“Social Norms, Behavioral Change and Sanitation: Initiating a Large-scale Sociocentric Network Study to Understand the Open Defecation “Puzzle” in India

PIs: Cristina Bicchieri, University of Pennsylvania cristina-bicchieri), Hans-Peter Kohler, University of Pennsylvania

The study was trying to investigate how social norms and social networks are linked to latrine use and sanitation practices in India. Even after rigorous efforts from the government, NGOs, and international organizations people are still going for open defecation. To better understand the social drivers of open defecation, a formative research mapping social networks in Indian communities, characterizing and diagnosing the collective behavior of open defecation practice. To do this, researchers at the Penn Social Norms Group conducted two waves of surveys, one focused on social networks, and another that focused on sanitation-related norms. The study included the mapping of social networks in targeted communities as well as an assessment of the norms surrounding a toilet use. Descriptive findings on toilet coverage and reported use, observed changes in coverage and use over time and results from diagnostic evaluations of collective sanitation behaviors were reported in the phase 1 report.

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Knowledge, Attitude, Practice and Perception on Climate Change among Medical, Para-Medical & Public Health Professionals in India

PIs: Shweta Narayan (Health Energy initiative) Dr Vishvaja Sambath, Pooja Kuamar, Dr. Gajapriaya G, Dr. Adithya Pradyumna, Azim Premji University

Morsel surveyed 3062 healthcare professionals across the six randomly selected states in different zones. These states are Bihar, Karnataka, Maharashtra, Uttar Pradesh, Chhattisgarh and Meghalaya. In 3062 healthcare professionals researchers included Doctors, Nurses, Paramedical Staff, Hospital administration staff, ASHA workers, NGO healthcare workers, Healthcare Students.This report is the first indigenous attempt to document the extent of the ongoing and future impacts of climate change on Health. Many global experts have foreseen the negative impacts on health due to Climate Change. The aim of the study is to understand how the medical and public health community in India perceives and relates to climate change and proposed solutions and mitigation plans in order to prepare the health systems to lead the response to climate change induced health impacts in India and engage with the medical, para-medical and public health community in India on the issues of climate change and health.

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Impact of the covid-19 pandemic lockdown on Livelihood, Food Security, and Hygiene practices in Jharkhand, India

PIs: Initiative for Sustainable Energy Policy

The Initiative for Sustainable Energy Policy (ISEP) and Morsel have been engaged in conducting a phone survey in Jharkhand to assess the impact of lockdown on individuals’ livelihood, food security, and hygiene practices. Started in 2020, the phone survey which has a total of 6 rounds, aims to target more than 900 respondents across all 24 districts of Jharkhand. Participants were selected using systematic random sampling from a database maintained by Morsel. The survey included questions related to employment loss by household members, concerns regarding food security, cash flow constraints, hygiene and social distancing practices, and government assistance since lockdown.Initial results depicted that lockdown over the period of last one year has gravely impacted employment and created cash constraints within households, with casual labourers (defined here as hourly or daily wage workers in a non-farm enterprise) being most-affected. Government assistance programs in the state have been effective in reducing the plight caused due to lockdown and unemployment, with the majority of assistance being provided in the form of food grains in the state.Social distancing measures seem to have been effective in the state, with non-essential trips (to places of religious worship, for instance) almost entirely halted. Hygiene practices at the household level are far from ideal, with frequency and timing of handwashing not sufficient to reduce infection.

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Prevalence of COVID-19 In Urban Areas in India

PIs: Anup Malani University of Chicago Manoj Mohanan Sanford School of Public Policy at Duke University and Government of Karnataka The study was supported by Mapmygenome

The second wave of COVID-19 pandemic was catastrophic in India. Outbreaks have spread faster than the scaling up of testing, tracing, isolation and all other public health efforts. Serosurveys are an important tool in helping us figure out how far the infection has spread within a population and how many people developed cellular immunity. Cellular immunity can be tested by taking the blood sample for B cells and T Cells. These two types of cells react with antigens. T cells play a central role in delayed hypersensitivity or cellular immunity. This study conducted in the slums and non-slums of Bangalore in January 2021, estimated both seroprevalence and cellular immunity Researchers are trying to determine how much seroprevalence surveys underestimate natural immunity because antibody concentrations decline after an infection is cleared. Morsel field team collected Household level survey data, blood sample and swab sample. Field team successfully collected blood samples of 2410 HHs and swab sample from 1580 HHs and collected primary data from 3057 Households. The refusal rate was very high (approximately 67 percent HHs refused to participate) and approximately it was same in slum and non-slum areas.

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Early Childhood Development for the Poor: Impacting at Scale

The Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (NIH) and the Strategic Impact Evaluation Fund (SIEF) funds this project. The project is a collaboration among The Institute for Fiscal Studies UK, Yale University (USA), University College London (UK), University of Pennsylvania (USA), the Centre for Early Childhood Education and Development (India), Pratham Education Foundation- ASER Centre (India) and the Abdul Latif Jameel Poverty Action Lab SA (India).

The purpose of the study is -

  • To improve the health and development of very young Indian children living in poor rural environments, hence contributing to breaking the intergenerational cycle of poverty.
  • To formulate a blueprint for early childhood development (ECD) strategies that will be applicable in poor communities, based on the use and empowerment of local resources, and capable of changing the developmental trajectories of children in a substantive way.
  • In each one of 192 study villages in 3 districts in Odisha (Bolangir, Cuttack and Balasore) Morsel collected Midline and Endline data and assess the target children under the supervision of IFS researchers. Read More

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    Willingness to pay and the role of informational and supply-side constraints

    PIs : Dr. Britta Augsburg (IFS), Alex Armand, Antonella Bancalari (IFS)

    While urbanization can bring benefits for economic, cultural and societal development, a rapid pace of urbanization can create enormous challenges. However, cities in low and middle-income countries, in particular, are struggling to keep up with necessary infrastructure investment especially on the water, sanitation, and hygiene. It is generally accepted that public and community toilets (CTs) will, for the foreseeable future, continue to be an important solution to improve sanitary conditions in slums, given numerous constraints to increasing access to safely-managed private toilets. Even where CTs are available, open defecation remains common behavior among slum-dwellers. In India, CTs have been widely introduced in slums, but they are only used by 15% of slum-dwellers. This study has three main objectives-

    1. to document slum dwellers' the willingness to pay (WTP) for community toilets and its link with usage; 2. to identify the impact of releasing supply-side or both supply-side and informational constraints on WTP and usage; 3. to determine the time horizon of such impacts (short-term, longer-term, or both);

    To do so, researchers implemented a cluster-randomized design in 110 slums in the Lucknow and Kanpur cities of Uttar Pradesh, India.

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    Improving Children Health and Cognition: Evidence from School-Based Nutrition Intervention in India

    PIs : Sebastian Vollmer, Assitant professor, Georg-August-Universität Göttingen, Marion Krämer and Santosh Kumar.

    We present experimental evidence on the impact of delivering double-fortified salt (DFS), salt fortified with iron and iodine, through the Indian school-feeding program called “mid-day meal” on anemia, cognition, and math and reading outcomes of primary school children. We conducted a field experiment that randomly provided a one-year supply of DFS at a subsidized price to public primary schools in one of the poorest regions of India. The DFS treatment had significant positive impacts on hemoglobin levels and reduced the prevalence of any form of anemia by 20 percent but these health gains did not translate into statistically significant impacts on cognition and test scores. While exploring the heterogeneity in effects, we find that treatment had statistically significant gains in anemia and test scores among children with higher treatment compliance. We further estimate that the intervention was very cost effective and can potentially be scaled up rather easily. MORSEL collected Baseline, Midline and Endline data for the project. Read More

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    Social Accountability And Healthcare Delivery

    PIs: Manoj Mohanan, Associate Professor of Public Policy ( Duke University ), Vikram Rajan ( World Bank ), Harsha Thirumurthy ( UNC )

    Social Accountability (SA) has received considerable global attention as a potential model to improve delivery of services and resulting population outcomes, particularly in health. SA encompasses a set of governance interventions aimed at increasing community participation and strengthening community members’ ability to hold service providers accountable at the local level.

    Under the guidance of Professor Manoj Mohanan. Morsel conducted IVR based survey to see the effect of Information and Facilitation. MORSEL also devised a new system of incentivizing few randomly selected households to study changes if any in villagers’ attitude towards their participation just after receiving an incentive or not. For more details please click here

    Location : Uttar Pradesh (Two districts: Sultanpur and Fatehpur)

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    Chronic Diseases, awareness, and economic behavior

    PIs: Manoj Mohanan and Harsha Thirumurthy and Elisa M. Maffioli

    The main goal of the study was to collect information about how individuals make decisions under uncertainty. Researchers studied this economic behavior in the context of chronic disease, where individuals experiences decline in health status but are often unaware of the specific illness they are suffering from, and lack information about the consequences of various courses of action (including not seeking treatment). Researchers studied, “How individuals make choices and decisions under uncertainty in the context of chronic disease management in the rural population of Tamil Nadu, India”.

    In this study, researchers collaborated with Sughavazhavu, a not-for-profit healthcare organization that provides health care to rural populations. Morsel helped researchers to develop the Android Application for data collection and collected the primary data as well.

    Morsel helped to screen individuals at high risk for chronic diseases among the adult population in the District of Thanjavur and researchers selected 500 adult individual at high risk for the following chronic diseases: diabetes, hyperlipidemia, and hypertension and screened them.

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    Touching Beliefs: Using Touchscreen Technology to Elicit Beliefs and Subjective Expectations in Survey Research

    PIs: Manoj Mohanan and Elisa M. Maffioli

    When making decisions under uncertainty, individuals may form subjective expectations about probabilities of events relevant to their choice. Accurate measurement of subjective expectations is critical for high-quality data needed to analyze individual behavior. This study examines the development and validity of a new method of eliciting subjective expectations. Researchers developed a touchscreen-based application that combines an animated slider along with dynamic images that change relative sizes based on the probability indicated by the respondent. They have compared this method to the more traditional approach of using beans as visual aids. Findings suggest that the slider could be a viable elucidation method for empirical researchers who aim to collect data on subjective expectations.

