India needs to make sanitation a priority – here’s why

By Moin Qazi 

Sanitation is the key to proper hygiene, which is essential for a health and safety of the public. India’s record, especially when it comes to sanitation, has been abysmal so far. However, thanks in part to the Modi government’s new Swachh Bharat initiative, it appears India is now primed for a “toilet revolution”.

How are the Centre’s efforts to further sanitation faring?

In 2014, the Modi government launched Swachh Bharat Abhiyan or Clean India Mission to modernise sanitation within five years. Its main aim was the elimination of open defecation by October 2019, and to provide new sanitary toilets to more than 60 million homes. A partial trigger for this move was the Supreme Court of India’s recognition of sanitation as a fundamental right in the 1990s, and the UN General Assembly following suit in recognising sanitation as a distinct human right.

The Indian government has been subsidising lavatories in remote villages for over three decades, but with poor outcomes, frustrating its hopes to wean its citizens off the obnoxious practice. However, the government ‘s drive so far has so far, proved to have taken great strides in eliminating public defecation.  A 2017 Economic Survey  revealed that the number of persons defecating in the open in rural areas, which was 55 crores in October 2014, declined to 25 crores in January 2017. 296 districts and 307,349 villages across India have been declared Open Defecation Free (ODF).

Around 450 million people continue to defecate in the open—behind bushes, by roadsides, on river banks and railway tracks. Credit: Flickr Commons

What are the challenges to achieving proper sanitation in India?

The ambitious goals set by the Indian government to clean up the nation faces several problems. In all probability, the Centre may not be able to achieve its goals within the set time limit. Around 450 million people continue to defecate in the open—behind bushes, by roadsides, on river banks and railway tracks. In cities, 157 million urban dwellers currently lack decent toilet facilities. Much of the solid waste is emptied into rivers, lakes, and ponds, with the untreated faecal sludge adding to the ever escalating levels of harmful pollution. The circulation of faecal bacteria in the environment spreads infectious diseases, and chronic infections that impair the human body’s ability to absorb nutrients.

Several surveys have revealed that increased availability of public lavatories across expanded areas, does not necessarily guarantee greater usage. The reality is that in many people only use toilets only in emergencies. In rural areas, especially in the past, toilets was often the only concrete structure in the house, and were mostly used as a storeroom for firewood, cow-dung cakes, grass, chickens, and food grains. In some cases, bathrooms also doubled as goat-sheds.

A study in October 2017 conducted by the Institute of Development Studies, Water Aid and Praxis, suggests that several ODF villages, which have been certified as ODF by a third-party evaluation, still practice open defecation. In the case of one of the villages—Pali, Rajasthan—which was observed as part of the study, the total usage of toilets was only 1%. The study also pointed towards coercive approaches used by vigilance committees, who imposed sanctions, such as the seizure of ration cards, stopping of rations, disallowance of benefits from a panchayat-related scheme, and disconnection of electricity—all of which was observed occurring in the village of Sehore, Madhya Pradesh. In several areas, coercion is allegedly still being used to meet the targets. This is in direct opposition of the government’s claims of the initiative being fulled through awareness and demand creation.

What more is needed to implement a proper sanitation system in India?

The government’s campaign needs to link sanitation to a series of other actions related to the social and cultural connections of sanitation. A strong cultural resistance to the current campaign is perhaps the main stumbling block. Collective behavioural change and an adequate volume of water is pre-requisite for an effective sanitation programme.

Apart from septic tanks being expensive for the majority, one of the primary issues with is solid and liquid waste management is that these tanks require waste disposal every year. At present, the toilets that are built are mostly single-pit latrines that clog up every few years in the villages, and have to be emptied by hand. People link that to manual scavenging, which is a social stigma and has horrifying implications associated with India’s age-old, cruel caste system. Till date, in many parts of India, scavengers are considered to be at the bottom of the social ladder.

With millions of new toilets slated to be set up, more sanitation workers will be needed to carry out solid waste management. This is sure to be challenging, as such jobs are stigmatised. Indeed, the conditions for such workers are very demeaning. Mechanisation of the process could go some way to help ensure that workers do not need to enter the sewers, and traditional emptiers of pits become part of a new, respectable, well-paid sanitary economy. Waste collection, recycling, and disposal, including the installation of local incinerators, treatment plants, aerobic digesters, and small- bore sewerage systems also present commercial opportunities.

Swachh Bharat Abhiyan has also been highlighting the relevance of twin-pit technology—a technique in which two pits are constructed, so that when one fills up, it can be covered and allowed to decompose. This technology is considered to be a “complete treatment plant” in itself and does not need to be emptied, especially since its contents become ordinary manure, once left to dry for a year.

Many financially well-off families in India prefer building a bathroom for convenience rather than health benefits. Arghyam, an organisation in Bengaluru, engaged in sustainable water management, feels that the government is spending too much money on toilets and very little on behavioural training. People need to consider toilets as inspirational and build them by themselves, after understanding the holistic benefits of having unfettered access to them, rather than perceiving them as handouts.

India could learn from other so-called third world nations, including our neighbour Bangladesh, which reduced open defecation from 34% to 1% between 1990 and 2015, without as much subsidy. As part of a sustained effort, its government partnered with village councils to educate people on the overall merits of proper sanitation. Instead of just focusing on the hazards of open defecation, the Bangladeshi government extolled the virtues of clean sanitation—with women playing a vital role in the success of the campaign. A toilet soon became a symbol of dignity.

Why proper sanitation is such a dire necessity

According to the World Health Organisation, societies that lack sanitation are at risk from cholera, dysentery diarrhoea, hepatitis A, and typhoid. Such societies also tend to have the highest number of child deaths.

However, any amount invested into such an initiative is estimated to not only bring in high returns, but also contribute positively to both economic and health outcomes, such as increased worker output and reduction in cases of chronic diarrhoea and other diseases. The real benefits would likely be even greater if we factor in the improvements to the environment and children’s performance in schools.

But this will only be an important first step needed to ensure that the country has interventions covering all dimensions of sanitation. To reach the goal, India will need a behavioural change, as well as new infrastructure to succeed.

UNICEF recently undertook a study across 10,000 rural households in 12 cities to estimate the cost benefits of the mission. It found out that every rupee invested in improving sanitation will help save Rs 4.30. The study found that the campaign could lead to each household saving around Rs 50,000 per year. The study concluded that if 85% of household members use their washrooms to defecate, the financial savings induced by improved sanitation had a cost-benefit ratio of 430% on average. In other words, one rupee invested allows a saving of 4.30 rupees.

The government’s current keen interest in helping make this mission a success, will likely propel entrepreneurs to come up with creative solutions to some of the glitches.The ecosystem is fast taking shape and convergence among various stakeholders, and actors should help us see an end to this uncivilised and unsanitory practice of open defecation soon.