Swachh Bharat Abhiyan can take a lesson from Alappuzha: Left leader to Modi

 By T M Thomas Isaac, indianexpress.com   October 17th, 2014

Once Alappuzha was notorious as one of the most unclean towns in Kerala

Alappuzha is a sleepy old town situated between the great Vembanad lake and the sea, nearly 60 kilometres south of Kochi. The port town, established by the king of Travancore in the late 18th century, had grown along the two trunk canals connecting the port to the great lake. The web of canals in the city and its surroundings earned Alappuzha the name, “Venice of the East”. It became the major port and industrial town in southern Kerala. But by the 1970s, it began to resemble a ghost town, as its port was eclipsed by Kochi’s and the coir industry moved out. This decline continued till the late 1990s, when backwater tourism gave it a new lease of life. But by then, the canals had got silted and become garbage pits. The town also began to rapidly lose its architectural heritage, a process that has been marvellously documented by Laurie Baker through his inimitable sketches and comments in Alleppey — Venice of the East (1991).

The insanitary conditions made the town an abode of ill health. In the state with the longest life expectancy and lowest infant mortality, we had a paradox of high morbidity, dominated by environment-related traditional diseases. Alappuzha became notorious as one of the most unclean towns in Kerala, seriously jeopardising its future as a tourism centre. Things came to a head in 2001, when the transport of solid waste from the town to its central processing plant in the neighbouring panchayat was disrupted. Though called a processing plant, it was really a dumping yard and an environmental hazard. The local population rightfully protested and blocked the movement of waste. The streets of the town were littered with garbage. Finally, an agreement was brokered with the protestors, reducing waste movement from 50 tonnes a day to five tonnes. The municipality pursued an aggressive policy of landfilling within the town, an evidently unsustainable policy.

With centralised processing ruled out, at least for the time being, what was to be done? Scavenger’s Son (1947), the first novel of the Jnanpith award winner, Thakazhi Sivasankara Pillai, an illustrious son of Alappuzha, held a clue. The novel, narrating the story of three generations of scavengers of the town, created such a social stir that it put an end to the century-old institution of manual scavenging in Alappuzha. The human excreta dumping yard in Sarvodayapuram was used for other solid waste from the town. The human excreta depot shifted to latrines within the town itself. Almost all the houses in the town now have latrines that are either inbuilt or in the compound. This raised a simple question. If human excreta could be processed in our own houses, why not the little bit of kitchen waste? The town folk usually lumped together all sorts of waste into a plastic kit and demanded that the municipal corporation collect and process the garbage. It was the duty of the present generation of sanitation workers in the municipality to segregate the waste. A new edition of Scavenger’s Son was in order. \

That was how a people’s campaign for processing waste at the source was born. A change in mindset was required. Normally, all government programmes consider sanitation to be merely an issue of technological choice. This was our major point of departure. Our pilot project for 12 wards was funded by the sanitation mission of the government of Kerala. But then it was converted into a popular campaign for better sanitation.

The approach was simple. Every household was to instal a biogas plant or pipe compost to process its organic waste. Three wards have already achieved this. If, for some reason, a household was not able to process its waste, it should not be littering the street. Anybody caught doing so would be fined. The organic waste was to be brought to the collection points set up by the municipal corporation, which would compost it in aerobic compost bins installed in various parts of the city. The aerobic composting system in Alappuzha is an innovation by the Kerala Agricultural University where layers of organic waste and dry leaves are laid in a bin with sufficient ventilation. Inoculum cultured from cow dung is sprayed on dry leaves before a layer of organic waste is deposited over it. Each bin can process two tonnes of waste and in three months, high quality compost is ready. Instead of being garbage collectors and segregators, municipal workers now manage community compost bins.

