Background During a microbicide trial feasibility study among women at high-risk of HIV and sexually transmitted infections in Mwanza, northern Tanzania we used participatory research tools to facilitate open dialogue and partnership between researchers and study participants.
Methods A community-based sexual and reproductive health service was established in ten city wards. Wards were divided into seventy-eight geographical clusters, representatives at cluster and ward level elected and a city-level Community Advisory Committee (CAC) with representatives from each ward established. Workshops and community meetings at ward and city-level were conducted to explore project-related concerns using tools adapted from participatory learning and action techniques such as listing, scoring, ranking, chapatti diagrams and pair-wise matrices.
Results Key issues identified included beliefs that blood specimens were being sold for witchcraft purposes; worries about specula not being clean; inadequacy of transport allowances; and delays in reporting laboratory test results to participants. To date, the project has responded by inviting members of the CAC to visit the laboratory to observe how blood and genital specimens are prepared; demonstrated the use of the autoclave to community representatives; raised reimbursement levels; introduced HIV rapid testing in the clinic; and streamlined laboratory reporting procedures.
Conclusion Participatory techniques were instrumental in promoting meaningful dialogue between the research team, study participants and community representatives in Mwanza, allowing researchers and community representatives to gain a shared understanding of project-related priority areas for intervention.
The Reality Check Approach is an internationally recognised qualitative research approach that requires the study team to live with people in poverty in their own homes for a period of time and to use this opportunity to have many informal conversations and interactions with all the members of the household, their neighbours and with the service providers with whom they interact.
This study was jointly commissioned by a group of stakeholders including the World Bank, KOMPAK and the Knowledge Sector Initiative. It was designed to understand the nuances of hygiene and nutrition behaviour from the perspective of families living in poverty.
The study was undertaken in three provinces across Indonesia (Central Kalimantan, Maluku, and North Sulawesi), the same districts as those chosen for the Frontline Service Providers RCA study to enable further examination and triangulation of the dynamics between the community and frontline service providers.
This report aims to provide inspiration and impetus to those making decisions about how to implement and monitor the Sustainable Development Goals (SDGs). It shows how local level experiences and ideas can contribute to greater accountability and ultimately to increasing the impact of policies and initiatives aimed at reaching the SDGs. The work featured here focuses on how to make cities and informal settlements safer and more inclusive, taking as a starting point the extremely high levels of insecurity and violence that characterise daily life for many within townships and informal settings in South Africa.
A team of researchers from the Community Led Total Sanitation (CLTS) knowledge hub at the Institute of Development Studies, WaterAid and Praxis adopted an Immersive Research Approach (IRA) to try to gain in-depth understanding of ground realities and community perspectives relevant for the Swachh Bharat Mission-Gramin (SBM-G). They sought to learn and be open to emerging findings, while keeping a focus on behaviour change.
This note describes what they did, what they learnt, challenges they faced, and lessons and guidance for its use by others.
Do we really need debiasing, yet another word? Yes, unless anyone can improve on it, because we need a word to describe a rigorous discipline we development professionals need for grounded realism. This has been coming on me slowly. But now explorations and ‘aha!’ moments in India have accumulated and combined into an epiphany. For me, things will never be the same again. Let me explain.
The biases of rural development tourism
The biases of rural development tourism are old news. These are biases in brief rural visits from urban centres. They were a collective discovery and articulation at IDS in the early 1980s. They have now receded into the mists of history and been largely forgotten. Few in later generations of development professionals have heard of them. But with rapid change, they are now more relevant than ever.
The biases are spatial (main tarmac road, roadside, accessible from an urban centre…) , project (special villages and places where there are projects, good things to show, contacts…..), person (males, elite, adults, government and NGO staff….), seasonal (during the dry season, not the rains…), professional (questions and curiosity limited to specialised professional mindsets and interests) and diplomatic (being tactful, not inquiring about sensitive subjects) and (an addition since the 1980s) security (confined to places considered safe, and limited to those accessible in daylight….).
The biases interlock and reinforce each other to exclude those people who are most remote, powerless, vulnerable, poor, stigmatised, discriminated against – those whom the SDGs are not to leave behind. With the intensifying capital trap – being stuck in a capital city or urban centre by meetings, emails, visitors, demands for accountability, reporting, and the like – the biases combine now more wickedly than ever.
‘Competitive campaigns’
And there is a new distorting influence to add: competitive campaigns. This is high profile campaigns in which districts and organisations compete to achieve, and to be seen to have achieved, more than others. This last bias is striking with the Swachh Bharat Mission-Gramin in India, the impressively massive and hugely ambitious campaign driven by political commitment and priority which seeks to make rural India open defecation free by 2 October 2019.
