The best sanitation articles this week

Written by on September 6th, 2014

These days, we end up posting useful articles on twitter and facebook first, and on the blog later. There has been a flurry of articles in the media recently on sanitation and toilets in India. In this blogpost, we curate the best of them for you.

The New York Times published an editorial on “India’s Sanitation Needs”. It said,

Some Indians are repulsed by the idea of having a toilet, which they associate with uncleanliness and the caste now known as Dalits, in their home. Others, according to research by the National Council of Applied Economic Research, are wary of the hygiene and odor of
toilets typically installed under government programs.

Changing entrenched attitudes and building the 12.5 million toilets that the Ministry of Drinking Water and Sanitation hopes to have in place by 2019 will be a colossal challenge. Mr. Modi’s continued leadership is needed, as is the participation of the private sector and nonprofit groups.

Our Associate Director, Sangita Vyas wrote an op-ed for the business newspaper Business Standard which was published under the title “Swachch Bharat Mission: It’s not just about building toilets”. It was primarily about the policy priorities for the Swachh Bharat Mission. We quote:

What India needs is a latrine use revolution, led by the country’s top leadership and known to every rural Indian. The prime minister clearly prioritises sanitation as an issue. But we need him to talk about latrine use, not just construction. We need the country’s best marketing experts to come up with clever messages that an army of dedicated behaviour change staff at the district and block levels will spread throughout rural India. We need to foster a market of pit-cleaners, so that people will not be afraid to use latrines with smaller and more affordable pits. We need to systematically and periodically collect data on toiletusage rather than just toilet construction, so we know how we are measuring up to the goal of eliminating open defecation by 2019. Most of all, we need to experiment like crazy to find the best strategies for changing people’s sanitation behaviours.

Fortunately, there are a number of large-scale campaigns that we can learn from. We need our latrine use revolution to look like Modi’s election campaign, which reached every village in India; like the Pulse Polio campaign, which eradicated polio in the country; like the anti-tobacco campaign, which has made even the most socially isolated aware of the negative health consequences of using tobacco products; the Aadhaar campaign, which enrolled 600 million Indian citizens in just five years. There is every reason to believe that a sanitation campaign of such epic proportions will help the government achieve its goal of a Swachch Bharat by 2019.

Reuters published an article called “Even if you build a toilet, they may not come: water expert“. It quoted senior sanitation professional from the World Bank, who argued:

“What Bangladesh realized very early on was that sanitation is about delivering an infrastructure and about creating behavior change… You have to first recognize that it’s a behavior shift that’s needed before you put in the infrastructure,” Ahmad, the senior director of global water practice at the World Bank, told Thomson Reuters Foundation on the sidelines of a global water conference in Stockholm.

“Health message is not enough to trigger people’s shift. You have to understand the behavior, what triggers that change.”

Hindustan Times’ Kumkum Dasgupta, wrote an “analysis” piece for the paper, in which they quoted Dean and Diane, Executive Directors of r.i.c.e.

But will all this lead to a change in the (sanitation) status quo? Unlikely, says Dean Spears of the Research Institute for Compassionate Economics. Spears, who has worked in El Salvador, India and South Africa, and his colleagues have done a study on the issue in Bihar, Haryana, Uttar Pradesh, Madhya Pradesh and Rajasthan. This is what they have found: More than half of the people in households that own a government-subsidised latrine still defecate in the open and many of the respondents thought that open defecation was as good for child health as latrine use by everyone in the village. This thought process needs to change before starting the next round of toilet construction.

To get people interested in building toilets, the NDA is mulling raising subsidies for individual household latrines from Rs. 10,000 to Rs. 15,000. This would be a misguided decision, contends Spears’ colleague Diane Coffey. She says it will not work for three reasons: The plan overlooks the fact that people in rural India do not want to use latrines — even latrines that cost Rs. 15,000 — because use and pit-emptying are seen as ritually polluting, and open defecation is seen as healthy and socially desirable. Moreover, building a Rs. 5,000 latrine for each of the 123 million households that lack one would cost Rs. 1,84,500 crore, which is 45 times the money the government budgeted for rural sanitation in 2014. It is one-tenth of the Union budget for 2014.

That there is no demand for latrines in rural areas is also evident from the fact that you hardly see any shops selling the wares; the ecosystem is just not there. Moreover, when people do not want to use latrines, it is very hard to give them one and so they don’t mind much when contractors steal the money earmarked for latrine construction. If people do get bricks and cement to make a latrine, they will use these materials for something they want, adds Coffey.

