Clean India Mission shows that flexibility is key to even poo healthy

Not any more.
Not any more.
Image: AP Photo/R S Iyer
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It’s a paradoxical era that we live in.

On the one hand, there are people living in smart homes, commanding “Alexa” to adjust the heating for them. On the other, is an astounding number of people who have to take to the fields, bushes or railway tracks daily, to go about their morning business. The dissimilarity in living standards could not be starker.

Up until 2015, over 960 million people worldwide had inadequate sanitation facilities and were defecating in the open. The detrimental implications of the fecal contamination of the environment, at this enormous scale, are well-documented. High transmission of infectious diseases such as diarrhea, dysentery, typhoid, and malnutrition are some of the serious health consequences of open defecation.

Together, they significantly contribute towards child mortality, morbidity, and incidents of stunting, in countries where open defecation is widely practiced.

That being said, poor sanitation triggers a cascade of failures. Its negative impact on education outcomes and economic opportunities cripples a country’s growth and development. The adverse impact of sanitation on multiple dimensions of development, explains the need for the globally agreed ambition of Sustainable Development Goal 6.2 (SDG 6.2) that urges to eliminate open defecation by 2030. In addition, the target requires countries to provide universal access to sanitation, with emphasis on equity, dignity, gender, and sustainability.

The global burden of open defecation is mainly shared by 26 low- and middle-income countries, and currently, the world is off-track (pdf) to eliminate open defecation by 2030. Case in point, sub-Saharan Africa. Due to high population growth, open defecation in the region has in fact been on a rise. From 200 million in 2000, today, Sub-Saharan Africa accounts for 220 million open defecators.

In the midst of failures, indisputably reversing the trend, stands India. Complementing infrastructure-led investments with sustained behavioural change interventions, India has had unprecedented progress towards eliminating open defecation. The country has received appreciation, globally, for the remarkable transformation of its sanitation landscape. Moreover, with India sharing 60% of the global burden of open defecation until 2014, its success is instrumental to the realisation of SDG 6.2.

Behaviour change and awareness

Poor and inadequate sanitation has been a long-standing problem in India. The Indian government since the 1980s has repeatedly committed billions of dollars for the elimination of open defecation, yet it has persisted.

The task at hand wasn’t easy: Up until 2014, over 500 million Indians had been engaging in open defecation, accounting for the world’s majority of open defecators.

The year 2014 brought in a major change in addressing the sanitation challenge in India. It all began with prime minister Narendra Modi launching a campaign called the Swachh Bharat Mission or the “Clean India Mission.” It was a multi-billion-dollar programme aimed at solving the sanitation and waste management challenges of the country.

Within five years, over 93 million toilets were built in rural areas. The campaign did involve heavy infrastructure investments, but the focus went beyond just toilet-construction. Fully attuned to the impact of the social, cultural, and behavioural drivers of open defecation, the campaign involved large-scale behavioural interventions to generate awareness and encourage toilet use. State governments increased spending on targeted information, education, and communications (IEC) materials and deployed dedicated sanitation workers to interact with communities, spread awareness of harmful open defecation effects, and encourage toilet use.

Political leadership and collective action

Being the largest democracy in the world, India’s federal structure involves the distribution of powers between the central and state governments, with some overlapping issues being shared by both.

Often, the interests and policies that the two pursue put them at odds with each other. It is a complex arrangement, sometimes leading to what is known as a “collective action problem,” where the individual (e.g. state) welfare is in conflict with collective (e.g. central) welfare. In the past, it has been difficult to get states to commit funds to build toilets. More “visible” infrastructure projects such as building roads have had a higher priority in state budgets, while the sheer scale, difficulty and potential political risks of the Swachh Bharat Mission could dissuade states from pursuing it.

Being aware of these potential difficulties, Swachh Bharat Mission focused on strategies to get the entire leadership chain involved. With the prime minister himself being the leading voice for the Swachh Bharat Mission, the campaign reflected the commitment of the highest office towards eliminating open defecation in the country.

This level of political leadership has been critical for the messages and initiatives of the mission to percolate down to village level. Further, a cascading model such as this allowed natural leaders to emerge in villages. What is particularly interesting about these trendsetters is their self-motivation and self-reliance in pursuing their sanitation goals.

Swachh Bharat Mission is a great example of the impact of political will, and how it can get the entire
leadership chain, down to the district and block level, to own up an agenda. It is an example of how
coordination among different units can be attained.

Further, the mission proved to be unique not only in terms of garnering political support at all levels but also for being the largest people’s mobilisation campaign in sanitation in the world. The mass participation has turned the mission into a national movement.

Flexibility and autonomy to states

India is a country with vast socio-economic and cultural diversities. It is hard or even impossible to implement blanket solutions across the country. Because of this, a critical element of the Swachh Bharat campaign strategy was to provide flexibility and autonomy to state governments. They were left to their own devices to implement policies and mechanisms, allowing them to take into account their state-specific characteristics.

This approach proved to be instrumental in making Swachh Bharat Mission a success.

By trusting state governments to understand the specific needs and values of their citizens, the central government motivated local bodies to do things in their own way, and thus own the change achieved in their region. Further, this approach was instrumental in addressing the heterogeneity that exists in toilet building and use.

Utilising the budgets and provisions of the mission, the states developed implementation frameworks aligned with the national priorities of sanitation, but tailored to their regional needs. This flexibility and state autonomy have fostered cooperation, indispensable to achieve such a momentous

Swachh Bharat Mission has shown us that there is no unique path to change people’s behaviour. It is critical to empower state governments, local bodies, and leadership at grassroots, such that they own the sanitation agenda for their regions, and innovate to shift attitudes towards using toilets. Lastly, it must be recognised that the prime minister of India has been the linchpin of this campaign, driving, urging and inspiring the country towards the realisation of “Clean India.”

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