Open defecation in rural India poses a profound threat to the health and survival of children and the productivity of the workforce that they will grow up to become. So, it is entirely appropriate that the Prime Minister named the elimination of open defecation by 2019 a flagship goal for his government.
Raising this issue deserved high praise a year ago. Still, today it may be more than what many political leaders have done for the many babies, who will not live until their first birthday, and will therefore never get to vote. But, that was already a year ago; only four years remain until the deadline.
The Swachh Bharat Mission (SBM) is more than one-fifth over. What has been accomplished in the first 20%? Are there processes in place to get the job done during the next 80%? Or to even get close?
As an economist, my first inclination would be to look at the quantitative evidence. But there isn’t any. Over 20% of the way through the SBM, there is no survey that monitors and tracks latrine use and open defecation throughout rural India, and no concrete plans that I know of to start one.
It would be easy to miss the surprising fact that such a monitoring survey simply doesn’t exist. The government guidelines of the SBM call for such a survey, but an exhortation in yesteryear’s bullet-pointed list is no substitute for a plan. The SBM website is full of detailed statistics on latrine construction, but these miss the point in at least two ways: first, they are inputs by the people whose job it is to manage the building of latrines (not by independent monitors), and second, they ignore the ample evidence from a wide range of sources that latrine construction is simply not the challenge. Promoting latrine use is.
It is a little baffling that SBM wouldn’t measure open defecation and latrine use each year, perhaps by state or region, if the goal is to eliminate open defecation in the next four years. People with diabetes are told to monitor their blood sugar, as a step to ensure good health. An athlete training for a race measures her pace each day. My Economics students, studying for their test, want to know whether they are getting their homework questions correct. As a recent World Bank report on statistics for sanitation in rural India summarizes, “you manage what you measure".
If SBM is not collecting statistics that would let us assess whether it is on pace, we have to make the best guess that we can from what we can see. A mounting body of evidence from independent researchers using epidemiological, econometric and qualitative research tools all agree: many, many people in rural India do not want to use the latrines that the government is scaling up to build. They defecate in the open even if they have one. This is despite the fact that such latrines are, if anything, an improvement on the basic design endorsed by the World Health Organization (WHO) and are widely used in countries much poorer than India.
Why do people in rural India reject latrines that the government and the WHO endorse? What makes rural India different from rural Kenya, Bangladesh or Vietnam? A range of qualitative and statistical evidence agrees: such latrines do not fit well with the culture of purity and pollution that also underpins the caste system. People are reluctant to accumulate faeces in latrine pits near their homes; they believe that latrine pits will fill up more quickly than is actually the case; and they are worried about how latrine pits will be emptied. Getting a latrine pit emptied in rural India is seriously complicated by the historical baggage and present-day renegotiation of untouchability. These are steep challenges.
Perhaps, even in the absence of a latrine use monitoring survey, we could be confident that SBM would eliminate open defecation by 2019, if its approaches were designed around the real reasons why people don’t want to use affordable latrines. Perhaps, we could even think so if SBM were to admit that no one really knows how to accelerate the reduction of open defecation throughout rural India and that it is going to take experimentation and learning to find out.
Such brave honesty could save millions of lives. But, if the remaining few years of the SBM prove to be merely a repeat of the latrine construction schemes of the past decades, then there is little reason to be confident that the SBM will accelerate the decline of rural open defecation much at all.
Dean Spears is an economist at Princeton University, is executive director of r.i.c.e., and is a visitor at the Indian Statistical Institute in Delhi.