'Toilet trouble' for Narendra Modi and Bill Gates
By Aparna Alluri
Indian Prime Minster Narendra Modi's high-profile visit to the US includes an evening in New York, where he will be honoured for a flagship government scheme. But the celebrity event has turned controversial.It all began with a tweet.A federal minister announced on 2 September that the Bill & Melinda Gates Foundation would recognise Mr Modi for his government's efforts to end open defecation. The Swachh Bharat Abhiyan, as it is known, or Clean India Mission, seeks to improve sanitation across the country by building tens of millions of toilets for the poor.
Twitter post by @DrJitendraSingh
Dr Jitendra Singh
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@DrJitendraSingh
Another award,another moment of pride for every Indian, as PM Modi's diligent and innovative initiatives bring laurels from across the world.
Sh @narendramodi to receive award from Bill & Melinda Gates Foundation for #SwachhBharatAbhiyaan during his visit to the United States.
But the seemingly innocuous award has sparked scathing opinion pieces, the disapproval of at least three Nobel laureates, a petition by more than 100,000 people, and even rejection by celebrities - British Asian actors Jameela Jamil and Riz Ahmed were due to attend but dropped out of the event, although neither has explained why.The award for Mr Modi has raised eyebrows because to date recipients of the Gates Foundation's "Goalkeeper" award have largely been grassroots political and community activists.
Why is Mr Modi getting an award?Hundreds of millions of Indians defecate in the open because they have no access to toilets or even running water. It has been a persistent problem, polluting soil and water, causing diseases and putting women and girls at risk as they go out alone in the night to relieve themselves.So Mr Modi's ambitious promise in 2014 that he would end this practice caught the attention of India and the world. And that goal lies at the heart of the Clean India Mission, arguably Mr Modi's most beloved campaign.He and his Bharatiya Janata Party-led government have touted it as a success - and in the run-up to this year's election, Mr Modi claimed that thanks to the programme, 90% of Indians now have access to a toilet, up from 40% before he came to office.
The Bill & Melinda Gates Foundation said in a statement to the BBC that it was honouring Mr Modi for the "progress India is making in improving sanitation, as part of its drive toward achievement of the UN Sustainable Development Goals".While it's true that the number of toilets has increased significantly, a BBC investigation found that many of them are not working or aren't being used for various reasons, from lack of running water to poor maintenance to deeply ingrained cultural habits. Recent research found that people in some parts of northern India preferred to defecate in the open because they found it more "comfortable" or thought it to be "part of a wholesome, healthy virtuous life".Another common problem is that the government offers subsidies for the poor to build a toilet in their home. But since the subsidy is paid out in instalments over more than a year, many poor households wait for months for the construction to be complete."Many beneficiaries have started construction but not competed it," says Siraz Hirani from the Mahila Housing Sewa Trust, a non-profit group that also works to improve sanitation. As a senior programme manager, Mr Hirani has worked closely with rural and urban governments to implement the Clean India scheme.
Millions of Indians defecate in the openHis other big worry is that the subsidy does not account for the cost of laying a sewer, which has often meant that people in rural areas end up building soak pits for drainage. This, he fears, will eventually lead to ground water and soil pollution in coastal areas where the water table is higher. Mr Hirani says open defecation has "significantly reduced", but the "biggest challenge is how do we sustain this?"He adds that the government data relies heavily on the existence of infrastructure - such as the toilet itself - rather than actual use or behavioural change to measure success.He says the Clean India mission is a "great idea" that put the spotlight on open defecation - and for that Mr Modi deserves the award. But he fears that such recognition might be seen as a victory."It's alright to prove yourself, but you must improve while proving yourself."
What do critics say?While they have pointed to the scheme's patchy record, their bigger criticism is about Mr Modi himself, a one-time pariah banned from entering the US for years for his alleged complicity in 2002 sectarian violence in his home state of Gujarat.The prime minister is a polarising figure in India, adored by many but also often blamed for divisive rhetoric and violence against minorities. And critics cite his security lockdown in Indian-administered Kashmir, which has been in place since 5 August when the government stripped the region of its special status.Thousands of political leaders, activists, businessmen and protesters have been detained, communications largely remain cut off and there have been allegations of abuse and excessive use of force by security forces.
Iranian political activist Shirin Ebadi is one of the Nobel laureates who has opposed the award
"The timing of the award - Kashmir is an issue that haunts us, not just Kashmiris," Shiv Visvanathan, a social and political commentator, told the BBC. "There is a deep need for trauma clinics [in Kashmir]. Will the Gates foundation establish these in the name of rights? Would the [Modi] regime allow it?"Dr Visvanathan adds that it's also hard to ignore the fact that "philanthropists like Bill Gates add legitimacy and gloss" to Mr Modi's government. "Why be naïve about it? It ensures the [Gates] foundation has a smoother time in India."Mr Modi has not responded to the criticism, but he tweeted, thanking the foundation for the award.

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@narendramodi
Replying to @narendramodi
I thank the Bill and Melinda Gates Foundation for conferring upon me the Global Goalkeepers Goals Award 2019. Over the last five years India has taken many efforts to improve cleanliness and sanitation, fulfilling Gandhi Ji's dream of a Swachh Bharat.What does the foundation say?The Bill & Melinda Gates Foundation never made an official announcement that Mr Modi would receive the 2019 Goalkeeper award - and the awards website says the names of this year's winners will be released at the event.But as the criticism gathered steam, it acknowledged that Mr Modi was indeed one of the recipients.Mr Modi is not the first politician to receive the award - Ellen Johnson Sirleaf, the former president of Liberia, was honoured in 2017.
hy do billions of people still lack basic sanitation?Defending its decision to honour him, the foundation said in its statement to the BBC that "sanitation has not received significant attention" and "a lot of governments are not willing to talk about it, in part because there are not easy solutions"."Before the Swachh Bharat mission, over 500 million people in India did not have access to safe sanitation, and now, the majority do. There is still a long way to go, but the impacts of access to sanitation in India are already being realized. The Swachh Bharat Mission can serve as a model for other countries around the world that urgently need to improve access to sanitation for the world's poorest."
Why India's sanitation crisis needs more than toilets
Soutik Biswas
When Prime Minister Narendra Modi, in his Independence Day speech, vowed to eliminate open defecation, India took notice.After all, it was unusual for a prime minister to use the bully pulpit in India to exhort people to end this appalling practice and build more toilets.A staggering 70% of Indians living in villages - or some 550 million people - defecate in the open. Even 13% of urban households do so. Open defecation continues to be high despite decades of sustained economic growth - and despite the obvious and glaring health hazards.The situation is so bad that open defecation is more common in India than in that are poorer countries such as Bangladesh, Kenya, Democratic Republic of Congo, Malawi, Burundi and Rwanda.But building toilets may not be enough to end open defecation in India, a new study has found.A team of researchers asked people in 3,235 rural households in five north Indian states where they defecate and their attitudes to it.Some 40% of Indians live in these states - Bihar, Madhya Pradesh, Rajasthan, Haryana and Uttar Pradesh. They also account for 45% of households without a toilet. Also, a third of all people worldwide who defecate in the open live in these five states.The study found that people in households with working toilets continue to defecate in the open, and that toilets provided by the state are especially unlikely to be used."In short," the study says, "we find that many people have a revealed preference for open defecating such that merely providing latrine access without promoting latrine use is unlikely to importantly reduce open defecation."The study found open defecation is very common, even in households with toilets. Toilet use did not necessarily increase with prosperity: in Haryana, one of India's richest states, most people in the villages continue to defecate in the open. Also, men living in households with toilets are more likely to defecate in the open than women.Why do so many Indians still prefer not to use toilets, even if they are available?The survey found a range of replies - most said they found it "pleasurable, comfortable, or convenient". Others said it "provides them an opportunity to take a morning walk, see their fields and take in the fresh air". Still others regarded open defecation as "part of a wholesome, healthy virtuous life".
"Building toilets is not enough. What you need is a widespread motivation and information campaign," says Dr Bindeshwar Pathak of Sulabh, a non-profit organisation which has built 1.3 million household toilets in villages.MP and writer Shashi Tharoor says Indians also have a cultural problem when it comes to sanitation: "We are a nation full of people who live in immaculate homes where we bathe twice a day, but think nothing of littering public spaces, spitting on walls, dumping garbage in the open and urinating and defecating in public, because those spaces are not 'ours'."So how do you promote behavioural and cultural change?India, researchers say, "needs a massive campaign to change sanitation preferences" and promote toilets by linking sanitation behaviour with health. One of the ways it can be done is by raising an army of sanitation workers and campaigners in the villages to spread the message.Punishment can also help, within reason: In a part of Haryana where Sulabh has built 100 household toilets a village council chief fines people caught defecating in the open.Imaginative designs could also help: Sulabh has designed an open roof toilet to incentivise men who feel claustrophobic in the confines of a toilet, although it is not clear how this will work in bitter winters or monsoons.Women could possibly be persuaded to help with education efforts - studies show that they are likely to use toilets more than the men."I know of women in villages who stay up all night to take their daughters to defecate outside," says Dr Pathak.Mr Modi has announced plans to build more than 100 million toilets in the country to end a shameful practice. But many believe the money will not be well spent unless it's accompanied by a massive awareness campaign, involving the government, non-profit groups and citizens.
Why do billions of people still lack basic sanitation?
