PaperSwachha Bharat Swastha Bharat

TitleInformation Collection and Dissemination for a more effective Swachh

Bharat Campaign: methods and perspectives

Authors:Arnab Bose, Balaji G

AbstractAccess to a clean living environment is a pre requisite and a socio-economic imperative

for a disease free world. A majority of illnesses (80%) in the developing world is linked

to poor water quality and sanitation. The survey results from National Sample Survey

Office (NSSO) in 2012, reveals only 32% of rural households in India have their own

toilets and that less than half of Indian households have a toilet at home (Approximately

130m households lack toilets). In addition, faecal contamination is also a cause for poor

water quality and many water borne diseases. Interestingly, the latest Census data from

2011 reveals that the percentage of households having access to television and

telephones in rural India exceeds the percentage of households with access to toilet

facilities. Recent research points out that increasing financial allocation may not lead to

any tangible improvements in human development indicators and the problem is largely

cultural in nature. Given the social context of the problem, the requirement is therefore

for a change in behavioral aspects brought about by proper information collection and

dissemination methods which need to be location-specific, based on cultural and

geographical aspects. This paper shall propose suitable methods of information

collection and dissemination which could help in synchronizing a range of aspects

including those related to Information Technology. This paper will have broader

implications particularly to help improve Social Impact Assessment methods in the

Indian scenario.

Introduction

This section elucidates the current sanitation status and the health, social and economic

impact of poor sanitation in the Indian and global context. It also looks into possible

reasons for sanitation becoming a social problem. This section sets the context, and

endeavors to highlight the fact that increasing financial allocation may not lead to any

tangible improvements in human development indicators and the problem is largely

cultural in nature.

This white paper iterates the fact that there is a need for a change in behavioral aspects

brought about by proper information collection and dissemination methods which need

to be location-specific, based on cultural and geographical aspects.

Finally this white paper ends with recommendations which may be key inputs to help

improve Social Impact Assessment (SIA) methods in the Indian scenario via a multi-

stakeholder approach.

Current sanitation status – Global and Indian Scenario

A key target of the Millennium Development Goals (MDG-7) is halving the proportion of

people without sustainable access to safe drinking-water and sanitation by 2015 (UN a,

2015). Sanitation generally refers to the provision of facilities and services for the safe

disposal of human urine and feaces. An improved sanitation facility is one that

hygienically separates human excreta from human contact. Improved sanitation

generally involves physically closer facilities, less waiting time, and safer disposal of

excreta (Van Minh et al, 2011)

The world is off track to meet the MDG sanitation target, which requires reducing the

proportion of people without access to improved sanitation from 51 per cent in 1990 to

25 per cent by 2015. UNICEF and WHO estimate that in 2015 some 2.4 billion people –

one-third of the world’s population – will remain without access to improved sanitation,

missing the MDG target by 8 per cent – or half a billion people. Open defecation refers

to when people without sanitation facilities are forced to defecate in fields, forests,

bushes, open bodies of water, beaches, and other open spaces. 1 billion (15% of the

world population) still practice open defecation. The majority (71%) of those without

sanitation lives in rural areas and 90% of all open defecation takes place in rural areas.

(UNICEF a, 2015) Approximately 2.5 billion people lacked access to an improved

sanitation facility. Of these, 761 million use public or shared sanitation facilities and 693

million use facilities that do not meet minimum standards of hygiene. (WHO, 2013)

India continues to be the country with the highest number of people (597 million people)

practising open defecation. Despite having some of the highest numbers of open

defecators, India does not feature among those countries making the greatest strides in

reducing open defecation. (WHO, 2014) According to the Indian government’s 2011

census, 53.1 percent of all Indian households and 69.3 percent of rural households do

not use any kind of toilet or latrine. This corroborates 2010 estimates from the

WHO/UNICEF Joint Monitoring Programme, which found that 1.1 billion people in the

world were not using a toilet or latrine, nearly 60 percent of who live in India (Water and

Sanitation Program, 2015). As per the 2011 census, there is no drainage facility in

48.9% households, while 33% households have only open drainage system in India.

