Cover Story: Time to Flush out Open Defecation

Intro: Toilets are necessary to solve the sanitation challenges we face in India, but they alone are not sufficient. Change in attitude will be as important as access to toilets to overcome health and economic implications that a bad state of sanitation can lead to.

Open defecation is much more common in India than it is in many of the poorest countries of the world, such as the Democratic Republic of the Congo, Malawi, Burundi, and Rwanda – to say nothing of richer countries that are still much poorer than India, such as Afghanistan, Kenya, and Bangladesh.

Going by the stats given by United Nations International Children's Emergency Fund (UNICEF) campaign, even today, half of India's population, or at least 620 million people, defecate outdoors. And while this share has declined slightly in the past decade, an analysis of census data indicate that because of rapid population growth most Indians are being exposed to more human waste than ever before.
The population of India is 1.2 billion, and close to fifty percent of this population does not have access to toilets. Most of these numbers are made up by people who live in urban slums and rural areas. A large populace in the rural areas still defecates in the open. Slum dwellers in major metropolitan cities, reside along railway tracks and have no access to toilets or a running supply of water. And India is still lagging far behind many countries in the field of sanitation. According to Harshal T. Pandve (2008), most cities and towns in India are characterised by over-crowding, congestion, inadequate water supply and inadequate facilities of disposal of human excreta, wastewater and solid wastes. No major city in India is known to have a continuous water supply and an estimated 72% of Indians still lack access to improved sanitation facilities.

Such pathetic is the state of sanitation that the Sanitation index in India has put the country behind China, Bangladesh and many African nations. There are far more people defecating outside in India more closely to one another's children and homes than there are in Africa or anywhere else in the world. Infact, so severe is the problem of open defecation in India that in February 2014, Unicef India started a campaign Take Poo to the Loo to fight against this menace on the streets and online by involving the youth. It also came out with a song called Poo Party.
The Economic burden of Sanitation
While the Indian state has been making interventions to ensure access to curative medical services, it has done precious little to provide preventive public health services to citizens even though such services are more cost-effective than medical services.
The World Bank estimates that poor sanitation costs India a whopping 6.4 percent of its GDP, or more than $53 billion a year.
Presently India spends about $26 billion annually on food and jobs programs, and less than $400 million on improving sanitation— a ratio of more than 60-to-1. There is need to reverse this ratio entirely.

