Development of a communication model focussing on behaviour change

towards social welfare schemes

Research Plan
submitted by
Niyati Raj
Research Scholar CRDT
2014RDZ8134

Supervisor
Dr. V M Chariar

Centre for Rural Development & Technology

Indian Institute of Technology, Delhi

June 2015
 BACKGROUND

India is home to 1.21 billion people, 68.8% (i.e. 800 million people) of whom reside in
rural areas. Unarguably, the government and non-government organizations have spent
huge sums of money and effort into the welfare of the Indian citizens [Table 1]. Looking
at the meticulously detailed policies, there remains no doubt about the government’s
intention to provide welfare assistance to the poor and facilitate their uplifment.
However, the outcomes at the ground level have rather been sub- optimal.

Most of the welfare programmes do not yield desired results due to variety of reasons;
including, lack of resources, rent seeking, disjoint between the schemes, implementation
challenges, focus on targets rather than on quality, lack of beneficiary involvement in
formulating & implementing the schemes, etc. The emphasis is more often than not on
providing the physical infrastructure (like construction of schools under the Sarva
Shiksha Abhiyan, or toilets under the Swachh Bharat Mission, etc.) which not only
consumes substantial financial allocations, but leaves very little resources for
community participation.

Success of these schemes is more often than not dependent on the beneficiaries’
themselves, who are either ignorant about the benefits of the schemes, the need for
these schemes or their impact, either at an individual or at the community level. This
lack of awareness and involvement is often neglected either while making the policy or
while implementing it. This results in unaccountability of the policy makers and the
functionaries of the schemes responsible for implementation at the ground level
towards the beneficiaries, who due to their lack of proper knowledge are not able to
question the proper functioning of the schemes1.

Hence, investment in marketing these social welfare schemes by appropriate

communication, eventually leading to a sustainable behaviour change, is the need of the
hour.

Two important welfare schemes are studied below to analyse why they are not as
successful as they should be, at least in certain regions and amongst certain group of
people, despite huge investment of public funds over plan periods.

Swachh Bharat Mission (SBM) - Out of the 800 million people residing in Indian
villages, 600 million defecate in open. Open defecation is one of the major reasons for
children suffering with diarrhoea, cholera and typhoid. Recent rape incidents in the
country also highlight a strong and an immediate need to provide safe sanitation
facilities to the otherwise vulnerable girls and women. The government has been trying
to tackle this issue since 1986, however has only been able to achieve very little or
1
Formative study to understand perception of parents & Community based structures regarding rights &
entitlements and redress systems within the RTE Act as well as the motivations/triggers for seeking redress-
Centre for Media Studies, CMS Communicationn
minimal success till date. The Total Sanitation Campaign (TSC, now renamed to SBM)
launched in 1999, provided financial incentives to below poverty line (BPL) households
to construct and use individual household latrines (IHHL). Also, to add vigour to the
TSC, the government of India in 2003 initiated an incentive scheme for fully sanitized &
open defecation free Gram Panchayats, Blocks, and Districts, called the Nirmal Gram
Puraskar (NGP). NGP promoted the role of Gram Panchayats and local communities in
achieving community wide total sanitation status. However, this policy failed to
translate into practice and was transformed into a government-led, infrastructure-
centred, supply-driven and subsidy-based program. The policy lacked sustainability
and inspite of planting thousands of toilets across the country, the involvement of the
beneficiaries’ seemed minimal. Census data also went on to show that only 1 out of the 5
toilets which were constructed in 2001 were still in place in 2011, implying that the real
coverage was just 31%2. The rest became defunct either because of low construction
quality, lack of maintenance or incomplete status. People started using their toilets
either for storage, bathing and or washing clothes. On a whole, during the TSC campaign
which lasted till 2012, the population growth outpaced the toilet coverage and the
number of rural households without toilets went up to 8.3 million, which means that
those defecating in the open increased by 10,000 people every day 3. Past research has
also shown that although subsidies can help in overcoming financial constraints they do
not necessarily convert into the desired action 4. The success must therefore be
measured on the basis of the final impact (elimination of open defecation) instead of the
final output (construction of toilets of externally prescribed designs)

Sarva Shiksha Abhiyan (SSA) - In a country where only 65% of the population is
literate, which too varies geographically (Kerala-91.58%, Bihar-63.82%) and
incorporates gender disparity (82.14% men, 65.46% women) 5, a universal scheme is a
must. The SSA is a flagship programme, launched in 2001, to achieve universalization of
elementary education (UEE) by making free and compulsory education to children
between 6-14 years of age, as a fundamental right. The GOI budget allocation (in Crores)
for education in the FY 2013-2014 was Rs.79, 451 and for SSA was Rs.27, 258 (i.e. 66%
of the total GOI elementary education budget) . Teacher Salaries account for the largest
component of the SSA allocations, followed by infrastructure and teacher training.
Inspite of such heavy investment, according to the Programme for International Student
Assessment (PISA) results, the two Indian states of Himachal Pradesh and Tamil Nadu
ranked 72nd and 73rd in both reading and mathematics out of the 74 countries tested
worldwide6.

