Understanding Open Defecation in the Age of Swachh Bharat Abhiyan: Agency, Accountability, and Anger in Rural Bihar.

Swachh Bharat Abhiyan, India's flagship sanitation intervention, set out to end open defecation by October 2019. While the program improved toilet coverage nationally, large regional disparities in construction and use remain. Our study used ethnographic methods to explore perspectives on open defecation and latrine use, and the socio-economic and political reasons for these perspectives, in rural Bihar. We draw on insights from social epidemiology and political ecology to explore the structural determinants of latrine ownership and use. Though researchers have often pointed to rural residents' preference for open defecation, we found that people were aware of its many risks. We also found that (i) while sanitation research and "behavior change" campaigns often conflate the reluctance to adopt latrines with a preference for open defecation, this is an erroneous conflation; (ii) a subsidy can help (some) households to construct latrines but the amount of the subsidy and the manner of its disbursement are key to its usefulness; and (iii) widespread resentment towards what many rural residents view as a development bias against rural areas reinforces distrust towards the government overall and its Swachh Bharat Abhiyan-funded latrines in particular. These social-structural explanations for the slow uptake of sanitation in rural Bihar (and potentially elsewhere) deserve more attention in sanitation research and promotion efforts

Sanitation Is a Business: Approaches for Demand-Oriented Policies

This brochure summarizes case studies that have been taken from all over the world, showing that sanitation can be a viable business. It seeks to motivate policy makers and donors to embrace a new paradigm that advocates for a strong state, managing the potential of the private sector to provide sustainable and demand driven solutions to sanitation needs. The brochure adopts a strong poverty focus, but the recommendations are also meant to be useful in transition countries. The majority of businesses that generate income from sanitation are small enterprises, some coming from the informal sector. And it is the poor who stand to benefit most, if products are affordable and adjusted to their demands

Playing in Invisible Markets: Innovations in the Market for Toilets to Harness the Economic Power of the Poor

Sanitation is at the heart of not only environmental security but also food security and health. Today about 41% of the global population or about 2.6 billion people do not have access to toilets and about 42,000 people die every week due to drinking water polluted with faecal matter. The problem is most acute in India, China, many countries of Africa and a few countries of Latin America. Why is there such a crisis in the toilets market? How much of the present problem is due to a lack of supply and how much is it due to a lack of demand? What is the optimal role of the State, the firms and the NPOs? The present paper attempts to give some insight on the above questions through the case study of the market for toilets for the poor in India. It examines the toilet history and achievements of India, the innovations in the market for toilets targeting the group at the bottom of the income pyramid and the factors that influence the adoption and usage of toilets in an Indian coastal village, in order to infer answers to the above questions.Toilets, Innovation, India, Health, Hygiene, Sanitation, BOP, Income Inequality, Empowerment, Entrepreneurship, Government Policy

Developing a conceptual model to improve patient experience as a strategy to engage public health sector reform in South Africa.

Doctoral Degree. University of KwaZulu-Natal, Durban.Patient Experience is well recognized in health quality improvement initiatives within developed countries due to the reforms that result thereof. Developing a conceptual model to improve patient experience in South Africa is undertaken in this study. The study consists of a qualitative (nine nursing service managers participated in semi-structured interviews) and quantitative component (three hundred patients were included in a survey). A one hundred percent response rate was noted for the qualitative interviews and a 93.3 percent response rate was noted for the surveys that were conducted. Data for the quantitative study was analyzed using the Statistical Package for Social Sciences and a thematic analysis using NVIVO was applied to the qualitative data. The results from the qualitative component highlight the need for patient experience to be incorporated in the drive for quality improvement and stress the value of a patient experience model. Nursing managers support that the patient experience is positive in the primary health clinic but the survey findings reveal that the majority of respondents reported a negative patient experience. The overall patient experience satisfaction variable indicates that more than 50% of the respondents are dissatisfied with the overall patient experience. The Kruskal-Wallis analysis reveals a significant association with age and race on the overall patient experience satisfaction. Older patients are more accepting of health service delivery as compared to younger patients who are more critical. Patients show agreement with more than 50% of respondents indicating that the fifteen domains as per the Conceptual Framework are influencers of their patient experience. Nursing managers showed support for all fifteen domains. A latent factor analysis revealed that Information, Communication, Management Effectiveness towards Producing Positive Outcomes and Patient Centered Care were not statistically significant towards influencing the patient experience. The conceptual model was developed by incorporating the remaining eleven domains that influence the patient experience and the positive reforms that result thereof. Given the changing landscape in SA, it was necessary to develop a model to improve patient experience in order to improve the quality of service delivery thus engaging sustainable positive reform

Tracing Biometric Assemblages in India’s Surveillance State: Reproducing Colonial Logics, Reifying Caste Purity, and Quelling Dissent Through Aadhaar