Bhupesh Bhandari, Editor at the Business Standard, wrote an op-ed called “Build toilets in the mind first”. He quoted r.i.c.e. research, and said,

The biggest deterrent to toilets is actually the Indian mindset. Recent work by Research Institute for Compassionate Economics in five states (Bihar, Haryana, Madhya Pradesh, Rajasthan and Uttar Pradesh) found that over 40 per cent of the households with a functional toilet have at least one member who defecates in the open. These people find open defecation more pleasurable and desirable. In other words, even if the government were to fit every home with a toilet, the problem is unlikely to vanish. There is ample evidence to suggest that toilets built with government help are often used as store rooms or even cowsheds. The Punjab government had launched a programme to build community toilets in the state, but these quickly fell into disuse.

That is why it is necessary to instill some sort of behavioural change amongst people. More than the money, Prime Minister has helped the cause of sanitation by bringing it to the forefront of the national conscience. It now needs to travel down the chain. Mr Mittal expects students of the 48 schools that the Bharti Foundation runs in Ludhiana to be the agents of change. While the money is important, people first need to build toilets in the mind.

Harsha Raj Getty at the Indian express wrote an extremely interesting article from Karnataka, called “Villages where building a toilet is considered bad luck“.

In his Independence Day speech, Prime Minister Narendra Modi called for universal access to toilets. In parts of Karnataka, however, convincing people to use a toilet is proving a mountainous task against established mindsets and cultural beliefs.

“In rural areas, household latrines are very rare. People prefer to go to farms, railway tracks or isolated areas,” says Meena Nagraj, additional director of NBA in Karnataka. This has led to parts of the region seeing outbreaks of cholera, malaria, diarrhoea, typhoid and jaundice, especially among children, she says.

Meanwhile, the very cool website vox.com, which we keep reading, carried one of our maps in an article called 38 maps that explain the global economy. Check out #35. Additionally, an article by Dean and Nikhil, Research and Policy Manager at r.i.c.e. was published in the Hindi Daily National Duniya. This is a first for r.i.c.e. as we don’t publish anything in Hindi still. We hope to do more of this, to reach out to more people. National Duniya gave us a full page, nothing less!

Varad Pande wrote a nice blog for the channel CNN-IBN, which discussed the Swachh Bharat Mission in detail. We have posted about Varad’s article before, so we won’t repeat it, but it was one of the best articles on sanitation in the recent past. WaterAid’s Andrés Hueso wrote a very nice blogpost for the WaterAid website too, called “Will India’s new Prime Minister free the country from open defecation?”. It argued:

The main lesson in my view is that better sanitation is not just about building toilets but about people’s behaviour. If someone doesn’t feel the need to change their sanitary practices, government will spend millions on building toiletsthat simply won’t be used and will soon fall into disrepair. So I hope that the campaign launching on 2 October will focus on behaviour. To do so, however, the mindset of politicians, officials, the media and the public towards the issue must change too.

That’s it, I think. If you think we have missed out an important article, let us know by email (aashish@riceinstitute.org) or leave a comment on facebook or twitter. We don’t allow comments on the blog because we get too many spam comments and its just hard to moderate them all!

See Nitin Dhaktode’s very nice aricle describing a village that became free from open defecation in Maharashtra

Written by on September 5th, 2014

The paper, available here, mirrors several of our findings. It says,

Even after constructing toilets, planting trees, and cleaning the village, it was not easy to convince some people to use their toilets. Though there were enough toilets, some were not comfort able with using them at home, and continued to defecate in the open. An old man, Rajendra Mali, said, “Jithe khaycha thithech hagyacha! Aplychane tar honar nahi! Khana ani hagnya madhe difference asayla pahije na” (Where one eats, how can one defecate? I cannot do this! There should be a distance between the food and toilet).

The cultural team performed skits to create awareness about the health issues related to open defecation. The people found them humorous; some were convinced, but not all. Two activists came up with a new strategy to solve this problem and launched a “good morning campaign” (GMC). From 5 am to 8 am, a group with musical instruments walked to places where people went for open defecation, ostensibly for practice sessions. This worked like magic – in five days, everyone had switched to the use of toilets.

There are several other very valuable insights in the paper, such as the benefits of a working panchayati raj system, overcoming barriers such as caste, and the tools that can be used to make people realise the health benefits of stopping open defecation. In particular, it discusses the vision of Dr. Ambedkar which helped inspire the village to become free from open defecation. I can only say that more such initiatives should be carried out, and more such articles written. Thank you, Nitin, for writing this one!

 

 

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.

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