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By Darryl D'Monte

700 million Indians have cell phones, but 638 million still don’t have access to proper sanitation. At this year’s South Asian Conference on Sanitation, social solutions to the problem were discussed, including “naming and shaming” and the CLTS programme which gets villagers to map the open areas where they defecate

There can hardly be a bigger taboo than sanitation when it comes to the government, bureaucracy or even the people themselves. Nobody wants to know how human waste is disposed of; in many cases, it simply isn’t. However, there is a small but growing band of international and national NGOs and multilateral institutions that’s homing in on the problem, which may well begin by naming it “shit” instead of the more polite “excrement”.

South Asia is the worst off in the entire world in this respect and, within it, India by far the biggest offender when it comes to sheer numbers. The fourth major South Asian conclave known as SACOSAN (South Asian Conference on Sanitation) was held in Colombo recently. It began in Dhaka, in 2003, and then Islamabad and Delhi in 2008. It has proved a useful exercise in stocktaking.

As is well-known, the United Nations has laid down several Millennium Development Goals which seek to halve the number of people deprived in the world of specific basic amenities, by 2015. Sanitation is set to be the biggest stumbling block. Around 2.6 billion people in the world do not have access to a toilet, of which 72% live in Asia. Only Sri Lanka, which expects to cover 85% of its population by 2015, and the Maldives are on track to meeting this UN goal.

A speaker at SACOSAN put the issue in perspective when he pointed to the paradox that while some 700 million people have cell phones in India, as many as 638 million people have to make do without sanitation. That too when the country is registering near double-digit growth.

Nobody has drawn the connection between poor sanitation and hygiene which is taking a terrible toll on health. As the India Country Paper at SACOSAN is candid enough to admit, it is estimated that one in every 10 deaths in the country is attributable to this lack. Indeed, diarrhoea, which is a preventable disease, is the biggest killer (more than tuberculosis, contrary to the public perception), accounting for one in every 20 deaths. In 2006, it is believed to have caused 450,000 deaths, of which nearly 90% were of children under 5 years of age.

If figures of this colossal magnitude still do not shake people out of their complacency about the human cost of the lack of sanitation, the economic figures corroborate the dismal story. According to the Water and Sanitation Programme of the World Bank, the adverse economic impact of inadequate sanitation in India in 2006 was in the order of Rs 2.4 lakh crore, or $53.8 billion. In per capita terms, this works out to Rs 2,180 per person. And, it accounts for a staggering 6.4% of GDP. All of this is preventable.

To those who argue that India doesn’t have the funds to combat poor sanitation, the counter argument is that the nation is already bearing a huge economic loss, hence it makes no sense not to invest in this sector as a topmost priority.

As speaker after speaker at SACOSAN argued, it is not so much the provision of hardware -- toilets and taps -- as “software” which can make the difference. In other words, it takes political and social solutions to transform the sector, more than the conventional development approach. Thus, in Maharashtra, as a state government official pointed out, there is now a law which debars anyone who does not have a toilet from contesting gram panchayat elections in future. Such “naming and shaming”, however provocative it may seem at first, is necessary to galvanise people, particularly in rural areas. As of July 2010, the UN has recognised safe water and sanitation as a human right. Countries should take their cue from this.

Official data put the sanitation coverage of villages in India at 68% in 2010, although it goes without saying that several toilets have been built but have fallen into disuse due to lack of water and maintenance. In certain areas they are used for entirely different purposes like keeping goats or stacking firewood. It is difficult to change people’s behaviour, and the practice of open defecation is centuries-old. However, it camouflages the social reality that women are the first to suffer from this deprivation, which experts term “imprisonment by daylight”. In Haryana, which has the worst sex ratio in the country, women have taken the lead in several villages to have a toilet installed in their homes.

Officially, three-quarters of the country’s urban population is estimated to have access to sanitation. Around half have individual toilets and 24% share facilities. As many as 18% of people in cities defecate out in the open. Using 2001 data, there are an estimated 30 million urban dwellers that do not have access to toilets; this is expected to rise to 40 million in 2011. Slums are a major problem due to the lack of space to build facilities. The social service organisation, Sulabh International, has catered to slum pockets in some cities, even with mobile toilets to overcome the shortage of space. The government enacted a National Urban Sanitation Policy in 2008 and cities are being rated from May last year. At last count, only four out of 423 made the grade.

There are schemes like the Total Sanitation Campaign, launched in 1999, and the Nirmal Gram Puruskar, initiated in 2003, under which villages that are “open defecation free” are awarded every year with a cash prize, given away by the President in the national capital. However, after an initial burst of enthusiasm with the Puruskar, many villages that received the award have since slipped, somewhat like India’s total literacy campaign. While India may take credit for bringing sanitation to 315 million people between 1990 and 2008, the government simply cannot keep pace with the growing population.

Multilateral institutions have crunched the figures of coverage in South Asian countries and found that while the rich always enjoyed access to sanitation, the lowest two percentiles are almost as badly off as they were two decades ago. In India, the middle class has gained access. There are other indices of deprivation in this country: tribals and dalits still fare the worst. In certain schools, SACOSAN heard, dalit boys are made to clean toilets.

