As per joint monitoring programme (JMP), carried out by WHO and UNI¬CEF as of 2010, India contributes to 58 per cent of the world’s population defecating in the open. The recent political war between Mr. Jai¬ram Ramesh and Mr. Narendra Modi has brought back the focus on the lack of basic toilet facilities in most parts of the country. According to world health organization (WHO) and UNICEF's joint monitoring pro¬gramme; India loses more than 1,000 children of less than five years of age to diarrhea everyday; 80% of such deaths are below the age of two.
The millennium development goals (MDGs) enjoins upon the signatory nations to extend access to improved sanitation to at least half the urban population by 2015, and 100% access by 2025. This implies extending cov¬erage to households with poor sanita¬tion, and providing proper sanitation facilities in public places to make cit¬ies open defecation free.
More than 2.5 billion people lack ad¬equate sanitation worldwide especial¬ly in developing countries like India. Of these, 1 billion people defecate in open. In the least developed countries one in four people defecate in the open, largely as a result of poverty and inability to build separate toilets and the issues of space and land as well.
According to a report by The Guard¬ian, Diarrhea is, after pneumonia, the biggest killer of children under five in the world, responsible for 800,000 deaths each year – around 2,000 children every day. Even when diarrhea does not kill, it empties nu¬trients from the body which in turn, after repeated occurrences results in stunting, stopping children in their growth. Stunted children are not just shorter and thinner. They are more vulnerable to disease and their brains do not develop as they should.
Recent studies suggest a strong link between open defecation and under nutrition in India, where rates of stunt¬ing are high, despite strong economic growth. The latest estimates show that 48% of children under-five in In¬dia are stunted. Children there tend to be shorter than their sub-Saharan African counterparts, even though In¬dians are, on average, richer.
The scenario of availability of latrine facilities in India has improved in the 10 years between 2001 and 2011; but more than half of the nation's households still lack toilet facilities. From as high as 78 per cent of the households without toilet facilities in Jharkhand and Odisha to 2 per cent in Lakshadweep, a large number of people defecate in the open because they cannot afford to build a toilet from their own resources.
The main reasons for large number of population in India still defecating in open are large sections of the Indian population are not convinced of the need to stop open defecation, because of lack of proper awareness about the problems associated with open def¬ecation. Building toilets is often not a priority even for people who can af¬ford to construct toilets and use them.
Sanitation is a major national problem in India, requiring urgent action, es-pecially given the rate of urbaniza¬tion expected in the coming decade. India’s urban sanitation sector is pres¬ently inadequate and the situation could worsen in the coming decades unless acted upon immediately.
Poor sanitation 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.
Slum dwellers in major metropolitan cities especially residing along railway tracks and roadsides with little living space are having no ac¬cess to toilets or a running supply of water. The situation in urban areas in terms of scale is not as serious as in rural areas. However, what escalate the problems in urban areas are poor sewerage systems and highly con¬gested living conditions.
India has exceptionally poor sanita¬tion: the country accounts for 60% of the incidence of open defecation. Open defecation is an immense hard¬ship for those who have no other prac¬tical option and an important issue of human dignity. The conference also presented striking convergence in the evidence showing open defecation as a key factor explaining widespread stunting in the country.
In a country like India, where more than 37% people live below the pover¬ty line, assuring basic hygiene for one and all is a major task for the Govern¬ment. In India, sanitation issues be¬gin from lack of availability of clean drinking water, to improper disposal of human and other waste. Poor sani¬tation is responsible for vector borne diseases like malaria and diarrhea.
In fact, the lack of sanitation is linked with both child protection and educa-tion. Most girls drop out from school because of lack of toilets in the school as they don’t feel safe going out in the open. India cannot become a devel¬oped country without ensuring that every household and every school has a toilet. This is very much necessary in cities as mostly schools and anganwadis are neglected and ignored in urban set up. It is a basic necessity which we can no longer afford to ignore if we want to have a safer healthier and produc¬tive childhood and life.
Though these issues are having greater impact in urban India; but the total sanitation Campaign of Central Gov¬ernment focuses on rural households. Under Total sanitation Campaign (TSC), significant progress has been made since its inception; over 9.04 crore toilets have been provided for rural households. However, open def¬ecation by large population in India remains a matter of concern. To ad¬dress the issues and to accelerate the progress of sanitation in rural areas, the Government of India has designed a paradigm shift in Total Sanitation Campaign (TSC) which is now called the Nirmal Bharat Abhiyan (NBA), in the XIIth Five Year Plan. Urban prospective of this sanitation drive has been a demand from many civil society organizations working on living conditions in urban poverty.
