The “5Ds”: Changing attitudes to open defecation in India


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Today, of the 2.4 billion people who lack access to
improved sanitation globally, more than 750 million
live in India, with 80 percent living in rural areas. 
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sanitation services. Read the World Water Day Blog Series

Co-author: Dharmendra Singh

In the village of Bharsauta in Uttar Pradesh, India, construction worker Vishwanath lives with his wife, four children and their elderly parents. Three years ago, the government paid to build a toilet in their house. But the job was not done well: the pit was too shallow, it overflows frequently, and the smell makes it suffocating to use. Cleaning the toilet requires carrying water from a community tap. Vishwanath and his family have decided it isn’t worth the hassle. Mostly, they continue to defecate in the open.

Vishwanath’s family is not alone. Research has shown that households which constructed their own toilets, rather than receiving a government subsidy, are more likely to use them. But what are the most effective ways to persuade people to construct their own toilets?

To improve understanding of this question, formative research was undertaken in Uttar Pradesh and neighboring states, including Rajasthan and Bihar.

The research helped behavioral change practitioners to strengthen the “community-led total sanitation” (CLTS) approach. Building on that, a new “5Ds” approach combines behavior change communications theory, research insights and strengths of the CLTS approach into a comprehensive framework for changing norms around open defecation.

The 5 “Ds” are:
1: Depict. Research reveals that many factors motivate people to decide to construct a toilet. For instance, in Bihar, 75% of respondents mentioned inconvenience in the rainy season; in Rajasthan, 69% mentioned security concerns for women and children.

However, the risk of attempting to convey multiple messages is that ultimately, none gets heard. It is more effective to focus on a single, clear message with emotional heft. Research points to self-esteem and the perceived social standing of the family — for example, a prospective son-in-law not wanting to stay in a house without a toilet — as the most promising focus for a message.

The “depict” stage therefore sets out to establish the norm that using a toilet is proof of being cultured and refined. It seeks to change people’s frame of reference: where they currently think of toilets as a government program, and expect subsidies, the messaging portrays it as a matter of evolving community norms and something they should be willing to invest in themselves.

The research identified the best channels through which to deliver messages in the “depict” stage. For example, television reaches 50% of households with toilets in UP and 29% of those without. Outdoor advertising emerged as a potentially particularly effective channel.

2: Divulge. Research shows that people do not construct a toilet because they are not aware of basic information, for example, the link between open defecation and diarrhea. Some have formed a negative opinion of toilets due to low-quality construction during government sanitation campaigns; 69% of those for whom toilets were constructed did not know the appropriate technology.

People often think toilets are much more expensive than they actually are. In UP, estimates ranged from INR 20,000 to 120,000 (around $300 to $1,500). Perceiving toilets as unaffordable, people prioritize other demands on resources, such as sending their children to school or saving for a daughter’s marriage.

The second “D,” divulge, therefore aims to provide practical information and dispel myths, through a combination of print material, audio-video clips and one-to-one or group conversations. Experience shows that these are more effective if messages are packaged as eye-opening revelations with elements of happiness or surprise.

3: Demonstrate. Even better than telling people is showing them what they need to know — the different models of a toilet, how they are constructed and maintained, how the compost looks — and giving them role models who have constructed and use a toilet. Demonstration is typically challenging in behavior change campaigns, but CLTS already achieves this third “D” through various methods, including travelling exhibitions and group discussions.

A common problem with demonstrations is that their impact fades without means of reinforcement. Often, people are initially convinced but lose their motivation. The 5Ds model addresses this problem by continually reinforcing the desire to act on knowledge learned, through social channels including mobisodes on mobile phones and at events that maintain buzz through word-of-mouth.

4: Dissuade. Even when people are aware of health benefits, the tipping point in behavior change comes when sanctions against open defecation are established and enforced by village authorities and local communities.

