Process Evaluation Study of FINISH Program in India

Several low-income and developing countries face major disease burdens associated with poor sanitation including diarrhea, soil-transmitted worm infections, trachoma, lymphatic filariasis, etc.1 This hurts the health care cost and the overall economic growth. Even though cost-effective preventive behaviors and investment are known, low uptake of these technologies poses a challenge for global health. In 2011, around 620 million people, or 50% of the population in India defecated in open, acting as a huge barrier in achieving the health outcomes envisaged for the country.2 To address sanitation-related challenges and with an ambitious goal to end open defecation in the country by 2019, the Government of India (GoI) launched the Swachh Bharat Mission (SBM) in 2014. It was a succession of myriads of government sanitation programs such as the Central Rural Sanitation Program (CRSP) in 1986, Total Sanitation Campaign (TSC) in 1999, and the Nirmal Bharat Abhiyan (NBA) in 2012. SBM-G follows GoI’s historical rural sanitation programs in adopting a supply-led, incentive-driven approach targeting latrine construction as a primary sanitation outcome. Along with providing government funding, the SBM has also sought active participation from both non-profits and the corporate sector to tackle the issue.

Prior to the launch of SBM, FINISH initiated one of the biggest sanitation programs in India in 2009-10. The program worked on a multi-stakeholder engagement approach with an end-to-end effort on the sanitation value chain, from demand generation to behavioral change to the facilitation of funds by Micro Finance Institutions (MFIs). The focus was on awareness generation at individual and community level to further behavioral change for adopting sanitary practices and generating demand for sanitation systems. Concurrently, there was also a need to mobilize funds for the construction of toilets and other sanitation facilities through government incentives and sanitation loans.

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