Tag Archives | toilets

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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