As of February 2011, 31% of rural households in India do not have toilets. A 2008 Unicef study points out that a mere 21% of rural India uses improved sanitation facilities. But sanitation is no one’s priority. Last year, India spent Rs1,422 crore, or 0.02%, of its gross domestic product (GDP), on the Total Sanitation Campaign (TSC), the government of India’s flagship programme. This limited expenditure costs India heavily. A recent study by the Water and Sanitation Program of the World Bank estimates that inadequate sanitation costs India the equivalent of 6.4% of its GDP due to costs associated with death and disease, accessing and treating water and loss of work among others.
Now the good news! Despite its disastrous record and misplaced priorities, there is much to be learnt from India’s sanitation policy. To begin with, it can be credited as one of the only social sector programmes to have recognized the limitations of an infrastructure-driven policy approach—toilet building in this instance—and attempted to shift focus by introducing a performance-driven, outcome-oriented programme. Crucial to this shift was the introduction of the Nirmal Gram Puraskar (NGP) in 2003, an incentive scheme that offers rewards of up to Rs50 lakh to panchayats that achieve open-defecation-free (ODF) status. The NGP is premised on the assumption that improving sanitation requires changing people’s behaviour towards toilet use through local government innovation, awareness creation and generating bottom-up demand for improved sanitation. The programme, as we reported in this series last year, has successfully accelerated sanitation coverage up from less than 20% in 2000 to over 69% in 2011. Interestingly, many state governments have adopted this approach and have begun to experiment with their own awards. In 2009 alone, Karnataka, Sikkim and Haryana launched versions of the NGP awards.
Also See Rural Sanitation: Basics Yet to be Fixed (PDF)
The implementation of NGP offers many practical insights both on “how to” and “how not to” reform public services delivery in India. First, NGP demonstrates the ease with which fiscal transfers can be tied to achieving outcomes. Given the success of NGP, there is no reason why other social sector programmes cannot innovate with similar fiscal transfer structures. In fact, rather than outcomes budgeting—the Centre’s answer to the vexed problem of poor outcomes—the focus ought to be on linking outlays to outcomes at the delivery point through fiscal incentives such as NGP. Second, it showcases the catalytic role that, given the right incentives, local governments can play in promoting outcomes. Panchayats have responded enthusiastically to NGP. According to estimates by the Water and Sanitation Program, by 2010, approximately 55,785 local government institutions had applied and sought verification of their ODF status. About 22,745, or 41%, of these have gone on to win awards. But all this rests on an objective, rigorous evaluation system. This is the third key insight from NGP. While NGP’s evaluation methods are far from perfect, in recent years it has tried to introduce innovations such as panchayat peer review. Partly as a consequence of improved evaluation, the number of NGP awardees actually fell from 12,227 in 2008 to 4,558 in 2009-10.
For all its successes, perhaps, the biggest lessons to be learnt from NGP can be found in what it has not done. For one, it hasn’t completely dismantled the toilet construction drive. In fact, over 90% of TSC funds—the primary vehicle through which NGP is implemented—are earmarked exclusively to toilet construction. Unsurprisingly, many states continue to build toilets rather than focusing on generating bottom-up demand. Not only has the continued emphasis on construction severely limited NGP’s potential—in fact, most of NGP awardees at the gram panchayat level come from three states—Sikkim, Kerala and Maharashtra—but, crucially, it has also meant that large sums of money continue to be spent on the wrong problem. India’s experience with building school toilets illustrates this phenomenon well. The 2010 Annual Status of Education Report (Aser) survey assessed the availability and usability of school toilets to find that while about 90% of India’s elementary schools had constructed toilets, about half were either locked or unusable. The problem in this case is not infrastructure (or lack of it), but a problem of maintenance and prioritization. Clearly, behaviour change in this case is more critical than toilet construction. Ironically, given the stated focus on behaviour change in the TSC, a mere 5% of its annual expenditure is earmarked for IEC (information, education and communication, scheme jargon for awareness raising and capacity building).
Second, NGP has not invested enough in building capacity and motivating officials at the front line and this has been its greatest failing. While there is no serious research, anecdotal evidence suggests that where the award has been prioritized, the goal post has simply shifted from building toilets to winning awards, often at the expense of strengthening local governments and generating genuine demand, and an increasing number of award-winning panchayats have failed to maintain their total sanitation status. NGP amply demonstrates the difficulties of implementing a bottom-up, performance-oriented programme in an input-focused bureaucratic culture. When faced with the complex task of mobilizing communities and encouraging their participation, front line officials invariably search for ways to reintroduce the familiar—in this instance, focusing on the procedural aspects of winning the award and the visible input—the award itself and the route to the award is invariably building toilets. Breaking this input culture requires long-term investment on the front line, one which creates an army of providers motivated by the vision of the programme rather than its tangible outputs.So in sum, India’s sanitation story is a mix of hits and misses. Its success lies in the fact that it has successfully developed a unique outcome-focused implementation architecture, which has resulted in significant improvements. But its game-changing potential is limited by weak implementation and misplaced priorities. What we need most is to prioritize outcomes; but inputs are all we seem to get!
Yamini Aiyar is a senior research fellow and director of the Accountability Initiative of the Centre for Policy Research.
(Data collected and analysed by Avani Kapur and Anirvan Chowdhury)
Respond to this column at firstname.lastname@example.org(Data collected and analysed by Avani Kapur and Anirvan Chowdhury)