India is getting closer to achieving Gandhi's dream

Eighty years ago, Mahatma Mohandas Gandhi, writing of the India he envisioned and dedicated his life to building, mused that an ideal village would be one that enjoyed ‘perfect sanitation.’

It was no idle wish. Gandhi had seen the harms caused by inadequate sanitation and hygiene. He had seen the disease and subsequent malnourishment it causes, threatening the lives and wellbeing of millions of Indians, especially children and other vulnerable people. He had also seen the impact of open-defecation on the safety and dignity of women and girls. And he understood that these harms were not only hurting individuals – they were holding back India’s economic and social progress as well.

Today, as the nation and indeed, the world, celebrate Gandhi’s birthday, his dream of perfect sanitation for India may be closer to becoming a reality than ever before.

Three years ago, the Government of India declared war on open defecation, launching the Swachh Bharat – or Clean India – Mission with the ambitious goal of achieving an open defecation-free India by 2019. In a nation where millions of people still lack basic sanitation and hygiene, the goals of SBM may seem unachievable. But the scale and pace of the progress achieved by the thus far is unprecedented.

Already, five States and nearly 250,000 villages in 200 districts have been declared open defecation-free – ODF – with more soon to follow. The increase in sanitation facilities is no less impressive: The Government of India reports that latrine coverage has gone from 39 per cent to over 69 per cent. Every hour, an estimated 3300 toilets are being built in India – nearly one toilet every second.

But it’s not enough to build toilets; people need to use them. For this reason, behaviour change is a centerpiece of the Swachh Bharat Mission. The government and its partners are fielding “sanitation armies” to drive community awareness and action. Bollywood stars and cricket legends have joined the effort – including UNICEF Goodwill Ambassador Sachin Tendulkar. Public health initiatives like the UNICEF-supported “Take your poo to the loo” campaign are breaking through where traditional efforts have failed. In fact, the whole of Indian society is being mobilized to end open defecation.

The Government is leaving nothing to chance. It has put in place a rigorous system to verify not only that a community, district or State is ODF – but that it remains ODF. A recent survey conducted by the Quality Council of India shows that in communities verified as ODF, usage of toilets remained above 91 per cent.

The stakes are very high – and especially for India’s youngest citizens. The World Health Organization estimates that 117,000 Indian children under the age of five died in 2015 from diarrheal diseases caused by unimproved sanitation and hygiene. This represents 22 per cent of the global burden. More than one in three children in India today are stunted, often due to the impact of chronic diarrhea caused by exposure to fecal matter. This affects both their physical and cognitive development, undermining their ability to learn and later, to earn a living.

Because ending open-defecation is not only a matter of smart health policy. It is also smart social and economic policy. A 2008 World Bank study showed that the total economic impact of inadequate sanitation in India amounted to US$ 53.8 billion per year – the equivalent of 6.4 per cent of India’s GDP during the same period. UNICEF just completed a study showing that when costs and benefits are compared over a ten-year period, savings realized through improved sanitation exceed costs by 4.3 times – a four-fold return for every rupee spent.

These financial benefits have a direct impact on families. The same UNICEF analysis – based on data from 10,000 households across 12 States – shows that households using a toilet are saving on average around 50,000 rupees (around US$760) per year, realized in medical costs averted, the value of time saved in not needing to seek medical treatment, and the value of deaths averted. For poor rural families in India, this represents a small fortune.

Crucially, the UNICEF study indicates that improving hygiene and sanitation for the poorest households brought the greatest immediate health benefits, since children living in poverty are at the greatest risk of diarrheal diseases, stunting and mortality.

The challenges India still faces to become open-defecation free are substantial. But India is showing that it can be done. And it must. Not only in India, but everywhere that open defecation threatens lives and futures.

Around the world, an estimated 2.3 billion people still lack basic sanitation – and among them, 892 million people still practice open defecation. As long as they do, their societies will pay the price in poor health and poor prospects for sustainable growth. That is why the Sustainable Development Goals include a target to end open-defecation everywhere.

If we are serious about realizing the promise of the SDGs, we need to work together to realize Gandhi’s dream – for India and for the world.