Meeting

A Toilet for All: Strengthening Health Outcomes, Human Security, and Developing Economies

Monday, April 22, 2019
Speakers
Jeffrey D. Goldberg

Acting Director, Office of Water, U.S. Agency for International Development (via videoconference)

Jason Kass

Founder, Toilets for People

Sangita Vyas

Research Fellow, r.i.c.e., a research institute for compassionate economics

Presider
Ella R. Gudwin

President, VisionSpring

More than four billion people lack access to safe sanitation, which has profound implications for public heath, physical safety, women's rights, and human dignity. Health problems stemming from this lack of access cost the global economy over $200 billion each year. Panelists discuss the challenges and prospects for improving access to sanitation in the developing world.

GUDWIN: OK. Great. Well, welcome, everybody. I’m Ella Gudwin. And it is my pleasure to be here and to bring toilets to the Council on Foreign Relations. So I am joined by Jeff Goldberg who is on our monitors here in Washington, D.C. And you all have his bio, but he heads up the office of water and oversees also the sanitation programming for USAID. Jason Kass, to my left, is the founder of Toilets for People. And Sangita Vyas is a research fellow at r.i.c.e. institute for compassionate economics. 

So before we get started, just a couple of reminders. We are on the record. So anything you say will and can be used against you. And we are going to start with a conversation and then we’ll go to Q&A about halfway through, an we’ll end on time at 7:00. Before we get started, just wanted to get a sense for who works on water and sanitation. Is anyone actively in the WASH sector? Anybody invested—great. OK. Anybody invested in WASH? Everyone’s just curious about our daily functions. OK. (Laughter.) So—(laughs)—ok, great. Well, then we have a wonderful—a wonderful conversation in store. 

So just to do a little bit of context setting, in the world of international development, water and sanitation always go together as WASH. But today we’re just going to really focus on the sanitation side of things. So that’s not to ignore the giant need for clean water in the world. A little bit of context setting: The toilets—toilets and sewers show up in the archeological record 5,000 years ago. And there’s evidence of some of the oldest toilets being in India and Pakistan, including in the Indus Valley circa 2800 B.C. And they were in toilets—they were in-home toilets, and they were covered sewers as well, with bricks. There’s evidence of toilets in Scotland circa 3000 B.C., Egypt circa 1800 B.C., and Vietnam circa 1500 B.C.  

But today, 68 percent of the world’s population—only 68 percent of the world’s population uses improved sanitation facilities. I had to look up what improved meant. So it means flush or pour latrines that flow into piped sewer systems and septic tanks, ventilated or improved pit latrines, or pit latrines with a slap, or a composing toilet. So 68 percent of the world has access to that. That leaves an estimated 2.4 billion people without sanitation, meaning there is no hygienic separation between the human excreta and human contact. So that means pit latrines with no slab, hanging or bucket toilets, and what we’re going to spend quite a bit of time talking about today, open defecation. Say it at the Council on Foreign Relations twice: open defecation. (Laughter.) Thirteen percent of the world’s population relies on open defecation. And I think some of the irony here is toilets were first in the archeological record in northern India, and this is the area which has the greatest burden of this—of this issue. 

So we are going to start with Jeff. Because we are at the Council, we’re going to start with policy and then we’ll get to toilets. So, Jeff, the U.S. government has elevated water, and particularly sanitation, into the category of being a big bet. We’re investing $435 million a year to create access. Can you talk to us about why this has become a priority for American bilateral assistance and, really importantly, what’s changed over the last five years or so in terms of our approach to water and sanitation? 

GOLDBERG: Yeah, absolutely. More than happy to. And just before I kick off, just wanted to thank you all for hosting tonight’s event. Having sanitation in particularly highlighted at the Council on Foreign Relations is something that we are very, very excited about. As you mentioned, relative to the larger stats, sanitation does lag very, very far behind water access in the kind of broader conceptualization of WASH. So it’s something that we are very, very excited to be talking about. 

And just with respect to how the U.S. government approaches this issue, I might—you mentioned policy—and just zoom out and provide a little bit of context about where sanitation in particular is situated. So the U.S. government has the whole of government approach to water and sanitation. It’s articulated through the 2017 Global Water Strategy. And so this is co-led by USAID and the Department of State. And it’s something that we’re very excited about. It’s the first time ever that we have had a whole of government strategy on water and sanitation.  

And this is really rooted in strong bipartisan support for water and sanitation as a cornerstone of our both foreign policy and our foreign assistance. So I’m sure many people have heard about this piece of authorizing legislation, but the Water for the World Act of 2014 specifically mandates that the U.S. government have this global water strategy in place at all times, beginning in 2017 to be revised every five years through 2032. So from a government standpoint, this is extremely exciting, because this is the authorizing framework and sets the strategic framework against which we program the $435 million that you mentioned. 