Initially, wherever we attempted to put the compost bin, there was stiff local opposition and the plans had to be shelved. So we chose the worst garbage dumping areas in the town to set up our compost bins. Nobody objected. Nothing could be worse than the existing situation. These sites were cleared and the sheds housing the bins decorated with plants and murals. The artists of Kochi Biennale lent their support to the setting up of the largest community compost centre, WATSAN Park. All meetings of the sanitation campaign are normally held at this park. Visitors and curious onlookers are amazed that there is no smell. The place truly has been converted into a park, with a vertical garden, poly house and flower pots. Thus, we broke the backbone of the opposition to community compost bins.

There are two innovations worthy of mention in our biogas plant and pipe compost campaign. Heavily subsidised programmes have generally failed in Kerala and other parts of the country. There are two reasons for this. One, sufficient attention is not paid to user education. The service provider instals the plant, pockets the service charge and moves on. Even if user meetings are held, they are normally attended by men folk who do not handle the waste processing. Because of faulty handling, most plants break down after some time. Second, there is no local maintenance team that could respond quickly to plant breakdowns. Sooner or later, the biogas plants and pipe composts are discarded and can become another hazard. Our campaign involves intense, targeted awareness programmes and also a maintenance team of two or three trained women in every ward.

Commercial establishments are to segregate their waste and either process the organic refuse themselves or enter into a contract with a service provider to remove it. Most of the waste is further segregated as feed for fish, chicken or pigs. The rest is composted. Just through systematic segregation, most of the organic waste can be transformed into inputs for agriculture. The plastic waste is periodically collected and given to contractors for recycling. We intend to collect the e-waste and store it till the government establishes a centralised processing plant.

The resident associations and the neighbourhood women’s groups of Kudumbashree are the main organisational support for the campaign. There is also a band of committed local resource persons, many of whom are experts with technical competency. Schoolchildren organised in WATSAN clubs are the main sanitation messengers to households. Every second Saturday, student leaders meet to chalk out certain simple activities that can be undertaken. Songs, street plays, exhibitions, marches and so on are effectively utilised for environment creation.

Currently, efforts are being made to scale up the Alappuzha experience to the rest of Kerala. This is possible because Kerala has social advantages like total literacy, better healthcare, effective land reform and decent housing for almost everyone. Besides, because of better infrastructural conditions in the countryside, urbanisation does not lead to slum creation. This may not be the situation in most parts of our country. Nevertheless, there are significant lessons to be learned from Alappuzha.

We cannot claim that we have achieved total sanitation in Alappuzha. But the difference between the situation two years back and the present is too marked for anybody to miss. Today, the transport of waste to the centralised processing plant has completely stopped. But the city is clean.

The writer is CPM MLA of Alappuzha and former finance minister of Kerala
express@expressindia.com

‘Who enjoys squatting in the open?’

  The Hindu Jockin Arputham, head of the National Slum Dwellers Federation. Photo:Omar Rashid. 

His days start and end with toilets. Jockin Arputham, 68, grassroots activist who has won the Magsaysay and Padma Shri awards, has been leading a struggle for the slum-dwellers’ rights to shelter and sanitation for four decades. He is based in Mumbai’s Dharavi, one of the largest slums in the world, serving as an inspiration for the poorest citizens. Mr. Arputham, together with the movement he heads, the National Slum Dwellers Federation, was nominated for the Nobel Peace Prize this year. He speaks to Omar Rashid about the progress India is making in building toilets, the Swachh Bharat Abhiyan and other sanitation issues.

 

.

 By Omar Rashid, www.thehindu.com   October 16th, 2014

 

 

"What has changed over the four decades you have been working for advancing the rights to shelter and sanitation?

"I built my first toilet in Kanpur in 1987. Since then, I have built 1,00,000 seats across the world, 20,000 of them in Mumbai. All the money I collected — five million dollars — I spent on toilets. Besides that, there is a remarkable change in the way people, and also the government, approach sanitation today. They talk about toilets much freely.

"You have been arrested more than 50 times for your campaigns, which include hiding dead mice in government buildings to “sensitise” officials to the hard life in slums. How difficult is life for a sanitation activist in India?

