I joined Swachh Bharat on the 9th of February, 2015. On 16th February, 2016, a letter under the signatures of Secretary was shot to Chief Secretaries of all the States, calling upon them to focus on the ODF approach.
In the letter, a study was quoted, concluding that percentage of households reporting diarrhoea reduced only marginally from 38% to 26% even when the percentage of households using toilets increased from 29% to 95%. However, when the last mile gap was achieved i.e. when 100% households used toilets, the diarrhoeal reduction was much more significant – from 26% to 7%[1] !
The letter also called upon States to base their planning for achievement of Swachh status on the number of ODF villages and to reorient their monitoring accordingly. This was the first official communication – and the first step of tilting the sanitation programme in this country from toilet construction approach to behaviour change approach.
Over the next one year, I accompanied Secretary to almost all the States, where in day long workshops with the key officials of the State, and with all the Collectors of the State, this message was hammered loud and clear. Secretary would invariably emphasize this in her speech: Swachh Bharat is not about toilet construction. To undo what was done during the last thirty years in the name of rural sanitation, this one year of shouting by the Secretary was essential and timely.
After this letter was sent, and as we began to tour the States, it was realised that three things were required to complete the ODF policy loop. The first one was a clear definition of ODF. While ODF sounds fairly simple to understand, it was essential that the term means the same thing to everyone across the country. Since this was to be the basis of programme implementation and monitoring, it could no longer remain a vague term, subject to different interpretations.
A common national definition was important to measure progress against this indicator, and to compare progress of different States against each other. The second component, after defining ODF, was putting in place guidelines to verify the ODF status. Unless there were guidelines to measure ODF, we could not have moved forward in terms of assessment of work done vs work remaining. In the past, there had been problems with correct assessment of sanitation status; and we were aware of false positive reporting in case of Nirmal Gram Puraskar (NGP) villages.
Who is to verify, when to verify, on what parameters to verify – these were to be standardised and put in black and white for the guidance of all the States. The third and final component was to put in place a mechanism for independent evaluation of ODF. An independent evaluation of ODF would streamline the role of Centre in correctly assessing progress in sanitation and would provide a basis for providing incentive grants. This was achieved through the World Bank project.
A simple thing is not easy to define. Various stakeholders were asked, what ODF definition should be. Organisations such as Feedback Infrastructure, that were already in the field for many years providing trainings on community approaches had prepared draft definition of ODF, that served as a good starting point. Also, there were a few officers in the field – emerging as sanitation ‘champions’ due to their focus and successful implementation of community approaches. Their views were elicited and incorporated. Multilateral agencies such as UNICEF, World Bank etc. were also consulted. A draft definition was ready within a month; however, for it to be widely accepted, much wider consultations were carried out.
WSSCC[2] was asked to support a national level consultation on the subject. This was held in Pune on 13-14 April,2015 with participation from many States, and helped broad-base the discussion.
We wanted the definition to be very simple and to convey the essence, while avoiding unnecessary details. Since evaluation of the programme was to be done on the basis of this definition, we also wanted it to be easily measurable. After studying the report of the Pune workshop, after getting approval at the Secretary level on 9th June 2015, the following definition of ODF was finally issued:
“ODF is the termination of faecal-oral transmission, defined by
a) no visible faeces found in the environment/village; and
b) every household as well as public/community institutions using safe technology option for disposal of faeces
(Tip: Safe technology option means no contamination of surface soil, ground water or surface water; excreta inaccessible to flies or animals; no handling of fresh excreta; and freedom from odour and unsightly condition)”
The key feature of this definition was absence of visible faeces in the village/environment. This seemingly small thing elevated the programme from toilet construction to actual outcomes. It was a very bold move. Perhaps in no government programme, the measurable thing is an outcome, rather than an output.
For example, education department would be satisfied if classrooms are built, or if school uniforms and books are provided, or even if sufficient number of children are enrolled in a school. But if education department were to evaluate its work in terms of how much do children know or how well they can read and write, that would be outcome evaluation. In the garb of difficulty in evaluation of actual outcomes, most government departments would limit their objectives to achievement of outputs.
