The making of “Swachh” India Lessons from the Swachh Bharat Mission – driving behaviour change at scale October 2018 KPMG.com/in © 2018 KPMG, an Indian Registered Partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Foreword The Swachh Bharat Mission (SBM), which is perhaps the largest behaviour change campaign ever, aims to make India a clean nation. There is enough evidence to show that India is on a new trajectory of growth owing to the achievements under the mission. SBM has witnessed a phenomenal increase in rural sanitation coverage from 39 per cent to 90 per cent in the last four years. It is heartening to see the people of our nation stepping beyond their roles as mere beneficiaries of the programme to becoming its leaders. The large majority of citizens in rural India, especially the women, no longer have to suffer the indignity of having to go out into the open to defecate. In fact, women are becoming the primary force in driving the nation in becoming free from open defecation. It marks a sea change in their attitude which has a direct impact on their dignity and quality of life. The World Health Organization (WHO) believes that SBM could prevent about 300,000 deaths due to water borne diseases assuming we achieve 100 per cent coverage by October 2019. The credit for this will go to every Indian who was part of this campaign. I take this opportunity to congratulate the Ministry of Drinking Water and Sanitation and every citizen in the country for catalysing the achievements achieved thus far. We have committed ourselves to attain a nation free from open defecation by Mahatma Gandhi’s 150th birth anniversary. The next 12 months are therefore crucial to achieving the goals of the mission and thereafter an accelerated achievement of Sustainable Development Goal (SDG) 6. Nilaya Varma Partner and Head Government and Healthcare KPMG in India © 2018 KPMG, an Indian Registered Partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved © 2018 KPMG, an Indian Registered Partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. Table of contents 1. Executive summary 01 2. Background 03 3. The scale of the problem 05 4. Success factors 06 5. Way forward 14 6. References and definitions 15 7. Acknowledgements 16 © 2018 KPMG, an Indian Registered Partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved 01 Executive summary Political support Think scale, not drip Engagement with critical drip implementers Continuous support from Programme initiatives must The Centre very early on the highest level drives think scalability during design in the mission realised change across levels. In process with an objective to continuous and close the case of SBM the Prime reach everyone, everywhere. engagement with states Minister’s call to action Change must come fast, and districts was paramount garnered participation from like a revolution, and not in their journey to all sections of the society incrementally. SBM has become Open Defecation and from stakeholders at created several sustainable Free (ODF)01. Regular various levels turning the and demonstrative models meetings with political and campaign into a Jan Andolan with a focus on quality of bureaucratic leadership of on the same year it was sanitation service delivery states were held to push launched, something that has and Mission sustainability. sanitation to the top of the never been achieved by any state’s development agenda. government-led sanitation Numerous cross-learning programme in the past. The platforms, trainings and Prime Minister backed the national level conferences programme with adequate have played a pivotal role in resources and a budget of establishing demonstrative over USD 20 billion. learning, and served as ready reckoners for implementers in replicating the successes across districts. Large scale events were organized to engage with grassroots leadership like Sarpanchs and Swachhagrahis. 01. ODF is the termination of feacal-oral transmission, defined by a) no visible faeces found in the environment/village; and b) every household as well as public/community institution using safe technology options for disposal of faeces © 2018 KPMG, an Indian Registered Partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved. 02 Getting everyone Success breeds Competition and involved success housekeeping The key differentiator of SBM By targeting the low Healthy competition is key has been its citizen-centric hanging fruits – converting to achieving the mission’s approach of engaging all high coverage districts to objectives. With the stakeholders and making ODF, the mission was able aim of fostering healthy sanitation everyone’s’ to create a demonstration competition between states business. This was done effect. This in turn inspired and districts for improving keeping in mind the objective the neighbouring districts to cleanliness standards that greater the recall, faster develop efficient systems across rural India, the the behaviour change. The and strategies to support Swachh Survekshan survey large scale attention drawn districts in becoming was launched. Apart from by the Mission can be ODF. The learnings from evaluating progress, the correlated with the perpetual these early successes survey encouraged large- campaign mode it adopts. were subsequently used scale citizen participation to support the more and accelerated Mission Further the Ministry has challenging districts. implementation by aiding engaged deeply with the incorporation of private philanthropies Further, the sunset clause of sustainability in Mission and corporates to drive making India ODF by 2019 implementation, through various initiatives and has demands a focused strategy focus on outcomes and collaborated with other and has proved beneficial in impact rather than inputs. departments/ministries, aligning various stakeholders which have not only helped towards a common goal. uniform implementation of SBM outcomes, but has also helped smoothen out frictions due to jurisdictional issues. © 2018 KPMG, an Indian Registered Partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved 03 Background Sanitation has remained a major challenge for India At the start of the SBM in 2014, about 600 million since Independence. According to Census 2011, only people in India defecated in the open, of which 31 per cent of rural households had access to toilets. 550 million were in rural areas. The SBM was The negative impact of this deficit was evident across broadly made up of two parts: the Swachh Bharat India and reflected by the high rates of stunting, Mission-Gramin (SBM-G), the rural component of the malnutrition, diarrhoea and death from water-borne Mission, driven by the Ministry of Drinking Water and diseases. India has seen a number of sanitation Sanitation (MDWS), and the Swachh Bharat Mission- programmes beginning 1986 to 2018. These include- Urban (SBM-U). The MDWS also works towards Central Rural Sanitation Programme (CRSP) in 1986, mainstreaming sanitation across other sectors and Total Sanitation Campaign (TSC) in 1999 and Nirmal Ministries like railways, schools, hospitals, highways, Bharat Abhiyan (NBA) in 2012. Neither of these tourist places etc. programmes could meet the set objectives nor As of September 2018, the sanitation coverage of sustain the outcomes, leading to major slippages. India is upwards of 93 per cent and over 465,000 On 2 October 2014, on the 145th birth anniversary villages have been declared ODF. Towards the end of Mahatma Gandhi, Prime Minister Narendra Modi of 2017, an independent verification agency (IVA) launched the Swachh Bharat Mission (SBM) with the conducted the National Annual Rural Sanitation objective of ensuring universal sanitation coverage Survey (NARSS)02, and found that 93.4 per cent by 2 October 2019, the Mahatma’s 150th birth people who had toilets, used them regularly. NARSS anniversary. also re- confirmed the ODF status of 95.6 per cent of Since its launch in 2014, SBM has been effective the villages that had been verified ODF by the state in bringing sanitation to the centre of India’s governments. development discourse. It is the world’s largest An assessment of the programme brings forth behaviour change programme initiated by any some key lessons for such missions, and this case government, involving and benefiting the health and study attempts to document them with an aim to livelihood of approximately 18 per cent of the global serve as an important starting point for other similar population. programmes globally. 02. NARSS is a part of the World Bank support project to Swachh Bharat Mission - Gramin © 2018 KPMG, an Indian Registered Partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss