The Largest Sanitation Programme in Human History
On 2 October 2014, Prime Minister Narendra Modi launched the Swachh Bharat Mission (SBM) from Rajpath in New Delhi, invoking Mahatma Gandhi’s vision of a clean India. What followed over the next five years was, by sheer scale, the largest sanitation programme ever undertaken anywhere in the world. The government pledged to build over 100 million toilets, eliminate open defecation, and fundamentally transform the hygiene landscape of a nation where, at the time, over 550 million people — roughly 40 per cent of the population — defecated in the open.
India’s sanitation challenge was not merely one of infrastructure. It was intertwined with poverty, caste, gender, public health, and deeply entrenched cultural practices. For decades, despite numerous government programmes — the Central Rural Sanitation Programme (1986), the Total Sanitation Campaign (1999), the Nirmal Bharat Abhiyan (2012) — progress had been sluggish. Open defecation rates barely moved. The Swachh Bharat Mission represented a dramatic scaling up of ambition, budget, and political will.
By October 2019, India officially declared itself Open Defecation Free (ODF). But as with most large-scale social programmes, the picture on the ground is considerably more nuanced than the declarations suggest. The numbers tell a story of remarkable progress — and stubborn, persistent gaps.
To understand the magnitude of what the Swachh Bharat Mission attempted, consider the baseline. According to the Census of India 2011, only 46.9 per cent of Indian households had access to a toilet. In rural India, the figure was far worse — just 30.7 per cent. The remaining households relied on fields, roadsides, railway tracks, and open drains.
India accounted for the largest share of open defecation globally. In 2014, the WHO/UNICEF Joint Monitoring Programme (JMP) estimated that 524 million Indians practised open defecation — nearly 60 per cent of the global total. No other country came close. Nigeria, the next largest contributor, had roughly 46 million.
The World Bank estimated that inadequate sanitation cost India 6.4 per cent of GDP annually — approximately $106 billion — through healthcare expenditure, lost productivity, and premature deaths.
The consequences were devastating. Diarrhoeal diseases, directly linked to poor sanitation, killed an estimated 1.17 lakh children under five in India every year. Contaminated water and faecal pathogens contributed to malnutrition, stunting, and chronic illness.
Women bore a disproportionate burden. Without toilets, women and girls were forced to wait until dark, exposing them to safety risks, urinary tract infections, and loss of dignity. Adolescent girls frequently cited the lack of toilets as a reason for dropping out of school. The intersection of sanitation with menstrual hygiene remains a critical concern, as inadequate toilet facilities compound the challenges of period poverty faced by millions of Indian women and girls.
The Swachh Bharat Mission operated through two verticals: SBM-Gramin (rural) under the Ministry of Jal Shakti, and SBM-Urban under the Ministry of Housing and Urban Affairs. The rural component was the larger of the two, given that the vast majority of open defecation occurred in villages.
Toilet Construction
Between 2014 and 2019, the government reported the construction of over 11 crore (110 million) household toilets under SBM-Gramin and approximately 66 lakh household toilets and over 6 lakh community and public toilets under SBM-Urban. Every state and union territory was declared ODF by October 2019.
The pace of construction was unprecedented. At its peak, India was building roughly 4 lakh toilets per day — a feat of logistics and mobilisation that drew international attention. The programme deployed a vast network of swachhagrahis (sanitation champions) at the village level, used behavioural nudging campaigns, and leveraged technology for geo-tagging and monitoring.
Financial Investment
The total expenditure on SBM Phase 1 (2014–2019) exceeded Rs 1.2 lakh crore. The Centre provided Rs 12,000 per toilet in rural areas (shared with states in a 60:40 ratio for most states, 90:10 for north-eastern and special category states). Additional funding came from corporate CSR contributions, multilateral agencies like the World Bank, and convergence with MGNREGA for toilet construction labour.
