Can Children and Cricket Team Up with UNICEF for a Cleaner Odisha, India?

by

India has the largest prevalence of human open defecation in the world. Approximately 564 million people don’t use toilets. Consequently, as many as 1/10 of the deaths in India are caused by poor hygiene and sanitation, linked to open defecation. This issue is particularly problematic for children. Children are more vulnerable to disease by being exposed to open defecation areas near their communities and are at greater risk for childhood stunting or death from diarrhea.

In 2015, UNICEF and the International Cricket Council announced a 5-year partnership aimed at advocating on behalf of the world’s most disadvantaged children. The first public step the partnership developed was the launching of Team Swachh, a program aimed at changing experiential and instrumental attitudes and subjective norms around open defecation in India. Utilizing big name celebrities, Team Swachh teaches children the importance of practicing sanitary behaviors and using toilets.

Figure 1 http://unicef.in/CkEditor/ck_Uploaded_Images/img_1265.jpg

One quick win for Team Swachh could be in Odisha. Odisha is a rural coastal state in India that has a high incidence of poverty and disease burden. Infant mortality is 50/1000 births. Reducing death in children under age 5 is a priority for the state. Odisha is also one of the lowest performing states in latrine coverage and only fifty percent of newly constructed latrines are used. While ~ 96% of households have access to piped, pumped or well water, sanitation remains a challenge. The state government has adopted the Swachch Odisha Mission to eliminate open defecation using a community-led approach, but more can be done to address this important issue.

Capitalizing on the influence celebrities have on subjective norms, members of UNICEF Odisha partnered with Team Swachh can increase utilization of existing latrines by recruiting more “sanitation champions” in 2017 to reach the 2019 goal of eliminating open defecation. Make Odisha a priority by tweeting “Bring Team Swachh to Odisha #toilets #health @UNICEF”

 

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11 Responses to “Can Children and Cricket Team Up with UNICEF for a Cleaner Odisha, India?”

  1. MegWalkerinDC Says:

    Sounds like an excellent initiative and I would be curious to see more specifics on the design and results of the intervention.

    In Australia – another cricket-loving nation – young children are deeply inspired by their favorite cricketers. And many famous cricketers lend their name to value causes. In particular, players from the national women’s team often host in-school sports days where they blend a day of cricket with lessons about the importance of physical exercise, anti-bullying messaging and serving as strong role models for young girls.

    As a public health student, I see the link from high-quality (or at least adequate) water, sanitation and hygine (WASH) to higher performance as a cricketer. WASH influences heath/nutritional status, which influences ability to perform on the field. I think it would be imporant to think through how the cricketers will make that meaningful connection in a cultural-sensitve and actionable way for an audience of young children.

  2. israakhan Says:

    Hello from another cricket loving nation- and from across the border! An interesting and thought-provoking post, an important public health concern and a problem we face in Pakistan too. Firstly, I was impressed with the creative launch of Team Swachh partnering UNICEF and ICC. As @megwalkerindc mentions how inspirational cricketers are an Australia, they are much celebrated and very loved in Pakistan too. They shine on billboards and splash the front pages of newspapers and magazines advertising their favorite soft drink, food product or brand of footwear. It would be helpful if they could be put to “better use” by public health officials to bring about health related issues.

    I was interested to read how despite 96% of households having access to water in Odisha, sanitation remains a problem. Why would you say that is the case @aguzmangva? Is it lack of awareness about the benefits of defecating in toilets (rather, the hazards of open defecation) or is that water not usable for some reason in the toilets or simply, the lack of toilet facilities in homes?

    I am somewhat embarrassed to admit, that even though I knew open (urination and) defecation was a problem in Pakistan, I had no idea that it had the fifth-highest number of open defecators in the world, shortly behind India and Indonesia. I researched this briefly and discovered that in Pakistan, 25 million people (or 13% of the population) practice open defecation. Since they largely reside in poor rural dwellings and insecure urban informal settlements, that makes them the most difficult to reach. Concurrent with the post, 110 children under the age of five die every day from diarrheal-related disease, due to poor water and sanitation and 43.7 % children are stunted in the country. There is a lack of policy on water, sanitation and hygiene (WASH) in Pakistan ─ and where it exists, it tends to be poorly informed and often implemented without consulting the local people.

    The Pakistan Approach to Total Sanitation (PATS) is a sanitation program adapted from the Community Approach to Total Sanitation by Unicef in Pakistan. PATS aims to create open defecation free (ODF) villages in Pakistan by making the practice of saying no to open defecation as a social norm. There are several models adopted by PATS such as Community Led Total Sanitation (CLTS), School Led Total Sanitation (SLTS), Component Sharing, Sanitation Marketing and Disaster Response. Fortunately, these resources have been effective and toilet use is rapidly becoming the new norm. In 2015, against considerable challenges, Pakistan achieved the Millennium Development Goal (MDG 7) to halve the proportion of people who in 1990 did not have access to improved sanitation.

