The dirty truth

On the occasion of the World Toilet Day, we present some stark truths about sanitation challenges in India, including the progress report of the government and experts’ observations

By Sushmita Sengupta, Subhojit Goswami, DTE Staff
Last Updated: Saturday 19 November 2016 | 01:06:32 AM
Credit: Morten Knutsen/ Flicker
Credit: Morten Knutsen/ Flicker Credit: Morten Knutsen/ Flicker

Down To Earth Hindi exposes poor progress of Swachh Bharat Mission

As the World Toilet Day is observed globally to raise awareness and inspire action to tackle the global sanitation crisis, India grapples with the challenge of making itself open defecation-free.

Prime Minister Narendra Modi has promised a toilet for every citizen by October 2, 2019. With the 2019 general elections round the corner, will the government be able to keep this promise made to a nation that leads the world in open defecation? We tried to find an answer by doing a first-of-its-kind assessment of the ‘toilet building’ performance of a number of Central ministers, chief ministers and a few opposition leaders ever since the initiative was launched in October 2014.

Only 7,327 toilets were built in Varanasi, Narendra Modi’s constituency, in the past two years against a five-year target of 234,489 (till October 2019). At this rate, the target cannot be met before 2048. Similarly, home minister Rajnath Singh’s constituency, Lucknow, has seen 5,332 new toilets against the 2019 target of 186,177. At this pace, the constituency will not reach the target before 2051. Such explosive findings are part of the analysis done by the inaugural issue of Down To Earth Hindi.

“This analysis by Down To Earth Hindi reminds us that building toilets is only a small part of the movement towards access to sanitation for all. Firstly, as we build toilets, we must ensure that they are used, that they are functional. Secondly, we must have clear answers to questions of how can we manage and treat our waste, our excreta,” says Narain.

Replete with case studies and individual stories of villagers from across India, the cover story followed a scientific method for arriving at the figures for each constituency and also shed light on the link between open defecation and cases of diarrhoea. The key political figures whose performance has been assessed include external affairs minister Sushma Swaraj, defence minister Manohar Parikkar, water resources minister Uma Bharti, surface transport minister Nitin Gadkari, Congress party leader Rahul Gandhi, Bihar chief minister Nitish Kumar, Haryana chief minister Manohar Lal Khattar, Madhya Pradesh chief minister Shivraj Singh Chauhan and Chhattisgarh chief minister Raman Singh.

"Prime Minister Narendra Modi has promised a toilet for every citizen of India by October 2, 2019—the year when the country will celebrate the 125th birth anniversary of Gandhi. Our analysis says that is easier said than done. In fact, the NDA government might find it easier to win the election than to fulfill this promise," says Richard Mahapatra, managing editor of Down To Earth.

Besides pointing out the economic burden of poor sanitation and associated risks of open defecation, the analysis also portrays the enormous challenge for the NDA government: building 2.3 million toilets every month (or 56 toilets every minute) to meet the target by 2019. Speaking at the inauguration of the magazine’s Hindi version, Sushmita Sengupta, programme manager at the Centre for Science and Environment and the lead author of this analysis, asserted, “As per our estimation and going by the prevailing rate, India will not be able to meet its target by 2019 as promised by the Prime Minister–but only by 2022.”

Poor sanitation cost India 5.2% of its GDP

A 2011 report published by Water Aid says that sanitation access lowered the odds of children suffering from diarrhoea by 7-17 per cent and reduced the mortality rate of children under the age of five by 5-20 per cent
Credit: Miran Rijavec/Flickr

A report—True cost of sanitation—was published jointly by the LIXIL Group Corporation, Water Aid and Oxford Economics recently. Oxford Economics mainly works on economic forecasting and modelling.

It says that in 2015 lack of access to sanitation cost the global economy around US $ 222.9 billion. This is almost 1.2 times the cost incurred in 2010. There has been a rise is US $ 40 billion in just five years.

The 2015 figure constitutes an average 0.9 per cent of the gross domestic product (GDP) of countries affected by poor sanitation.

The report looks at economic development to estimate the global cost incurred due to poor sanitation. It talks about the high economic burden in low-and-middle-income economies.

Heavy burden

The economic burden of poor sanitation is the heaviest in Asia-Pacific, which is almost 77 per cent of the total amount. Latin America and the Caribbean and Africa each account for approximately 10 per cent of the global cost.

On a national level, in terms of total cost, India suffers the most, with US $ 106.7 billion wiped off the GDP in 2015. It is almost half of the total global losses and 5.2 per cent of the nation’s GDP.

