Health and Healthcare Systems

Better sanitation for India is in the pipeline

A boy throws a banana after collecting it from the polluted waters of river Sabarmati, in the western Indian city of Ahmedabad July 18, 2013.

Around 2.3 billion people worldwide still do not have access to rudimentary sanitation facilities. Image: Reuters/Amit Dave

Sharmishta Sivaramakrishnan
Community Specialist, Young Global Leaders - Asia, World Economic Forum Geneva
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Recently, I had the privilege of spending a day in Patna, Bihar. Beautiful as it is, Bihar is one of India’s poorest states, with a record 70% of its population under the poverty line. Moreover, in 2018, the Research Institute for Compassionate Economics (RICE) reported that 44%of households practised open defecation in Bihar as well as in the Indian states of Madhya Pradesh, Uttar Pradesh and Rajasthan.

According to the World Health Organization, an approximated 2.3 billion people worldwide still do not have access to rudimentary sanitation facilities. Of the world’s 7.7 billion population, only 27% use private sanitation facilities with properly connected sewage pipes, and 13% use toilets or latrines where human waste is disposed of in the right manner. These figures point to an underlying implication: sanitation is about services.

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The Indian government’s Swachh Bharat Mission (SBM), launched in 2014, is a national campaign launched by the prime minister of India to free the country from open defecation practices. Through this campaign, in Bihar alone, 19 times as many toilets were built in Patna between 2017 and 2018, compared to before 2014 when SBM was launched. This progress in building infrastructure around toilets is remarkable, pointing to the dedication of public policy to addressing the prevalence of open defecation.

However, such developments also call attention to a larger nuance. In urban environments, where cities pose a multitude of complex design challenges, the establishment of an adequate sanitation habit extends past construction and supply of sufficient toilets, and rather requires a clear service chain around waste. Such a service chain needs to be focused on the following key aspects: containment, removal, transport, treatment and disposal.

And while I was in Patna, the integral nature of these various services and the actors they depend on was only made more apparent. During our visit, I had the opportunity to engage in a consultation with both a local private-sewage operators’ association, as well as two households privately outsourcing their waste. The private sewage operators provide several key functions for low- and middle-income households in a city like Patna. First, they are patient scribes. By being the direct representatives of the waste that a household produces, the private operators are also the first points of reliant contact for a household to depend on. These private operators are able to speak with households and record their frequent waste management needs.

Second, they are driven entrepreneurs. Not only are these operators the ones who own the first line of contact with households who require their waste to be cleaned out, the private operators have begun to form “associations”. These informal networks not only provide a means for employment but also contribute to a sense of peer-bolstered solidarity. By adopting the burden of cleaning out waste repositories in households, the private operators, in the process, also have innovated a need-driven service.

Image: Mekko Graphics

The third cross-cutting function a private waste operator can play is that of a market player. Of the association of approximately a dozen operators we spoke to, 80% had never completed high school. However, when we asked the same group if they felt that their present means of employment was sustainable and something they saw as profit-generating in the future, the answer was a resounding yes. While operating in the informal sector, these private waste operators are developing their own kind of access into the formal market for waste collection and disposal.

In addition to the multi-faceted services these operators provide for households and the ways in which they are transforming the market, the role of the sewage treatment plant (STP) cannot be overemphasized. In 2015, only 66% of the total treatment capacity in each of the 816 STPs across India was being utilized, while 70% of the total number of STPs were defunct or not working at optimal efficiency. Without STPs that operate at maximum capacity, the waste that households are producing in cities is going to open water bodies, thereby polluting our rivers, lakes, and oceans. Keeping ourselves accountable with regards to where our human waste is going means we can keep our environment intact and not compromise the health of present and future generations.

To tackle the bottlenecks of the waste management process, the Forum of Young Global Leaders, in collaboration with the Maverick Collective and Population Services International, is co-leading #AfterTheFlush, dedicated to creating channels of innovation in the urban Indian sanitation ecosystem. Specifically, the initiative will mobilize the expertise, networks and commitment of the YGL community to scale up investment infrastructure and waste management across a select number of Indian cities. Through effective leadership and coordinated mobilization of resources within the YGL community, #AfterTheFlush will re-design the financial model governing waste management at present and scale up successful outcomes in the waste management process across India over the next two years.

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