Sanitation lessons Ugandans can pick from India

As one enters the outer courtyard of the Jaat household, the first thing they will see is a tiled squat toilet. Next to it is a bathroom, and beyond, a small water tank.
The design of the courtyard, and placement of amenities is not different from other houses in the village – which has 500 households – in Taranagar Block, Churu District, in northern India’s Rajasthan State.
Things were different, although, five years ago, the family did not have a toilet and neither did the village have a community latrine. Shakuntala Jaat, 35, vividly recalls the challenges.
“Every day, the girls and women of the household woke up at 4am to defecate in the fields. This happened in all the homes in the village. For anyone to answer or hold nature’s call during the day, you hold it until nightfall because during the day, men were up and about.
“Those who couldn’t hold it – like pregnant women – would defecate while the men were watching. They would do it while standing to protect their modesty,” she says.
This is a region where women are kept indoors, and if they venture out, they cover their entire face with a light veil. While answering nature’s call as a group, the women held discussions about their plans for the day.
“We faced a huge health problem, with the children and old people constantly suffering from diarrhoea. Flies would sit on human waste and then, rest on our food,” Ms Jaat adds.
Churu District – one of the 644 districts in India – is located on the fringes of the Thar Desert.
There are no rivers, and rainfall is only 300mm a year. The district has a population of more than two million people, and of these, 1,029,222 practise open defecation because they did not have toilets or preferred not to use one.

The high disease burden
Open defecation refers to disposal of human faeces in fields, bushes, dustbins, water bodies and other open spaces. This was not a problem of Churu alone, but of the entire country.
According to a 2014 report jointly published by World Health Organisation (WHO) and United Nations Children’s Fund (Unicef), India accounted for 60 per cent of the world’s open defecation. In 2014, only 39 per cent of households in India had toilets.
Naturally, faecal material found its way into the water sources. Statistics from WHO Bulletin show that the estimated actual burden of cholera in India is in the vicinity of three to five million cases and 100,000 to 130,000 deaths per year.
According to India’s National Health Profile 2008, more than 11,237,039 cases of acute diarrhoea were recorded that year.
Ten years later, the 2018 National Health Profile shows that 13,194,775 people suffered from acute diarrhoea.

Central government steps in
On October 2, 2014, India’s Prime Minister Narendra Modi launched the Swachh Bharat (Clean India) Mission (SBM). Achieving an open defecation-free (ODF) society within five years was the main objective of the SBM.
Other goals included cleaning the streets, achieving 100 per cent door-to-door waste collection, and building solid waste management plants in each town.
The mission hinged on four pillars – political leadership, public financing, partnerships, and people’s participation. The central government earmarked $20 billion (about Shs73.7 trillion) for building 120 million toilets.
Mr Arun Baroka, the Additional Secretary in the Department of Drinking Water and Sanitation and Ministry of Jal Shakti, says the central government contributed 60 per cent of the funds, while state governments contributed 40 per cent.
“Poor households were given an incentive of INR12,000 (about Shs621,000) to construct a toilet.
At first, some states resisted thinking that talking about sanitation was beneath the Prime Minister. Some did not like the name of the mission so they changed it. However, once they received the government contribution, they had to chip in,” he says.
In Churu, toilets were built under the slogan: Choko Churu (Clean Churu).
Mr Sandesh Nayak, the Churu District’s magistrate, says the slogan was used repeatedly to imprint it on people’s minds.
“It wasn’t about sanitation alone. We connected it to the pride (dignity) of women. Women cover their faces with veils yet they were defecating in the open, in front of men. Identifying this trigger point was essential to the campaign,” he says.

Challenges and reception
However, behavioural change is not easy in this country of 50 million households, and Mr Baroka says the biggest challenge they faced was to come up with a right communication and channels that would appeal to everyone.
“We used every form of communication to get the message out, including Bollywood stars, politicians and sports personalities, making short videos about ODF. We made a connection between open defecation and religious practices.
“We told people they couldn’t say a river was holy yet they were defecating and cleaning themselves in it,” he says.
For Churu, the availability of water to clean the toilets was a big problem. The State had to think fast. Through an Integrated Shed Water Management Programme, underground water tanks have been constructed in 200 homesteads in the district.
The water tanks, built with cement, can hold 20,000 litres of water, which is harvested in the two months of July and August.
In the dry months, the district supplies homesteads with water from the Indra Ghandi Canal.
Each tank was constructed at a cost of INR100,000 (Shs5.1 million), with the State paying 90 per cent of the cost and the beneficiary paying 10 per cent. Besides cleaning the toilets, the tanks offer households clean drinking water.
Churu was the first district in India to be declared ODF. However, according to Nayak, some people are still sticking to their old ways, even though neighbourhood watches shame them.
“Eighty-six per cent of those who constructed toilets are using them. But it was easy for someone to build a toilet and then use it as a store or kraal, while the family still defecates in the bush,” he says.
On October 2, 2019, Mr Modi declared India ODF, saying in a period of 60 months, 600 million people had been given access to toilets, and more than 110 million geo-tagged toilets had been built. However, building toilets is one thing, but getting people to use them consistently is another.