"I am like some celebrity today. Earlier, I was treated like a filthy criminal … an untouchable. Each time I decide to start a project, I have to run to 10 places to seek “permission.” Even if there is support from officials, it is “inadequate” or to misdirect us. Sanitation workers are easily harassed. We live under constant tension. Unless the barriers for the stakeholders are removed, no sanitation policy will work.

Prime Minister Narendra Modi recently declared that by 2019, every slum-dweller in Mumbai would have a shelter, with proper health, water, sanitation and educational facilities. No Prime Minister has had the guts to talk about toilets from the Red Fort. I appreciate him for that. But that is not the end. I ask him, if you are serious, why can’t you do this in one year? Why 2019? This is not rocket science. He is back to the same old “five-year” approach started by Nehru. All we require is a single, simple and independent toilet strategy. The Prime Minister must take it up on a war-footing.

"How applicable is the Swachh Bharat Abhiyan?

"The SBA is noteworthy. But it won’t be successful if we merely depend on celebrities, as those the Prime Minister has chosen at present. How many of the nine ambassadors have seen slum garbage or walked into a slum? Symbolisms like the Prime Minister sweeping at a Valmik Basti are okay, but not sufficient. We need to involve the stakeholders and community leadership through consultancy and participation. Go to a small pocket, plan meetings on the field and start work immediately. Mr. Modi should have gone to the slums, taken the inputs of those living there and tried to fulfil their urgent demands.

"You are not too optimistic about the SBA?

"I am always critical of timelines. Academically, they are good; practically, not so. You start with a backlog and keep changing your goalpost. If you want to work, then start now. You have the power. Where is the start? Show me the core committee. Take steps now, choose five slums in each city and build toilets there on a war-footing. Give us a start. The United Nations Millennium Development Goals shifted from 2015 to 2030. We might face the same situation because our planning is slow.
How practical is an “urgent” approach?

"When slums get razed in fire, politicians rush to offer money. Why can’t they show the same urgency in building toilets? And see the small change. Show us a little evidence and we will trust you. The government’s actions also need to be backed up by a shift in mindset of people — for instance, in controlling open defecation.

"Even if I desire privacy, I can’t have it. How can the government blame the people for open defecation? Who enjoys squatting in the open? I can recall the toilets in my town, Kolar Gold Fields [in Karnataka] — two stones with a bucket placed below them and no door. Awareness can come only if you build toilets; not 1,000 metres away, but within 50 metres. I may have good awareness, but even in a “world-class city,” as Mr. Modi plans to portray Mumbai, the sanitation situation is shameful. You have not even planned for simple cleanliness and sanitation.

"Your organisation, the National Slum Dwellers Federation, works closely with women and involves them in the sanitation debate.

"In households, it is mostly the women who deal with garbage every day and directly. Women’s role is dynamic and relevant to the cleanliness debate. Go to the poorest house in Dharavi, women will be seen mopping the floor and keeping it tidy. We need more women stakeholders. The Prime Minister talks about cleanliness, but where are the women in his project? If you don’t involve women, you are either not creative or don’t understand the issue of cleanliness.

Toilets on paper

• By Rukmini S., www.thehindu.com  October 12th, 2014

More than half the households in the country still lack access to sanitation. In its villages, some toilets built under past schemes exist only on paper.

In 2019, India will observe the 150th birth anniversary of Mahatma Gandhi, who gave the clarion call, “Clean up your own mess.” But even 67 years after Independence, our cities and towns present a sorry picture replete with mounds of garbage, rotting sewers and children defecating in the open. Can the Swachh Bharat Abhiyan, launched by Prime Minister Narendra Modi on October 2, Gandhiji’s birth anniversary, do what nearly 30 years of sanitation schemes have not been able to do in independent India?

The funding numbers for sanitation programmes have been impressive. Since 1986, India has spent over Rs. 18,000 crore on what are essentially toilet-building schemes — the Central Rural Sanitation Programme, followed by the Total Sanitation Campaign and then the Nirmal Bharat Abhiyaan. The Swachh Bharat Abhiyaan (SBA) will be a significant jump forward — to build the 11.11 crore toilets that the government needs to cover every household, it will spend every year nearly double the amount the government has spent cumulatively over the past 25 years.