    Links:

    UNICEF Pakistan Media Center
    http://www.unicef.org/pakistan/media_9678.htm

    PATS:
    http://www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/PATS.pdf

    WHO water sanitation and health
    http://www.who.int/water_sanitation_health/monitoring/jmp2012/fast_facts/en/

    http://www.dawn.com/news/1168181

    http://www.dawn.com/news/1145615

  3. shabanawalia Says:

    Great post! So is the issues in rural places like Odisha that they may have latrines, but the cultural norm is to not use them? That surprises me. I completely agree that cultural and societal norms outweigh the popular school of though, however one would think that after a certain amount of media representation and an adequate communication strategy to disclose the serious dangers of open defecation to children, community members would place this high on their task list. I believe one of the greatest inventions in human history was the toilet, as this separated waste from everyday human life and was a major contributor to the reduction of infectious disease. It humbles us and reminds us how lucky we are have access to basic needs. What we have had since the industrial revolution in high income countries is still not the norm in low to middle income countries, which seems beyond unfair. Thank you for posting this!

  4. edlinpatrick Says:

    Hi Meg & Shabanawalia,

    I am going to attempt responding to your alls comments both at the same time. First of all thank you for the comments! The problem of open defecation in India is rooted in cultural and religious norms and the health benefits of latrines are not fully appreciated.

    An educational approach is one intervention; however we do not believe education alone would be sufficient. If we frame the issue in a reasoned action/planned behavior change model, education only addresses the construct of instrumental attitude (belief that behavior performance is associated with certain outcomes).

    The celebrity power of the cricket players addresses the subject/injunctive norm (belief about whether people approve of the behavior) as well.

    What this intervention fails to address are the personal agency constructs of self efficacy and perceived behavior control.

  5. israakhan Says:

    Reposting this comment (without the links, since it didn’t go through earlier 😦

    Hello from another cricket loving nation- and from across the border! An interesting and thought-provoking post, an important public health concern and a problem we face in Pakistan too. Firstly, I was impressed with the creative launch of Team Swachh partnering UNICEF and ICC. As @megwalkerindc mentions how inspirational cricketers are an Australia, they are much celebrated and very loved in Pakistan too. They shine on billboards and splash the front pages of newspapers and magazines advertising their favorite soft drink, food product or brand of footwear. It would be helpful if they could be put to “better use” by public health officials to bring about health related issues.

    I was interested to read how despite 96% of households having access to water in Odisha, sanitation remains a problem. Why would you say that is the case @aguzmangva? Is it lack of awareness about the benefits of defecating in toilets (rather, the hazards of open defecation) or is that water not usable for some reason in the toilets or simply, the lack of toilet facilities in homes?

    I am somewhat embarrassed to admit, that even though I knew open (urination and) defecation was a problem in Pakistan, I had no idea that it had the fifth-highest number of open defecators in the world, shortly behind India and Indonesia. I researched this briefly and discovered that in Pakistan, 25 million people (or 13% of the population) practice open defecation. Since they largely reside in poor rural dwellings and insecure urban informal settlements, that makes them the most difficult to reach. Concurrent with the post, 110 children under the age of five die every day from diarrheal-related disease, due to poor water and sanitation and 43.7 % children are stunted in the country. There is a lack of policy on water, sanitation and hygiene (WASH) in Pakistan ─ and where it exists, it tends to be poorly informed and often implemented without consulting the local people.

    The Pakistan Approach to Total Sanitation (PATS) is a sanitation program adapted from the Community Approach to Total Sanitation by Unicef in Pakistan. PATS aims to create open defecation free (ODF) villages in Pakistan by making the practice of saying no to open defecation as a social norm. There are several models adopted by PATS such as Community Led Total Sanitation (CLTS), School Led Total Sanitation (SLTS), Component Sharing, Sanitation Marketing and Disaster Response. Fortunately, these resources have been effective and toilet use is rapidly becoming the new norm. In 2015, against considerable challenges, Pakistan achieved the Millennium Development Goal (MDG 7) to halve the proportion of people who in 1990 did not have access to improved sanitation.

  6. israakhan Says:

    Posting the links (again) in a separate post *fingers crossed! 😀

    UNICEF Pakistan Media Center
    http://www.unicef.org/pakistan/media_9678.htm

    PATS:
    http://www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/PATS.pdf

    WHO water sanitation and health
    http://www.who.int/water_sanitation_health/monitoring/jmp2012/fast_facts/en/

    http://www.dawn.com/news/1168181

    http://www.dawn.com/news/1145615

  7. shogokubota Says:

    You successfully convince the readers how important the issue on open defecation in India is with relevant data and links. One point I want to clarify is what you expect to the audience to act upon. How do you expect this article to trigger political commitment? Who are the target audience?

