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Is Swachhata only about litter? -Ruhi Saith
-The Hindu


The programme needs to retain the momentum of a movement than that of a litter-cleaning project

"Slum districts... consisted of poorly built houses, a deficiency of ventilation and toilets, unpaved narrow streets, mud, and stomach-turning stenches due to the presence of decaying refuse and sewerage. In such conditions, ill health was observably endemic."

This is not a description of Indian cities today (though it may well be), but of Britain around 150 years ago, prior to Britain's sanitary reform movement, by Dr. James Kay-Shuttleworth. The movement that began in Britain and then spread to other industrialised countries like the United States was spurred in London by Edwin Chadwick's report "Inquiry into the Sanitary Conditions of the Laboring Populations of Great Britain". The sweeping changes it brought about in the industrialised world are believed to have saved many lives and contributed to increases in life expectancy - much more than advances in medicine like antibiotics and vaccination.

A momentous opportunity

Given rapid urbanisation and similar conditions today in our cities and towns, Swachh Bharat Abhiyaan is a programme whose time has indeed come. It is a momentous opportunity that has opened up a policy window (having caught the attention of the media, legislators and the public), especially at a time when a new health policy is being framed. At present, the focus of Swachh Bharat Abhiyaan seems to be on exhorting individuals not to litter. But the programme needs to retain the momentum of a movement rather than a litter-cleaning project. Besides, Purna Swachhata is not just about litter. As Professor A.K. Gosain, Professor of Civil Engineering at IIT Delhi, who is working on issues of urban sanitation, says, Purna Swachh requires three things to be addressed. The first is sewerage or wet waste generated from bathrooms, for which we need a proper system of sewers and sewerage treatment plants; the second is storm drainage or rain water, for which water tables need to be recharged through natural and man-made water drains which remain dry during the monsoons; and the third is solid waste which needs to be dealt with through landfill, incineration, and so on. Given the range of tasks that need to be undertaken, just sweeping litter from the roads under the carpet is not going to solve much.

Action is needed to increase knowledge, change attitudes and transform practice. While an excellent start has been made by targeting attitudes, synchronous action on other fronts is needed to ensure progression from one step to the other.

There are gaps in knowledge and so we need to ask the following questions: Has the Swachh Bharat Abhiyaan instituted campaigns to make people aware of the links between cleanliness and health? Is there going to be a campaign to increase citizen awareness of their rights to healthy and clean environments? This could then translate into demands of municipal authorities to deliver on their responsibilities.

In the context of promoting practice, we could well ask of the SBA campaign: When are dustbins, clean public toilets, functional sewers and adequate sewage treatment plants going to be provided? For instance, in Delhi, only around 30 per cent of the sewage is treated, with the remaining either flowing into the Yamuna or seeping into the ground and contaminating our drinking water. Also, are there any plans to ensure the presence of motivated municipal staff (with protection to their health and dignity), to undertake tasks related to keeping bins empty, storm drains dry and clear, and sewers unblocked and functional?

Lessons from Britain

Besides, action at the level of individuals is clearly not enough. Sanitised and clean public spaces are a public good and have to, by definition, be provided by the state. It is worthwhile reflecting on the broad swathe of interventions, including pieces of legislation, which accompanied sanitary reform in Britain and other industrialising countries about 150 years ago. First, the sanitary movement involved linking cleanliness with sanitation and water supply - one cannot happen without the other. Second, it established the inescapable links between public health and sanitation in the form of a Public Health Act, initiating the idea of public health districts with sanitary inspectors and public health officers. (It is important to note that the only State in India that separates public health from medical departments is Tamil Nadu.) Third, it made municipal authorities responsible not just for cleanliness, but for health (given the necessity of one for the other) in cities, with a gradual transition from permissive to compulsory legislation.

It is also important to realise that all these changes took place over a century or so. We cannot wait that long, but the good news is that we are well down the road to reform, beginning from a much later point. A Swachh Bharat is however not going to be achieved by 2019 by focussing solely on citizen participation in clearing litter. This is a start, but it is going to require appropriate budget allocations, which reduced government expenditure on health care and higher growth due to a healthy labour force would more than make up for. It is also going to require multi-sectoral, well-planned and well-executed policies. Exhorting individuals needs to be accompanied by extensive action if the goal of a clean and healthy India is to be realised in our lifetime.

(Dr. Ruhi Saith is a public health expert and is currently working as a senior consultant in public health at Oxford Policy Management. She is also the Developing Countries Editorial Consultant with the Cochrane Public Health Group.)