Lyle Birkey Final Individual Project Strategic Communication Program Management Center for Communication Programs Johns Hopkins University

1. Flush India
India’s Campaign to End
Open Defecation
Final Individual Project
Strategic Communication Program Management
Center for Communication Programs
Johns Hopkins University
By Lyle Birkey

2. 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
2

3. Future under Current Conditions
(Situation vs. Destination)
3
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

4. Desired Future State
(Situation vs. Destination)
Destination Public defecation in India ended by 2030
Impacts
Improve public health by reducing incidences of
intestinal worms and bacterial infections
5
Public Health
Malnutrition
Child
Mortality
Reduce diarrhea-causing ailments and childhood
malnutrition
Improve child mortality rates through increased
public health and reduction of malnutrition

5. Introducing:
Flush India Program
 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”
5
Figure 1: Campaign Logo

6. 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:
6
Education
Level
Community
and Social
Engagement
Homeowner
Status
1 2 3

7. Audience Segmentation
(Target Audience)
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.
7
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

8. 8
Audience Profile

9. Communication Objectives
9
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.

10. 10
Winning Key Benefit
Social Approval
Positive 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.
1
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

11. 11
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.

12. Media Plan
(Advantages and Disadvantages)
Media Channel Advantages Disadvantages
12
Peer Education Meaningful personal context
Difficult to implement and
monitor
Public Meetings
Opportunity 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 advertisements
Small percentage of population
has access to internet
Hotlines Provides public participation Dependent on engaged public
Community Radio Reaches more rural areas
Difficult to determine audience
demographics
Outdoor Media High visibility in public space Expensive
Secondary Primary

13. 13
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!

14. 14
Materials Development
(Billboard)

15. 15
Program Analysis
Key Constraint:
Preference for open-field defecation regardless of
latrine availability.

16. 16
Program Analysis
(SWOT Snapshot)
16
Strengths
Weaknesses
S
W
O
Opportunities
 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.
T  Lack of space in houses to construct household
Threats
latrines.
 Sustainability of learning and interest in behavior
change.

17. 17
Evaluation Indicators
Quantity Quality
Effort
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
Effect
Impact
• % of population regularly using lavatory facilities
• % of population treated for enteropathy and encephalitis
• % of deaths due to enteropathy and encephalitis

18. Management Plan
Ensuring 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.
18
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.

19.  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.
19
Lessons Learned