The Greek philosopher Socrates once said: “It is not living that matters, but living rightly.” As the clock is inching towards the 2015 deadline of Millennium Development Goals (MDG), the philosophy has become more relevant than ever before as the MDG targets to improve socio-economic condition of all the citizens. The MDG of “Environmental Sustainability” also advocates providing adequate sanitation facilities to all citizens thus giving them the right to a healthy life. According to WHO: “Sanitation generally refers to the provision of facilities and services for the safe disposal of human urine and faeces. Inadequate sanitation is a major cause of disease worldwide and improving sanitation is known to have a significant beneficial impact on health of households and communities.” Despite the seriousness of this topic, our community is still reluctant to openly talk about the subject of sanitation and the good practices around it.

The ill-effect of this taboo can be clearly seen from the continued unhealthy sanitation practices as it is estimated that still 1.1 billion people defecate openly leading to diseases such as diarrhoea, cholera, dysentery, typhoid, and hepatitis A. In India, around 1,000 children below the age of five die from diarrhoea, hepatitis-causing pathogens and other sanitation-related diseases, according to the report of United Nations Children's Fund. Additionally, sanitation in schools has led to an increase in enrolment of children, especially girls, highlighting its manifold benefits.

Many countries are taking measures to control the practice of open defecation. For example, Southern Zambia under the leadership of Chief Macha was transformed in just two years and declared “open-defecation free” as access to sanitation in his community was doubled from 50 per cent to 100 per cent.

Brazil developed a condominial approach or simplified sewerage to construct water and sewerage networks as a response to the challenges posed by expanding services into peri-urban neighbourhoods. Condominial sewerage is a low-cost sewer system that emphasises on community participation in planning and the maintenance of sewer system at the block level. Brazil quickly operationalised a 1,200-km network of condominial sewers, the largest example of simplified sewerage in the world.

Rwanda, a landlocked nation bordering Uganda with a population of 11 million, focussed its efforts and enhanced the sanitation coverage to its citizen beyond the regional average of Sub-Sahara after community-led sanitation campaign. Rwanda attracted international tourists after the government reformed water and sanitation programmes and took away the fear of waterborne disease from the visitors.

The Indian government too is burning its candle from both ends, hoping for the return of ancient Indus Valley Civilisation days, when sanitation systems were far more advanced than contemporary urban sites. It started the Total Sanitation Campaign in 1999 with the goal of improving sanitation coverage to both rural and urban areas and eradicating the practice of open defecation. The key focus areas of TSC are individual household toilets, school sanitation and hygiene education (SSHE), community sanitary complex & anganwadi toilets supported by rural sanitary marts (RSMs) and production centres (PCs). However, things are not hunky-dory and the number clearly state that. As per latest WHO report, India still accounts for 626 million (59 per cent) of the 1.1 billion people in the world, who practice open defecation. This is twice the number of the next 18 countries combined. Additionally, India recorded nearly 22 per cent of the total deaths of children under five and a majority of those cases were due to diarrhoea or sanitation-related diseases.

Although the government has been able to ramp up toilet coverage, little effort has gone into changing citizen behaviour. A glimpse at the TSC portal gives information about the toilets constructed till date but fails to capture the data on the continued practice of open defecation despite the availability of toilets.

The government must understand that creating mere toilet structures will not lead to change; instead the focus should also be on behavioural change. A massive educational campaign to explain the correlation between poor sanitation and its ill-effects on health should be launched. Secondly, ignorance towards bathroom etiquette in public toilets by some could turn off others and divert them to open defecation. School curriculum should touch upon this topic and at least train the future drivers of this country. The government of India was able to wipe out polio by massive campaigning and participation at the block, district, State and national levels. Similar awareness campaigns in participation with local community, NGOs and the State governments can be placed to get the message across. Thirdly, make sanitation business attractive for the private sector allowing them to generate income by providing sanitation services.

Loan finance for sanitation support has shown some promising results for the micro finance companies; however, its effects at large scale is yet to be hypothesised. Finally, allow innovation to reach the mass. E-toilets used in Kerala by the name “Delight” have shown excellent results because of its unique features and automatic functioning. Similarly, Eco-san toilets are used for low income housing in many countries.

Throughout his life, Gandhiji preached and practiced healthy sanitation practices and once said: “The cause of many of our diseases is the condition of our lavatories and our bad habit of disposing of excreta anywhere and everywhere.” Let us work towards getting our society free from open defecation and make our ancestors of the Indus Valley Civilisation proud of us.

(The writer is a social healthcare analyst. Email: