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.

... contd.