Census data reveals that the percentage of households having access to television and

telephones in rural India in 2011 exceeds the percentage of households having access

to toilet facilities and tap water (Census of India, 2011)

While it is an established fact that sanitation has a direct impact on the health and

hygiene, these figures further strengthen the need for focused efforts towards creating a

clean India : Swachha Bharat.

Possible reasons for sanitation becoming a social problem:

There can be some credulity in saying that Colonial mismanagement, discrimination of

Indians and incorrect understanding of Indian base line conditions (behavioral,

infrastructural or governance related) as evidenced via a journal correspondence

(Hewlett et al, 1915) by the colonial government had transformed India to a failed model

with respect to sanitation and hygiene practices which now have reached shameful

proportions to extent that is becoming a public health issue. The correspondence (Hehir

1923) alludes to the fact that the malaise that is seen presently with municipal work in

sanitation and hygiene was very similar during circa 1923 too.

In Hewlett et al (1915) we see that the correspondence is not at all about sanitation,

however it is about Indians’ ability to qualify as Sanitation officers, and if so – they

should at least have a degree from England. These strange articulations happened so

often from the colonial rulers that a place which was one of the richest countries even

with respect to per capita income, slowly degenerated into a poor state with abject

poverty all around and a societal failure which persists till today even lacking basic

hygiene.

The narrative of the colonial rulers exists even today as we see in The Economist

(2014) and will be discussed in a later section.

Health and social impact of poor sanitation: Global and Indian scenario

Poor sanitation is responsible for one of the heaviest existing disease burdens

worldwide. The diseases associated with poor sanitation and unsafe water account for

about 10% of the global burden of disease (Van Minh et al, 2011). 1.8 million People die

every year from diarrhoeal diseases (including cholera); 90% are children under 5,

mostly in developing countries. 88% of diarrhoeal disease is attributed to unsafe water

supply, inadequate sanitation and hygiene. Improved sanitation reduces diarrhoea

morbidity by 37.5%. An estimated 160 million people are infected with schistosomiasis.

The disease causes tens of thousands of deaths every year and it is strongly related to

unsanitary excreta disposal and absence of nearby sources of safe water. Basic

sanitation reduces the disease by up to 77%. Poor sanitation is associated with various

infectious diseases, including Intestinal helminths (Ascariasis, Trichuriasis, Hookworm

disease), trachoma, malaria & Japanese encephalitis. (WHO a, 2015)

According to the UNICEF, water-borne diseases such as diarrhoea and respiratory

infections are the number one cause for child deaths in India. Children weakened by

frequent diarrhoea episodes are more vulnerable to malnutrition and opportunistic

infections such as pneumonia. With 638 million people defecating in the open and 44

per cent mothers disposing their children’s faeces in the open, there is a very high risk

of microbial contamination (bacteria, viruses, amoeba) of water which causes diarrhoea

in children. Also, diarrhoea and worm infection are two major health conditions that

affect school children impacting their learning abilities. Only 11 per cent of the Indian

rural families dispose child stools safely. 80 per cent children’s stools are left in the

open or thrown into the garbage. Only 6 per cent of rural children less than five years of

age use toilets. (UNICEF b, 2015)

According to the call to action on sanitation issued by the Deputy Secretary-General of

the United Nations in March 2013, open defecation perpetuates the vicious cycle of

disease and poverty and is an affront to personal dignity. Those countries where open

defecation is most widely practiced have the highest numbers of deaths of children

under the age of five, as well as high levels of under nutrition, high levels of poverty

and large disparities between the rich and poor. There are also strong gender impacts:

lack of safe, private toilets makes women and girls vulnerable to violence and is an

impediment to girls’ education. (UN b, 2015)

Economic impact of poor sanitation: Global and Indian scenario

The economic benefits from sanitation interventions have been estimated in a WHO

study to be considerable, and include foregone medical costs, the cost of time lost at

school and work, and the time savings from closer access. Estimates show economic

benefits to the order of $63 billion per year from reaching the MDG sanitation target

(which calls for a 50% reduction in the proportion without coverage) (World Bank, 2015).

India is losing more than 6% of its GDP annually due to premature deaths and

preventable illnesses, according to a 2010 World Bank report (WHO b, 2015).

