Tag Archives | Sanitation

INI9: 9 minute conversation with Rohini Nilekani

I discuss sanitation, malnutrition and dams with Rohini Nilekani in the latest INI9: 9 minute conversations on strategy, policy and politics.

The conversation happened on the sidelines of the Takshashila-Hudson conference, Shaping India’s New Growth Agenda: Implications for the World, Bangalore 2014.

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Toilets and access

The National Sample Survey Office released new findings this week from the 69th round of the National Sample Survey conducted in 2012, providing the latest state-level data on sanitation, water supply and electricity access.

The last set of reliable numbers on rural sanitation came from the 2011 census, where we found that about 30.7 percent of rural Indian households had their own toilets in 2010. As covered by The Transition State, this had improved in the previous decade by about 9 percentage points.

Broadly consistent with that rate of increase, the NSS round from 2012 reports that 31.9 percent of rural households had their own toilets in 2012, an increase of ~1.2 percent in two years. What the NSS press release dwells on at greater length is the number of rural households with access to toilets, which is a significantly greater number in most Indian states.

This access is self-reported by surveyed households and can mean that they share or use a neighbour’s toilet, have access to a community/public toilet or perhaps have access at their workplace, especially if they live close to towns and cities. However, the access data is likely an overestimate as there is nothing to prove that every member of the household avails the use of toilets, or uses them all the time.

Nationally, 40.6 percent rural households have access to toilets, as opposed to about 31.9 percent of them owning or having exclusive access to toilets. Since there is a two year lag between the two data points collected (as shown below for all states) this gap can be treated as a minor overestimate.

Toilets vs Access2

As one can see, there is a phenomenal range of differences between households owning toilets and households having access to them. A state like Karnataka has almost no difference, implying that toilets are treated as private, household goods in the southern state. Meghalaya is the other extreme, where the number of households with access to toilets is almost double the number of households who own them. If only access were to be measured, states like Nagaland, Delhi, Sikkim, Mizoram and others could declare themselves to be free of open defecation today.

The chart below illustrates the difference between the ranking of states on rural sanitation between the two measures.

Toilets vs Access

As one can see, most of the change happens in states with higher toilet ownership. Delhi, Nagaland, Meghalaya and Arunachal Pradesh are the biggest gainers when access is considered, with Kerala, Manipur, Punjab and Himachal Pradesh losing the most ground.

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Census Towns and Toilets

The Transition State returns to examining sanitation data today and we take a look at toilets in the odd entities called ‘Census Towns’. (For previous analyses see this and this.)

Census towns are formed by villages that show an increasingly urban character in terms of density, size and economy. They are considered towns only by the Census and not by state governments and are hence called ‘Census towns’ as opposed to ‘statutory towns’. Census towns are governed locally by village panchayats.

Why are census towns relevant from a sanitation perspective? Rural sanitation in India is still stuck at a level where a majority of people continue to defecate in the open, and less than 1 in 3 households have a toilet. Understanding what drives people to build and use toilets is necessary to change this. Urban India fares much better in toilet ownership – but fails quite spectacularly in other aspects of sanitation like waste collection and disposal.

Census towns are of interest here because they are places which have *just* urbanised, and are still at the margin. Census towns get called so when they have crossed all three of the following thresholds: a population density of 500 people per square kilometre, village size of 5,000 residents and 75 percent of the working age male population employed in non-agricultural sectors.

So how do census towns fare in toilet ownership compared to their rural surroundings? I compare census towns with the rural taluk (sub-district) in terms of toilet ownership for the state of Karnataka. The taluks are ordered in an ascending order of toilet ownership.

Toilets-Census-Towns-Karnataka

Census towns in Karnataka appear to have much higher toilet ownership than their rural surroundings. And when the rural base goes higher than 20 percent, most of the census towns cross the 80 percent mark in toilet ownership.

Several things change between census towns and other villages. The services sector would have taken off in census towns, likely also resulting in higher incomes. But the most important change is that of population density. This increase in density results in a reduction in open spaces where people can defecate conveniently. If people have to go more than say 200 yards every time they need to relieve themselves, then the case for a toilet becomes a lot stronger. The ‘call of nature’ becomes more difficult as nature is beating a retreat out of the census town.

Urbanisation seems solve the toilet ownership problem. But toilets are far from sufficient in a city to achieve the public good that is sanitation. Waste collection and treatment become vital – be it through a sewerage network, local treatment plants, septage management or some other means.

