1st NITI Aayog – Centre for Policy Research: Open Seminar Series

Framing the ODF measurement question

Shubhagato Dasgupta, Senior Fellow

Background: India's sanitation challenge

India  

Indonesia  

Pakistan  

Nigeria  

Ethiopia  Sudan  

Niger  

Nepal   China  Mozambique  

Burkina  Faso  

Madagascar  

Cambodia   South  Sudan  

Rest  of  the  world  

59%,  605.3  million  persons  

Source  :  JMP  2014  

Background: the evolution of Sanitation Policy

‘47

International Water & Sanitation Decade

‘80 ‘86 ‘90 ‘93 ‘95 2000 ‘01 ‘03 ’04 ‘05 ‘07 ‘08 ‘10 ‘12 ‘14 ‘15

ILCS-­‐  Integrated  Low-­‐cost  SanitaJon,  CRSP-­‐  Central  Rural  SanitaJon  Programme,  GAP-­‐  Ganga  AcJon  Plan,  NRCP-­‐  NaJonal  River  ConservaJon  Programme,  TSC-­‐  Total  SanitaJon  Campaign,  NGP-­‐  Nirmal  Gram  Puraskar,  JNNURM-­‐  Jawaharlal  Nehru  NaJonal  Urban  Renewal  Mission,  NUSP-­‐  NaJonal  Urban  SanitaJon  Policy  ,  SBM  –  Swachh  Bharat  Mission,  NUDM  

–  NaJonal  Urban  Development  Mission  

Millennium Summit & MDG International Year of Sanitation. Part of Water for Life Decade

SDGs

ILCS CRSP

GAP

Manual Scavenging Act 1993

NRCP

GAP subsumed into NRCP

NGP

Pune Decl.

JNNURM, GOI financing for urban sanitation sector

started to increase

NUSP released

SBM AMRUT

Smart Cities

TSC

‘95 ‘16 ‘17 ‘18 ‘19 ‘20 ‘21 ‘22

Goal of an ODF India!

Background: Genealogy of the term “Open Defecation Free”

“100%  sani8zed  village”  -­‐Mosmoil  

N a 8 o n a l  Focus   on  1 0 0 %  s an i8 zed  v i l l age   /ODF  

TSC  

Sant  Gadge  Baba  

Swatchata  Abhiyan  

ODF  in  SBM  G  

2000 ‘01 ’04 ‘05 ‘07 ‘08 ‘10 ‘12 ‘14 ‘15 ‘16 ‘17 ‘18 ‘19 ‘02 ‘03

SDG  WDR  2004  

TSC/NBA    ODF  

1999

INDIA   ODF  India  target  

Global  ODF  elimina8on  

target  GLOBAL  

BANGLADESH  

Nirmal  Gram  

Puraskar  

From   78%  to  3  %  OD  

SACOSAN  (T  2022)  

‘30

OTHER  COUNTRIES  

Background: Why has the “Open Defecation Free Community” concept received so much purchase? : Some explanations

•  Clear recognition of the public good aspect of sanitation •  Recognition that partial coverage and use of toilets leads to

unsatisfactory public health outcomes from sanitation •  Clarifies the role of the community in sanitation •  Sets up a clear identifiable stage in the sanitation improvemet matrix

aimed at safely containing human excreta thereby breaking the faecal oral route of transmission of disease

•  Helps raise awareness across communities •  Has induced innovative community approaches and participation •  In a number of situations lead to rapid scaling up of absorption of

improved sanitation practices

Measurement : MDGs to SDGs: from access to improved sanitation facilities to ending Open Defecation

MDGs (2000-2015) GOAL

Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation

TARGET Halve by 2015, the proportion of population without sustainable access to safe drinking water & basic sanitation

INDICATORS •  The proportion of the population that

use an improved drinking water source

•  The proportion of the population that use an improved sanitation facility

SDGs: 2015-2030 GOAL: Ensure availability and sustainable management of water & sanitation for all

