The sanitation crisis in India - An urgent need to look beyond toilet provision

Recent evidence indicates that India is heading towards a major sanitation crisis in the coming years. Efforts made at meeting the sanitation challenges have been found to have very limited results, with as high as 65% of the population not having toilet facilities coupled with very low use of existing toilets in urban and rural areas. It is perhaps the right time to critically evaluate and move beyond the excessive focus we have on 'provision' and pay attention to the underlying complexities of the mechanisms involved, that influence sanitation behaviour among people. If we dont do so, we stand the risk of "missing all the trees for the forest", i.e. missing the social and economic dimensions of the sanitation needs of the people, in the hurry to count the number of toilets provided ! Aarti Kelkar-Khambete writes about the issue.

Guest post byAarti Kelkar-Khambete

Image Courtesy: Wikimedia Commons

The sanitation crisis and the recent evidence on lack of toilet facilities 

Recent evidence indicates that India is heading towards a major sanitation crisis in the coming years. The fastest growing economy seems to have missed out on having adequate toilet facilities for as high as 65% of its population. For example, nearly half of India’s 1.2 billion people have no toilet at home, but more than half of India's people own a mobile phone, indicates the latest census data [1].

According to the census of 2011, 53.1% (63.6% in 2001) of the households in India do not have a toilet, with the percentage being as high as 69.3% (78.1% in 2001) in rural areas and 18.6% (26.3% in 2001) in urban areas [1]. Furthermore, field studies indicate that even the use of the existing toilets in both rural and urban areas is very low [10].

These facts have also been reconfirmed by another report released on 6th March 2012 by the WHO/UNICEF’s Joint Monitoring Programme on sanitation for the Millennium Development Goals, which has also indicated that 59% (626 million) Indians still do not have access to toilets and practice open defecation and that majority of them live in rural areas [13].

Within India amongst the different states, Jharkhand tops the list with as high as 77% of homes having no toilet facilities, while the figure is 76.6% for Orissa and 75.8% in Bihar. All three are among India’s poorest states with huge populations that live on less than Rs 50/- a day [2].

Lack of access to water supply and drainage facilities and implications for sanitation

In addition to more than half of Indian homes having no toilets within their premises, access to water supply and drainage facilities is also another serious problem. For example, two-thirds of Indian homes have no drinking water facility from a treated tap source, and four-fifths are devoid of closed drainage connectivity for discharge of wastewater [3]. While 87% of the households now use tap, tube-well, hand-pumps and covered wells as the main source for drinking water, only 47% have the source of water within the premises. A good 36% households still have to fetch water from a source located within 500 meters in rural areas and 100 meters in urban areas [3].

This has a significant impact on the sanitation and hygiene practices and the health of women in terms of extra workload and evidence indicates that 17% women in the rural areas have to walk more than half a km to get water for their families and for their cattle, and 55% of them are forced to bathe in the open because they do not have any private bathing facilities [4]. The situation is even worse in areas, which are drought-prone or face perennial water shortage, such as the Bundelkhand region in Uttar Pradesh and states like Rajasthan, Bihar, Jharkhand and Orissa [4].

The still widespread practice of manual scavenging

Manual scavenging is still widespread in India. Over 1% of all households in both the urban as well as rural areas continue to rely even today on this practice. Evidence indicates that there are 7.94 lakh dry latrines in the country and excreta is regularly cleaned by scavengers. In over 13 lakh toilets, the waste is flushed into open drains and cleaned by humans. Around 25 crore households, nearly 12 lakh in rural areas and 13 lakh in urban areas depend on manual scavengers to remove night soil from the toilets [5]. In Jammu & Kashmir, 8.9% of households still have their toilets emptied by manual scavengers [2].

Toilet Goa

Image Source: Wikimedia Commons

A typical toilet in rural India


Increase in budget allocation and plan for better monitoring systems by the Planning Commission in response to this crisis

Following the report of the Joint Monitoring Programme for Water and Sanitation (JMP) released by UNICEF and WHO, which has pointed out that India is lagging behind by around 11 years in meeting the Millennium Development Goal targets, the government has resolved, that it will deal with the situation. However, the census report findings have complicated matters further and present an alarming development with an 11% decline in households having toilets. The percentage has gone down to 53 from 64 in 2011 [4].

The officials from the Ministry of Drinking Water and Sanitation, Government of India, have admitted that although a lot is being done by the government to tackle the problem of sanitation, and although efforts are yielding positive results, a lot still needs to be done, looking at the needs of the population [4]. In response to the situation, the budget for the sector has been more than doubled, from Rs 1,500 crore in 2011-12 to Rs 3,500 crore for the coming fiscal year [4]. A Steering Committee of the Planning Commission has proposed an allocation of Rs 44,116 crore (at a hike of 675 per cent over the 11th plan allocation) for sanitation and Rs 1,22,570 crore (hike of 312 per cent over the 11th plan allocation) for drinking water in the 12th Plan [6].

