The Art And Science Of Winning The Poo War

A silent war has gripped India as the forces of open defecation threaten to defeat our overall health. In 2014 Prime Minister Modi, armed with a broom and a now familiar public relations machine, swept the streets of Delhi and Assi Ghat, and exhorted us to dream about winning this war and think of a Swachh Bharat by 2019.

The Swachh Bharat Mission (SBM), like its predecessors (Total Sanitation Campaign, Nirmal Bharat Abhiyaan, Central Rural Sanitation Programme, the first national sanitation plan in 1954), is doomed to fail. It will fail to achieve its target of an open defecation free India. Even if constructing toilets for all Indians is (miraculously) achieved, building and using toilets are not the same thing. A survey by the research institute for compassionate economics (r.i.c.e.) conducted in Bihar, Madhya Pradesh, Rajasthan, Haryana and Uttar Pradesh found that only 48% of rural households that had a functioning latrine still had at least one household member defecating in the open. In fact, the percentage of verified open defecation-free (ODF) villages in India stands at a paltry 5%, including those verified before SBM.

Standing in the way of toilet use are a number of factors, such as poorly constructed toilets, lack of access to toilets, the convenience of open defecation, and sociocultural perceptions about impurity and fear of a pit latrine filling up with no recourse for emptying it. Complicating these matters are disorganisation and corruption at the government level. One report last year detailed the misappropriation of Rs 283 crores from SBM program funds, which were used for other purposes such as advance payments to staff, and leave salary pension contributions.

We think that the government can take a few simple measures to ensure more effective sanitation efforts moving forward. First, it can stop thinking just about toilet construction numbers and start thinking last mile. The last mile in achieving toilet use is where the focus needs to be; this means that the focus on behaviour cannot be an afterthought. In this vein, we suggest first a real time, high quality evaluation of past efforts, that is rigorous, clearly measures outcomes realized by programme activities and also pays heed to unintended consequences. We also suggest that this evaluation rigorously synthesise previous studies, while assessing them for bias, and, pools learning from these collectively so that the overall national mission may be informed by a body of evidence, rather than from single studies.

Second, invest in empowering community based organizations: Investing in the outcome of toilet use also means empowering rural residents to design ODF strategies themselves. A good example is the Bikaner district in Rajasthan where monetary incentives by residents and local government officials resulted in 81 gram panchayats achieving ODF status in the first four months of the campaign. Here, monetary incentives were transferred directly to the beneficiaries' bank accounts only after the entire gram panchayat became ODF.

Finally, the government should incentivize private action and enterprise to reach these goals while using performance-based targets and outcome investing (but also testing these approaches). This in turn means that the government will need to clearly define what these outcomes are - and we urge them to think about toilet use rather than construction. There is also a large potential market for sanitation products - hand washing liquids, toilet cleaners etc. that the private sector can potentially tap into to realize profits. Engaging with communities will be key to monitoring and supporting behaviour change.

SBM needs to refocus. Toilets may indeed be more important than temples, but only if they are used.