A household survey shows that they don’t think using a toilet is good for their health, pointing to the need for sanitation policies that focus on changing attitudes rather than just building latrines, says Sangita Vyas.
The Bharatiya Janata Party (BJP)’s manifesto says it will “Create an open defecation-free India by awareness campaign and enabling people to build toilets in their home as well as in schools and public places,” and it sets the target of a Swachh Bharat by 2019.
It is right that the BJP should emphasise the importance of sanitation in today’s India, and should set goals by which to measure progress.
In order to deliver on this goal, though, the new government should learn from past failures, and recognise that policies to address open defecation should be tailored to Indians’ attitudes towards sanitation.
More recently, statements by Team Modi have suggested that the government may pursue a sanitation policy much the same as the United Progressive Alliance: a policy of building toilets. Although there are certainly some people who would benefit from such a scheme, the data suggest that most Indians could already afford to build a sanitary latrine if they wanted to.
Does this mean that there is nothing for the government to do to improve sanitation? Far from it!
Exactly because so many people in rural India are satisfied about defecating in the open, the new prime minister will only meet his goal if he can create a social movement that changes people’s attitudes, and builds demand for toilet use.
How do we know that money isn’t the problem? Nepal, for instance, has a gross domestic product per capita of roughly one-third of India’s. In the 2005-2006 Demographic and Health Surveys (DHS) for both countries, 47 per cent of households in India had a dirt floor compared to 73 per cent in Nepal.
Yet, sanitation facilities among the poor in Nepal were more prevalent than among the poor in India. Households with a dirt floor in Nepal were twice as likely to have a latrine compared to such households in India.
Moreover, Nepal’s rate of sanitation coverage has increased much more rapidly than India’s in the six years after these surveys. In 2005-2006, 55 per cent of households did not have a toilet, a statistic that had hardly changed in the 2011 Census.
In Nepal, however, 51 per cent did not have a toilet in the 2006 DHS, and since then, the lack of access to sanitation facilities decreased to 36 per cent in the 2011 DHS, a striking reduction in just five years.
What is remarkable is that much of Nepal’s improvement in sanitation did not come about because the government started building toilets for people. In fact, in Nepal’s Sanitation and Hygiene Master Plan, which was in the making for five years and ultimately finalised in 2011, there is no provision for subsidising toilet construction except for the ultra-poor.
So if poor people in Nepal can afford a toilet, why do we see a much richer country like India making so little progress on sanitation?
Over the past six months, we have visited over 3,500 rural households across six states in northern India, talking to people about where they defecate and what they think about it.
What we have found is that sanitation is just not a priority among many rural households.
Many Indians don’t think that using a toilet is good for their health: half of the respondents in our survey who don’t have a toilet believe that defecating in the open is the same or better for health than going in a latrine.
It doesn’t help that rural Indians have a very expensive idea of what constitutes a toilet. For many people in rural India, a toilet is either a large cement septic tank with a cement superstructure, or a field.
The preference for fancy latrines with a large pit is perhaps why so many of the latrines built by the government remain unused. Fully, 56 per cent of households in our sample reported that at least someone in their family still regularly defecated in the open, even though they had a government latrine.
In contrast, when we visited Nepal’s Terai region last month, we met a number of people who had constructed inexpensive latrines with cement rings and simple, kaccha, superstructures. Inexpensive latrines like this are almost impossible to find in India.
Sanitation policy needs a radical restructuring in India. Although there are some people, for instance, the elderly and disabled, who would use a toilet if the government built them one, just building toilets won’t work for most people because a lack of money is not the main barrier to adoption, people’s attitudes are.
What India needs is a concerted effort to change the attitudes and behaviours of its citizens to get them out of the fields and into the simple but sanitary toilets they can already afford.
Nepal has perhaps been so successful because it launched a full-on sanitation movement with commitment at the highest level of government. Ram Baran Yadav, Nepal’s President, has even presided over district open defecation-free celebrations.
If Modi did the same in India, there’s no doubt that people would start paying attention to sanitation. Even villagers in remote districts of Nepal’s Terai region had heard about Modi’s development agenda. If Modi’s election message spread that far, so can his message on sanitation.
The writer is Associate Director of Sanitation at RICE, an organisation focused on research and policy advocacy around issues affecting child and maternal health in India.