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The Best Form of the Argument

For the past few days and weeks, I have been wracking my brains to find the best form of the argument for the national food security bill for India.

Let’s leave aside for the moment the fiscal cost of the bill, any distortions of agricultural markets, inefficiency of the supply systems, mis-targeting of the grains and the signals it sends to investors. These are all serious problems of various magnitudes, and those magnitudes are contested. However, they still refer to the unintended consequences of the FSB rather talk about its stated or intended benefits.

The best form of the argument that I can come up with for the food security bill is this:

Inexpensive cereals can address malnutrition and hunger.

Readers are welcome to contest this one line statement and suggest one of their own. Hunger is a problem that we have all but solved in India, thanks in large part to the Green Revolution, better infrastructure and a rise in incomes. Only 2 percent of India self-report that they do not always get to eat 2 square meals a day, compared to 67 percent of the population that the FSB wants to cover. Make no mistake, 2 percent of India’s population is still a whopping 24 million people. These 24 million people are also largely concentrated in pockets that have several other problems such as maoist violence and the lack of even basic infrastructure. Their needs, however, are perhaps best addressed by an idea that Arvind Virmani proposed: an ‘elimination of hunger’ act that works in a targeted manner to address just this problem.

Malnutrition remains a large national problem that hasn’t been sufficiently addressed to date. I have argued in the past in Pragati that malnutrition is largely a sanitation problem (and perhaps a nutritional knowledge problem) and not one of insufficient grain supply. Several others have written on the nutrition-sanitation link as well.

Thus if malnutrition and hunger are set aside from the primary outcomes of the food security bill, all that remains is a government-sponsored income supplement to 67 percent of India’s population. If we were to openly admit that as the goal – then we can discuss as to how best we can go about providing that income supplement. (The Acorn calls it theft – which it is, legitimate or no.) Unconditional cash transfers, conditional transfers and food vouchers are all means of providing an income supplement. To impose a monopoly supply of cheap grains through a leaky government setup on 800+ million people who range from the residents of an isolated hamlet to urban slum dwellers is ludicrous.

Malnutrition and ‘food security’ have been subjects of national debate for the better part of 2013. The sanitation community missed a great opportunity to shift some of the national focus onto sanitation, a debate which has remained fixated on a the idea of a public grain supply system. Sanitation is one of the toughest public policy challenges that India faces, and opportunities that have been squandered are very difficult to come by.

There are two difficulties with public drives and investments in sanitation: first, it isn’t a problem you can just throw money at. It needs a change in public behaviour and attitudes, and it requires a rethink on some of the systems. Second, it gives very poor political and electoral returns. But to even get there we need sustained public attention and rigorous debate that isn’t restricted to department officials, think tanks and sectoral experts. Jairam Ramesh remains the sole politician who has been persuaded to the cause of sanitation to date. It’s a shame that this opportunity was missed to persuade a few more.

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No food security without sanitation

Debate has been raging on the Food Security Bill in India for quite a while now, at least in the English press and online commentary. Until recently, the role of sanitation in malnutrition (and by extension, in food security) was largely missing from the public discourse. This prompted me to write an article in Pragati back in May:

While the National Food Security Bill proponents have been looking at nutrition as a ‘gross’ problem which requires more input in the form of cheaper food, the reality is that it is largely a ‘net’ problem. Far too much nutrition is lost to recurring diarrhoea, dysentery, persistent worm infestations and chronic environmental enteropathy linked to open defecation and a lack of sanitation. People in 69 percent of rural Indian households continue to defecate in the open. While most of the urban population uses toilets, little human waste gets collected and treated properly.

It is ludicrous that sanitation has not been made a priority in development policies addressing malnutrition. While the official government of India position has always been that malnutrition is ‘complex, multidimensional and inter-generational’, the interventions have largely been about targeted and non-targeted nutritional interventions, subsidized healthcare, and with token mention of clean drinking water supply and sanitation. This is like giving dysentery patients subsidized food and medicine, and asking them to eat more, and stopping the medical advice there. In the absence of focus on sanitation, what we have is taxpayer-funded diarrhea and little else. [Think Sanitation, Not Food Security | Pragati – May 2013 PDF]

It has been encouraging to see that the popular discourse has changed significantly in the last month, with sanitation and clean water getting  due recognition for their role in nutrition and food security. Several excellent articles have been written on the subject in that time.