The “dissuade” stage needs to make open defecators feel that they are being reminded of emerging community norms, rather than bullied into changing behavior that they still see as acceptable. It helps if sanctions are designed with the community’s participation and uniformly imposed, rather than encouraging ad-hoc actions by vigilante groups. Mass media messages and street plays can help reinforce the new norms.

5: Dignify. The final “D” links back to the “depict” stage, rewarding those who have decided to construct a toilet with enhanced social status. One way to “dignify” toilet use is linking the tradition of singing “Sohar” — a song used to mark joyous household events — with toilet construction. Low-cost ways of spreading this tradition include mobile ringtones and WhatsApp audio messages. Even households without a toilet, 91% have a mobile phone.

Other tactics include local authorities giving “clean house” nameplates to be displayed with pride by households with toilets, and holding periodic public events to recognize local champions of ending open defecation.

The 5Ds approach was developed in partnership with the UP government and is currently being deployed in the state. The mobisodes were shown on International Women’s Day at an event in Gandhinagar attended by the Prime Minister and six thousand Sarpanches, or women community leaders. As the experience in UP proceeds, it should generate valuable lessons that could be used to adapt the program in other Indian states.

Editor's note: This research is property of the World Bank and can be used freely as long as the source is acknowledged.  


Vandana Mehra

Communications Specialist, The World Bank Water Global Practice in New Delhi

Join the Conversation

March 23, 2017

It is so simple. Once you decide to go to toilet, then it is done. But to do this it will need pressure from the people living in the area. If owning a car is a social pressure, then I would buy a car as soon as I can, even if I have to take a loan for it. Will the same logic apply everywhere?

Ragini Pasricha
March 22, 2017

Very succinct summary of a stages of change approach to open defecation. Are the stages linear and has this approach shown demonstrated success in specific geographies in India?
You have mentioned that the impact of demonstrations fades and needs reinforcement. Would digitizing demonstrations and putting them on the mobile phones or tablets of swachhata doots help, provided they have the equipment? But for the most, it seems a question of behavioural economics and having other spending priorities.

Isabella Micali Drossos
March 22, 2017

Congratulations, Vandana, this is a great article, especially in relation to gender analysis. We all know that in Africa, for instance, if there are no latrines in schools, parents will not send their daughters. Your 5 D are also very interesting because I reckon they can be used in any initiative that targets behavior changes. Thanks again and all the very best, Isabella

Abed Khalil
March 22, 2017

Nice blog. Very succinct and rich of substance.

March 24, 2017

Dear Vandana,
This is a very informative article - easy to read and clearly written. Even a layman like me can clearly see that the 5 Ds you write about are so pertinent to solving this problem.
I speak with my house help from Jharkhand- each of these points apply to her region too. Hope your work can spread. More power to you.
Best wishes

Anushka Malvea
March 24, 2017

Not just good analysis, but great ideas to resolve a rampant problem. Congratulation, Vandana!

Clarissa Brocklehurst
March 24, 2017

Great blog! nice to have some really specific ideas on how to address open defecation in India. Lots to learn here. Interesting how demonstration is acted upon....for too long we have done demonstrations and then just expected things to happen magically. I also like the role of street theatre and other interventions and would like to know more about how this can work. Is there any research on this?

Junaid Ahmaf
March 26, 2017

An excellent summary of the lessons we have learned about addressing the challenge of convincing communities and households. Two important insights have been highlighted: a focus on behaviour change and the role of focusing on the collective. But, there is an equally important focus that needs to be highlighted: how to convince governments to move away from a construction mode -- if you build they will "use" paradigm -- to one of developing a program focused on behaviour change and associated incentives. Is there a parallel set of "Ds" about changing government behaviours? What are the lessons in this case? Junaid

Liaqat hayat
March 27, 2017

The way the slum deweller will opt for toilet option is first prepare a demonstration toilet in a nearby locality so that they may see and realise its benefit specially when they have to spend something from hard earned money

