The document discusses strategies for reducing open defecation in rural India. It notes that open defecation is a major public health issue, killing many children through diarrhea. Though toilet construction has increased access from 22% to 31% over 10 years, 69% of rural Indians still lack access. Key barriers include lack of toilets, poor quality construction, and social norms. Strategies proposed include improving delivery of subsidies for construction, ensuring quality construction with water supply and drainage, changing social norms among men, and monitoring usage not just construction. Addressing these issues could enable rural Indians to stop open defecation and improve health.

1. The Ask HOW Analysis
How can we enable
rural Indians to stop
open defecation?
Data and Analysis source:

2. The Ask HOW Analysis
HOW CAN WE REDUCE OPEN DEFECATION?
Why Is It Important? Use of toilets by ALL (100%) members of the community is necessary
to significantly reduce fecally transmitted diseases.
PUBLIC HEALTH

3. The Ask HOW Analysis
Why Is It Important? Sanitation- related diseases are major killers.
ŸDiarrhoea - 88% of which is
due to poor water and
sanitation.
ŸDiarrhoea kills more
children than HIV/AIDS,
malaria and measles
combined.
Sources:
Ÿ Department for International Development, Water Sanitation and Hygiene Evidence Paper, May 2013.
Ÿ http://www.cdc.gov/safewater/disease.html
Fatalities attributed to sanitation- related diseases outnumber the
fatalities caused by Malaria, HIV/AIDS and Measles COMBINED.
Most diarrhoea - related deaths are children.
>
HOW CAN WE REDUCE OPEN DEFECATION?
Malaria Deaths (under 5 years)
Diarrhoea Deaths (under 5 years)
HIV/AIDS Deaths (under 5 years)
Measles Deaths (under 5 years)

4. The Ask HOW Analysis
Why Is It Important? CHILDREN pay the price for the lack of sanitation.
Sources:
Ÿ http://blogs.wsj.com/indiarealtime/2012/09/13/almost-5000-indian-children-die-daily/
Ÿ4650 children died every day in India in 2011– for every 1000 children
born, 61 are unlikely to make it to their 5th birthday. One of the major
reasons for this, is poor sanitation.
3 children die EVERY MINUTE
and poor sanitation is one of the reasons.
HOW CAN WE REDUCE OPEN DEFECATION?

5. The Ask HOW Analysis
How Many People Do It?
Sources:
Ÿ
Ÿ Census 2011
Progress on Drinking Water & Sanitation: 2012 Update; UNICEF, WHO - http://www.unicef.org/media/files/JMPreport2012.pdf
Out of 10 people
who practice
open defecation
across the world,
6 live in India
People defecating
in the open in India
People defecating
in the open in China,
Pakistan and Nepal
put together
>>>>>>>>>9 TIMES THE NUMBER
TOILET ELSEWHERE 7 out of 10
Indians living
in villages
defecate in
the open.
HOW CAN WE REDUCE OPEN DEFECATION?

6. The Ask HOW Analysis
Why Do People Defecate In The Open?
REASON 1:
Not enough toilets have been constructed and where constructed
they are not all usable.
REASON 2:
Even when usable toilets are available, people do not use them.
Sources:
Ÿ Water and Sanitation Programme, Department of Drinking Water and Sanitation, A decade after the Total Sanitation Campaign, Rapid Assessment of Processes and Outcomes. Volume 1
HOW CAN WE REDUCE OPEN DEFECATION?

7. The Ask HOW Analysis
69% OF INDIANS IN VILLAGES DO NOT HAVE ACCESS TO A TOILET
Sources:
Ÿ Census 2011
Ÿ Water and Sanitation Programme, Department of Drinking Water and Sanitation, A decade after the Total Sanitation Campaign, Rapid Assessment of Processes and Outcomes. Volume 1
Ÿ From Outlays to Outcomes, Understanding the Status of Rural Sanitation Data, Avani Kapur, Saamia Ibrahim,Accountability Initiative, Centre for Policy Research (CPR) for the State of Sanitation Project, Arghyam
TIME (yrs.)
GROWTH IN ACCESS
Access has grown by less than 10% in
the last 10 years - from 22% in 2001 to
31%in2011.
HOW CAN WE REDUCE OPEN DEFECATION?

8. The Ask HOW Analysis
WHY DO PEOPLE NOT HAVE ACCESS TO TOILETS?
Whilesanitationisaprioritytowomen,mendonot
recognise its importance. In situations where men
are responsible for taking investment decisions,
sanitationtakeslesserpriority
Sources:
Ÿ Sanitation Markets: Using economics to improve the delivery of services along the sanitation value chain Pathfinder paper, 2012
Ÿ Strategic communication for total sanitation campaign;
Ÿ Arghyam survey in Davangere district, Karnataka
`9100
per family for
buillding toilets
Nirmal Bharat Abhiyan Scheme
Awareness is very low and
deliveryoftheschemeispoor
HOW CAN WE REDUCE OPEN DEFECATION?

9. The Ask HOW Analysis
Toilet Construction does not automatically translate into toilet usage.
Sources:
Ÿ Water and Sanitation Programme, Department of Drinking Water and Sanitation, A decade after the Total
Sanitation Campaign, Rapid Assessment of Processes and Outcomes. Volume 1
Ÿ Strategic communication for total sanitation campaign
HOW CAN WE REDUCE OPEN DEFECATION?

10. The Ask HOW Analysis
Some key reasons for not using toilets include:
Sources:
Ÿ Gonzalez, Pathways to sustainability in Community Led Total Sanitation. PhD Thesis available at:
http://riunet.upv.es/bitstream/handle/10251/31520/Pathways%20to%20sustainability%20in%20community_5653.pdf?sequence=16;
Ÿ Department of Drinking Water and Sanitation, Ministry of Rural Development, Toward Nirmal Bharat, Rural Sanitation and
Hygiene Strategy 2012-2022, published on 4 July 2011
HOW CAN WE REDUCE OPEN DEFECATION?
Poor Quality
Construction
Poor Water SupplyFear of bringing waste
close to home and
dealing with it

11. The Ask HOW Analysis
How Do We Ensure Access?
ŸFocus on rural men and connecting the
image of a responsible man as someone who
will build sanitation facilities for the women
inhisfamily
ŸImprovedeliverymechanism
HOW CAN WE REDUCE OPEN DEFECATION?

12. The Ask HOW Analysis
How Do We Ensure Usage?
Build better toilets with more space, light and better ventilation,
that would use less water and can be maintained easily.
HOW CAN WE REDUCE OPEN DEFECATION?

13. The Ask HOW Analysis
What Is Needed Now?
ŸMonitor usage of toilets and not just
theirconstruction.
ŸEncourage access and usage in mission
modeby:
1) Hiring more people (swachata doots) to
implement and training them better to
createdemandandsustainusage
2) Designing better toilets - in terms of
enhancing user experience and using
technologies that don't negatively
impactgroundwaterquality.
3) Clearing choke points in the supply
chain and enabling smooth flow of
money
ventilation
water supply
proper drainage
good construction
Ÿ improved sanitation
Ÿ reduced health problems
Ÿ cleaner, hygienic surroundings
HOW CAN WE REDUCE OPEN DEFECATION?

14. How can we
persuade people to use
toilets already built?
How can we construct
more and better toilets?
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How can we enable
rural Indians to stop
open defecation?
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