Open Defecation Rates
The most meaningful metric is not toilet construction but actual usage. Here the data tells a more complex story:
- NFHS-4 (2015-16): 48.4 per cent of rural households used improved sanitation facilities
- NFHS-5 (2019-21): 70.2 per cent of rural households used improved sanitation facilities
- NARSS 2018-19 (National Annual Rural Sanitation Survey): 93.1 per cent of rural households that had access to toilets used them
- WHO/UNICEF JMP 2023: Open defecation in India dropped from 39 per cent (2015) to 15 per cent (2022)
The gap between construction and usage — between having a toilet and consistently using one — is the central challenge of India’s sanitation story.
Multiple independent surveys and academic studies have highlighted a persistent gap between government declarations of ODF status and ground reality.
The RICE Institute Studies
The Research Institute for Compassionate Economics (RICE), led by researchers Diane Coffey and Dean Spears, conducted extensive surveys in rural north India and found that even in households with government-built toilets, open defecation persisted. Their 2018-19 survey in Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh found that roughly 44 per cent of household members in these states still defecated in the open, despite owning toilets.
The reasons were varied: toilets were too small, pits filled up quickly (or were feared to fill up), water supply was inadequate, and deeply ingrained habits — particularly among older men — proved resistant to change. Some households used toilets as storage rooms. Others reported that the toilets were built but never connected to water supply or sewerage.
Quality of Construction
A significant proportion of toilets built under SBM were single-pit latrines with design deficiencies. Reports from the Comptroller and Auditor General (CAG) flagged issues including:
- Toilets built without water connections
- Substandard construction that deteriorated within months
- Pits that were too shallow and filled up quickly
- Missing superstructures (walls, doors, roofs)
- Lack of provision for pit emptying and faecal sludge management
The CAG’s 2020 performance audit of SBM-Gramin found that in several states, the verification of ODF status was perfunctory, relying on self-declaration rather than rigorous independent assessment.
The Behaviour Change Challenge
Sanitation experts have long argued that building toilets without sustained behaviour change interventions is insufficient. India’s sanitation challenge is not purely an infrastructure deficit — it is also a behavioural and cultural one. In parts of rural India, open defecation is not merely a practice born of necessity but one embedded in daily routine, spatial habits, and even notions of ritual purity (the belief that toilets inside or near the home are polluting). The psychological dimensions of such entrenched behaviours echo broader patterns seen in India’s approach to mental health, where stigma and cultural attitudes often impede progress more than lack of resources.
The Community-Led Total Sanitation (CLTS) approach, which emphasises shame and social pressure to trigger collective abandonment of open defecation, has had mixed results in India. It works in some communities but fails in others where social structures are more fragmented or where caste dynamics complicate collective action.
Despite the gaps in usage, the overall health impact of improved sanitation access has been significant, though difficult to isolate from other concurrent improvements in healthcare and nutrition.
Diarrhoeal Disease
The WHO estimated that between 2014 and 2019, improved sanitation in India prevented an estimated 3 lakh diarrhoeal deaths. The reduction in under-five mortality from diarrhoea has been one of the most notable public health achievements of the SBM period, though attribution is complicated by simultaneous improvements in oral rehydration therapy, immunisation, and nutrition programmes.
Stunting and Malnutrition
Research has established a strong link between open defecation and childhood stunting. Faecal pathogens in the environment lead to a condition called environmental enteropathy, where chronic low-level infections damage the intestinal lining and impair nutrient absorption. A study published in the BMJ Global Health found that increased toilet usage in Indian districts was associated with a measurable reduction in stunting rates.
NFHS-5 reported that 35.5 per cent of children under five are stunted — down from 38.4 per cent in NFHS-4, but still among the highest rates globally. Sanitation improvements alone cannot resolve malnutrition. The issue requires integrated action on diet, healthcare, water quality, and women’s education.
Water Contamination
Groundwater contamination from poorly constructed toilets is an emerging concern. In areas with high water tables, single-pit latrines can leach faecal matter into groundwater sources used for drinking. A study by the Indian Institute of Technology (IIT) found elevated levels of nitrates and faecal coliforms in groundwater near toilet pits in several states. This creates a paradox: toilets built to improve health may, if poorly sited and constructed, contaminate the very water supplies that communities depend on.