So that’s a little bit about the policy context that this operates within. And what we are excited, and what’s new and different about the Global Water Strategy, is a couple things. First and foremost, we are—we have historically focused a lot on what we term hardware or infrastructure—so focusing on the toilets themselves and on the water side water points, piped water. But we are making a concerted effort under this new strategic framework to call out governance and finance and the enabling environment as something that is critical for us to be investing in over the long term, in tandem with any infrastructure. And that’s specifically because we know that there have been decades and decades of investment in infrastructure—latrines, water points—but without corresponding assistance on governance and domestic financial flows. We know that those assets can’t be sustained over the longer term. 

So that’s something— 

GUDWIN: Can I jump in and interrupt? Can you define governance in this context? Because I think some of us think about board governance, we think about political governance. What does governance look like in the context of sanitation? 

GOLDBERG: So in the context of sanitation it is typically highly fragmented as an issue. You can find sanitation managed, depending on the country that you’re in, in the ministry of health, as part of the ministry of public workers, as part of the ministry of education sometimes for WASH in schools. And so part of our technical assistance is to try and bring overarching coherence to this as an issue with different line ministries that are managing it. And in some cases, where there are the structures in place to establish regulatory frameworks that can enable the participation of the private sector, in particular. So when we’re talking about governance, we’re talking about enabling those structures to be in place that authorize and support the delivery of infrastructure in sanitation services over the long term. 

GUDWIN: Great. Great. 

GOLDBERG: And then just the other thing that I think is super important to call out about this new strategic framework is that we have intentionally disaggregated sanitation from water in our USAID plan and results framework. And we think that this is really important. As you mentioned, typically in development we talk about water and sanitation through WASH, through that acronym. And they certainly are technically interrelated, but the approaches that we need to be taking in sanitation are often very different than the approaches that we need to be taking in water. 

And you mentioned the term “improved sanitation.” But importantly, the global community has actually raised the bar even beyond improved sanitation, talking now about something called safely managed sanitation. And that gets beyond the initial access to a latrine and talks about the safe disposal and treatment of human fecal matter. And that is something that we are absolutely prioritizing and does require a little bit of a different approach. So because of that, we’ve elevated the importance of sanitation as a standalone result area that we’ll be tracking moving forward. 

GUDWIN: Great. And we’re going to come back to some of those bigger questions about financing and things through the conversation. 

GOLDBERG: Yes. 

GUDWIN: Sangita, let me—let me turn to you. So the Sustainable Development Goals call for an end to open defecation by 2030. More than half of open defecation occurs in India. Can you describe why it’s so prevalent in India? And really specifically what is unique to India that’s different from other low and low-middle income countries, particularly in other parts of Asia and sub-Saharan Africa? Why is India so different? 

VYAS: Well, in a lot of other developing countries in the world, many people in rural areas build and use simple latrines that don’t cost very much money to construct. And— 

GUDWIN: How much money are we talking about? 

VYAS: Less than $20. And, you know, the World Health Organization promotes the construction of these types of latrines because they’re an improvement on open defecation and they limit the spread of disease. And they have pits that are about three feet wide by three feet deep. And every few years or so, the latrine pit fills up and it has to be emptied manually. In rural India, manually emptying a latrine pit carries a very serious social stigma. And it’s—so this social stigma is very rooted in India’s history of caste. Caste has a lot to do with sanitation in India because historically lower-caste people have been compelled to do manual scavenging, which is manually cleaning the feces from a dry latrine every day. 

And this work is actually—it considered to be very ritually polluting in Indian society. And because lower-caste people have been compelled to do this work, they are considered to be ritually polluted in Indian society. Unfortunately— 

GUDWIN: Hence the name “untouchable.” 

VYAS: Exactly. And so these are the groups of people that have been called untouchables. Unfortunately, caste is still a very influential par of society in rural India. And so what that means is that the higher caste people don’t really want to come into contact with lower-caste people, or their work, because they think that if they do they will also become ritually polluted. So what this means for latrine use is that people don’t want to build simple pit latrines that have be emptied manually. And many rural Indians would consider it basically inconceivable to empty a latrine pit manually. At the same time, and understandably, lower-caste Indians are seeking to distance themselves from this work because it’s a symbol of their social ostracization and oppression. And for that reason, many people would prefer to defecate in the open rather than building and using simple pit latrines. 

Now, some rural Indians do build and use latrines. And those latrines have really large pits. They have pits—it’s a common refrain to hear people in villages say that they want a latrine that has a pit that’s ten feet by ten feet by ten feet. It’s essentially a very large room underground. 

GUDWIN: So just to put this into context, as opposed to? 

VYAS: A three-foot-by-three-foot latrine. 

GUDWIN: OK. 

VYAS: And it costs a lot of money to build a latrine pit that is that large. So it’s not affordable for the average rural Indian. 

