Which Came First – The Latrine or Behaviour Change?

UNICEF estimates that India contributes 60 percent to the total population of individuals who practice open defecation which has grave consequences for water source contamination. MPP student Gaurav Ganti examines how a behaviour change is the only feasible way of addressing India’s embedded cultural aversion towards public sanitation

A photo of Indian State Health Minister Kalicharan Saraf urinating in public has been doing the rounds on the internet. Caught with its pants down, the Indian government can no longer merely pay lip service to the issue of sanitation.

UNICEF estimates that India contributes 60 percent to the total population of individuals who practice open defecation. To put this in context, the next highest contributor is the entire Sub-Saharan African region, at 24 percent. UNICEF identifies open defecation and associated contamination of water sources as a major driver of health issues such as diarrhoea. Every year, diarrhoea kills 188,000 children under the age of five.

This prompts the question of why a country which aims to be a global superpower finds itself incapable of eradicating this practice and ensuring universal access to sanitation facilities. The problem is twofold. First, the subject of sanitation is a deeply sensitive socio-cultural issue in India. Society is plagued by the evils of the caste system, a form of social organisation particular to India. The job of cleaning toilets is considered to be the work of the so-called “lower castes”. As a consequence of the attached stigma, many Indians who practice open defecation view it as a cultural practice and are unwilling to build or maintain their own toilets.

Second, due to the sensitivity of the subject, many politicians find it expedient to ignore it. Thus, there is a tacit agreement between those who practice open defecation and politicians to keep the issue out of the realm of political discussions. People who view the practice as backward and unhygienic merely show disgust and prefer to keep their distance, considering the open defecators as inferior and uneducated.

There has been an effort to bridge this widening chasm in recent years with the “Clean India Program”, initiated by the Indian Government in 2015. The goals of the program are quite ambitious: it aims to ensure that all households in India have a functioning toilet and to increase the involvement of all citizens in maintaining sanitation and cleanliness standards. The winds of political change seem to be blowing in the right direction. Building latrines is seen as an attractive solution for the government as it provides quantifiable means to show progress. However, lack of use and the subsequent lack of maintenance means that many latrines are now in a state of neglect after significant expenditure to build them.

To secure lasting change, it is more important to focus on the related cultural attitudes and to foster a sense of ownership of the latrines. These require sustained intervention, by well-trained motivators. Success stories of such schemes have been observed in Gwalior for example, a city in Northern India, where the increased demand for sanitary products following sustained intervention led to local stores readily stocking the shelves. These activities should receive funding based on need, proportioning amounts based on the proposed level of the districts’ goals, as well as spending more in low-performing districts, which would be likely to increase the use of toilets which have already been built.

Awareness goes hand in hand with a sense of ownership. To engender a feeling of ownership, the local community needs to experience agency. Setting up executive communities in the villages, which would conduct community reviews, will complement the awareness activities. These communities will also allow the villagers to get information directly through to the appropriate authorities without needing intermediaries, giving rise to greater confidence in the system and by extension in sanitation practices.

Furthermore, these executive communities can be used to achieve the complementary goal of empowering women. The burden of collecting water and maintaining sanitation is a job traditionally ascribed to women in many areas of India. Encouraging women to take leadership roles in local community reviews is unlikely to be viewed as a threat by men. In fact, there are several cases where men are willing to eschew these positions, considering them to be the traditional duty of women. Increasing the participation of women in roles which exceed those customarily ascribed to them is likely to increase their sense of involvement and self-esteem. It is also likely to provide a strong but subtle signalling effect to young children who will view this empowerment in stark contrast to the other forms of patriarchy surrounding them.

Many practitioners in this arena are likely to dismiss the argument that cultural change should precede the drive to provide access. They argue that the two processes can and should take place simultaneously. However, this fails to account for the large amount of money which is being sunk into toilets which are neither used nor properly maintained. They forget that there is a distinction between measuring success on the basis of mere output and measuring it based on outcomes.

Kalicharan Saraf maintains that the matter of his public urination is “not a big issue”. Though it is exactly this nonchalant attitude towards public sanitation which serves to highlight how needed behaviour change towards sanitation is. The State Health Minister may be a lost cause when it comes to instigating this shift, but for the “Clean India Program” to be successful, it needs to start with attitude change not more latrines.

Gaurav Ganti is deeply interested in climate and sustainability policy. A mechanical engineer and energy modeler by training, he is interested in data driven, rigorous approaches to policy making and evaluation.