South Asia has 900 million people without sanitation. The problem, as the success of recent total-sanitation community projects have demonstrated, is not a lack of funds but a lack of conviction amongst people that they need sanitation, and that they can meet those needs themselves
Ask anyone what holds back the provision of toilets - either in villages or towns - and in 99 cases out of a hundred, the answer is bound to be lack of funds, either on the part of the poor, or the State, or both. However, as experience after experience in rural and urban areas at the recent SACOSAN conference in Islamabad on sanitation in South Asia demonstrated, the real reason lies elsewhere.
More than the lack of funds, it is the lack of will to bring about this change that is impeding fuller coverage of sanitation. In the region as a whole, there are 900 million people without this most basic amenity, a third of the global total of the unserved. If people are convinced of the need, they can meet it, not necessarily from their personal income but as a community.
Kalyan Kar, an articulate proponent of this approach from the Water & Sanitation Programme of the World Bank in Delhi, has worked out a detailed modus operandi for this to happen. Wherever he goes in South Asia, he first enlists the cooperation of community leaders and assembles villagers at a meeting. Almost inevitably, the women are tackled. They are first asked to draw a large, crude map of the outline of their village on the ground. They are then encouraged to indicate their modest homes with a certain coloured piece of paper, which elicits a great deal of excitement, as the first such exercise ever in cartography.
Then comes the uncomfortable part. The women are asked to indicate, with yellow pieces of paper, where they, their men folk and children, defecate. Giggling and shamefacedly, they comply. Before they know it, right in front of their eyes, the surroundings of the village - and in the case of very small children, right within it - fill up with yellow, tell-tale markings. This visual exercise, rather than any amount of exhorting and appeals to logic, helps make villagers see how they are contaminating themselves in the bargain.
Because this process is not always visible, the impact of poor or a total lack of sanitation is not perceived as a health problem. As Kar emphasises, "We don't lecture them; they are fully aware of the situation: let them analyse it. We call this exercise the 'walk of shame'. Everybody measures their own 'output', and the largest families get the most derisive claps!"
India as a whole has to deal with 155,000 truckloads of faeces every day. And this takes an enormous toll of health, but since the source isn't usually visible, the problem goes unnoticed. As is only too well-known, water-borne diseases account for 80% of the total disease burden in the country. Every hour, 40 children die of diarrhoea here.
Kar puts it much more bluntly, to jog development experts out of their apathy regarding this enormous crisis. "Such participatory research analysis reveals to villagers that they are eating each other's shit." There is nowhere to dispose of it in a typical, reasonably densely populated, village. In Bahirwadi village in Ahmednagar district, for instance, people were asked where they went when they had diarrhoea. Since they couldn't go far from the village in that condition, they simply defecated around someone else's home.
And yet, the taboos regarding defecation are so strong that everybody would rather not think about it. In Indonesia, villagers thought nothing of defecating and bathing in the same river, till the implications of what they were doing were brought home to them. On the other hand, Kar cites how he met a well-to-do Haryana farmer, who used to take his entire family out to the outlying areas in his Maruti to perform their morning ablutions. Asked why, "We are poor people," he replied. Kar, in his inimitable fashion, likens this to mental poverty or constipation.
In a paper he co-wrote for the Institute of Development Studies in Sussex this April as an update on some recent developments in community-led total sanitation, he underlines the successes the approach has had in India, Bangladesh and Nepal, along with Cambodia, China and Indonesia. However, these experts cite governments caught in the mindset of providing subsidies as one of the major obstacles towards reaching the UN Millennium Development Goal of halving those without sanitation - 2.4 billion people - by 2015. A conference on Women & Sanitation in South Asia this March at the Rajiv Gandhi Foundation in Delhi summed up this approach as one which concentrates only on "taps and toilets".
There is a danger that in the haste to get developing countries - particularly those in sub-Saharan Africa - to meet their sanitation coverage targets, donors will allocate more funds for such subsidies. NGOs working in this sector have long pointed out that building a toilet is less than half the battle: maintaining it, particularly without an adequate supply of water, is even more challenging. In India, critics have time and again pointed to the anomalies in remote rural areas where expensive toilets have been built only to be abandoned when these are unusable due to lack of maintenance or, especially when they are tiled, used to store household objects as the best built part of a house!
Journalists attending SACOSAN were taken to a village called Sereh, 35 km from Islamabad, which has adopted a community-led approach. Of course, situated in the Punjab, these villages are fairly well-off, since the entire district is irrigated. Even so, the Community Uplift Programme has succeeded in providing virtually every household with a small toilet within their modest dwellings. The wastewater is recyled by treating it and using it to irrigate nearby fields. Sanitation is thus one of the elements which have combined to alleviate poverty in the village, where women have been trained in skills like tailoring.
