Skills 2015: International Conference

Introduction

Step 1: 

Step 2: 

Step 3:

India has a problem with toilets: Every second person relieves themselves outdoors, a centuries-old practice that contributes to child malnutrition, economic loss and evenviolence against women.
It’s a problem that India’s Prime Minister NarendraModi wants to fix by making sure every home in the country has a toilet of its own by 2019.

The answer though, sanitation experts say, doesn’t lie only in building more bathrooms. First, people need to learn to love using the latrine.

“Many people regard open defecation as part of a wholesome, healthy, virtuous life,” a recent study conducted in Bihar, Haryana, Madhya Pradesh, Rajasthan and Uttar Pradesh found.  Researchers at the New Delhi-based Research Institute for Compassionate Economics added that the practice is “not widely recognized among rural north Indians as a threat to health.”

Those five northern Indian states account for 45% of the country’s households without a toilet, according to data from the 2011 census. But even in homes where toilets were installed, many people still prefer to go outside.

The RICE study found that out of 3,235 rural homes, 43% had a working toilet. Of those, over 40% had at least one member of the household who nevertheless opted to defecate in the open. When asked why, almost 75% said they did so because it was pleasurable, comfortable and convenient.
The government says it has recognized that it needs to address this mindset making it “top priority” while setting out to build 110 million new toilets across swathes of rural India in the next few years.
The full policy has so far not been published but will include a door-to-door campaign similar to that used in the eradication of polio.

When you get down to brass tacks though, the picture looks slightly less positive.
To build toilets across India’s cities and villages, over $30 billion has been earmarked, a large chunk of it provided by the federal government.

But only 8% of this money will go towards what the government calls “information, education and communication,” or IEC.

Experts say that’s too little.

“I would spend at least half of the money on IEC,” said SantoshMehrotra, a professor of economics at New Delhi’s Jawaharlal Nehru University.

“The IEC strategy is the heart and soul of a sanitation scheme to bring real change on the ground,” he added.
Previous sanitation programs in India have failed to spend all the money allocated.

SangitaVyas, one of the authors of the RICE study, said this is partly because of the red tape involved in getting education campaigns approved. She worries it will be the same for Mr. Modi’s new mission.

When the money is spent, it’s not all being put to good use: Researchers point out that the government has failed to inform people about the adverse health effects of open defecation as it has done in campaigns to reduce tobacco and alcohol consumption.

In the past, India has also relied on subsidies to get people to embrace toilets and handouts will play a big part in the new program, Mr. Mehrotra added.

The result? “Toilets that are not being used for what they are meant for and instead are made into storage rooms,” he said. “With subsidies, they go back to their bad habits after they have received the prize.”

India could learn from its neighbor Bangladesh when it comes to eradicating open defecation without relying on incentives.

In 2000, that country introduced a program in which health workers would encourage communities to identify the consequences of poor sanitation, spurring them to want to build toilets for themselves. The focus was to alter behavior before building the infrastructure to accommodate the change.
Known as community-led total sanitation and pioneered by Indian-born development consultant Kamal Kar, it is now in place in more than 50 countries, including in parts of India.

The method has reduced the number of people in Bangladesh defecating in the open from 19% in 2000 to 3% in 2012.

But it’s not perfect. CLTS does not define what makes a good toilet and regards access to a toilet, even a poorly built one, as better than not using one at all. Often in Bangladesh, a toilet can be just a shallow pit covered by two wooden planks. This pit is able to store human waste, but is often washed away during heavy rains and floods, increasing the risk of contracting diseases like diarrhea and cholera. That’s why the focus there has now shifted to manage the disposal of waste collected in the country’s toilets.

In India, the challenge remains to get people to use them at all.

In the village where two girls were gang-raped and hanged earlier this year, toilets may help protect women and health

In the evening gloom of their dirt courtyard, Raj Beti and her six daughters are growing desperate. They last answered nature's call 13 hours ago, but it's not yet dark enough to venture into the fields.
For generations, most of the 750 families in Katra, in Uttar Pradesh, northern India, have lived without toilets. They've grown used to holding their bladders and bowels, being stalked by wild boars and hyenas and, during the rainy season, watching out for snakes.

But since 27 May, when two girls, 14 and 15, were found gang raped and hanged after they went to relieve themselves in the dark, Katra's residents have been gripped by a new fear.
"There are no crops now, nowhere to hide, and men can see us from all sides," explains Raj Beti, as a teenage daughter stirs a potato curry over a wood fire, while her youngest, Soumya, two, plays hide and seek in a tattered Teletubbies dress. "We don't know who's watching, who's waiting for us."


