Over 600 million Indians have no access to toilets – if you line up the countries where open defecation is practised, India leads and also has more than twice the number as the next 18 countries with no access to toilets. The proportion is worse in rural India – where 68% of rural households don’t have their own toilets (Source:NSSO, WHO).
Why is open defecation an issue?
Open defecation has been linked to a host of problems, from stunting in children, to diarrhoea to lowered IQs. Diarrhoea is still the biggest cause of child deaths around the world, with about a quarter of them occurring in India. 1600 deaths occur EVERYDAY in India due to diarrhoea, and most of them are linked to poor rural sanitation. Stunting is also a marker of malnutrition, and shows that children have had health problems that keep them from being productive, smart adults as they grow.
India spends 7000 crores a year on rural toilets
The large numbers of open defecation in India is quite an embarrassment, considering that it has been steadily in decline everywhere across the world. World Bank research shows that a nine times return for every rupee spent on sanitation is possible. These returns are in the form of improved health, lowered mortality rates, higher school attendance rates, and disease control. Nutrition itself does not prevent stunting and ill health, they have to be complemented with sanitation facilities. So tackling sanitation should be a key focus for governments trying to augment health and nutrition programs too.
Back in 1999, the Government of India started the Total Sanitation Campaign, and it has now been replaced by a campaign called NBA-Nirmal Bharat Abhiyan. The NBA spends INR 7000 crore every year to subsidise rural toilet construction. Additional financial support is expected from the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS), but the process for availing this subsidy is not clear in many states.
So, why are toilets not being built?
It isn’t that the demand for toilets it missing – studies show that demand for toilets does exist in India, with people acknowledging that it is safer or more convenient (the health aspect is not so obvious to most people). People are also more likely to think of constructing toilets if they have used one before. Yet, less than 60% of approved funds from the Government’s NBA campaign have actually been used, reports Deloitte, in its 2013 study titled ‘A market led, evidence based, approach to rural sanitation’. Then why aren’t toilets coming up in rural areas?
1. Well, the poor cannot afford them
The subsidy amount under NBA, covers only part of the cost of toilets, and most households, particularly the poorest are still unable to afford the cost of construction and maintenance of individual toilets. The limited subsidy amount has also led to poor construction, leaving toilets unusable. The per–toilet subsidy is currently around Rs. 4600 under NBA.
2. If they do get built, they quickly become unusable
The superstructure of a toilet does not require skilled masonry but the leach pit does. The Ministry of Rural Development reports that 78 million toilets were constructed under the TSC until March 2011, but the Census (2011) shows only 51 million households as owning working toilets. Toilet designs also need to be modified for flood prone or drier areas.
3. Men are the decision makers, while women face issues
In most households, men are the decision makers but women face inconvenience due to lack of toilets. People also rarely see the link between open defecation and ill-health, unless they have been subjected to a personal health crisis in the family that can be directly linked to toilets.
Toilet models in India
The rural environment in India is complex, and there are a variety of models available for constructing and funding these toilets – and some of these models work better in some places than others – depending on region, implementing agencies, availability of credit etc.
Worldwide, there are several models that have shown success. In India, there are two:
The government led subsidy model
Here the government subsidises toilet construction. The subsidy model has had limited success because of the partial subsidy, and because people do not see it as a priority.
Community Led Total Sanitation (CLTS)
CLTS works primarily by raising awareness that as long as even a minority continues to defecate in the open everyone is at risk of disease. The CLTS also creates village-level water sanitation committees, with volunteers who generate awareness about the health hazards of open defecation. CLTS is an example of how rejecting the subsidy model has actually worked, and focuses instead on persuasion and reward. CLTS has shown remarkable progress in certain Indian states. For example, Haryana : Census 2001 data shows that 71% of households had no toilets, but by Census 2011, this number had fallen to 36%. Haryana and Himachal Pradesh show similar leaps in toilet construction and are great examples of the success of CLTS model which was implemented in all districts of these states.
Apart from just construction of toilets, success has been seen in teaching people that open defecation is bad and leads to health problems. Another crucial part is good quality construction and maintenance of toilets. Poorly maintained toilets and broken or collapsed structures are another reason why toilets get disused.
Who will pay for the poor to use toilets?
Finance for toilet construction in India is a tricky thing as toilets are neither under priority sector lending for banks nor are they investments that give a monetary return. The 3SI’s work indicates that affordable sanitation financing itself can drive conversion. A number of organizations have demonstrated that toilets can be constructed in under Rs. 10,000 in India, but the average costs end up being higher. Temporary toilets can be made for as low as Rs. 1515, through models like Gramalaya.
Monitor Deloitte recently brought out a white paper on rural sanitation in India, bringing out two potential models for toilet construction. Both models require a central player or ‘market maker’ to conduct market-building activities to get the models started. Organisations such as NGOs, microfinance institution (MFIs) and cement companies can play this role, while the Government has a key role in facilitating the development of the sanitation market.
— DIY (Do It Yourself) model
Here the customer collects all the construction material from suppliers, and supervises or involves himself in the construction. This model has the benefit of customization and potential cost savings though it is time-consuming. It is also the familiar way of building private and home toilets.
— TSP (Turnkey Solution Provider) model
Here an entrepreneur sells a toilet as a product, and delivers the chosen product at the promised price. The TSP model provides toilets of a fixed quality as construction is done by specialists.
Organisations working on it
There are several organisations working on toilet models in India. In 2011, World Toilet Organization(WTO) established its SaniShop model in India to increase access of rural households to safe and affordable sanitation. PSI (Population Services International), is piloting the DIY and TSP models in Bihar. Guardian has taken a sanitation MFI-led approach in Tamil Nadu. Grameen Koota, a large financial institution is using its ‘sister’ foundation to do ‘market building’ activities while the main business provides loans. WaterAid and Water.org is working with 21 organizations in India to facilitate credit for water and sanitation. Gramalaya has been implementing various toilet models for over 25 years in South India, depending on the geographic area, water availability and costs.
The toilet road ahead
Today India is in the same position as Haryana was in the ‘90s – with a large percentage of population that practices open defecation, the success made by Haryana in this area is heartening. Toilet construction could be a Rs. 500-700 billion (USD 10-14Bn) opportunity at the national level, creating an ~Rs. 300-450 billion (USD 6-9Bn) financing market, including bridge loans. These numbers are likely to rise as rural incomes increase and subsidies from the government continue. There is potential for companies to expand into the sanitation sector as part of their CSR work as well.
And while we are here
How did the word ‘loo’ originate? Some theories point to the French phrase – ‘regardez l’eau’ (‘watch out for the water’), shouted by medieval servants as they emptied chamber pots out of upstairs windows into the street. Some others point to the origin being ‘Waterloo’ as was inscribed on iron cisterns in Britain in the 20th century. Did you know that flush toilets were invented in India? There is evidence, dating back to 1000 BC, of a water closet with a seat and a crude flushing device in the Indus Valley civilisation!
First Principles is a fortnightly Business feature on The Alternative that takes an in-depth look at insights and challenges in pressing development issues that Sustainable Businesses, Social enterprises, Governments and Foundations are working on.