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The United Nations’ Sustainable Development Goal (SDG) No. 6 aims to “ensure availability and sustainable management of water and sanitation for all" by 2030. Its importance extends beyond this mere objective, as it will help nations achieve other SDG goals as well, such as SGD 1 (poverty eradication), SDG 2 (improving nutrition), SDG 3 (promotion of well-being) and SDG 5 (gender equality), among others. And yet, despite decades of national sanitation policies, data from the fifth National Family Health Survey (NFHS-5) indicates that India is far from achieving it (bit.ly/3kWNRw4). It is thus important to understand the evolution of India’s sanitation policies and lessons that will help India frame revised sanitation policies and achieve SDG 6 by 2030.

In 1981, the Census reported that only 1% of rural households had sanitation coverage (i.e. access to toilets). To address this, India’s government launched its Central Rural Sanitation Programme (CRSP; 1986-1999). To encourage the construction of ‘individual household latrines’ (IHHLs), it offered financial assistance to below-poverty-line (BPL) homes. The CRSP was criticized for slow construction and lack of demand-led ‘behaviour change communication’ (BCC), which is now considered a critical aspect of any sanitation intervention in rural India, as open defecation (OD) has persisted despite the presence of toilets. This stems from OD having been a practice for centuries and perceptions of its hygiene and health benefits.

In 1999, the CRSP was restructured as a Total Sanitation Campaign (TSC; 1999-2011), focused on driving up demand for toilet adoption. Around 15% of its budget was dedicated to educational activities, along with continued financial assistance to BPL households. To effect behaviour change, the educational emphasis was primarily on achieving community-led total sanitation (CLTS). Developed in Bangladesh, this a multi-step participatory process which acknowledges that the mere provision of toilets does not guarantee its usage, uses audio-visual aids to arouse a sense of discomfort and disgust with OD, and motivates local communities to end the practice collectively. However, the TSC was also criticized, as a study found that the officials running it lacked the training needed for educational activities. Like the CRSP, it was also infrastructure-focused rather than demand-led. By Census data, we saw less than a 10% increase in toilet coverage under the programme (from 22% in 2001 to 31% in 2011). Various studies estimated that its gains in terms of toilet-use were even lower.

After the TSC, the government introduced the Nirmal Bharat Abhiyan (NBA) in 2012, which ran for 18 months. Soon after, the government launched its Swachh Bharat Mission (SBM) on 2 October 2014, with the goal of achieving an OD-free India within five years. The SBM was the first to include urban (along with rural) sanitation guidelines. Along with financial assistance, the SBM also purported to focus heavily on BCC, but the rigour of its implementation is often questioned by independent researchers. Under the SBM, India achieved the construction of around 100 million toilets and was declared an OD-free nation on 2 October 2019. However, many independent studies, along with NFHS-5 data, have raised questions over this claim.

So, what can be done about the obstinate issue of low sanitation adoption in India?

India’s evolution of sanitation policies teaches us that BCC is critical to achieving the dream of an OD-free India. Bangladesh is a shining example, as it has used the community mobilization power of CLTS to reduce OD from 42% in 2003 to 1% in 2016. Its government was committed to the cause of not just providing basic sanitation facilities to all, but also recognized early on that a change in sanitation attitudes was just as crucial. It formed collaborations with state and local governments along with national and international NGOs, which helped accelerate the spread of the CLTS message. Dhaka also recognized that since women bear a disproportionate burden of OD, their participation and leadership had to be encouraged for Bangladesh to achieve the greater good of social equality with higher toilet use.

New Delhi’s sanitation policies have had a top-down approach with a focus on building toilets. This has successfully led to a higher number of installed toilets, but not their use. To bring about a sustainable change in toilet adoption in the country, both the Central and state governments should forge partnerships with village councils and schools, and go beyond CLTS teachings. The information disseminated should not just induce disgust over OD, but also explain the merits of using toilets and having clean surroundings. Social norms should be remoulded in such a manner that toilets begin to be associated with the household’s dignity and social status.

To get women aboard as agents of change, their presence must be mandated in any community-level sanitation intervention, along with their participation in decisions over the location and type of toilets planned. Their endorsement of plans will ensure that investments in sanitation do not go waste.

Research has shown that even after successful BCC and adoption of toilets, there is always the possibility of a reversion to OD if toilets are not kept structurally intact and suitably clean. Hence, we need adequate provisions for the upkeep of toilets in future budgets to lower the chances of a slide-back. Finally, linking our SDG 6 goal with the sanitation programmes of governments at all levels—national, state and local—will allow a unified approach towards that end.

Payal Seth & Palakh Jain are, respectively, an economics researcher at Tata-Cornell Institute, Cornell University, and an associate professor at Bennett University

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