About 88 percent of diarrhoea-associated deaths are attributable to unsafe water, inadequate sanitation, and insufficient hygiene. Nearly two billion people from across the world today lack access to basic sanitation, and millions die from waterborne diseases, mainly caused by faecal oral contamination and poor sanitation.

According to a 2015 report of John Hopkins Bloomberg School of Public Health, India carries the highest burden of pneumonia and diarrheoa deaths in children, accounting for one out of five child deaths due to the two diseases. Of the projected 5.9 million deaths of children (aged less than five) in 2015 across the world, pneumonia was the top killer at 16 percent, while diarrheoa came second at nine percent share globally.

According to UNICEF, 48 percent of children in India who are younger than five years of age are stunted, meaning almost half of these children suffer from chronic undernutrition during the most critical periods of growth and development in early life.

However, the journey has been different for our neighbours. According to the 2015 JMP Report, Bangladesh, Nepal and Pakistan have all achieved reductions of more than 30 percentage points since 1990 in the percentage of population practising open defecation. Bangladesh has reduced the percentage of population defecating in the open from 34 percent in 1990 to one percent in 2015. Nepal has reduced it from a shocking 88 percent in 1990 to 32 percent in 2015, while in Pakistan, the percentage has gone from 49 percent to 13 percent in the same span of 25 years.

India, on the other hand, despite projecting better growth numbers and GDP, continues to be the country with the highest number of people practicing open defecation: around 600 million people or nearly half of the population.  Most of it occurs in rural areas, where the prevalence is estimated at 65 percent of the population. For a country taking pride in its military might, space probe and GDP growth, these are pretty humiliating numbers.

The road ahead for India was discussed at the International conclave ‘Beyond Just Toilets – Fast tracking an Open Defecation Free South Asia’, organised on January 10, in Dhaka, Bangladesh. Representatives from India, Bangladesh, Afghanistan, Nepal and Sri Lanka together dreamt of an open defecation-free South Asia. These representatives included policy and decision makers, practitioners, and programme managers from at least 30 different organisations across South Asia.

The conclave was organised jointly by Community Led Total Sanitation (CLTS) Foundation and Water Supply and Sanitation Collaborative Council (WSSCC), Geneva. CLTS has played a pivotal role in improving sanitation standards in Bangladesh, and later in other Asian and African countries (with India being an exception). The concept of CLTS involves provoking shame and disgust about poor sanitation in order to bring about change. Such sustained behaviour change in mainly rural people goes a long way in reducing open defecation.

CLTS was first applied by Kamal Kar in Bangladesh. In just about a decade’s time, the country has witnessed unprecedented transformation. Speaking at the conclave, Dr Kar, Chairman of the CLTS Foundation Global, said, “I distinctly remember the day when I was introducing CLTS through my keynote speech at the inaugural technical session of the first SACOSAN held here in Dhaka in 2003. CLTS was only two years old at the time when access to basic sanitation in Bangladesh was around 35 percent. Open defecation was rampant in rural Bangladesh.”

Over the last decade, through local community empowerment, Bangladesh has achieved a nearly open defecation-free status. Once a country with the highest rate of infant mortality in the world, Bangladesh has transformed itself radically.

The same had been the experience from Nepal, as presented by Sudha Shrestha, Acting Chief Technical Advisor/GSF Programme Manager, UN-HABITAT, Nepal. While speaking to the gathering, Sudha said that after the recent earthquake in Nepal, the affected communities started building up their toilets first and then their houses. An impact of positive behaviour change was also seen when there were very few diarrhoea cases reported after the earthquake.

These examples in drastically reducing child mortality and human drudgery in such a short time can be emulated by India too. According to Sujoy Majumdar of UNICEF India, the Swachh Bharat Mission has the potential to imitate the success story of Bangladesh. Effort is being made to intensely involve and engage local government, NGOs and civil society organisations to create more public awareness, which is also the cornerstone of the success in Bangladesh.

In India, despite efforts being in place, the results are nowhere in sight. Figures from the Ministry of Drinking Water and Sanitation show that since 1986, India has spent over $3 billion on constructing toilets across the country, but positive results are still not visible. An all-India survey conducted by the National Sample Survey Office (NSSO) has also revealed that just 46 percent of the 95 lakh toilets built in rural India are being used, while the figure is barely 50 percent even in urban areas.

While appreciating Bangladesh’s achievements in eliminating open defecation, all participants in the conclave recognised that change has been possible mainly because of their focus on collective behaviour change rather than on construction of toilets. Anowarul Haq, Director, Extreme Rural Poverty Program, CARE, Bangladesh focussed on sanitation being a trigger to wider development benefits like livelihoods, food security, eliminating hunger, primary education, inequality, and health. While India seems to have joined the bandwagon, the road ahead will be a tightrope walk.

This was first published on Your Story by Sourav Roy. 

Caption of Featured Image: Children defecate in the open in India. Lack of sanitation is a major reason for malnourishment and stunting in children. Photo: Creative Commons

The post What we can learn from Bangladesh to make India open defecation-free appeared first on CLTS Foundation Global.

What can be done about this resistance? That was the theme of an international conclave organised by the CLTS Foundation Global and the Water Supply and Sanitation Collaborative Council (WSSCC), where government and international agency officials, NGOs and community representatives discussed the nuts and bolts of behavioural change. “India spends on the hardware, on big subsidies to build toilets, but many of them are never used,” said development expert Robert Chambers. Even out of 9.5 million toilets in rural India built in the first year of the Swachh Bharat Abhiyan (2014-15), only 46% were being used, according to NSSO data. Around 630 million Indians still defecate in the open.

Making them go 

By now, it is abundantly clear that open defecation cannot be ended only by providing toilets. The Community-Led Total Sanitation (CLTS) approach, pioneered by development consultant Kamal Kar in Bangladesh in 2000, advocates a 180-degree mental flip. It rejects sanitation subsidies; instead it mobilises communities through emotions like shame and disgust. It shows people how they are literally eating their neighbour’s shit, and how this makes them ill and stunts their children. It finds community representatives to trigger these messages, and rouses the community to adopt better hygiene habits, including menstrual hygiene. “The answer is local empowerment, not a tsunami of toiletisation,” said Kar.

