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The true cost of sanitation

Blog Post2 min read

Written by Payal Hathi on October 22nd, 2014

In Rohini Nilekani’s recent LiveMint piece, she argues that before we “rush out to build toilets everywhere” it is important to understand both the costs of poor sanitation, and the complexities in overcoming the challenge.

Ms. Nilekani quotes our work in talking about some of the hidden, and difficult to measure, costs of poor sanitation:

The work of economist Dean Spears and the Research Institute for Compassionate Economics, or R.I.C.E., shows us that this true cost of not completing the sanitation loop is also reflected in millions of stunted or malnourished children, and in high maternal and infant mortality rates.

Ms. Nilekani also importantly points out that access alone is not the issue.  Getting people to actually use their latrines is not a simple thing to do in rural India, and creating demand takes time, manpower, and resources:

What is important to accept is that even when people have access to toilets, many prefer to use the outdoors.  Over the past two decades, the experience of many organizations working on rural sanitation has yielded some explanations. People behave perfectly rationally when they prefer an open-air space to a small, smelly loo. They are worried that the small underground pits which collect the waste from the toilets will fill up quickly and that it will require money and added work to empty them. Hence, many men think they are being considerate when they desist from using the toilet, in favour of the women of the house.

We need to carefully understand the situation, the emotions and the rationales of people in order to understand what it will cost to improve sanitation facilities in the country…

First, there is the question of proper demand generation. People have to clearly see the connection between their family’s health and their sanitation habits. And they need sustained help to break old habits and make the appropriate change in behaviour. We can now leverage the work of many agencies that have successfully designed and delivered scientific and effective communication. But this comes at a price. To use an example from the work of my foundation, Arghyam in Davangere district in Karnataka, the communication campaign cost was around Rs.1,000 per toilet. Gramalaya, an NGO believes it takes as much as Rs.2,500 per toilet over several months on behaviour-change communication so as to achieve sustainable sanitation outcomes.

It is absolutely true that the costs of poor sanitation are far too high and that we can no longer afford failure in addressing the challenge.  Many more players are needed to learn how to motivate people to change their behavior if we are to prevent these costs from rising even further.


r.i.c.e. is a non-profit research organization focused on health and well-being in India. Our core focus is on children in rural north India. Our research studies health care at the start of life, sanitation, air pollution, maternal health, social inequality, and other dimensions of population-level social wellbeing.

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