2
An untold story of policy failure: the Total Sanitation Campaign in India- Andrés Huesoa and Brian Bellb
3

http://www.iwawaterwiki.org/xwiki/bin/view/Blog/An+untold+story+of+policy+failure+the+Total+Sanitation+Campaign+in+Ind
ia+
4
Shame or subsidy revisited: social mobilization for sanitation in Orissa, India. Subhrendu K Pattanayak,a Jui-Chen Yang,b Katherine
L Dickinson,c Christine Poulos,b Sumeet R Patil,d Ranjan K Mallick,e Jonathan L Blitstein b & Purujit Praharaj
5
Census Data 2011
6
Budget Briefs. Sarva Shiksha Ahiyan, GOI, 2013-14- Accountability Initiative
The policy thoroughly ensures that schools should be built within 1 km of habitation, an
adequate pupil: teacher ratio (1:30 for primary and 1:35 for elementary) and proper
infrastructure. But still learning outcome remains a challenge. Amongst various other
reasons, parent involvement (especially in rural areas) is extremely low. Due to their
lack of participation with children and also with their teachers, children show very little
interest in learning and acquiring the skills taught at school 7. Educating parents on the
importance of their participation, which can happen through behaviour change
communication, is a must to not only ensure accountability of teachers but also so that
the students get a supportive environment to learn.

Both these schemes suggest that inspite of being highly detailed on paper and been in
existence for years, the ground reality is very disappointing. Other sectors, especially
health, are also focussing more on biomedical and technological innovations, including
an on-line Clinical Trials Registry, Uniform Multidrug Therapy Regimen (UMDT) for
Leprosy, kits for improved diagnosis of malaria, dengue fever, TB (including drug
resistant),cholera and development of indigenous H1N1 vaccine, amongst others. The
Twelfth Plan document has recognized that behaviour change communication is a major
factor to make a significant difference to long term health outcomes 8.

However, very few policies emphasize on the need of behaviour change and even the
ones which do, do not have a proper plan to implement it. Few of the policy guidelines
highlight the use of information, education and communication campaign (IEC) but that
too is limited to minimal advertising and publicity. There is no functioning component
to instil behaviour change in any of the welfare schemes, [Table 2] as it is mistakenly
assumed that if the beneficiaries knew or cared more about the scheme, they would
change their behaviour and adapt to its requirements automatically. The percentage of
budget allocated to even IEC (if at all) is negligible, all though most of the schemes do
not have any such provision at all, leave alone behaviour change.

Hence, the need for behaviour change, in order to ensure sustainability and optimal
implementation of the welfare schemes, either at an individual or at the community
level is still unexplored.

7
A Look at the Condition of Rural Education Research: Setting a Direction for Future Research- Michael L. Arnold, John H. Newman,
Barbara B. Gaddy, and Ceri B. Dean- Mid-continent Research for Education and Learning
8
12th Plan documents, Social sectors Volume III
 PRELIMINARY LITERATURE REVIEW

Preliminary literature review was undertaken to understand the existing research on

behaviour change communication. The discipline of social marketing is considered
(amongst other theories and frameworks) as it applies the principles of marketing to
address social problems by influencing behaviour change.

Tackling some of the country’s most important problems require us to change our
behaviour. Some of these might be small, like turning off the lights and some may be
large, like changing our diet. Some behaviour on one hand, may have tragic short term
consequences like rash driving while others may have long term consequences like drug
abuse. Behaviour change can be achieved by a number of tools- legal, technological,
economic and informational approaches. Legal approach involves passing laws, i.e.,
making a particular behaviour illegal, e.g. smoking in public places. Technological
approach is to develop an innovation which will help people modify their behaviour, e.g.
antismoking patches. Economic approach is to raise the cost of continuing with that
particular behaviour, e.g. higher cigarette tax. Finally informational approach is the one
which involves directing persuasive messages to the beneficiary, educating her/him
about the benefits of changing her/his behaviour. The roots of social marketing lie in
this informational approach9.