The CLTS is one of the powerful tools that Bangladesh used to achieve its target. Its techniques are used in over 60 countries now, and taken up by many international agencies. And it has demonstrated clear results. Nepal, for instance, has speeded up sanitation progress from 6% in 1990 to 81% now. “Even though last year’s earthquake damaged the physical infrastructure, people’s minds had been changed; they chose to rebuild toilets even before homes. And so, there was no diarrhoea outbreak after the disaster,” said Sudha Srestha of UN Habitat.

For policymakers, it is not easy to move out of the hardware-centric mentality. “Once a subsidy is given, it is hard to roll back,” said Khairul Islam of WaterAid Bangladesh. India has been a hard terrain for CLTS, admitted Kar. He pointed out that Chhattisgarh has been willing to stop incentivising toilets, choosing instead to trigger community demand, and then reward them for toilet use. There are success stories in Himachal Pradesh, in municipalities and districts that have tried CLTS, he said.

This was first published in Times of India by Amulya Gopalakrishnan.

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Those of us who do not live in Delhi and live far away from the inner-chambers of power, some aspects of the new Union government’s initial pronouncements were indeed exciting.

Firstly, in consonance with the tone set by its leader in the 2014 Lok Sabha election campaign, the central government wanted to be an enabler and not a micro-manager in people’s lives and aspirations. Secondly, it talked about co-operative federalism, by which, real federalism would be ushered in, in a spirit of co-operation between the constituent states of the Indian Union. Right now, these feel like promises from a different planet.

It is true that the government of India increased the percentage of tax money that would be given by the Centre to the states. But that came with a serious catch, the Union government at Delhi was simultaneously either severely cutting back or completely discontinuing their funding of many schemes run in the states where the money used to come primarily from the Centre. Hence, if the schemes were to be continued, the increased allocation for tax money to states would simply be used to continue earlier existing schemes.

Many states have protested this because this is no real financial devolution at all. What is important here is how the Union government, that is the so-called Centre, constantly talks about federalism and decentralisation, and in practise has been continuing the centralising policies of the previous government. If the Union government was actually interested in federalism by empowering the states, why has it not given up the revenue collection rights from even a single revenue source in favour of the states? What is the point or meaning of decentralisation when the revenue is collected as before by the Union government only and the states are completely dependent on Delhi’s whims.

After all, if states became revenue owners and collectors, they could plan projects and outlays completely, without the Union government as a meaning-less middle-man, which apparently collects the money with the intent of giving most of it up to the states. Then why collect it in the first place and why not let the states collect the revenues and also retain the money? We need to understand why Delhi retains these rights and does not give up any revenue collection rights to the states. Without that, it would not be able to allocate more money to a bullet-train project compared to the whole of a typical annual Indian Railways budget. If the amount of revenue available to Delhi decreased drastically, it would be able to announce financial “packages” for those states from whom the government party tries to gain power.

This is precisely why there would be fat financial “packages” announced for Jammu and Kashmir or Bihar but never for West Bengal or Telengana or any other state where the party in power in Lok Sabha has no chance of gaining in the near future. With all its high talk of decentralisation and cooperative federalism, can New Delhi care or dare to give any revenue source back to state, not as alms from babus of finance commission but as an inalienable constitutional right? No, sir. Those constitutional changes are only meant for taking away taxation powers from the state. The feverish enthusiasm to pass the GST is a case in point. The GST takes away several taxation powers from the states. And yes, the Congress will also support it. It is a matter of time. When it comes to imposing the ideology and power of Delhi over the states, the Congress and the BJP are two sides of the same coin.

But wait, it is not as if the Union government is content with having less money and less financial obligations. After having gotten out of major funding of various schemes, its has been slapping certain kinds of taxes called “cess”, which are cunningly outside the purview of its sharing-with-states “generosity”. What it means is that the Union government is actually extracting more money from the people, with the new extractions being called “cess”, that is, of the type that won’t be shared with the states. A cess is essentially a tax whose collections are ear-marked for a particular purpose. Among this extra money that the so-called Centre is extracting from us, the people, is the ‘Swachh Bharat’ cess. The money collected from this cess will apparently go in “cleaning up” this land.

Given the vagueness of what “cleaning up” entails, this money can be used to pursue any number of pet projects conjured up by Delhi. One thing is for sure – such projects would often involve contractors and thekedars. This is all rather predictable and sad. The party that had come to power by promising decentralisation and being an enabler of people has now officially decided that cleaning your neighbourhood drain is its job, whether you like it or not, and you have to pay for it. The thing is, the real cleanliness issues lie elsewhere and inside the Indian Union itself, there are success stories of communities taking charge of their destiny in cleanliness and hygiene, even before the present bunch of decentralisers in Delhi decided to centralise even the job of cleaning your neighbourhood, or at least collect immense amounts of money under that ruse.

It is the height of centralisation where New Delhi grabs extra money from your pocket, ostensibly to clean your locality, but who will clean the muck in New Delhi’s mind that treats the states as irritants at best and revenue plunder zones at worst? While photo-ops of broom-stick wielding khadi-wearers have been a hit, open defecation is something for which photo-ops are a rarity. And while a lot of money is to be made and is being made by building made-to-order government latrines by contractors big and small, communities in many parts of the Indian Union are leading by a very different set of examples. In the canal irrigated zones of the Thar in Rajasthan, IAS officer Arti Dogra, as District Magistrate of Bikaner, took the challenge of open defecation in these zones very seriously. Incidentally, the Indian Union is the top defecator in the world, with nearly half of its population defecating in the open, as per the 2014 Progress on Drinking Water and Sanitation report. Ms Dogra empowered local communities through community-led total sanitation approach, a people-centric awareness triggering method that has had astounding success in the much more swachh and nearly open-defecation free People’s Republic of Bangladesh.