A sanitation programme should be or¬ganised for urban slums and schools in major Indian cities keeping the growing slum populace in mind. This programme should be handled keeping the views and concerns of slum dwellers and specifically of children. This must include a behavioral change practice discouraging open defecation to all. The absence of which is leading India to misery. The programme should include converting existing toilet complexes to start functioning as community managed toilets, and repair toilet complexes and associated sanitation facilities like drains and dustbins. It should also been included in major housing and neighborhood development plans.
The programme should have long last¬ing initiatives to improve the hygiene and sanitation facilities for the most marginalized urban and rural house¬holds in India and increasing the ac¬cess to clean and hygienic sanitation facilities and the knowledge particu¬larly of girl’s health. These activities will contribute to an improved quality of life for families and their children, and provide them with the dignity and privacy they deserve.
It's also a social problem; women hold all day and it’s a question of dignity.” Open defecation doesn’t go away because of the reason in urban India that open defecation does not emerge as a key factor explaining shortfalls in child growth. The link between sanitation and child health outcomes across countries at the population lev¬el was also examined. An internation¬al comparison by Dean Spears shows that countries where people defecate in the open are the same countries where the most children are stunted and the average child is shortest. In a country like India, where more than 37% people live below the poverty line, as¬suring basic hygiene for one and all is a major task for the Government. In India, sanita¬tion issues begin from lack of availability of clean drinking water, to improper disposal of human and other waste.
There has been much discussion about World Toilet day these days. When the UN designated November 19 as World Toilet Day, it urged member states and other organizations to discuss and act on the sanitation issues plaguing developing countries. Through our work with CEPT, we hope to fulfill that call to action by engaging banks, social investors, and foundations to make small town sanitation a big deal.
The ramification of this sanitation shortage in Small and medium towns in India have particularly felt in the context of its impact on children. Of the 1.2 billion people living in India, roughly 112 million live in small and medium towns and 7.6 million young children live in the slums of these cities.
Jawaharlal Nehru National Urban Renewal Mission (JNNURM), the major urban development policy in India has focused most of its budget on infrastructure investments in 65 major cities. Only one-fifth of the total budget was allocated towards small and medium towns where one-third of the urban population resides. Furthermore, this investment was focused mainly on improving the water supply rather than sanitation.
Maharashtra, being the India’s most urbanized state, 46.9% of households lack a toilet. Out of which 13% of people depend on public toilets and 34% defecation in open.
Open defecation is a major health hazard and causes enormous hardship, especially to rural women. Government funds for constructing toilets have to be supplemented with awareness campaigns to motivate ordinary people to do their part. Sarola, a village in Maharashtra, was able to become "open defecation free" with effective community participation, taking advantage of the Sant Gadgebaba Gram Swachhata Abhiyan. Toilets were built in every house, along with systematic management of solid waste. The village testifi es to the larger social benefi ts that can come from the efforts of a group of determined youth.
The author would like to thank Swati Banerjee, Dnyaneshwar Bansode, Jean Drèze, Reetika Khera, Sowmya Kidambi, Sudhir Maske and Ashwini Survase for their support and encouragement.
Statements by two heavyweight politicians (Jairam Ramesh and Narendra Modi) suggesting that toilets are more important to India than temples have attracted a lot of attention. They provided an opportunity for a well-informed debate on issues related to sanitation in the country, including why India is lagging behind even its poorer neighbour Bangladesh. For instance, Drèze and Sen (2013: 63) point out that the proportion of households with access to toilets in Bangladesh is 92% compared to 45% in India. Spears, Ghosh and Cumming (2013) find that more than 70% of households in India defecate in the open. The failure to effectively contain and manage human excreta is associated with a wide range of health problems and a large disease burden (Prüss-Üstün et al 2008).
Clearly, sanitation is one of the most important areas where effective government intervention is required today. In 1999, the Central Rural Sanitation Programme (CRSP) was reintroduced as the Total Sanitation Campaign (TSC), and it is also known as the Nirmal Bharat Abhiyan (NBA). The government introduced a cash prize for villages that became fully “open defecation free” (ODF). After the launch of the TSC, state governments initiated their own programmes. For instance, the Government of Maharashtra introduced the Sant Gadgebaba Gram Swachhata Abhiyan (SGGSA). The SGGSA was launched along with other innovative ideas such as community participation through sub-programmes like Shahu, Phule and the Ambedkar Dalit Wasti Swachhata Abhiyan (SFADWSA), all under the umbrella of the NBA.