    Morsel helped researchers to develop the Android Application and data collection from 300 HHS.

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    Urban Poverty, Health, and Community Action: Evidence from slums of Delhi

    While the issue of poverty in the rural context has been studied extensively, there has been much less focus on poverty in urban settings despite the considerable challenges urban poverty poses to development. This research (Funded by Texas A&M University ) focuses on the issue of access to sanitation in legally recognized slums. Assistant Professor YuJung (Julia) Lee (Department of Political Science at Colorado State University) and Professor Tiffany Radcliff ( Texas A&M University ) investigate how and when community organization translates into political demands for basic services, and whether there are gender differences in the channels used for demands. Morsel collected data from Households in slum areas as well as surveyed community leaders’ and measured traffic at community toilets.

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    The impact evaluation of FINISH program

    PIs: Dr. Britta Augsburg (IFS)

    The impact evaluation of FINISH program, a project to create, test, and mainstream the use of microfinance by rural households in India, in order to create a local, market-based approach to sanitation services. MORSEL worked in Gwalior, Madhya Pradesh to collect household level data from 56 slum areas and peripheral revenue villages for the Endline survey. MORSEL partnered with Sambhav, an implementing NGO in that area and IFS/ Institute for Fiscal Studies based in London, UK. This project was funded by WASTE, advisers on urban environment and development based in Gouda, the Netherlands.

    For this, the project partners ( TATA-AIG, SNS-REAAL, UNU-MERIT, BISWA and WASTE) have developed an economic vision of sanitation in support of noticeable improvements in water supply and sanitation. The project has tested the use of microfinance for rural sanitation in order to accelerate access of the poor to demand-led sanitation, resulting in better health, economic, and social impact; and greater sustainability in sanitation service delivery, which can be implemented at a larger scale.

    Location : Gwalior, Madhya Pradesh

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    Sura India: Panel Survey; Unrecorded Alchohal in India

    PIs: International Alliance for Responsible Drinking (IARD)

    MORSEL conducted a survey-based research in five states of Andhra Pradesh/Telangana, Rajasthan, Jharkhand, Kerala and Assam under the supervision of Ms. Jennifer Tujague , Senior Scientist at International Alliance for Responsible Drinking (IARD). The project is aimed to study alcohol drinking patterns in India and to analyze if the prevalence of unrecorded alcohol consumption varies by state. It is to estimate alcohol consumption from all alcohol beverage types from a representative sample of 1300 in each of five states.

    Locations: Andhra Pradesh/Telangana; Rajasthan; Jharkhand; Kerala; Assam

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    Evaluation of primary health centres in Chhattisgarh

    Funded by Oxfam, in this project Council on Energy, Environment and Water evaluated the impact of solar PV systems on the quality of service delivery in the PHCs of Chhatisgarh. Morsel surveyed 150 PHCs across 15 districts in the state to evaluate the impact of improved access to electricity (through solar PV systems) on healthcare services.

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    Impact evaluation of Gram Varta

    Gram Varta is a Community Mobilization initiative using Participatory Learning and Action Approaches with SHG’s (SWASTH Project). The University of Göttingen received a grant from the International Initiative for Impact Evaluation to evaluate Gram Varta. MORSEL was selected as a sub-contractor by the University of Göttingen to survey 4000 households (household heads and women separately), around 2600 adolescent girls and 2000 pregnant women in 184 GPs of Madhepura district of Bihar. MORSEL also collected anthropometric data of Households and hemoglobin level of all members of 4000 households and 2000 pregnant women and their husbands. MORSEL also tested the presence of E Coli in the stored drinking water of 4000 households and the presence of parasites in the stool of kids below 5 years in the selected households

    Location : Madhepura district of Bihar

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    Health and Poverty: Impact Evaluation in Bihar

    PIs : Sebastian Vollmer, Assitant professor, Georg-August-Universität Göttingen

    The aim of this project was to understand the health aspects and the related economic consequences for the people. Here Morsel conducted health survey in 2000 households. It also administered gender gender related questionnaire to adolescent girls, faecal test of children between 0-5 years, blood test and anthropometric test. It also collected portable water sample from the households to test the presence of E. coli. MORSEL collected Baseline, Midline and Endline data for the project.

    Location: Madhepura district, Bihar

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    Air Pollution Awareness Study Amongst Residents of Delhi-NCR

    PIs: Abhishek Kumar, Co-Founder & CEO, Lung Care Foundation

    The survey has been conducted by Lung Care Foundation and Morsel Research and Development Pvt. Ltd. This is an Air pollution awareness study that has been done Amongst Residents of Delhi-NCR. In the survey, Delhi has been divided into the 7 zones and then data has been collect near to the metro station and from a few urban slums to collect the sample of 1500 respondents. This study shows that more than half of the respondents said that they feel the air quality is bad in Delhi NCR. Maximum (84%) respondents are unaware of the air quality index (AQI).

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