The dust has settled (literally) after the October 2 sweeping gesture by politicians from the Prime Minister to local MLAs and we are back to business as usual. Dirty villages, towns and cities and the “swachata” is compounded by ope defaecation – a country that is one big shauchalya rather than swachalya! The sanitation problem of open defaecation and its effect on malnutrition, stunting has been debated extensively but there is no visible impact on the ground. Rural families interested in building toilets continue to run around for financial and technical support. Any Government support for construction of toilets requires that the CPHEEO manual’s design be followed – complex, water intensive and expensive. So what is the solution? How can we, seriously, address this problem of open defaecation? There are two studies that must be consulted and taken seriously both by planners and those working on the ground in the area of sanitation: the first is a paper in EPW by Diane Coffey and others. It provides very valuable insight into revealed preference for open defaecation through a survey of rural areas in some states of North India. This paper clearly shows the need for a region and state specific strategy taking into consideration local attitudes and preferences rather than merely focussing on infrastructure. The study urges the need for a large-scale campaign to promote latrine use together with investing in infrastructure (http://www.epw.in/system/files/SA_XLIX_38_200914_Diane_Coffey_ Aashish_Gupta_Payal_Hathi_ Nidhi_Khurana_Dean_Spears_Nikhil_Srivastav_ Sangita_Vyas.pdf). The survey reports that – “Many survey respondents’ behaviour reveals a preference for open defecation: over 40% of households with a working latrine have at least one member who defecates in the open. Our data predict that if the government were to build a latrine for every rural household that lacks one, without changing sanitation preferences, most people in our sample in these states would nevertheless defecate in the open. Policymakers in India must lead a large-scale campaign to promote latrine use.” What works in the Southern States may not work in the Northern States and the Western and Eastern States may require a different strategy.
Another study that must be looked at seriously is a recent paper published in the medical journal Lancet by researchers from Emory University in the United States. They found that increased toilet coverage did not lead to any significant improvements in the occurrence of child diarrhoea, prevalence of parasitic worm infections, child stunting or child mortality (http://www.thehindu.com/news/national/increased-toilet-coverage-has-little-health-impact-study/article6486660.ece). This new evidence is indeed troubling given India’s 25 year strategy that has focussed mainly on building toilets. The researchers have indicated that the absence of health impact could be “the patchy implementation of the scheme, and uneven rates of use of toilets — at the end of the study period, just 63 per cent of households in the villages where the scheme ran had any toilet, and two-thirds of this group reported a family member using the toilet. Usage was substantially lower among men than among women”. This gender difference was also notes in the study of the Northern States.