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Up for Debate: Getting to Full Water and Sanitation Coverage

At an April press conference, the president of the World Bank, Jim Yong Kim, held up a handwritten number and announced, “2030. This is it. This is the global target to end poverty.”  That historic moment also served to underscore some of the dilemmas actors in the WASH sector grapple with. How do we establish audacious, yet realistic goals? How do we announce an ambitious goal, such as full water and sanitation coverage in a number of countries, and have confidence that we have a reasonable chance of achieving it? This week is World Water Week, and in partnership with the Thomson Reuters Foundation, we asked some of the world's water experts exactly these questions.


The Global Sanitation Crisis: Together We Can Solve It

Sanjay Wijesekera

Associate Director and Chief of Water, Sanitation and Hygeine, UNICEF


The Dream: Full Water and Sanitation Coverage for India

The Dream: Full Water and Sanitation Coverage for India

September 3, 2013

August 3, 2010, The UN General Assembly recognizes the “right to safe and clean drinking water and sanitation as a human right that is essential for the full enjoyment of life and all human rights”. And therefore calls “upon states and international organizations to provide financial resources, capacity building and technology transfer […] in order to scale up efforts to provide safe, clean, accessible and affordable drinking water and sanitation for all”.

At the beginning of the 21st Century, lack of access to safe drinking water and inadequate sanitation are still major causes of death and diseases in developing countries. Despite unprecedented progress, 768 million people still drew water from unsafe sources in 2011. 83% of the population without access to improved drinking water sources (636 million) live in rural areas.

The 2011 MDG Report for India states that the proportion of households having access to improved water sources was 91.4%. And, even if 100% coverage is not attainable by 2015, yet the objective of halving the proportion of households without access to safe drinking water sources from its 1990 level (34%) has already been achieved. This is good news, but the report shows a much worse picture regarding sanitation, with 49.2% of households with no sanitation facility – just 11.3% of urban households against 65.2% in rural areas.

Parameters for attaining full coverage are different for water vis-à-vis sanitation. While water availability is determined on a population basis, sanitation coverage is determined on the basis of households, thus calling for a change in implementation strategy. By installing tube-wells in a village, one could declare full water-coverage depending upon the population; this is not possible for sanitation. Thus, meeting the MDG goals for sanitation needs a drastic change in approach at the country level. Gram Vikas – a rural development organisation working on sanitation and safe water since 1992 in eastern India – has established sanitation and water supply systems in over 1000 villages, with 100% coverage of all families, which have now a toilet, a shower and 24/7 potable piped water supply. Gram Vikas proposes the following in order to achieve full sanitation and water coverage in India.

Start with full coverage. In order to achieve “full coverage” of sanitation, Gram Vikas believes that we need to start with full coverage. Policies at all levels should target full coverage, starting with the village, then Gram Panchayat, block, district, state which will constitute the national level achievement. It should be a bottom-up approach with officials at each level planning for complete coverage in their area of responsibility.

In order to achieve this, a united effort by bilateral and multilateral agencies, governments as well as civil society organizations is needed. There should also be greater incentives to achieve full coverage. A target approach of providing incentives on economic criteria was not proved effective as evidenced in the Total Sanitation Campaign, in force for over a decade in India. Universal or near universal incentives will be an encouraging step to go on the path towards total transformation of human waste disposal. Further, incentivising piped-water availability in homes could encourage communities to opt for full coverage. Additional resources are needed, and the government needs multilateral and bilateral agencies’ support to move towards “full coverage”.

The dominant mindset that “poor people” need “poor quality” solutions must be challenged. Poor solutions are not necessarily cost-effective. This has been proven in the quantum of resources spent on low cost toilets since the launch of Total Sanitation Campaign in 1999 and their current use rate, as low as 31 %. Poor people are willing to pay for quality service with some minimal support from the government. Gram Vikas has proved this in the over 1000 villages in Odisha where economically marginalised communities, especially indigenous and excluded sections of people, have contributed to over 60% of the cost of sanitation infrastructure for the quality of toilets and availability of piped water connection in the toilet.



Toilets in India without water will not work, as water is used for cleaning after defecation. Therefore mere assessment of coverage in terms of number of toilets built does not necessarily lead to the desired outcome. The policy for sanitation coverage should have clear links to the availability of water in or near the toilets.

Behavioural changes are an integral component of sanitation, thus there should be greater thrust towards hygiene education at community level. Health workers and schoolteachers should be part of the programme so that children, the “future citizens”, could be inculcated into hygienic practices early on.

“Half of India’s homes have mobile phones but no toilets”, reveals the Census of India 2011. This reflects the failure of the Government and other agencies to generate demand for sanitation even though it was backed by incentives. The presence of low quality toilets, unusable in the countryside, has done little to enthuse people to adopt toilets. India has the ignoble distinction of being responsible for 60% of open defecation worldwide.

Nothing works better than a strong and robust demonstration. Demand generation in India can also be done using effective communication campaigns drawing the link between toilets, health and dignity. Entertaining films having popular artists as ambassadors for the cause can be one method; while locally, social art and popular education tools can also help in boosting demand.

Communities must be empowered to ensure that they enjoy and exercise the right to safe water and sanitation. Building strong community networks that act as watchdogs to monitor use of public resources and generate accountability from the service providers need to be invested upon. If people in power are committed to see India freed of open defecation by 2020, a serious reflection on past efforts and a sound strategy to break the demand inertia could propel much needed radical changes in terms of health and quality of life.


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