PM Narendra Modi launched the Swachh Bharat Abhiyan on 2nd October 2014. At that time there were almost 550 million people practicing open defecation; today more than 250 million of them no longer practice open defecation. The main mission of the Abhiyan is to place a focus on sanitation, cleanliness, and to eliminate open defecation in India by 2019 as declared by PM Shri Narendra Modi on Oct 2, 2014. A sub but most prioritized goal of the mission is to achieve a clean and Open Defecation Free (ODF) India by October 2, 2019.

The Mission is divided into urban and rural missions taken over by Ministry of Urban Development (MoUD) and Ministry of Drinking Water and Sanitation (MDWS) respectively. The total estimated cost of Swachh Bharat Mission-Urban for years 2014-19 is Rs. 62,009 crores and the same is Rs. 1,34,000 crores for Swachh Bharat Mission-Gramin. The national movement for ‘Swachh Bharat’ can also be viewed as ‘Swastha Bharat’ as it comprises of a series of public health initiatives towards practicing preventive health. PM Narendra Modi is the first ever Prime Minister of India who has paid attention to this crucial link between open defecation/sanitation and health of the nation. Although, building toilets will be job half-done but ending open defecation is as much about fighting mind-sets and PM Modi is driving this transition through behavioral change among people through awareness campaigns, speeches and celebrity involvement in the program. Swachh Bharat Abhiyan receives 15 percent of the funding for Information, Education, and Communication (IEC) to trigger behavior change and generate demand for sanitation. Corporate houses have been encouraged to participate in the SBM (G) as a part of the Corporate Social Responsibility. Many initiatives have sprung up around the country either through a public-private partnership or private entrepreneurial ventures that are working towards waste management and waste collection/segregation. Swachh Bharat Mission also has a huge economic impact on the country. UNICEF estimates that each household in India will save Rs. 50,000 per year from PM Modi’s Swachh Bharat Mission.

PM and the MDWS launched a transparent third-party verification survey report conducted by Quality Council of India (QCI) to take stock of rural sanitation in all States and UTs, called Swachh Survekshan Gramin 2017. It found the overall toilet coverage to be 63.73% and that 91.29% of the people that have access to a toilet, use it. In the urban areas, the number of households without toilets has come down to 14.5 percent from 18 percent in three years (2014-2017).

Sanitation is a state subject and hence the focus of the mission is to move towards a ‘Swachh Bharat’ by providing flexibility to State Governments to decide on their implementation policy and mechanisms. The Government of India (GoI) estimated the cost of implementation of SBM (U) for all the years to be Rs. 62,009 crore. Out of this GoI will fund Rs 14,623 crore and the States or ULBs shall contribute another Rs 4,874 crore for the mission. The balance fund is to be generated through other sources in the form of beneficiary contribution, user charges, corporate social responsibility (CSR) funds, and private sector participation, among others. (Source: MoUD, 2014; MoHUA, 2017)

HEALTH IMPACT

Preventive healthcare or preventive medicine consists of measures taken for disease prevention as opposed to disease treatment. For the longest time in our country, we have ignored the essential link between cleanliness and public health.

According to the Ministry of Health & Family Welfare, Government of India 13 Children dies of Diarrhea every hour in India. In the year 2014 alone, there were 600 million adult cases, and 300 million cases of diarrhea in children under 5 years of age in India (RGI, 2014).

Close to 90 percent of the wastewater being discharged, is untreated and causes environment pollution thereby creating health hazards for the population. A paper in The National Bureau of Economic Research (USA) by Duflo et al., “Toilets Can Work” estimated the impact of an integrated water and sanitation improvement program in rural India that provided household water connections, latrines and bathing facilities to all households in approximately 100 villages. It suggests that the intervention reduced treated diarrhea episodes by 30-50%. Various researchers and experts continue to produce evidence of the linkages between poor sanitation and adverse health through diseases such as diarrhea, typhoid, and malaria. India’s inability to root out open defecation has been connected to infant deaths, high incidence of diarrheal diseases and stunting.