In just one year, spending on rural toilet-building will multiply seven times and rival the government’s outlay on the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS).

What has systematically been less impressive is the bang Indians are getting for their buck. More than half the households in the country still lack access to sanitation. In its villages, some toilets built under past schemes exist only on paper — in Uttar Pradesh’s Fatehpur district, villages this correspondent visited, which were awarded “Nirmal Gram” titles by the President for being free of open defecation, had no toilets for any members of Dalit bastis. In their study of 3,200 households in five States, scholars from the Research Institute for Compassionate Economics (RICE) found that 80 per cent of the households reported having constructed toilets spending their own funds.

This, the government promises, will change now. “The Prime Minister has made it a priority, and that message is not lost on government staff. There will be more supervision now,” a senior SBA official told The Hindu. The de-linking of the MGNREGS from toilet-building is a step towards ensuring better compliance, the official said. While the MGNREGS paid for half the Rs. 10,000 subsidy given to households for rural toilets in the past, now the entire amount will come from the sanitation mission. “MGNREGS payments are extremely delayed. That has, of course, put the rural employment guarantee scheme in trouble, but it was also causing problem for Nirmal Bharat Abhiyaan,” a District Magistrate in Rajasthan said. Apart from this, there are no substantive changes yet in how the money will be spent, or how the implementation monitored, the Delhi-based SBA official said.

Behavioural change

The other thing that will change, the government says, is an emphasis on behavioural change. Over the last year, a series of research studies have shown that not everyone who gets a toilet uses it — 40 per cent of the households with access to toilets had at least one family member not using it, economists from RICE found in a five-State study.

The government says this will change. “Building toilets and effecting behaviour change — these are the two prongs of the strategy,” Sandhya Singh, Joint Director of the SBA (Rural), said. Yet, as RICE economist Payal Hathi points out, funding for the information, education and communication segment of the scheme has fallen from 15 per cent to 8 per cent as a proportion of total funds spent.

“With the SBA, this new government has the opportunity to do things differently and put India on a better trajectory … the government will need to increase its capacity to carry out the important work of changing people’s attitudes about latrine use, and make clear that the use of latrines is more important than simply constructing them,” Ms. Hathi said.

Following its research on toilet use in 45 gram panchayats in Davangere in Karnataka, Arghyam, a Bangalore-based water and sanitation group, began to work with behaviour architecture firm FinalMile Consulting on why people were not using toilets and how to fix this reluctance. One of the issues they found was of toilet structures.

“We have seen that toilets in the currently accepted designs are cramped, dark and unfriendly structures and spaces. Windows are small and don’t let light in,” Radhika Viswanathan, project officer at Arghyam, said. The organisation has begun to look into innovative ways to make the toilet more user-friendly. But whether this is cost-effective to do on a national scale is unclear; RICE researchers point out that toilets in Nepal and Bangladesh are far more basic and cheaper, yet widely used.

But Gandhiji’s vision of a clean India cannot be achieved by a purely toilet-centric approach to sanitation alone. It is not going to deliver the health benefits that better sanitation should.

Behavioural change critical

• By T-, www.thehindu.com  October 12th, 2014

That high toilet coverage without concomitant utilisation of the facilities at a very high level and washing hands with soap will not bring about a reduction in diarrhoeal episodes and worm infestation, or any improvement in nutrition and growth, has been clearly brought out in a study undertaken in rural Odisha. The study involved about 4,600 households from 50 villages grouped in an intervention arm and about 4,900 households from 50 villages in a control group; there were nearly 25,000 individuals in each group. The coverage of toilets shot up from 9 per cent to 63 per cent among those in the intervention arm within 18 months, compared with an increase from 8 to 12 per cent in the control villages. Eleven of the 50 villages in the intervention arm had toilet coverage of 50 per cent and above; only two villages in the control group had coverage that was this high. 

