While the shortage of water is now recognised as one of the world's biggest problems - and even mistakenly believed to be a likely source of wars between countries in the future - its step-sister, sanitation, is widely neglected. As I discovered at a recent Global WASH (Water, Sanitation and Hygiene for All) Forum in Dakar, Senegal, early this month, people are far more concerned about what emanates from their mouths than from other orifices in their bodies. The technology employed in ridding ourselves of our bodily wastes has remained unchanged, more or less, for three centuries.

As practitioners of the alternative - known as "ecological sanitation" - never tire of reminding us, the disposal method actually compounds the problem because it takes a small amount of waste and increases the volume several times by flushing it into sewers. What this does is simply transport or transfer the problem some distance away from where we live: out of sight and out of mind.

The Water Supply & Sanitation Collaborative Council (WSSCC), a multi-stakeholder organisation under the umbrella of the World Health Organisation in Geneva, has been almost single-handedly trying to put sanitation and hygiene on the international agenda. It succeeded in including sanitation as one of the UN's Millennium Development Goals (MDGs), at the World Summit on Sustainable Development in Johannesburg in 2002 (the precursor to which was the spectacular Earth Summit at Rio 20 years earlier). Countries have now pledged to halve the number of people without access to sanitation in the world, a staggering 2.5 billion, by 2015.

Considerable progress has been made towards this, with the glaring exception of sub-Saharan Africa, which, like South Asia, suffers from deep poverty, and acute water scarcity to boot. Increasingly, governments and multilateral institutions are realising that it will be impossible for the state to provide sanitation and inculcate hygiene practices on the scale required to meet the MDGs. The only solution is to allow people to do this themselves, with a little institutional and financial support.

This was the strong message delivered at the Global WASH Forum in Dakar, which understandably had an emphatic African focus. On the very first day, the plenary session heard of the remarkable success achieved in West Bengal. That this state's "people-centred" approach is a clear change from the past was illustrated dramatically by one of the slides in the presentation by Dr Suryakant Mishra, the state Health Minister - showing a man balancing a toilet literally on his head. "Earlier, instead of a person sitting comfortably on a toilet, the toilet was imposed on him," he said.

The Centre had taken the first strides towards change through a Central Rural Sanitation Programme in 1986 - a full 40 years after independence - to construct household toilets for the poor. Eighty per cent of the cost was to be subsidised, up to a maximum of Rs.2500. By 1991, India had a backlog of 100 million toilets. West Bengal launched an Intensive Sanitation programme in Midnapore district in 1990 with the federal government and UNICEF. "Earlier the government designed the programme and got the people to participate in it. Toilets were used for every purpose other than what they were intended for," Dr Mishra noted.

The first step was to simply determine how toilet use could be encouraged and supported by the government. The state initiated an Information, Education and Communication (IEC) campaign to generate demand for toilets. Six years later, a survey by the Indian Institute of Mass Communication showed that only 2% of owners of toilets were motivated by subsidies, but 54% by convenience and privacy, contrary to conventional wisdom. Further, as many as half the respondents were prepared to pay Rs.1000 to own their toilets.

Implementation became the next challenge. "The programme needs empowerment of local bodies as a pre-condition," explained Dr Mishra. Luckily, India was just instituting the sort of local government bodies that would be needed - the Panchayats. The state has 80 million people, while each district has an average of 3.2 million and the sub-district an average of 170,000. The government decided that the panchayats, working with knowledgeable partners, could get the job done.

"In Midnapore, we had a reputed NGO as our partner," added Dr Mishra. "Women were involved in turning out hand-made pans, which were delivered to people's doorsteps, and this created local employment. In the process, we created hundreds of motivators for local marketing: the panchayats were made to own this initiative." The subsidy was very drastically reduced to about Rs.200, a tenth of its previous level.