In India, there has been the prevalence of certain group of bacterial and parasitic diseases known as Neglected Tropical Diseases (NTDs) such as elephantiasis and soil-transmitted helminths. They are mainly caused by unhygienic environments. NTDs are spread by insects such as mosquitos and flies, or through contact with contaminated water or soil. They affect the world’s poorest people who lack access to clean water or improved sanitation and hygiene infrastructure like toilets. While these diseases are not fatal, they are known to cause disability, anemia, and malnourishment; undermining the country’s human capital.

The correlation between open defecation and stunting in children implies the prevalence of malnutrition caused by the inability to absorb and retain nutrients with its permanent adverse impact on the mental development of children. These diseases hence impede the achievement of goals for other programs such as mid-day meals which aim to solve the problems of malnourishment. Some estimates suggest that over 600 million people are at risk of contracting one or more NTDs in India.

There were almost 550 million people practicing open defecation till 2014; close to 300 million of them still practice open defecation. Swachh Bharat Mission, the movement for a clean and open-defecation free society can also be viewed as a movement for a healthy society and it should comprise of a series of public health initiatives towards practicing preventive health and promotive health.

The national movement for ‘Swachh Bharat’ can also be viewed as ‘Swastha Bharat’, as it comprises of a series of public health initiatives towards implementing preventive and promotive health. The campaign aims to plug the loss of excessive expenditure on preventable diseases to a large extent to ease the pressure on the current healthcare facilities. Proper water management would ensure prevention breeding of mosquitoes, which serve as carriers of various diseases. The positive ramifications of the Swachh Bharat Mission are manifold; from improved living standards to better health status, increased economic productivity, environment protection, and above all ensuring safety, privacy and dignity.

BEHAVIORAL CHANGE

Behavior change is the science that deals with the forming of new perceptions and abolition of old perceptions. There is a persistent attitude problem in the country where people don’t care how clean the roads or the neighborhood are as long as their house is clean. SBM (U) receives 15 percent of the funding for Information, Education, and Communication (IEC) to trigger behavior change and generate demand for sanitation. IEC plays a vital role in the promotion of the importance of sanitation and hygiene by highlighting its linkages with public health. The impact of SBM has been so huge that the total population of India defecating in the open has reduced to more half in a short span of 4 years.

The Inter-Ministerial Projects were conducted all over the country to create awareness which included Swachhta Pakhwadas, Namami Gange, Swachhta Action Plan, Swachh Swasth Sarvatra campaign, School Sanitation drives, Anganwadi Sanitation drives, Railway Sanitation etc. Swachhta Action Plans were developed by 76 Union Ministries and departments and the web-based portal was developed to monitor progress and highlight implementation status. Women Swachhagrahis were appointed and Swachh Shakti Awards were instituted to further enhance women involved with the program. Feedback Foundation has been working to motivate ODF villages through behavior change by catalyzing community adoption.

ECONOMIC IMPACT

Apart from cleanliness and disease-prevention, the Swachh Bharat campaign will also lead to notable economic development for the country. Tourism generates approximately 6.5% of India’s total GDP and over 40 million Indian citizens derive their income from this sector. The government has been influenced by Singapore’s idea of undergoing a cleanliness drive in the 1970’s. It transformed the country into an FDI magnet and this led to a steep surge in its economic growth. According to a 2016 report by Oxford Economics and Water Aid, the lack of sanitation alone cost India $106.7 billion in 2015, almost half of the total global losses, and 5.2% of the country’s GDP in that year. A study by WHO shows that lack of cleanliness leads to an annual loss of over Rs 6500 every year to each Indian. 70% of all diseases diagnosed are related to sanitation. If this goes on then India is facing a 2.2 trillion dollar expenditure on public health care because of lack of awareness about sanitation. According to an estimate by UNICEF, each household in India will save Rs 50,000 per year from PM Modi’s Swachh Bharat mission.

