Focus on usage, not construction
Sanitation in India has come a long way from being no one’s priority to a politically salient issue
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Our politicians are finally talking toilets. From former minister Jairam Ramesh’s infamous statement that India needed more toilets than temples to becoming a campaign issue in the recent elections, sanitation in India has come a long way from being no one’s priority to a politically salient issue. On becoming Prime Minister, Narendra Modi was quick to commit his government to launching the “Swachh Bharat Mission” and building 200,000 toilets across India’s villages.
But even as politicians have begun to take sanitation seriously, India faces the enormous risk of investing its money and political capital in the wrong problem.
A widely held myth about sanitation, mirrored in the political rhetoric, is that lack of sanitation is a problem of access that can be solved through toilet construction drives. While many in India do not have access to toilets, the truth is that having a toilet doesn’t necessarily mean that people use it. The Research Institute for Compassionate Economics recently surveyed over 3,200 rural households across Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh. The survey found that 45% of the households with toilets have at least one person who regularly defecates in the open.
More worrying, the connection between open defecation and poor health is not clearly established. Fifty-one per cent of the respondents who defecate in the open did not consider open defecation a threat to children’s health—even though there is conclusive evidence to show that open defecation is directly related to stunted growth and lower cognitive ability.
So any policy that focuses only on toilet construction without tackling the issue of “usage” will achieve little, apart perhaps from fattening the pockets of the contractor lobby.
The government has long acknowledged the limitations of toilet construction drives. In 1999, it launched the Total Sanitation Campaign (TSC), designed to focus on the links between public health and sanitation. This was accompanied by the Nirmal Gram Puraskar (NGP), a financial award to panchayats that achieve total sanitation by eliminating open defecation.
But having identified the right policy solutions, when it came to implementation, the government went on to do precisely everything it could to reinforce the construction drive.
First, it simply failed to create any mechanism to monitor outcomes. No government database collects information on usage, bacterial contamination in water, or any other indicator that measures progress toward achieving total sanitation. TSC has built a sophisticated, real-time database on performance. But the only indicators tracked are about toilet construction. This emphasis on monitoring construction sent a clear signal to the administrative apparatus that construction is what needs to be done. And so the entire implementation machinery concentrated its energy on the wrong problem.
Second, for all its awareness-raising rhetoric, the government simply did not invest its resources in the right places. In 2012, the government rechristened TSC as the Nirmal Bharat Abhiyan (NBA). NBA allocates a maximum of 15% of its annual budget to awareness and mobilization-related activities. Allocating the bulk of the budget to construction served to reinforce the view that construction is what matters.
Unsurprisingly, even the innovatively designed NGP was reduced to a toilet construction drive where winning the award rather than achieving zero open defecation became the target.
So how can the new government avoid the mistakes of the past? There is little argument that total sanitation can only be achieved through collective behaviour change. But engineering shifts in social behaviour is not something that governments, even efficient ones, are good at. Doing this right would require a nuanced approach—one that understands the reasons behind user preferences, and develops awareness campaigns and solutions linked to that. This is something that advertising firms might be better at than bureaucrats trained to move files.
Even as India’s policymakers grapple with finding the best solution, there are a few small steps that the new government must take. First, start measuring the right problem. Appropriate measurement will serve two purposes.
One, it will send a clear message that the goal of sanitation policy is “usage” and not construction. Two, if done innovatively by reaching out to communities to get involved in data collection, it can also be an awareness creation strategy. What better way to understand the problem than by being part of identifying it. Here the government can learn from large-scale citizen-led surveys like ASER (Annual Status of Education Report) and the ASHWAS (a survey of household water and sanitation) survey that measured water quality and sanitation in Karnataka.
Second, incentivize innovation and experimentation. Rather than developing a tightly controlled, Delhi-centric scheme, the Swachh Bharat Mission should be designed as an innovation fund, which allows states and local governments to develop appropriate strategies. Funds to states should be tied to cost of state-specific innovations and achievements against outcome indicators. A message from the Prime Minister that the goal is to promote toilet usage and not toilet construction will ensure that this fund doesn’t fall into the NGP construction trap.
Current widespread political support affords a great opportunity for India to get rid of a problem that kills millions and costs us 6.4% of GDP due to death and disease. But this opportunity will only be realized if we learn from past mistakes and build solutions that focus on the right problem. Our neighbours Bangladesh and Nepal have achieved great success in sanitation precisely because they focused on sanitation outcomes over construction. Perhaps the next summit of the South Asian Association for Regional Cooperation should focus on sanitation—what better way to build regional ties than to learn from our neighbours.
Yamini Aiyar and Avani Kapur are from the Accountability Initiative of the Centre for Policy Research.