An entire session was devoted to “reaching the unserved”. Even in Sri Lanka, 1 million schoolchildren have no access to sanitation. A speaker recommended that in South Asia, in future, no school should be built without toilets. This acquires utmost urgency for girls who are reaching puberty, with menstrual hygiene being an even bigger taboo than sanitation per se. The Maharashtra government official cited how, in certain water supply projects, women’s groups had taken over the maintenance, and also initiated income-generating activities. One of these was to make inexpensive sanitary napkins in zilla parishad schools, which are sold for Rs 1-2 a piece.

Before SACOSAN, the London-based international NGO WaterAid, in collaboration with other partners, brought out a “Traffic Lights” score sheet for India’s progress on sanitation, using the colours at traffic signals. This was based on the perceptions of NGOs working in the sector. Thus, green indicates that more can be done, yellow that progress is not what it should be, while red indicates that there are roadblocks ahead. Most of India’s indicators received a green signal, though the scorers were liberal -- perhaps afraid of stepping on the toes of the biggest country in South Asia! -- in altering some red scores to yellow.

On the all-important issue of whether the Indian government has initiated any steps after the Delhi SACOSAN on including the right to water and sanitation in the Constitution, India received a yellow. It has signed the UN resolution to this effect, while a working sub-group on drinking water and sanitation for the 12th Five-Year Plan is giving its recommendations on the issue. However, there has been no progress on including this right in the nation’s Constitution; these rights are not even mentioned in the National Water Policy document. There are only “some vague references” to them in the National Drinking Water Guidelines.

On whether any special moves have been made to reach the unserved -- particularly vulnerable sections like women, socially and economically deprived people -- India again gets a yellow light. At SACOSAN, a speaker mentioned how as many as 10% of South Asia’s population suffers from some form of physical disability, including HIV/AIDS, which is presumably much higher than in other countries. The health ministry has been monitoring the progress of sanitation in areas dominated by scheduled castes, tribes and minorities. It has also started a programme to distribute sanitary napkins in 200 districts.

SACOSAN was flexible enough to include outstanding performers in the sanitation sector. From India, Kusam Rajamouli, sarpanch of Gangadevipally village in Warangal district, Andhra Pradesh, related his experience, which had to be translated from Telugu. In 10 years, the gram panchayat had been completely represented by women, with the one exception. The village enjoyed total sanitation and uninterrupted water supply. All the children were enrolled in school. Gangadevipally has received 14 awards, including the Nirmal Gram Puruskar and a Google award worth Rs 5 lakh. People from neighbouring villages visited it to find out how it had managed to achieve these wonders!

Rajamouli stressed five points. Water and sanitation had to be asserted as a human right. Villagers had to share the responsibility of providing these amenities (“they have to be crazy about it, like they are about cricket!” he said). The village had to draw up a micro-plan and obtain government support. The gram panchayat lacked funds, which had to be remedied. And, finally, there were many obstacles in the way of obtaining funds.

Several speakers referred to the omission of the innovative approach towards achieving goals known as “Community-Led Total Sanitation” or CLTS. A leading exponent, who runs a CLTS Foundation in Kolkata, is Dr Kamal Kar, who has propagated the technique throughout Asia and other continents. For some reason, many multilateral development organisations and international NGOs did not mention CLTS, although they endorsed the approach in general. This drew a sharp comment from, among others, Dr Robert Chambers, a veteran economist from the Institute of Development Studies at Sussex in the UK.

The approach resembles a street play, to some extent. “Conscientisers” visit a village and ask those who are present to gather in an open area. Usually, since the men are at work in the fields, it is the women who assemble. They are then asked to draw the outline of the village with a stick on the bare ground. This causes considerable excitement and debate among the instant cartographers.

Next, they are asked to indicate where their houses are, using a pinch of white powder, which is provided. There is more merriment among the villagers who try and locate their dwellings on the ground. Then, the CLTS person pulls out a bottle of yellow turmeric powder, and asks the women to indicate on the map where in the village they defecate. Obviously, there is a great deal of resistance to this move and the women have to be cajoled into cooperating.

But the exercise is not quite over yet. They are asked to mark where their children defecate when they have diarrhoea, which is obviously closer to their dwellings as the children are unable to walk the distance. The CLTS person then asks for a glass of water, into which he drops a pinch of turmeric powder and offers it to anyone to drink. Having associated the powder with excrement, there are no takers. The conscientiser tells them that this is actually what they drink every day of their lives, since they are defecating near water sources close to their villages. The message quickly sinks in.

At a national level, India would do well to study how Bangladesh has been able to take bigger strides in the sanitation sector, given that Sri Lanka is far ahead in its human development indices. It has to do with greater mobilisation of communities, and, not least, women’s empowerment. That should be a sobering thought for this country, considering it thinks of Bangladesh as something of a basket case.

Read earlier reports by Darryl D’Monte on SACOSAN at The-crow-and-the-broom-Progress-on-sanitation-in-the-South.html and A-bottom-up-approach-to-sanitation.html

Infochange News & Features, April 2011