Is India really closer to achieving sanitation goals?

Political will needs to be coupled with transparency & accountability to ensure that India meets the UN-mandated goal of universal access to sanitation by 2030

While the whole world is grappling with the Covid-19 pandemic, there is another public health issue which needs to be addressed with equal rigour and that is of sanitation. The WHO, in collaboration with UNICEF, released a report in November, on the state of the world’s sanitation and it paints a grim picture. While the global progress towards achieving sanitation-related sustainable development goals has been rather slow, the report states that India is one of the thirty countries that is on its way to meeting the targets. Last year, on October 2, India was declared open defecation free (ODF).

The WHO report states that the rate at which the world is progressing towards meeting the goal of universal access to sanitation by 2030 would need to be quadrupled. As of 2019, two billion people across the world still lacked access to basic sanitation services. About 367 million children went to schools that did not have any sanitation facility at all. Most of these schools and households are located in sub-Saharan Africa and Central and South Asia.

India launched the Swachh Bharat Mission in October 2014 to eliminate open defecation in rural areas through behavioural change, construction of household-owned and community-owned toilets, and establishing mechanisms for monitoring the progress. For a village to be declared ODF, no visible faeces should be found in the surroundings and every household, as well as public/community institutions, must use the safe technology option for disposal of faeces.

Persisting problems

In contrast to the claim of India being 100 per cent ODF, the National Annual Rural Sanitation Survey 2018-19 found that 93.1 per cent of rural households had access to toilets and 96.5 per cent of them used the toilets. Around 10 per cent of the villages that were declared ODF, were actually not.

Many have criticised the mechanisms developed for declaring a village ODF. Gram panchayats are responsible for self-declaring the villages ODF and the state governments are responsible for verifying that status. It is up to the state governments whether to involve independent agencies or not. With no compulsion for independent verification, the integrity of the process might be undermined.

The focus for declaring villages ODF seems to be on the construction of the toilets but not on its actual usage. Behavioural factors also need to be considered, especially when it comes to matters of sanitation and hygiene.

Universal access to sanitation has implications not only for the health of populations but also for the economy. The WHO report, in its case study on India, states that the economic cost of poor sanitation, in the fiscal year 2018-19, was estimated to be 3.87 per cent of the Gross Value Added (GVA). This was in contrast to 9.7 per cent of GVA if the sanitation coverage would have been the same as in 2013-14.

The health benefits of sanitation are very obvious with diseases like worm infections, diarrhoea, cholera being prevented, which affect children the most. Sanitation can also reduce gender disparity in education. Many girls, especially in rural villages, have to drop out of schools due to the lack of toilets in the vicinity.

Road ahead

While the increase in sanitation coverage from 38.7 per cent in 2014 to 93.1 per cent in 2019 is commendable, the momentum needs to be maintained if India is to achieve the Sustainable Development Goal of access to adequate and equitable sanitation and hygiene for all and end open defecation by 2030.

The political will that has been shown by India through Swachch Bharat Abhiyan is something that will be needed in the long run. However, that has to be coupled with transparency and accountability. Behavioural change has to be pursued with rigour, because people in India have been practising open defecation since years and getting them to use toilets will not be as easy as it seems.

There have been reports about newly constructed toilets being used as storerooms or not being used due to lack of consistent water supply. A rounded approach which takes into consideration the aspects of health, society, and economy is needed to achieve universal access to sanitation truly.

(Sunila Dixit is a research analyst at The Takshashila Institution with an interest in various aspects of public health. She tweets at @SunilaDixit)

Disclaimer: The views expressed above are the author’s own. They do not necessarily reflect the views of DH.