Swachh Bharat Mission as a ‘Game-Changer’ for Public Health

General Studies Paper-2

Context: A study published in the Nature journal by the International Food Policy Research Institute suggests that the Swachh Bharat Mission (SBM) has led to a significant reduction in infant deaths by improving sanitation.

About SBM:

• Swachh Bharat Mission (SBM) was launched on October 2, 2014, to fulfil the vision of a cleaner India by October 2, 2019. The objective of the Mission was to eliminate open defecation, eradicate manual scavenging, and promote scientific solid waste management.

Key Findings of the Report:

• Infant and Child Mortality: The post-Swachh Bharat Mission (SBM) period showed accelerated reductions in infant and under-five mortality rates.
• Toilet Coverage: Districts with over 30% toilet coverage under SBM saw a 5.3 lower Infant Mortality Rate (IMR) and 6.8 lower Under-Five Mortality Rate (U5MR).
• Improved Health Outcomes: Higher SBM coverage corresponded with greater utilization of health programs such as antenatal care (ANC) and institutional deliveries.
• Reduced Diarrheal Deaths: WHO reported 300,000 fewer diarrheal deaths in 2019 compared to 2014 due to improved sanitation.
• Child Wasting: Non-ODF areas experienced 58% higher rates of child wasting (Bill & Melinda Gates Foundation).
• Women’s Safety: 93% of women reported feeling safer at home with improved sanitation facilities (UNICEF).
• Education: Poor WASH facilities hinder student attendance and enrollment, particularly for girls.

Reasons for the success of the Swachh Bharat Mission (SBM):

• Community Engagement: SBM combined toilet construction with community involvement, encouraging local ownership of sanitation efforts.
• Information, Education, and Communication (IEC): Substantial investments in IEC campaigns helped bring about behavioural changes by raising awareness of the importance of sanitation and hygiene.
• Capacity Building and Training: Extensive training programs for government officials, frontline workers, volunteers, and communities enhanced the implementation and sustainability of SBM.
• Waste Management Systems: Developed systems for waste segregation, collection, transportation, disposal, and treatment, including recycling centres for effective waste management.
• Citizen Engagement and Monitoring: Introduced mobile and web applications for active citizen participation, feedback, and monitoring of sanitation progress.
• National Annual Rural Sanitation Survey (NARSS): Periodic assessment of progress through NARSS ensured accountability and data-driven decision-making in rural sanitation efforts.

Limitations of Swachh Bharat Mission:

• Low Toilet Usage: Despite achieving 100% sanitation coverage by 2019, only 85% of rural Indians utilize safe and hygienic toilets, indicating a usage gap.
• Quality and Infrastructure Issues: Problems such as malfunctioning facilities, unhygienic conditions, and structural defects like full pits or collapsing superstructures impede toilet usage.
• Water Scarcity Impact: Limited water access, particularly in rural areas like Gujarat’s Dahod district, contributes to increased non-usage of toilets.
• Behavioural and Social Norms: Cultural norms and behaviours influence toilet usage, with some households repurposing toilets for activities other than defecation.
• Caste-Based Variances: Toilet access and usage exhibit variations across castes, with surprising trends showing higher non-usage rates among upper castes.
• Challenges in Larger Households: Overcrowding and inadequate facilities pose challenges to toilet usage in larger households.
• Issues in solid waste management: While toilet construction has been successful, scientific collection, segregation and disposal of growing waste volumes remain an issue due to resource and capacity constraints of urban local bodies.
• Partial focus on plastic waste: The mission has focused mostly on toilet construction and solid waste. Effectively tackling and recycling plastic waste is still a gap area.
• Centralized approach and targets: The focus has been on meeting toilet construction targets in a centralized, top-down manner. Decentralized, community-driven efforts have been fewer.

Way forward:

• Greater focus on behaviour changes communication and public awareness campaigns, especially for hygienic toilet use, waste segregation and not littering. Engaging school children and youth groups can be highly impactful.
• The “Darwaza Band” campaign and community-level awareness programs have promoted positive sanitation norms.
• Innovations in Technology: Decentralized sewage treatment plants, as seen in Devanahalli, highlight technological advancements in sanitation.
• Strengthening capacities of urban local bodies for scientifically collecting, segregating, transporting and processing different types of waste. Mechanized sweeping, underground waste bins can be expanded.
• Linking with other programmes: Align sanitation initiatives with other related programs like the Jal Jeevan Mission for better outcomes.
• Developing localized waste management models through community participation, and public-private partnerships, so that solutions are tailored to local needs.
• Programs like the “Nirmal Gram Puraskar” foster community involvement and awareness in achieving open-defecation-free villages.
• Expanding solid waste processing infrastructure through bio methanation plants, material recovery facilities, composting units etc. across towns and cities.
• Improved monitoring for functionality and maintenance of public/community toilets through citizen oversight and social audits.
• Expanding coverage of toilets to include slums and public spaces like bus stops, and parks, through customizable, prefabricated toilet models.
• Incentivizing waste segregation, recycling and reuse through both regulatory policies as well as awareness programs on circular economy principles.

Other initiatives for sanitation:

• Central Rural Sanitation Programme (CRSP): Launched in 1986, it was India’s initial step towards improving rural sanitation with substantial subsidies.
• Total Sanitation Campaign: Started in 1999, this marked a shift to a lower subsidy, demand-driven approach.
• Phase II of SBM-G: Focuses on sustainability, promoting solid and liquid waste management, and covering households left out earlier.
• National Annual Rural Sanitation Survey (NARSS): Conducted to assess rural sanitation coverage, showing 95% of rural India having toilet access.
• Rural Sanitation Strategy 2019 to 2029: The Ministry of Jal Shakti’s Department of Drinking Water and Sanitation (DDWS) has initiated a 10-year Rural Sanitation Strategy spanning from 2019 to 2029.

Conclusion

• The mission should transition from a toilet-construction-focused programme to a more holistic, decentralized, community-driven cleanliness model relying on public participation for sustainability. The aim should be to make Swachhata a national way of life.