Social Marketing by definition uses the principles and practices of marketing to

encourage voluntary behaviour change; resulting in social good. Kotler and Zaltman
(1971) emphasized the role of marketing to propagate social causes and behaviours.
The focus is on changing attitudes, beliefs, and behaviour of individuals or the
community for a societal benefit. Overall benefit of the community is the primary
objective10. Effective communication seeks to address one of the below behavioural
changes11:

 Start or adopt a new behaviour

 Stop doing something damaging
 Prevent the adoption of a negative behaviour
 Change or modify existing behaviour

Human behaviour is changed either at an individual level- factors which affect only the
individual, like awareness level, ability to change, etc. or at a social level- factors which
are concerned with how individuals relate to each other and influence each other.
Environmental factors like the geographical constraints, economy of the country, etc.
also impact one’s behaviour, but we have very little control over that.

9
The marketing of social causes: the first 10 years- Karen F A Fox, Philip Kotler
10
Focussing on the concept of social marketing- Harvard Business Review,1991
11
Communication and behaviour change- Government communication network
The customer/beneficiary is an active participant in this change process and a
relationship & understanding is developed and maintained through formative, process
and evaluative research. In order to encourage exchange, the stakeholders need to offer
something people actually want. This is usually difficult if the benefits are abstract or
long term12. However, unlike commercial marketing where the objective of the
organization is to make financial or monetary gains, in social marketing, the concerned
organization does not necessarily benefit financially. It is the individual or society as a
whole which gains from the efforts put into social marketing 13.

The SEED-SCALE theory by UNICEF, lays utmost importance to behaviour change in

order to bring about a change in the society. The theory understands the importance of
financial resources, however, argues that any sustainable change can only happen by
the way people redirect their energies. The 4 key principles of this theory are:

1. Build from community success, instead of trying to fix failures

2. A three-way partnership between the community, officials who form and adjust
policies & regulation and experts who can work on capacity building, introduce new
ideas, help monitor change, etc.
3. Evidence based decision making, without relying on money or power
4. Ultimate goal is behaviour change, to ensure sustainability 14

Social change by nature is not linear in process. Economic, Natural, Cultural dimensions
are kept in mind to bring about a change. It is impossible to separate these dimensions
at the community level because improvement in one area will demand development in
another. For example, only educating people about good health & immunization will not
ensure a healthy community without simultaneous improvements in diet and
sanitation, which are in turn linked to the need of improving agriculture and rural
infrastructure.

Therefore, any social change more often than not begins by altering people’s core belief
and attitudes which is the prelude to any sort of behaviour change, and this creates
resistance. Unlike commercial marketing where the target audience is receptive and
welcoming to the campaign, the beneficiaries, in case of social marketing, often oppose
the change, making the process challenging.

Few variables (identified by a World Bank report) which can induce behaviour change
are threat, fear, response efficacy, self-efficacy, physical/cultural barriers, benefits,
subjective norms, attitudes, intentions, cues to action and reactance. A different strategy
is applied to deal with each variable. 15 The Theory of Planned Behaviour Change 16
12
Critical social marketing: assessing the cumulative impact of alcohol marketing on youth drinking- University of Stirling
13
Social Marketing: A new paradigm in marketing, Richard Remedios [International journal of management research and business
strategy]
14
http://www.seed-scale.org/
15
Witte, K. (1997). Research review theory-based interventions and evaluations of outreach efforts [electronic version]. Planning
and Evaluating Information Outreach among Minority Communities: Model Development Based on Native Americans in the Pacific
Northwest. Retrieved January 29, 2006 from http://nnlm.gov/archive/pnr/eval/witte.html
16
Ajzen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50, 179–211
suggests that intention is however the most important variable in predicting behaviour
change, implying that behaviour is linked with one’s personal motivation. It is therefore
important to present information to help shape positive attitude towards the expected
behaviour change.

Also in changing any behaviour, the adoption cost (in terms of money, time and effort)
often outweighs the tangible benefits at the individual level, implying that the benefit
accrues only when the entire community accepts the proposed change 17[Appendix-
Figure 1]. For instance, to make India open defecation free, in order to ensure a clean,
healthy and a dignified society, everyone in the country needs to build and use a toilet.
The desired outcome will not be achieved if only a select few agree to modify their
behaviour. The adoption cost in this case is extremely high, and the benefit is primarily
to the society. This combination makes change difficult (falls in cell D of figure 1).

In order to change any behaviour, it is first and foremost important to understand the
behaviour which needs to be changed. Then, one needs to know what barriers prevent
the adoption of the change and the ways to motivate people to act 18.