Systemically, with almost every brief rural visit, there is a special reason for where the visitor is taken, who is met, what is said and what is shown. This is most brazen with atypical model communities such as the Millennium villages in African countries. It is also manifest in visits to successful projects, or where the Government or an NGO works or has contacts, somewhere easily accessible and so on. This leads to a scattered archipelago of islands of special cases and contacts that are seen, studied, quoted, and then quoted again and again back and forth by visitors, with the authority of their personal experience of rural, or for that matter urban, reality.
Visiting these islands is better than not visiting at all. But it results not in representative ground truth but in a take-off through repetition into sustainably biased myth. The expanses of sea between the scattered islands are overlooked, unvisited and unexplored, but are many times larger, and more typical, than the islands. Even those who demand representative rigour in statistics are themselves through such visits systemically vulnerable to grossly unrepresentative views of reality. And all this is accentuated when there are competitive target-driven campaigns.
How to offset bias
We need a systematic, timely and cost-effective approach offsetting the biases and for finding and exploring the seas between the islands. Here is what, again and again, I have found works astonishingly well, and far better than one might suppose.
Ring fence a day. Take a day’s leave if necessary. Do not have any government or NGO person with you – just a driver, perhaps a colleague, and (in my case usually) an interpreter.
Hire an unmarked vehicle.
Drive out from your urban centre in any direction for 15-20km.
Turn off left or right and drive for 5-10km.
Turn left or right again and stop anywhere, perhaps a poor or typical village or other settlement.
Wander around on foot, meet people, explain who you are and your interests, notice and ask about things, be friendly and interested, ask what people would like to show you, seek out those we might not meet – women, children disabled, low status, living on the fringes, key informants like teachers, local representatives, masons, health workers and so on.
Tea shops can be brilliant. Go to a tea shop and chat. A male bias can be expected, but discussions can be immediately frank and revealing. You can carry out quick order-of-magnitude surveys based on people’s knowledge of different villages and other questions.
Follow up on offers to show you things, or take you to see people or things.
Go to several contrasting places during the day.
Chai shop, India. Credit: Axel Drainville / Flickr (CC BY-NC 2.0)
Discover the unexpected
Using this approach here is a tiny sample of what I have stumbled on in India. All happened to be in States or Districts that had been declared open defecation free (ODF). Except for one that was affluent and exceptional being on a main road, all were very far from ODF.
A community of 40 Dalits in government-constructed housing with no toilets. In one was a pregnant woman with both legs paralysed who had to pull herself with her hands and crawl to a road and cross it to defecate. The only toilet in the whole community was just being completed, having been constructed by a woman entirely from her family resources.
A mason who boasted that he had demolished over a hundred twin pit toilets (the cheaper and more sustainable type favoured by Government) and replaced them with more expensive and less sustainable septic tanks. This was good for his income but bad for the owners of the toilets.
A village where a number of toilets each bore a painted statement that the government incentive money of Rs 12,000 had been spent on their construction. All were raised up because of seasonal flooding. They had walls but neither roof nor door nor pit! One was used for urination and stank.
In a relatively affluent roadside village, beautifully decorated toilets. A mason said the absolute minimum for a toilet was Rs 80,000. A woman with no toilet said she could not afford this. She had to practise OD. The mason had never constructed a twin pit toilet which should cost less than the Government incentive of Rs 12,000. No way was a septic tank an option for the poor woman.
A village with 175 households, 35 defunct toilets built by an earlier programme, and about 14 septic tanks entirely paid for and built by their owners. In this village it emerged from conversations with the village head, then with a group of men and then separately with a group of women, that they knew nothing or had barely heard about the SBM-G campaign, then near the end of its fourth year. No one had ever come to the village to tell them about the campaign. They had never heard of twin-pit toilets.
The point of these is not to denigrate the programme but to illustrate how the vast sea can differ from the scattered archipelago normally visited.
A challenge to all development professionals
So let me invite all, yes all, development professionals who see this to look in the mirror and be wary of visits which systemically reinforce misperceptions and generate and sustain myths. Ring fence days for you to ground truth through de-biasing. It is fulfilling, informative, fascinating and fun, to explore, to meet people casually, to wander, observe, ask, listen and gain new insights. Every single de-biasing visit I have done has made me wonder – will it happen again? Will I learn anything new this time? Will there be aha moments? Or will this be a wasted day? And every time, every single time, I have been startled and provoked by unexpected revelations. This has always happened. The insights have been intense and memorable, and the implications for policy, practice and research significant. The use of time has been extraordinarily cost-effective.