TARGET

(6.2) By 2030 achieve access to adequate & equitable sanitation & hygiene for all, and end open defecation, paying special attention to the needs of women and girls

INDICATORS •  % of all population using safely

managed sanitation services [progressive elimination of inequalities in access]

•  Population with a hand-washing facility with soap & water in the household [progressive elimination of inequalities in access

Measured  by  the  Joint  Monitoring  Program  (JMP)  of  the  WHO  &  UNICEF  (Dependent  on  naJonal  household  surveys  /  census)  

Open Defecation (JMP) Census 2011 NSSO 69th Round

Open defecation: when human faeces are disposed of in fields, forests, bushes, open bodies of water, beaches, or other open spaces, or disposed off with solid waste

No  latrine  within  premises  –    Public  latrine    -­‐    Open    

•  Access  to  latrine  –  no  latrine  -­‐  OD  •  Type  of  latrine  –  not  used  -­‐    OD  

•  Whether  all  household  members  are  using  the  latrine  (male  /  female;  above/below  15  yrs)  &  Reason  

Census 2011

Latrine within premises?

Yes No Flush / Pour flush

latrine :

Pit latrine:

Service latrine: Open defecation

No

Public latrine?

Measurement : JMP uses National Survey data from India and elsewhere

Indonesia (2012 DHS; 2010 Census)

Pakistan (1998 Census; 2007 DHS)

Nigeria (Census 2006)

Ethiopia (Census 2007)

What type of toilet facility? – No toilet

1.  Latrine – no latrine 2. What kind of toilet

facility do members of your household usually use? – o  No facility / bush /

field o  Flush or pour flush

toilet: to somewhere else; don't know where

1.  What type of toilet do you use in this household? - Nearby (bush/beach/field)

2.  What kind of toilet facility do members of your household usually use? – No facility / bush / field

What type of toilet facility does the housing unit have? – no toilet facility

Measurement : JMP uses National Survey data from India and elsewhere

Measurement : Increasing engagement with ODF measures in Indian programmes – NGP to NBA to SBM

§  Nirmal Gram Puraskar 2005

§  Objective : To incentivize PRIs to make villages ODF and to adopt Solid & Liquid Waste Management (SLWM)

§  Detailed critrea : incl Toilet usage by all households, migrant labour at public places and no open defecation found in GP

§  Total Sanitation Campeign 2011

§  Asks GPs for “Plan of action to attain ODF/Nirmal Status”

§  Nirmal Bharat Abhyan 2012

§  Additionally : “that GPs will be monitored for ‘Nirmal’ status”

§  Swachh Bharat Abhiyan 2014

§  Objective 2.1(a): “……eliminating open defecation”

§  “community incentive, if any, … released after the village unit is ODF for a significant length of times”

§  Urban : “no households engage in the practice of OD”

India-NGP Nigeria Indonesia JMP CLTS PLAN

No OD found in the area ✓ ✓ ✓ ✓ ✓ ✓

100% presence of a functioning HH latrine ✓ ✓ ✓ ✓ ✓

> With superstructure ✓ ✓

>evidence of use ✓ ✓ ✓ ✓

>Latrines are well maintained ✓ ✓

Child stools are safely disposed of ✓ ✓ ✓

Safe containment of excreta ✓ ✓ ✓ ✓

Handwashing facilities are present ✓ ✓ ✓ ✓

>above with soap ✓ ✓ ✓ ✓

IEC activities ✓ ✓

>use of sanctions ✓

>existence of a monitoring system ✓ ✓

School sanitation ✓ ✓ ✓

>with handwashing facilities ✓ ✓

Aanganwadi sanitation ✓

Community toilets ✓ ✓

Health centre sanitation ✓

No manual scavenging ✓

Access to water ✓

Solid waste management ✓

Liquid waste management ✓ ✓

Time for certification (months) 24 3 NA NA 3-6 24

Source: WaterAid Policy Note – “Open Defecation Free”

Measurement : ODF indicators used across programmes

Source:  Ministry  of  Drinking  Water  and  SanitaJon,  Government  of  India  (2011)  

