India’s sanitation record is extremely poor. According to the United Nations Human Development Report, 2006, a mere 33 per cent of India’s population has access to improved sanitation facilities. And this is the cause of over 500,000 infant deaths annually and cost India Rs 5 billion every year in medical treatment and loss of work.

Unfortunately sanitation has always been accorded very low priority by government. But more importantly, even where money has been spent, it has addressed the wrong problem. Take the Central Rural Sanitation Programme (CRSP) for instance. Started in 1986, the CRSP aimed to construct toilets in every village through the provision of subsidies. There was little traction for the programme and coverage remained low — at 20 per cent in 2001. Worse, when toilets where built, they were rarely used. In Himachal Pradesh alone, of the 4 lakh toilets constructed, a mere 3 per cent where being used. In Maharashtra, 1.7 million toilets were constructed with less than 50 per cent usage. Most of the time, the toilets were used for reasons other than latrines — in Maharashtra there are cases reported where toilets where converted into puja rooms since they were the only concrete structures in the village! In states like Himachal Pradesh and Maharashtra, there is inadequate understanding about the links between sanitation and health.

But sanitation is not simply about using toilets. It is about using them correctly. Take the case of Kerala and Goa. Both states boast of almost 100 per cent coverage and usage of toilets. Yet, bacterial contamination in water (a key indicator of poor sanitation) remains high. This is because latrines were constructed close to water sources and with very poor sewage systems.

So how does one promote health education, and with it behaviour change? Maharashtra identified an innovative solution in 2000 when the government launched the Sant Gadge Baba Swacchatta Abhiyan, and later the Hadanghari Mukt Abhiyan (2003) that gave gram panchayats the responsibility to motivate communities to follow safe, hygienic practices and stop open defecation. They were provided with administrative and technical support, and information campaigns, training, and exposure visits. Gram panchayats also competed against one another for a cash prize of Rs 2.5 lakh awarded to the cleanest gram panchayat. The competition proved to be a whopping success. Consequently, the demand for toilet facilities in Maharashtra has risen dramatically. By 2003, an estimated Rs 200 crore worth of infrastructure had been built (and used) by rural communities. Maharashtra now boasts of being the only state in India where over 5 million people live in clean, open defecation-free villages environments.

Drawing on Maharashtra’s experience, the government of India reoriented its sanitation policy with the launch of the Total Sanitation Campaign (TSC) in 1999 and later the Nirmal Gram Puraskar in 2003. The emphasis is on motivating individual households so that they realise the importance of sanitary practices. This is coupled with a subsidy package for households that fall below the poverty line.

Nirmal Gram Puraskar (NGP) is an incentive scheme that offers rewards of up to 50 lakh (based on population) to panchayats that successfully declare themselves open defecation free. Both the TSC and the NGP have been successful in accelerating access to sanitation. Between 2001-2005 alone 2.8 million toilets where constructed with usage ranging from 60-80 per cent all over India. But this is a small dent in the context of the magnitude of the problem — according to projections, it will take till 2024 to achieve 100 per cent sanitation.

However, weaknesses exist. One, the TSC continues to promote a subsidy regime, albeit lower than previous programmes, and states continue to focus on construction drives rather than health education. Two, the NGP programme lacks a rigorous evaluation procedure and thus runs the risk of deteriorating into a targeted numbers game rather than a reward for sustained behaviour change. Lastly, there is almost no effort at motivating and building capacity for officials implementing these programmes. This of course translates into poor delivery. Experience from states like Maharashtra suggests that panchayats are best placed to initiate change. But in practice they lack funds and capacity. Funds and technical support to panchayats to initiate communication programmes coupled with state-level rewards to better performing panchayats can go a long way in speeding up the sanitation process.

In the final analysis, however, it is all about policy priorities. There is no sustained commitment on the part of the government of India or the state government to push for better sanitary services. This is why events like the World Toilet Summit are so critical to India’s future.

After all, if this won’t make the government sit up and act, what will?

The writer is a freelance consultant working on issues of governance reform