Beyond brooms and toilets
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Prime Minister Narendra Modi’s pet project, the Swachh Bharat Abhiyan (SBA) has an extraordinary mandate—getting nearly 600 million Indians who currently defecate in the open to use toilets. SBA’s inordinate focus on toilet construction, however, is baffling. It means that the government has not fully grasped the nature of the sanitation problem for what it is. Indeed, if Modi is to achieve his ambitious goal of an open defecation free India by 2019, we will need to treble the rate of decline in open defecation in the next five years. To this end, the government must be willing to learn from past failures and tailor its policy to address attitudes that make open defecation such an obdurate problem. It will simply not do to implement half-baked, poorly conceived schemes.
What is it then that we need beyond broom-wielding photo-ops and exhorting the countrymen to pledge to make Mother India clean? Let us see how the current sanitation policy stacks up against the evidence. SBA is a big ticket on the public exchequer. Its five-year budgetary allocation stands at Rs.2 trillion with Rs.1.34 trillion dedicated to rural sanitation. This is a significant leap from past programmes and the government has done well to increase the overall budgetary envelope. However, it has not been especially perspicacious in planning fund use. As much as 92% of the proposed Rs.1.34 trillion rural sanitation tab is devoted to toilet construction, with a measly 8% set aside for the critical information, education and communication component targeted at encouraging toilet use and changing sanitation behaviour.
Past experience shows that poor compliance behaviour (lack of toilet use) has been the proverbial thorn in the side. Both the Nirmal Bharat Abhiyan and its 90s predecessor, the Total Sanitation Campaign, were centred on building toilets, and failed for this reason. Clearly, building toilets works only when people use them. So while building 111.1 million toilets over the next five years (that’s over 2,500 toilets an hour) to cover every household might seem like the obvious answer, it is a partial answer at best. Understanding and changing attitudes towards sanitation is more vital, if any of these planned toilets are ever going to be used. A recent sanitation survey in rural north India conducted by the Research Institute for Compassionate Economics revealed that as many as 40% of the households that owned a private toilet had at least one member who still defecated in the open. Having a toilet is no guarantee for using it.
The government’s current policy ensures that even more public resources would, quite literally, be flushed down the toilet, unless there is a shift in the emphasis of spending away from building latrines. It is important that the government invests in sensitizing communities on the benefits of using affordable latrines, rather than thrusting unwanted, unused toilets on them. It would do well to take a leaf from the sanitation playbooks of Nepal and Bangladesh, where an accent on demand-driven and community-led approaches has significantly reduced open defecation. Bangladesh in particular has turned the page, reducing open defecation from 34% to 3% from 1990 to 2012.
Modi has urged citizens to pledge allegiance to Mohandas Gandhi’s vision of a clean India. Surprisingly though, the Swachhta Pledge skips mention of latrine use. A broad-brushed message on cleanliness in a social milieu where toilet use is not necessarily an accepted norm is unlikely to work. An appeal to cleanliness does not automatically translate into toilet use, especially when your target audience considers open defecation healthy. The survey cited earlier found 51% of those who defecated in the open considered it as good for child health as latrine use.
Modi’s interesting, if somewhat dramatic invocation of service to Mother India and civic pride to drive social change is an excellent prop to get traction on sanitation. But why limit it to cleaning the streets?
Modi’s plug for serving the country should extend to improving India’s abysmal child health indicators, specifically by improving toilet use. Evidence bears out that exposure to faeces resulting from open defecation kills thousands of children before their fifth birthday and irreversibly stunts those that survive. It should be a matter of shame for every self-respecting citizen. Mere cleanliness, in the way it is commonly understood, will not produce the health benefits that sanitation should.
To take stock of programme performance, the government should develop robust monitoring indicators. Latrine use rather than construction should be the key metric. There is good news on this front. The ministry of drinking water and sanitation is expected to set up a latrine-use monitoring unit soon. Further, open defecation rates should be tracked to see if the programme is making a difference on the ground.
Intelligent policymaking that learns from the mistakes of the past avatars of SBA is imperative. Expensive subsidy to construct toilets that will not be used even if they are built, or at best, be used partially, is a colossal waste of public money. It is wiser to generate demand first. Ploughing greater resources in behavioural change through community engagement that helps people understand the harmful effects of open defecation is the way forward. Foisting unwanted toilets on unwilling users will not solve anything.
It’s time to plumb the sanitation policy lest it go down the tubes.
Nidhi Khurana is a researcher at the Johns Hopkins University’s Bloomberg School of Public Health.
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