This article is on Sarola village (in Tuljapur block of Osmanabad district, Maharashtra) that took an initiative for its sustainable development with the help of government agencies and succeeded in establishing a new identity for the village. It discusses how various factors, especially community organisation and community action, enabled Sarola to become ODF.
Profile of Sarola
Sarola is a small village with 1,032 inhabitants (Sarola ICDS Survey Report 2013), of whom 75% are dalits (scheduled castes), Other Backward Classes (OBCs), and the vimukta jati nomadic tribes (VJNT), and 25% from other castes. It is 9 km from Tuljapur block. Apart from agriculture (the main source of livelihood), another important source of livelihood is construction work in surrounding villages and at the block. Almost 40% of the population belongs to the Wadar community (VJNT), whose main source of livelihood is stone-cutting and construction. Only five residents of Sarola are government employees. Education facilities are poor. There is only one primary school, and students go to Malumbra village (8 km away) or Tuljapur (9 km away) after their schooling there.
About SGGSA
The SGGSA was launched in 2000 in the name of Sant Gadge Baba, a 19th century folk hero who inspired people with his philosophy of self-reliance, community-sharing, and village cleanliness. Sanitation was the focus of his spiritualism, speeches, and life.1 He would visit villages every day, and as soon as he entered a village, he and his followers would sweep the roads and clean the drains. He relied on villagers for food and shelter. At night, there would be a programme (kirtan) where he talked about the divine, alongside sanitation to create awareness among villagers. Throughout his life, he organised communities with folk songs, spiritual speeches, skits, and dances, helping them to achieve cleanliness and self-reliance.
Drawing inspiration from him, the Government of Maharashtra launched the SGGSA. There were two reasons for this – the need for an integrated approach to sanitation, and the need for community participation in the campaign.2 The state government decided to play the role of a facilitator and help communities to take their own initiatives to implement the programme (Thakre 2000).3 The campaign uses strategies such as working with individuals, youth groups, self-help groups (SHGs), and schoolchildren to involve the community. Other sub-programmes such as solid waste management and biogas plants are also a part of the SGGSA’s integrated approach.
Problem Identification and Community Initiative
During a break from studies at the Tata Institute of Social Sciences (TISS), Tuljapur, I began discussing issues such as the ravages of malaria, water and sanitation problems, the lack of quality education, and the issue of accountability in local self-governance with friends in Sarola. Though people were aware of the problems, they did not know how to solve them.
In November 2006, I noticed an advertisement on the SFADWSA in Dainik Samrat, a Marathi daily, at the Swami Vivekanand Gramin Vachnalay (rural library). It was published by the state government with an appeal to people to participate in the programme. It also mentioned a prize of Rs 1.5 lakh. I discussed this appeal and its possible benefits (cleanliness, health benefits, prizes, and so on) with friends. The next challenge was to convince other dalit youth, whose daily routine was limited to home and work, of the value of the SFADWSA. We did this by arguing that the dalit part of the village (called Bhimnagar) was small, and it would be easy for us to clean it up, and win prizes. We discussed this with 10 to 15 friends in the Panchshil Tarun Mandal, a youth group that actively participates in organising B R Ambedkar’s birth anniversary celebrations in the village. We focused on two important benefits. First, Bhimnagar would become clean, and that was part of Babasaheb’s message (“Leave the dirty life and adopt a new clean lifestyle”). Health-related problems and expenses on them could be avoided. Second, if we won the prize, it could be used for Bhimnagar’s development. The next obstacle was to raise the funds required to buy plants, hire a tractor, and so on. I suggested that the problem would be solved if each of the 22 Bhimnagar households contributed.
To spread awareness, the youth group called a meeting of the dalit community and presented their idea. Senior members of the community raised many practical questions about the requirements for the prize, the need for money to participate, the participation of other village communities, and so on.
The youth group decided to form various committees (for awareness, finance, cultural activities, and the like) with members from all sections of society – men, women, youth and children. Members of the dalit community were used to contributing each year to the Ambedkar birth anniversary celebrations. That culture helped to partly solve the funding problem – the people readily agreed to contribute Rs 50 per household. Of 22 households, 18 paid up and the remaining said that they would contribute in kind. These small contributions were supplemented with the government’s financial incentives for below the poverty line (BPL) households (Rs 1,200 per household) and contributions from gram panchayat members and others, and gram panchayat funds (Government of India 2013).
On the first day, an early morning rally was organised in the village with slogans and posters about the sanitation programme. The first assignment was to clean the roads. Everyone took a jhadu (broom) and began sweeping the roads. The enthusiasm of the youth was infectious and eventually their family members joined in. This also became an opportunity to create awareness. People asked questions such as “Why are you doing this?” In response, the youth informed them that a sanitation programme was being implemented in Bhimnagar.