A detailed exercise is also being conducted to identify the shortcomings of the existing sanitation and drinking water efforts and incorporate them into the 12th Five Year Plan [4]. However, a lot of confusion exists in terms of the reliability of the information available. For example, the Ministry of Drinking Water and Sanitation claims 74% sanitation coverage in the urban areas of the country while the Joint Monitoring Programme quotes 39% and the Census report puts sanitation coverage at 30.7%, which is less than half of the figures presented by the Ministry [4].

Even in the case of rural sanitation, the Ministry claims that the coverage is 53% whereas the Joint Monitoring Programme and census data keep the figure at 33% and 30%, respectively. At the state level, The Ministry of Drinking Water and Sanitation claims that in states like Uttar Pradesh and Madhya Pradesh, only 31.7% and 34.8% of the population lacks sanitation facilities. However, according to the the Census data, 78% population in Uttar Pradesh and 86.9% population in Madhya Pradesh do not have access to sanitation facilities. The Ministry claims that only 23.4% people do not have sanitation coverage in Tamil Nadu, while the Census data reports that 76.8% people lack sanitation coverage in Tamil Nadu [4]. In the context of this situation, there is a need to develop a more accurate monitoring system by revamping the existing monitoring mechanism and evolving a community-based monitoring system. GPS technology is being taken into consideration and pilot projects are already underway in a few states like Himachal Pradesh and Bihar [4].

Integration of housing, water and sanitation programmes in the 12th Five Year Plan

The Steering Committee of the Planning Commission has also pointed out that one of the major drawbacks of the current approach to National Rural Drinking Water Programme and Total Sanitation Campaign is that water and sanitation are taken as independent activities. Therefore in the 12th Plan, a need has been identified for integration of housing, water and sanitation needs. It also recommended that the Government should converge water and sanitation programmes with the Mahatma Gandhi National Rural Employment Guarantee Act in the 12th Plan [6].

Introduction of a new Act on manual scavenging

In the context of manual scavenging, inspite of the enactment of the Employment of Manual Scavengers and Construction of Dry Latrine (Prohibition) Act by the Parliament in 1993, which considers hiring scavengers and construction of dry (non-flush) latrines as offences punishable with imprisonment of up to one year with a fine of Rs 2,000/-, the law has rarely been enforced [5]. As a response to this, the Sonia Gandhi-headed National Advisory Council has recommended, that the government take steps in coordinating with states to end this shameful practice. The government is planning to bring in a new act to tackle this problem, which may include provisions for rehabilitating those engaged in manual scavenging in other economic activities [5].

Toilets in India

Image Source: Wikimedia Commons

A pay and use public toilet

Is increase in resources a solution to the problem?

One needs to look at this response in the context of the grave crisis that the country is facing, and is going to struggle with in the coming years, and the tremendous health and economic burden it is already having, and predicted to have in the coming years. Will just increasing resources in terms of more budgets really take care of this problem? It has already been realised that this strategy has yielded limited results.

The fault probably lies with the approach and the way in which problems are understood as and solutions implemented. For example, many times, centralised, narrow, target-oriented programmes that do not take into consideration the genuine local and contextual needs of the people, the micro-realities of the areas, the underlying socio-cultural factors influencing behaviours of people and the lack of involvement of people and consideration to the long term sustainability of the programmes, have found to yield very limited results.

For example, in rural areas, the sanitation programme in India has been accused of being only about constructing a toilet for stopping the practice of open defecation through awards like Nirmal Gram Puraskar. However, many villages tend to revert to open defecation practices. Will just more number of toilets help in dealing with the situation? Current evidence indicates the contrary. For example, India has been constructing 1.5 million toilets a year under its Total Sanitation Campaign. However, 50 per cent of them remain unused, according to the admission by the Prime Minister Manmohan Singh himself at SACOSAN in Delhi in 2008 [7, 11].

Factors affecting toilet use

A number of factors have been found to play an important role in determining toilet use. Sticking to toilet-using habit depends on construction aspects such as a good and well maintained, user friendly structure that protects privacy, has availability of water and where the owners are aware of the benefits of good sanitation. For example, the experiences such as those of an organisation working in Odisha have shown that ensuring availability of well constructed toilets with assured water supply along with motivation and taking up of responsibility of maintenance of toilets at the community level, helped in making toilets sustainable in the long run [7].

Experiences on the use of public toilets in urban areas of the country have also identified that a number of factors have found to lead to poor use of toilets. These include:

  • Absence of mechanisms to maintain the toilets
  • Lack of plumbing and drainage facilities
  • Lack of water, lack of adequate and systematically designed sewage systems
  • Inadequate mechanisms to maintain these sewage pipelines
  • Absence of grievance redressal mechanisms
  • Poor consideration of gender-based factors such as security concerns, extra charges for women, lack of attention to accessibility factors such as separate entrance for women, have further led to reduced use of toilets among women [8].