Tracing Biometric Assemblages in India’s Surveillance State seeks to understand the historical conditions that rendered the nation-state of India as having the world’s largest biometric surveillance system: Aadhaar. Surveillance practices used by the British Raj mirrors the current social order of the ruling Bharatiya Janata Party (BJP), as they use surveillance to similar ends in today’s political economy, through the intersecting forces of neoliberalism and ethnonationalism. This thesis is an exploration into how India’s current surveillance regimes cultivate biometric surveillant assemblages through Aadhaar. Contrary to claims that Aadhaar was created to empower the poor, I argue that these surveillance regimes are actually fundamentally oppressive. On one hand, Aadhaar champions biopolitical control used to uphold caste purity, control and coerce marginalized bodies, and anticipate, suppress, and punish dissent against the Indian nation-state. On the other hand, Aadhaar is also used as a means to achieve necropolitical control over those who fail to assimilate into the system and become disposable to the nation-state. These processes are informed by values of Brahmanical hegemony, capitalism, Hindu supremacy, and patriarchy. In order to move towards a praxis of anti-surveillance, we must make political demands for dominationless societies where care, solidarity, and trust substitute surveillance

Disputing contraception: Muslim reform, secular change and fertility

In South Asia, Muslim reformers have often attempted to 'rationalize' and gentrify the everyday behaviour of ordinary Muslims. Yet, despite the existence of discussions of contraceptive techniques in the yūnān-ī tibb curricula of 19th century India and the apparent affinity between rationalism and fertility regulation, contraception was rarely discussed in public debates involving Muslim reformers. In this paper we discuss some of the relationships between élite debates among Muslim leaders and the grassroots behaviour of villagers in rural Bijnor, in western Uttar Pradesh. Villagers' voices are ambiguous, with fears for mother and child health surfacing as often as concerns for religious orthodoxy and one's destiny in the afterlife. In addition, many of the villagers' views of Islam were much more restrictive than those of the locally accepted authoritative voices: although the staff at Daru'l 'Ulūm, Deoband, saw much modern contraception as an unwelcome sign of modernity, their discussions of the acceptability of family planning circled round notions of majbūrī (compulsion), repentance, and the unfathomable mercy of Allah. We conclude that focusing on local notions of Islam to understand the fertility behaviour of rural Muslims is less fruitful than considering a "political economy of hopelessness" that, increasingly since 1947, affects many Muslims in north India

Environmental capital as cultural capital : environmentalism and identity-formation in the Indian middle class

The environment as a conceptual category is utilised by middle-class Delhites to negotiate and exhibit differences from one another as well as from other class fractions, particularly the poor. This thesis employs Bourdieu’s tools of habitus and cultural capital as a point of departure to explore how the environment is embodied by various class fractions. Additionally, in recognising the complex social, economic and cultural environment in contemporary, post-liberalisation India the thesis explores the conscious processes that are employed by fractions of the middle class as subjective experiences of the environment: forms of environmentality (Agarwal, 2005). This is done through a series of case studies. The first case analyses formal environmental education in three Delhi schools. Students showed knowledge and concerns that focused largely on proximate concerns and, in fee-paying schools, narratives of wildlife conservation. These narratives were also reinforced in the curriculum, which emphasised local environmental issues and reaffirmed class boundaries through the language of the environment. The second case study explores how residents of two middle-class neighbourhoods embody the environment as social practice and how their local subjectivities influence how and in what form they engage with the environment. The final case study examines the ways in which the environment is embodied and discursively framed by middle-class members of two wildlife clubs. Members of the two clubs conceptualised the environment quite differently, reflecting different fractions of the middle class: specifically, an upwardly mobile consuming global new middle class and an older, post-Independence (Nehruvian) middle class. Together these case studies suggest that the environment is both embodied, in different forms of social practice, in addition to being consciously negotiated, drawing on their subjective experiences of the environment

American wasteland : a social and cultural history of excrement, 1860-1920

textHuman excrement is seldom considered to be an integral part of the human condition. Despite the relative silence regarding it, however, excrement has played a significant role in American history. Today the U.S. has more than two million miles of sewer pipes underneath it. Every year Americans flush more than a trillion gallons of water and fertilizer down the toilet, and farmers spend billions of dollars to buy artificial fertilizer. Furthermore, excrement is bound up in many complicated power relationships regarding race, gender, and ethnicity. This dissertation examines the period in American history, from the Civil War through the Progressive Era, when excrement transformed from commodity to waste. More specifically, it examines the cultural and social factors that led to its formulation as waste and the roles it played in the histories of American health, architecture, and imperialism. The first chapter assesses the vast changes to the country’s infrastructure and social fabric beginning in the late nineteenth century. On the subterranean level, much of America’s immense network of sewers was constructed during this era—making it one of the largest public works projects in U.S. history. Above ground, the United States Sanitary Commission, founded at the onset of the Civil War, commenced a widespread creation of sanitary commissions in municipalities, regions, and even internationally, that regulated defecation habits. Chapter Two assesses the social and architectural change that occurred as the toilet moved from the outhouse to inside the house—specifically, how awkwardly newly built homes accommodated this novel room and how the toilet’s move inside actually hastened its removal. The third chapter shifts focus to the way Americans considered their excrement in relation to their body in a time when efficiency a great virtue. Americans feared ailments related to “autointoxication” (constipation) and went to absurd lengths to rid their bodies of excrement. The fourth chapter analyzes the way excrement was racialized and the role it had in the various projects of American imperialism. The colonial subjects and potential American citizens—from Native Americans to Cubans, Filipinos, and Puerto Ricans—were regularly scrutinized, punished, and re-educated regarding their defecation habits.American Studie