Open defecation in cities: A faltering India story

Despite significant public investment in urban sanitation, over 37 million people in Indian cities resort to open defecation. This column examines the existing information on open defecation in urban India, and finds that the most important determinant is access to on-premise toilets. Local government leadership, targeted and smart subsidies, stakeholder collaboration and innovative financing options can help increase such access and accelerate elimination of the problem.

While India is home to about 11% of the world’s urban population, it has over 47% of the world’s population practicing open defecation (OD)1. India also fares worse than other countries at similar income levels (Asian Development Bank (ADB) 2009).

The 2011 Census of India provides some startling results. Nearly 12% of urban households resort to OD and another 8% use public or shared toilet facilities2. The situation is far worse in smaller cities (population below 100,000), with OD rates around 22%. Though significantly less prevalent than in rural India, OD in urban settings poses more serious challenges. With higher population densities and a lack of safe spaces, OD affords little dignity and poses grave security risks for women. Moreover, recent literature suggests that OD causes stunting among Indian children, particularly in more dense urban areas (Ghosh et al. 2014, Rheingans et al. (2012), Spears 2013).

Access to on-premise toilets in cities explains the OD variation across states

No state in India is OD free. However, the situation varies across states. Though this variation is influenced greatly by the state per capita income (Figure 1), there are two groups of outlier states. The first group comprises largely the North East states and Kerala, with lower OD rates despite their lower income levels. This group of states has achieved lower OD rates largely through increased access to on-premise toilets.

Figure 1. Per capita income of states and urban OD rates

Source: Analysis by authors using data from Census of India 2011, and from Central Statistics Office for state income.

The second group of outlier states include Madhya Pradesh, Odisha, Bihar and Chhatisgarh, which have a higher than expected OD levels. These states are low income states and have large numbers of households that do not have on-premise toilets. Thus, it appears that access to on-premise toilets is one of the key determinants of OD rates across states. This is validated by an analysis of Census 2011 data on 3,980 cities, which suggests that access to on-premise toilets is the most important and significant determinant of city-level OD rate³.

Can community toilets help reduce OD?

Some states and local governments have relied on provision of community toilets (CTs) to reduce OD. For example, Maharashtra has achieved a low OD rate (7.7%) through provision of CTs; 22% of households rely on CTs as compared to the national average of 6%. A number of other states including Delhi, Chandigarh and Tamil Nadu have also adopted similar strategies to reduce OD.

However, provision of CTs is no panacea. While a few cities have well-functioning CTs, in many others one sees them in a perpetual state of disrepair and people are forced to defecate in open4. Moreover, CTs entail large public expenditure as unit costs of these toilets tend to be high, and they require operation and maintenance support throughout their life cycle. In addition, CTs may also pose greater health hazards. For example, a systematic review referred by the Sanitation and Hygiene Applied Research for Equity (SHARE) Project of the London School of Hygiene and Tropical Medicine (LSHTM) (2014) stated, “a pattern of increased risk of adverse health outcomes associated with shared sanitation compared to individual household latrines”.

Evolving ‘group toilets’ as an appropriate solution

Thus, the dilemma facing state and local governments is the choice between programmes that facilitate provision of toilets to every family vis-à-vis those that build CTs.

Ongoing work in some cities in Maharashtra suggests that there is a middle-path solution to this dilemma. It is possible to address this issue by considering group toilets5. A group toilet is shared by less than four households who know one another well. It is maintained by them and thus, does not require any ongoing government support. Essentially as compared to CT, a group toilet helps to shift the responsibility for a toilet to the private realm where it belongs.

The group toilet concept is in line with the proposed approach by the Sanitation Working Group set up by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) for the Post-2015 deliberations, where a sanitation facility is considered adequate “if the facility is shared among no more than 5 families or 30 persons, whichever is fewer, and if the users know each other” (Joint Monitoring Program (JMP) 2013). This was based on an earlier meeting of a technical taskforce that had deliberated on the issue of considering shared sanitation facilities as adequate.

Group toilets help address two key issues that affect demand for individual on-premise toilets. Household surveys across cities in the states of Gujarat and Maharashtra suggest that principal reasons for households not having on-premise toilets is space constraints and lack of affordability (CEPT University 2014).

Figure 2. Reasons for not having on-premise toilets

Source: Based on data from household surveys undertaken in 2010 under the PAS Project, CEPT University.