A study conducted by World Bank’s ‘South Asia Water and Sanitation Unit’ estimated that India loses Rs 240 billion annually due to lack of proper sanitation facilities. The multilateral body said that premature deaths, treatment for the sick and loss of productivity and revenue from tourism were the main factors behind the significant economic loss. Poor sanitation is something that not only affects the health of the people of the country, but also affects the development of the nation. In fact, women are most affected by the hazards of lack of proper sanitation. For instance, in India majority of the girls drop out of school because of lack of toilets. Only 22% of them manage to even complete class 10. On economic grounds, according to the Indian Ministry of Health and Family Welfare, more than Rs 12 billion is spent every year on poor sanitation and its resultant illnesses.
Severe sanitation-related illnesses like cholera can spread rapidly, bringing sudden death to many people. Children have a high risk of illness from poor sanitation. And while adults may live with diarrheal diseases and worms, children die from these illnesses. More than 300 million episodes of acute diarrhoea occur every year in India in children below 5 years of age. Of the 9.2 million cases of Tuberculosis (TB) that occur in the world every year, nearly 1.9 million are in India accounting for one-fifth of the global TB cases. More than 1.5 million persons are infected with malaria every year. Diseases like dengue and chikungunya have emerged in different parts of India and a population of over 300 million is at risk of getting acute encephalitis syndrome/Japanese encephalitis. One-third of global cases infected with filaria live in India. Nearly half of leprosy cases detected in the world in 2008 were contributed by India (MOHFW 2010: 14).
India’s sanitation deficit leads to losses worth roughly 6% of India’s gross domestic product (GDP), according to World Bank estimates, by raising the disease burden in the country.
Modi’s action plan
Four months into his tenure, Prime Minister Narendra Modi is leaving no stone unturned to fulfill promise made to the Indian public. Swachh Bharat Mission will be launched by the Prime Minister on October 2, Gandhi Jayanti, and it aims at making India an open defecation free country.
He has given a clarion call for Swachh Bharat as a movement to realize Gnadhiji’s dream of a clean India by the 150th birth anniversary of Mahatma Gandhi in 2019.
“I beg every citizen of the country to pledge 100 hours a year towards cleanliness. This work cannot be done by the PM, CMs or ministers alone. Every citizen of the nation has to pledge to keep the country clean,” Modi said in his first-ever address in Karnataka after taking charge of the country.
The Union Minister of Rural Development and Drinking Water and Sanitation Nitin Gadkari said that Swachh Bharat Mission will be converted into a mass movement to make India an open defecation free country in Five Years. Addressing a Joint Press conference with the Urban Development Minister Shri M. Venkaiah Naidu, Gadkari said, one lakh thirty four thousand crore rupees will be spent for construction of about 11 crore 11 lakh toilets in the country. The Urban Development Ministry will earmark more than 60,000 Crore rupees for this purpose. The Minister also underlined that technology will be used on a large scale to convert waste into wealth in rural India in the forms of bio-fertilizer and different forms of energy.
Gadkari informed that the pet mission of the prime minister will be executed on war footing with the involvement of every gram panchayat, panchayat samiti and Zila Parishad in the country, besides roping in large sections of rural population and school teachers and students in this endeavor.
The Ministry has decided to observe the Week from 26th September to 2nd of October as Panchayat Week for creation of awareness about sanitation and cleanliness.
Earlier, giving “utmost importance” to sanitation, Finance Minister Arun Jaitley in his budget speech said that the government intends to cover every household under the 'Swatchh Bharat Abhiyan' (Clean India Mission) by 2019.
This goal of a clean India was also set by the previous UPA government and the erstwhile government's plan was to achieve 100 per cent access to sanitation for all rural households in the country by 2022. For completion of this goal they were working under the programme Nirmal Bharat Abhiyan (NBA).
HRD Minister Smriti Irani has also asked states to prepare an action plan for construction of toilets for girls in all government schools by July next year in keeping with the goal set up by Prime Minister Narendra Modi.
Icon of sanitation and social reform, social activist, and founder of Sulabh Sanitation and Social Reform Movement, Dr. Bindeshwar Pathak believes that the toilet is a tool for social change. He has developed and implemented on pan-Indian scale a low-cost and appropriate toilet technology (popularly known as the Sulabh Shauchalaya System) recommended as a Global Best
Applauding the proposal to provide sanitation to all households by 2019, Pathak said the step would bring down sexual crimes against women in the country.
Eco-friendly Technology
Environmental friendly two-pit, pour-flush compost toilet known as Sulabh Shauchalaya is socially acceptable, economically affordable, technologically appropriate and does not require scavengers to clean the pits and implemented in more than 1.2 million houses all over India that has helped liberate over a million scavengers
Putting in context that sexual assaults often take place because women are forced to answer the call of nature in the open, Pathak cited the horrific gang rape and murder of two sisters in Uttar Pradesh's Badaun village who were abducted when they went to relieve themselves in the open.
“By giving such importance to the issue of toilets, the government will also succeed in tackling women-related crimes and sexual assaults which they face for want of toilets in rural areas,” Pathak said in a statement to IANS.
The problem and the solution
The concept of sanitation was earlier limited to disposal of human excreta by cesspools, open ditches, pit latrines, bucket system etc. Today it connotes a comprehensive concept, which includes liquid and solid waste disposal, food hygiene, and personal, domestic as well as environmental hygiene. It is important to realise that proper sanitation is important not only from the general health point of view but it has a vital role to play in our individual and social life too.
As sanitation is one of the basic determinants of quality of life and human development index. The concept of sanitation is, therefore, expanded to include personal hygiene, home sanitation, safe water, garbage disposal, excreta disposal and waste water disposal.
According to research study, just 1 per cent of Chinese and 3 per cent of Bangladeshis relieve themselves outside compared with half of Indians. Therefore Latrine construction alone is not enough to substantially reduce open defecation in the northern plains states where it is concentrated. However, the insufficiency of building latrines does not excuse the government from responsibility. India needs a large scale campaign to promote latrine use. Attitudes may be just as important as access to toilets.
Hence, Government latrine construction will not be enough to eliminate open defecation, without a revolution in latrine use.
“Our realization about the connection between stunting and sanitation is just emerging,” Sue Coates, chief of water, sanitation and hygiene at Unicef India, was quoted as saying by the New York Times. “At this point, it is still just a hypothesis, but it is an incredibly exciting and important one because of its potential impact.”
This new linkage has only compounded the problems for India. Despite plans like Nirmal Bharat Abhiyan, the Centre has not succeeded in putting an end to open defecation. The background of the Nirmal Bharat Abhiyan says: “The concept of sanitation was expanded to include personal hygiene, home sanitation, safe water, garbage disposal, excreta disposal and waste water disposal. With this broader concept of sanitation, Central Rural sanitation Programme (CRSP) adopted a “demand driven” approach with the name “Total Sanitation Campaign” ( now renamed as Nirmal Bharat Abhiyan) with effect from 1999. The revised approach emphasized more on Information, Education and Communication (IEC), Human Resource Development, Capacity Development activities to increase awareness among the rural people and generation of demand for sanitary facilities. This enhanced people’s capacity to choose appropriate options through alternate delivery mechanisms as per their economic condition. The Programme was implemented with focus on community-led and people centered initiatives. Financial incentives were provided to Below Poverty Line (BPL) households for construction and usage of individual household latrines (IHHL) in recognition of their achievements. Assistance was also extended for construction of school toilet units, Anganwadi toilets and Community Sanitary Complexes (CSC) apart from undertaking activities under Solid and Liquid Waste Management (SLWM).” But not much improvement has been observed. With over 77 percent population of Bihar defecating in the open, Union Minister of State (MoS) for Rural Development, Panchayati Raj, Drinking Water and Sanitation Upendra Kushwaha said Bihar was the worst state in use of toilets.

“National average for open defecation is at 60 percent, but in Bihar it is 77 percent. Hardly 33 percent homes in the state have toilets. I am telling you on the basis of data provided by the officials but the ground reality could be even worse. Of all the states, Bihar is the worst state in use of toilets,” Kushwaha said while talking to the media. The new government at the Centre has also focussed on Nirmal Bharat Abhiyan in its 100-day agenda. States were also asked to pull up their socks to achieve their target as seen in this internal directive from the Ministry of Drinking Water and Sanitation. But the problem remains, regardless of the effort and planning.
But it should be remembered, just building toilets is not going to solve the problem, because open defecation is a practice acquired from the time you learn how to walk.
Therefore, the Central government alone cannot be blamed for lack of sanitation, the people at large and the state governments in particular are equal stakeholders to make the programme a success. Internal communications between the Centre and the states will be as important as the collective will and participation of Indian citizens.
-Deepshika Chauhan (With inputs from Monica Sangwan, Nishant Kumar Azad & agencies)