GUDWIN: And they’re creating it this big because they don’t want to empty it? 

VYAS: Exactly. 

GUDWIN: Yeah. 

VYAS: So they’re constructing a latrine pit that will last a generation or longer. And so that—these ideas of ritual impurity and untouchability are really a big part of the reason why open defecation is still so prevalent in rural India and is not as big of a problem—and it’s, you know, slowly being eliminated in most other developing countries in the world. 

GUDWIN: OK. So we’re going to come back to the issue of behavior change and differences in technology in a minute, but let’s just talk about—let’s go to Jason for a moment, and talk about there are many kinds of toilets. So we were just talking about pit latrines. There’s flush, there’s squat, there’s urine-diverting. And you have developed a waterless self-contained composting toilet. Can you tell us a little bit about what was your journey to creating this better composting toilet? You’re using it for the U.S. and higher-income markets. So just take us through that journey and a little bit about what you’ve learned about bringing this new technology to market—bringing it to market in the U.S., but also in the lower-income settings where you’re working. 

KASS: Yeah, absolutely. One thing I’d like to say, first off, is there was a working draft of the title of the talk that had the word sanitation in the place where toilet is now. And I’m glad that the final version says toilet.  

GUDWIN: Keep it straight to the point. (Laughs.) 

KASS: When you say toilet, everybody knows what you’re talking about. When you say sanitation it could be garbage collection. You think of the Department of Sanitation. It’s kind of an opaque word. But if—since we’re talking toilets, we should use the word toilets. 

So my journey into self-contained composing toilets came from a very practical place. I have a cabin in Vermont. I couldn’t put in a septic system there. I did a lot of research. And I’m environmental engineer, so I just looked at all the different technologies that were available—porta-potties, chemical toilets, incineration toilets. And composting toilets were one of the waterless technologies available that have the best customer reviews. They’re the most ecological, the most sustainable. And then in that—in that realm, the spinning drum compositing toilet, that was actually originated in Scandinavia, because there they have permafrost so they can’t have flush toilets there. You can’t have a septic system because it can’t percolate. So they were very advanced in developing these sustainable, ecological composing toilets. 

GUDWIN: So a spinning drum, as in using centrifugal force? 

KASS: Good point. No. Spinning drum on its axis this way. So basically it’s—think of it, like, as a backyard composter. So if you put your veggie scraps into a backyard composter with leaves and you spin it every once in a while eventually that’s going to be become soil, and then you use that in your garden. Composting toilets act on the exact same principle except instead of veggie scraps your pooping into the drum and you’re adding in wood shavings, and then you’re spinning it, and it’s becoming—it’s become a fertilizer. And what you use it for is typically you plant ornamentals or fruit trees with it. You don’t use it for surface crops. 

So that’s the technology. Created in Scandinavia. I used it in my cabin in Vermont back in 2005. I used it for many, many years. Completely solved my toilet problem. And I was volunteering with Engineers Without Borders in 2010. And we had a project in a flood-prone area of Peru. Iquitos is the city, Belen is the informal settlement next to the city where all the town is underwater half the year. So they can’t have a pit latrine. They can’t have a flush toilet. And I proposed the idea of bringing this technology down to Peru and using local materials to replicate that very simple, elegant technology of a spinning drum inside of a box. And that’s what I’ve been doing initially through Engineers Without Borders, but then I created Toilets for People to bring that worldwide.  

So we’re trying to take an innovation from the 1960s and ’70s from Scandinavia that has been tweaked and really perfected over time, and bring that to a different environment, a different geography with, instead of permafrost problem they have a flooding problem. 

GUDWIN: So if a pit latrine’s twenty bucks, how much are you able to do the self-composting toilets for? And as you’re looking at the lower-income communities, where do you see the most potential for replication and sort of that demand and uptake of this particular technology? 

KASS: So if anyone’s really interested in buying a spinning drum composting toilet and looks online, they can run a thousand dollars to $2,000. Our toilets cost between $50-100, depending on the local market, basically, if people are able to—a lot of times we’ll make the toilets out of wood. So if they’re able to cut their wood themselves using chainsaws, and then they can get it, you know, for $50, which is very affordable and comparable to a lot of other technologies. And we’re— 

VYAS: Are you able to locally source the materials for these toilets? 

KASS: Exactly. So what we do is we bring a template with us. It’s an open-source technology. And then we find local components that are either functional equivalents of the ones we have or the same ones, if they have it. And then we build it—so it’s always a little different. And it’s adaptable. And it’s able to be maintained and fixed if ever needed because all the supply chains are local. 

GUDWIN: And so when you’re coming into a community and you’re putting these kinds of toilets in, where do you start? Are you starting in houses? Are you starting in schools? Like, where do you—where do you start? 

KASS: A lot of times it’s— 

GUDWIN: And how many do you have to do to normalize it? 

