Sanitation in India: Progress, differentials, correlates and challenges – A report by ADB

This report by Asian Development Bank (ADB) deals with sanitation in India, in particular the progress, differentials, correlates, and challenges. Improved sanitation is essential to reduce ill health, child mortality, lost income associated with morbidity, and to improve environment, human dignity, and quality of life. Goal 7, target 3 of the Millennium Development Goals (MDGs) stipulates decreasing the proportion of population without sustainable access to basic sanitation by 50 per cent in the year 2015.

To achieve time-bound results committed under the MDGs, public resources need to be deployed effectively in tandem with private resources. To be effective, public policy needs to be evidence-based, while empirically driven research can support more effective public policy making and more efficient public expenditure. This empirical research, based on large-scale data sets, highlights several key findings that can help fine-tune efforts to improve sanitation in India.

The discussion on progress, differentials and correlates indicate the following -

• Economic growth and sanitation: Data shows that the relationship between sanitation and economic growth is ambivalent. Indian states with much lower economic growth can achieve higher levels of sanitation. For example, North-East states have outperformed Maharashtra and Gujarat, despite lower levels of economic development. For policy purposes, the reasons for this dichotomy at the state level could offer important insights.
• Cost estimates: The cost estimates for urban infrastructure have varied widely over time. The variation in the cost estimates is understandable given the lack of accurate data and differences in assumptions made. The cost estimates are very high and difficult to be met in a short period exclusively through public resources. Hence, innovative solutions, including low cost solutions, public–private partnerships, and appropriate technology, should be explored further.
• Appropriate cost-effective solutions: By adopting low-cost solutions, Assam and Kerala managed to increase toilet coverage despite economic hurdles, conforming to longstanding recommendations for progressive improvement in the type of toilet coverage.
• Cost recovery for higher-cost solutions that mostly benefit the wealthy: Similarly, high cost and high-end drainage solutions, such as underground drainage systems, largely benefit urban areas and wealthy people. Appropriate cost-effective solutions that cater to a wider range of population require further exploration and scaled-up policy to extend public health benefits to the maximum number of people within the constraints of fiscal realities.
• Planning and sequencing: A household may contaminate a shallow aquifer in their neighborhood when converting pit latrine to pour-flush latrine. Neighborhood sewage may pollute the discharge point in the receiving body of water much more intensely than before. Lacking proper coordination, some household investments can become wasteful and/or redundant. Therefore, some regulation is necessary.
• Concerted investment efforts between households and government are the key: This leads to the need for proper medium term sequencing strategy (say, for the coming 20 years). (Probably, there will be a need for several model sequencing strategies.) Choice of on-site system versus off-site system vis-à-vis population density is particularly crucial depending, among other things, on investment capacity.
• Inadequate progress in meeting goals: Progress following the launch of Total Sanitation Campaign (TSC) has not accelerated sufficiently, especially in rural areas, to achieve either the government’s goal of “Sanitation for All” by 2012 or the MDG that aims to reduce by 50 per cent the number of people lacking access to sanitation by 2015.
• Wealth differentials: The TSC, a targeted program for households below the poverty line (BPL), provides an almost 80 per cent subsidy for construction of individual household sanitary latrine (IHHL). As of September 2008, TSC gained higher achievement in BPL households (26 million IHHL, or 45 per cent of the set target) compared to households above the poverty line (APL) (20.8 million IHHL, or 34.3 per cent of the set target).
• Sociocultural differentials: In addition, the disaggregated analysis shows that certain areas and population groups have greater resistance to adopting household sanitation facilities than others. Thus, cultural attitudes toward the entire concept of defecation within the house may affect progress, affordability aside. Information, communication, and education campaigns with the help of communities and grassroots organizations, including non-government organizations, community-based organizations, panchayati raj institutions, and others, can accelerate change and hasten the adoption of sanitary practices.
• Scheduled Tribes (STs) need special attention: STs include some of the most disadvantaged groups in India. Regarding access to drainage facilities, STs clearly are at the bottom of the pyramid. Without special attention and focused effort, it is unlikely that these differentials will change in the near future.

The key findings and recommendations of the study are as follows:

• Though progress has been made in access to sanitation in the last decade, the unmet need for sanitation is huge.
• A number of social, cultural, geographical, and economic differentials hinder access to universal sanitation in India. An effective strategy to bridge the gap in access to sanitation will have to focus on the disadvantaged, which include households from the poorest quintile, scheduled tribes, and the states that have consistently underperformed—Orissa, Bihar, and Madhya Pradesh.
• The financing requirements are huge; hence, the paper suggests progressive improvement in the types of sanitation solutions. Sewerage systems tend to benefit richer households; hence, some form of capital cost recovery could be considered to finance sewerage-related infrastructure.

Download the report here -