On 15 August 2014, we were holidaying in a charming little resort near Kochi, nestled between the backwaters and the sea. I recall that after a quick breakfast we settled down to watch the new prime minister on television, delivering his maiden Independence Day speech. We were curious about the direction in which he planned to lead the country. He made many important announcements. But what completely surprised us was his emphasis on the goal of Swachh Bharat and the problem of open defecation. Instead of all the lofty goals and exhortations that are typical of an Independence Day speech, here was the new prime minister of the country announcing to all his countrymen and women, and indeed the world, from the ramparts of the Red Fort that one of his main ambitions as prime minister was to rid the country of open defecation. That earthy connect with the conditions of daily life facing ordinary people, especially women, was quite remarkable.
Of course, there was nothing unambitious about such a goal, however humble it may sound. How do you even begin to think about equipping 100 million rural households with toilets that they do not have? How do you go about changing the mindset of 1.2 billion people whose pre-dominant view of cleanliness is to push all the dirt out of the home and into the public space? As the months passed by and I continued to see the open piles of stinking garbage and clogged drains in the cities and towns and along the highways and byways throughout the country, I assumed that Swachh Bharat was just another zombie scheme. A scheme is announced with much fanfare, a budget allocation is made, and then nothing much changes on the ground.
The occasion that changed my mind was the recent launch of Naina Lal Kidwai’s book Survive Or Sink. At that book launch, Param Iyer, a former Indian Administrative Service officer and World Bank staff, who returned to India to head the SBM, reeled out some amazing figures about how much had in fact been achieved on the ground during the past four years. The core programme of SBM is to ensure usage of toilets in all homes through behaviour change, and, thereby, eliminate open defecation. Since October 2014, when the programme was launched, SBM has equipped 75 million households with toilets. At the time of its launch, fewer than 40% of households had toilets at home. Today that figure is up to over 85%. The number of open defecation-free (ODF) villages has gone up from 47,000 to 384,000 over the same period—about 65% of all villages in the country.
Seventeen states and Union Territories (UTs) are now ODF. Of the remaining 16, another three are almost ODF (>90%) and six are more than 85% ODF. Only seven states/UTs are lagging behind. Odisha is the worst off with only 56% sanitation coverage, followed by Bihar (57%), Puducherry (68%), Uttar Pradesh (72%), Tripura (75%) and Goa (76%). An independent survey of over 92,000 households across the country, guided by a group of international experts and representatives of Unicef and World Bank, verified that 96% of the villages declared ODF were indeed ODF, and 77% of the households surveyed had toilets (consistent with the official estimate of 76% at the time of the survey). Of the people who had access to toilets, 93% were found to use them regularly, which is very close to an even higher estimate of 95% revealed by a separate survey conducted by the National Sample Survey Office. Finally, 70% of the villages surveyed also had minimum litter or stagnant water.
The behaviour change reflected in these statistics is fairly dramatic for a programme that started less than four years ago. But why is this important? That the large majority of our citizens in rural India, especially the women, no longer have to suffer the indignity of having to go out into the open to defecate marks a sea change in their daily life. In another year or so all Indians will hopefully be spared this indignity. But, apart from the intrinsic value of enhancing the dignity of daily life, elimination of open defecation also has great instrumental value in enhancing health and economic well-being.
Shah Alam Khan of the All India Institute of Medical Sciences claimed that the SBM had not been effective as there was no statistically significant reduction in the incidence of epidemics following its launch (“Evaluating The Success Of Swacch Bharat Abhiyan", The Wire, 13 November 2017). However, such a conclusion without controlling for others factors affecting the incidence of epidemics seems unwarranted. A more robust measure of the health impact of the SBM is its impact on malnutrition. There is much scholarly research available now to show that poor hygiene may be as important a factor contributing towards malnutrition as income poverty. Hence the Bill and Melinda Gates Foundation (BMGF) commissioned an independent survey across several states of India using a stratified random sample design to compare the incidence of diarrhoea and malnutrition in ODF and non-ODF villages.
The BMGF survey report is appropriately cautious about attributing causality, but it found that the incidence of diarrhoea was significantly less in ODF villages compared to non-ODF villages and that measures of undernutrition (stunting and wasting), were also significantly better in the ODF villages. These differences between ODF and non-ODF villages are all statistically significant. There are also significant financial gains from SBM. A survey of over 10,000 households last year, sponsored by Unicef, estimated that, on average, an ODF village household could be gaining as much as Rs50,000 per year from savings in medical expenditure because of lower incidence of illness and less income loss due to fewer days of unpaid sick leave. A very significant gain, especially for poor households.
Those living in urban India may not be aware of the achievements cited above because all of it relates to rural areas covered under the Grameen component of SBM (SBM-G). This is as it should be, since the problem of open defecation is primarily a rural problem. However, sanitation is also a major challenge in urban India so SBM also has an urban component. Cities are now rated in terms of their sanitation status. As Kidwai reports in her book, 22% of Indian cities are now ODF and 50% of all urban wards have 100% door-to-door solid waste collection. A million schools (91%) now have separate toilets for girls, up from 37% when the SBM was launched, though there is no statistic on how many are actually functional. While not insignificant, the achievements in the urban component are not as impressive as in SBM-G. Moreover, beyond sanitation, our cities and towns also have to deal with alarming levels of water and air pollution. Clearly, there is still a long way to go in cleaning urban India.
Recently I met secretary Iyer, who is in charge of SBM-G and also responsible for coordination among all the departments dealing with SBM components and matters cutting across these components. I asked him about the way forward and the challenges ahead. He seemed confident that the SBM-G target of ODF rural India would be achieved. His ministry is also encouraging other ministries to extend the sanitation programme to their sectors by installing and maintaining toilets at public spaces, highway fuel stops, tourist destinations, rail and bus stations, and bio toilets in trains.
The main challenge, he said, is to sustain what had been achieved, namely, the changed rural sanitation behaviour. Over 450,000 grass-roots motivators, called Swachhagrahis, are now dealing with this task in rural areas. Another challenge we discussed was bureaucratic engagement. While this can often make or break a programme, Iyer said he had so far found the bureaucracy responsive, both in the central government and in the states. In fact, in many states, young and committed district collectors are delivering results faster and better than expected.
I also raised with him a political question. The terms of reference of the 15th Finance Commission have become a focal point around which some of the opposition-led state governments are now coalescing. Union encroachment into the constitutional space of the states is the main concern. Against that background, what is the response he encounters in the states to a programme like SBM, as water supply and sanitation is clearly a state subject? Obviously, the Bharatiya Janata Party-led governments at the Centre and in the states are enthusiastic about the programme. But Iyer said he found the opposition-led state governments were also quite enthusiastic.
Such bipartisan support augurs well for the future of SBM. Some of India’s most successful programmes have been sustained over the years, regardless of who was in power. The green revolution, the white revolution and economic liberalization, to mention only a few. Some of the best programmes launched by the Atal Bihari Vajpayee government, such as the highway development programme and the Pradhan Mantri Gram Sadak Yojna, were sustained by the Manmohan Singh government. Similarly, some of the better programmes launched by the United Progressive Alliance have been retained by the Modi government, sometimes with a new name and some change in content. This healthy bipartisan tradition gives us hope that a remarkable programme like the SBM will be extended and sustained, regardless of who forms the next government in May 2019.
Sudipto Mundle is emeritus professor at the National Institute of Public Finance and Policy and was a member of the Fourteenth Finance Commission.
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