The Transtheoritcal Model (Stages of Change) 19 proposes that change happens through
6 stages, starting from the point where the beneficiary is not at all interested in
changing her/his behaviour to the stage where she/he has internalized the change and
made it a part of his life. It is therefore essential to match behaviour change
interventions to people’s stages. For example, for someone in the pre-contemplation
stage it is important to raise their awareness about the concerned behaviour in order
for them to contemplate making the desired change.

Behaviour change is being tried out across the globe. For example, Indian states of
Himachal Pradesh and Haryana have been able to increase their sanitation coverage by
60-70% (over a period of 5 years, 2006-2010) 20 by adopting the community led total
sanitation (CLTS) methodology which works solely on behaviour change, without
providing any financial assistance to the beneficiary. Similarly, in UK, a campaign
encouraging women to get tests done for cervical cancer was initiated in 2011, by
directly linking data trends, target audience and their behaviour. The campaign resulted
in an increase of 16% in quarter one itself 21. Various initiatives in the field of health
(aids, polio, breast feeding, malnourishment, etc.), gender equality, education, substance
abuse, etc. are being tried in pockets, across the world, by independent groups; however
because of lack of theoretical frameworks and understanding, the scope of change is
limited.

17
Do better at doing good- V Kasturi Rangan, Sohel Karim and Sheryl K. Sandberg
18
Choosing effective behaviour tools- Doug McKenzie-Mohr, P. Wesley Schultz
19
Prochaska, J., Johnson, S., & Lee, P. (1998). The Transtheoretical model of behaviour change. In S. Schumaker, E. Schron, J. Ockene
& W. McBee (Eds.), The Handbook of Health Behaviour Change, 2nd ed. New York, NY: Springer
20
http://www.communityledtotalsanitation.org/country/india
21
http://www.thensmc.com/resources/showcase/whats-pants-could-save-your-life
Thus, depending on the behaviour which is to be altered, the adoption cost involved
with it and the nature of benefits reaped by the beneficiary, an efficient strategy is
formulated.
 RESEARCH GAP

It is clear that there is a perceptible disconnect between the welfare scheme policies, the
realities on ground and the theoretical frameworks available. As suggested in our
background section, there is an urgent need to incorporate behaviour change
communication as an integral part of the policy making. Inspite of various social
marketing frameworks available, there relevance in the Indian context is yet to be
tested.

This research aims to develop a behaviour change communication model by studying

issues like inter-alia, sanitation, education, health, etc. in rural areas of India, in order to
aid the policy makers and practioners in getting their voices heard by the beneficiaries
(and visa a versa) in a more effective way, leading to a meaningful and a sustainable
change. The focus will be on delivering a holistic solution to suit any social problem with
the possibility to add additional variables if needed.

The phenomenon I wish to study is that the welfare schemes might perform optimally
by focussing on behaviour change, in the context of rural India.

All stakeholders will benefit from this research, including the policy makers,
practioners, NGOs, CSR initiatives of the corporate houses, advocacy groups and the
beneficiaries themselves.

OBJECTIVES

The objectives, therefore, of the research being undertaken is as follows:

 To study various behavioural change models and their implementation across the
world to assess their applicability in the Indian context, especially rural India

 To study sanitation and education in rural India, with the intention to identify
variables to help develop a communication model, focussing on behaviour change
with policy interventions, if required.

 To extrapolate the findings of the above mentioned domains to other welfare

schemes to ensure optimal outcome

 To identify relevant communication tools and channels to spread the developed

model
 RESEARCH METHODOLOGY

The research will include, Literature Review, qualitative and quantitative research of
both secondary data available and primary data collected from the field and lastly
analysis of the data to fulfill the set objectives of this research study.

1. Literature Review will be conducted in specific areas, these being:

 Existing theories, models and frameworks on behaviour change across

disciplines

 Implementation of these models across the world and the relevant success or
failure stories

 Sanitation and Education in Rural India to understand in detail the reasons

behind their sub optimal performance

 Interdependence and commonalities between various welfare programs with

the beneficiaries’ point of view. Example, the relation between health and
sanitation, or construction of toilets within Indira Awas Yojna, Swachh Bharat
Abhiyan, etc.

2. The second phase will cover the collection of primary and secondary data. The
various sub phases at this stage include:

 Collection of secondary data to understand the welfare schemes, primarily

sanitation and education

 Sanitation and Education will be studied one by one, both qualitatively and
quantitatively, focussing the questions and discussions on behaviour change.
Will also try to identify factors which inhibit/encourage behaviour change
adoption

 The studies on both the domains will be done across 3-4 states of India, to
accommodate other dimensions like geography, culture, lifestyle, etc.

