Clean India-challenges And Remedies

KEYTAKEWAYS:

• The Clean India Mission, also known as the Swachh Bharat Mission (Gramin), claims to have increased sanitation coverage in rural India from 39% to 100% between 2014 and 2019.
• However, open defecation persists in large numbers. Despite efforts to improve toilet coverage, over 100 million latrines have been built and all villages declared open defecation-free.
• Key challenges include lack of piped water supply, poor toilet construction, and misconceptions about toilet use. Prioritizing sanitation-related behavioral change and improving toilet facilities can accelerate universal access to sanitation and meet Sustainable Development Goals.

INTRODUCTION:

• The Global Nutrition Report 2018 reports that stunting is the highest prevalence among children under 5 years in India, with 38.4% suffering from it. Diarrhea is the third most common cause of death among this age group, accounting for 13% of deaths. Poor sanitation and hygiene practices are linked to stunting, with three main pathways: environmental enteric dysfunction (EED), diarrheal diseases, and nematode infections. Poor sanitation can lead to growth retardation, fecal contamination, and soil-transmitted infections, causing malnutrition and growth failure. Despite these challenges, safe sanitation is essential for child growth, health, and gender equity.
• Open defecation and poor sanitation facilities negatively impact public health and child growth, leading to premature mortality. In India, stunted growth is strongly correlated with unsafe environmental conditions and open defecation. Lack of sanitation causes psychosocial stress, leading to productivity loss, tourism losses, and medical costs, costing India approximately $189 billion.
• While there has been a noticeable decrease in open defecation in rural India and improvements in toilet coverage under the Swachh Bharat Mission (Gramin), there are still interstate differences in coverage and toilet uptake across regions. Concerns have also been raised by numerous researchers regarding the public statistics released by the government and the process used to verify open defecation-free (ODF) status. For instance, a study found that only one of the eight villages with truly universal sanitation coverage in 2018 declared itself to be ODF. Consequently, in order to ensure that India's Swachh Bharat Mission is a success, we look at the accomplishments of the initiative (Gramin) and pinpoint the gaps and issues that still need to be addressed.

ABOUT INDIA’S SWACHH BHARAT MISSION

• Numerous nations, particularly those in South East Asia and sub-Saharan Africa, have made efforts to raise the percentage of people who own latrines. India, a country in the global south, has undergone significant change over the last five years thanks to a government initiative run centrally called the Clean India Mission (Swachh Bharat Mission) (Gramin), or SBM (G). The largest sanitation program in the world, the SBM was introduced in 2014 by Mr. Narendra Modi, the prime minister of India at the time. It seeks to make villages clean, sanitized, and ODF in addition to achieving universal access to sanitation for all.
• Many nations have attempted to increase the proportion of people who own latrines, especially those in South East Asia and sub-Saharan Africa. India, a nation in the global south, has experienced tremendous transformation over the past five years as a result of a centrally managed government program known as the Clean India Mission (Swachh Bharat Mission) (Gramin), or SBM (G). The SBM, the biggest sanitation program globally, was unveiled in 2014 by Indian Prime Minister Mr. Narendra Modi. In addition to providing everyone with universal access to sanitation, it aims to make villages hygienic, sanitized, and ODF.
• In public health, preventing harmful pathogens from entering human bodies and halting fecal-oral transmissions are the cornerstones of sanitation. SBM thus served as a crucial barrier in putting an end to this through the construction of latrines and the encouragement of latrine use. Numerous studies conducted worldwide have shown that improved child health and nutritional status are significantly correlated with widespread use of sanitation practices, which in turn lowers the catastrophic costs associated with health care for households. In order to fully realize the benefits that can be derived from SBM, India must now quicken this national sanitation campaign by enhancing the connections between sanitation and health.

SANITATION TECHNOLOGY UNDER SWACHH BHARAT MISSION

• The availability of space for an on-site containment system and the adaptation of toilet technology are the two main factors affecting the safely managed sanitation in homes. Safe sanitation technologies include bio-toilets, twin leach pits, eco-scanners, septic tanks with soak pits, and others. SBM did, however, promote the construction of twin-leach pit latrines. These latrines are composed of inexpensive sanitation technology, are simple to construct, and, when built properly, can handle excreta through an easier on-site treatment process. However, due to incorrect architecture modification and poorly constructed toilet substructures that lower toilet efficacy, this technology has not been widely accepted. 
• Many rural homes have constructed excreta containment structures, but these structures only hold the excreta and do not handle human waste from toilets. This is a result of people's perception that twin-leach pit latrines are only intended for low-income households and their concern that the pits will quickly fill up. Families will sometimes dig deeper or wider pits that defy design principles without considering the government-recommended suggested distance from water sources.
• The country's diverse topography, which includes rocky, hilly, coastal, and desert regions, and its fluctuating water table necessitate the use of different building technologies for toilets. Failure to do so could result in environmental contamination. Site-specific solutions are required to guarantee everyone has access to safe sanitation. Furthermore, once filled, septic tanks, containment structures, and single leach pit latrines need professional services to empty and transport the fecal sludge to the treatment facilities for disposal or reuse later on.
• Lack of these facilities, which are more common in rural areas, can result in the cruel practice of manual scavenging, which can cause caste-based stigma and oppression among the underprivileged.