While rural open defecation received the bulk of attention, urban sanitation presents its own set of complex challenges that the Swachh Bharat Mission has only partially addressed.
Sewage Treatment
India generates approximately 72,368 million litres per day (MLD) of sewage from urban areas, according to the Central Pollution Control Board (CPCB). The installed treatment capacity is only about 36,668 MLD — roughly 50 per cent of what is generated. Even this installed capacity is not fully utilised; operational capacity is estimated at around 28,000 MLD. The result is that more than 60 per cent of urban sewage flows untreated into rivers, lakes, and the sea.
The Yamuna in Delhi, the Ganga through Varanasi, the Mithi in Mumbai — India’s urban rivers are essentially open sewers. The Namami Gange programme has invested over Rs 30,000 crore in sewage treatment infrastructure along the Ganga, but progress has been slow.
Informal Settlements and Slums
India’s 65 million slum dwellers face the most acute urban sanitation challenges. Community toilets in slums are often poorly maintained, inadequate in number (sometimes one toilet for 50-100 people), and unsafe for women at night. The lack of individual household toilets in informal settlements remains a critical gap.
Septage and Faecal Sludge Management
In cities without sewerage networks — which is the majority of Indian cities — on-site sanitation systems (septic tanks and pits) require periodic emptying. The management of faecal sludge is largely unregulated. Manual emptying by sanitation workers (often Dalit communities) persists despite being illegal. Mechanised desludging services are expensive and unevenly available. The National Faecal Sludge and Septage Management (FSSM) Policy of 2017 laid out a framework, but implementation varies widely across states.
Recognising that Phase 1 focused primarily on toilet construction and ODF declarations, the government launched SBM Phase 2 in 2020 with a broader mandate.
SBM-Gramin Phase 2 (2020-2025)
The focus has shifted to:
- ODF Sustainability: Ensuring that ODF status is maintained and that toilet usage continues
- Solid and Liquid Waste Management (SLWM): Addressing garbage disposal, grey water management, and composting at the village level
- Plastic Waste Management: Reducing single-use plastics in rural areas
- Faecal Sludge Management: Setting up pit-emptying services and treatment facilities
- GOBARdhan: Converting cattle dung and organic waste into biogas and bio-CNG
The budget for SBM-Gramin Phase 2 is Rs 1.4 lakh crore over five years. The programme introduces the concept of ODF Plus villages — villages that have sustained ODF status and implemented solid and liquid waste management systems. By 2024, over 2.96 lakh villages had been declared ODF Plus.
SBM-Urban 2.0 (2021-2026)
The urban phase focuses on:
- Complete liquid waste management: Sewage treatment in all cities
- Faecal sludge management: For cities without sewerage
- Waste processing: 100 per cent source segregation and scientific processing
- Construction and demolition waste: Recycling and reuse
- Remediation of legacy dump sites: Cleaning up old landfills
The total outlay is Rs 1.41 lakh crore with a focus on making all cities garbage-free.
India’s sanitation progress has been deeply uneven across states, reflecting differences in governance capacity, political will, cultural norms, and pre-existing infrastructure.
Leaders
- Sikkim: The first state declared ODF (2016), with strong pre-existing sanitation infrastructure
- Himachal Pradesh: High toilet usage rates, effective behaviour change campaigns
- Kerala: Near-universal access to toilets even before SBM, high health awareness
- Tamil Nadu: Strong urban sanitation infrastructure, innovative FSSM models
- Indore (Madhya Pradesh): Declared India’s cleanest city seven consecutive times under Swachh Survekshan
Laggards
- Bihar: Despite being declared ODF, independent surveys show persistent open defecation. Low toilet usage among men, quality of construction issues
- Uttar Pradesh: The state with the largest absolute number of people previously practising open defecation. Progress has been significant but sustainability is uncertain
- Jharkhand: Tribal areas with dispersed habitations face unique challenges in sanitation delivery
- Odisha: Coastal areas and tribal districts continue to lag behind state averages
India’s sanitation story cannot be told without addressing caste. The manual emptying of pit latrines, septic tanks, and sewers has historically been performed by Dalit communities — specifically sub-castes designated for this work. Despite multiple laws banning manual scavenging (most recently the Prohibition of Employment as Manual Scavengers Act, 2013), the practice persists. The deeply entrenched caste system that sustains manual scavenging remains one of the most shameful aspects of India’s sanitation landscape, demanding urgent legislative enforcement and social reform.
