Role of WASH and Agency in Health: A study of isolated rural communities in Nilgiris and Jalpaiguri

The objective of the Swachh Bharath Mission (SBM) or Clean India Mission of the Indian Government is to eliminate open defecation in India through installation of toilets and triggering of behavioural change by 2019. The problem is most daunting in isolated communities with poor WASH infrastructure and local agencies with scarce resources. In India, tribal communities, living near forests and along mountain ranges are among the most isolated, which means that the study of the impact of WASH (water, sanitation and hygiene behaviour) and the effectiveness of local agencies responsible for public hygiene in such communities is pertinent for our research query. Thus, this working paper presents the results of a study of 20 villages located in two districts, Nilgiris and Jalpaiguri, in two distinct Indian states - Tamil Nadu and West Bengal respectively. The central research question is: What is the role of WASH infrastructure and capabilities and local agencies in containing the incidence of excreta related diseases in isolated rural Indian communities? A novel multi-level model is developed and estimated and further validated through focus research groups. It confirms that disease incidence is jointly determined by the quantity as well as the quality of WASH. The role of agency seems to matter more at village level rather than at the household level.