Since 2011, that has changed. As shown in Figure 1, the proportion of people with access to a toilet has more than trebled – from under 20 percent to nearly 68 percent. Of 9,892 Gram Panchayats, the local level of government in India, almost a third – 3,545 – has been declared free of open defecation. That includes all Gram Panchayats in five of the state’s 33 districts, with more set to follow. What has gone right?
Swachh Bharat Mission Grameen (SBM (G)) – the rural clean India mission – plans to eliminate open defecation by 2019. SBM (G) is time-bound with a stronger results orientation, targeting the monitoring of both outputs (access to sanitation) and outcomes (usage). There is also a stronger focus on behavior change interventions and states have been accorded greater flexibility to adopt their own delivery mechanisms.
The World Bank has provided India with a US$1.5 billion loan and embarked on a technical assistance program to support the strengthening of SBM-G program delivery institutions at the national level, and in select states in planning, implementing and monitoring of the program.
Most behavior change approaches and frameworks for addressing open defecation have focused on relatively conscious, “reflective” drivers of behavior, including people’s emotions (such as pride or shame), rational knowledge (e.g., of germ theory), social norms, and explicit action plans (such as commitments to change). Using the framework popularized by renowned social psychologist Daniel Kahneman .<, these factors can be described as “System 2” drivers of behavior i.e., relatively conscious and motivational factors. It is now well established, however, that human behavior can also be heavily influenced by “System 1” drivers i.e., relatively automatic, cue-driven factors .
Imagine you are a busy mother scrubbing your laundry next to the public water stand near your yard. You realize your two year old — who is playing in the dirt — has to go to the toilet. What do you do? Chances are good you might just let them go on the ground somewhere nearby.
According to a recent analysis by the United Nations Children Fund (UNICEF) and the World Bank Global Water Practice's Water and Sanitation Program (WSP) in key countries, over 50 percent of households with children under age three reported that the feces of their children were unsafely disposed of the last time they defecated. What this really means is that children are literally pooping where they are and their feces are left there, in the open. Meanwhile, the feces of other children in the neighborhood are put or rinsed in a ditch or drain, or buried or thrown into solid waste streams that keep the feces near the household environment.
Inadequate sanitation costs India $54 billion a year. To that, add the challenge of juggling our nationalistic aspirations of superpowerdom with the ignominy of housing the largest share of human population that defecates in the open. In light of this, here are six steps to a success sanitation campaign.
The study finds that the govt’s rural sanitation programme, implemented by NGOs, was unable to reduce exposure to faecal matter.
No one denies the importance of good sanitation and the impact it has on human health. It must follow therefore that the lack of positive impact is down to poor implementation of the sanitation programme in the study area. In fact, a process evaluation of the programme concludes that the implementation was far from perfect, both in terms of the levels of coverage achieved and the levels of awareness. Over an implementation period of 13 months (January 2011—January 2012), the villages where the programme was implemented saw an increase in toilet coverage from 9% to 63%, but only 38% of the households had a functional toilet. It would have been interesting to learn more about the gap between toilet construction and usage (25 percentage points). In any case, the state of implementation, the authors point out, is typical of the prevalent Total Sanitation Campaign across the country.
We rarely give the toilet a second thought. We use it when we need to, and we flush and forget. We are also able to conveniently wash our hands afterwards. But imagine if you are on a long hiking trip or a bus ride with no stops in sight and had no access to a toilet or running water. It’s a situation most people would dread.
In poorer parts of the world, this is the daily reality for many. The humble toilet—perhaps the most important contributor to improved human health in history—is a luxury item which relatively few people enjoy. Without a toilet, the poor have to go in the open, behind bushes, or next to streams. They cannot flush their waste away or wash their hands afterwards if they wanted to. In poorer countries, managing human waste remains a major challenge, and failure to meet that challenge exposes millions of children and adults to waste-borne diseases that can have deadly consequences.
In Nepal, a country of approximately 26 million people, nearly 40% of the population do not have toilets. In parts the Terai or lowland areas, this number climbs to a staggering 75%. To be sure, the Government of Nepal has achieved remarkable progress in improving sanitation coverage in the last two decades. In 1990, only 6% of Nepalis had access to a toilet. By 2011, 62% had access, with the sanitation Millennium Development Goal (MDG) achieved ahead of the 2015 target. However, that achievement still leaves a large population—more than nine million people—without toilets. So the Government decided to aim for a new and more ambitious target—universal access by 2017. And it may get there.
Last month, I visited Nangkhel, a Newari village near Bhaktapur in the eastern corner of the Kathmandu Valley, to see how one village succeeded in bringing the luxury of a toilet to all 181 households (or about 900 people).
Alassane Sow, World Bank Country Manager for Cambodia, and Rana Flowers, UNICEF Representative to Cambodia, wrote an op-ed for The Phnom Penh Post. Read the op-ed below, courtesy of The Phnom Penh Post.Did you know that in communities where a high proportion of people defecate outdoors, children are on average shorter than children living in communities where most people use toilets?