Despite usage at the household level in the intervention arm being 84 per cent for women and 79 for men and children, it translated to only about 50 per cent at the community level. As a result, in both the arms the number of children below five years who were affected by diarrhoea was nearly the same. There was no difference in worm infestation rates or any improvement in nutrition or growth rates, either. There was no decrease in faecal contamination of water or any significant drop in contamination of the hands of individuals.

The results of the trial should serve as a painful reminder that emphasis on high toilet coverage without ensuring very high usage will not lead to improvement in health indicators. After all, the only way to reduce the overwhelming load of diarrhoeal and other pathogenic bacteria in the environment and improve health indicators is to refrain from shedding such bacteria in the environment. The timing of the results is perfect. 

The government recently rolled out its ambitious Swachh Bharat Mission with the aim of ensuring a toilet in every Indian household by the end of 2019; an earlier programme primarily targeted families that were below the poverty line. Building toilets is the necessary but easier part; bringing about behavioural change is the more daunting challenge. This is amply reflected in the study, done in accordance with the government’s earlier programme. 

The Mission should not remain a mere infrastructure-centred programme but should give equal priority to creating awareness of the benefits of toilet usage through a massive campaign. On paper, the “top priority” of the Mission is to improve toilet usage by bringing about behavioural change. There is also a provision to “monitor usage”. It is important that such ideals get translated into discernible actions and results on the ground.

The rhetoric of Swachh Bharat amid filthy toilets

Damini Nath  The Hindu, New Delhi, October 11, 2014

Special Arrangement

Public urinals are still not connected to water and sewer lines.

TOPICS

Lack of manpower leaves toilets in South Delhi dirty or otherwise locked

Public toilets in South Delhi are still filthy and many remain closed to the public a month after senior local body officials inspected the facilities and found them in a sad state. 

Congress leaders in the South Delhi Municipal Corporation had inspected community toilet complexes (CTCs) and waterless urinals on September 7 only to find them dirty and lacking water and sewage connections. 

On Friday, SDMC Deputy Mayor Praveen Rana, Leader of the Opposition Farhad Suri and Sriniwaspuri councillor Indu Verma inspected sanitation in South Delhi. At a waterless urinal facility on Lodhi Road, the stench and filth was so bad that a senior citizen was forced to relieve himself outside the complex. 

Another facility at Ashram, which the Congress leaders had inspected on September 7, was still not connected to water and sewers. A local shopkeeper, Harjeet Singh, said the facility had been in a sorry state for three years.

“There is no one to clean the urinals. We, the shopkeepers, are forced to use these as they are the only ones in the entire area. So, we clean them ourselves when the smell becomes too bad,” said Mr. Singh. 

Another nearby shopkeeper, Shiv Kumar, added that there were no toilets for ladies in all of Ashram. “Ladies who come to this area have to knock on doors and request residents to use their toilets,” said Mr. Kumar. 

At Srinivaspuri’s L-Market, fixtures at a waterless urinal were caked with filth as it had not been cleaned in at least a month. “This urinal is hardly cleaned. The stench is unbearable so no one can use it anymore,” said Inderjeet Singh, a member of the Srinivaspuri Vikas Manch.

Ms. Verma said since the waterless urinal had been given to a private company to run, the SDMC can’t maintain it. “I have personally called the contractors for the toilets and the garbage dumps numerous times, but we are lucky if they come once a month,” said the councillor. 

While these facilities were filthy, a CTC outside Lady Shri Ram College was locked. Locals said it had been shut for years, but the contractor had consistently displayed advertisements on its façade. The Hindu had already reported on Sunday that this facility on Kalka Devi Marg, near the Aman Colony police station, was locked. 

Mr. Suri said: “What Swachh Bharat campaign are we talking about when we haven’t been able to give basic facilities like public toilets.”

However, the civic body is in the process of taking back these facilities from the concessionaires (Prabhatam Group and GraphisAds). SDMC Commissioner Manish Gupta said there was a long legal dispute between two concessionaires and civic body. 