Statistics
According to the World Bank, more than 300 million Indians were still defecating in the open in 2017.
Research conducted in 2014 and 2018 by the Research Institute for Compassionate Economics (Rice) in four north Indian states found that open defecation had reduced by 26 per cent since October 2014 and that access to household toilets increased from 37 per cent in 2014 to 71 per cent in 2018. The research found that 23 per cent of people who owned a toilet continued to defecate in the open, including in Rajasthan, which had been declared ODF.
For instance, Nayak says after Churu was declared ODF, 9,000 households have been given funds to construct toilets. Baroka says while ODF remains India’s top sanitation goal, it is a continuous process.
“I won’t say we have achieved it, but October 2, 2019, was an important milestone for the country. Communities are doing their own independent verifications – and it is a big country – to declare themselves ODF. But, there are still gaps because new households come up and people still have the same habits,” he says.
Perhaps, the construction of community toilets across the country is part of the answer in a country where more than 90 million people are homeless.
Nayak says 206 community toilets are being built in Churu, with each community contributing INR20,000 (Shs1 million) while government contributes INR1,020,000 (Shs52.6 million).

Managing solid waste
In the rural areas, managing solid waste when the latrines get full is a challenge.
Ms Sunita Narain, the director general of Centre for Science and Environment (CSE), a not-for-profit public interest research and advocacy organisation based in New Delhi, India, says, the focus should shift to managing excreta if the toilets are to be sustainable.
“Otherwise, we transfer the problem from a health burden because of lack of toilets to a health burden because of pollution. This is a big challenge for India because there is no safe disposal of solid waste in all cities.
“The government was supposed to give every village INR 2million (Shs103.2 million) to manage solid waste, but this has not been done. Waste from septic tanks is dumped in open sewers, rivers, and fields, yet, if managed, it can be transformed into biogas for cooking,” she says.
Mr Baroka says Phase Two of the SBM will focus on solid and waste management. Under the concept of Waste to Wealth, people in the rural areas are being encouraged to build twin pit-latrines. Bricks are used to construct the pits. Feacal matter is allowed to settle in one pit only. In four or five years when the pit is full, the channel to it is sealed off, so that the family can use the second pit. After a year, the contents of the first pit are converted into compost. It is non-toxic compost because the waterproof seal does not allow oxygen to enter the pit.

Lessons for Uganda
In 2018, Uganda’s latrine coverage was 79 per cent, according to the Ministry of Health website.
The Uganda Demographic and Health Survey (UDHS) 2016, indicates that eight per cent of rural households, and 12.6 per cent of urban households, practise open defecation; with a World Bank Water and Sanitation Program study estimating that healthcare costs related to poor sanitation cost the country Shs389 billion ($106.5 million) annually.
For Uganda to become ODF, the participation of the political leadership at all levels, to mobilise communities, is essential.
For India, the support and drive of the country’s top political leadership (Prime Minister and Chief Ministers in every state) gave the SBM the much needed impetus to succeed.
Public financing is also important in attaining an ODF society. But, as it is, sanitation seems not to be a priority to the government.
This financial year, the water and environment sector took up only three per cent of the national budget. Government needs to develop a clear financing and management strategy for sanitation, especially at the local government level.
A step in the right direction is the Uganda Sanitation Fund, whose key result area is stopping open defection.
Ms Narain says poverty is part of the problem with open defecation in many countries and it needs to be addressed.
“Nobody would like to go out in the open if they had a well-constructed toilet in their house. Which means you have to provide a certain amount of subsidy. Secondly, we need to invest in behavioural change. Connect the toilet to health and get women to understand how it impacts their children’s health. That is a big trigger for change.”
Also, for any behavioural change to succeed, the approach needs to have the willing participation of the community.

Waste management
Alternative. Mr Arun Baroka, the Additional Secretary in the Department of Drinking Water and Sanitation, says Phase Two of Clean India will focus on solid and waste management. Under the concept of Waste to Wealth, people in the rural areas are being encouraged to build twin pit-latrines. Bricks are used to construct the pits. Feacal matter is allowed to settle in one pit only. In four or five years when the pit is full, the channel to it is sealed off, so that the family can use the second pit. After a year, the contents of the first pit are converted into compost.
It is non-toxic compost because the waterproof seal does not allow oxygen to enter the pit.