Business Standard published an editorial early in June, questioning the assumptions behind the food security bill and arguing against rushing it through, while citing a lack of sanitation as one of several important reasons behind malnutrition.

Arvind Virmani wrote in the Times of India on how we need a ‘hunger elimitation’ act coupled with a strong policy focus on clean water, sanitation and communication about good nutrition instead of a gargantuan food security bill. Dr. Virmani, a former advisor to the Planning Commission and a Chief Economic Advisor to the Government of India, has written extensively on the topic even in the past as well.

Adi Narayan wrote a well-researched piece in Bloomberg on how extra food means nothing to stunted kids with bad water.

Robert Chambers (most famous for his development of Participatory Rural Appraisals) co-authored an article with Gregor von Medeazza in the Economic & Political Weekly on sanitation and stunting in India, on the link between sanitation and undernutrition in the country.

And most recently, Sadanand Dhume also critiqued the ‘hunger games’ in India, calling instead for a fix of the woeful public sanitation in the country.

Much of the credit for this goes to some excellent research done by Dean Spears, currently heading a start-up RICE Institute in Uttar Pradesh. While there is a whole body of research on sanitation and health, Spears catalysed the field with original analyses of large, disparate datasets.

All said, it is unlikely that anything will stop the current government from their pursuit of this ill-considered bill. One can but hope that in the long run, sanitation occupies a larger portion of the public mindspace when it comes to matters of nutrition, health and food security.

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Toilets in Rural Karnataka – A peer effect?

In my previous post, I had taken a look at how sanitation improved in rural Karnataka and India over the decade of 2001 to 2011. Three broad categories of districts had emerged in Karnataka, and a relationship was visible between a district’s starting position on toilet ownership and how well it improved.

Going by the spirit that drove the previous analysis, I go a level deeper and more granular, and take a look at Karnataka’s taluks (or sub-district units) to see how things are changing in rural sanitation.

Karnataka Rural Sanitation - Improvement in Districts and Taluks

The above graph tries to see just that: where taluks and districts were in 2001, and how much they improved over 2001-2011. It is immediately apparent that taluks follow the districts of Karnataka in their behaviour: there again appears to be a strong link between where a taluk is starting from in terms of toilet ownership, and how much it has improved in the past 10 years.

If we simplify the first graphic by removing the district data points,  the positions of all 176 taluks of Karnataka are more clearly visible.

Karnataka Rural Sanitation - Sanitation Trap

What one can see is that when the starting point of a taluk is below 15% toilet ownership, the improvements are never phenomenal. When the starting point crosses about 20%, many more high performers become visible. It is possible that taluks and districts have to get out of a “poor sanitation trap” before being able to improve significantly.

Complementing the trend, every district that started with 40% toilet ownership or higher, improved by at least 20 percentage points, underscoring the relationship between the two. While the trends are easy enough to visualise and comprehend, the reasons for them may be complex and difficult to be certain of.

One reason for this link between starting position and improvement in sanitation could be the peer effect. The peer effect is where someone’s behaviour is influenced by those around them. It has been well studied in the field of education, where it’s been found that a student’s educational outcome is strongly linked to his or her peer group and the group of friends. ‘Peer pressure’  is a form of this as well, although mostly with negative connotations, where people pick up habits and mannerisms from their peers.

Coming to toilets in Karnataka, imagine the 15-20% mark: it’s where 1 in 6 or 1 in 5 houses have a toilet. At those numbers, most people have a neighbour who owns a toilet and uses it. People who are still defecating in the open can not only imagine, but also see what the benefits and comforts of owning a toilet can do. Possibly, even the transition to using toilets (and cleaning them!) can become easier as people can learn from each other. Toilets also possibly become aspirational objects – in effect nudging more households to avail what subsidies come their way.

An alternate reason could be a lot more mundane: the link could simply be a result of the Nirmal Gram Puraskar award and the programmatic design of the government’s total sanitation campaign. A large focus of the campaign was to take villages that were doing reasonably well on sanitation – and push them to near-complete toilet ownership, making them “Open Defecation Free” (at least in theory). Here, individual toilet subsidies were coupled with a cash award to villages (and their panchayats) which managed to go open-defecation-free. While it is possible for the NGP to have had an effect on the correlation, it is unlikely that it can explain it entirely.

