Rohini Nilekani: Why we must measure the true cost of sanitation

It’s wonderful that so much attention is being paid to the issue of sanitation in the country. We have a confluence of rising public demand, political will and increased public and private financing. Can we get it right this time?

The word sanitation can include many things, but for the purposes of this article, I will limit its usage to human waste and its treatment. So we are talking about where people urinate and defecate, whether there is enough water to carry the waste away and to wash their hands and feet, where does that waste then go, and what impact does it have on public health if the waste is not handled properly.

This is simple to understand. What is less easy to explain is why, decades after public funds started moving into the sanitation sector in a fairly organized way, at least one out of two citizens does not have proper access to full sanitation.

What is important to accept is that even when people have access to toilets, many prefer to use the outdoors.

We need to carefully understand the situation, the emotions and the rationales of people in order to understand what it will cost to improve sanitation facilities in the country. Since the primary driver for the government’s programme is improved public health, halfway measures will simply not achieve the desired outcome. For example, if everyone had toilets, yet wastewater from these toilets was contaminating local water resources, residents would face more health risks than if they were defecating in the open but without polluting their water source.

So what is the true cost of sanitation? We should arrive at some common understanding on this before we rush out to build toilets everywhere.

First, there is the question of proper demand generation. People have to clearly see the connection between their family’s health and their sanitation habits. And they need sustained help to break old habits and make the appropriate change in behaviour. We can now leverage the work of many agencies that have successfully designed and delivered scientific and effective communication. But this comes at a price. To use an example from the work of my foundation, Arghyam in Davangere district in Karnataka, the communication campaign cost was around ₹ 1,000 per toilet. Gramalaya, an NGO believes it takes as much as ₹ 2,500 per toilet over several months on behaviour-change communication so as to achieve sustainable sanitation outcomes.

Then there is the cost of the land. Many of those who defecate in the open do so because they are landless or do not have enough space to build a decent shelter, let alone a toilet. It is not easy to calculate the cost of land to build individual or community toilet systems. But we need to account for it when we total up the true cost of sanitation.

Then comes the construction of the toilet itself. Government subsidies allow for almost ₹ 12,000 per toilet at present. A simple squatting toilet with minimum facilities can cost less than that. But research in some areas has indicated that people believe that a toilet that would be usable for all would probably cost more. Many households also feel the need for an extra toilet, and one with a proper bathing area nearby. This is critical to know, as usability and usage decline when the toilet is not designed and built to suit all needs. Also, the government subsidy comes only after the toilet is built. Often, people raise loans, at an interest rate anywhere from 4-40%, to build the toilet. This too must be factored in.

Then comes the handling of the waste. By analysing a few projects that have been well executed in rural areas, it appears that the one-time cost of implementing a solid and liquid waste management solution for a village can be around ₹ 6,000 per household. This includes the waste streams from the kitchen and the bath area as well. Connecting 500 million urbanites to a Western-style sewerage system, would obviously be much more capital-and water-intensive.

Often, we overlook the operations and maintenance costs of toilets, including soap, water, cleaning materials, pit emptying, and the time cost of the person who cleans the toilet, usually a woman! Without maintenance, toilets become rapidly dysfunctional, and the process of educating and communicating must start all over again.

This is just a snapshot of what it will take to achieve sanitation that delivers on the promise of public health and personal dignity that we as a society seek. Are we prepared to bear this true cost?

Let’s just take the ₹ 12,000 subsidy the government has promised those who will construct toilets. There are 111.10 million households that would need toilets. That totals up to ₹ 1.34 trillion for the toilet construction alone.

It becomes easier to choose when we look at the true cost of not providing safe sanitation to all. A study by the Water and Sanitation Programme and others has estimated this at 6.4% of GDP of India in 2006. Not included in this is the cost of wasting the fertilizer and soil regeneration value of the human waste of a billion people.

The work of economist Dean Spears and the Research Institute for Compassionate Economics, or R.I.C.E., shows us that this true cost of not completing the sanitation loop is also reflected in millions of stunted or malnourished children, and in high maternal and infant mortality rates. We all know that it is also visible in the daily violation of safety, privacy and dignity.

It is too high a cost to bear any longer.

And so, at this great confluence of public demand, political will, and increased outlays, there is a real opportunity to innovate, reduce costs, re-engineer, close loops on waste systems, create scientific communication for behaviour change, and involve both citizens and the corporate sector in this societal mission. But the government at all levels has to first step up massively to create the public infrastructure for sanitation.

Let’s be realistic though, about the true financial and social costs of such an enterprise, so as not to set us up to fail again. This time, we cannot afford failure.

Rohini Nilekani is the chairperson of Arghyam and author of Stillborn and Uncommon Ground. Team Arghyam contributed to this story.