ZPs  awarded  in  that  State  

Measurement and Results : NGP awarded GPs (2012) by state in percentage

10.58  

33.2  

60.9  

111.47  

55.8  

0  

20  

40  

60  

80  

100  

120  

Census   TSC   Expon.  (1991-­‐2001  Growth  rate)   Linear  (1991-­‐2001  Growth)  

(10%)  

(23%)  

(34%)  

Million  HH

s  

Source:  Ministry  of  Drinking  Water  and  SanitaJon,  Government  of  India  (2012);  Census  1991,2001,2011  

Measurement and Results : TSC and Census 2011 compared

Measurement and Results : Some questions and explanations for the Slip back

SLIP BACK STATUS : NGP Impact Assessment Study

•  80.8% HHs from NGP had access to latrines at the time of the study •  26% HHs had fully functional latrines •  67% HHs all members used latrines •  Similar findings from UNICEF-TARU and Arghyam Surveys Some issues identified by the NGP Impact Assessment Study – WHY?

Source:  Assessment  Study  of  Impact  and  Sustainability  of  Nirmal  Gram  Puraskar  (GoI  2011)    

Measurement and Results : Some questions and explanations of the complexity of behavioral issues involved

Sanitation Quality, Use, Access and Trends (SQUAT) Survey, 2014 in 5 North Indian states

•  A preference for open defecation: –  over 40% of HHs with a working latrine have at least one member who

defecates in the open – Why? •  Psychology of the “un-clean” – create distance, build high capacity pits… •  Feedback on benefits to defecating in the open:

–  47% of those that defecate in the open say they do so because it is pleasant, comfortable, or convenient – Why?

•  Rural households in India do not build inexpensive latrines like the ones in countries in the region or Southeast Asia, and sub-Saharan Africa – WHY?

•  Most people who own a government-constructed latrine continue to defecate in the open - this is mentioned as a choice – Why?

Source:    hfp://squatreport.in/about-­‐the-­‐survey/  (3,235 adults on defecation practices and individual level latrine use data for 22,787 household members)    

Randomized Control Trials (RCTs)

•  London School of Hygiene & Tropical Medicine- Helminths infection

•  Sanitation and stunting in I n d o n e s i a , O r i s s a , Maharashtra

•  TSC, defecation behaviours and health

Hand washing and habit formation

Higher intensity

Lower intensity

Government driven ODF

surveys eg. NGP surveys

NSSO surveys

Non-governmental

sample surveys

Census household

survey

Programme evaluations eg. NGP scheme,

JNNURM

Sanitation Baseline surveys

100%  Surveys   Sample  Surveys   Aggregator  Surveys  

What we have learnt on ODF communities and its measurement

What we have learnt on ODF communities and its measurement

1.  India is among a few countries that have a significant toilet (output) subsidy program

2.  It is the only country that has an incentive and reward scheme for sanitation •  Others have recognition schemes / awards etc.

3.  Slip back, is highly probable, so social mobilisation innovations and special efforts needed for maintaining and improving status

4.  One time measurement and declaration of ODF status has not worked well enough •  ODF status needs to be confirmed only after few years of

consistent ODF results 5.  Sanitation advances cannot be achieved and improvements

maintained as a one time effort but need ongoing programmes 6.  Program Survey and aggregator biases difficult to control, so an

independent ongoing measurement system is needed, to monitor and record sanitation status along a matrix on ODF, SLWM, Hygiene and safe water

Some ideas going forward on measuring ODF communities

•  There is a need for an non-program linked annual survey on a Sanitation Matrix

•  Possibly conducted by the NSSO and NITI Aayog? •  With the objective to gauge the sanitation situation from the

perspective of the extent to which waste (human excreta, liquid and solid waste) is disposed of safely so that there are no adverse effects on health

•  Possibly understand where different states of the country rank on a sanitation index (constructed through the survey) so that the efficacy of their sanitation efforts can be reflected upon

• THANK YOU