05/01/2016 8:24 AM IST | Updated 15/07/2016 8:25 AM IST

Beyond Toilets: Swachh Bharat Mission 2.0

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Signage for a Sulabh International Social Service Organisation office is displayed on a building wall in Hirmtala village, Haryana, India, on Wednesday, Nov. 4, 2015. Prime Minister Narendra Modi's Clean India' campaign includes a pledge to build 50 million toilets by the 150th anniversary of Mahatma Gandhi's birth in 2019. The effort aims to halt the contamination of groundwater that causes illnesses such as diarrhea and cholera, costing the nation about $54 billion a year, according to the United Nation's Children's Fund. Photographer: Prashanth Vishwanathan/Bloomberg via Getty Images

There is nothing glamorous about sanitation. Talking about faecal sludge can be something of a conversation stopper. This is where Prime Minister Narendra Modi's Swachh Bharat Mission has been a game changer. The initiative has prioritised issues of open defecation, sanitation and construction of toilets and brought them to the centrestage. It is commendable that the government is working towards achieving safe sanitation in 4,041 cities and towns by investing in over 10 million household toilet units and 500,000 units of community and public toilets. Through the initiative, the government aims to achieve 100% scientific solid waste management in urban areas. All of these are a part of the larger plan of constructing millions of toilets in rural India by October 2019.

One in two Indians defecates in the open, exposing children to diarrheal and other infections transmitted by faeces. Close to 600,000 children under five die every year due to diarrhoea and pneumonia. Infections transmitted by faeces also result in reduced ability to absorb important nutrients, and life-saving vaccines. The impact goes well beyond poor health. Lack of toilets forces women and girls to go out at night. Besides all the risks to their personal safety this also brings, and increases their health risks, including at critical times during pregnancy and when they are menstruating.

Improved sanitation can deliver up to Rs 300 in social and economic benefits for every Rs 60 invested...

And, of course, all of this seriously undermines economic performance and prosperity. The World Bank has estimated that poor sanitation costs India more than $53 billion a year or over 6% of its GDP.

By improving how we deal with human waste, we can reduce chronic diarrhoea, improve children's ability to build healthy minds and bodies, and help everyone lead more prosperous and productive lives.

Improved sanitation can deliver up to Rs 300 in social and economic benefits for every Rs 60 invested because it increases productivity, reduces healthcare costs, and prevents illness, disability and early death.

Yet despite the terrible damage that poor sanitation does to well-being and prosperity, it remains one of the world's most neglected challenges. A key part of Millennium Development Goal 7 was to halve the numbers of people without access to sanitation but this was the MDG with the biggest gap between ambition and achievement.

The result is that, in 2015, over 2.4 billion people - 40% of the global population -- are still forced to practice open defecation or lack adequate sanitation facilities. The human waste from another two billion residents in towns and cities is not safely treated and can end up dangerously polluting neighbourhoods, rivers, lakes or seas.

It was to draw attention to this collective failure and the urgent need to correct it that the UN officially recognised World Toilet Day on 19 November, 2013.

World Toilet Day draws attention to this grim reality -- it does not, of course, cover the breadth of the sanitation challenge. Damage to public health can be almost as severe even when everyone is using a toilet if the waste produced is not safely treated. And all too often, this is the case. The waste -- with its disease-carrying pathogens -- is often piped into ditches, dumped into fields or released into rivers and the sea. Unsurprisingly, the consequences are continuing high rates of illness.

[E]ffective faecal sludge management (FSM) can also help with providing reusable resources like treated water, energy and fertiliser.

What we therefore need to look at now is an extension of the Swachh Bharat vision where we go beyond building basic facilities and look holistically at the sanitation value chain - from containment to treatment and safe disposal/reuse. So while toilets are an essential part of overcoming the sanitation challenge, they are the means not the end. They will only deliver the desired public health outcomes we all need for India if coupled with measures to reduce the amount of untreated waste that is let loose into the environment.

Achieving this aim urgently needs new thinking. The Bill & Melinda Gates Foundation has partnered with the Government of India to explore opportunities that will help address the issue of providing sustainable sanitation solutions, and to eliminate open defecation and safely contain, treat and dispose human waste, so that public health, hygiene and dignity are achieved for millions of households that are still forced to live without access to safe sanitation.

The foundation supports the use of city diagnostic tools that help cities diagnose how faecal waste flows, and target areas of greatest need and gap in access to safe sanitation. The idea is to eliminate a situation where the investment in individual toilets does not result in the public health outcomes and disease prevention that are achievable with attention to the entire range of sanitation solutions. While many countries have had remarkable success in achieving their goals on open defecation, with very little attention to treatment of the waste, there has been little or no public health impact. A majority of the waste simply overflows into the environment, within the area where people live, children play, keeping them at high risk of disease and chronic illness.

We need to re-imagine creating an environment where... communities are protected against the ill-effects of exposure to untreated faecal waste.

It is important to understand that effective faecal sludge management (FSM) can also help with providing reusable resources like treated water, energy and fertiliser. This makes it critical for cities to plan for safe and sustainable sanitation services across the sanitation value chain. They should also create enabling regulatory frameworks that encourage private sector participation and build robust markets for sanitation products and services. We are trying to work with a number of cities in India to support city-wide sanitation in this frame.

The arguments above accentuate the need for us to target and track more than just toilet use. We need to re-imagine creating an environment where people are not only practicing healthy sanitation habits, but where communities are protected against the ill-effects of exposure to untreated faecal waste. A great call to action has been made on a topic that has long gone without the high political attention it needs. Citizens and city governments now need to work together to ensure that this historic effort covers all Indians with the sanitation protection that will keep them healthy, productive and safe, through Swachh Bharat Mission 2.0.

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