Kerala State, India

Project status:

Awaiting for Cabinet decision

Need (CMR, IMR, DD morbidity & mortality): 

Under 5 mortality: Low diarrhoeal mortality
Morbidity: 12% of children under 3 had diarrhea in the 2 weeks preceding the survey (NFHS-2, 98/99). 19.27/1000 diarrhoea prevalence rate. Diarrhoea is the second largest infectious disease, after acute respiratory infection. (source: Government of Kerala)

Demand (as expressed by beneficiaries) Rationale:

Drivers/obstacles to handwashing with soap:

The handwashing behavior study carried out in 2002 in eight districts shows that:

• 35% mothers washed hands with soap after defaecation.

• 34% mothers washed hands with soap after cleaning up after a child.

The drivers found were:
Disgust: Handwashing with soap can remove negative odors and visible dirt from hands (feelings of contentment, appear clean to others, protection of children from ill-health). NB: Absence of sensory cues of dirt and contamination limit its practice.
Social acceptance: The desire to look and smell good for the sake of social status and dignity, and to be attractive to others.
Nurture: Mothers' desire to protect the health of their children.
Habit
Environment: Men control household's purchase of soap. Lack of money and difficulties in water collection. Yet, cost of soap could not be avoided.
Soap features: Must smell nice, produce a good lather, be kind to the skin and affordable. Women clearly favor the use of a separate toilet soap for handwashing. (HWBS 2002 Full report)

Participation
- community
- public sector
- private sector
- international partners

Lead Agency: Kerala Rural Water and Sanitation Agency (KRWSA), Department of Water Resources, State Government
One year campaign
Private sector (Hindustan Lever Limited, Indian Soap and Toiletries Manufacturers' Association): Technical assistance, marketing expertise for campaign design
External Support Agencies:  
UNICEF and  World Bank: Funds

Program incentive for behavior change:

Anganwadi workers (AWW) in 300 selected aanganwaadis (districts) to receive soap for about 4 months (first year), handwashing facilities, soap, kits to promote hygiene among mothers, referral cards, flipcharts, retributions, performance reward. Reminder buttons for families with young children.

Campaign objectives:  

• To increase handwashing behavior by 8 points.

• To develop a sustainable partnership intervention model that can subsequently be scaled up.

• To inform the national IEC strategy in hygiene, water and sanitation related areas.

Expected cost-benefit: If handwashing at critical junctures increases by 8 points, diarrheal diseases incidence is expected to drop by 43%, that is a program internal rate of return (IRR) of 90%.
Expected large reduction in medical costs in target families.
Program paying for itself in savings in health care and lost days of work.  

Outcome:

Campaign objectives (cont'd): To substantially reduce the incidence of DD.

Contact person:

Key documents: 

Related links:

India: Kerala Rural Water Supply and Environmental Sanitation Project

Reforming the Indian Rural Water Supply Sector

A state government decision will be made on the revised proposal.