The author is a social healthcare analyst.
Greek philosopher Socrates once said, "It is not living that matters, but living rightly." As the clock is inching towards the 2015 deadline of the Millennium Development Goals (MDGs), this saying becomes more relevant than ever before.
The MDGs target to improve socio-economic conditions of all citizens. The MDG of "Environmental Sustainability" also advocates providing adequate sanitation facilities to all citizens, thus giving them right to healthy life.
According to WHO, "Sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and feces. Inadequate sanitation is a major cause of disease worldwide and improving sanitation is known to have a significant beneficial impact on health of households and communities."
Despite the seriousness of this topic, our community is still reluctant to openly talk about the subject of sanitation and the good practices associated with it. The ill effect of this taboo can be clearly seen from the continued unhealthy sanitation practices as it is estimated that still 1.1 billion people across the world defecate out in the open, thus leading to spread of diseases like diarrhoea, cholera, dysentery, typhoid, and hepatitis A etc.
In India, around 1,000 children below the age of five die from diarrhoea, hepatitis-causing pathogens and other sanitation-related diseases, according to the report of United Nations Children's Fund. Additionally, sanitation in schools has led to increase in enrolment of children, especially girls, highlighting its manifold benefits. Progressive efforts and effective monitoring mechanism should be taken to provide adequate sanitation and make our society free from open defecation.
Alarmed by this growing problem, many countries have taken a serious note of this issue and are taking measures to control the practice of open defecation. For example, Southern Zambia under the leadership of Chief Macha was transformed in just two years and declared 'open defecation free' as access to sanitation in his community was doubled from 50 per cent to 100 per cent. The Community Led Total Sanitation (CLTS) campaign in partnership with UNICEF gave a slogan: 'No shit please! One family, one toilet' and brought a sense of ownership to each dwelling owner.
Brazil developed the condominial approach. The Brazilians simplified sewerage to construct water and sewerage networks as a response to the challenges posed by expanding services into peri-urban neighbourhoods. Condominial sewerage is a low cost sewer system that emphasises on community participation in planning and maintenance of sewer system at the block level. Brazil quickly operationalised a 1,200 km network of condominial sewers, the largest example of simplified sewerage in the world.
Rwanda, a land-locked nation bordering Uganda with a population of 11 million, focussed its efforts and enhanced the sanitation coverage to its citizens beyond the regional average of sub-Sahara after a community-led sanitation campaign was sparked off. Rwanda attracted international tourists after the government reformed water and sanitation programmes and took away the fear of waterborne disease from the visitors.
The Indian government, too, is burning its candle from both ends, hoping for the return of the ancient Indus Valley civilisation days, when sanitation systems were far more advanced than contemporary urban sites. The Centre started the Total Sanitation Campaign (TSC) in 1999 with a goal to improve sanitation coverage in both rural and urban areas and eradicate the practice of open defecation.
The key focus areas of TSC are individual household toilets, the School Sanitation and Hygiene Education (SSHE) programme, the Community Sanitary Complex and Anganwadi toilets supported by Rural Sanitary Marts (RSMs) and Production Centres (PCs).
However, things are not hunky dory and the numbers clearly show that. As per the latest WHO report, India still accounts for 626 million (59 per cent) of the 1.1 billion people in the world who practice open defecation. This is twice the number of the next 18 countries combined. Additionally, India recorded nearly 22 per cent of the total deaths of children under five and majority of those cases were due to diarrhoea or sanitation-related diseases. Although government has been able to ramp up the toilet coverage, little efforts have gone behind changing the citizens' behaviour. A glimpse at the TSC portal gives information about the toilets constructed till date but fails to capture data on continued practice of open defecation despite the availability of toilets.
The Government must understand that creating mere toilet structures will not lead o change. Instead, focus should also be on changing the behaviour of the people. A massive educational campaign to explain the correlation between poor sanitation and its ill effect on health should be launched. Secondly, ignorance towards bathroom etiquette in public toilets by some could turn off others and divert them to open defecation.
The school curriculum should touch upon these topics and at least train the future drivers of this country. The Government of India was able to wipe out polio by riding on the back of a massive campaign and participation at block, district, state and national levels. Similar awareness campaign in participation with local communities, NGOs and state governments can be launched to get the message across.
Secondly, make the sanitation business attractive for the private sector by allowing them to generate income by providing sanitation services. Loan finance for sanitation support has shown some promising results for the micro finance companies. However, its effect at a large scale is yet to be hypothesised. Finally, allow innovation to reach the masses. E-toilets used in Kerala by the name "Delight" have shown excellent results because of its unique features and automatic functioning.
Similarly, Eco-san toilets are used for low income housing and are used in many countries due to its low cost and dry use.
Throughout his life, Gandhiji preached and practiced healthy sanitation practice and once said, "The cause of many of our diseases is the condition of our lavatories and our bad habit of disposing of excreta anywhere and everywhere." Let us work towards getting our society free from open defecation. That will make our ancestors, the founders of the Indus Valley civilization, proud of us.
(The article was published in The Hindu on April 29, 2012)