The Economics of Sanitation Initiative (ESI) study estimates that the total annual

economic impact of inadequate sanitation in India amounted to a loss of INR 2.4 trillion

($53.8 billion) in 2006. This implies a per capita annual loss of INR 2,180 ($48). In

purchasing power parity (PPP) terms, the adverse economic impact of inadequate

sanitation in India was $161 billion, or $144 per person. These economic impacts were

the equivalent of about 6.4 percent of India’s gross domestic product (GDP) in 2006.

The health-related economic impact of inadequate sanitation was INR 1.75 trillion

($38.5 billion), which was 72 percent of the total impact. Within the health category,

more than INR 1.3 trillion ($29 billion) was lost due to premature mortality, the single

largest subcategory. Access time costs for households, estimated at INR 478 billion

($10.5 billion), had the second-largest impact, and healthcare costs (INR 212 billion,

$4.7 billion) and health-related productivity losses (INR 217 billion, $4.8 billion) made up

the other main impact subcategories. Urban and rural households in the poorest quintile

bear the per capita economic losses of INR 1,699 ($37.5) and INR 1,000 ($22) due to

inadequate sanitation respectively (Water and Sanitation Program, 2011).

Swachh Bharat AbhiyanThe Government of India has launched “Swachh Bharat Mission” on 2nd October, 2014

with the following objectives:-

1. To eliminate open defecation

2. Conversion of insanitary toilets to pour flush toilets

3. To Eradicate manual scavenging

4. 100% collection and scientific processing/disposal reuse/recycle of

Municipal Solid Waste

5. To bring about a behavioral change in people regarding healthy sanitation

practices

6. Generate awareness among the citizens about sanitation and its linkages

with public health

7. Strengthening urban local bodies to design, execute and operate systems

8. To create enabling environment for private sector participation in Capital

Expenditure and Operation & Maintenance (O&M) costs ( Press

Information Bureau, 2015)

This campaign aims to accomplish the vision of 'Clean India' by 2 October 2019, the

150th birth anniversary of Mahatma Gandhi and is expected to cost over INR 62,000

crore (US$9.7 billion). The urban component of the mission is proposed to be

implemented over 5 years starting from October 2, 2014 in all 4,041 statutory towns.

The total expected cost of the programme is Rs 62,009 crore, out of which the proposed

central assistance will be of Rs 14,623 crore. (Zee News, 2015)

The campaign is India's biggest ever cleanliness drive and 3 million government

employees and schools and colleges students of India participated in this event. Each

individual will devote 100 hours per year towards cleanliness which translates to

approximately 2 hours per week. The campaign urges everyone to take up the Swachh

Bharat challenge and also inspire others to take up the same challenge given by you. It

also puts the responsibility on all the citizens to make this nationwide campaign a

resounding success by efforts as an individual, institutional and organizational

campaigner. Celebrities and public figures nominated by the Prime Minister have taken

to the Swachh Bharat challenge in a big way and are working towards multiplying the

impact. Each of the nominated celebrities have invited nine other people to join the

mission, who in turn are expected to nominate nine more. Thus, creating a chain of

volunteers working towards a single national cause (Mane, 2014).

There is a need to put in the mechanisms to bring about and sustain behavioral

changes aimed at adoption of healthy sanitation practices. Though the health aspects

are fundamental, the economic and social benefits of sanitation should be emphasized,

and will be a key to building support for the campaign. The behavior change

communication should generate awareness about sanitation and its linkages with public

and environmental health amongst communities and institutions. The mere availability

of latrines will not end open defecation immediately since we also need to confront the

cultural reasons for bad sanitation. The need of the hour is to have public campaigns, in

schools and in the media, to explain the health and economic benefits of using toilets

and of better hygiene with active involvement of the community. (Mane, 2014)

(Dean, 2014) Percent change in open defecation density by state. Each state is shaded

according to the percent increase or decrease of its average open defecation density

from the 2001 to the 2011 census.

The reasons for the present situation

Very often it is cited in international media (example: The Economist, 2014) that one key

reason especially for open defecation is supposedly what was written in ‘Manusmriti’ –

that is an instruction was given to defecate far away from home. Even if the instruction

was given, the narrative is incorrect. Meaning, in the Anglican (or even northern

European) cultural context the ‘what’ is being said is more important than ‘why’.

