How can we reduce open defecation in rural India?

Majority of people practicing open defecation in the world are from India. This has very serious implications on health especially the health of children. We believe that the discussion needs to move beyond toilet construction and should start focusing on usage.

1. TheAsk HOW Analysis
How can we enable
rural Indians to stop
open defecation?
Data and Analysis source:

2. TheAsk HOW Analysis
HOW CAN WE REDUCE OPEN DEFECATION?
Why Is It Important?Use of toilets by ALL (100%) members of the community is necessary
to significantly reduce fecally transmitted diseases.
PUBLIC HEALTH

3. TheAsk HOW Analysis
Why Is It Important?Sanitation- related diseases are major killers.
ŸDiarrhoea - 88% of which is
due to poor water and
sanitation.
ŸDiarrhoea kills more
children than HIV/AIDS,
malaria and measles
combined.
Sources:
ŸDepartment for International Development, Water Sanitation and Hygiene Evidence Paper, May 2013.
Ÿhttp://www.cdc.gov/safewater/disease.html
Fatalities attributed to sanitation- related diseases outnumber the
fatalities caused by Malaria, HIV/AIDS and Measles COMBINED.
Most diarrhoea - related deaths are children.
>
HOW CAN WE REDUCE OPEN DEFECATION?
Malaria Deaths (under 5 years)
Diarrhoea Deaths (under 5 years)
HIV/AIDS Deaths (under 5 years)
Measles Deaths (under 5 years)

4. TheAsk HOW Analysis
Why Is It Important?CHILDREN pay the price for the lack of sanitation.
Sources:
Ÿhttp://blogs.wsj.com/indiarealtime/2012/09/13/almost-5000-indian-children-die-daily/
Ÿ4650 children died every day in India in 2011 due to poor sanitation –
for every 1000 children born, 61 are unlikely to make it to their 5th
birthday
3 children die EVERY MINUTE
due to sanitation related problems
HOW CAN WE REDUCE OPEN DEFECATION?

5. TheAsk HOW Analysis
How Many People Do It?
Sources:
Ÿ
ŸCensus 2011
Progress on Drinking Water & Sanitation: 2012 Update; UNICEF, WHO - http://www.unicef.org/media/files/JMPreport2012.pdf
Out of 10 people
who practice
open defecation
across the world,
6 live in India
People defecating
in the open in India
People defecating
in the open in China,
Pakistan and Nepal
put together
>>>>>>>>>
9 TIMES THE NUMBER
TOILET ELSEWHERE 7 out of 10
Indians living
in villages
defecate in
the open.
HOW CAN WE REDUCE OPEN DEFECATION?

6. TheAsk HOW Analysis
Why Do People Defecate In The Open?
REASON 1:
Not enough toilets have been constructed and where constructed
they are not all usable.
REASON 2:
Even when usable toilets are available, people do not use them.
Sources:
ŸWater and Sanitation Programme, Department of Drinking Water and Sanitation, A decade after the Total Sanitation Campaign, Rapid Assessment of Processes and Outcomes. Volume 1
HOW CAN WE REDUCE OPEN DEFECATION?

7. TheAsk HOW Analysis
69% OF INDIANS IN VILLAGES DO NOT HAVE ACCESS TO A TOILET
Sources:
ŸCensus 2011
ŸWater and Sanitation Programme, Department of Drinking Water and Sanitation, A decade after the Total Sanitation Campaign, Rapid Assessment of Processes and Outcomes. Volume 1
ŸFrom Outlays to Outcomes, Understanding the Status of Rural Sanitation Data, Avani Kapur, Saamia Ibrahim,Accountability Initiative, Centre for Policy Research (CPR) for the State of Sanitation Project, Arghyam
TIME (yrs.)
GROWTH IN ACCESS
Access has grown by less than 10% in
the last 10 years - from 22% in 2001 to
31% in 2011.
HOW CAN WE REDUCE OPEN DEFECATION?

8. TheAsk HOW Analysis
WHY DO PEOPLE NOT HAVE ACCESS TO TOILETS?
While sanitation is a priority to women, men do not
recognise its importance. In situations where men
are responsible for taking investment decisions,
sanitation takes lesser priority
Sources:
ŸSanitation Markets: Using economics to improve the delivery of services along the sanitation value chain Pathfinder paper, 2012
ŸStrategic communication for total sanitation campaign;
ŸArghyam survey in Davangere district, Karnataka
`9100
per family for
buillding toilets
Nirmal Bharat Abhiyan Scheme
Awareness is very low and
delivery of the scheme is poor
HOW CAN WE REDUCE OPEN DEFECATION?

9. TheAsk HOW Analysis
Toilet Construction does not automatically translate into toilet usage.
Sources:
ŸWater and Sanitation Programme, Department of Drinking Water and Sanitation, A decade after the Total
Sanitation Campaign, Rapid Assessment of Processes and Outcomes. Volume 1
ŸStrategic communication for total sanitation campaign
HOW CAN WE REDUCE OPEN DEFECATION?

10. TheAsk HOW Analysis
Some key reasons for not using toilets include:
Sources:
ŸGonzalez, Pathways to sustainability in Community Led Total Sanitation. PhD Thesis available at:
http://riunet.upv.es/bitstream/handle/10251/31520/Pathways%20to%20sustainability%20in%20community_5653.pdf?sequence=16;
ŸDepartment of Drinking Water and Sanitation, Ministry of Rural Development, Toward Nirmal Bharat, Rural Sanitation and
Hygiene Strategy 2012-2022, published on 4 July 2011
HOW CAN WE REDUCE OPEN DEFECATION?
Poor Quality
Construction
Poor Water SupplyFear of bringing waste
close to home and
dealing with it

11. TheAsk HOW Analysis
How Do We Ensure Access?
ŸFocus on rural men and connecting the
image of a responsible man as someone who
will build sanitation facilities for the women
in his family
ŸImprove delivery mechanism
HOW CAN WE REDUCE OPEN DEFECATION?

12. TheAsk HOW Analysis
How Do We Ensure Usage?
Build better toilets with more space, light and better ventilation,
that would use less water and can be maintained easily.
HOW CAN WE REDUCE OPEN DEFECATION?

13. TheAsk HOW Analysis
What Is Needed Now?
ŸMonitor usage of toilets and not just
their construction.
ŸEncourage access and usage in mission
mode by:
1) Hiring more people (swachata doots) to
implement and training them better to
create demand and sustain usage
2) Designing better toilets - in terms of
enhancing user experience and using
technologies that don't negatively
impact groundwater quality.
3) Clearing choke points in the supply
chain and enabling smooth flow of
money
ventilation
water supply
proper drainage
good construction
Ÿimproved sanitation
Ÿreduced health problems
Ÿcleaner, hygienic surroundings
HOW CAN WE REDUCE OPEN DEFECATION?

14. How can we
persuade people to use
toilets already built?
How can we construct
more and better toilets?
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more Ask How
How can we enable
rural Indians to stop
open defecation?
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