Sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and feces. Inadequate sanitation is a major cause of disease world-wide and improving sanitation is known to have a significant beneficial impact on health both in households and across communities. The word ‘sanitation’ also refers to the maintenance of hygienic conditions, through services such as garbage collection and wastewater disposal.
— World Health Organisation
About 577 million people in rural India continue to defecate in the open, living in households that do not have toilets. That is a full 69.3 percent of India’s rural households in 2011. Adequate sanitation requires the provision of multiple facilities and services, as well as the knowledge of hygienic practices. Much of rural India, as the numbers tell us, is yet to build and use even a basic toilet. While hygiene and the disposal of waste after the toilet are important concerns, promoting the construction and use of toilets remains the largest concern today in much of rural India.
To promote toilet construction in villages, the Government of India has been running the Total Sanitation Campaign since 1999, which was revised and renamed as the Nirmal Bharat Abhiyan in 2012. The scheme provides subsidies to households to construct individual toilets. By means of the subsidy, along with cash incentives for village leaders and communication campaigns, the government has tried to promote toilet construction and the need for adequate sanitation for over a decade now.
A rural household toilet built through Parishudh, an initiative of Infosys Foundation in Gulbarga, Karnataka
The government programme, along with growing incomes and other changes that took place over the decade, only managed to push up the number of rural households having toilets from 21.9% to 30.7% between 2001 and 2011, an increase of a little under 10 percentage points. Several large, richer-than-average states have also performed poorly, including the South Indian states including Tamil Nadu, Andhra Pradesh and Karnataka. Of the increase that has been seen in toilet construction, it is anyone’s guess as to how many are being used regularly, and by all members of a household.
Programmatic problems such as inadequate subsidies, red tape and corruption have all plagued the total sanitation campaign, but it is highly unlikely that these factors alone explain the lack of improvement in toilet construction.
A key missing ingredient seen across much of the country is a lack of demand for toilets and for good sanitation.