Local elected representatives were taken into confidence, public meetings were held where women’s concerns were specifically highlighted. The results have been impressive which huge swathes in nearly desolate desert land having humble hutments with newly erected toilets – not sarkari public toilets but private ones built largely with people’s own funds. More than money, it is earnestness, community-centric empowerment and decentralisation of decision-making that matters, when it comes to solving most problems. If the government of India is at all seriously interested in what it calls the Swachh Bharat campaign, these are the examples it needs to look at seriously. It also might want to learn from Bangladesh – there is no shame in learning from areas where best practises have achieved success, especially in cash-poor zones such as the subcontinent.

In Haryana, Karnataka, Chhattisgarh and Gujarat, the presence of a latrine at home has been made a mandatory condition for qualifying as a candidate for local-body or panchayat elections. Such rules, made from above, only reflect non-engagement with reality and a deep contempt for communities. Such rules are biased against those who are usually excluded from their rightful share of money and power – the poor and the so-called backward castes. Communities do not need apathetic and criminal rulers from above. What lies behind such election qualifications is a mentality of prejudice and bias which in turn requires cleaning. Empowered communities can take care of themselves.

By Garga Chatterjee. Garga is a journalist and a PHD from Harvard University.

The article was first published at DNA India as part of a media advocacy partnership between WSSCC and CLTS Foundation Global. 

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Deepak Sanan, IAS

In recent years, especially after the launch of major programmes like Swachh Bharat Abhiyan, sanitation has become a hotly debated topic in India. Crores of rupees have gone into building toilets but they remain unused, villages that were declared open defecation free (ODF) are unable to sustain that, and sewage treatment continues to be a big challenge. In such a scenario, community led total sanitation (CLTS) offers a different approach. It calls for the suspension of toilet subsidies and instead works towards securing collective behaviour change by instilling disgust or fear in the community.

Himachal Pradesh was one of the early adopters of this concept, reaching about 67 percent rural toilet coverage as per Census 2011 which was more than double the national average of 31 percent. But urban areas have started facing problem of sewage disposal with state capital Shimla registering major jaundice outbreaks frequently.

We talk to Deepak Sanan, Additional Chief Secretary in the Himachal Pradesh government and one of the flag bearers of CLTS on how the state achieved such a feat and what are some challenges.

CLTS has been tried in other states of India as well. Was the social set up in Himachal Pradesh different that it worked so well in the State?

I don’t think there is any difference in the social set up of Himachal that was critical. Himachal Pradesh has strong caste divisions even if it is a predominantly Hindu state. CLTS focuses on collective behaviour change and not on subsidy and it can work anywhere. For instance, Chhattisgarh which is very different when compared to Himachal in terms of education levels, poverty and other social aspects, is moving very fast in the last year using CLTS and abjuring individual household subsides. In fact, it’s setting a good example for states like Bihar and Jharkhand where people say you cannot have toilets without doling out money.

In Himachal, as at other places that have got CLTS right, what worked was the policy shift from subsidies on individual toilets to collective behaviour change. Capacity building in CLTS techniques was arranged at the state level. Local champions like the Deputy Commissioner of Mandi district engaged appropriate NGO support, constituted committees, prepared action plans and involved Panchayati raj institutions. Other DCs followed suit as they also wanted the accolades and awards Mandi district was getting.

CLTS has the potential to work even in urban locations like Kalyani town in West Bengal has shown. The key is to locate the right triggers, involve local governments and facilitate an appropriate action plan that can ensure safe confinement and disposal of human waste irrespective of whether the location is rural or urban, or whether the community is homogenous or diverse.

You mentioned that poverty and illiteracy are not the barriers. What do you feel is the barrier to CLTS?

The only barrier as Dr. Kamal Kar, the pioneer of CLTS says, is “intellectual constipation”. It needs a change in perspective that sanitation improves with collective behavior change and not subsidy. By giving out money for building toilets, you are not helping the poor. It sends out a message, “this is my problem more than yours which is way I am giving you money”. Let them access toilets because they feel the need for it.

You have to spread the idea to entire communities that excreta contaminates their surrounding environment and they are ingesting their own shit. Once the community is triggered and decide to get rid of open defecation, they will come forward to assist the poor and needy amongst them. Even the poorest are not willing to eat shit and the better off will also ensure they do not eat the shit of the poor.

If the entire community is not involved, open defecation by a few people places the entire habitation at risk. This is happening in most villages of India where toilets have been built but not put to use. Favourable public health outcomes are secured only when the entire community changes its behaviour.

Instead of subsidies, give them award money for achieving total sanitation and let them decide how they want to spend it for community welfare. By giving individual subsidies, you also create divisions in the community and reinforce the feeling that certain people need toilets more than others. So it is the perception that subsidy from above is essential that has to change. That is the only barrier to make rapid progress in ending open defecation.

Safe disposal of sewage in the hills is a big issue as the overflow goes on to contaminate water sources downstream as is evident in the annual jaundice outbreaks in Shimla. How do you think high toilet coverage can translate into safe waste disposal as well?

That’s the next big challenge for us. In urban areas, proper sewage linkages and waste water management are crying for attention. There needs to be proper Faecal Sludge Management (FSM) for septic tank-based households. In rural areas, this problem will emerge in the coming times. We need to start putting in place monitoring systems where people can test their own environment for contamination and then devise treatment strategies. Waste management is not a very big issue yet in rural areas but we will have to deal with it pretty soon. In addition, Himachal has forgotten the gains made with CLTS and has gone back to subsidising individual household toilets so there is still the last mile of dealing with left out households, migrants and public spaces to end open defecation.

Are all community members able to opt for sanitary toilets or do they gradually move to improved toilets as and when they have the money?

In Himachal Pradesh, I have seen a few instances of triggered communities ensuring immediate construction of basic pit toilets before moving to improved toilets. But by and large, communities have straightaway adopted improved toilets. Twin pit toilet is the best option for rural areas if there’s no proper onsite treatment system. But in Himachal, people have mostly gone for septic tanks as they feel it is a better option.

In certain remote areas like Lahaul and Spiti, night soil is often used in the fields as manure. What do you think about such traditional practices?

It is a very good model as people mix excreta with soil and use it in the fields. In fact, these areas could easily move to twin pit toilets since that also involves the use of excreta as compost after the waiting period is over. Twin pit toilet is also a more hygienic way to confine and reuse the waste.

