Toilets, and the lack of enough of them, are a recurrent topic on prime time news these days. It would have been difficult to imagine such a situation just a couple of years back.

We need to remember that our real goal is not toilets, but sanitation. The former is easier to understand. The latter is much more than just toilets. Sanitation, by the textbook, means the process of keeping people and places free from dirt and germs and thereby, infection and disease. This is achieved by the safe handling and disposing of human excreta, garbage and other waste. Other requirements include personal hygiene (including hand-washing and menstrual hygiene), clean food and water, storm water management, and more. So toilets are only one step in the long road to complete sanitation. However, evidence suggests that it is one of the most important steps.

Theoretically, one can safely handle human excreta without building toilets—in some cases, all it takes is a hole in the ground, properly covered, to safely dispose of human waste. Conversely, building toilets does not guarantee sanitation; in fact perverse results can happen with inappropriate technology and construction. Case in point being Kerala, where the high groundwater table has resulted in toilet pits contaminating the groundwater. As a nation, we have survived for centuries without toilets. While at work in the fields, agricultural workers do not have access to toilets and this is unlikely to change. They will, therefore, continue to spend their workday in no-toilet zones. The goal of the Nirmal Bharat Abhiyan, the flagship programme in rural sanitation, on which ₹ 6,140.2 crore had been spent through 2011, is an “open defecation-free society". Getting there quickly will be very difficult from where we stand today.

Assuming that the demand is spawned, what happens then? The Nirmal Bharat Abhiyan provides significant money to families as an incentive for building a toilet—upwards of ₹ 9,000 per household. But accessing this money is not easy. We have seen many problems on the ground. These range from process ambiguities, lack of adequate administrative capacity, difficulty in accessing seed capital, as well as an insufficient technical appreciation for the type and quality of toilets to be constructed. It is critical that these supply-side issues be addressed, in parallel with the creation of demand.

Once the toilets are built, getting everyone in the family to use the toilet is quite another ballgame. In a majority of cases, only the women or children use the toilets. Sometimes, no one uses it at all. Open defecation is natural, has no space constraints and is a social norm in most of rural India. Toilets are seen as a “discount" acquisition from a government scheme. There is a lot of disgust associated with a toilet, and more so with one in your own backyard. There is also an initial sense of unfamiliarity that causes anxiety—which way to sit? How long before the pit fills up? All this often means that the behaviour change towards toilet usage does not take off. Our research findings provide a base for thinking about interventions designed to “nudge" people into using the toilet often enough that it becomes a habit. This is where an understanding of human psychology and ways to modify human behaviour can inform public policy and scheme implementation.

Much work has happened and is happening in sanitation. Many models do exist. But sanitation is a complex problem. More research and innovation is needed. Diverse knowledge and expertise of community mobilizers, communication and behavioural professionals, health, financial, technology and process experts—from both the public and private sectors, need to come together, if we are to make substantial progress. Working through this journey is like solving a jigsaw puzzle. Though challenging, it is extremely exciting and engaging. We need more people to join this effort.

Jayamala Subramaniam is chief executive officer, Arghyam, a foundation focused on domestic water and sanitation.

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