Junaid Ahmad
March 27, 2017

Liaqat, there is evidence that in urban areas -- as opposed to rural areas -- more than demonstration effects or use of the Ds, granting tenure and property rights may be a stronger determinant of better sanitation investment by communities. Would be curious to hear from others on this rural urban difference. Junaid

Dr.Bathula Sanjeevarayudu
March 27, 2017

Literacy awareness on WATER Harvesting & CONSERVATION , Public Health
PSS Educational Development Society Regd NGO Secretary Dr Bathula Sanjeevarayudu has doing clean and green sanitation Ground water and Rain conservation Literacy awareness programmes excelled in reviving water resources in Rural areas of of ANDHRA PRADESH STATE KARNATAKA KERALA TAMILNADU WIDE
Report Title ;- in public health main role ground Water Literacy on Rain water conservation Rural Tribal areas water Elexir of life rural water Resources now only Eradication of Rural poverty in India
To improve the quality of the eco system and meet the livelihood needs of Rural people which will contribute to improve the socio economic nutrition health status of people and ecological condition of the environment
Literacy awareness In a country like India where population is growing at the rate of nearly 2 per annum and about 70 of its population is engaged in subsistence farming water shed management assumes an exceedingly important sole not only for the production of more food but also for prevention of degradation of land and mainly water in the process Experiments with water shed management have so far yielded rich dividend and provided valuable in right to the aspects of management of our natural resources basic particularly land and water. Water shed management is not a passing fad it is intricately related with an extremely beneficial to the lives of millions of farmers throughout the world
Spreading Science & Technological Awareness ;- Rural literacy Public health &Water resources using methods water can reservation It is necessarily to educate spreading message through conducted public meetings Kalajathas Rallies workshops exhibitions printed pamphlets wall posters showing films and formation water conservation clubs in schools colleges etc. to the people about the new opportunities available water resources and create responsibility for the protection preservation and responsible management of all the available water resources in A P State wide and Southern States also
Science & Technological Innovation
PSS Educational Development society Regd NGO Secretary Dr Bathula Sanjeevarayudu have identified the need for developing training innovative modules for Rural people engaged in their livelihood on natural resources Eradicate common diceses through water resources and enable them to improve their livelihood through Agriculture and Animal Health aquaculture etc this programmes does not envisage trainings as an end itself but aims to strength water shad management Rain water conservation water utility eradication of water wastage and upgrading the technical skills of people on Agriculture Aquaculture and provided them with equipments and financial support to set their our self employment and Income Generation spreading messages on drip irrigation new techniques in agriculture field etc
Impact on society about Health ;-
It is also our team of NGO s visited within beneficiaries our activities all are grand successfully implemented and get good result they become agents of Health peace and communal harmony in a place that is in constant disturbance we feel that the long term objective of this venture is Health peace and human dignity through fully healthly and self sufficiency
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Target set Achieved
Our NGO Dr Bathula Sanjeevarayudu selected target of Rural areas hilly areas remote areas Agency areas near by forests villages etc implemented and conducted over 91924 breath water sound and Free Health Medical workshops benefited 4 million people in nationwide Conducted 34310 cleanliness and water utilization campaigns Since 15 years organized national environmental awareness campaigns in A P state wide, INDIA

R C Rath
March 28, 2017

5-D's are very impressive, easy to follow and implement. By following these, we can create a clean India and a Healthy India. Thanks to world bank and Government of UP for their sincerity in bringing out the report. Jai Hind

Srinivasa Rao Podipireddy
March 29, 2017

5D approach is quite interesting. thanks for this article

Sanjay Deshpande
April 14, 2017

Well written and exactly the path we followed at Jambudiyapura a tribal village outside Baroda, Gujarat. The only thing I would add is that one should not use soak pits as they will contaminate nearby water sources especially during the monsoons. Check out the case study on our website or…

habibu yakubu
April 16, 2017

5D approach is very important, clean environment healthy life.