According to the 2015 report of the Joint Monitoring Programme of the United Nations International Children’s Emergency Fund and the World Health Organization, around 44 per cent of Indians defecate in the open.

Poor sanitation has a range of negative impacts on the society and the economy. It causes debilitating and deadly diseases through the contamination of drinking water sources and food with pathogen-laden human wastes.

It also gives rise to associated losses in productivity due to sickness and toilet access and increased healthcare costs from caring for the sick.

A 2011 report published by Water Aid says that sanitation access lowered the odds of children suffering from diarrhoea by 7-17 per cent and reduced the mortality rate of children under the age of five by 5-20 per cent. Water Aid is an international organisation dealing with water, health and sanitation.

Credit: True cost of sanitation, 2016

Finding solutions

The report talks about how to move towards sustainable solutions. Three solutions suggested are as follows:

Innovative solutions: sanitation systems in the developed world require vast amount of land, energy, and water. They are expensive to build, maintain and operate. Innovation is a key to solving the sanitation crisis. It is not limited to designing new sanitation hardware. The report says that there should be planning in place so that sanitation products reach consumers. LIXIL is developing sanitation solutions for regions where water intensive systems are not appropriate. It delivers human-centric innovation that enhances people’s living spaces

Political prioritisation: the social and economic impacts of improving sanitation are irrefutable. Politicians at the international, national and local levels must put sanitation at the top of their agenda and reflect this in national planning and budgeting. This point has proved true for India in many cases. Such prioritisation has helped states like Sikkim and Kerala to move towards cleanliness

Collaboration and coordination: The sanitation crisis can be solved if there is collaboration among different stakeholders. The government, communities, NGOs, researchers, academia, corporate and the private sector should come together to solve the complex sanitation issues. This approach enables each stakeholder to efficiently leverage their core skills, thereby ensuring that effective programmes can be taken to scale up with the necessary speed. Sanitation success in India and Bangladesh came only when communities were involved in the programme

India is talking about attaining a clean state by October 2019. Sanitation crisis in the country needs to be solved at a war footing to reduce the economic burden caused due to health problems connected to poor sanitation.

This needs not only construction of toilets, but usage. Managing liquid and solid wastes is also important that needs special care. Innovative technologies with low-water usage can be of great help in this regard.

What's the right strategy to fight the scourge of open defecation?

"Sustaining use of toilets is the biggest challenge"

The fisrt crucial step to tackle the challenge of sanitation in rural India is already taken. Prime Minister Narendra Modi has brought this issue into national agenda. His personal persuasion of the sanitation agenda has already galvanised the administration on the Swachh Bharat Mission. More than 1 00,000 villages have been declared open defecation-free; many thousands will soon join the list. Now the challenge is: how to sustain this status for- ever? I know that there is slippage in sanitation status; people get back to open defecation even after having a toilet at home. Why does it happen? There are many reasons. But the biggest challenge is bringing the behavioural change that will ensure that people stop defecating in the open. And this challenge has many dimensions; each of them is a further challenge. It is going to be a long-term engagement and in future it will require the same kind of political backing as the sanitation programme is receiving now. Here is an example of how difficult the job of bringing behavioural change is. In the United States of America, government had to work for 30-40 years to ensure that people use seat belts while driving cars.

The government feels strongly that just building toilets is not going to fetch anyone the swachh (clean) tag. Rather it must be a broader attempt to make a village clean with toilets and also the crucial solid and waste management mechanism. This makes our job further challenging, though at the policy level we are seriously pursuing this. To make it a campaign, we need to work at the PM (prime minister), CM (chief minister), DM (district magistrate) and VM (village mukhiya or head) levels; each doing their bit to make people aware of the benefits of sanitation. Each of the institutional heads must give her or his support, both political and policy and programmatic. This is the reason the government is working on a village-level cleanliness index. Under this, each village will take the responsibility of becoming open defecation-free and we will empower them to self-certify their status. This will bring in ownership over the programme.
"Sanitation should be a habit, rather than a compulsion"

Sindhudurg district has been termed the cleanest in the country. In April this year, it became open defecation-free. The journey has been worth the destination. There is no one way of ensuring toilets to all and that people use them in the long term. Making the district open defecation-free was a tough call as every household has to subscribe to this objective.

I used religious faith as a tool to convince people of the importance of sanitation. We have 745 villages comprising more than 5,000 hamlets. Each hamlet has one traditional religious leader, locally called “Gaonkar”. We worked with them to reach out to the larger community. But to begin with, we had to convince the religious leaders of the health and spiritual aspects of sanitation. Once that was achieved, it was easy as these religious leaders spread the message of total sanitation among their constituencies.

