JOIN USA UN report on the state of sanitation all over the world has again brought out the shameful fact that India has the largest number of people who defecate in the open.
It is a terrible comment on our sanitation and public health system that about 600 million people, half of the country’s population, have no access to toilets. Good sanitation is the basic requirement for public health and access to toilets has the most important role in it. Poor sanitation causes widespread medical problems. It is estimated that about 2,00,000 children die of diseases caused by lack of toilet facilities. The cost of medical treatment runs into thousands of crores. The impact on the GDP, according to the World Bank, is about 6 per cent. Access to toilets is also important for the safety and security of women. About 10 per cent of the country’s schools have no toilets, and 30 per cent of those that are there are dysfunctional and unusable. This is a big deterrent against girl’s education.
It is not that no efforts have been made and there is no progress in improving sanitation. The overall sanitation coverage has gone up from 18 per cent in 1990 to about 45 per cent now and the central and state governments are paying more attention to it now. But even countries like Bangladesh have reduced open defecation to single digits during the same period.
Within the country some states have done much better than others. Sikkim creditably became the first state to achieve 100 per cent sanitation coverage. Assam, Maharashtra, Gujarat and Kerala have done much better than others. The Total Sanitation Campaign, the Nirmal Gram Puraskar and the JNNURM have helped to improve sanitation levels. There is even a ‘no toilet, no bride’ campaign. But the spending on sanitation as a percentage of the GDP actually declined in the last five years.
There is a proposal to deny certain benefits to those who do not build toilets at home. This is coercive and may not work for large numbers of people who may not have the means to build toilets. A community-based approach, where the governments and local authorities take the initiative, is best. It should be supported by an information and awareness campaign. It may also have to deal with problems related to caste and social attitudes, especially in rural areas. A comprehensive plan and efforts are needed to address the problem on an urgent basis.