He said on October 1, Prabhatam Group has agreed to surrender 165 waterless urinals, which the SDMC is in the process of repairing. GraphisAds, which had 38 waterless urinals, will be upgrading the facilities and SDMC officials will monitor the work. Mr. Gupta said the repair and maintenance work should be finished by October 31. 

The world's biggest sanitation programme

 

timesofindia.indiatimes.com October 10th, 2014

LONDON: The world's biggest sanitation programme, being run in India, will reduce the shameful practise of open defecation in the country but may not improve the country's abysmal health indicators, according to a study by an international group of scientists. 

The study comes at a time when Prime Minister Narendra Modi has launched the Swachh Bharat Abhiyan with great fanfare.Once covered toilets were made for families, the researchers looked at whether practising hygienic sanitation improved their health.

To everyone's surprise, the researchers found no evidence that the intervention protected against diarrhoea in children younger than 5 years: 7-day prevalence of reported diarrhoea was 8.8% in the intervention group (data from 1,919 children) and 9.1% in the control group (1,916 children).
Defecating in a toilet with water did not reduce the prevalence of parasitic worms that are transmitted via soil and can cause reduced physical growth and impaired cognitive function in children.

There was also no impact on child weight or height — measures of nutritional status.
Lead author of the study professor Thomas Clasen from Emory University, Atlanta and the London School of Hygiene and Tropical Medicine in the UK said, "Many householders do not always use the latrines. This, combined with continued exposure from poor hygiene, contaminated water, and unsafe disposal of child faeces, may explain the lack of a health impact".

More Indians have a cell phone than a covered toilet.

Around 626 million people in the country don't have access to a close toilet and consequently practice open defecation. The sanitation intervention delivered under the terms of the Government of India's Total Sanitation Campaign — the world's largest sanitation initiative — provided almost 25,000 individuals in rural India with access to a latrine.  (NDMC staff cleaning eco-friendly toilet near Valmiki colony.)

However, a study to be published in the British Medical Journal Lancet on Friday, involving 100 rural villages, shows that it did not reduce exposure to faecal pathogens or decrease the occurrence of diarrhoea, parasitic worm infections or child malnutrition.

This cluster randomised trial involved 9,480 households in 100 rural villages in Odisha with a child younger than four years or a pregnant woman.

Households in 50 villages were randomly assigned to receive the sanitation intervention in early 2011; control villages received the intervention after a 14-month surveillance period.
The intervention increased the average proportion of households in a village with a latrine from 9% to 63%, compared to an increase of 8% to 12% in control villages.

Worldwide, around 2.5 million people lack access to basic sanitation facilities such as a latrine, a third of who live in India. Two-thirds of the 1.1 billion people who practise open defecation and a quarter of the 1.5 million who die every year from diarrhoeal diseases caused by poor hygiene and sanitation also live in India.

Trying to explain why the intervention did not help bring down India's abysmally high diorrhea rates, the researchers suggest a number of possible explanations including insufficient coverage and inconsistent use of latrines, or that a lack of handwashing with soap or animal faeces could also be contributing to the disease burden.

Dr Stephen Luby, research deputy director at the Centre for Innovation in Global Health, Stanford University, said, "This rigorous assessment is important, because it provides the best evidence so far for the uncomfortable conclusion that well -funded, professionally delivered sanitation programmes, even when they reach coverage levels that are quite commendable for large scale interventions, do not necessarily improve health".

In 1990, households without any sanitation facility in India stood at 76%. To meet its Millenium Development Goals, India was required to reduce the proportion of households having no access to improved sanitation to 38% by 2015. The government had earlier estimated that India may reduce the proportion of households without any sanitation to about 43% by 2015 missing the target by about 5 percentage points. By 2015, India is likely to reduce the rural proportion of no sanitation to 58.8% (against target of 46.6%) and urban proportion of no sanitation to 11.6% (against target of 12.1%).

The UN had recently said that the number of people forced to resort to open defecation remains a widespread health hazard and a global scandal. "In 11 countries, a majority of the population still practices open defecation. Even in countries with rapidly growing economies, large numbers of people still must resort to this practice — 626 million in India, 14 million in China and 7 million in Brazil," a UN MDG report said recently.

