“Sanitation is more important than independence.”– Mahatma Gandhi
India has a massive problem of open defecation. In 2010, the World Health Organization (WHO) and United Nations International Children’s Fund (UNICEF) estimated that there are more than 640 million people practicing open defecation in the country, or nearly half the population of India.
Poor sanitary measures set India back by crores of rupees every year due to illnesses. It’s cost to families in terms of expenditure on medicines and public health care and productivity losses to the economy as a whole are enormous. Some of the latest available statistics in a Government report on the subject are:
- 5 of the 10 top killer diseases of children aged 1-14 in rural areas are related to water and sanitation. Almost 1500 children die every day from diarrheal diseases.
- It results in high rate of infant and children under-5 mortality. The rural Infant Mortality Rate (IFM) is 62 as compared to urban which is just 42 (as per the National Family Health Survey-3).
- The water and sanitation related disease not only affects the nutritional status of the children but also impacts their attendance in the school. Close to 50% of school going children in rural areas do not reach classV.
In 2014, the Government defined sanitation and hygiene in India as a priority. It re-launched the Swachh Bharat Abhiyan (SBA), chiefly targeting improving access to toilets. But providing millions of people with a toilet was just the infrastructural part of the solution. What presented a surprisingly complex behavioral challenge was moving millions of Indians to consistently use the toilets.
In four years of SBA from 2014-2019, sanitation coverage went up to 93% from 38% with over 8.4 crore toilets constructed across rural India and over 2,900 cities having declared themselves Open Defecation Free (ODF).
“We shall not defeat any of the infectious diseases that plague the developing world until we have also won the battle for safe drinking water, sanitation, and basic health care.” – Kofi Annan
In a world of struggle for basic livelihood and survival, where sanitation is not even considered a pressing issue, lies the success of a project which aims for an Open Defecation Free (ODF) village.
NGOs AROEHAN and Aga Khan Agency for Habitat, India (AKAHI) collaborated to implement the Rural Health Improvement Program (RuHIP) in Shiwli village, Palghar district of Maharashtra. The project was made possible when Quantum Asset Management Company (January 2016 – December 2017) and Quantum Advisors Private Limited (January 2016 – March 2017) chose to utilize their Corporate Social Responsibility (CSR) funds towards achieving change on the subject of sanitation.
Some of the families in the targeted village were using toilets constructed in 2003 which were in an extremely dilapidated and rundown condition. Many had no walls, with the entire lavatory consisting of a foundation with a pit in the ground. In the absence of walls, the families had covered the sides with a cloth for privacy. The toilets were attached to a single soakpit. Before the project, the residents of Shiwli village were practicing open defecation and majority of households were practicing indigenous and/or unhygienic ways of hand-washing after defecation. Thus, the objective of the program was to ensure that 100% families not only have easy access to toilets, but also use them and follow hygienic sanitation practices.
A sustainable, long-term solution
While AKAHI provided the technical expertise, AROEHAN implemented the project as per the developed plan. They focused on leveraging Government resources, ensuring community participation and creation of demand through Behavior Change Communication (BCC). The collaboration resulted in the creation of 173 sanitation units during the project period. 181 families and more than 800 beneficiaries gained safe and easy access to hygienic sanitation units.
AROEHAN worked to mobilize resources from local government via the Gram Panchayat and Central Government schemes to reduce the dependency on private funds. They ensured that the community had ownership of the key activities like community mobilization, house visits and hygiene promotion. In the long run, this ensured success of the project even after the implementing partners withdrew.
Information, Education and Communication (IEC) and BCC are important tools of any successful sanitation project and were extensively used for educating the masses about safe sanitation and hygiene practices. IEC leads to more awareness amongst the community members and BCC contributes to sustained behavior change, thereby making communities ODF.
It was also necessary to minimize the cost of the sanitation unit with a view to ensure scalability of such a project at any other time in the future. Key strategies adopted for achieving this included engaging and motivating community in providing labour as required. This had multiple benefits – it created ownership in the community, engaged local vendors and brought skilled local resources on board.
After Implementation of RuHIP
“Earlier I had to walk upto 2 kilometers in this hilly area, in the dark. There are so many animals and snakes in this area especially during monsoons. Now I don’t need to walk a kilometer…Now we reach the toilet in less than two minutes.” – Bachi Gangaram Saura
What could possibly explain the impact of a sanitation project better than the smiles on the faces of the residents?
With 173 sanitation units constructed, around 800 beneficiaries had access to safe sanitation facilities. Follow-up household visits undertaken to assess the impact two years after the project indicated that most of the respondents were regularly using their sanitation facilities and had complete knowledge about critical times for hand washing. The beneficiaries had detailed knowledge about the use of twin pit latrines.
Besides the infrastructural support, an equally important impact is the behavior change observed in terms of regular use of the sanitation facilities, hand-washing practices and upkeep of twin pit latrines.
With the help of RuHIP, Shiwli Village has become 100% Open Defecation Free!Shiwli is on its way to become a model village in its area where the community stewards the responsibility of safe sanitation and hygiene for all.
As India strives towards achieving ODF status for all, let us hope there will be day when we will realize Sulabh International founder Dr.Bindeshwar Pathak’s wish, “Nobody should go outside for defecation and every house in India should have a toilet.”
 ‘India tops list of nations lacking toilets’, Economic Times, (https://economictimes.indiatimes.com/india-tops-list-of-nations-lacking-toilets/articleshow/6970170.cms), 2010
 ‘CSR Guideline for Sanitation Program’ Ministry of Drinking Water and Sanitation, Government of India, https://swachhbharatmission.gov.in/sbmcms/writereaddata/Portal/Images/Guide_Line_Sanitation_CSR.pdf,
 ‘Sanitation coverage in rural India reached 92% under Swachh Bharat Mission’: Govt’, The Hindu Businessline, https://www.thehindubusinessline.com/news/sanitation-coverage-in-rural-india-reached-92-under-swachh-bharat-mission-govt/article24884203.ece, 2018