Inadequate sanitation costs India $54 billion a year. To that, add the challenge of juggling our nationalistic aspirations of superpowerdom with the ignominy of housing the largest share of human population that defecates in the open.
Amid many reports that the Swachh Bharat Abhiyan (SBA) is failing, we need a dose of optimism. While SBA might be failing, it certainly isn’t the first, nor will it be the last state-led sanitation programme to fail in India. Our large schemes to tackle this challenge have, more often than not, ended up as models of just what one should avoid doing if they are serious about bringing about total sanitation.
It is now widely acknowledged that conventional approaches are not working: those that set up a false dichotomy between construction and behaviour change; those that are content with pit latrines as opposed to functional toilets; those that use reductionist conceptions such as communities being open defecation free rather than focusing on personal and environmental sanitation and hygiene as a whole; and those that settle for incremental coverage instead of full coverage from the start.
However, it’s not that there are no success stories within India or in our immediate neighbourhood. For one, the experiences of locally-embedded NGOs that have taken their interventions to scale can be highly instructive. There have also been state-led successes in Maharashtra and Himachal Pradesh that can offer valuable lessons. So what could some key design elements in a sanitation programme be?
First, do not approach communities with a single message (build and use toilets), but with a comprehensive health and hygiene intervention. Gram Vikas, an Odisha-based NGO, approaches communities with a package of interventions: a toilet and bathing room, and a community-level overhead tank to provide piped water supply to all houses through three taps (one each in the toilet, bathing room and kitchen). The community engagement should start with the promotion of individual level, household level and environmental sanitation. This will automatically place an emphasis on the participation of every household in the community. Also, talk about menstrual hygiene. Doing this makes the programme one that talks to communities about their lifestyles, health, livelihoods and dignity, rather than just about toilets.
Second, instead of being subsidy-averse, be ready to experiment until you get the design right. Recent research in Bangladesh shows that a subsidy helps overcome barriers to sanitation that cannot be overcome by information campaigns alone. Specifically, they find that joint investment commitments from a community accompanied with subsidies targeted at the poorest families helps increase take-up. The same is the experience in Maharashtra under a state-led sanitation programme. The popular failings of subsidies in India have been due to a combination of mis-targeting, poor community buy-in and shoddy construction. However, an optimal level of financial assistance and delivery should continue to be part of the policy design and implementation strategy.
Third, play on local power relations. Messages targeted at young women encouraging them to demand that toilets be available in households they marry into seem to have worked in many places. On the other hand, it is important to ensure that messages targeting women and girls are not misinterpreted in patriarchal societies that usually make up the audience. Supporting the poorest households (who are also likely to lower caste groups) can also translate into social pressure on the rich (and upper caste) households to catch up in terms of adopting safe sanitation practices.
Fourth, allow communities to evolve their own norms around individual and collective rights and responsibilities. As the water and sanitation infrastructure is being built up, gram sabhas should deliberate about shared codes of conduct and keeping the campaign to promote toilet usage running. While one may not be in favour of local norms that border on coercion, it is best to allow time for shared norms to evolve.
Fifth, do not hurry into scaling up: Yes, big numbers are important in a vast country like India. However, all too often, organisations in a rush to scale up end up compromising on key design elements that made their pilots a success. This is a typical problem with sanitation programmes. When communities become aware of the ‘target-pressures’ on the field staff, it gives them undue bargaining capacity. In an attempt to hasten their work, staff also focus more on the ‘hardware’, ignoring the critical ‘software’.
Sixth, and perhaps most important, be conscientious about quality. The poor do not deserve poor solutions to be thrust upon them. When designing a communications campaign, do not insult the intelligence of the communities you are working with. When constructing toilets, pay utmost attention to technical specifications.
One may be tempted to say that these are impossible conditions for a large-scale state-led programme to pull off. In each of these six components outlined above, it is important to integrate a dose of experiential learning and evidence-informed decision-making. It is critical that implementers are responsive to the dynamic context. The successful sanitation practitioners bring with them years of experience of engagement with informal institutions, local governance structures and local institutions such as schools, clinics and anganwadi centres.
A clear message from years of failure is that technocratic and reductionist approaches will struggle on the ground. Transformative change requires a willingness to work with local politics, allowing for interventions to take root and mature, and an evidence-informed learning approach that eschews pre-conceived biases. A fully decentralised system of implementation is non-negotiable. Only then will we start making progress towards the goal of ‘Swachh Bharat’.
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