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Eliminate Open Defecation

Introduction

 

Open defecation refers to the practice whereby people go out in fields, bushes, forests, open bodies of water, or other open spaces rather than using the toilet to defecate. The practice is rampant in India and the country is home to the world’s largest population of people who defecate in the open and excrete close to 65,000 tonnes of faeces into the environment each day.
 
Around 564 million people, which is nearly half the population of India, defecate in the open. India accounts for 90 per cent of the people in South Asia and 59 per cent of the 1.1 billion people in the world who practise open defecation. 
 
Open defecation poses a serious threat to the health of children in India. The practice is the main reason India reports the highest number of diarrhoeal deaths among children under-five in the world.  Every year, diarrhoea kills 188,000 children under five in India. Children weakened by frequent diarrhoea episodes are more vulnerable to malnutrition, stunting, and opportunistic infections such as pneumonia.
 
About 43 per cent of children in India suffer from some degree of malnutrition. Diarrhoea and worm infection are two major health conditions that affect school-age children impacting their learning abilities. Open defecation also puts at risk the dignity of women in India. Women feel constrained to relieve themselves only under the cover of dark for reasons of privacy to protect their dignity.

Open defecation exposes women to the danger of physical attacks and encounters such as snake bites.  Poor sanitation also cripples national development: workers produce less, live shorter lives, save and invest less, and are less able to send their children to school.
 
Combatting a culture of Open Defecation: 
 
In India, open defecation is a well-established traditional practice deeply ingrained from early childhood. Sanitation is not a socially acceptable topic, and as a result, people do not discuss it. Consequently, open defecation has persisted as a norm for many Indians. In addition to tradition and the communication taboo, the practice still exists due to poverty; many of the poorest people will not prioritise toilets and besides, many are living in rented homes without toilets.
 
Society does not view the lack of a toilet as unacceptable. Building and owning a toilet is not perceived as aspirational. Construction of toilets is still seen as the government’s responsibility, rather than a priority that individual households should take responsibility for. The challenge is to motivate people to see a toilet as fundamental to their social standing, status and well-being.
 
A significant gap also exists between knowledge and practice. Even when people are aware of the health risks related to poor sanitation (specifically of not using a toilet and practising good hygiene), they continue with unhealthy practices.
 
The practice of open defecation is not limited to rural India. It is found in urban areas too where the percentage of people who defecate in the open is 12 percent, while in rural settings it is about 65 percent. 
 
Open defecation in urban areas is driven by a number of reasons including, lack of space to build toilets in high-density settlements and tenants unwilling to invest in toilets where landlords do not provide them. In rural India, open defecation is prevalent among all socio-economic groups although the bottom two wealth quintiles practice it most.
 
One of the main challenges faced in the drive to eliminate open defecation is the inadequate human resource base for sanitation. In sub-districts where they are most needed, there are no dedicated frontline workers to promote and implement sanitation strategies. While some states have now began to recruit frontline workers, there are still no mechanisms for their training, management, and supervision.
 
Another key requirement is to integrate Social and Behaviour Change Communication (SBCC) elements into the government programme, Swatchh Bharat Mission (SBM). Gram Panchayats (village governments) who receive resources from the SBM do not benefit from an SBCC drive to stimulate demand for toilets.
 
Equally, community approaches that involve systematic and structured Information, Education, and Communication (IEC) and Inter-Personal Communication (IPC) elements are not yet integrated in the SBM. The absence of SBCC activities means that many households that receive toilets have not demanded them. As a result, not all members of the household use the toilets because they do not know their benefits. In a small number of cases, no members of the household use the toilets, illustrating the need for more community-level information about sanitation.
 
Silver lining in recent years
 
In spite of the large number of people still practising open defecation, the Government of India has made progress in reducing the practice. The 2010 JMP report showed that 54 per cent of people were practising open defecation, translating to around 637million people. According to the April 2014 update, this figure has come down to 48 per cent, or 595million people, after taking into account population growth.
 
Although access to sanitation in rural India is improving, the increase is not equitable. Open defecation is still almost universal among the poorest 20 per cent of the population.
 
Progress has also been made in creating awareness about the many benefits of toilets, but many barriers to uptake still remain in rural India. A study by consulting firm Monitor Deloitte in 2012 in Bihar state showed that the majority of people interviewed wanted a toilet and a number had taken steps to find out how to get one.

Awareness campaigns, media exposure, and pressure from school-age children, are some of the drivers of this awareness. Further, with a growing population and increasing agricultural cultivation and urbanization, the number of spaces available for open defecation continues to reduce.

