How many missing toilets will there be after the first 100 days?

Written by on August 28th, 2014

Now, I don’t really like to talk too much about toilets because it takes away from the conversation on latrine use, but Aashish and I just did some math on missing toilets, and the statistics are pretty stark.

For the past 15 years, the Total Sanitation Campaign, and then the Nirmal Bharat Abhiyan (NBA), has been building latrines across rural India, but despite these efforts, there has been little reduction in open defecation. In fact, from 2001 to 2011, latrine coverage in rural India increased by about 1 percentage point each year. A total of 5.2 crore rural households, or 31 percent of rural families, had toilets by 2011 in total. The website for the NBA, however, states that it built 8.7 crore toilets between 2001 and 2011

The government’s claims are even more startling when you consider that the Census showed that only about 80 lakh new toilets were built in rural areas over the same period. Let’s make the incorrect assumption that the government was responsible for all of these new toilets. For every toilet that was actually constructed, the government spent money to build 10!

So how many more missing toilets will there be on 31st August, the end of the PMs first 100 days, and the deadline for the construction of 5.2 million toilets? Wouldn’t it be a much better use of funds to instead focus on promoting latrine use, instead of building phantom toilets?

don’t overlook the annual sanitation survey

Written by on August 26th, 2014

annualsanitationsurveyThe above is a snip out of the new draft action plan for the Swachh Bharat Mission.  I am very concerned that the emphasis of the new plan will be on latrine construction — especially in practice, whatever comprehensive list the guidelines may include.  However, one great piece of news is the serious commitment to an actual survey of latrine use.  There is no serious path to ending open defecation that does not involve keeping track of how much of it is going on.

Three cheers for everyone who has pushed for this survey and who will help make it happen going forward!

go read Varad Pande: “Swachh Bharat Mission: The Long Walk from Rhetoric to Implementation”

Written by on August 25th, 2014

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Today’s must-read is Varad Pande’s blog on IBN live:

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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.

Public service announcement: Ending open defecation is in our hands!

Written by on August 23rd, 2014

Check out this public service announcement, called “Ending open defecation is in our hands,” made by WASH United.  It calls upon us all to join in and help: “India is ready for another epic achievement – ending open defecation…It is in our hands.” Plans are set for the government to start using this soon too, which we’re very excited about!

Showing low-cost latrines at the end of the video, the message is clear that we can change India’s national shame into another major public health success (much like the recent eradication of polio).  Although we can’t give out Oscar or Emmy awards, if we could, the r.i.c.e. team would love to create the “Shitty Awards” for efforts that have the potential to motivate each one of us to get involved in a much-needed national scale movement to end open defecation – WASH United’s PSA would surely be a winner!

Ideas for India and Live Mint do sanitation series

Written by on August 18th, 2014

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Ideas for India and Live Mint are publishing a series on sanitation and r.i.c.e. work.  You can see Diane’s piece on the conclusions from the SQUAT and qualitative “switching” study about why so many people in India defecate in the open here in Ideas for India, and here in Mint.  You can see Michael Geruso’s piece on the effects of sanitation on child mortality here in Ideas for India and here in Mint.  Dean’s pieces on the unique challenges for sanitation policy in India are coming out tomorrow.

I used a picture of a latrine pit for this post because it reminds us that when we’re thinking about rural sanitation solutions for north India, we need to remember that the pit is the part of the latrine that is most important to people in villages!

Sanitation is a core message in PMs Independence Day speech!

Written by on August 16th, 2014

The Prime Minister yesterday gave his Independence Day speech at the Red Fort, and brought up sanitation as an important issue for the next 4 years! He says,

I, therefore, have to launch a “Clean India” campaign from 2nd October this year and carry it forward in 4 years. I want to make a beginning today itself and that is – all schools in the country should have toilets with separate toilets for girls. Only then our daughters will not be compelled to leave schools midway. Our parliamentarians utilising MPLAD fund are there. I appeal to them to spend it for constructing toilets in schools for a year. The government should utilise its budget on providing toilets. I call upon the corporate sector also to give priority to the provision of toilets in schools with your expenditure under Corporate Social Responsibility. This target should be finished within one year with the help of state governments and on the next 15th August, we should be in a firm position to announce that there is no school in India without separate toilets for boys and girls.

While we are very happy to know that Modi continues to prioritize improving sanitation, any successful campaign to eliminate open defecation in India will need to focus on latrine use, not just building latrines. We hope that the designers of the “Clean India” campaign will keep this in mind.

Read the whole speech here.

Does the IEC messaging on sanitation needs to change?

Written by on August 15th, 2014

The government of India over the years has focused on latrine construction and its spending on behavioral change in the form of Information and Educations Campaigns (IEC) has been minuscule. Infact, the IEC spending between financial year 2013-14 were just 209 cr in comparison to 2518 cr spent on construction.

Figure 1

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The results of this lack of IEC spending and its non effectiveness can be seen clearly in the SQUAT data. In the SQUAT Survey, we asked people if they have ever heard or seen any messages on sanitation (in the form of wall paintings, street plays, fliers, posters, short films, etc). In figure 1, among all the people who participated in our survey, only 32% of the respondents had seen some form of sanitation message, and a majority of respondents (68%) had never seen one.

