Flush India

By Lyle Birkey

Final Individual Project

Strategic Communication Program Management

Center for Communication Programs

Johns Hopkins University

India’s Campaign to End

Open Defecation

Current Situation(Situation vs. Destination)

Hundreds of thousands of Indians die every year from ailments associated with poor sanitation conditions.

This is especially evident in the Northern regions of India.

Approximately 130 million households do not have toilets and more than 72% of rural people defecate in public places.

By relieving themselves behind bushes, on road-sides, and in fields, enteropathy and diseases like encephalitis are rampant

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Future under Current Conditions(Situation vs. Destination)

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Preventable deaths and substandard living conditions

will continue to plague Northern regions of India even

as affluence increases and more nutritional diets

become economically viable

Desired Future State(Situation vs. Destination)

Destination Public defecation in India ended by 2030

Improve public health by reducing incidences of

intestinal worms and bacterial infections

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Public Health

Malnutrition

Child

Mortality

Reduce diarrhea-causing ailments and childhood

malnutrition

Improve child mortality rates through increased

public health and reduction of malnutrition

Impacts

Flush India is India’s

campaign to end open

defecation.

The name came be

customized to regional and

local movements. For

example, a Bengal

campaign can be titled

“Flush Bengal”

Introducing:

Flush India Program

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Figure 1: Campaign Logo

Audience Segmentation(Segmentation Criteria)

Given the complexity of the behavioral pattern, multiple

aspects of population demographics must be considered.

At minimum, three demographic aspects may be employed

to segment target audiences:

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Education

Level

Community

and Social

Engagement

Homeowner

Status

1 2 3

Audience Segmentation(Target Audience)

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This campaign will focus on audiences on the client side of the

issue. Populations in northern India are of special interest given

the prevalence of the desired behavior change in this region.

Figure 1: Change in people

defecating in the open per square

kilometer

Figure 2: Regions with the highest

rate of open defecation:

Rajasthan, Uttar Pradesh, Bihar,

Orissa, Delhi, and West Bengal

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Audience Profile

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Communication Objectives

Knowledge

Attitudes

Behavior

1

2

3

Within 3 months of the campaign start, 30%

increase in public knowledge of public health

effects of open defecation.

Within 6 months of the campaign start, 20%

increase in public support for ending open

defecation.

Within 4 months of campaign start, mobilize 10%

of the general public to share information about

the health effects of open defecation with family.

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Winning Key Benefit

Social ApprovalPositive messaging toward the use of indoor facilities was pretested as the most

likely benefit to resonate with the target audience given the strong cultural

emphasis that Indian populations place on friends, family, and community.

Additional supporting points:

Social approval of the behavior change is more sustainable than

direct knowledge transfer of public health facts since it is more

habit-forming.

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More likely to make the local impacts felt by the whole community

rather than a few educated sections of the population.

Social enforcement of the behavior change will be more cost

effective than direct regulation/policies.

2

3

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Media Plan

Interpersonal-

Hotlines - will collect the opinions of affected citizens and provide a conduit for anonymous reporting of “hot spot” areas where open defecation is known to take place.

Peer Education - trained community members will hold meetings at public places to inform and involve their peers. This method will reach few individuals, but will have a high recall rate due to the level of intensity.

Community Based-

Public Meetings- facilitated by government officials in a town-hall format. Will also have a limited reach, but create an intense dialogue on the subject.

Community Radio – used in remote regions where computers may not be common and outdoor media may not be cost-effective.

Mass Media-

Print- brochures containing fact sheets will be used to inform the public and promote engagement in the program

Computers/Internet - Twitter and Facebook campaigns and monitoring will increase accessibility to prompt response to inquiries and broader public knowledge of the issue.

Outdoor Media- billboards will be placed in strategically high-traffic areas to attract the attention of the target audience.

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Media Plan(Advantages and Disadvantages)

Media Channel Advantages Disadvantages

Peer Education Meaningful personal contextDifficult to implement and monitor

Public MeetingsOpportunity for community

leaders to share knowledge with public

Low attendance may result in ineffective meeting

Bulletin Board

Accessible in remote areas

where other means of

communication are not available

Limited geographical reach

Computers/Internet More targeted advertisementsSmall percentage of population has access to internet

Hotlines Provides public participation Dependent on engaged public

Community Radio Reaches more rural areasDifficult to determine audience demographics

Outdoor Media High visibility in public space Expensive

Pri

mary

Secondary

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Materials Development(Radio Spot)

45 SECONDS:

Can’t seem to keep your meals from running straight through you?

There’s a reason! It has everything to do with that person relieving

themselves in your alley, in the field down the road, or even on your

front porch right now! Human waste in these open public areas is

plaguing our community with disease. Flush India is our way to fight back

against this nasty habit which is sending our children to the hospital and

endangering our families.

If you would like to help our community get more public toilets, identify

local hot spots, and ensure a healthier future for our youth, join us for a

public meeting at noon on October 3rd in front of the community center.

All are welcome!

Together, we can Flush this problem away!

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Materials Development(Billboard)

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Program Analysis

Key Constraint: Preference for open-field defecation regardless of

latrine availability.

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Program Analysis(SWOT Snapshot)

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Strengths

Weaknesses

Opportunities

S

W

O

Socially-oriented programs that shift public sentiment

toward behavior change.

Media outlets that enable identification of open

defecation “Hot Spots”.

Difficulty in monitoring behavioral change on the

national scale.

Dependence on infrastructure development to provide

alternative behaviors (use of indoor facilities)

Tapping additional resources for infrastructure

development.

Learn from experiences to adapt messaging depending

on level of local facilities development.

Threats

T Lack of space in houses to construct household

latrines.

Sustainability of learning and interest in behavior

change.

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Evaluation Indicators

Quantity Quality

Eff

ort

Quantity/Effort(How well did we do?)• No. of bulletin boards posted

• No. of peer education classes

held

• No. of public meetings held

• No. of radio spots

• No. of billboards purchased

Quality/Effort(How well did we do?)• % recall of bulletin boards

• Attendance at peer education

classes

• Attendance at public meetings

• No. of listeners during radio spots

• % recall of billboards

Eff

ect Impact

• % of population regularly using lavatory facilities

• % of population treated for enteropathy and encephalitis

• % of deaths due to enteropathy and encephalitis

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Management PlanEnsuring overall effectiveness

The organizational climate of “Flush India” will be that of a

learning organization that encourages life-long learning of the

staff. This includes hands-on cultural and social experiences

that help the staff remain in touch with the populations which

they mean to impact.

Management behavior will be the primary guide to

organizational climate. Management will insure that the

following activities are regularly undertaken:

Open and structured conversations about key constraints and

barriers to success in the shared vision (both internal and

external).

Merit-based bonuses are given commensurate with managerial

evaluations.

Managers are required to present recommendations from junior

staff to the executive staff and/or board members.

Too often in communications we focus only on the media

materials and the audience, but every aspect of a truly

strategic communications program contributes to the

environment that dictates success.

Nothing in communications happens in isolation. All factors

are important to consider and must be addressed on some

scale if complete success is to be attained.

How we measure and monitor program success is critical to

equipping the next iteration of program evaluation with

quantifiable and measurable feedback.

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Lessons Learned