A group toilet programme can overcome the space constraint, by identifying a location for a toilet that can serve 2-4 families, within the properties of the families. When these families share a toilet, the affordability issue is also resolved, as costs are shared and public subsidies become available to all the families sharing the toilet. Analysis in a small town in Maharashtra suggests that this programme can be fully supported through local funds, without waiting for any state or national funding6. When more families shift to group toilets, CTs can be closed down. This would result in savings in expenditure on their operation and maintenance as well as free up public land. To accelerate this process, however, innovative financing from corporates under their Corporate Social Responsibility (CSR) and social investors needs to be explored.

Conventionally public subsidy for toilets under programmes such as Integrated Low Cost Sanitation (ILCS) is linked to the toilet. In many states, public funds are also used to build CTs. However, incentive for households to use the group toilet option is possible using smart subsidies that are provided on a per household basis rather than on a per toilet basis as conventionally done. The extent of subsidy can be minimised by facilitating access of households to a variety of micro-credit options through self-help groups (SHGs), microfinance institutions (MFIs), credit cooperative societies or the new housing finance companies being set up with a focus on small loans⁷.

Accelerating elimination of OD in urban India

The importance of eliminating OD in our cities is an urgent necessity - for better health, safety and dignity. Given the adverse impact on health, there is an urgent need to eliminate OD through adequate sanitation as defined by the WHO and UNICEF (2014). In order to accelerate this process, the rate of growth of on-premise toilets will need to be doubled. Even with a focus on group toilets, this will require an addition of about 750,000 toilets per year, over the next 10 years, to meet the gap fully. While this will entail a total investment of about Rs. 1,700 crore ($283 million approx.) per year, with appropriate subsidy design and targeting, only Rs. 500 to 750 crore per year ($83-125 million approx.) will be needed as subsidies8. Well-designed subsidies will help leverage household savings and micro-credit through different sources.

Latent demand for toilets exists in most urban areas. However, efforts are needed to convert this to effective demand in order to accelerate the process of making our cities OD free. This will result in safe and clean toilet infrastructure that keeps pace with urban growth. Evidence suggests that this is possible with motivated state and local leadership. Many city sanitation plans in India have focused mainly on creating costly infrastructure. These plans have paid little attention to the financing of such infrastructure investment. Greater focus is needed on mobilising local resources, as well as evolving innovative ways such as results-based funding and grants, and creating avenues for funding by CSR and social investors through new instruments (for example, social or development impact bonds)9 (CEPT University 2014).

A major lesson from our ongoing work in small towns in Maharashtra is that it is important to focus on realistic and doable targets, such as ensuring access to on-premise or group toilets for all households. This is the first step in achieving the broader goal of a “fully sanitised city” envisaged in the National Urban Sanitation Policy. Achieving the goal of OD free cities does not require large public resources. It requires leadership by local governments, collaboration among people, enabling policies and programmes of the state governments, and innovative financing to effectively tap community and market resources.

The ratio of share of open defecation to share of urban population is 4.4 for India, as compared to only 2.7 for Sub-Saharan Africa (Source: Authors’ analysis using World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) data 2013).
Please see below taxonomy of toilets by users and by private/ public ownership.
This result is from on ongoing unpublished analysis by the authors of sanitation-related information from the Census of India, as part of the Performance Assessment System (PAS) Project at CEPT University (www.pas.org.in).
See, for example, ‘Preparing performance improvement plans for making Class A municipalities in Maharashtra open defecation free’ (PAS project 2012-2013, CEPT University).
This is based on the support being provided under the PAS Project to selected small cities in Maharashtra for preparing city sanitation plans.
This is based on authors’ analysis of municipal finances carried out under the PAS Project support to cities in Maharashtra. The analysis suggests it will require 5-6 years to cover all households using only municipal funds.
In some states the use of group toilets will also require appropriate policies to provide services in “non-notified” slum areas. In some states, such services can only be provided in slums that are notified under the relevant slum legislation in the state. However, special resolutions of the state or local governments can generally override this provision.
This is based on ongoing work on financing urban sanitation under the PAS Project. The estimate is at 2013 price and assuming a cost of Rs. 20,000 ($333 approx.) per toilet including a septic tank. It uses a 10-year timeframe.
“Development Impact Bonds are a variation of Social Impact Bonds (SIBs), which have been implemented in UK, US, and other industrialised countries to facilitate impact investment.” (Centre for Global Development (CGD) Social Finance (SF) 2013). They essentially help extend results-based funding for development using funds from social impact investors.