Better toilets may not mean better health

timesofindia.indiatimes.com October 10th, 2014

LONDON: The world's biggest sanitation programme, being run in India, will reduce the shameful practise of open defecation in the country but may not improve the country's abysmal health indicators, according to a study by an international group of scientists.

The study comes at a time when Prime Minister Narendra Modi has launched the Swachh Bharat Abhiyan with great fanfare.

Once covered toilets were made for families, the researchers looked at whether practising hygienic sanitation improved their health.

To everyone's surprise, the researchers found no evidence that the intervention protected against diarrhoea in children younger than 5 years: 7-day prevalence of reported diarrhoea was 8.8% in the intervention group (data from 1,919 children) and 9.1% in the control group (1,916 children).
Defecating in a toilet with water did not reduce the prevalence of parasitic worms that are transmitted via soil and can cause reduced physical growth and impaired cognitive function in children.

There was also no impact on child weight or height — measures of nutritional status.
Lead author of the study professor Thomas Clasen from Emory University, Atlanta and the London School of Hygiene and Tropical Medicine in the UK said, "Many householders do not always use the latrines. This, combined with continued exposure from poor hygiene, contaminated water, and unsafe disposal of child faeces, may explain the lack of a health impact".

More Indians have a cell phone than a covered toilet.

Around 626 million people in the country don't have access to a close toilet and consequently practice open defecation. The sanitation intervention delivered under the terms of the Government of India's Total Sanitation Campaign — the world's largest sanitation initiative — provided almost 25,000 individuals in rural India with access to a latrine.  (NDMC staff cleaning eco-friendly toilet near Valmiki colony.)

However, a study to be published in the British Medical Journal Lancet on Friday, involving 100 rural villages, shows that it did not reduce exposure to faecal pathogens or decrease the occurrence of diarrhoea, parasitic worm infections or child malnutrition.

This cluster randomised trial involved 9,480 households in 100 rural villages in Odisha with a child younger than four years or a pregnant woman.

Households in 50 villages were randomly assigned to receive the sanitation intervention in early 2011; control villages received the intervention after a 14-month surveillance period.
The intervention increased the average proportion of households in a village with a latrine from 9% to 63%, compared to an increase of 8% to 12% in control villages.

Worldwide, around 2.5 million people lack access to basic sanitation facilities such as a latrine, a third of who live in India. Two-thirds of the 1.1 billion people who practise open defecation and a quarter of the 1.5 million who die every year from diarrhoeal diseases caused by poor hygiene and sanitation also live in India.

Trying to explain why the intervention did not help bring down India's abysmally high diorrhea rates, the researchers suggest a number of possible explanations including insufficient coverage and inconsistent use of latrines, or that a lack of handwashing with soap or animal faeces could also be contributing to the disease burden.

Dr Stephen Luby, research deputy director at the Centre for Innovation in Global Health, Stanford University, said, "This rigorous assessment is important, because it provides the best evidence so far for the uncomfortable conclusion that well -funded, professionally delivered sanitation programmes, even when they reach coverage levels that are quite commendable for large scale interventions, do not necessarily improve health".

In 1990, households without any sanitation facility in India stood at 76%. To meet its Millenium Development Goals, India was required to reduce the proportion of households having no access to improved sanitation to 38% by 2015. The government had earlier estimated that India may reduce the proportion of households without any sanitation to about 43% by 2015 missing the target by about 5 percentage points. By 2015, India is likely to reduce the rural proportion of no sanitation to 58.8% (against target of 46.6%) and urban proportion of no sanitation to 11.6% (against target of 12.1%).

The UN had recently said that the number of people forced to resort to open defecation remains a widespread health hazard and a global scandal. "In 11 countries, a majority of the population still practices open defecation. Even in countries with rapidly growing economies, large numbers of people still must resort to this practice — 626 million in India, 14 million in China and 7 million in Brazil," a UN MDG report said recently.