Improving sanitation sustainably
When our Prime Minister assterted his government's commitment to improving sanitation facilities across the country and hailed all those involved in building toilets, it was to remind afresh that India resides far and wide beyond the big bright metropolitan cities. There has been a remarkable level of awareness about general cleanliness and sanitation that came about with the rigourous execution of the Swachh Bharat mission. It remains a fact that despite this considerable progress, more than 732 million people still suffer fear and indignity of relieving themselves out in the open or in unsafe or unhygienic toilets. Predictably, the situation is far more compounded for girls and women. As per WaterAid's State of the World's Toilets 2017 report, "In India, a staggering 355 million women and girls are still waiting for a toilet; if they were all to stand in a queue, it would stretch around the Earth more than four times!"
Despite the massive progress made in facilitating accessibility to sanitation, a major hurdle in letting this mission fully materialise is the difficult to alter mindset that prevents people from being convinced that open defecation is a health hazard and that it must stop. There are about 343 million people in India without decent toilets. Improved sanitation is not a development that should be expected to happen in isolation. It is in fact a result of several integrated efforts in that direction. Lack of access to water supply and drainage facilities hamper achieving this national goal. Hookworms is known to spread through open defecation. It causes diarrhoea, anaemia, and weight loss in women. Indian states with poor access to sanitation report high incidence of diarrhoeal diseases.
This link is established with the examples of these two states: Kerala had the highest percentage of households with improved sanitation at 98.1 per cent (the national average is 48.4 per cent) also had the lowest prevalence of diarrhoea (3.4 per cent) and the lowest percentage of women with anaemia (22.6 per cent). Bihar, on the other hand, has only 25 per cent households using improved sanitation and had the highest prevalence of diarrhoea (10.2 per cent) and the highest percentage of anaemic pregnant women (58.3 per cent). One main area of concern with regard to curb open defecation is that the emphasis on promoting behaviour change seems to have taken a backseat. It is argued that the emphasis was only on the construction of new toilets, instead of how many of them are used by the common citizen. In a stinging critique months ago, researchers at the Research Institute for Compassionate Economics wrote that "The new sanitation policy now caps the allocation to information, education and communication, the expenditure head for behaviour change campaign activities, at 8 per cent of the total allocation to rural sanitation. These funds have been reduced almost by half".
The implication was that the expenditure on promoting behaviour change per open defecator had been reduced by half. Through advertisement, across both the visual and print medium, has sought to promote behaviour change in toilet usage. But how do you measure the outcomes of such initiatives, where there is little data available on the use of the toilets constructed? Numerous surveys have argued that income constraints may not be the main determinant of open defecation, indicating that it may be more of a behavioural issue. Particularly with regard to females, besides being a point of dignity, there is another aspect associated with open defacation that pertains to social set up. Women in rural areas who are mostly confined to the premises of their home get a chance to socialise and interact beyond home on the pretext of not having a toilet at home. This social aspect is a very crucial one and must be given due consideration as this is a facet the goes beyond toilet and sanitation.
The emphasis on behavioural change cannot be strengthened any further. One only has to look at the levels of open defecation that take place in the national capital to understand why more expenditure needs to be diverted to promoting behavioural changes. For example, many residents of Delhi would earlier use public toilets maintained by Sulabh International, which would charge Rs 1-2 per use. Despite such low costs, many of Delhi's citizens found it more convenient to defecate in the open. Therefore, the Centre, in consonance with State governments must up the ante on promoting a change in behaviour.