Sanitation & Behavior Change in India

As is well known and well covered in the media, there is a sanitation crisis in India, with over half the population (roughly 600 million people) forced toopen-defecateevery day due to a lack of adequate facilities, infrastructure, and even a basic understanding of the importance of healthy sanitation habits. This makes India the world's biggest culprit in terms of open-defecation, with more than double the amount of the next11 countries combined.

Additionally, the country loses overUS$50 billiondollars per year (roughly 6% of GDP) due to sanitation-related illnesses,one child under the age of 5 dies every 20-seconds from diarrheastemming from water-borne illnesses, safety of women and girls remains one of the primary concerns in settings where they are forced into the fields due to lack of access to toilets, generations of Indians havestuntedmental and physical development from nutrient deficiency stemming from persistent diarrhea related to inadequate sanitation, and on and on; there is no degree of hyperbole to overstate the dire state of sanitation in India, and the impact this has on the country.

Presently, there is cause for at least mild optimism in the sector. Prime Minister Narendra Modi'sSwachh Bharat(Clean India) Mission seeks to completely eradicate open defecation in India by 2019, and has committedthousands of croresin support of it. Efforts have also been made to free up tens of thousands of crores in additional funding throughCSR initiatives, an estimated half of which will go directly towards sanitation programs. Perhaps most encouraging, though, is the shift in focus on how the effectiveness of the campaign is gauged: in tracking actualtoilet userather than simply by the number of toilets purportedly built. (The latter metric is particularly flawed given the unfortunate reality that what isreportedis oftentimes not reflective ofground realities.)

There is clearly a demand for improvements in the sanitation space, an understanding of this reality in the public and private sectors, and an appreciation for the complex challenge that solving this crisis presents. The announcement of such a massive infusion of capital in addressing the sanitation crisis through infrastructural interventions, even if actual toilet use is closely monitored, has rightfully caused concern amongst sanitation practitioners in India and beyond. Without addressing the perceptions and attitudes that drive people away from using toilets, adding more toilets will simply not move the needle. Collectively, then, there is push for "behavior change" activities to accompany the Swachh Bharat mission.

Behavior change is certainly not a new concept, and is a key component in theCommunity Led Total Sanitationapproach popularized by Kolkata-based consultant Kamal Kar, and currently employed in over 60 countries worldwide. The issue that arises when talking about such a change is the lens in which it is viewed through: it is far too often that behavior change is looked at only as the responsibility of the end-users that are forced to open-defecate due to inadequate, dysfunctional or simply nonexistent sanitation options.

Disturbingly, a popular view is that those open-defecating are doing so purely as a function of preference, that they willfully snub their noses at available facilities. While there is certainly a portion of the more than half-billion people in India open-defecating that do cite OD as a preference, they are a minority. Further to this, opting to open defecate versus using a toilet is oftentimes driven by the quality of the facility available. The belief that there are pristine, well-maintained facilities being ignored and unused because people prefer using fields, train tracks, and other open spaces to answer nature's call is not only fallacious, it's dangerous: people do not empathize with the plight of so many because they discount their struggle as "it's their choice".

This is especially true when taken to the halls of the various national, state, and local government agencies tasked with providing adequate, safe, and sustainable sanitation to all of India's citizenry. And no group benefits more from the focus of behavior change on the end-user than these government officials.

Over the past three years, I have worked on a innovative sanitation initiative seeking to holistically reimagine the community sanitation experience for India's urban slums. The intent is to improve the infrastructural design, operations and maintenance approach, pricing models, community outreach and education, end-mile waste management, and other aspects of the ecosystem to provide a sustainable solution that community members value, and use. The plan is to build over 100 of these facilities, then rigorously evaluate the impact they have on increasing toilet usage and, by extension, reducing instances of open-defecation. By all estimates, over 60,000 people would directly benefit from the project.

One of the most exciting aspects of the project, at least initially, was the inclusion of the local municipal corporations as stakeholders in the project. They are to contribute not only the land and a majority of the funding to construct the facilities, but also establish what will effectively be help desks to address any issues community members may have that affect the functioning of the facilities. This was viewed as a coup to be held up as a prime example of an effective Private Public Partnership in India. Unfortunately, what was planned versus what has been experienced stand in stark contrast.

The initial timeline for the project was 20-months for all activities including the rigorous post-construction evaluation, which was agreed upon by all partners. Again, it's been three years now and we've yet to build even a single facility. While there have certainly been learnings and necessary course-corrections along the way, it would be accurate to say that a lot of the delays stem from a largely labyrinthine, intentionally opaque government run by officials that can act with impunity and devoid of fear of reproach. That is not to say all officials exploit this, but it is fair to say that a majority of those we have worked with do.

As a foreigner newly exposed to working with the Indian government, I approached my charge with an embarrassing level of naïveté. I genuinely believed that, with the local governments as partners, our project would be immediately successful and free from many of the challenges that have plagued other initiatives. I was therefore unprepared for such questions from our government partners like, "Why should I care about sanitation?", "How do Ibenefit from this project?", and on and on. Surprisingly, It's remarkably challenging to try and sell through the importance of empathy or, short of that, just doing the job one is tasked with.