"There was a campaign to prevent open defecation, " Dr Mishra added. "Women and the poor had group discussions about their participation. Women demanded the right to privacy and dignity at the end of their drudgery. As many as 20,000 later took part in a 'victory' rally." The results spoke for themselves. In 1993, some 19,000 household toilets were constructed; this year the figure has crossed 1 million and is expected to rise to 1.7 million next year. The financial figures are also revealing. "Of the 2 million toilets constructed between 2000 and 2004, people paid 68% of the cost. The government contributed less than a third (about US $4 million), when it would have conventionally cost over $100 million." Dr Mishra observed.

This sort of success has been the exception, however, and many participants at the forum were alert to this. They were especially vexed at attempts by government spokesmen to overstate the progress made in tackling sanitation and access to drinking water.

For example, they were skeptical of the official facts and figures on drinking water and sanitation cited by Dr V.K. Duggal, Secretary, Water Resources and Drinking Water Supply, at a plenary session titled "Developing a Realistic Agenda". In particular, they disputed his claim, published in India's official document for the Global WASH Forum, that the "coverage of rural population increased from 56% habitations in 1985 to 99.6% habitation in 2004". That sort of conclusion is typically reached by refering to the number of villages covered, rather than households within them. This, the NGOs found misleading.

Dr. Duggal was insistent that progress was being made. He stressed that the National Common Minimum Programme of the UPA government had doubled the budget for rural development, and this would yield results within years. "We hope to have complete satisfaction on drinking water by 2012," he added. However, he admitted that "over a period of time two problems have cropped up". Some 216,000 habitations, which had earlier been categorized as covered, had now slipped back. One reason was that the quality of the water delivered left much to be desired. The other shortcoming was the availability of water. It was found that some 300,000 habitations were only partly covered - the criterion being the delivery of 40 litres per head per day.

"Drinking water has to be readdressed," he conceded. "We need better water management to ensure perennial access, which would be the challenge for the next half decade. There is now an emphasis on the total ownership of water schemes by the panchayats, where people own their own water facility. With World Bank aid, we hope to achieve 100% satisfaction in the next three to four years." On sanitation, he emphasised that the earlier emphasis on providing infrastructure has now given way to a total sanitation campaign. In 1980-81, only 1% of India's households were covered by sanitation, which has now risen to 30-35%, he said. He claimed that all households would be covered three years before the MDG deadline.

India's official document for the Global WASH Forum, that the "coverage of rural population increased from 56% habitations in 1985 to 99.6% habitation in 2004".
 •  Local water, battle of scales
Nafisa Barot of Utthan, a rural water NGO in Gujarat, wanted to know how Dr Duggal had arrived at these figures and targets. As anyone with experience working on these issues was certain to know, she said, it would be an uphill task to meet either the drinking water or sanitation goals. Even the reallocation of resources for rural development would be fruitless if not done properly, she pointed out, citing the example of handpumps, where 80% of the installed units fail to function as intended.

Sushmita Shekhar, Vice President of Sulabh International, the Delhi-based organisation which has done pioneering work in providing public pay toilets throughout India, was similarly sceptical. She agreed that the official targets were good, but the question remained as to how these would be achieved, and asked for more clarity on the mechanism by which the government would deliver on these promises.

Joe Madiath, Executive Director of Gram Vikas, an NGO based in Berhampur in Orissa, was even more critical of the claims of the central government government regarding progress made in rural sanitation. Moreover, he expressed dissatisfaction at the 'success' story from West Bengal, insisting that standards for measuring progress in rural areas were unacceptably low.

"I challenge anyone to use these toilets and be happy with them. Why do we advocate something which we wouldn't use ourselves? And should we subsidise sanitation in cities for ever and ever?" he questioned. While sanitation is funded by the state in urban areas, the poor have to bear the cost in villages (as is the example cited by the Bengal minister), which amounted to a double standard. He pointed out also that the West Bengal government had not revealed that the federal authorities provide a Rs.500 subsidy for each rural toilet to cover the cost of a commode and three concrete rings. "These rings are usually used for something else," he claimed.

While delivering drinking water is demand-driven, providing sanitation isn't "sexy" in the same way, and is thus neglected by government, he said. "You need a lot of hand-holding in the cow-belt (the poor states in the Indo-Gangetic plains). There is definite need for investment to cover the external cost of providing amenities".