It is important to frame sanitation not just in terms of toilet use, but as a social and health issue
Areas of expertiseGovernance , Health
KeywordsPublic Sector Governance (PSG) , Health monitoring, evaluation, research, and learning (Heath MERL) , Water sanitation and hygiene (WASH)
ProjectImproving HABIT: households, attitudes, and behaviours to increase toilet use
India’s sanitation journey starts in 2014 with the launch of the flagship Swachh Bharat Mission (SBM) – a new sanitation movement aimed at eradicating open defecation in the country by October 2019. As the first phase finishes, it is important to reflect on the successes and pitfalls of the past five years, and consider next steps for sanitation policy to further boost public health outcomes.
Together with World Vision India and Ideas42, we implemented a three year Improving H.A.B.I.T project, studying and understanding rural households’ attitudes and barriers to toilet use in six districts of Bihar. This project was part of a larger initiative, led by the International Initiative for Impact Evaluation, which promoted latrine usage across rural India.
During this work, we introduced behavioural interventions to change people’s attitudes to toilet use. Our findings show a steep increase in reported toilet use, which can be attributed to the efforts of the SBM. However, households’ knowledge about and attitudes towards their toilet infrastructure and sanitation overall still need improving.
We found that the toilet pit size varied widely across households, not necessarily adhering to the SBM standards. More than a third of households reported pits of more than five feet in depth. Household members indicated that pits constructed with government or NGO support tended to be three to four feet deep, whereas privately constructed pits could be considerably deeper. Previous research suggests people’s aspiration for deeper pits is due to their inherent aversion to pit emptying.
In addition, it appears that there is asymmetry in the types of toilets constructed. While the SBM has advocated for twin-pit toilets, several households have single-pit toilets or septic tanks. A recent study suggests that close to 80% of sampled toilets in rural Bihar were either single-pit latrines or septic tanks, while some examples also show that contractor-led toilets were not constructed properly, for instance both pits in a twin-pit model were simultaneously operational.
These findings pose a critical challenge for sustainability of sanitation outcomes in rural Bihar. It is important to understand why the SBM guidelines provide strict instruction around latrine building. The recommended standard sized, properly constructed twin-pit latrine allows for an on-site treatment of faecal matter which can be easily emptied by the household and used as manure. This, however, may be difficult for deeper sized pits, septic tanks, or pits with faulty construction. Given that the significant proportions of rural latrines don’t conform to the recommended design, this raises a major issue for faecal waste management in the area.
In addition, the lack of a faecal waste management plan for rural areas has led to unregulated and private disposal of waste. These practices could have harmful consequences for public health and sanitation. Lack of a designated area for safe disposal or treatment of faecal waste leads people to dispose wet waste from their pits into open canals and fields - a completely counter-productive practice, which negates public health benefits of toilet use.
Sanitation and caste
At the start of this project we found that one of the reasons for low toilet use is because of people’s aversion to self-pit emptying. To combat the feelings of pollution and disgust with the faecal matter, our intervention explained the process of faecal matter decomposition to the targeted households. In addition, during community meetings facilitators handled the decomposed faecal matter to reduce the aversion associated with it.
However, the results of our impact evaluation show that even though households appeared to understand faecal matter decomposition and were at ease with handling the decomposed matter, their aversion to self-pit emptying persists. Most households reported that they would still outsource the pit emptying task, thus largely reiterating caste-based pit emptying practices. This continues to reinforce caste hierarchies and notions of purity and pollution in India’s society, and further excludes an already marginalised community.
While SBM has been successful in increasing awareness around sanitation and improving toilet usage, further policy engagement is needed to realise the full public health outcomes.
Practice shows that improvements in toilet use are not supported by complementary safe sanitation practices, such as correct disposal of faecal matter. To ensure the sustainability for sanitation policy, we recommend:
- Publishing new nationwide rural sanitation guidelines on faecal waste management
- Empowering local authorities with knowledge and training on low cost and safe technologies for treatment and correct waste disposal
- Enabling states and local bodies to adapt these models to fit the demand, with available funding to build local capacity
- Engaging with the communities to improve understanding about sanitation practices and waste management
The rural sanitation policy needs to consider the inherent caste dynamics and realities of rural India. Change will require active community engagement to battle social taboos, including involving faith leaders, running socially inclusive campaigns, and advocating self-pit emptying for standard twin-pit models or safe de-sludging and disposal practices for other prevalent toilet designs. It is also vital to empower and safeguard marginalised communities involved in caste-based pit emptying and support them with finding alternative employment opportunities.