Much has been said about the recent priority placed on sanitation, with the Prime Minister taking up the issue most recently from the ramparts of the Red Fort on Independence Day. He must be commended on this rhetoric – open defecation is a potent silent killer especially in rural India, where more than 60 percent households still practice open defecation. 4 lakh children in India die of diarrhea every year, lakhs others grow up stunted, and several lakh others are malnourished. Recent evidence shows all this can be linked directly to the practice of open defecation, especially in rural India. So the renewed political emphasis on sanitation is more than welcome.
But as many with experience of the ‘system’ know, there is a rather large chasm between intent and the reality of implementation in India. The apparatus of India’s ‘flailing state‘ has a way of scuttling the best-laid plans and the most nobly intended speeches.
So it was useful to see the first details of the new government’s Swachh Bharat Mission (SBM), emerging in a draft Action Plan, released with the agenda papers for a National Meeting on State Ministers on Water & Sanitation to be held this week. This gives the first insight into how the government plans to achieve the ambitious goal of a ‘Swachh Bharat’ by 2019, and how its plans may be different from the existing ‘Nirmal Bharat Abhiyan’.
Four things were particularly noteworthy.
First, the draft document recognizes the importance of changing people’s attitudes, mindsets and behaviors as a central challenge in winning the battle on sanitation. There is remarkable consensus among those who work on rural sanitation that fighting open defecation is not primarily about constructing subsidized toilets, but about getting people to use them. Countries like Indonesia and Bangladesh have shown that it is possible to fight open defecation by singularly focusing on behavior change, and without any subsidized toilet construction at all. So this emphasis on behaviour change and thus the importance of Information, Education and Communication (IEC) is welcome (though it exists equally strongly in the Nirmal Bharat Abhiyan guidelines as well). The challenge is that while the Plan lists almost every known IEC technique – mass media, community mobilization, folk media, entertainment education etc. – the nuts and bolts of the Plan still focus on constructing toilets. The budget for IEC is kept at only 15 per cent, and the Action Plan sets a target of constructing 8.84 crore toilets in rural India over 5 years, and even notes that this translates into constructing 48,000 toilets a day (up from 14000 a day that get built right now!). We know from past experience, that rural India has crores of toilets were made only on paper (Indeed, the 2011 census showed there were 3.75 crore ‘missing toilets‘, i.e., toilets constructed according to government ministry figures, but missing on the ground.) And as the old adage goes, “What gets measured is what gets done” – if government targets continue to focus on number of toilets built, we will have just that – crores more toilets built (which also suits the local contractor-bureacrat-politician nexus), but never used. A coherent plan that puts behaviour change first, with adequate budgets and appropriate campaigns that put panchayats and communities at their heart, is the need of the hour. Assistance from institutions like the World Bank that have successfully helped other countries with such campaigns can be leveraged here.
Interestingly, the draft also calls for a ‘National Reach Out Campaign’ (on the model of the Pulse Polio Campaign), with the first effort starting September 25, culminating on October 2 on Gandhiji’s birthday. This is again welcome – in fact what we need really is more than a standard government campaign – we need a national movement – a rashtriya junoon – as the former Water & Sanitation Minister Jairam Ramesh called it. Chief Ministers and District Collectors must drive this as an overriding priority. The draft also calls for a sanitation related field-force – Block-level Sanitation Coordinators and Swachhata Doots (incidentally, also there in the Nirmal Bharat Abhiyan), but its not clear how they will be incentivized and why they will be any more effective than government school teachers and public health workers, often known for their absenteeism.
Second, the draft calls for the setting up of a ‘Special Purpose Vehicle (SPV)’ – a Company that will act as a specialized Project Management Agency for water & sanitation projects, help prepare District Project Reports, and process PPP and CSR projects. This is a potentially innovative idea, as such a vehicle can be professionally run with skilled personnel, have greater flexibility in budget and implementation decisions than government departments, etc., but exactly what the SPV will do and how, especially given that the central challenge is not about toilet construction, remains largely defined.
Third, the draft calls for the Centre to sign MoUs with States, where States commit to doing their part to achieve ‘Swachh Bharat’ by 2019 and in return, the Centre promises (presumably) a smoother funds flow and more flexibility to States for implementation, etc. This is also potentially a powerful idea that can empower States and hold them accountable for outcomes, i.e., toilet use or open defecation free Panchayats, and not toilet construction targets. The flow of funds from Centre to the States can also be based on achievement of such outcomes, making it a form of ‘results-based financing‘, which is in vogue in development projects globally these days. But here again, the details are far from clear in the draft. A related idea that is mentioned is to allow States to provide incentives to communities/GPs, rather than individuals, which is also welcome, especially as evidence from other countries (and indeed from ‘successful’ states like Himachal Pradesh and successful districts like Churu and Bikaner in Rajasthan) shows that it is collective community commitment that is needed to achieve and sustain open defecation free status.
Fourth, and perhaps most promisingly, the draft calls for an Annual Survey of Toilet Use to track how many households are actually using toilets. This is critical to change the mindset of the government machinery, and serve as a carrot and stick for the States. Sanitation is today is where primary education was ten years ago in the policy debate in India. The ASER Survey, conducted annually across rural India by the ASER Centre of Pratham since 2005, has created a major mindset shift away from tracking ‘enrollment’ in schools to ‘learning outcomes’, which is what we really care about. We need a similar mindset shift in sanitation today from ‘construction’ to ‘toilet use’, which such a survey can help catalyse. This idea needs to be now given shape, and it requires the best minds on survey design and impact evaluation in the development sector to work on it – organisations like J-PAL, ASER, and r.i.c.e., who have intensive experience on this, must be engaged to do this.
The Swachh Bharat Mission can well be more than a re-branding exercise and possibly turn the page on the scourge of open defecation if we set our minds to it and are willing to face the real issues, not just construct toilets. Let us hope we will.