IMPLEMENTATION AND EVALUATION

Just like any other great initiative, Swachh Bharat Abhiyan has received its share of criticism. Since the launch of the Abhiyan, there has been a criticism against its implementation and evaluation techniques. A lot of people argue that the reports of success being published by the government cannot be trusted as they can be easily manipulated and hence does not provide a legitimate basis for evaluation.

The fact of the matter is, PM Modi and the MDWS launched a transparent third-party verification survey report conducted by Quality Council of India (QCI) to take stock of rural sanitation in all States and Union Territories, called Swachh Survekshan Gramin 2017. QCI conducted an extensive survey across 73 cities, including 53 cities with the population of more than 1 million and state capitals commissioned the Ministry of Urban Development (MoUD). The survey confirmed work done by 73 municipalities on the construction of individual household toilets, community, and public toilet seats, door-to-door collection of garbage & waste management and treatment. 1 lakh citizens were surveyed by 110 assessors across 73 cities at 3000 plus locations. 15 cities were categorized as ‘Leaders’ which had to have a high level of cleanliness and sanitation facilities. 20 cities became aspiring leaders which had a decent cleanliness level and could aim to be in the category of ‘Leaders’. Under the Swachh Survekshan Gramin 2017, QCI surveyed 1.4 lakh rural households across 4626 villages and found the overall toilet coverage to be 63.73% at the time of the survey, i.e. May-June 2017. The survey also observed that 91.29% of the people who have access to a toilet, use it. The World Bank had sanctioned a loan of $1.5 billion and the money was to be released in tranches on the basis of performance of the SBM-G and it had demanded an independent agency report for the same. The Union government has awarded the contract for Rs 37.85 crore to a consortium of two international independent agencies and they are in the process of finalizing the questionnaire for their survey. The sanctioning of the loan will help overcome the shortfall of funding for the Abhiyan.

IS SWACHH BHARAT ABHIYAAN AN UNACHIEVABLE GOAL?

With the completion of 4 years, the goals set by Shri Narendra Modi for the Abhiyan seem far-fetched which has bought a huge amount of criticism for the movement. Ending open defecation for all Indians by 2019 is what is known, in management parlance, as a BHAG, a Big Hairy Audacious Goal. Leadership experts know that by offering a worthwhile, but difficult to achieve a vision, you can mobilize an institution, motivate a workforce, drive change and, sometimes, even reach that goal. It has long been known that lack of toilets allows fecal germs to spread, which cause sometimes fatal illnesses like cholera and diarrhea, especially among children. But there is a more insidious danger from human excreta. As Coffey and Spears’ book, Where India Goes: Abandoned Toilets, Stunted

Development and the Cost of Caste sets out, Indians are shorter than they should be, and this pattern of stunted growth cannot be explained by genetics, poverty or lack of food. Being born and brought up in a place where open defecation is common means that guts are constantly being damaged by fecal pathogens and parasites. Undernutrition sets in, leaving kids more vulnerable to infections, which in turn make them more malnourished. Energy is diverted from cognitive development, lowered intelligence compromises the ability to earn and poverty is entrenched. By one estimate, open defecation costs India a staggering 6.4 percent of its GDP. Hence, setting such a BHAG seems like a part of the plan, to push government and otherwise workers to deliver utmost instead of taking the issue lightly; something which had been happening for the last many many years.

A detailed report prepared by the author on ‘Swachh Bharat Abhiyaan’ can be accessed from here: http://www.spmrf.org/wp-content/uploads/2018/02/Sawaksha-bharat-abhiyan-Medium-Resolution.pdf

The author Shubhendu Anand is a lawyer, practicing primarily in the Supreme Court of India. He loves to read and write about law, politics, and religion. You can reach him @BBTheorist 

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