Have you noticed villages covered by CLTS slipping back on their ODF status? If yes, what could be the reasons?

I have not seen any ‘slipback’ as such in Himachal Pradesh. A 2010 survey in the state reported that in villages which got Nirmal Gram Puraskars, there was no reversion to open defecation. There was a small (6%) reversion noted in the other villages.

The article is republished with permission from India Water Portal. It was originally published here.

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By AmitSengupta

You have probably heard of this place or perhaps not. It’s an industrial town tucked away around 50 kms from Kolkata. It’s primarily a quintessential planned urban township but that belies the other reality that this township faced at one point – a lurking sanitation and hygiene crisis which people living across its slums faced and struggled to overcome.

We are talking about Kalyani a bustling municipality in the district of Nadia, which is now an Open Defecation Free (ODF) area. Kalyani’s journey to zero defecation in the open began in the year 2006-06. It was declared an ODF municipality by the government of India in the year 2008. But the journey of this bustling township to ODF was a tough one.

It was at the intervention of the then chairman of Kalyani municipality, Dr. ShantanuJha (he is now an academician attached with Bidhan Chandra KrishiVishwavidyalaya) which was instrumental in triggering the transformational journey of Kalyani to an ODF township. It was his untiring efforts that brought this municipality into the national (it won the National Urban Water Award in 2009) and international radar (much before the Government of India’s flagship sanitation and hygiene campaigns grabbed newsprint).

Dr. Jha adopted the community led total sanitation approach to tackle the staring on-your-face sanitation crisis. He got in touch with Dr. Kamal Kar and the team at CLTS Foundation Global in 2005-06 to understand more about the approach and plan an intervention on behalf of the municipality. Being at the helm of affairs at the municipality Dr. Jha had all the power and authority to bring a change. More than that, he showed a persistent spirit to learn about the CLTS approach and took the challenge head on.

Speaking to CLTS Foundation Global, Dr. Jha said: “There were about 51 slums surrounding the municipality which didn’t the basic facilities of toilets. These were mostly unrecognized lands and hence people and workers living in these areas were deprived from government’s interventions and schemes. The community was used to defecation in the open in the absence of latrines.” The chairman had a mandate to implement the Kolkata Urban Sanitation Programme funded by the DFID. Dr. Jha reminisces: “At that time, we decided not to use the KUSP’s project fund for construction of toilets, initially, in the slums. We rather decided to tackle the behavioral issues and challenges and sanitation and hygiene awareness campaigns.”

“The CLTS approach was the most flexible of a development model I had heard of. It was about breaking the barrier. Even if the slum dwellers’ land was not recognized, we could address the issue by talking to the communities. I also had an able medical officer Dr. KasturiBakshi who worked tirelessly on this project,” said Dr. Jha while discussing about his team.

The chairman said that their approach in intervening in the slums was bottom up and participatory. “The community didn’t’ feel the presence of the municipality during the project. That was an added advantage for us since they completely owned the whole process. Our team did regular stakeholder consultations with elderly people, women and girls, children and youth. We selected some natural leaders in the slums who were instrumental in motivating and influencing the larger community. They were the local champions in triggering change,” he observed.

This created an enabling environment in execution of the project. In the meantime there were rounds of visits from Government authorities and senior ministry officials got to know about the stories of change. Kalyani municipality and Dr. Jha and his team gradually became recognized at the state and national level. Their two years of consistent efforts and community intervention started showing results when the slum dwellers stopped defecation in the open.

“The municipality was declared ODF in 2008-09. I still remember a call I received from a senior bureaucrat from the state government who jovially asked ‘How did you declare yourself ODF and which mechanisms you followed?’.Kalyani municipality was finally recognized by Government of India when we received the National Urban Water Award from the President of India in 2009. Even today when the people of the slums recognize me and talks about the transformational journey they undertook together with our team, nothing can be more satisfying than that,” recalls a proud Dr. Jha.

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By Amit Sengupta

New Delhi: The Union Minister of Drinking Water and Sanitation, Govt. of India, Mr. Chaudhary Birender Singhtaking stock on Swachh Bharat Mission said that SBM is not only about construction of toilets but also about behavior change. He said that India has to learn from Bangladesh while tackling open defecation in the country. The Union Minister said this while speaking at the National Review Meeting of ‘Swachh Bharat Mission’ (Rural Sanitation)at Vigyan Bhawan, New Delhi on 3 February, 2016.

Mr. Chaudhary Birender Singh, Union Minister of Drinking Water and Sanitation, Govt. of India while lauding the efforts by the stakeholders and state governments on Swachh Bharat Mission said: “We have successfully completed more than one year of Swachh Bharat Mission and moved a step further towards achieving universal sanitation coverage and eliminating open defecation in India by 2019. Sanitation has witnessed a spurt and more than 143,00,000 rural households have gained access to satisfactory level of improved sanitation facilities.”

Stating that over 40,000 villages in India have declared themselves as ODF, the minister gave reference to the recently held SACOSAN VI conference at Dhaka, Bangladesh (11-13 January, 2016; CLTS Foundation Global was part of the Govt. of India delegation at SACOSAN VI in Dhaka). The Union Minister said: “Bangladesh has reduced their OD rate to less than 1 percent. They have done this by following the community approach for bringing in behavior change. Let us also, therefore, remind ourselves that Swachh Bharat Mission is a programme of involving communities into changing their behavior, and not merely a programme of toilet construction.”

During the national conference which was attended by 12 State Ministers of Drinking Water and Sanitation, the Union Ministry of Drinking Water and Sanitation launched a mobile app during the conference called ‘mRWS App’. This android based app is available free for download at Google’s Play Store.

Mr. Ram Kripal Yadav, Minister of State, MDWS said at the conference: “Our ministry is working towards meeting the Prime Minister’s target of not even living a single household without toilet and OD. Some states are doing good work while rest needs to pad up fast. We are working to fulfill the target of reaching out to every single household with drinking water by 2022 (Water for All by 2022).” Talking about Swacch Bharat Mission, the minster said that there are lot of toilets which are lying defunct. It’s a mindset change that has to happen. Our ministry is doing large scale campaigns to increase awareness and bring collective change, he further added.