Figure 2

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Among the people who had seen IEC messages, we asked about the content of the message and.43% of the respondents (G+H) either said they remember it being some slogan or photo but do not remember what the slogan/photo was about or they do not remember the content at all. Another 25% (D+E) said that the message promoted latrines as enabling women’s modesty or as being beneficial to woman in some form. Only 12% of the respondents in the survey had been exposure to a correct message on the health benefits of latrine use.

These graphs not only point to the importance of increasing IEC spending on sanitation, they also highlight an important issue regarding the content of these messages. It’s important for the government to think seriously about what these messages contain because promoting some themes may actually do more harm than good. For instance, the IEC message focusing on women re-enforces gender inequality, endorses restricted mobility of woman in rural areas, and also distracts from the important message that everyone needs to use a latrine. The answer may not just be to advertise the health benefits of latrine use and so we need to do lots of experimentation.

Lots of educated men who have toilets still defecate in the open

Written by on August 13th, 2014

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We often think that education in general, and educating people on how bacteria spread, will get people to use their latrines. In the graph above, we are able to see latrine use by sex and level of education for people who live in households that have a latrine. The data are from the SQUAT Survey of sanitation attitudes and behaviors in the rural parts of 5 north Indian states. What the graph shows is that even among highly educated individuals who have a latrine, a sizeable proportion still defecate in the open.

Of course, more educated people are more likely to use the latrines they have than less educated people, and women are more likely to use their latrines than men at every level of education. But, what is striking is that close to 20% of men who have studied up to the 12th class still defecate in the open even though they have a latrine at home. A larger fraction of men in our sample who are 12th class graduates in households that own latrines defecate in the open than do all people in Ghana, Senegal, and Zambia.

Defecating in the open is very much a part of Indian culture, and is much harder to change than just through education. Just relying on teachers to teach germ-theory in schools may not do the trick.

Bloomberg News also finds unused government latrines

Written by on August 5th, 2014
Photographer: Kartikay Mehrotra/Bloomberg

Photographer: Kartikay Mehrotra/Bloomberg

Bloomberg News came out with a story yesterday on how government latrines are often not used in rural north India because people are often disgusted by them. The journalist quotes Yamini Aiyar, of Accountability Initiative, saying:

Targets for construction of toilets are somewhat irrelevant to resolving the sanitation problem. Building toilets does not mean that people will use them and there seems to be a host of cultural, social and caste-based reasons for that. People need to be taught the value of sanitation.

He also cites some research from the SQUAT Study! Check the full story out here!

Purity, latrine use, and religion

Written by on July 31st, 2014

From the SQUAT Survey, we found that many people prefer open defecation to latrine use, and that latrines are often seen as dirty and unpleasant.  Through our conversations with people in rural India, it seems that part of this distaste is rooted in notions of purity and pollution: many expect latrines to emit foul smells, which are often seen as unhealthy and disease-inducing, and are averse to the periodic cleaning that pits require.

We asked our respondents what they thought about latrines and open defecation in terms of purity.  We asked whether they thought defecating in the open near or far from the house was pure or impure, and whether they thought a latrine constructed near or far from the house was pure or impure.  This post focuses on impurity, since it is the perception of impurity that seems to be holding people back from latrine use.

For respondents overall,  defecating in the open near the house is considered the most impure out of all defecation practices listed (a full 91% say it’s impure), while latrine construction far from the house is considered to be the least impure (only 4% say it’s impure).

It is between latrine construction near the house and defecating in the open far from the house where there are differing opinions.  The graph below shows the percentage of people who report each of these options as “impure” for respondents overall, just for toilet owners, and just for toilet users.

As we move from the overall sample, to those who own latrines, to those who actually use latrines, we see that more respondents report that open defecation far from the house is impure (from 42% to 51% to 59%), and fewer respondents report that latrine construction near the house is impure (42% to 39% to 37%). Of course we can’t know with our data which comes first – the ownership and use of the latrine, or changing beliefs around open defecation – but it is certainly interesting to see the connection between perceptions of purity and latrine practices in these trends.

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So where might these ideas of purity come from?  If ideas of purity are associated with latrines, we wanted to explore how religion may or may not influence these perceptions.  What we find is that Muslims are less likely than Hindus to say that a latrine constructed near the house is impure.  In the graph below, the bottom segment (dark red) shows the percentage of Hindu and Muslim respondents who reported that a latrine near the house is “pure” and the middle section (lighter red) shows the percentage of respondents who said that having a latrine near the house is “not pure.”  In both segments we see that Muslims are less averse to having a latrine near the house.

In the context of knowing that Muslims are much more likely to both own and use a latrine, we see a clear possibility.  Ideas of purity and the cleanliness of latrines are cultural notions that appear to be holding back progress in eliminating open defecation for a majority of rural Indians.

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These graphs tell us that it is going to be important both to convince people of the detrimental impacts of open defecation, and that there is nothing bad or dirty about latrines.  How cultural perceptions shape these beliefs is something we need to examine more deeply.  If indeed cultural forces are influencing sanitation outcomes, we need to develop a better understanding of them so that they can be fully incorporated in the design of government sanitation policy.

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