A huge issue that we have fought diligently to push through is the need for innovation in the sanitation space to solve the problem, and save lives. Oftentimes, we have encountered government officials hesitant to sign off on our project based on the fact that there are aspects of it that are new, and therefore lacking any sort of baseline for comparison, an example of this being the inclusion of menstrual waste incinerators in our facilities. One engineer said outright that he would never approve our project with these incinerators included, and without any sense of shame supported this by saying that he was risk-averse and unwilling to put his neck on the line. Carrying that logic out with him, we asked if he would approve plans for a facility he knew was destined to fail because plans for such had previously been approved. Without hesitating, he said yes.

Beyond this, an omnipresent challenge is just getting in to meet with our government partners. Interactions with them are rarely done over the phone, never via email, and we oftentimes have to resort to communicate via letters in hopes that such dialogues make their way into our project file and, therefore, part of some permanent record. Any visitor to a government office here can attest that there are literally rooms with files stacked floor-to-ceiling, so whether or not anyone will ever give our initiative some ex post facto review is a longshot. No matter, though, it is certainly much better than doing nothing, and being reactive with the government will only lead to greater delays.

Following years of effort, we successfully established enough of a rapport to ensure that some of our meeting requests are granted, but if I'm being honest, the meetings we do get are on an ad hoc basis and are largely contingent upon our willingness to wait, for hours at times, outside an official's office in hopes of getting a few minutes of their time. Oftentimes, weeks can go by between meetings, irrespective of our daily attempts at scheduling such interactions. To further reinforce how challenging this is, our project has a dedicated, and well compensated, company solely responsible for interacting with the government. In spite of this, we have absolutely no leverage when it comes to government interactions. What makes this an even harsher reality is the fact that they are more than aware of this dynamic as well.

These challenges are when the officials are actually at work, which is certainly not a regularity. Governmenttruancyis so endemic that Prime Minister Modi launched awebsiteto track attendance of officials in various offices. It is truly an incredible challenge. How do you accomplish something when you require the active participation of individuals that are either unavailable outright, or unwilling to so much as speak to you even if they are in their offices?

One incident that stands out as the most distressing in my personal experience, and which is the impetus behind writing this, occurred when our government partners decided to reduce the number of facilities we were to build by more than half, citing vague "budget concerns" as the cause. Mere hours after being told this, I sat in a press conference and listened to these same officials proudly announce that sanitation is their top priority. When asked how one could drastically cut budgets on a sanitation project while simultaneously announce that sanitation is the top priority, I was told simply that, "We say what we have to, but do what we want."

As long as this attitude, and the environment that fosters it, persists, no amount of infrastructure or behavioral change achieved by end-users will make a bit of difference.

2 Comments

1. Kevin, You are bang on ! I recently faced a similar situation. What to talk of the challenges of sustaining simplistic solutions, under a city sanitation plan there was demand from one city commissioner to provide 'vacuum sewers' in a difficult slum locality, notwithstanding the technological complexities, higher capex and opex, etc. Well intentioned sustainability and affordability arguments are quite a challenge to put across ! Best regards

