Economic Survey 2019: Swachhagrahis to help push health, sanitation goals under Sundar Bharat

The Economic Survey 2019 has asked the ambassadors of Swachh Bharat Mission (SBM) to ensure health and sanitation goals by getting people to pre-commit to an action. These individuals, called ‘Swachhagrahis’ will make people pre-commit to the sanitation goals.

Here, the mission would be called ‘Sundar Bharat’ which involves a mix of health and sanitation goals. This is an extension of the Swachh Bharat (Clean India) and Ayushman Bharat (free health insurance to certain families) schemes.

The Swachhagrahis are already part of the Swachh Bharat mission.

For instance, the survey said a swachhagrahi may disseminate information about the incidence of sanitation-related illness in the village and how this rate has improved after the adoption of sanitation practices.

Further, the swachhagrahis would also assist people in assessing themselves periodically, say once a month. An assisted reflection session in the community or on a one-on-one basis with the local swachhagrahi can prompt people to think about whether they acted as planned and how many times they detracted.

“These reflection sessions should culminate in a commitment about how people plan to act in the near-term future – whether they will refrain from open defecation next month or not,” said the Economic Survey.

Further, the Economic Survey said if people find an improvement in health outcomes after adopting the new practice, they are likely to persist in that practice. Here, a set of behavioural tools will be used to enforce this behaviour.

According to the Economic Survey, due to the information asymmetry between the doctor and the patient, hyperbolic tendencies of health consumers, and high variability of health care expenditures, people often make wrong decisions. These range from failing to enrol in health insurance to which they are entitled, to engaging in harmful behaviours like smoking and drug abuse.

Tweaks to promote Sundar Bharat 

The Economic Survey has put out a list of ways in which ‘Sundar Bharat’ can be enforced. For instance, it said that asking consumers the factors that are most important to them while choosing a health plan and restricting the plan to these factors can make the choice easier, it said.

Interestingly, the Economic Survey has also suggested minor behavioural alterations in school and college canteen menus to increase uptake of nutritious food. These include giving interesting names to healthy options, putting them near the cash counter and making the process of buying unhealthy options more time-consuming.

Another unique proposal mentioned in the Economic Survey is negative incentives. It said people often find it difficult to achieve goals like weight loss or ceasing to smoke.

For this, it suggested that people should be voluntarily made to post bonds (deposit contracts) or lottery tickets on a website. These will be returned to them if they achieve their goals, but are forfeited otherwise. This, said the Economic Survey, can help them achieve these difficult goals.

In the case of medical ailments, the Economic Survey pointed out that the doctor should enable positive behaviour.