Self-Help Women’s Groups in India help change behavior around diets and toilet use to improve health


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Sushila Devi, a mother of four in the rural Rohtas district of Bihar, India, has no significant assets and depends primarily on casual labor for income. She recently was able to take out a bank loan of INR 12,000 (US$180), which she used to construct a toilet in her family home

It was the Self-Help Group (SHG) in her village that persuaded Sushila of the importance of sanitation for her children’s health and nutrition, and helped her get the loan she needed. SHGs generally consist of 12 to 15 rural women, grouped into larger federations. They engage with formal financial institutions to help unbanked households access financial services, acting as platforms for standardized large-scale sensitization of community members on a variety of subjects.

Sushila’s actions are part of a larger change driven across Bihar by the recently launched Bihar Transformative Development Project (BTDP), commonly known as JEEViKA-II. This joint initiative of the Government of Bihar and the World Bank covers 300 (56 percent) of the blocks of rural Bihar. The project is working through SHGs to deliver awareness, training, finance, and monitoring on sanitation and nutrition in an integrated manner.

Bihar is a challenging terrain. It has the highest rural population density in India and a per capita income barely half of the national average. A third of its population lives below the poverty line, and more than two-thirds of rural households do not have access to individual toilets. Only seven percent of children between six months and two years receive an adequate diet both in terms of diversity of nutrients and quantity — dictated more by lack of knowledge than resources. With a growing body of research linking open defecation to disease and child malnutrition, it is not surprising that the prevalence of stunting in children under the age of five in Bihar is a staggering 49 percent, much higher than the national average of 38 percent.
The Bihar Transformative Development Projects is using SHGs to address these issues and reach women at an unprecedented scale. The project’s integrated approach reflects lessons learned internationally, in fields such as rural sanitation, nutrition, and rural livelihoods. It involves collaboration among a number of departments within the World Bank, including the Water Global Practice, the Agriculture Global Practice, and Health, Nutrition, and Population Global Practice — each bringing lessons learned from their respective disciplines.

The approach has been tested in varied settings, and detailed guidelines and toolkits are now being drawn up. Project staff is trained to scale up this initiative across Bihar, and the lessons learnt, guidelines, and toolkits are used to scale up across rural livelihood projects in other states, such as Andhra Pradesh, Tamil Nadu, Telangana, and Maharashtra.

Scaling up involves several steps. First, a comprehensive package of behavior change communications on sanitation and nutrition practices is delivered across a village. Working through SHGs makes mobilization and communication easier, as they hold regular weekly meetings where trained female community mobilizers can deliver a uniform set of messages repeatedly across the community.

When this triggers demand for better sanitation among SHG members, such as Sushila, the SHG’s federation is able to provide them with ready options for financing the construction of a toilet, as well as to help them see if they are eligible for benefits from government programs such as Swachh Bharat Mission (SBM). Importantly, these links with finance providers reduce the gap from mere orientation to taking immediate action. Similarly, an understanding of the benefits of diet diversity on maternal and child health is supported by resources and training to grow nutrient-rich vegetables in backyard kitchen gardens. 

By design, the project works exclusively with women. Membership of SHGs empowers women by enhancing their economic contribution to their households , thereby giving them a greater say in household decisions.

The project’s design also addresses the common problem that a new toilet doesn’t always translate into active usage or sustained behavior change. Village federations lead post-construction monitoring through regular visits to these households, while messages around the health linkages between nutrition, hygiene, and sanitation continue to be delivered through SHGs. Capacity-building and peer support help women adopt hygienic practices and improve dietary habits. 

For Sushila Devi, in addition to constructing a toilet, she also grew a vegetable garden in her backyard; a good example of improving her diet that the project will use to try to persuade more than five million rural poor households in Bihar to follow.


Vinay Kumar Vutukuru

Senior Agriculture Specialist

Mohini Kak

Senior Health Specialist

Paramveer Singh

Consultant, World Bank Agriculture Global Practice

Mathew Azu
May 01, 2017

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Asad Umar
May 01, 2017

With rural development department at the helmnow sanitation programme is picking up in Bihar.I am sure the approach of engaging with SHGs will not only improve the coverage but toilet usage is also going to improve.

Jing G
May 02, 2017

Amazing story, Vinay. You mentioned a comprehensive package of behavior change communications on sanitation and nutrition practices in your post. Can you please share more about it and what are the lessons learnt from leveraging strategic communications in project implementation in your case?

Dr.Bathula Sanjeevarayudu
May 06, 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
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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
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Science & Technological Innovation
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Impact on society about Health ;-
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May 07, 2017

I was always aware, I think, of the water in the soil, the way it travels from particle to particle, molecules adhering, clustering, evaporating, heating, cooling, freezing, rising upward to the surface and fogging the cool air or sinking downward, dissolving this nutrient and that, quick in everything it does, endlessly working and flowing, a river sometimes, a lake sometimes until it reaches human mouth.
#SaveWater, SaveLife.
Water is life. Water is wealth. because clean water or unpolluted water or potable water brings no illness to humans

swati sem
August 27, 2018

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Beest Wishes
Swati sem
Celebrity Interviews

NGO for health nutrition and hygiene
November 19, 2021

Hey, I appreciate those who take action towards health nutrition and hygiene for children s and women, Some NGOs are working towards it. I also want people to take their own responsibility for social issues.