  8. bbland1 Says:

    What an interesting topic. I especially liked reading all the comments, especially learning about the different initiatives in Pakistan as well thanks to @israakhan. I was shocked by the statistics in the WHO article that 2.4 billion people don’t have toilets and 946 million perform open defecation (which they said was 1/8 people in the world). From the blog post above, I was also found it fascinating the statistics that only ~50% of new latrines are being used by the population. Implementing behavior changes like reducing open defecation can clearly have such an impact at improving the health and well-being of the population. I think that these types of programming and initiatives often don’t get as much attention or interest in the media / donors, so it is great to see UNICEF partnering with celebrities to really bring attention and education to impacted populations.

    I was curious, so I googled to look for some more news articles and found a lot of interesting pieces on India and other countries (Ghana). Thanks for a great post!

    http://timesofindia.indiatimes.com/city/vadodara/No-more-open-defecation/articleshow/53802966.cms

    http://allafrica.com/stories/201608220535.html

  9. hasanalihali4 Says:

    Great blog post and thank you for sharing. I think that this blog post, pertaining to the impact that poor hygiene-related preventable illness can have on a community’s overall health, is directly analogous to community case study #2 (Hygiene and Sanitation in Karimu) from Lab#3 and could benefit from a revisiting of the lessons learned in Karimu. To summarize, a public health team decided to form a VHC (Village Health Committee) comprised of village elders to help facilitate and construct an educational outreach program that spread the importance of hygiene to schools, homes, and other parts of the community. I think that Odisha could benefit from a similar grass-roots program that attempted to leverage community leaders, rather than celebrities, to seek a sustainable solution to this open defecation issue that is oriented around educational outreach. Educating families regarding the link between their hygiene and overall health, the importance of health in general, clean and hygienic practices, and even the presence of hygiene-related resources in their communities (i.e latrine locations, well locations) could go a long way towards alleviating this issue. The creation of a community advocacy group would also help the longevity of the intervention and hopefully make strides towards changing the societal norms that currently allow for open defecation to occur without sufficient resistance.

  10. aguzmangva Says:

    Thank you everyone for your additional and excellent comments. I’d like to especially compliment Israakhan who identified one of the key ways that open defecation can be achieved. Community Total Led Sanitation (CLTS) is one of the main drivers for behavior change, and PATS in Pakistan is an excellent example of this program.

    And you are also correct Shogokubota – without political commitments and follow-up to those commitments, it will take a very long time for improved sanitation to be achieved. In countries with populations as large as India and Pakistan, investments in sanitation can yield so many positive outcomes for health on multiple scales.

    Thankfully, there has been recent political will on the part of PM Modi (India) and PM (Sharif). With continued support from the international community, donors, and the private sector, I see hope for momentum, and for an open defecation free future.

  11. mstodoka Says:

    Excellent post and thank you for drawing attention to this important public health issue. I had no idea this was such problem in India, and in other parts of the world. I agree with @israakhancreative that the partnership of UNICEF with the International Cricket Council (ICC) is a creative approach to changing the social norms surrounding open defecation. I found it particularly interesting that the post reports that only fifty percent of newly constructed latrines in Odisha, India are used, and that although 96% of households have access to piped, pumped or well water, sanitation remains an issue. Clearly the plan to address the social norms that leads to an acceptance of open defection is the right approach. While I think the UNICET/ICC Team Swachh initiative is a creative approach, I have a bit of a love-hate relationship with celebrities and, in this case, athletes influencing the health related behaviors of the public. For better or worse, we are globally obsessed with celebrities and athletes. We look to them for queues on fashion and the latest in diet and fitness trends. In the case of Team Swahh, ICC celebrities are presented as ‘sanitation champions’ and their influence is being used to encourage positive behavior. In general; however, I think that looking to celebrities for advice on potentially life-altering behavior could be a dangerous proposition. I think back to Lab 1 where we reviewed the influence of social networks at the Interpersonal Level of the Ecological Model. In my example, celebrities had a profound impact on parents electing to vaccinate their children. Public figures such as Jenny McCarthy have gone to great lengths to propagate their anti-vaccine points of view. The result has been to instill fear and trepidation in parents who are faced with vaccination choices. Despite the discrediting of the scientific studies some of these public figures have based their options on, the damage has been done in the form of an increase in the number measles and whooping cough cases (1). Again, while I applaud the success of the Team Swachh program, we should trend lightly when looking to celebrities and athlete for health related guidance.

    (1) http://www.sp-exchange.ca/2014/05/06/celebrities-influence-on-public-health/

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