By Padraig Belton
Hi-tech loos that use little or no water and can recycle waste products safely and sustainably promise to give billions of people around the world access to much-needed sanitation. So why do so many still lack this basic amenity?About 2.3 billion people still lack basic toilets, according to the World Health Organization (WHO). And 4.5 billion don't have safely managed sanitation, with waste disposed in a way that won't contaminate drinking water.Each year contaminated water kills half a million children under five through diarrhoeal diseases, the WHO says.So many inventors, entrepreneurs and research institutions around the world have been working on hi-tech loos that can function without the need for expensive mains sewerage systems.
Millions of people live next to unsanitary open sewers with potentially fatal consequencesOne approach is taking chloride from urine, turning it into chlorine with electricity, and using that as a disinfectant, says Dr Brian Hawkins, a research scientist in nanomaterials at Duke University, North Carolina.Activated charcoal can remove organic material and nano-membranes replace the need for septic tanks, he says.A solar-powered toilet using this approach, developed at Duke and nearby universities, is being tested at a cotton mill in Coimbatore, India and a township in South Africa.Currently, it can handle about 15 users a day.New membrane technology means toilets can "get clean water out of human waste, which is pretty cool", says Dr Alison Parker, a lecturer at Cranfield University in Bedford.But power is needed to push waste through the membranes. So the challenge is making a self-contained loo that doesn't need external electricity.
Cranfield University's clever loo can produce clean water from human wasteHer lab's Nano Membrane Toilet works by "relying on the energy we can get from human waste, burning faeces, and the person lifting the lid and closing it again - so that's not a huge amount of energy to work with," she says.But reverse electrodialysis, from putting faeces components on one side of the membrane and urine on the other, "gives us a little extra energy", she says, and is "just enough to give it the boost to do what we need".Heating urine before it goes through the membrane to be closer to the vapour state makes it more efficient, too, says Dr Parker.
She says her lab's waterless flush toilet is "basically ready and could be commercialised straight away".A challenge now is making them feasible for rural areas - the membranes need cleaning every three months, which is more easily achieved in cities.Reducing costsWhile there is lots of innovation going on, the key challenge is making sanitation affordable, says Jack Sim, World Toilet Day founder.He remembers growing up in Singapore in the 1950s and 60s and having to use his village's communal outhouse. It was a "very traumatic" experience, he says, involving buckets and lots of green flies.Moving to public housing with a flushable loo was "like a miracle", he recalls.World Toilet Day founder Jack Sim (r) meets Indian Prime Minister Narendra ModiHe believes people on low incomes need to be convinced to "sacrifice something else and build a toilet first".But many promising products are now stuck in the "valley of death", says Duke University's Dr Hawkins.This is the space between developing a successful prototype and "getting to a locked-down product you can scale up, mass produce, and find a market share".The aim is to get the operating expenses of clean toilets down to five cents (3.8p) per person per day, he says.
And Neil Jeffery, chief executive of Water & Sanitation for the Urban Poor, a non-profit organisation focusing on African and Indian cities, points out that it's "not just about the toilets - it's about how you collect waste safely, transport it, treat it, and how it's then used".Most African cities only have 10-15% of households connected to mains sewerage, he says, with many urban settlements sharing pit latrines instead.When these fill up, a lorry needs to take their contents to a treatment plant.But this can be a costly two- or three-hour drive, says Mark Hassman, project manager for the Mobile Septage Treatment System at Crane Engineering in Wisconsin.He says the amount of waste that trucks actually bring to treatment plants is "less than 5% [of the total] in some cities".Instead, they dump it in ditches, mix it with rubbish and burn it, or "plop it in a ditch, and if it's rainy season, it goes downstream".Mr Hassman has been leading a team designing trucks that can process 70-80% of the waste on site. So instead of emptying two pits, "they can now maybe do eight in one drive, and that hopefully reduces the cost and enables people to afford clean pit emptying," he says.He says the trucks are "fairly close" to producing potable water.The trucks will have trial runs in Africa in 2019, and his company is "looking to get these units out there" commercially in 2020.The crucial requirement is to create a market that enables companies to make a profit from loos that are also affordable for poorer households, he says.
Lack of sanitation also has an economic impact.The Bill & Melinda Gates Foundation, which has been running its Reinvent the Toilet Challenge since 2011, says "more than $200bn (£155bn) is lost due to healthcare costs and decreased income and productivity" as a result of poor sanitation.This is one of the reasons why Indian Prime Minister Narendra Modi has committed $20bn to build 111 million latrines by 2019 - "the biggest toilet building project in the history of mankind", says Mr Sim.The goal of sanitation for all may still be "some years" away. "But I can see this problem being solved in the next decade," he says.Not a day too soon for the billions still suffering.