In India, Maharashtra and West Bengal have been two states at the forefront in adopting this approach. The Water & Sanitation Programme has been working in Ahmednagar and Nanded, Maharashtra, since 2003. Two pilot projects succeeded in making their communities free of open defecation. This has now spread to all districts. Once they are declared free of open defecation, gram panchayats are given incentives in the form of a reward or Nirmal Gram Puruskar from the government. These range from Rs 2 lakh for the smallest panchayat to Rs 50 lakh for the biggest district. But more than the money, it is the honour of going to Delhi to receive the award at the hands of the President that is the main incentive.
In Maharashtra, two other blocks - Mahabaleshwar in Satara district and Murud in Raigad - have also attained this status. When the central government awarded 770 gram panchayats the Nirmal Gram Puruskar in March 2006, 381 were from Maharashtra. In Nanded, there have been innovations in providing bathing areas and proper drainage too. Midnapore in West Bengal and South Tripura - not areas which one normally associates with rapid advancement - are in the running to become the first districts to breast the tape. It is also a comment on much more economically prosperous states like Punjab and Haryana, which are backward in this respect. The irony is that 70% of rural homes in some states have TVs but less than 40% have toilets, which only underlines how it isn't a matter of affordability so much as a mindset.
Kar notes the catalytic role of children in reporting cases of open defecation in and around villages. They chant slogans when someone is caught in the act and often, children have shamed their parents and superiors in this regard. As Kar reports: "When members of the community - particularly women and adolescent girls - listen to the slogans and see the spirit of the procession, they begin to think about the issue." When toilets are provided in schools, attendance rises rapidly. Children are truly the agents of change.
Perhaps the only urban body where the community-led approach is being practised is in Kalyani municipality near Kolkata, which comprises 52 slums. The Chairman, Dr Shantanu Jha, initiated such a project with an organisation called Kolkata Urban Services for the Poor. West Bengal as a whole is doing well in sanitation coverage. This columnist can recall a cartoon displayed by the state government minister who attended the Global WASH (Water, Sanitation & Hygiene for All) Forum in Dakar in November 2004, depicting a man with a toilet hovering over his head, indicating that it was being imposed on him. Instead, it calls for a bottom-up approach (pardon the pun!).
As a whole, however, sanitation is not getting the priority it deserves in the country, despite proactive initiatives by the Union Rural Development Minister, Raghuvansh Prasad Singh. Controversially, this RJD politician raised several hackles when he proposed that only those with toilets in their homes should be allowed to contest gram panchayat elections. As he told Outlook magazine this July, "A toilet or the lack of it is the indicator of a country's health, not the GDP or Sensex." He has vowed to make every village free of open defecation by 2012, three years ahead of the world deadline. The annual budget for the Total Sanitation Campaign has risen from Rs 165 crore in 2003-04 to Rs 800 crore in the current year. Undoubtedly, he is unlikely to succeed in his mission.
Doing entirely without subsidies may prove difficult in very poor states like Orissa, where some innovations are called for. An NGO called Gram Vikas has been working in backward districts for two decades and has launched a successful Rural Health & Environment Programme. Social inclusion is the crux here: the programme cannot work unless every family participates in it. Gram Vikas insists on full participation, the contribution of Rs 1,000 per household, the construction of a toilet before water supply starts, and the provision of a bathing room and tap in the kitchen.
When poorer families find it difficult, women "inclusion ambassadors" persuade the better-off to contribute more and lower what the poor have to pay to the corpus. This money is invested and the interest used to fund the water and sanitation schemes. This arrangement permits the community to manage its resources. In the water and sanitation projects, communities bear a third of the capital cost, half is obtained from the government and Gram Vikas provides the rest, which works out to a viable collaboration. The community attempts to tap the local development funds available with local elected representatives. On an average, Gram Vikas provides Rs 4,000 for a family towards constructing a toilet and bathing room, considered "social cost".
While Gram Vikas has been criticised for providing an expensive option, Director Joe Madiath counters this by pointing out that the success marked in West Bengal is unrealistic because the standards are unacceptably low. As he told the Delhi-based NGO WaterIndia, in a compilation for SACOSAN: "I challenge anyone to use these toilets and be happy with them. Why do we advocate something which we wouldn't use ourselves? And why should we subsidise sanitation in cities for ever and ever?"
Thus, despite such differences, there are certain trends which are clearly emerging in sanitation coverage. One is the movement towards stopping open defecation - which calls for social mobilisation - rather than building toilets per se, which involves hardware. Second is an emphasis on hygiene - again a social factor - which relates to cleanliness, odour and privacy, with health as the outcome. Third is the provision of design options, suiting the environment and local materials, not the 'one size fits all' approach. For instance, in deltaic areas which are prone to flooding, such as parts of West Bengal, the designs must incorporate such realities.
Last, but by no means least, people's sensibilities must always be taken into consideration. The World Bank had inadvisedly tried to introduce a hand-washing experiment with MNCs which provided tablets of soap free of charge in Kerala and Ghana. Not only was the initiative accused of promoting the MNCs' interests but it rankled in the minds of Keralites, who thought they were being patronised by being preached at about hygiene. The project had to be called off there.
InfoChange News & Features, October 2006