Earlier in the day, welcoming the delegates and giving a brief outline of the programme schedule, Mr. Nipun Vinayak, Director, Ministry of Drinking Water and Sanitation, Government of India said in his opening remark: “Sikkim is on its way to become a fully ODF state. Verification is going on in Sikkim. We have also examples of pockets of ODF regions from Rajasthan and West Bengal.”

In his presentation on ‘Status of Rural Sanitation in the States / UTs of India, Mr. Vinayak said: “Some states with high percentage of access to sanitation need not wait till 2019 in becoming a fully ODF state.  We need dramatic improvements in terms of access to sanitation in states like Bihar, Jammu & Kashmir to come out of the vicious circle of falling back to the trap of OD states.”

The director reiterated in his speech: “We have to keep the ‘toilet’ out of consideration while evaluation of an ODF village. There is ample flexibility given to the States and UTs. The state governments need to introspect if their respective district administration needs adequate flexibility while implementation of the Swacch Bharat Mission programme. There has to be a balance on the need to be restrictive and applying innovation.”

“ODF is a sustainable index. State has to take their own decision. We have to emphasise on community approaches especially for North Indian states which is not doing too good in terms of access to sanitation coverage,” he further added.

Talking about the upcoming World Bank’s 1.5 Billion USD project, the director mentioned: “The World Bank’s proposal has been sent to the Cabinet for their approval. The project will roll out this year. The entire money that would be allocated to the states/UTs will be on the basis of incentives, that would be based on certain parameters. These parameters would be specifically – 1) Reduction of Open Defecation at household level 2) How many of your population is ODF as a collective effort.” These parameters would consist the Index for the Baseline, he said. These will be verified by an annual third party sample survey. He further added that if the state / UT administration needs capacity building they can approach UNICEF which has a customized training module for officials.

Dr. Geetha, Mission Director, SBM, Govt. of Chhattisgarh in her presentation stated that they are implementing the mission with CLTS approach.  They are expected to facilitate their 10971 gram panchayats towards ODF. “ODF Status is an enabling factor for development. 936 villages are verified as ODF in our state. However, the status of about 10 lakhs dysfunctional toilets is a huge challenge. We are thinking of the concept of sustainable toilets and ODF Festival,” Dr. Geetha said.

 In the next few hours in the day long conference, states of Sikkim, Madhya Pradesh (Harda and Indore Districts), West Bengal (Nadia), Tamil Nadu (Madurai), Rajasthan (Districts of Jalore and Bikaner), Jharkhand (Hazaribagh), Punjab, Manipur and Karnataka presented their status and progress on ‘coverage of rural sanitation’. While Sikkim mentioned that they have fulfilled the target of construction of toilets, currently they are witnessing verification of OD. They are focusing on behaviourial change, garbage and solid waste management. They need funds for IEC campaigns, the official said.

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As district magistrate in Bikaner, one of the most disturbing sights late in the night, were lines of women squatting along the roadside in the dark, often springing up to stand if the headlight of the passing cars fall upon them. These women wait until it is “dark” and “safe” enough to step out to defecate, away from prying eyes in order to retain some modicum of dignity, as little as is left once they defecate in the open.

This is a reality that affects thousands of rural women across India. Around 595 million people, which is nearly half the population of India, defecate in the open. India accounts for 59 per cent of the 1.1 billion people in the world who practise open defecation. The issue is not just one of dignity of women alone. Open Defecation has huge health implications and in turn implications for the entire economy. Diarrhea kills more than 2195 children in the world every day, more than the number killed by AIDS, malaria and measles combined. This hard statistic is an even grimmer reality in India which reports the highest number of dihaorreal deaths, in the world, of children under five. Frequent bouts of diarrhea weaken the immunity system of children making them more susceptible to other infections like pneumonia and making them severely malnourished. According to World Bank research, interventions in sanitation and hygiene can be a huge propellant to economic growth. For every $1 spent on sanitation, approximately $5.50-worth of economic benefits are generated, including school days gained & reduction in medical expenditure.

Open defecation is therefore not just a social and economic problem but also an issue of human rights.

Owning a toilet is not an aspirational need in India. It is easy to find households in rural India which own mobile phones and television sets but continue to practice open defecation. Social values and traditions have also had an impact and topic of toilets and defecation not discussed in public. The issue is not just that of economic deprivation or social mores but more a behavioural one. Despite health problems, problems during pregnancy and illnesses, women in Bikaner continued to defecate in open since it was something done for generations and because toilets were never a felt need and thus they had no access to them.

Therefore the clarion call of the Prime Minister to end Open Defecation in India by 2019 is one of the most challenging developmental goals today. The 2011 census showed that only 31% of rural households in India had access to toilets.

Swachh Bharat Mission (Grameen) for the first time talks about creation of Open Defecation Free Gram Panchayats and the monitoring of not just output (toilets) but also outcomes ( their usage). Since 1951, Government of India has spent close to Rs1.57 lakh crores on water and sanitation programmes in rural India; govt data states that 87 million toilets were constructed across Indian villages under Nirmal Bharat Abhiyan. The 2011 census however, found that the total number of toilets was 52 million (including toilets constructed much earlier), indicating that, at the very least, 35 million toilets were either constructed on paper or fell apart later.

Closer home a country like Bangladesh has only 3% of the total population defecating in the open. What varies in the approach of the Bangladesh programme to end open defecation and the earlier programmes in India is the difference in focus. Instead of merely running the scheme as a toilet construction programme there has to be an attempt to bring about behavioural change in the people. Toilets have to become a means to the end of creating an open defecation free community. States like Himachal Pradesh and certain districts in Maharashtra and Rajasthan have successfully implemented a programme to bring about behavioural change.

What Swachh Bharat Mission (Grameen) does differently, is it allows states the enabling freedom to devise a programme with a focus on ODF communities. It is based on the premise that a mere subsidy programme to build toilets with concurrent IEC activities is not enough. Merely lecturing people through slogans and posters has failed to deliver on the goal of creating ODF communities. In districts like Bikaner, Community Led Total Sanitation (CLTS) approach was adopted with miraculous results.