SOME CHALLENEGES AND FOCUSES ON BEHAVIOUR CHANGE:

• Toilet infrastructure is crucial, but it is not sufficient on its own to stop the spread of pathogens from feces to the mouth. Lack of access to water for toilet use is a major problem in rural areas; according to 30 households, only 42.5% of them had access, which raises the rate of toilet non usage. Other obstacles that make it dangerous to achieve sanitation coverage in rural areas include inappropriate toilet technologies, poor management of fecal sludge, and a lack of human resources. Important factors that not only increase toilet use but also support ODF status, which ultimately benefits population health, include appropriate and sustainable technologies, full participation in sanitation programs, social norms and individual attitudes toward latrine use, sanitation-related behaviors, raising awareness, and various social movements.
• In this situation, hygiene-related behaviors must come first. According to recent national surveys, among households with access to a toilet in rural areas, 95.7% of females and 94.7% of males regularly used the restroom. A different study carried out in four states in northern India indicates that there is a 56% increase in the use of toilets in rural households. Furthermore, fieldwork and research conducted in rural India indicate that the habit of using the toilet is gradually becoming ingrained in people. Although there may have been a 12% drop in open defecation between 2015 and 2019, data indicate that nearly half of rural residents still defecate outside. In rural India, open defection is a customary practice that is seen as cleaner, healthier, and occasionally even "religiously acceptable."
• Government studies show that the percentage of children under the age of 15 who practice open defecation more frequently than other age groups makes this a more concerning and worrisome issue. Approximately 57% of children under the age of ten in urban areas and 15% in rural areas defecate outdoors. This endangers the health of the child and can result in a number of diseases that are connected to improper hygiene practices. Unsafe stool disposal is one of the main contributing factors to stunting and mortality among children under five in India, according to a recent study. It is evident that homes with unsafe stool disposal and open defecation practices have higher rates of diarrhea and stunting.
• Consequently, it is impossible to attribute an improvement in India's sanitation program to investment alone. In their research in rural Himachal Pradesh and West Bengal, O'Reilly and Louiss proposed three factors (i.e., the Toilet Tripod) that can be regarded as successful adaptations of the sanitation program in India: (1) a favorable political environment; (2) strong political will; and (3) person-to-person contact (proximate) social pressure. Hand hygiene is another crucial and affordable public health intervention, just as important as using the restroom.
• Even if someone uses the restroom, they run the risk of spreading germs to the kids when they feed them, cook, or eat if they can't wash their hands after handling child excrement or after defecating. In many rural areas of India, the practice of washing hands with soap and water becomes inconsistent due to the unavailability of hand washing facilities, including soap, water, and space. Efficient strategies addressing hygienic habits are essential to guaranteeing the availability of water and soap when using the restroom in order to achieve positive health outcomes.

DISCUSSION AND WAY FORWARD:

• Even though India has made significant strides in improving sanitation coverage, some people, households, and communities that belong to marginalized groups in society—such as female-headed households, landless individuals, migrant laborers, and disabled people—still lack access to toilets or find that the ones that do exist are inaccessible. From the standpoints of human rights and public health, it is imperative to assist these underserved populations, as they are already disadvantaged and face a range of health problems. Sanitation practices need to be improved further for educational institutions, child care centers, hospitals, and other government facilities. In this context, innovation is essential to cover the population that is often overlooked when it comes to sanitation coverage disaggregated information in public facilities as well as among the less fortunate segments of society.
• India's goal of achieving sustainable development goal 6 (SDG) of ensuring access to water and sanitation for all by 2030 requires addressing several factors. The country's vast diversity, culture, and population, with 60% of the population in rural areas, have shown that only toilet access does not guarantee hygienic and safe sanitation practices. The first sanitation program, the Central Rural Sanitation Program, failed due to lack of focus on behavior change. The Total Sanitation Campaign (TSC) aimed to make India ODF by 2017, but faced poor results due to inadequacy in political leadership, misuse of subsidies, lack of confidence in measuring success, poor monitoring mechanisms, and a supply-led top-down approach. The SBM (G) aims to change people's behavior through information, education, and communication campaigns, and provide individual toilet facilities in all households to achieve ODF by October 2, 2019.
• This paper examines sanitation coverage and ODF status in India from 2014 to 2019 under the first phase of SBM (G). It focuses on challenges and success of centrally led government sanitation programs, focusing on behavioral changes to improve cleanliness and prevent stunting and malnourishment in villages like Mawlynnong.

CONCLUSION:

• The Indian government has implemented SBM (G) phase II (2020-2025) to transform villages from ODF to ODF plus, aiming to sustain investment in ODF status and improve cleanliness through effective waste management. The objective is to maintain ODF status, ensure solid and liquid waste management, and maintain visual cleanliness. The impact of SBM phase II on millions of people in rural villages is expected to be significant by 2025.
• India has undoubtedly advanced quickly toward achieving SDG 6 by expanding access to toilets across the country through SBM (G). Simultaneously, India needs to assess its progress in terms of environmental safety and faecal-oral disease transmission, which are crucial in preventing malnourishment and early mortality, particularly for children. In doing so, and in addressing the complexities of SBM that this study has uncovered, we will demonstrate to India and other nations how to fully realize the sanitation agendas in order to meet the SDGs and achieve universal sanitation for all.