Trained facilitators will continue mobilizing the community
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25. Dr. Dale Dickinson for his mentorship
Dr. Daniel Chavez-Yenter for support throughout the week
Sparkman Center of Global Health
Fellow classmates for invaluable commentary, guidance and
discussions
Thank You! 25

26. ● http://www.indiasanitationportal.org/
● http://www.communityledtotalsanitation.org/country/india
● http://www.popcouncil.org/uploads/pdfs/2010India_PolicyBrief10.pdf
● http://riceinstitute.org/wordpress/2014/07/30/do-religious-leaders-talk-about-defecation-
in-india/
● http://riceinstitute.org/blog/three-government-sanitaiton-programs-fail-to-improve-open-
defecation-in-one-switching-study-village/
● http://www.gatesfoundation.org/What-We-Do/Global-Development/Reinvent-the-Toilet-
Challenge
● http://personales.upv.es/anhuegon/latrines.html
● http://www.endwaterpoverty.org/sites/endwaterpoverty.org/files/WTD%20Dossier.pdf
● http://www.census2011.co.in/census/district/503-saharanpur.html
● http://riceinstitute.org/wordpress/wp-content/uploads/2014/09/Open_Defecation.pdf
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27. TOILET COVERAGE AND
SANITATION
PERFORMANCE IN INDIA
BY STATES (2001-2011)
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28. Sample Workshop
Day 1- Introduction to CTLS
 Groups discussed expectations on how to stop open defecation, how to motivate, how
to change thinking, and how to increase low cost toilets and develop effectiveness
 Groups presented on projects that failed and addressed why they failed
 Role Play- attitudes and behaviors of facilitators
Day 2- Triggering Tools
 Rapport building, defecation mapping, calculation of fecal matter, calculation on
expenditure of diseases, low cost toilets, and commitment date (These are considered
tools)
 Goal is to motivate participants to make changes
Day 3- Roles and Responsibilities
 Groups demonstrated strategies and tools to villages
Day 4- Triggering Outcomes and Film Show
 The groups presented on their outcomes in the villages and had follow-up visits
Day 5- Natural Leader Presentations
Overall Process
Pre-
Triggering
Triggering
Post
Triggering
Beyond
CLTS
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29. Phase 1: Team Building
 Teams consisting of builders, village health workers, and an Environmental Health
Officer
 Identify root of issue
 Identify advantages and disadvantages of current technology (latrines)
Phase 2: Discovery
 Identify potential design options for latrines geared towards villagers’ needs
 Brainstorm and mapout designs
 Identify
Phase 3: Prototyping
 Create small prototypes of designs
 Gain feedback from villagers 29

30. Saharanpur Statistics
Uttar Pradesh Region Saharanpur District
Population
200,581,477
3,466,382
Literacy Rate 68% 70%
% OD (highest)
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