Sanitation is a public good and must be recognised to be one. Its benefits will be achieved when the whole community adopts it. Even a single household or person defecating in the open puts the entire community at risk. Once a community is “triggered” to realizing the risks they are putting themselves to, the collective behavioural change is a result. Toilets are not just constructed but also used.

One of the weaknesses of the earlier govt sponsored programmes has been non usage of toilets after they are constructed. Earlier programmes allowed third party construction either through gram panchayat or NGOs without bringing about any behavioural change. These toilets ended up as becoming stores for household items or shelters for domestic animals.

The campaign in Bikaner conversely stressed on a household building its own toilets. This facilitates a feeling of ownership and ensures usage. Once a collective mind-set change was ensured, communities came together generating innovative practices at the grass-root level to ensure that each and every person in the village, constructed and later used the toilets. Ensuring ODF status through early morning nigrani become the interest of the community. Toilets, therefore became an aspirational need and a symbol of the dignity and pride of the family and the community as a whole.

By reorienting administrative set up in Bikaner to act as facilitators (of behavioral change) and not providers (of individual toilets), the collective conscious of the community was kindled. This led to a massive increase in number of ODF villages in Bikaner and increase in percentage coverage of toilets from 29% (2011 census) to 82% (in March 2015). Over 1.99 lakh toilets (highest in Rajasthan) could be constructed in the district during a 2 year period re-emphasising the point that when focus in on creating ODF Communities, the toilets get built on their own. Over 200 Gram Panchayats were declared ODF.

In the rush to achieve targets just building toilets will be detrimental to the larger goals of the campaign. The focus of the Prime Minister has sounded the battle cry on Open Defecation. Now it remains to be seen whether the administrative system can reorient itself to ensure that the war is won.

The author of this blog is Arti Dogra. She is an IAS Officer of Rajasthan cadre. The views expressed here are her own.

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India is home to 58% of the world’s open defecators and Uttar  Pradesh (U.P.), India’s largest and most populous state contributes significantly to India’s poor sanitation status. The population density of open defecators in the state of U.P. is one of the highest in the world (12% of open defecators of the world live in the state* ) and the Census 2011 data points out that 78% population in U.P. do not have access to basic sanitation.

Interestingly, the U.P. government has started a unique initiative to usher in the Community–led Total Sanitation (CLTS) approach in the country with a renewed vigour after it was successfully adopted and introduced by the state government of Himachal Pradesh eight years ago. Himachal Pradesh saw a 60-70% increase in sanitation coverage over a period of 4-5 years during 2006-2010, when CLTS was implemented with the right enabling environment required to make it successful. Inspite of the state’s demonstrated success, so far there has been no enabling environment ensured for CLTS to succeed in any other state, barring a few successful attempts made in states such as Haryana and Maharashtra. This was possible due to the great commitment shown by a few individuals who emerged as institutional champions within the bureaucracy and the political leadership.

CLTS was introduced in India almost immediately after it was innovated in Bangladesh. As the story of success of CLTS in Bangladesh started spreading, this attracted the attention of the neighbouring countries and a major orientation workshop was conducted in Bangladesh Academy of Rural Development (BARD) in Bogra in 2002. More than 20 senior officials from different states and the Central government of India participated in the two-day workshop to explore the possibilities of bringing the approach in India for enhancing the access to basic sanitation in rural areas. Amongst others it was Shri B.C. Khatua, the then Principal Secretary, Water Supply and Sanitation Department, Government of Maharashtra, who was convinced about the ability of CLTS in empowering and mobilising local communities to initiate collective action towards ending open defecation without waiting for any outside subsidy or dole. With this conviction, Shri Khatua was determined to pilot this approach in two districts in Maharashtra and ensured that no upfront household hardware sanitation subsidy was given to the two pilot districts. These two districts were Ahmednagar and  Nanded. The CLTS pilots in the two districts were successful and they created a lot of interest in the state government of Maharashtra. Subsequently, the approach was introduced in all the 32 districts in the state through a series of hands-on training workshops, advocacy and post-triggering follow up activities. A number of government officials, elected people’s representatives, like the Chairman/Deputy Chairman of Zilla Parishad, ministers and NGO’s were taken to Bangladesh for exposure visits over a period of a next couple of years.

With face to face interaction and consultation with the local administration, the visitors from India were more than convinced of the efficacy of the CLTS approach in enhancing the access of rural sanitation by allowing the community to take the lead. The story of rural sanitation in Maharashtra started changing rapidly. High level delegations including ministers and secretaries from the states of Haryana, Himachal Pradesh, Andhra Pradesh, Karnataka and Rajasthan visited the open defecation free (ODF) villages in the two pilot districts and other districts of the state of Maharashtra in later years.

Being motivated by the power of CLTS in changing the mindsets of the community in stopping open defecation, some of the state governments introduced the approach on a pilot basis and experienced instant successes sporadically. However, the individual household hardware subsidy under the Nirmal Bharat Abhiyan (NBA) continued to be the prevalent policy, thereby preventing the scaling up of small successes across the block or the district.  Naturally, the dream of an ODF state was a far cry. Meanwhile, a remarkable decision taken by the government of Himachal Pradesh in 2005 of abolishing upfront, individual, household hardware subsidy and getting the approval of the assembly through legislation was ground breaking. Within the three and a half years of adoption of CLTS in the state sanitation policy, access to basic sanitation of the state moved to 84% from a meagre 34%. It is important to mention here that the success was only measured in terms of counting ODF communities and not the number of toilets.

However in 2012, the subsidised approach to rural sanitation was brought back by the state government stalling the progress being made in the state. One important factor why most of the state governments were hesitant in adopting the no-upfront hardware household sanitation subsidy was because they didn’t want to lose the lion’s share of the hardware cost for toilet construction being provided by the central government. Although the central government allowed the states flexibility in choosing their implementation strategy,  the mechanisms for monitoring the state’s progress still remained restricted to the number of toilets constructed and the money spent for these purposes. Thus the central issue of measuring the health impact resulting from sanitation interventions was not given any attention at all.  Further, the fact that this impact could only come about as a result of collective hygiene behaviour change focused on producing ODF communities instead of just toilets, remained invisible.  This has been India’s sanitation story for decades now, and this trend of increasing subsidy provision as the panacea to India’s sanitation crisis has continued well into the Nirmal Bharat Abhiyan (NBA) era and exists now in its newly incarnated avatar, the Swachh Bharat Mission (SBM).