2. English French Hello Kevin Your long presentation of the issue of sanitation is similar to that happens in all countries of the world. In the technique developed ultra countries overcomes this problem by hiding all the eyes of the general public and believes that all is well. The state invests a lot of money for it. The finding is more catastrophic. In developing countries the problem is the same as you just grow. Little money, limited infrastructure and abandoned, a return to individual sanitation see defecation in the open. In other indigenous places just give latrines made their dispositios to defecate in the open. 1 person wants to declare that sanitation sercices are unable to find a real solution to this problem excrement. 2 it is mostly the same principle of treatment of excreta wrong. It raises the single question: why sanitation transform feces into mud? 3 From the moment or feces become mud, they are in an advanced state of putrefaction that gives off unpleasant smell odors. 4 the only solution proposed to date whether here in Europe, Africa, the USA is the drain clearing of rotting devices. We only moved the problem away from the general public to hide the inability to really deal with these feces. 5 more than 40 million tons of excrement become mud annually. 75% will be released into the environment. Your problem is a global observation: ineffectiveness of treatment systems to effectively deal with these feces. Why? simply because sanitation systems operate on the principle of the dividing filtration. Sewage treatment plants produce wastewater sludge, individual plants produce sludge is transported to a treatment plant that will reproduce output the same amount of mud. Tails we die. But if I'm hard to criticize I must present solutions. They are: The concept of Biological Remediation cleans and treats wastewater completely removing all traces of excrement. the concept thus produces no mud. As it only works on the principle of -biologique- biodegradation by micro organisms Toilet rooms do not spread from stinking. The water remaining rejected the output of the process is scattered on the vegetated biodiversity, garden or agronomic culture. This saves a huge amount of drinking water. For sanitation. All very developes countries have implemented collective remediation. Very expensive, basic investment ever cushioning, compulsory rehabilitation after 15 years perforamnce purification anywhere near zero docks. Despite this fact these countries continue to Developer practice. Poor they know no other way and offers nothing enleur other for over 60 years. The administration reflected the huge budget like a bottomless hole by taxing the citizens. But nothing to do management, maintenance, palliative treatments, permanent rehabilitation engloutisent the majority of funds lost. This is what I propose The state pays for the installation of individual sanitation that users pay back in the form of a sanitation tax until concurrency of total reimbursement of the base amount. Then the state disengages from the implementation that is the responsibility of the users. By this principle, the state is certain that an individual sanitation is in place. The state favors the individual location setting 20% ​​cheaper rather than collective implantation. Individual sanitation users are much more responsible when it belongs to them and even more when he watered their vegetable garden. But to get such a performance must implement the concept of Biological Remediation, otherwise putting the traditional one in the same issue rentere I put at your disposal all the necessary documentation if you joined me on my mail lyseconcept@gmail.com Pleasure Jean Marius Hello Kevin Ta longue présentation de la problématique de l'assainissement est similaire de celle qui se passe dans tous les pays du monde. Dans les pays ultra développés la technique pallie à cette problématique en cachant tout aux yeux du grand public qui croit ainsi que tout va bien. L'état investit énormément d'argent pour cela. Le constat est des plus catastrophiques. Dans les pays en voie de développement la problématique est identique à celle que tu viens de développer. Peu d'argent, des infrastructures limitées et abandonnées, un retour vers l'assainissement individuel voir la défécation à l'air libre. Dans d'autres endroits les autochtones abandonnent tout simplement les latrines mises à leurs dispositios pour déféquer à l'air libre. 1 personne ne veut déclarer que les sercices d'assainissement sont incapables de trouver une véritable solution à cette problématique des excréments. 2 c'est surtout le principe même du traitement des excréments qui ne va pas. On pose alors la seule et unique question : pourquoi les systèmes d'assainissement transforment les excréments en boue? 3 A partir du moment ou les excréments se transforment en boue, ils sont dans un état de putréfaction avancée qui dégage des odeurs olfactives désagréables. 4 la seule solution proposée à ce jour que ce soit ici en Europe qu'en Afrique, aux USA , c'est la vidange curage des dispositifs en putréfaction. On en fait que déplacer la problématique loin du grand public pour cacher l'incapacité à traiter réellement ces excréments. 5 plus de 40 millions de tonnes d'excréments deviennent de la boue annuellement. 75 % sera déversé dans l'environnement. Ta problématique est donc un constat mondial: l'inéfficacité des systèmes de traitement à réellement traiter ces excréments. Pourquoi? tout simplement parce que les systèmes d'assainissement fonctionnent suivant le principe de la filtration séparative. Les stations d'épuration produisent des boues d'assainissement, les installations individuelles produisent de la boue qui est transportée vers une station d'épuration qui reproduira en sortie la même quantité de boue. On se mort la queue. Mais si je suis fort pour critiquer je dois aussi présenter des solutions. Les voici: Le concept d'Assainissement Biologique épure et traite les eaux usées en éliminant entièrement toute trace d'excréments. le concept ne produit donc pas de boue. Comme il fonctionne uniquement sur le principe -biologique- de la biodégradation par les micros organismes les lieux d'aisances ne propagent pas d'odeurs pestilentielles. Le reliquat d'eau rejeté en sortie du procédé est dispersé sur la biodiversité végétalisée, jardin potager ou culture agronomique. Cela permet d'économiser d'énorme quantité d'eau potable. Concernant l'assainissement. Tous les pays très dévelopés ont implanté des assainissements collectifs. Très couteux, investissement de base jamais amorti, réhabilitation obligatoire au bout de 15 ans, perforamnce épuratoire quais nulle proche de zéro. Malgré ce constat ces pays continuent à déveloper cette pratique. Les pauvres ils ne savent pas faire autrement et on enleur propose rien d'autres depuis plus de 60 ans. L'administration répercutent cet immense budget comme un trou sans fond en taxant les administrés. Mais rien à faire la gestion, la maintenance, les traitements palliatifs, les réhabilitations permanentes engloutisent la majorité des fonds perdus. Voilà ce que je propose L'état prend à sa charge l'implantation d'assainissement individuel que les utilisateurs remboursent sous la forme d'une taxe d'assainissement jusqu'à concurence du remboursement totale de la somme de base. Ensuite l'état se désengage de l'implantation qui est à la charge des utilisateurs. De par ce principe, l'état est certaine qu'un assainissement individuel est bien en place. L'état privilégie la mise en place d'implantation individuelle 20% moins chère plutot que d'implantation collective. Les utilisateurs de l'assainissement individuel sont beaucoup plus responsable quand celui leur appartient et encore plus quand il arrose leur jardin potager. Mais pour obtenir une telle performance il faut implanter le concept d'Assainissement Biologique, sinon en mettant le traditionnel on rentere dans la même problématique Je mets à ta disposition toute la documentation nécessaire si tu me joint sur ma messagerie lyseconcept@gmail.com Au plaisir Jean Marius