So let me challenge all fellow professionals who are engaged with rural or urban development – in government organisations, NGOs, training and research institutes, academics, the media, and funding agencies – all who have the scope to do so – to de-bias. Let me challenge all who can to encourage or require others in their organisations to do likewise. Escape the cognitive trap and help your colleagues to escape theirs. Be a devil. Straight away ring-fence a de-biasing day for yourself. Be systematically rigorous. De-bias, enjoy and tell others what you did and what you learnt.
The CLTS Knowledge Hub, based at the Institute of Development Studies, WaterAid, WSSCC and UNICEF co-convened a regional workshop in Saly, Senegal, 25th-28th June 2018 with support from AGETIP. The event brought together those engaged in rural WASH programming from 14 countries across the region (Benin, Burkina Faso, Cameroon, Chad, Democratic Republic Congo (DRC), Gambia, Ghana, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, and Togo) alongside experts working at regional and global levels. Over the course of four days participants shared latest experiences, innovations, challenges and research, mapped knowledge gaps and discussed ways forward with the aim of improving capacity and knowledge.
This learning brief presents the common challenges identified across the region, summarises some of the discussions held, highlights some promising practices and considers priority actions moving forward.
The CLTS Knowledge Hub, based at the Institute of Development Studies, convened a regional workshop in Arusha, Tanzania, 16-20 April 2018 with support from SNV Tanzania. The event brought together those engaged in rural WASH programming from eight countries across the region (Burundi, Eritrea, Ethiopia, Kenya, Malawi, Tanzania, Uganda and Zambia) alongside experts working at regional and global levels. Over the course of five days participants shared experiences, innovations, challenges and learning, and mapped gaps in knowledge with the aim of improving capacity and future learning, and building consensus on the way forward. SNV Tanzania also facilitated a field visit to its Sustainable Sanitation and Hygiene for All (SSH4A) project areas in Babati and Karatu districts.
This learning brief presents the common challenges and barriers to achieving Sustainable Development Goal (SDG) 6.2 that the workshop participants identified across the region. It summarises discussions held across the week, highlights promising practices and considers priority actions moving forward.
The brief is available to download in English (to the right) and also in French here.
While there is growing scholarship on the intersectional nature of people’s experience of marginalisation, analyses tend to ignore religion-based inequalities. A lack of Freedom of Religion and Belief (FoRB) undermines people’s possibilities of accessing services and rights and enjoying wellbeing.
In this paper, the authors discuss how religion and faith-based inequalities intersect with other horizontal and vertical inequalities, to create further exclusions within as well as between groups. They offer our experience of using participatory action research (PAR) methodologies to enable insights into lived experiences of intersecting inequalities. In particular, they reflect on intersecting inequalities in the context of India, and share some experiences of facilitating PAR processes with marginalised groups, such as Denotified Tribes (DNT).
The authors introduce a FoRB lens to understand how DNT communities in India experience marginalisation and oppression. The examples discussed here focus on the intersection of religious belief with caste, tribal, gender and other socially constructed identities, as well as poverty. Through taking a PAR approach to working with these communities, they show how PAR can offer space for reflection, analysis, and sometimes action with relation to religion-based and other inequalities. They share some lessons that are useful for research, policy and practice, which they have learned about methods for working with vulnerable groups, about how religion-based inequalities intersect with others, and the assumptions and blind spots that can perpetuate these inequalities.
This working paper reflects the findings of the first phase of the REJUVENATE project, which set out to understand and map approaches to integrating children, youth, and community participation in child rights initiatives.
In this paper, we:
present a user-friendly summary of the existing tradition of substantive children’s participation in social change work;
share case studies across various sectors and regions of the world;
highlight ongoing challenges and evidence gaps;
showcase expert opinions on the inclusion of child rights and, in particular, child/youth-led approaches in project-based work.
Grounded in an understanding of child rights as ‘living rights’, we propose building on the 3Ps of the UNCRC (protection, provision and participation) towards the 3Ss – space, support and system change.
We offer a set of field principles (REJUVENATE) to guide substantively participatory work with children and young people, underpinned by our Ndoro Ndoro model, which refers to intergenerational, community-driven approaches that put children and youth at the centre, while being accountable to them.
We recognise that this paper is far from exhaustive, and we intend it to be a springboard for further work that substantively recognises the importance of children’s participation in work to further child rights, and to enrich and rejuvenate the societies of which children are a part.
In this WASH Talks video, Robert Chambers talks about the use of Rapid Action Learning (RAL) workshops, immersive research and participatory mapping methodologies in India with the purpose of checking what is actually happening on the ground, and learning from this, in relation to the national Swachh Bharat Mission (Gramin) (SBM-G) (clean India mission).
