Prioritising behavioural change
Until three years ago, millions of people across India, mostly the rural population and many in urban regions, were nonchalant about performing their early morning rituals, particularly relieving themselves anywhere out in the open. They were unconcerned about hygiene, and diseases that could afflict them. Parents were exposing their children to grave dangers.
All these have changed considerably for the better following Prime Minister Narendra Modi's call for a Swachh Bharat with universal sanitation by October 2, 2019 (Mahatma Gandhi's150th birth anniversary). Down this period, open defecation, a way of life over centuries, has been curtailed.
Universal sanitation is at the core of India's development agenda. Till 2014, only 39 per cent people had access to safe sanitation facilities. As the Swachh Bharat Mission (SBM) completes three years, five states, nearly 200 districts and nearly 2.4 lakh villages across the country have declared themselves open defecation free (ODF). Besides, 1.5 lakh villages have ranked themselves on the village Swachhta Index based on solid and liquid waste management in villages.
Improved sanitation has resulted in major household savings. Every rupee invested in improving sanitation leads to a saving of Rs 4.30, shows a recent independent study by UNICEF to estimate the cost benefits of the SBM. On an average, the cost-benefit ratio was 430 per cent, "considering, on one hand, the expenditure from households and the government, and on the other hand the financial savings induced by improved sanitation," the study found. The benefits are the highest for the poorest quintile of the population.
Besides, in fully ODF communities, an average family that invests in a toilet saves around Rs 50,000 per year--considering medical costs and mortality averted, and also time savings. The study, carried out in 10,000 rural households randomly selected across 12 states, found that 85 per cent of family members use their latrines. The survey was conducted to measure the economic impact of sanitation at a household level.
Parameswaran Iyer, Secretary, Ministry of Water and Sanitation, says an independent survey conducted across 140,000 households by the Quality Council of India found that "household toilet usage stands at 91 per cent."
Accessible and secure toilets have induced a big qualitative change in villagers' lives, especially women who were forced to defecate in the open in darkness, suffering mental torture—with their safety, security, and dignity imperilled.
Want of access to proper sanitation prompts high health and economic outlay: it costs India 6 per cent of its GDP every year. Research has highlighted an indisputable link between toilets, malnutrition and irreversible stunting. For the populace continuously exposed to a faecally-contaminated environment, absence of a toilet can have far-reaching effects. Insanitation affects children leading to 100,000 deaths due to diarrhoeal diseases. Nearly 40 per cent of India's children are physically and cognitively stunted, according to the World Bank.
A major challenge facing the government is to bring about behavioural change in people's mindsets, especially among rural masses—totally different from building a toilet, an infrastructure programme, that can be accomplished. It is focusing on this most important factor, which requires dealing with a centuries-old deep-rooted habit of people going out (to defecate) and then getting them to talk about it. Several interpersonal techniques through community approaches to sanitation are being used across the country to trigger behavioural change; fundamental to the SBM.
"Beyond the hundreds of thousands of toilets being built, "a genuine prioritisation of behaviour change interventions is taking place," says Nicolas Osbert, Chief of WASH (Water, Sanitation, Hygiene), UNICEF India.
To strengthen and take the mission forward, the Centre, under an accelerated fortnight-long campaign "Swachhta hi Seva" (cleanliness is service), is executing a series of activities--such as cleaning toilets, bus stands, movie halls, railway stations, public halls and more. The campaign will culminate with Swachh Bharat Diwas on October 2.
Efforts are on to move beyond the current drive for open defecation-free cities and work towards faecal sludge management for a safe urban environment without any risk to land and rivers. Every day, India generates a colossal 1.7 million tonnes of faecal waste. About 78 per cent of this sludge (human excreta and water mixture) remains untreated and is dumped into rivers, groundwater or lakes in the absence of proper treatment systems. Sludge contains disease-carrying bacteria and pathogens and poses threat to health.
Youths and other stakeholders are being encouraged to come up with innovative solutions to problems for sustainable, environmental-friendly and affordable toilet technology for hilly, dry, flood-prone and remote areas; novel technological solutions to monitor usage of toilets and bring behavioural change for toilet usage and hygiene;
They have been invited to suggest unconventional models and methods to improve operation and maintenance of school toilets; pioneering solutions for menstrual health management and innovative solutions for early decomposition of faecal matter.
Unlike earlier open-ended programmes, the mission has been put on a fast track to accomplish the sunset clause--an ODF India by constructing 12 million toilets. Realising that this is a difficult and time-consuming venture involving behaviour change, sanitation has been made everyone's business—be it the pradhan or the collector or the Member of Parliament. It is being operated through the Prime Minister, Chief Ministers, District Magistrates, VMs (village mukhiyas). Also, an army of swachhagrahis has been created and nukkad nataks (street plays) have been promoted. Behavioural change is being motivated through mass media and interpersonal messages communicated by celebrities, who are creating awareness about the ill-effects of open defecation.
(The author is an independent journalist and columnist and writes on science and developmental issues. Views expressed are personal.)