According to the Census of India over a fourth of India’s urban households lacked sanitation facilities in 2001, and rural coverage was merely 21.9% (Ganguly, 2008).1 India has long recognized the need for change, and nationwide policies date back to the 1980s. However, most efforts prior to 1999 have been labeled failures (Ganguly, 2008). While sanitation policy in India has historically been supply-driven, recent attempts have shifted towards a more demand-driven approach. This section provides a brief history of sanitation policy in India.
The Central Rural Sanitation Program (CRSP), launched in 1986, was India’s first nation- wide sanitation program with the goal to eradicate open defecation. The program provided a large subsidy of Rs 2,000 to households that were below the poverty line for the construction of sanitary toilets (Ganguly, 2008). A review of the CRSP revealed that while several new toilets were con- structed, they remained largely unused and the space was often used for storage purposes (Ganguly, 2008). Moreover, it was assumed that the subsidized toilets would drive demand for families that could afford the technology, but this did not happen (Ganguly, 2008). The program led to a 1% annual increase in rural sanitation coverage, but considering the investment of $370M, this increase was negligible (Ganguly, 2008).
It became clear that education was necessary to stimulate demand, and as a result, strategies shifted from subsidy to an effort to educate the population on areas of dignity and security for women, health, and the affordability of adoption of sanitary technologies. A large reform was implemented in 1999 and the CRSP was renamed the Total Sanitation Campaign (TSC). By 2008, TSC was operating in 578 of the 610 Indian districts. The project outlay was $3.35B, of which $2.1B was paid by the government, $43.7M was paid by the states and $500.7M was contributed by the communities (Ganguly, 2008). The resources were made available to the local governments through the state district water and sanitary committees. The funds were used to build household toilets, school toilets, and also for construction of sanitary complexes for women which also included bathing
1
This section draws heavily from Ganguly (2008), a report on the success of the adoption of sanitation policies in two Indian states of Maharashtra and West Bengal.
facilities (Ganguly, 2008). Local governments also hired folk singers, painters and performing artists to help motivate and educate the public on sanitary practices (Ganguly, 2008). Two states that benefited the most from the program are - not surprisingly - those with well functioning delivery systems of funds from the state to the local bodies (Ganguly, 2008). West Bengal and Maharashtra both have strong local governments, and hence those were the states that reaped the largest benefits from the TSC in its earliest years.
As already mentioned, the efforts in Maharashtra were unique and particularly successful. In- stead of focusing on individual toilet construction, Maharashtra emphasized total coverage through building sanitary complexes as well as individual household latrines (Ganguly, 2008). To encourage community participation, several meetings were organized at the district, block, and the village level (Devaki, 2001). Maharastran state government awarded cash to villages based on various aspects including: drinking water on the basis of cleanliness, water waste disposal, performance of sanitation committee, women’s participation, sanitation environment around houses, and chil- dren’s hygiene habits (Devaki, 2001). Following this state effort, the government of India launched a similar nationwide program called the Nirmal Gram Puraskar (NGP) in October 2003. NGP awarded cash to village-level local bodies that achieved full sanitation, zero open defecation, and adopted good hygiene behaviors. A more populated local body earned a larger award, for example a village-level local body with population that is less than 1000 earned Rs. 100,000, while a village- level local body with a population between 1000 to 1999 earned Rs 200,000 (Government of India, 2012). Additionally, the intent of the award money was to maintain sanitation in the villages, and 25% of the award money was released at the time of the announcement of the award, while 75% of the award money was to be released after 2 years of its announcement (Government of India, 2012). The extent of early success in Maharashtra is captured by the number of NGP awards won in Maharashtra by 2006: The state had won 394 NGP awards by 2006, while other states had won an average of 20 NGP awards.
3.3 Data
I use two different data sets in this analysis. The first data set is the Indian National Fertility and Heath Survey (NFHS), which is publicly available from the Demographic and Health Survey’s (DHS) website. I rely on child survey data which outline standard household characteristics as well as health data for young children. I use the latest two phases of the Indian NFHS conducted in 1998-1999 (phase 2) and in 2005-2006 (phase 3). NFHS 2 includes health information for children under 3 years of age, while NFHS 3 includes health information for children under 5 years of age.2 Because the state of Maharashtra was one of the only states that had achieved notable sanitation by the time of the latest NFHS survey (2006), analysis using the NFHS focuses on the impact of sanitation achieved in the state of Maharashtra.
I also make use of a different Indian representative health and fertility data set, the District Level Household Survey (DLHS). These data can be purchased from the International Institute for Population Sciences, Mumbai. I use phase 2 (1998/1999) and phase 3 (2007/2008) of the DLHS survey. The benefit of introducing the DLHS data set is that the latest survey was conducted in 2007/2008, allowing analysis of sanitation policies adopted in more recent years. The data, however, suffer from an alternative limitation. The phrasing of questions related to children’s health changed from one survey year to another, complicating interpretation of the results. Nevertheless, the latest survey of the DLHS was carried out two years after the latest survey of the Indian NFHS, which allows analysis of sanitation policy implementation in more states.