Though the inhabitants were cleaning their surroundings each day, it was difficult to make the village 100% clean. For one, the garbage collection point was in front of the anganwadi. Earlier attempts to move the pit, which belonged to an OBC family, had failed. The youth tried to convince them, without success. A legal notice by the dalit sarpanch also did not work. The zilla parishad school headmaster had been observing us, and had good community mobilisation skills. He took it upon himself to request the family to shift the garbage collection point and requested the gram panchayat to provide an alternative site.
The involvement of the headmaster proved very useful. He explained to us that cleaning Bhimnagar alone would not qualify us for the prize, and informed us about the other government guidelines – everyone should have toilets and use them, there should be trees in front of all the houses, and so on. Further, we realised that it was not enough for dalit households alone to be ODF; the entire village had to be so. Though some had strong doubts about other people participating, especially those from other castes, we held discussions with the sarpanch, village secretary, gram panchayat members, and the members of several panchayat committees.
Role of Local Self-governance
The sarpanch decided to call a gram sabha meeting. The panchayat secretary explained the programme and the responsibilities the people would have to undertake to make it successful. The youth who had taken the initiative explained its benefits. The headmaster did a brilliant job of building people’s confidence about their being able to do it. To convince those who remained doubtful, the youth began working with different groups, talking to youngsters and women in all the communities. The headmaster and teachers began teaching students about the sanitation programme and also motivated them to convince their parents. Schoolchildren even organised awareness rallies. After 10 days of collective work, there were positive results, and almost all the villagers were ready to participate in the programme and contribute to it.
Again, the first assignment was to clean the village. At the start, the response from the villagers was very poor, but when all the teachers, children, and the youth began wielding brooms, many of the others joined in. The next important task was to build toilets and stop open defecation.
An important aspect of the programme was the inclusion of every section of the village in it. Winning the full support and participation of the Wadar community was the first target. Towards this, the youth began working with the panchayat members and two former sarpanches, they organised awareness programmes and meetings, and initiated forming SHGs.
Even after constructing toilets, planting trees, and cleaning the village, it was not easy to convince some people to use their toilets. Though there were enough toilets, some were not comfortable with using them at home, and continued to defecate in the open. An old man, Rajendra Mali, said, “Jithe khaycha thithech hagyacha! Aplychane tar honar nahi! Khana ani hagnya madhe difference asayla pahije na” (Where one eats, how can one defecate? I cannot do this! There should be a distance between the food and toilet). The cultural team performed skits to create awareness about the health issues related to open defecation. The people found them humorous; some were convinced, but not all. Two activists came up with a new strategy to solve this problem and launched a “good morning campaign” (GMC). From 5 am to 8 am, a group with musical instruments walked to places where people went for open defecation, ostensibly for practice sessions. This worked like magic – in five days, everyone had switched to the use of toilets.
Conclusions
After one year, in 2008-09, the village was awarded the central government’s Nirmal Gram Puraskar by the president of India. In 2008, the village received a district-level prize for implementing the SGGSA successfully. In the same year, the dalit community participated separately in the SFADWSA and received the block-level first prize of Rs 5 lakh, which was spent on the development of the dalit quarter. The village also got a regional award (in three financial years) for effective solid-waste and water management, and for being “eco-friendly”. These awards are incidental to the other outcomes of the sanitation programme – increased awareness, a culture of collective action (including strengthening of panchayati raj institutions), women’s empowerment through SHGs, greater accountability and transparency, and so on.
This case study shows that the goal of being ODF is not as simple as building toilets. Many factors are at work – Sarola’s journey began with an advertisement in a Marathi regional newspaper. It required education as well as access to information (provided by a village reading room). It shows the importance of education not just in the narrow sense of literacy, but also other government interventions. Cash incentives such as awards are also not enough. Achieving ODF status required public action in an otherwise divided local community (in terms of caste, among other things). In Sarola, this was facilitated by local government institutions such as the gram sabha, which met regularly.
Maharashtra has in recent years made a real effort to encourage rural households to adopt cleaner and healthier sanitation practices. According to the Census of India (2011), the proportion of households practising open defecation in the state is 34%, which is an improvement on the all-India average of 50%. A Planning Commission study (Government of India 2013) credits the state’s initiatives, including the SGGSA, for the rapid progress that has been achieved in promoting cleanliness and hygiene.