In spite of this, over the years, sporadic cases of successful CLTS stories have emerged due to the personal initiatives of individual champions in districts [district magistrates (DMs), elected people’s representatives, senior government officials of states, etc.], a few sterling examples being Panipat and Hisar in Haryana; Jalna, Nanded and Ahmednagar in Maharashtra; Guna in Madhya Pradesh, Angul in Odisha and Bikaner in Rajasthan. These cases clearly show that achieving ODF environments through community empowerment is possible in India, as in other countries of the world. In fact, since CLTS was introduced in the year 2000, India has been one of the countries where a large number of CLTS training workshops have been conducted, but its outcome in terms of the number of ODF villages produced have been very minimal. This has happened because CLTS triggering has been viewed narrowly as the application of CLTS tools, with no proper post-triggering follow-up to ensure that communities become ODF.  Also the absence of an enabling environment to transform collective behaviour change has made it very difficult for CLTS successes to be scaled up across districts and the entire state. This is an issue not particular to India alone. A huge gap in the ratio between triggered vs ODF communities exists in many other countries as well. However, many of them have begun taking corrective measures by learning from their past mistakes and allowing the community to take the lead towards making their environments ODF

This current initiative by the government of U.P. to implement CLTS as a pilot project in a few districts could really be a pioneering initiative in India. I am finding hope in the fact that at least the state has started thinking in the right direction, of creating the right enabling environment for scaling up community-led initiatives. If this yields an encouraging result, certainly this will pave the way for a new thinking in sanitation sector interventions in India for rapid change.

The one-day workshop held in Lucknow on June 27, 2015 brought together more than 150 government officials from all over the state. The Panchayati Raj Department invited the 10 top performing DMs from the state, about 15 District Project Co-ordinators, and District Panchayati Raj officers from the 75 districts of the state. Hearing of the experience of CLTS in different countries across the world and realising the potential of the approach to change the sanitation situation in U.P., Hon. Shri Kailash Nath Yadav, Minister of Panchayati Raj; Hon. Shri Chanchal Kumar Tewary (IAS), Principal Secretary, Panchayati Raj; Shri Alok Kumar (IAS),  Chief Staff Officer to the Chief Secretary, and Shri Amit Gupta (IAS), Special Secretary to Chief Minister, Uttar Pradesh decided to initiate full-fledged activities to introduce CLTS in select 10 districts and urged all officers from 75 other districts to kick start CLTS in their respective areas.

Discussions with Hon. Shri Kailash Nath Yadav, Minister of Panchayati Raj and other senior government officials on the sidelines of the workshop

A meeting with Shri Alok Ranjan  (IAS), Chief Secretary of State later helped in moving forward the day’s discussions towards a concrete action plan, as the Chief Secretary was convinced that this was the way to move the state forward.

Shri Alok Ranjan, IAS,Chief Secretary of State, Govt of U.P. and Dr Kamal Kar, Chairman, CLTS Foundation Global in an informal meeting

When I reflect on what has made this development in U.P. possible, I believe this has been due to the relentless work and persuasion of Alok Kumar, who many years earlier, participated in one of my lectures on CLTS at the Administrative Training Institute in Nainital in 2010. His motivation and enthusiasm for CLTS, that led to him introduce the approach in Saharanpur district, where he was the DM at that time. It was one of the districts to produce some of the earlier ODF villages in India. The success of CLTS in Saharanpur district strengthened his conviction that CLTS is the approach that will work on a large scale if facilitated properly along with post-triggering follow up ensured within the right enabling environment. Like Alok Kumar, a number of DMs have been equally successful in rolling out CLTS in a small scale in different districts of the country. In the Indian context, DMs/Collectors/Deputy Commissioners enjoy an enormous authority and respect from all the line departments working in a district. When a district officer like a DM is convinced and drives CLTS, it is as good as enforcing a law and ensures a very high level of enabling environment although it is not written on any official document.

The informal meeting at the Chief Secretary’s residence

Now, we will wait and see whether U.P. emerges as an example for the other states in producing concrete results on the ground by adopting an appropriate sanitation policy that empowers local communities for the 10 selected districts. Considering that the upfront hardware and subsidy approach has failed to bring about the desired results and health outcomes in the state so far, it is to the credit of the state authorities that they are now taking ownership for community-led initiatives and paving the way for CLTS to be implemented and scaled up in the state.

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For comprehensive and effective sanitation planning and implementation in urban and peri-urban areas, the full participation and engagement of all stakeholders, particularly the local community members, at all stages of planning and services delivery is essential. Here it is important that all slums/squatter areas, authorised or unauthorised, are included in order to generate a city-wide urban community-led drive. ​For this, there is a need to shift away from the traditional model of centralised and conventional supply of infrastructure, solid waste/garbage collection, drainage and sewerage systems towards a more decentralised planning and implementation ​model where the municipality​ or ​city corporation​ is not ​be ​seen as the provider of ​infrastructure and services alone. ​Instead, ​they take on​ a proactive role of a process facilitator to enhance the participation and accountability of a range of stakeholders including community neighbourhoods, ​elected ​ward councillors​ ( in the case of non-regulated or illegal urban poor settlements e.g. refugees, IDPs etc. it would include the strong informal leaders), ​civil society, private sector and other relevant actors to ensure that the responsibility for planning, implementation, and operation & maintenance is ​based on a partnership and cost-sharing basis.​ This kind of engagement is only possible if those in positions of power in municipal governance understand the inner dynamics and power relations that are inherent within the above mentioned formal/informal groups.