 Common variables will be identified from the study mentioned above to draw
interdependence between these two programs

3. In the third phase the aim would be to analyse the data and extrapolate it to other
welfare programs to finally come up with a holistic model.
 Data Analysis will be used to seek validation of the role of behaviour change in the
expected performance of welfare schemes.

The results will have policy implications with respect to formation, implementation
and marketing the schemes, with the help of identified communication tools.

SUMMARY WORK PLAN

The work plan for the work proposed above is as indicated in the table below:

Phase Time (Months)

1 Literature Review 4

2 Field Work- Data Collection 8

3 Analysis 3

4 Report Writing 3

5 Presentation/Review/Revision 2
 APPENDIX

Table 1: Budget allotted to the welfare schemes, 5 year plan wise22

9th Plan 10th Plan 11th Plan 12th Plan

S.No.Name of Flagship Programme s Ye ar of Inception
(1997-2002) (2002-2007) (2007-2012) (2012-2017)
Mahatma Gandhi National Rural Total Outlay (in Crores)
Employment Guarantee Act
1 (MGNREGA) 25th August, 2005 NA 11300 147200 66000
National Social Assistance
2 Programme (NSAP) 15th August, 1985 3520 4645 22761 17923
National Rural Health Mission
3 (NRHM) 12th April, 2005 NA 16189 70030 41541
Integrated Child Development
4 Services (ICDS) 2nd October, 1975 4071.3 11660 33143.4 30162.2
Total Sanitation Campaign
renamed as Nirmal Bharat CRSP in 1986, renamed
5 Abhiyan (NBA) as TSC in 1999 571 2007 6344 7760
Mid-Day Meal Scheme
6 (MDMS) 15th August, 1995 5103.25 12291 42958.1 25064.25

7 Sarva Shiksha Abhiyan (SSA) 2001 860 24676 72871 52813

st
9 Indira Awas Yojana (IAY) 1  January 1996 7413.3 10632 35409 26259
Accelerated Irrigation Benefit
10 Programme (AIBP) 1996-1997 8112 20321 42950 27204
Started in 1972, but after
National Rural Drinking Water many changes, NRDWP-
11 Programme (NRDWP) 1st april, 2009 7000 15273 37970 21500
Rashtriya Krishi Vikas Yojana
12 (RKVY) August,2007 NA NA 23265.61 19171
National Rural Livelihoods
13 Mission (NRLM) June,2011 1350 4218 11264 7915
Backward Regions Grant Fund
14 (BRGF) 19th February, 2007 NA 5000 34590 23540
Total 38000.85 138212 580756.11 366852.45

22
Data Collected from Niti Aayog
Table 2: Provision of behaviour change in the scheme guidelines, and budget allotted
for the same23
Provision of
communication plan in the % Budge t alloted for behaviour
S.No Sche me guide line change communication
Yes. Guidelines specify that
all states should develop an
IEC Plan focussing the
Mahatma Gandhi National Rural registered workers as well as
Employment Guarantee Act others who can benefit from
1 (MGNREGA) the scheme. No percentage specified
National Social Assistance
2 Programme (NSAP) No NA
National Rural Health Mission
3 (NRHM) Yes Varies from program to program
Integrated Child Development
4 Services (ICDS) Yes No percentage specified
For Swacch Bharat Mission, IEC is
Total Sanitation Campaign renamed earmarked as 8% of the budget allocation
5 as Nirmal Bharat Abhiyan (NBA) Yes (5% by the state and 3% by the centre)
No budget allocated for behaviour change
communication towards nutrition, health or
6 Mid-Day Meal Scheme (MDMS) Yes education
0.088% of the budget alloted to publicity
and advertisement, but nothing towards
7 Sarva Shiksha Abhiyan (SSA) Yes behaviour change
upto 1% of the administrative expenses
8 Indira Awas Yojana (IAY) Yes should be used for IEC activities
Accelerated Irrigation Benefit
9 Programme (AIBP) No NA
IEC activities included within support
National Rural Drinking Water activities, which are alloted 5% of the total
10 Programme (NRDWP) Yes budget
Rashtriya Krishi Vikas Yojana
11 (RKVY) No NA
National Rural Livelihoods Mission
12 (NRLM) No NA
Backward Regions Grant Fund
13 (BRGF) No NA

23
Compiled by going through the guidelines of all the listed schemes
Figure 1: Cost-Benefit Grid24

Figure 2: Transtheoritcal Model (Stages of change)

24
Do better at doing good- V Kasturi Rangan, Sohel Karim and Sheryl K. Sandberg