Department of Social Geography and Regional Development, Faculty of Science, Charles University, Albertov 6,, Prague,, Czechia.
School of Geography, University of Leeds, Leeds, UK.
BMC Public Health. 2024 Apr 12;24(1):997. doi: 10.1186/s12889-024-18388-y.
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.
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.
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.
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.
印度清洁印度运动（SBM）于 2014 年启动，目标是在 2019 年 10 月前使印度实现无露天排便。尽管人们知道这一雄心勃勃的目标并未实现，但 SBM 在印度不同地区带来的卫生变化性质仍知之甚少。原因之一是缺乏案例研究，无法同时了解 SBM 在其不同领域的表现。本文提供了这样一个研究的例子。本文采用过程、结果、背景方法，旨在了解印度恰尔康德邦农村地区特定背景下 SBM 引发的卫生变化过程和结果。
该研究利用在印度中东部恰尔康德邦兰契区农村地区进行的实地研究收集的数据。这些数据是通过在 SBM 开始和结束时进行的多次横断面家庭调查获得的，并辅之以 SBM 利益相关者的关键人物访谈。
我们确定了 SBM 实施的政治支持及其在民众中的接受程度。女性社区工作者成为 SBM 在地方一级实施的关键代理人。SBM 将研究区域的厕所覆盖率从 15%提高到 85%，将露天排便率从 93%降低到 26%。它大大减少了获取厕所方面的结构性不平等，进一步推动了社会卫生规范，改善了一些人对使用厕所的态度，但对卫生和卫生知识的影响较小。实施主要集中在建造补贴厕所上，但在提高公众对安全卫生习惯的理解方面做得较少。
尽管 SBM 减少了研究区域获取厕所方面的卫生不平等，但行为改变部分被轻视，更多地侧重于传播规范的卫生信息，而对公众教育的关注较少。未来，可持续性仍然是一个关键问题。本文呼吁系统地产生有关卫生干预措施绩效的地理位置知识。
