Why it is so hard to fix India’s sanitation?

One in ten deaths in the country is linked to poor hygiene standards

INDIA vies with China to be the world’s fastest-growing large economy, but its record on basic sanitation is dreadful. Around 450m people relieve themselves in playgrounds, behind trees, by roadsides, and on railway tracks and river banks. In cities 157m urban dwellers, more than the population of Russia, lack decent toilet facilities. Much of the solid waste is emptied into rivers, lakes and ponds untreated.

The World Bank links one in ten deaths in India to poor sanitation. From contaminated groundwater children pick up chronic infections that impair their bodies’ ability to absorb nutrients. Almost 44m children under five, says the bank, have stunted growth, and every year over 300,000 die from diarrheal diseases. What can India do to change this grim reality?

In 2014 the government pledged to end open defecation by 2019. That year marks the 150th anniversary of the birth of Mahatma Gandhi, who considered sanitation to be sacred and “more important than political freedom”. Authorities have set aside $29bn for the nationwide programme, which claims to have constructed 49m household toilets to date, with another 61m still to go. Families get 12,000 rupees ($187) to build a toilet. The initiative is part of a long line of programmes that go back to the country’s first five-year plan of the early 1950s. The Indian government has been subsidising lavatories in remote villages for over three decades. Between 1986 and 1999 it installed 9.4m latrines, giving 7.4m more people access to sanitation every year. But improved coverage does not guarantee greater usage. A survey by the Research Institute for Compassionate Economics in 2014 found that in 40% of households with a working toilet, at least one family member preferred to defecate outside.

People in villages often fail to acknowledge that a lack of sanitation is a problem. Many use toilets only in emergencies, worrying that the pits will clog up quickly when, in fact, they are meant to last a family of five about ten years. Caste division plays a part, too. Villagers are loth to empty latrine pits manually, a task relegated historically to dalits (formerly untouchables). Some consider defecating in the open to be a sign of virility, and believe a stroll to the fields aids digestion. Toilets, often the only concrete structure in the house, are used as a storeroom for firewood, grass, chickens, cow-dung cakes and food grains, or double up as goat-sheds or even temples. On-ground implementation is patchy, too. Families who receive a toilet-building subsidy do not always build one. Often the sarpanch (village head), the junior engineer who surveys the site and the local contractor are in cahoots and skimp on building materials and design, says Nitya Jacob, a sanitation consultant. 

Simply punching holes in the ground at breakneck speed will not solve the problem. India could learn from neighbouring Bangladesh, which reduced open defecation from 34% to 1% between 1990 and 2015. As part of a sustained effort, its government partnered with village councils to educate people in the merits of good sanitation. Instead of just highlighting the hazards of open defecation, it extolled the virtues of clean sanitation. Having a toilet became a symbol of dignity. Women decided on the location and type of toilets to be built in their homes. In India, on the other hand, officials have at times brutally punished those who defecate outside. Some have been beaten up, and a few others have been denied government benefits like pensions and monthly household provisions unless they build a toilet at home. In the short run such coercive tactics might work to increase the number of installed toilets, but they will do little to promote their use.