Operational aspects such as well-defined institutional roles and mechanisms, appropriate plans for management of funds, coordination between the departments to deal with all the aspects of sanitation, empowerment and capacity building of people within these institutions and use of improved and appropriate technologies have also been found to be important determinants for improving sanitation outcomes. Current evidence indicates that there is a gap between the number of toilets provided by the Total Sanitation Campaign and the actual existing toilets according to the census figures, which suggests a gross mismanagement of funds, which in turn has significantly hindered the progress in sanitation [11, 12].

Just making laws for preventing manual scavenging might not help, unless they are coupled with efforts that eliminate the very need for the shameful practice of manual scavenging through use of modern and appropriate technologies for toilets and sewage collection and processing systems, ensuring adequate water supply, and importantly, changing the sanitation behaviour of people based on building awareness and responsibility among the community.

Evidence also suggests that there cannot be blanket centralised solutions for all the parts of the country. There are significant differences among urban and rural populations in terms of the attitudes, perceptions, resources available, local needs as well as by states as well as geographical areas, which need to be taken into consideration while meeting the sanitation needs of the people. It has now been realised that there is a need to focus on what can be called as software or addressing a range of factors that affect demand generation of toilets among people, which is as important as the hardware or in other words, social engineering as much as conventional construction [8].

The new rural development policy and beyond

The outlines of the new rural development policy that focuses on 2022 as the new target date for Open Defecation Free (ODF) India has been set and includes a much larger budget, more than double the hardware subsidy to individual households, removing positive discrimination towards poorer households, and decentralisation of funds to the Gram Panchayat level. The focus is on achieving ODF communities, rather than toilets constructed, which is a welcome step [9].

It is high time we stop justifying our efforts made by focusing only on 'provision' in sanitation. Rather, it is important to pay attention to the underlying complexities of the mechanisms involved that influence sanitation behaviour among people, or we stand the risk of missing all the trees for the forest, i.e. missing the social and economic dimensions of the sanitation needs of the people in the hurry to count the number of toilets provided !

Ecosan toilets

Image source: Wikimedia Commons

An ecosan toilet

(The author is a public health researcher based in Trivandrum, and works with the India Water Portal)

References

1. Farhana Ahmed (2012) Water and sanitation in India’s Census - 2012. Downloaded from the site: http://www.scoop.co.nz/stories/HL1203/S00268/water-and-sanitation-in-indias-census-2012.htm on 10th April 2012.

2. Sanitation updates (2012), India census: more people have a mobile phone than a household toilet. Downloaded from the site:  http://sanitationupdates.wordpress.com/2012/03/16/india-census-more-people-have-a-mobile-phone-than-a-household-toilet/ on 10th April 2012.

3. The Hindu Business Line (2012) Households have easier access to phones than sanitation, drinking water facilities. Downloaded from the site:  http://www.thehindubusinessline.com/industry-and-economy/article2991835.ece on 10th April 2012.

4. Alka Pande (2012) No toilets for 53 per cent population of world’s third biggest economy. Downloaded from the site: http://www.citizen-news.org/2012/03/no-toilets-for-53-per-cent-population.html on 10th April 2012.

5.Basant Kumar Mohanty (2012) Census bares the manual scavenging shocker. Downloaded from the site: http://www.telegraphindia.com/1120408/jsp/frontpage/story_15348149.jsp  on 10th April 2012.

6. Seema Sindhu (2012) Third fastest economy but 2/3 households sans toilets! Downloaded from the site: http://www.dailypioneer.com/home/online-channel/360-todays-newspaper/54485-third-fastest-economy-but-23-households-sans-toilets.html on 10th April 2012

7. Richard Mahapatra (2011) A toilet per second. Downloaded from the website: http://www.downtoearth.org.in/content/toilet-second on 10th April 2012.

8. Indiatogether (2011) Reaching the unserved in cities. Downloaded from the site: http://www.indiatogether.org/2011/apr/hlt-sanit.htm on 10th April 2012

9. Chambers, Robert (2012) Reflections on India's enormous sanitation challenges and some opportunities. Downloaded from the site:  http://www.communityledtotalsanitation.org/blog/reflections-indias-enormous-sanitation-challenges-and-some-opportunities on 10th April 2012

10. FINISH (2010) Urban Sanitation. Downloaded from the website: http://www.finishsociety.com/page.php?page_id=36 on 10th April 2012

11. CPR (2012) Sanitation drive: A policy mismatch. Downloaded from the website:
http://www.livemint.com/2012/02/28100550/Sanitation-drive-A-policy-mis.html on 10th April 2012.

12. Basant Kumar Mohanty (2012) Toilet scam leaps out of closet: Govt and census figures show disparity of 3.5 crore latrines Downloaded from the website: http://www.telegraphindia.com/1120418/jsp/frontpage/story_15387948.jsp on 17th April 2012.

13. UNICEF and WHO (2012) Progress on drinking water and sanitation: A 2012 update.

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