Malnutrition and Sanitation in India

This is an edited version of Rohini Nilekani and Pavan Srinath’s discussion on malnutrition and sanitation in India. This conversation took place on the sidelines of the Takshashila-Hudson conference, “Shaping India’s New Growth Agenda: Implications for the World” in Bangalore on August 1-2, 2014.

Over the last two decades India has made a lot of progress in the area of sanitation, and this is due to several factors including greater public policy changes. Now that the nation’s attention is focused on sanitation, it’s become clear to us how sanitation is crucially linked to public health.

For young children and vulnerable populations, lack of access to clean water and sanitation has multiple long-term implications. Our public policy must aggressively drive institutional reforms around the issue of sanitation. Through the work that we’ve been doing at our foundation, Arghyam, we know that behavioural choices can affect a significant amount of change. The government has a program where people who need toilets will be given financial incentives to install them. But I think we will need to do more than that, in terms of making sure that everybody uses clean toilets and reduces open defecation.

There is good public policy, but we also need to plug some of the gaps. We need a lot more philanthropic capital to come in, perhaps through a sanitation fund, so we can work with the government on this issue. If we want to see lower malnutrition and child mortality rates, we need to work on sanitation aggressively, as well as women’s safety. The demand for sanitation has been building up because of the pressure on land and urbanisation, and we only have another 10 years to address this so it is time to get our act together.

Financing toilets for the poor is certainly an issue, and there’s a need for money upfront to build those toilets with access to water. But I think we need to work around that, perhaps by encouraging banks to give out loans, etc. The financial aspect of it is a problem right now because of corruption and bureaucratic delays in getting that money to the people who need it. However, the bigger obstacle is cultural behaviour that we need to change. People need to internalise the idea that every single person in a household, including women, children, and the elderly, must have access to safe and clean sanitation. There’s a lot the government can do to spread more awareness, and I think more research is required. Civil society actors also have a big role to play in this.

We know that clean water and safe sanitation would go much further in terms of the prevention of malnutrition than any other solution. But we must also have a framework of rights for people to have equitable access to food. In India, we must focus on implementation, whether it’s about food policy, toilets, or education outcomes. We need to focus on getting the right incentive structures from the executive, along with the political class which is listening to people’s demands. We all seem to have some broad consensus on the ‘what’, so now we need to focus on the ‘how’. We have to build up the quality of demand, and that is where civil society comes in. When the quality of demand is built up, the supply system has to respond. We can’t have 600 million young restless people and not respond to their demands. And we are seeing some of those breakthroughs now, in the areas of water and sanitation. The next decade is a critical one, so we need to work together to demand and implement these changes.