At the same time, we adopted the name and shame strategy for households who did not have toilets. That helped us in forcing people to build toilets. An interesting aspect of the district is that almost every household has a member working in Mumbai, and almost all of the district population aspires to work in the city. Our point was without having a toilet at home how could they aspire to adjust to life in a city. We also shame those who are already earning well in Mumbai but never bothered to construct a toilet for their family in the village. It all happened in meetings of panchayats which everybody attends.

At the same time, we facilitated those who wanted to build a toilet but could not afford it. The district administration arranges loans of Rs 12,000 from District Cooperative Banks at minimal interest of Rs 110 per month. The people of the district have a very high civic sense and the district has been historically doing well on the cleanliness front. There is good synergy between the people and the local government that has made cleanliness a habit rather than a compulsion.
"If people don't own sanitation programme, open defecation will continue"

By November this year, Kurukshetra would be an open defecation-free district. But it could have achieved this status in 2013. This is where a lesson for total sanitation lies. In 2010, I was an additional deputy commissioner in the district. I took up a massive campaign for making the district open defecation-free. It was not just my personal agenda, but there was similar government attention to the problem. We roped in the community, particularly the women, to make the use of toilet a fundamental habit. The results were overwhelming: in three years a record 303 villages were declared open defecation-free and got the coveted Nirmal Gram Puraskar (Clean Village Award). In these three years I focused on the construction of toilet facilities and their use. For a state that is infamous for “honour”-related crimes, having a toilet became the new honour.

In 2013, I was transferred out of the district. But I used to come back for other official works. During such visits, I could see the collapse of the great stride the district had made in achieving total sanitation. Most of the villages that took pride in the open defecation-free status had gone back to defecating in the open. We were back to where we started. But the pertinent question is: why did this happen?

This is because we failed in sustaining the engagement with the community on sanitation. Our efforts were not consistent and in just a few months all past work collapsed. The community lost the sense of ownership over the programme; it was just a government programme that distributed money to build toilets. This can happen to any village in the country.

We are back to correct this failure. This time, the emphasis is on involving the community. We are also looking at solid waste management so that people don’t complain about disposal of toilet waste. The district has been divided into 25 clusters; each will be supervised by a senior official. These officials are drawn from all relevant departments so that sanitation does not remain just a toilet construction initiative. Elected members of the panchayat are being used to motivate people in their constituencies to use toilets. It is a new beginning but with lessons from the past having been learnt.
"Use both positive and negative pressures for toilet use"

Sikkim is the first Indian state to be declared open defecation-free. That way, the state is the first example of achieving total sanitation at this scale.

We achieved it because the government showed both political and administrative will. Sikkim is a small hilly state. Its elected members in Legislative Assembly and Parliament showed eagerness to make it the first state of the country to achieve the status. This was coupled with administrative will. Some officers also showed their keenness in implementing it. Finally, we became open defecation-free two years ago.

Now the challenge is to sustain this effort and change people’s behaviour. Since I joined as the district commissioner of South Sikkim two years ago, it has been a challenge to keep this momentum up. I joined when the state was about to achieve this status. We adopted a few innovative methods to keep engaging with the public on sanitation and other developmental issues. We have started “field day” and “village adoption” methods to take things further.

We hold the “field day” on every Friday where our officers visit villages to take stock of the situation, interact with village heads and organise meetings with village representatives to keep them motivated. This provides the opportunity to keep a tab on whether people are using toilets. But our conversations are mostly about the benefits of sanitation.

In the scheme “District Administration Adoption Village”, we adopt two panchayats for six months to turn them into model panchayats. The main component of this initiative is to encourage good sanitation practices. Leaders of these model panchayats assume crucial role in ensuring that all sanitation-related works get importance and people continue to use the toilets. They also interact with neighbouring village residents to encourage them to construct and use toilets.

We followed a strategy of putting two types of pressure on the people—one positive and the other negative. Positive pressure was put through campaigns and social messages across sections of society. Negative pressure was applied by restricting and denying government benefits to those who have not constructed toilets or have not given up open defecation. This has helped create an overall positive impact.

Behaviour change at many levels needed to make India open defecation-free

We need to look beyond toilets and establish a connection between sanitation and health in order to trigger a mindset change in rural India. This is one of the key takeaways from the National Consultation on Rural Sanitation, hosted by the Centre for Science and Environment (CSE) in New Delhi on October 6.

Laying bare the concerns related to poor sanitation in India, Sunita Narain, the director of CSE, said that we need to answer a fundamental question: how does the waste get treated? “The government’s emphasis should be on safe disposal of waste and not just building toilets and sewage treatment plants,” she observed. On this note, Sunita announced that the CSE is setting up an independent faecal sludge testing laboratory.