A successful example of urban sanitation intervention exists in India, where systematic community-led methodologies developed by CLTS Foundation Global were implemented a few years ago. This is the Kalyani Municipality[1] in West Bengal which was declared the first Open Defecation Free (ODF) urban town in India in the year 2009. As part of a DFID funded initiative, a pilot project was undertaken in 5 slums in Kalyani in the year 2006, at the time when Open Defecation (OD) was rampant in these slum communities and freely distributed toilets remained abandoned all around their area. Unlike rural Community-led Total Sanitation (CLTS), the urban sanitation intervention began at the Municipal Council level, involving the Chairman and Ward Councillors belonging to different political parties. Once the need for the involvement of the local community was understood by them and local power relations and dynamics were identified and addressed, community triggering was facilitated. The key was to make sure that both formal and informal leaders in the slums were engaged in the process.

Community triggering resulted in people building their own toilets wherever possible or sharing toilets or reviving the previously abandoned and unused ones thus putting a stop to OD. The municipality was completely involved in the triggering process and post-triggering follow up stages. They also extended minor support to the communities in terms of extending water pipelines or putting up solar panels near the boundaries of the slums (this was because these were unauthorised slums where the municipality could not extend formal services) or bricks were given to the community to pave roads etc.

Within 6 months of the triggering process, these 5 slums were declared ODF. Soon a spill over effect was seen in other neighbouring slums as well and by 2009, all the 51 slums of the Municipality were declared ODF. This process of rapid scaling up was an outcome of the collective action ignited within the community through the triggering process. Another important factor that enabled this progress were the Natural leaders, who emerged during this process from within the community, and worked tirelessly to ensure that all the slums were made ODF. However, the rate of progress of all the slums were not the same because of the varied nature of involvement and commitment of different ward councillors. For this, a participatory monitoring mechanism was evolved and that worked very well.

Recently, almost after 6 years of Kalyani having achieved ODF status, the CLTS Foundation Global team visited Kalyani and we saw that the communities have not only maintained their ODF status over these years, but they have also made great progress in moving up along the sanitation ladder. We found that many families had upgraded their toilets using their own money. In one of the slum communities, families had invested in RCC roofing and tiled flooring whereas their houses still had roofing with CGI sheets/ tiles and matt walls.  This is absolutely amazing because this clearly showed that the families prioritised family expenditure on sanitation, understanding the collective health benefits that this brought them. This was clearly the effect of sanitation and hygiene behaviour change that they had internalised. It is important to highlight here the key facilitating role that the Municipality played in this entire change process. During the triggering they allowed the community to take the lead and made sure that the messages for collective hygiene behaviour was sustained through the Honorary Health Workers (HHW) who belonged to the community, in the follow up stages.

We also saw that a number of central and state sponsored sanitation programmes had been introduced in Kalyani such as the Jawaharlal Nehru National Urban Renewal Mission (JNNURM), Water and Sanitation for the Urban Poor (WSUP) and the recently launched Swachh Bharat Mission (SBM). Unlike other municipalities (there are 39 municipalities and 3 City Corporations in the Kolkata Metropolitan Area) urban slum communities in Kalyani were fully prepared to accept and adopt these state/central sponsored technologies because using toilets had become a way of life for the people here. The key point to note is that the slum communities in Kalyani, in 2006, would never have imagined that one day so many central and state sponsored urban development programmes would be introduced in their slums to meet the appropriate need of the community, creating excellent combinations of external support and household investment. Fantastic facilities have been developed by the families in Kalyani, and moreover, that which has been the bane of traditional sanitation programmes all over India – the sight of abandoned toilets – is nowhere to be found here.  We observed that the use of the government provided infrastructure was 100%. In the neighbouring municipalities the story is not the same.

Additionally, in a few slums in Kalyani where the sewerage line is being laid out by centrally sponsored schemes, it is fascinating to see that a high degree of community involvement and participation is enabling faster implementation of the schemes. Many families are eagerly waiting to connect their toilets to the underground sewerage line. Not every household is connecting the toilets directly to the sewerage line but connecting the overflow from the septic tank into the sewerage line. We saw at least 5 different styles of community cooperation models in making the urban sanitation infrastructure in Kalyani unique and exemplary. It is also worth mentioning that while Kalyani was undergoing this metamorphosis, the political leadership in Kalyani changed, as it did in the whole of West Bengal, but there is no dearth of ownership and pride amongst the new leadership of Kalyani municipality in embracing their town’s success in urban sanitation. Kalyani offers valuable and innovative lessons for implementing and scaling up community-led sanitation efforts in urban and peri-urban areas.

[1] Kalyani is a Municipal Town, 55 km North of Kolkata in West Bengal. Most of the slum dwellers of Kalyani are migrants from erstwhile East Pakistan & Bangladesh.

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Having said that, the SDG for sanitation could be couched better. In its current formulation, it suffers on three counts. First, a goal that wishes to secure both an end to open defecation and sanitation for all only by 2030, condemns millions to suffer the scourge of water borne disease for longer than should be countenanced. Secondly, the language still draws on the traditional association of sanitation with water (a vastly different commodity) in finding it necessary to speak of adequate and equitable access and inclusion of certain sections, as if sanitation that is not safe and sustainable for all, can still be an achievement. Thirdly, it needs to implicitly recognize that achieving sanitation is about changing collective behaviour and this happens when communities (from village to metropolitan city) realize this need themselves and are empowered to take action to redress their situation.

With only months to go a substantive rewriting of the goal seems unlikely now. However to address the infirmities listed above and recognizing the need to be succint and follow a common format, we would, given the opportunity, seek a reformulation of the SDG on sanitation on the following lines:

By 2030, achieve safe and sustainable sanitation for all  while securing the end of open defecation at the earliest through inclusive action by empowered communities that addresses the special needs of girls and women as well as those of other vulnerable sections, in undertaking this responsibility.

The author of this article is Deepak Sanan. Mr. Sanan is an Advisor to the CLTS Foundation Global. He was instrumental in the introduction of CLTS in a number of states in India including Himachal Pradesh. He has worked with the Water and Sanitation Programme (WSP) of the World Bank and has published on a variety subjects related to sanitation as well as other public policy issues .

The article was originally published on Eldis

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