India is the country with the biggest open defecation problem in the world.  In India, open defecation is practiced by more than half of households and by about 67% percent of rural households.  In fact, 60 percent of people anywhere who defecate in the open live in India.  This widespread lack of sanitation, combined with India’s high population density, poses important health threats for children. 

In this context, it is extremely important to examine programs and policies designed to improve sanitation.  Community Led Total Sanitation (CLTS) is one strategy for improving sanitation that focuses on mobilizing people to end open defecation.  Since the early 2000s, CLTS and CLTS inspired strategies have played a role in sanitation programs in many regions of the developing world, including India.

Preliminary findings from an ongoing study of sanitation adoption in Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh, and Haryana suggest that some of the principles of CLTS are importantly relevant to that context, but also suggest likely challenges to the success of CLTS in rural north India. (*Note: According to the 2011 census, these five states were home to 39% of rural households in the country, and 46% of rural households practicing open defecation.)

How can CLTS inform sanitation policy in rural north India?

CLTS focuses on attitudes, beliefs and behaviors.  CLTS rightly recognizes that in order to end open defecation, one must take seriously the attitudes and beliefs of the people who practice it.  It asks people to reflect on their practices in order to bring about behavior change.  Such a stance is important in rural north India, where, our research suggests, many people have a preference for open defecation.  Many people believe open defecation to be more pleasant, less dirty, and better for health than defecating in a latrine.  This strong preference for open defecation presents a major obstacle to interventions that promote latrines and latrine use.  CLTS is correct to start with an emphasis on attitudes, beliefs and behaviors.

CLTS questions the blind provision of latrine subsidies.   A central principle of CLTS is that the provision of the “hardware” of sanitation—often pit latrines—is not sufficient to ensure that people will stop defecating in the open.  CLTS warns that subsidizing or building toilets without ensuring that people will use them wastes resources and fails to make children healthier.  Considering the preference for open defecation described above, and the corresponding lack of demand for latrines, it is no surprise that the majority of people in rural north Indian villages who have “benefited” from latrine construction programs continue to defecate in the open.

What are the challenges to the CLTS approach in rural north India?

CLTS tries to harness disgust about open defecation, but people in rural north India are already disgusted by latrines.  CLTS facilitators try to awaken villagers’ disgust about defecating in the open, sometimes by having them calculate the quantity of feces that it leaves in the environment, or demonstrating how flies move between feces and food.  In rural north India, however, the strategy may not be very effective.  Many people believe that defecating in the open is healthier than using a latrines, indeed, many people are quite disgusted by latrines!  There is a widespread belief that it is polluting or impure to build a latrine close to one’s house, or even worse, close to one’s kitchen.  Some people find it disgusting to defecate in a closed space, others worry about shit accumulating near their house, and others say that it might contaminate their drinking water.

CLTS tries to bring people onto a bottom rung of a “sanitation ladder,” but no such ladder exists in rural north India.  CLTS stresses that first, a village should become open defecation free by encouraging people to design and construct their own rudimentary pit latrines.  With time and follow up, CLTS maintains, people will move up a “sanitation ladder,” by improving their pit latrines.  In principle, this is a good idea; many families in rural India can already afford to construct inexpensive pit latrines.  However, our research suggests that families strongly oppose inexpensive latrines with small pits or temporary superstructures, preferring open defecation to inexpensive latrines.  Indeed, those in our sample who built their own latrines constructed enormous pits with brick and cement superstructures; in many cases this cost at least as much as adding another room to the house.  Those in our sample who had gotten government latrines referred to them disdainfully as “temporary” or “small pit” latrines.  Many emphasized pit size as a reason for not using the latrines.  This suggests that there is hardly any “sanitation ladder” in rural India to climb—or, that the only rung to the ladder is the top one!  Before CLTS can encourage people to make rudimentary latrines, villagers’ rejection of such latrines must be explicitly addressed. 

CLTS tries to encourage people to take collective action to end open defecation, but collective action is difficult in rural north India.  CLTS advocates explain that where the approach has succeeded, it has harnessed the cooperation of people who see themselves as belonging to one community.  Ideally, communities take a collective decision to stop defecating in the open, support one another in constructing latrines, and apply social pressure to those who continue to defecate in the open.  However, villages in rural north India are often not cohesive “communities” able to work together towards common goals.  Village size in rural north India is large, and families often belong to different castes and religions.  Oppression of lower castes and women, and social fragmentation on caste, gender and class lines mean that it is hard for people to identify with each other and work together.  Although further research is needed, sanitation triggering in fragmented villages of rural north India may need to target caste groups within or across villages, or even individual households, which would be a different, and perhaps more difficult approach.

This post argues that some of the central principles of CLTS are importantly relevant in rural north India, but other aspects of CLTS make the program unlikely to succeed in reducing open defecation in this context.  In particular, researchers and rural sanitation program implementers should consider how programs can address preferences for open defecation and distaste for latrines, the rejection of rudimentary, affordable latrines, and the difficulty of spurring collective action in fragmented villages.

Further reading

You can read more about our ongoing research projects about sanitation in rural north India in these rice blog posts.
1. Asking dirty questions in Bihar.
2. No shame in a simple pit latrine.
3. My hang up.
4. Government sanitation programs: Three times a failure.
5. A guru gets my goat.
 

Diane Coffey, Aashish Gupta, Dean Spears, Nikhil Srivastav and Sangita Vyas work with rice, a research institute for compassionate economics.