‘Cleanliness is next to Godliness.’ We’ve all heard this proverb and claim to believe in it. But when it comes to practice, we often forget. But whether we believe in or practise this age-old saying, it has been proven without doubt that clean and sanitary living practices have a great bearing on our lives, especially health.

Healthy sanitation practices are the first step towards ensuring a healthy life. Unfortunately, many people in the subcontinent do not give as much importance to healthy living practices as they should. One example of this is open defecation, or going to the fields rather than the toilet to answer the call of nature. This practice is quite common — rather a norm — in rural areas. It is not only unsightly and unhygienic, but has also been linked to poor health, especially of children. The World Health Organisation calls open defecation “the riskiest sanitation practice of all”, and the United Nations Sustainable Development Goal 6 calls for “clean water and sanitation for all” by 2030.

To curb this unhealthy practice and make India cleaner and healthier, on Mohandas Karamchand Gandhi’s birth anniversary in 2014, Indian Prime Minister Narendra Modi declared his vision for an Open Defecation-Free (ODF) India, setting the target of Oct 2, 2019 — Gandhi’s 150th birth anniversary — for achieving this goal.

Sanity in Sanitation: Jajaroo Ni Jhumbesh by Jayanti S. Ravi is about Ravi’s struggle to achieve ODF status for the state of Gujarat. Ravi, a budding nuclear physicist who later joined the Indian Administrative Services, is one of the leaders of the Swachh Bharat [Clean India] Mission (SBM). As principal secretary and commissioner of rural development, Gujarat, she championed the SBM for rural sanitation in the state.

With November 19 being World Toilet Day, a book from Indian Gujarat charts the challenges and success of a programme to tackle unsanitary practices that can have severe repercussions on health

Ravi explains the situation in which she started her campaign and the problems associated with it. Until about five years ago, 69 percent of Indians defecated in the open; of the nearly 2.5 billion people around the world who didn’t have access to clean toilets, 60 percent were from India. In 2014, at the beginning of the SBM, Gujarat’s total toilet cover was only 40.7 percent.

Using fields and open spaces as toilets has a severe impact on human health and wellbeing. It not only leaves children vulnerable to polio and malnutrition and is a cause of high mortality among children under five years of age because of hookworm and diarrhoeal diseases, but also results in high school-dropout rates. Women wait until dark so they can have some privacy, but holding on throughout the day affects their health, putting them at risk of many diseases. Meanwhile, the cover of darkness leaves them vulnerable to assault and rape, not to mention the indignity faced while ‘attending to business’ in the open. People also run the risk of snake bites and attacks from wild animals.

When Ravi assumed charge of her state’s Rural Development Department and set about actualising an ODF Gujarat, she realised that more than three million toilets needed to be built to achieve the target. But she was not deterred by the enormity of the task. Adopting an innovative and creative multidisciplinary approach to problem-solving, she set to work and, by the end of 2017, Gujarat was declared ODF. It was not just building toilets and making people use them, but ensuring dignity and the opportunity for a healthy life for everyone.

A major problem faced in the crusade was that people were not ready to change their age-old practices; they could not see the harm in what they and their forefathers had been doing for ages. But Ravi and her team were determined and used various approaches to make people understand the need for using a toilet. They realised that, for any success, they would have to first change mindsets. Mann bannao, sauchalay bannao [make up your mind, make the toilet] became their motto. They also realised that merely constructing toilets would not help — people still picked up the lota and went to the fields, leaving the toilet locked. They had to be taught to use the toilet and keep it clean.

During her visits to various villages to assess the situation and convince people to build toilets in their homes, Ravi discovered that, wherever toilets were available, each had a story: “It may be an inspiring call by the silent ones; recognition of [the] needs of women and the elderly, power dynamics in the village, sensitivity on the part of a new family towards its bahus, the sarpanch organising construction of a toilet, a local contractor dumping bricks and pans for toilet construction, brothers gifting a toilet on Raksha Bandhan, a husband constructing a jajaroo for his new bride wearing a jhaanjhar, an educated mother dreaming of toilets for her children as she watched them play in the courtyard or parents giving in to their children’s urges and aspirations of the new generation,” she writes.

In other areas, with other people, Ravi used some of these examples to convince them — asking men to think of the dignity of their womenfolk, asking brothers to protect their sisters’ health and give them a toilet as a present on Raksha Bandhan. Her team also used mothers’ desire for the wellbeing of their children as an incentive for building toilets, telling them that children were falling sick and dying because of unhealthy sanitary practices.

Completing a project of this magnitude could not have been possible without the involvement of all sectors of society. When women were told about the effects of open defecation on their children’s health, they got motivated and joined the campaign in the form of Self Help Groups (SHGs). They were given training in construction and later empowered by being facilitated to supply material to others. This way, they were able to earn some extra money for themselves as well.

One strategy was to involve children so they could ask their parents to provide them with better hygienic living conditions. For this purpose, various kits were prepared, games were designed and existing games such as snakes and ladders were modified.

One reads with interest of about 6,000 students, from engineering colleges affiliated with the Gujarat Technological University, joining hands with the SHGs and building 9,000 toilets in 107 villages under India’s National Service Scheme.

All in all, the book is a detailed account of how various stakeholders — the government, various organisations, local change-makers and citizens — joined hands to make an impact. It also provides an insight into the numerous challenges — behavioural, infrastructural and social — that were encountered and how they were addressed with creativity and a multiplicity of approaches. Written as a first-person narrative, the book shows how enthusiasm, commitment and determination on the part of a leader can achieve much more than expected.

The book has deep lessons on how to achieve large-scale change, and how to motivate a team of well-meaning — but often not well-coordinated — government officers towards a goal they might not have thought important. Ravi’s book provides a wonderful treasury of innovative ideas that can be replicated elsewhere. We in Pakistan can learn a lot from the experience of Ravi and her team, as we have similar conditions and anyone embarking on a journey to rectify it will definitely face similar problems.

Sanity in Sanitation: Jajaroo Ni Jhumbesh
By Jayanti S. Ravi
Penguin, India
ISBN: 978-0143447573
296pp.

The reviewer is a former member of staff

Published in Dawn, Books & Authors, November 17th, 2019