‘Why’(implicit) is the subtext – which in the cultural context of India is more important

than the text or ‘what’(explicit) has been written. (Reference for cultural contexts: Yang

et al, 2011). So, if we try and understand ‘why’ it was so written in ‘Manusmriti’ - is

possibly because in that time period that was how one could be clean or practice

cleanliness!

Since the British colonial rulers/historians were excessively documenting texts, and

were not taking sub-texts into account (similar narratives can be found in: Thapar,

1968), the true picture of what constituted Indian societal structures were distorted.

These distortions have given incorrect feedback to administrative mechanisms that

lasted to this day (as the case of bus stop design alludes to).

Explaining cultural contexts specific for the Manusmriti instruction (Adapted from Bose,

2014):

Suppose there was an instruction in Manusmriti that – “people should defecate away

from their homes”.

Given the instructions there will be two kinds of questions:

First -

Why was this instruction given? – this is the implicit question which is more important in

the traditional Indian cultural context. The answer to this question is – to be clean. This

is the subtext or implicit behavioral pattern which is more important in traditional Indian

cultural context.

Second –

What is the instruction given? – this is the explicit question which is more relevant in the

cultural context of United Kingdom. In this case the activity will be further mapped, and

when documented - the narrative will look like Indian tradition promotes open

defecation, and so on while losing out that the instruction was to be clean.

Therefore one might ask – that how come the second question became more prevalent

in India; it will be difficult to say, however one conjecture is that the administrative/rulers

culture (UK, explicit, low context) will take precedence over the culture of those who are

being ruled (Indian, implicit, high context). Further, much of the problem of information

collection, dissipation and stakeholder consultations is due to this dichotomy of

administrative culture and the actual culture of the people.

Cultural contexts

India is a high context country with multiple cultures and customs; there are certain

methods of information collection and dissipation which will not work in India. For

example - Town halls, questionnaires (especially with not known people), emphasis on

texts (written rigid mechanisms) –all traditional methods used in governance during

colonial and post colonial times in India, has not revealed the correct needs assessment

of the society. The reason behind this is that the information seeker and the information

giver has laid stress on the text (questions) and the answers specific to the questions

which are alien to the Indian culture.

Given that sub text is more important, the information seeker has to be known to the

person, information should be collected on a person to person basis (Also anecdotal

evidence will suggest that better information is collected from known people where you

hide a paper questionnaire!) ; also information dissipated via pamphlets/news paper

advertisements will not be viable at all – given that they are explicit in nature, to

maintain the implicit relationship, identification of strategic actors is important, build trust

in social and cultural context, then drive learning and agenda.

Case: In a work being done by the Resilience Center Global Network, they have

highlighted that most new bus stops in Delhi are incorrectly designed; what happened

was that earlier the buses were high floor, and passengers had to jump into them – and

apparently during stakeholder consultations it was suggested to increase the height of

the bus stops. This was not a good idea for two reasons. First, the buses in Delhi

became low floor; and second in any case people do not get into buses from the bus

stops directly, they have to get on to the road, as buses are not trains. This feedback

error happens as the old colonial rigidity in stakeholder consultations have remained in

our administrative mechanism.

It is not to say that all consultative methods are incorrect; Delhi metro or various

methods of livelihood security particularly in Meghalaya are examples where

stakeholder consultations were done effectively. In Meghalaya for instance work done

by Meghalaya Basin Development Authority had asked officials to interact and stay with

community for a considerable period of time, such that the true nuances of what is

required could be understood.

Incorrect – bus stop design in Delhi; Singur/Nandigram conflict in West Bengal

Correct – Meghalaya livelihood security programs; Delhi metro

Source: GDA (2015)

Conclusion

The important narrative of this paper is that – the present malaise in social structure is

due to the dichotomy of administrative culture and the actual culture of the people. The

paper has highlighted this aspect, and suggests that more work be done on this such

Social Impact Assessments methods can be improved upon.

Reference:

Banerjee, M., Dasgupta, S., & Mondal, S. (2014) Case Study on Some Positive Initiative

for Solid Waste Management in West Bengal.

