India’s Swachh Bharat Mission: how can toilet use be sustained?

30-second summary Progress has been made but barriers still exist to habitual toilet use in India Covid-19 has created more challenges as people look to avoid places they could contract the disease Policymakers have a key role to play in promoting sustained use by supporting community leadership and a sense of ownership around toilets .

Last month, the occasion of Gandhi Jayanti, marked the first anniversary of the Open Defecation Free (ODF) declaration under the Swachh Bharat Mission - Grameen (SBM) in India. Today’s World Toilet Day is an opportunity to reflect on a post-SBM India. The SBM’s mass reach ensured that sanitation and toilet use became a community and household level conversation, especially in rural parts of the country. But, can the progress made hit the Sustainable Development Goal targets to end open defecation and provide access to sanitation and hygiene’ by 2030? And can we contribute towards ensuring this?

Counteracting slippage in India

A major learning from all sanitation programmes preceding the SBM is the lack of sustainability of toilet use across communities. This phenomenon, commonly known as slippage in sanitation literature, means a return to previous unhygienic behaviour or in this case, the practice of open defecation. Most large-scale sanitation and hygiene programmes encounter such slippage because transition to hygienic practices involves significant behaviour change and its continuation requires sustained efforts. Given the scale of the SBM and high prevalence of open defecation (OD) in India (until the SBM), slippage is an expected concern for India’s ODF status. Sustaining ODF is especially important in a context where covid-19 has raised its own challenges. For example, low income residents may hesitate to use community toilets or toilets shared by multiple families, due to fear of contracting infection and may instead choose to defecate in the open. Given that using toilets could very well be a recently acquired behavior induced by the SBM, the chances of such regression become even more likely.

We recently undertook a study, funded by the International Initiative for Impact Evaluation, in partnership with World Vision India and Ideas42 in rural Bihar, focusing on the use of twin pit latrines under the SBM. We found that while toilet use had substantially increased, underlying knowledge and attitude barriers to toilet use persisted in a high proportion of the population. This raises the possibility that the change in behaviour may be temporary. Lack of toilets in agricultural fields where people work, and overall, the lack of water especially in summer, were identified as key impediments to sustained toilet use. We also found overwhelming cases of faulty toilet designs, which also has a huge potential to hinder toilet use at some point in the future.

Challenges and solutions in Ghana

In rural Ghana (in partnership with UNICEF and the Government of Ghana), we carried out research amongst communities who faced a high rate of toilet collapse and damage soon after achieving the ODF status. Unlike India, funding toilet construction or other supply materials has not been a major feature of the rural sanitation programme in Ghana: toilets are self-constructed by communities in most cases. As a result, they are basic in design, usually made using mud, thatch, wood etc. and hence, are more prone to collapse during the rainy season, signaling high likelihood of slippage. However, during the study we found that some communities demonstrated resilience either by rebuilding collapsed toilets (instead of returning to open defecation) or constructing durable toilets, in the first place.

One of the primary reasons for this resilience and limited slippage was the facilitating role played by the Government and other funding institutions. They mobilise communities towards toilet use as well as help develop their abilities to build the toilets themselves. We found this was further strengthened by community leadership and vigilance as well as community members supporting each other with rebuilding of toilets wherever toilets collapsed. Sustained institutional nudges as well as community mobilisation efforts gradually led to individuals developing a sense of ownership as well as preference towards toilet use for reasons such as privacy, safety, convenience and even health. This combined sense of ownership (given own funding) and preference for toilets (ingrained through community mobilisation efforts) contributed towards ensuring resilience in these Ghanaian communities.

Sustainable sanitation for the future

Placing these individual, social and institutional drivers in Ghana together with our findings from rural Bihar in the Indian rural sanitation context, we get some key insights towards achieving greater post-ODF sustainability in India. The Government has played an all-encompassing role throughout the implementation of SBM in India, ranging from funding support, capacity building, community mobilisation and vigilance. A continuation of government support, hence, is vital. In fact the Government’s current Jal Mission offers an opportunity to link adequate provision of water to sustainability of hygienic behaviours acquired during covid-19 (like hand washing) – and to the habit of toilet use. However, at the same time, it is pertinent for the sanitation policy to now shift focus towards empowering communities and individuals, to develop a deeper sense of ownership and preference towards toilets and their use, by continuing to address knowledge and attitude related barriers. Programmes to increase awareness regarding retrofitting of toilets with faulty designs, offer a good entry point to increase the sense of ownership, while also building community level capacities. A combination of such emphases would hopefully contribute to ensuring that our communities become resilient, sustain ODF practices, and reap the long-term health benefits of sanitation.

The article is based on the results of two research studies carried out in Bihar (India) and Ghana. The Improving HABIT study conducted in rural Bihar, was funded by the International Initiative for Impact Evaluation (3ie) and the study consortium included Oxford Policy Management, World Vision India, and ideas42. The study in Ghana, the Sustainability study, undertaken as part of the larger rural sanitation operational research, was funded by UNICEF Ghana (Study consortium - Oxford Policy Management, MAPLE consult, and IRC).