Government’s approach

Parameswaran Iyer, secretary in the Ministry of Drinking Water & Sanitation, spoke about making the Swachh Bharat Mission (SBM) a success by treating it not as a sarkari programme but as a jan andolan (people’s movement). While claiming that more than 100,000 villages have been made ODF in the last two years, he added that verification of these villages has been done through third parties.

Explaining the concept of Swachh Gram, Iyer pointed out that any village that is open defecation-free and has effective solid and liquid waste management mechanism at place will be declared a clean village. “The government will introduce a self-rating system in all the 650,000 villages in India wherein the panchayat will rate a village every six months. The members of the panchayats will receive some training to assess the sanitation situation, following which third-party verification will be conducted in assistance with the World Bank.

Gender gap

Taking cue from Joe Mediath, Founder of Gram Vikas, who raised the issue about privacy for women during bathing and building a bathroom along with toilet, Srestha Kumar from International Center for Research on Women (ICRW) said that there is a gender gap in the way we look at solving sanitation problem. “Women are being shamed and discouraged to defecate in the open, while men go out in the open and defecate. How can we expect to make a village ODF when male members don’t embrace this shift? Moreover, availability of water is also an issue because ultimately, it is the women who have to walk miles and fetch water for using in toilets,” said Sreshtha.

Scarcity of data

The general opinion that emerged from the discussion is that there is not enough disaggregated and conclusive data down to the village level. “Each sector is collecting data in its own way and they are working in silos. That’s why there is no concrete data on health and sanitation, said Madhumita Dobe, Director- Professor (Public Health) at All India Institute of Hygiene & Public Health, Kolkata.

“We want tangible information on open defecation, sanitation and water-borne diseases to bring change in people's mindset. Since water-borne diseases have been denotifed, it has become a struggle to find data about them. Without data we can’t establish a viable argument,” said Sunita.

Clear wins and challenges in districts

Kamal Kar, Founder & Director of CLTS Foundation, referred to Ahmednagar and Nanded districts of Maharashtra where community-led total sanitation is now a reality. For him, this was made possible because of the commitment to construction of toilets shown by the villagers, who even refused to accept government subsidy in return. “Peer pressure also worked when it comes to making districts open defecation-free. They also mobilised resources and brought the unused toilets into use,” said Kamal.

But an open defecation-free campaign can fast lose steam if villagers don’t cooperate with local administration. Highlighting the challenges that district authorities face in sustaining such a campaign, Sumedha Kataria, District Collector, Kurukshetra, said, ‘You have to do constant hammering and constant checks to keep people motivated and bring that social change.”

Role of Health Ministry

While Sunita called for a common work plan to improve sanitation issue in India, Madhumita emphasised the need to involve the Health Ministry to ensure we have “convergence of thought” on tackling waste management, open defecation and water-borne diseases. “In Bangladesh, sanitation status of a village used to be assessed by the number of cholera and diarrhea cases reported in nearby hospitals and health centres,” said Kamal taking a leaf from his experience of working in the country.

Behaviour change needed but not with a coercive approach

The panelists were unanimous in their opinion that the SBM has always been about toilets, numbers and incentives, but not about bringing a change in the mindset of villagers.

According to one of the panelists, the government’s biggest mistake has been to take responsibility on behalf of the people to trigger behaviour change. The authorities arbitrarily decided to thrust technology on people and focussed only on construction of toilets.

“Indian Constitution says sanitation is a state subject. So let’s leave sanitation to panchayat and state and don’t let the Centre prescribe an approach. Right now, the Union Government is thrusting its policies on all the districts without understanding that one-size-fits-all approach cannot work. That’s why there is a need for behaviour change at the level of policymaking,” asserted Deepak Sanan, Former Additional Chief Secretary, Government of Himachal Pradesh and advisor to the CLTS Foundation.

Sanan also added that SBM has been chasing toilets—a private good—but it has ignored the behavioural change—a public good, which is essential to improve sanitation situation.

But there is a danger in adopting a coercive approach to force people to have toilets since it may create a division within the community. “Shaming people in public, not marking students’ attendance in school and not allowing villagers to vote in local elections for defecating in the open are not the way to trigger a change in mindset,” argued Arundati Muralidharan of Water Aid.

Besides talking about the focus on collective behaviour change, Anowarul Haq, director of CARE, Bangladesh, pointed out how the country opened market for sanitation accessories. Manu Prakash, executive director at TARU Leading Edge, noted that while there has been a huge hike in money spent on SBM but there is no invest in sanitation market.

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