One way to decide between the two (and other!) possible reasons for the pattern of rural sanitation improvement is to go deeper once more look at it at the habitation level – at villages and hamlets and how they improved. Unfortunately, this isn’t possible with Census data. Either way, these results have a significant bearing on how we can improve rural sanitation in the coming decade, where we have to achieve a high, sustained improvement in sanitation but with reasonable public investment.

Data used in this post are available here: Karnataka Districts | Karnataka Taluks.

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Sanitation in Rural India and Karnataka – How has the needle moved?

Sanitation is among the most dismal and depressing topics in India, across the country. While sanitation in our cities comes with its own set of problems, rural sanitation in India is stuck a primitive stage where too few people have access toilets.

To promote toilet construction in villages, a ‘Total Sanitation Campaign’ was launched by the Government of India in 1999 where subsidies were given to households to construct individual toilets. By means of the subsidy, cash incentives for village leaders and other communication campaigns, the state has tried to promote toilet construction and the need for adequate sanitation for over a decade now. As one can expect, several problems such as  inadequate subsidies, red tape, corruption, plus a lack of demand for good sanitation have all plagued the campaign.

After the Census results came out last summer, there was a major controversy as the census numbers for toilet ownership violently disagreed with numbers that the government campaign was putting out.

This post takes a look at how the needle has moved on toilets and sanitation – be it because of the government scheme or in spite of it  –  in rural India and in rural Karnataka.

As of 2001, only 21.9% of rural Indian households had toilets. After a decade, the percentage of households increased to 30.7% – an increase of less than 10 percentage points. Below is a graph of how toilet ownership has improved across all states of India, arranged in an ascending order based on how things were in 2011.

Sanitation in Rural India - The Transition State

While Kerala, Manipur, Mizoram and Sikkim are states that are ahead of the rest on rural toilet ownership, it is important to note that Himachal Pradesh, Punjab, Sikkim and Goa have improved the most in toilet ownership between 2001 and 2011. It is also interesting to note that relatively well-off states like Tamil Nadu and Karnataka actually fall below the national average, with Andhra Pradesh barely doing better.

The above performance, however, has been talked of quite a few times by journalists, policymakers and other sectoral experts. To really understand how rural sanitation is improving, one needs to dig deeper and go more granular. This blog makes a preliminary attempt at doing so by looking at all the districts of the southern state of Karnataka.

As shown in the graph above, toilet ownership in rural Karnataka increased from 17.4% in 2001 to 28.4% in 2011. The spread of this growth across districts can be seen in the graph below.

Sanitation in Rural Karnataka - The Transition State

At the district level, a lot of fascinating trends emerge. Firstly, there’s a curious change in the gross “shape” of the graph, compared to the first graph of states. There appear to be three distinct types of districts in 2011: the poor, the middling, and the stellar performers.

The poor performers are the bottom 10-15 districts, that had a low base of toilets to begin with, and improved by only a few percentage points in the last decade. The middling performers are those that had between 10 and 20% toilet ownership in 2001, and all improved by about 10 percentage points since then – similar to the state average. The third type are the stellar performers, who had more than 20% toilets to begin with, and improved significantly over the decade.

However, the most prolific district in Karnataka is undoubtedly Bangalore (Rural) making a phenomenal leap of almost 50 percentage points in toilet ownership. This performance is perhaps attributable, at least in part, to a very proactive civil servant, Manjula Naik, who was the CEO of the district Zilla Panchayat for a while.

One can also posit that how well a district improves is also incumbent on what its starting position is. It is possible that districts with about 20-30% rural toilet ownership have reached a certain stage of socio-economic development, where the prosperity, aspirations, governance quality and cluster effects of some households having toilets spurs the rest in building toilets. If that is so, then the middling districts of Karnataka – Hassan, Mysore, Mandya, Davangere, Ramanagara and Haveri are all ripe for rapid improvements in rural sanitation.

Let us hope that smarter policies and better economic growth result in far greater improvements in the coming decade.

Some of the ideas in this post came about due to several conversations with my colleague, Vijay Krishna

Notes. While this post tracks the percentage of households with individual toilets, a small portion of rural households also has access to community toilets. It is the remainder of households who continue to practice open defecation, along with a subset of the former households who may not be using their toilets.

Data used in this post are available here: States | Karnataka Districts.

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