Parameswaran Iyer, secretary, Department of Drinking Water and Sanitation, Ministry of Jal Shakti, has been instrumental in taking forward the Swachh Bharat Mission. Iyer, who returned from the US to head the Swachch Bharat Mission-Gramin, spoke about the success of the sanitation scheme in rural India, its impact, ongoing work and the challenges ahead. Edited excerpts from an interview:

How has rural India responded to Swachh Bharat Mission in the last five years?

The Swachh Bharat Mission - Gramin (SBM-G) was launched on 2 October 2014 with the aim of achieving an open defecation free (ODF) India by 2 October 2019, the 150th birth anniversary of Mahatma Gandhi. Under the personal and inspirational leadership of the Prime Minister of India, the programme has revolutionised rural sanitation in India.

SBM-G has become an unprecedented mass movement, and has changed the age-old habits of millions of people. In just five years, India has gone from being responsible for over half of the world’s open defection burden to becoming open defecation free. Six hundred million people have changed their sanitation behaviour and have now started to use toilets.

More than 100 million toilets have been constructed in rural areas, and the national rural sanitation coverage which was 38.7% in October 2014 has increased to 100% in October 2019. A total of 599,963 villages have become ODF in the process, leading to all 699 districts in 35 states and Union territories with rural areas to declare themselves ODF.

The impact of the SBM-G has already begun to show as has been articulated by global agencies. A few of the impacts are -- in 2018, World Health Organization (WHO) estimated that SBM-G will result in averting more than 300,000 deaths (diarrhoea and protein-energy malnutrition) between 2014 and October 2019. UNICEF’s assessment of the economic impact of the SBM estimated that in an ODF village in India, each family saves up to Rs.50,000 per year on account of avoided medical costs, time savings which can be used more productively, and lives saved. UNICEF’s assessment of SBM on faecal contamination of water, soil, and food found that ODF villages are 11.25 times less likely to have their groundwater sources contaminated, and 12.7 times less from contaminants traceable to humans alone.

The Bill & Melinda Gates Foundation (BMGF) assessed the health impacts of the SBM in 2017 and found that non-ODF areas in comparison to ODF had 46% higher cases of diarrhoea among children, 17% higher cases of stunting among children in non-ODF areas, and 48% higher cases of women with lower body mass index than normal in non-ODF areas.

As the Prime Minister said, all villages are now ODF, are there any parts in rural India still witnessing open defecation?

All rural villages across the country and all 699 districts have declared themselves ODF. In addition to this, as shared by the Prime Minister in Ahmedabad on 2 October (Swachh Bharat Diwas and 150th birth anniversary of Mahatma Gandhi), this has been a huge milestone but the work to sustain the outcomes of ODF has to go on. The Swachh Bharat Mission will focus to sustain the gains made under the programme these last five years and ensure that no one is left behind.

These ‘ODF-Sustainability’ efforts are also being supported by other efforts like solid and liquid waste management toward holistic cleanliness in villages.

How do you think Swachh Bharat mission has helped in reducing the disease burden related to open defecation in rural India?

As illustrated above, with the studies undertaken by various organisations, the SBM-G has resulted in averting more than 300,000 deaths (due to diarrhoea and protein-energy malnutrition) between 2014 and October 2019.

The WHO further said that unsafe sanitation caused an estimated 199 million cases of diarrhoea annually before the start of the SBM in 2014. These have been gradually reducing, and will almost be eliminated when universal use of safe sanitation facilities is achieved by October 2019. More than 1.4 crore Disability-Adjusted Life Years (DALYs) are estimated to be avoided (diarrhoea and protein-energy malnutrition) between 2014 and October 2019.

Do you think Swachh Bharat mission can help India in achieving Sustainable Development Goals?

In 2014, India was home to 60% of the world’s open defecators, i.e., 600 million people were defecating in the open, of which approximately 550 million were in rural India.

By changing the behaviour of these 600 million people and achieving Sustainable Development Goal 6.2 (elimination of open defecation), India has made a significant contribution towards the global achievement of the SDGs.

Independent surveys from various organizations have shown that in rural India despite having toilets, villagers are not using them. What do you want to say about this?

The latest round of the National Annual Rural Sanitation Survey (NARSS) under the World Bank support project was conducted by an independent verification agency between November 2018 and February 2019. It covered over 90,000 randomly selected households in 6000 villages in all States of India, following the PPS sampling approach. It also covered schools, anganwadis and public/community toilets, making it the largest, most comprehensive and most representative sanitation survey in the country. It was overseen by an Expert Working Group comprising many national and international development organizations, including the World Bank, UNICEF, BMGF and Water Aid.

NARSS 2018-19 found that over 93% of rural households in India had access to a toilet (the official sanitation coverage at the time was around 97%), and the toilet usage was in excess of 96%. This is testament to the successful behaviour change approach adopted by the SBM.

What is your ministry doing for behavioural change apart from building toilets?

The SBM-G is at its core a behaviour change programme. The Mission has adopted a host of information, education and communication (IEC) strategies, and also strengthened implementation and delivery mechanisms down to the village level by giving States the flexibility to design delivery mechanisms that take into account local cultures, practices, sensibilities and demands. Recent studies have shown that the SBM has managed to leverage over $3.5 billion in IEC spends from all stakeholders, and that every rural Indian had been exposed to sanitation messaging on an average 2500 times in the past five years.

In addition to massive national mass media campaigns featuring the who’s who of the country, nearly 6,50,000 grassroots sanitation champions or ‘swachhagrahis’ were trained to deliver sanitation messages in their villages. They worked at the cutting edge and motivate and inspire communities to build and use toilets through community approaches to sanitation and behaviour change triggering.

Large scale people’s participation campaigns like the ‘Swachchata Hi Seva’ in the last fortnight of September in the past few years have seen participation of over 200 million people who personally carried out sanitation and cleanliness messaging in their communities.

Our Communicator-in-Chief has been the Prime Minister, who himself has participated in several national sanitation events in the past five years, each of which has been attended by thousands of sanitation champions from all walks of life. He has also constantly communicated the Swachhata message through his monthly Mann Ki Baat radio broadcast.