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.”
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.
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.
"Sustaining use of toilets is the biggest challenge"
"Sanitation should be a habit, rather than a compulsion"
"If people don't own sanitation programme, open defecation will continue"
"Use both positive and negative pressures for toilet use"