Between 2017 and 2023, over 340 people died while cleaning sewers and septic tanks — almost all of them Dalit workers. True sanitation reform requires not only toilets but also safe, mechanised systems for faecal sludge management.
The SBM’s focus on toilet construction did not adequately address the question of who empties those toilets once the pits are full. In the absence of mechanised desludging infrastructure, the burden falls on the same marginalised communities. True sanitation reform in India requires not only toilets but also safe, mechanised systems for faecal sludge management and the complete elimination of manual scavenging.
India’s sanitation journey is far from complete. The construction of over 110 million toilets is a historic achievement, but the work ahead is equally daunting.
1. Sustained Behaviour Change
Investment in Information, Education, and Communication (IEC) must continue long after toilets are built. Behaviour change is a generational process. Programmes like the Swachh Bharat Kosh and the use of swachhagrahis need sustained funding and local ownership.
2. Quality and Maintenance
Toilets must be built to last, with adequate water supply and provision for pit emptying. Maintenance budgets must be allocated at the village and urban local body level.
3. Sewage Treatment
India needs to close the massive gap in sewage treatment capacity. Every city and town needs either a sewerage network or a functional FSSM system. The current situation — where over 60 per cent of urban sewage is untreated — is an environmental and public health crisis.
4. End Manual Scavenging
Mechanised desludging must become universal. Every municipality must have access to suction machines and treatment facilities. The social and economic rehabilitation of manual scavenging communities must be prioritised.
5. Integrated Approach
Sanitation cannot be addressed in isolation. It must be integrated with water supply (Jal Jeevan Mission), solid waste management, nutrition programmes (Poshan Abhiyan), and rural development (MGNREGA). The convergence of these programmes at the district and village level is critical.
6. Independent Monitoring
ODF declarations must be verified through rigorous, independent surveys — not self-certification by implementing agencies. The gap between official claims and ground reality undermines public trust and policy effectiveness.
India’s sanitation revolution is one of the most ambitious public health interventions of the 21st century. The numbers — 110 million toilets built, 500+ million people gaining access to sanitation for the first time — are staggering by any measure. The programme has saved lives, improved health outcomes, and given dignity to millions of women and girls.
But the revolution is incomplete. The gap between construction and usage, between declarations and reality, between policy and practice, remains wide. Phase 2 of SBM rightly shifts focus to sustainability, waste management, and sewage treatment. The challenge now is not building more toilets — it is ensuring that the ones already built are used, maintained, and integrated into a functioning sanitation ecosystem.
India’s sanitation story is ultimately a story about the tension between scale and quality, between top-down targets and bottom-up behaviour change, between what governments can build and what communities must own. Getting this balance right will determine whether the sanitation revolution becomes India’s greatest public health success — or one of its most expensive incomplete projects.
Key Data Sources
- Swachh Bharat Mission Dashboard (sbm.gov.in)
- National Family Health Survey (NFHS-5), 2019-21
- WHO/UNICEF Joint Monitoring Programme (JMP), 2023
- Comptroller and Auditor General (CAG) Performance Audit Reports
- RICE Institute Survey Reports (riceinstitute.org)
- Central Pollution Control Board (CPCB) Sewage Reports
- PRS Legislative Research Budget Briefs
- National Annual Rural Sanitation Survey (NARSS) 2018-19