Since the murders, the dead girls' families have a police escort when they use the fields, but millions of other Indian villagers and slum dwellers do not have that luxury.

India leads the world in open defecation. At least 636 million Indians lack toilets, according to the latest census data, a crisis that contributes to disease, childhood malnutrition, loss of economic output and, as highlighted recently, violence against women.

The issue is so critical that it featured prominently in NarendraModi's first Independence Day speech, in which the prime minister said India should ensure there were toilets for all within four years. "We are in the 21st century and yet there is still no dignity for women as they have to go out in the open to defecate and they have to wait for darkness to fall," Modi said. "Can you imagine the number of problems they have to face because of this?"

India's government has allocated nearly £1bn over five years to build toilets, but a tour of Katra shows the money has made little difference.



In Maya Devi's home, the bowl of the government-built latrine is cracked and the cubicle's door has blown off. But poor aesthetics are not the main problem. "The pit is full," said Maya Devi. "We don't know how to empty it so we've started using the fields again."

Advertisement

However, help is on the way. Spurred by private donors worldwide reacting to the murders, the charity Sulabh International, which builds pay-as-you-go lavatories in India's urban slums, has pledged to provide more than 400 toilets in Katra. Ramesh Mishra, a civil engineer, has been posted in the village for the past month, overseeing construction of the first 108 composting toilets in the poorest homes. Each one is designed to be used with minimal water, to be easily cleanable with stone floors and tiled walls, and to last for decades without any special maintenance.

Mishra has become Katra's most popular man and is trailed wherever he goes. "I have six daughters," Raj Beti harangues him. "You're building toilets for others, why not me?"

"It's unfortunate that it took a terrible crime to change attitudes," Mishra said, explaining that some villagers will have to wait for the next phase of construction. "But at least now they all want toilets."
Across the rest of India, promoting toilet use is still a struggle. A survey released in June showed that 40% of households with a working latrine still had at least one person who regularly defecates in the open and that half of them said they did so because it was pleasurable, comfortable and convenient.

"Among women, toilets figure in the top three needs for their own security and health," said HariMenon, deputy director of India programmes for the Gates Foundation. "It's a much bigger problem with the men. They see their responsibility as just building a toilet, not using it."


Experts say India's emphasis must shift to educating people on the need for better sanitation.
Advertisement

"In India, a large, hierarchical bureaucracy is attempting to do a job that a good advertising agency could do," said YaminiAiyar, from the Accountability Initiative of the Centre for Policy Research in New Delhi.

She points to simple educational tools that could be employed.

"There are tiny strips available to test bacterial contamination of water. You dip it and it will go from being totally clean to completely black, which powerfully illustrates to people that there is really something wrong with their water if they don't practise sanitation," Aiyar said.

India could also learn valuable lessons from poorer neighbours such as Bangladesh, which has cut rates of open defecation from 19% to 3% in just two years by decentralising sanitation programmes.
The UN's eight millennium development goals include halving the proportion of people who do not have access to sanitation facilities by 2015. But India's high open defecation rates have slowed down progress.

There are few organisations like Sulabh with the expertise necessary to build low-cost, environmentally sound and user-friendly toilets. To spread sanitation, Sulabh's founder, DrBindeshwarPathak, said he needed an army of "toilet missionaries".

"If we trained 30,000 young people in building good toilets, in health, in basic sanitation at the village level, if every politician and industrialist pledged to pay for one toilet, then there could be progress," said Pathak. "We need freedom from dirt and filth, but everyone will have to participate."
In Raj Beti's courtyard, the evening light fades, leaving her face in shadow. She balances Soumya on one hip and she and her older daughters head single-file towards the fields.

To the chirrup of bullfrogs and crickets and the occasional cry of a peacock, they march past the last dwelling in the village to a fallow field.

Shrouded in darkness, the girls spread out, pulling down their baggy shalwars. They're frightened, uncomfortable and trying to hurry up as a tractor shudders past about 20 metres away, driven by men.
As they wash and walk back to the village, other girls and women appear in pairs and small groups from the gloom.

Outside his home, now guarded by six constables, SohanLal, the father of the 15-year-old girl who was raped and killed, said that for him, improved sanitation was as important as obtaining justice for his murdered daughter. "We don't want to see this happening to another family," he said. "I wouldn't be able to tolerate it."