 


Big Picture


Globally, India has the largest number of people still defecating in the open: more than 564 million. One in two people uses a toilet.
Half of the population excretes more than 65,000 tonnes of poo outside every day.  
An even lower proportion of India’s rural population uses toilets. About 65 per cent of people in rural areas do not have access to toilets.
Of the more than 160 million people who have access to improved sanitation, the coverage is highly inequitable. Open defecation is actually still increasing amongst the poorest segment of the population.
Only 11 per cent of Indian rural families dispose of child faeces safely. Eighty per cent of children’s faeces are left in the open or thrown into the garbage.
With 44 per cent of mothers disposing of their children’s faeces in the open, there is a very high risk of microbial contamination (bacteria, viruses, and amoeba) of water which causes diarrhoea in children.
India reports the highest number of deaths due to diarrhoea in children under five in the world.  Every year, diarrhoea kills 188,000 children in this age group.
Children weakened by frequent diarrhoea episodes are more vulnerable to malnutrition, stunting, and opportunistic infections such as pneumonia. About 43 per cent of children in India suffer from some degree of malnutrition.
The faecal-oral route is an important polio transmission pathway. Open defecation increases communities’ risk of polio infection.

Did you know?
 
One GRAM of faeces contains:
     • 10,000,000 viruses
     • 1,000,000 bacteria
     • 1,000 parasite cysts
 
Child faeces contain more germs than adults’.

Women and girls face shame and a loss of personal dignity and risk their safety if there is no toilet at home. They have to wait for nightfall to relieve themselves in privacy.

UNICEF In Action

The Government of India with help of partners like UNICEF is looking at the challenge of Open Defecation very seriously. The government has a target to make India “Open Defecation Free” by 2019 and UNICEF India is a key partner in its flagship programme to achieve this target through the Swatchh Bharat Mission (SBM). 
 
SBM emphasizes generating awareness, sharing information and creating behaviour change to bridge the gap between building toilets and their proper use.
 
UNICEF developed the national sanitation and hygiene, advocacy and communication strategy for the Government of India and is working with state governments to develop and implement state sanitation and hygiene, advocacy and communication strategies.

UNICEF is also working with governments to establish state open defecation elimination plans which aim to create an enabling environment that will support and improve the efficiency of the roll-out of the government’s sanitation programme SBM.
 
UNICEF is also working with other departments of the government of India such as the Ministry of Human Resource Development and Ministry of Health and Family Welfare to improve the situation of WASH in schools and in health centres. UNICEF works through UNICEF’s network of field offices in India to provide technical support to state governments.
 
CATS Pilots: UNICEF in India has introduced pilots of Community Approaches to Total Sanitation (CATS) in six states, to demonstrate how grassroots methods can be harnessed to deliver open defecation free (ODF) communities quickly and with quality. UNICEF is also working on building local capacity to implement quality CATS programmes and training master trainers to widen the pool of trained workers to perform CATS triggering.
 
WASH in Health Centres

UNICEF in India is working in collaboration with the Health ministry to map WASH compliance in health facilities in the most deprived districts and is making recommendations to address non-compliance.
 
Institution Strengthening

The WASH section works with state governments to identify where institutions need capacity-building. For example, it is helping reform State Water and Sanitation Missions to become responsive when they are in mission mode.

Efforts are also underway to address mechanisms to ensure that supply chains can be activated as demand for toilets within communities increases. It also works to identify toilet technologies suited to different climatic and geographic zones and is supporting efforts to improve the skills of masons to build better quality toilets. In West Bengal, there is a pilot under way to create a model institutional and delivery structure to make districts open defecation free.
 
Communication support
In terms of communication campaigns, the WASH section provided technical support to the Government of India to develop the national Sanitation and Hygiene, Advocacy and Communication Strategy (SHACS).

This strategy has been contextualised by all states that have a UNICEF presence and district implementation plans have been developed in all states ready for rollout. UNICEF is also providing technical inputs to the India chapter of the Global Inter-faith WASH Alliance (GIWA), to plan its programme of strategies including outreach to create demand for toilets.  
 
Advocacy support
 
Jointly, UNICEF’s WASH, and Advocacy and Communication sections developed the Poo2Loo campaign. This unique campaign deliberately chooses to address the population of young Indians who have a toilet at home, in order to sensitize them to the plight of those who do not have toilets, and create a youth social movement to stand up and advocate for the need for everyone to have a toilet. The campaign launched in the largest cities of India and in its second phase, is being spread to state capitals and smaller cities.