Bose A. (2014); Understanding nuances of cultural contexts with a case on Mehrauli

(Project Resilience; further reference – Styczynski, 2014)

Yang, J., Morris, M. R., Teevan, J., Adamic, L. A., & Ackerman, M. S. (2011). Culture

Matters: A Survey Study of Social Q&A Behavior. ICWSM, 11, 409-416.

Hehir, P. (1923). Sanitation In India. British medical journal, 2(3287), 1276.

Hewlett, R. T., King, W. G., & Simpson, W. J. (1915). Sanitation In India.British medical

journal, 1(2827), 446.

Sohoni, M. (2014). The University and the Development Agenda.

GDA (2015); http://www.jeitosa.com/service/global-diversity-awareness-gda/ (accessed

14th January 2015)

(image:

http://www.jeitosa.com/wp-content/uploads/2011/10/LowHighContextCultureGraphic.jp

g)

(UN a, 2015) http://www.un.org/millenniumgoals/environ.shtml (accessed 19th January

2015)

Van Minh, H., & Nguyen-Viet, H. (2011). Economic aspects of sanitation in developing

countries. Environmental health insights, 5, 63.

(UNICEF a, 2015) http://www.unicef.org/media/media_45481.html (accessed 19th

January 2015)

Styczynski, A.; Wolf, J.; Tah, S.; Bose, A. (2014) When decision making processes fail:

an argument for robust climate adaptation strategies for planning in the face of

uncertainty, Environment Systems and Decision Journal, Springer.

Thapar, R. (1968). Interpretations of ancient Indian history. History and Theory, 318-

335.

The Economist (2014); http://www.economist.com/news/asia/21607837-fixing-dreadful-

sanitation-india-requires-not-just-building-lavatories-also-changing

(WHO, 2013) WHO/UNICEF. Progress on sanitation and drinking water:2013 update:

World Health Organization:Geneva, 2013.

(WHO, 2014) WHO/UNICEF. Progress on sanitation and drinking water: 2014 update:

World Health Organization, 2014.

http://www.unicef.org/gambia/Progress_on_drinking_water_and_sanitation_2014_updat

e.pdf(accessed 19th January 2015)

Water and Sanitation Program http://www.wsp.org/sites/wsp.org/files/publications/WSP-

Coming-Up-Short-without-Sanitation-India.pdf (accessed 19th January 2015)

Census of India, 2011. Available at http://censusindia.gov.in/

(WHO a, 2015)

http://www.who.int/water_sanitation_health/publications/factsfigures04/en/ (accessed

19th January 2015)

(UNICEF b, 2015) http://www.unicef.org/india/wes.html(accessed 19th January 2015)

(UN b, 2015) http://www.un.org/millenniumgoals/pdf/DSG%20sanitation%20two-pager

%20FINAL.pdf(accessed 19th January 2015)

(World Bank 2015) http://water.worldbank.org/node/83311/(accessed 19th January

2015)

(WHO b,

2015)http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_ind_en.pdf

(accessed 19th January 2015)

(Water and Sanitation Program, 2011) INDIA, I. S. I. Inadequate Sanitation Costs India

Rs. 2.4 Trillion (US $53.8 Billion)

(Press Information Bureau, 2015) http://pib.nic.in/newsite/PrintRelease.aspx?

relid=113643 (accessed 19th January 2015)

(Zee News, 2015) http://zeenews.india.com/news/india/pm-narendra-modi-with-broom-

launches-swachh-bharat-abhiyan-says-its-patriotism-not-politics_1479062.html

(accessed 19th January 2015)

Mane Abhay, B. SWACHH BHARAT MISSION FOR INDIA’S SANITATION

PROBLEM: NEED OF THE HOUR.

http://www.economist.com/news/asia/21607837-fixing-dreadful-sanitation-india-

requires-not-just-building-lavatories-also-changing

Dean Spears (2014) Increasing average exposure to open defecation in India, 2001-

2011 http://riceinstitute.org/wordpress/wp-content/uploads/downloads/2014/06/Spears-

2014-increasing-OD-density.pdf (accessed on 20th Jan 2015)