CHEER any Indian leader who takes on the taboo of public hygiene, one of the country’s great problems. Narendra Modi, India’s prime minister, says building toilets is a priority over temples. His finance minister, Arun Jaitley, used this month’s budget to set a goal of ending defecating in the open by 2019. That will be 150 years since the birth of Mohandas Gandhi, who said good sanitation was more important than independence.
Ending open defecation would bring immense benefits. Some 130m households lack toilets. More than 72% of rural people relieve themselves behind bushes, in fields or by roadsides. The share is barely shrinking. Of the 1 billion people in the world who have no toilet, India accounts for nearly 600m.
The costs are high. Public safety is one underappreciated problem, as young women have to leave their rural homes after dark. In May two teenage girls in Uttar Pradesh visiting a field used as a communal toilet were raped, murdered and strung up from a tree. That case won notoriety for its extreme barbarity, but similar attacks are distressingly common.
A broader matter is public health. Open defecation is disastrous when practised by groups in close contact with each other. Because India’s population is huge, growing rapidly and densely settled, it is impossible even in rural areas to keep human faeces from crops, wells, food and children’s hands. Ingested bacteria and worms spread diseases, especially of the intestine. They cause enteropathy, a chronic illness that prevents the body from absorbing calories and nutrients. That helps to explain why, in spite of rising incomes and better diets, rates of child malnourishment in India do not improve faster. Unicef, the UN’s agency for children, estimates that nearly one-half of Indian children remain malnourished.
Hundreds of thousands of them die from preventable conditions each year, especially in the north, which has most of the open defecation (see map). Faeces in groundwater spread diseases such as encephalitis, an annual post-monsoon scourge in eastern Uttar Pradesh. Diarrhoea leaves Indians’ bodies smaller on average than those of people in poorer countries where people eat fewer calories, notably in Africa. Underweight mothers produce stunted babies prone to sickness who may fail to develop to their full cognitive potential. Dean Spears, a Delhi-based economist, says the costs of all this, in incomes and taxes forfeited, are far greater than the price of fixing it.
How to do so? India fares worse on sanitation than a host of poorer places including Afghanistan, Burundi and Congo, partly because too many of its leaders are too squeamish to face up to the issue. Thankfully, that appears now to be changing. The government, gung-ho for infrastructure, has just said it will build 5.2m toilets by September, or one every second.
Pouring concrete will not in itself solve India’s problems. Leaders need also to confront the cultural reasons for bad sanitation. Hindu tradition, seen for example in the “Laws of Manu”, a Hindu text some 2,000 years old, encourages defecation in the open, far from home, to avoid ritual impurity. Caste division is another factor, as by tradition it was only the lowliest in society, “untouchables” (now Dalits), who cleared human waste. Many people, notably in the Hindu-dominated Gangetic plains, today still show a preference for going in the open—even if they have latrines at home.
Evidence is growing that India must urgently correct its cultural practices, though it is sensitive to say so. Studies of India’s population show how since at least the 1960s child mortality rates have consistently been higher in Hindu families than Muslim ones—though Muslims typically are poorer, less educated and have less access to clean water. Today, out of every 100 children, 1.7 more Muslim than Hindu ones survive to five years, a big gap.
Mr Spears and his colleagues argue that this can be explained only by differences in sanitation habits. A 2005 government survey, the most recent national one, found that 67% of all Hindu households, rural and urban, practised open defecation, compared with just 42% of Muslim ones. (In rare places where there is more open defecation among Muslims than Hindus, the mortality gap is reversed.)
A new household survey of nearly 23,000 north Indians offers more evidence, especially from Hindu households. Led by Diane Coffey, an economist at Princeton, it found that even among households with a working latrine, more than 40% reported that at least one family member preferred to defecate in the open. Those with a government-built toilet were especially likely to choose a bush instead.
In an unpublished parallel survey of Hindu-dominated villages in north India and Nepal, respondents lauded open defecation as wholesome, healthy and social. By contrast, latrines were seen as potentially impure, especially if near the home. Men often described them as for use only by women, the infirm and the elderly. In short, demand for latrines is constrained.
This suggests that the mere availability of government-built latrines will not end open defecation for decades yet. What is needed instead are public campaigns, in schools and in the media, to explain the health and economic benefits of using toilets and of better hygiene. Researchers found that only a quarter of rural householders understood that washing hands helps prevent diarrhoea.
Such campaigns not only mean government-built latrines have a better chance of being used; they would also encourage households to build them for themselves. Precisely how to raise awareness about a touchy subject is not clear, but some at least are trying. A catchy animated music video put out by Unicef urges Indians to “take the poo to the loo”. The intention is right, even if the dancing turds will not immediately be to everyone’s taste.
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