These methodologies have been developed and implemented with the Institute of Development Studies (IDS), the Water Supply and Sanitation Collaborative Council (WSSCC), WaterAid, Delhi University and the Indian government.
Over the past few years, the Sanitation Learning Hub, in collaboration with the Government of India, Praxis, WSSCC and WaterAid India, have been developing Rapid Action Learning approaches. Multiple approaches have been trialled, with flexible formats, but the essential criteria is that learning is timely, relevant and actionable.
These learning approaches are the focus of the latest edition of the Frontiers of Sanitation series. This Frontiers explains the advantages and disadvantages of the approaches trialled and sets out a challenge to those working in the water, sanitation and hygiene sector to:
Reflect on what, for you, constitutes rigour.
Adopt and adapt approaches to fit your context and needs.
Develop your own approaches.
Record your experiences and lessons learnt.
Take the time to share your experiences with us. (Email the Hub on SLH@ids.ac.uk)
To commemorate and reflect on the publication, the Hub sat down with colleagues and partners WaterAid India and WSSCC to discuss lessons learned and the future of Rapid Action Learning. You can watch these five short videos in the playlist below.
This paper focuses on an Immersive Research Approach designed by Praxis, the Sanitation Learning Hub at IDS and WaterAid whereby researchers lived in villages in recently declared open defecation free districts, to gain an in-depth understanding of ground realities and community perspectives of the Swachh Bharat Mission-Gramin.
The study shed light on key aspects and dynamics influencing local ownership, behaviour change and construction quality, and also revealed multifaceted exclusion processes. The immersive approach helped build trust with villagers and allowed a unique insight into the SBM in its ‘real life’ context, necessary to explore hidden dynamics and diverse perspectives, and understand the complexities involved.
Despite some practical challenges, undertaking immersive studies and experiences would be beneficial for improving the Swachh Bharat Mission and other sanitation programmes. The approach could be adopted pragmatically, but always respecting some basic principles and ethical behaviour.
The Disabling Menstrual Barriers research aims to investigate and address the barriers to menstrual health and hygiene that adolescents and young people with disabilities face in the Kavre district in Nepal.
It is a collaboration between WaterAid and the London School of Hygiene and Tropical Medicine (LSHTM), with funding from the Bill & Melinda Gates Foundation. During September 2017, qualitative data was collected using participatory methods, including PhotoVoice.
This Learning Note presents the research questions, timeline, data collection methods and ethics. It also captures the preliminary findings from PhotoVoice and highlights the emerging research themes from this.
Recent debates on ensuring equity and inclusion in sanitation and hygiene provision in the Global South have begun to explore the needs of excluded groups of individuals. Yet, the sanitation and hygiene needs of perimenopausal (PM) women, who are making the transition to menopause, are neglected.
This study explores this new field of research and aims to provide recommendations to meet the sanitation and hygiene needs of PM women. Opening the doors to these needs warrants the use of adaptive, participative, feminist methodologies, placing PM women at the centre of the study to enable them to share their experiences. This research uses a six-stage case study methodology: a literature review, a phenomenological review, research design, case study selection, data collection, and data analysis.
This research identified several sanitation and hygiene needs as crucial to PM women’s health. This research concludes that the hidden sanitation and hygiene needs of PM women require participatory techniques to reveal them. Relationships with certain people allow PM women to discuss and meet the sanitation and hygiene needs to a degree. PM symptoms vary in nature, between women and day to day. This research demonstrates that the sanitation and hygiene sector needs to become more attentive to bathing and laundry issues overall, learning from the needs of PM women.
With PhotoVoice research participants can express themselves in a visual medium instead of using words, which is beneficial for those who can’t communicate their WASH needs as easily or find it difficult to speak about taboo issues.
This Sanitation Learning Hub Learning Paper explores the potential of an innovative participatory visual method known as PhotoVoice to help to achieve universal access to water, sanitation and hygiene (WASH) by 2030. The paper outlines what PhotoVoice is, and shares learning relating to its use in the WASH sector around the world for research, programming and advocacy.
It draws on lessons learned from these experiences to show how PhotoVoice can be used for learning in WASH, how it can be used with other methodologies to explore topics which are neglected or taboo, and the benefits and drawbacks of PhotoVoice to consider. It includes practical recommendations for using PhotoVoice in WASH and the ethical considerations to make when it is used. The paper reflects on how PhotoVoice is important for exploring new frontiers in WASH, and can help us gain a deeper understanding into how people experience, interpret and respond to their realities.
