Appalling sanitation

On November 19, the world including India will be celebrating the World Toilet Day 2016, the theme of which is 'Toilets and Jobs'. It aims to increase awareness on how access to or lack of access to sanitation affects the livelihood of people, impacts the economy, and the health and physical safety of people, especially women and girls.

The world over, about 2.4 billion people do not have access to improved sanitation, and about one billion people still defecate in the open, of which India's contribution is sizable. The Millennium Development Goals' (MDGs) sanitation targets during 1990-2015, which promised to reduce the number of people without access to improved sanitation by half, were not achieved in 95 countries, including India. The new global promises under Sustainable Development Goals (SDGs), also aim that by 2030 every country in the world should achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women, girls and those in vulnerable situations. India is also committed to achieve this target.

Unlike 'access to safe water' goals under MDGs, India has achieved 'moderately' with respect to sanitation access targets. In 2015, 54 per cent urban sanitation coverage and 21 per cent rural coverage were achieved, and the proportion of population (urban and rural) that gained access to sanitation has gone up to 31 per cent. Still, about 564 million people openly defecate in India, categorizing her as a country with the highest open defecators in the world.

Lack of improved access to water and sanitation causes health hazard to the population, resulting in loss of productivity. A World Bank estimate (2016) shows that about 6.4 per cent of the gross domestic product in 2006 (at US $ 53.8 billion) was lost in India due to inadequate sanitation. Every year about 73 million workdays are lost in this country due to lack of access to safe water and improved sanitation.

To address the entire issue, initiatives have been taken by the governments in the past, the latest being the Swachh Bharat Mission (SBM) with an objective, inter alia, to eliminate open defecation and to eradicate manual scavenging, by constructing a huge number of new toilets and reconstructing a large number of dysfunctional toilets by October 2019. The construction of toilets is taking place rapidly, but the overall progress is not encouraging.

Although the SBM also aims to create awareness and effect behavioral changes among the non users, these aspects are given less emphasis. While construction of toilets is a must, ignoring these soft aspects and also relegating the faecal sludge management to a secondary or tertiary position would imply that the ultimate objectives of having healthy population in our society may not be achieved.

For instance, it may take many years to change the behaviour of people in terms of usage of improved toilets. Success stories in Kerala show that the initiatives for making the state free from open defection started way back in 1970s with a mass awareness programme for toilet usage, backed up by a civil society movement in the 1980s, and supplemented through total literacy campaign, demand of women's group for improved toilets, and allocating as much as about one-third of the state budget to municipalities in the 1990s.

Such efforts will have to be supplemented with faecal sludge management efforts as well. Presently, human waste is either disposed through 'off site' methods, suh as conveyance through centralized sewerage network for treatment, or if untreated, putting the same in open drains causing water contamination, or through 'onsite' arrangement which includes use of septic latrines or pit latrines for disposal of such septage. About 50 per cent of the urban population use the latter system. In the absence of a national regulation on septage management, lack of commitment of states, and poor enforcement capabilities by local bodies, there is poor management in handling faecal sludge matter at all levels of the value chain ~ access, containment, conveyance, and disposal/reuse of human waste.

Improper construction of septic tanks and usage of toilets with septic/pit latrines pose danger to the availability of safe drinking water due to faecal bacteria which cause tropical enteropathy and stunting in children.

India needs to look into the entire issue of sanitation from the demand side as well as through understanding the locally specific barriers for changing the behaviour of the people for usage of improved latrines, and addressing the same. This task is impossible to achieve through the governments' efforts alone. Involvement of stakeholders including the private sector is a must. In addition, faecal sludge management for 'end to end' solution has to be undertaken on an urgent basis, as 'on site' sanitation coverage is increasing rapidly every year. In the absence of scientific management of faecal waste, health hazards are bound to linger.