Lessons from past sanitation policies for future efforts

In 1981, the census reported that only 1% of rural households had sanitation coverage (ie access to toilets). To address this, the Government of India launched its Central Rural Sanitation Program (CRSP; 1986–1999). To encourage the construction of ‘Individual Household Toilets’ (IHHL), it offered financial assistance to Below Poverty Line (BPL) households. CRSP has been criticized for slow construction and lack of demand-led ‘behavior change communication’ (BCC), which is now considered an important aspect of any sanitation intervention in rural India, as open defecation (OD) ) continues despite the presence of toilets. , This OD stems from a practice for centuries and the notion of its hygienic and health benefits.

In 1999, the CRSP was reorganized as a Total Sanitation Campaign (TSC; 1999–2011), focused on increasing the demand for toilet adoption. About 15% of its budget was devoted to educational activities along with continued financial assistance to BPL families. To effect behavior change, the educational emphasis was mainly on achieving community-led total sanitation (CLTS). Developed in Bangladesh, it is a multi-stage participatory process that acknowledges that mere provision of toilets does not guarantee its use, uses audio-visual aids to create a sense of discomfort and disgust with OD, and inspires local communities to collectively end the practice. , However, the TSC was also criticized, as one study found that the officers running it lacked the necessary training for educational activities. Like CRSP, this too focused on infrastructure rather than demand. According to census data, we saw a less than 10% increase in toilet coverage under the program (from 22% in 2001 to 31% in 2011). Various studies estimated that the benefit was even less in terms of toilet use.

After TSC, the government started the Nirmal Bharat Abhiyan (NBA) in 2012, which lasted for 18 months. Soon after, the government launched its Swachh Bharat Mission (SBM) on 2 October 2014, aiming to achieve an OD-free India within five years. SBM was the first to incorporate urban (along with rural) sanitation guidelines. Along with financial support, SBM also claimed to focus heavily on the BCC, but the rigor of its implementation is frequently questioned by independent researchers. Under SBM, India achieved construction of around 100 million toilets and was declared an OD-free nation on 2 October 2019. However, several independent studies with NFHS-5 data have questioned this claim.

So, what can be done about the stubborn issue of low sanitation adoption in India?

The evolution of India’s sanitation policies teaches us that BCC is vital to achieving the dream of an OD-free India. Bangladesh is a shining example, as it has harnessed the community mobilization power of the CLTS to reduce the OD from 42% in 2003 to 1% in 2016. Its government is not only committed to providing basic sanitation facilities to all but is recognized. Equally important was the change in attitudes towards cleanliness at the beginning of that time. It collaborated with national and international NGOs as well as state and local governments, helping to accelerate the dissemination of the CLTS message. Dhaka also recognized that since women bear the bulk of the ordnance depot, their participation and leadership had to be encouraged to achieve the greater good of social equality with higher toilet usage for Bangladesh.

New Delhi’s sanitation policies have a top-down approach with a focus on building toilets. It has increased the number of toilets successfully installed but not in use. To bring about a lasting change in toilet adoption in the country, both the central and state governments must forge partnerships with village councils and schools and go beyond CLTS teachings. The information disseminated should not only generate hatred towards OD, but should also explain the virtues of using toilets and having a clean environment. Social norms should be changed in such a way that toilets are linked to the dignity and social status of the household.

For women to be included as agents of change, their presence in any community-level sanitation intervention must be mandatory, as well as their participation in decisions about the location and type of toilets planned. Their endorsement of the schemes will ensure that the investment in sanitation will not go to waste.

Research has shown that even after successful BCC and latrine adoption, there is always a possibility of reverting to OD if latrines are not kept structurally intact and suitably clean. Therefore, we need adequate provisions for the maintenance of toilets in the future budget to reduce the chances of slide-back. Finally, linking our SDG 6 goal with the sanitation programs of governments at all levels—national, state and local—will allow for an integrated approach to that goal.

Payal Seth and Palak Jain are economics researchers at the Tata-Cornell Institute, Cornell University and an associate professor at Bennett University, respectively.