In this sense, ODF was revolutionary: it was exposing itself to an outcome that is far more complex and that depends on behaviour change of every individual in that community. No visible faeces meant that even if one individual chose to shit outside, the outcome is not achieved! It was much beyond excellence in professional service delivery – where toilets are provided. It went on to look at usage of those toilets as well. And usage by everyone. At all times.
The definition also included something that is a natural precondition for no visible faeces – access of toilet to every household and every public institution. It may be noted that the definition did not necessitate presence of a toilet in each individual household. It just mentioned ‘each household using’ which meant that it sufficed for ODF if a household used the toilet of its neighbours! Although in practical terms, access for individual households does translate to possession of an independent toilet, this was not specified in the definition, since it would have taken the focus away from ‘absence of shit’ to ‘provision of toilets’.
When government money is attached to a toilet, it may not be unnatural that availability of toilet takes precedence over its usage! Indeed, in a Haryana village, it was observed that the village was not declaring itself ODF even though every household had a toilet (and presumably were using them). When the reason was asked, it was found that a few ‘beneficiaries’ in that village were yet to ‘receive a toilet’. It did not matter that those beneficiaries were staying in joint families and sharing the common household toilet!
Finally, the definition of ODF included the term ‘safe disposal of faeces’. This was critical, since it was not uncommon in few States to build big septic tank toilets, and letting out their sewage untreated in open drains. This was worse than open daefecation. Shit in the open is at least confined at a place: here, sewage was being circulated throughout the village!
In some other States, such as North East, other problems of technology were there: for example, open pits, that exposed faecal matter to flies. In some States, it was observed that there was a risk of water contamination due to close location of toilet pit and water source. Due to these reasons, the ODF definition unequivocally talked of ‘safe’ disposal. Again, this was in sync with achievement of actual outcome in terms of health benefit. If toilets were to prevent faeco-oral transmission, then they had to be safe.
Faeco- oral transmission means passage of infection from faeces to mouth (oral). This happens through flies that commonly sit on shit, and carry the germs when they sit on food, that is consumed. This can also happen in other ways such as faecal contamination of drinking water. Daefecation in the open – where it is exposed to flies: and can pollute the air, water etc. is a major cause of faeco-oral transmission. ODF was therefore defined as ‘termination of faeco-oral transmission.’
Since ODF was to be the basis of evaluation of the programme, its definition had to incorporate parameters that were easily measurable. ODF was about usage of toilets. The best parameter to judge whether the toilets were being used or not was to go, look out for any signs of visible faeces in the surroundings. This was an acid-test for usage. No visible shit in the surroundings meant that toilets were being used. Therefore, this seemingly weird clause was put in the definition itself. Therefore, in order to verify whether a village was ODF or not, the verifying teams were supposed to work like detectives: find out the erstwhile places of open daefecation – close to a nalla, a deserted road, near the pond, bushes: and actually have the grit to go there and see whether there is any faeces! Disgusting. But necessary. Many champion officers/ people would find innovative ways to apply this rigourous test. In one place, they believed that if actually there is no shit, there would be no flies. So, they went about checking presence of flies: with ‘sweets’ in their hand to lure the flies!
Other parameters of ODF – availability of toilet and its safety – were also possible to measure.
One thing that was difficult to measure was personal hygiene or cleanliness, say washing of hands after daefecation or before meals. While this can also affect faeco-oral transmission – a person who does not wash hands after daefecation carries those germs on his hands that can be transmitted to his body whenever he eats anything – the actual observance of this behaviour is variable over time. Also, a person is not likely to remember easily how many times he washed hands! The focus of ODF programme was on behaviour change towards construction and usage of toilets. A simultaneous focus on hygiene would have confounded the evaluation of ODF: and it was therefore considered desirable that hand washing may not be considered part of ODF in the first stage, although there was a demand for the same from some quarters.
The definition of ODF was overall accepted and hailed by the sanitation community/ experts nationally and internationally. It was considered an important milestone in the history of sanitation programmes.
[1] Since a few other factors such as personal hygiene, safe drinking water etc. also influence diarrhoea, the incidence may not become zero even with complete ODF achievement unless other factors are also addressed.
[2] Water Supply and Sanitation Collaborative Council
–originally written in 2016