KASS: Right. So, yeah, normalizing it is really the end goal. What we are usually called in is for schools. That’s typically where there’s money and interest in getting toilet facilities for kids in school, especially if they’re being built anew. And a lot of time we’ll put in urinals for boys and pee toilets for girls, and a certain number of composting toilets that can treat both. Because a lot of times the kids just need a place to pee that’s clean and hygienic. And urine is, generally speaking, sterile. So it can go right into the ground. And pee toilets, you can make that for about $10. Very simple. And sometimes the kids wait to go home to do number-two.  

So that’s where we start. And we feel like that’s a great place for us to because then the kids see it, they get to see a toilet for the first time in their lives often, and then the parents come in for, like, PTA meetings, and they see it. And then that’s a way of getting interest and getting—triggering the community to say, oh, I could have one of these in my house.  

And then the next piece is we’ll train local craftsmen how to make the toilets for the school. And then the idea is that they would carry on—and we work through partners on location—to make more toilets and maybe make a business for themselves. And ideally what we’d like to see down the road are vocational training centers where they’re taught how to make all kinds of toilets, pit latrine toilets that are safe, that aren’t maybe enormous and difficult to engineer, and even pour/flush toilets that are going to a soak pit that isn’t so deep that it’s contaminating the groundwater, and then composting toilets, so. 

GUDWIN: So in the spirit of talking about building toilets, India’s building a hundred million of them. So, Sangita, talk to us a little bit about Modi and the Indian government. So Modi launched a campaign to build a hundred million toilets in rural areas by October of 2019. How are we doing? And if we build it, will people use it? 

VYAS: Yeah. So four years ago, in 2014, the Indian government announced a very big sanitation policy, the Swachh Bharat Mission, to eliminate open defecation—not just build a hundred million toilets, but eliminate open defecation in India. 

GUDWIN: Which means there are police in the mornings going around stopping people from going in the fields. OK, yeah. 

VYAS: That happens.  

GUDWIN: It happens. 

VYAS: So in 2014, when this was announced, about 65 to 70 percent of rural Indians defecated in the open. So that just gives you a sense of how big of a challenge this was, and still is. And so, you know, we’re four years down the line. And India’s supposed to be ODF, open defecation free, in October of this year. But what has the—what has been achieved? Well, that was a big question for my colleagues and I at r.i.c.e. And recently, we revisited households in rural north India. We originally had visited these households in 2014, just before the Swachh Bharat Mission, the sanitation campaign, started. And a big question for us was, OK, what has the SBM done on the ground? 

And so through this fieldwork, we talked to about—or we, you know, asked about the behaviors of about 10,000 people in the rural parts of four north Indian states. And so our sample—our survey results are representative of about one-fifth of India’s rural population. And what we found is that, yeah, well, the government has managed to build a whole lot of toilets. So latrine ownership increased—it basically doubled. 

GUDWIN: And these are family latrines or they’re community latrines, or both? 

VYAS: They’re family latrines, yeah. So it’s—I mean, in urban areas I think that they have been constructing community latrines, but India is still primarily rural. It’s 70 percent rural. And so most of the investment on the SBM has been in rural areas. And those have been individual household latrines. 

And so toilet ownership increased a lot, to about 70 percent of the rural—of rural households. And because of that increase in latrine ownership, there has been an acceleration in the reduction of open defecation. And that’s a good thing. But still, nevertheless, about 50 percent of the rural Indians in this area that we revisited defecate in the open. So it is still a very big problem. And many people— 

GUDWIN: So why? Why is that? 

VYAS: Because the government has been constructing latrines that are—while they are much fancier than latrines that are commonly built and used in other developing countries in the world, they are still considered to have subjectively small pits. And people are worried about emptying these pits. And so people don’t want to use them. 

GUDWIN: So it all comes back—so it doesn’t come back to—because there’s a little bit of the morning ritual, right, of—particularly for men—going out into the field, going for a walk. But it’s really tied—so, first of all, just put this into context. Put it into the context of the morning rituals. The family wakes up, and how far are they walking to— 

VYAS: People often walk about a kilometer or two away, early in the morning. And they—it’s very much a part of the rural Indian lifestyle. You wake up in the morning. You go out into the fields to defecate. You come back. You take a bath. You eat your breakfast. 

GUDWIN: So the convenience—the convenience of having it right near your home is not enough to overcome the other psychological pending trauma of having—of the emptying of the latrine pit. 

VYAS: Exactly. Yeah, that’s right. And so that’s a big part of the reason why so many people still defecate in the open, despite the fact that they’ve received a latrine from the government. Another important thing that we found in our survey was that threats and coercion were commonly used by local government officials in the process of getting households to accept these latrines. So in our survey we asked people—we asked respondents whether they were ever harassed while going to the open, whether they were ever prevented from going in the open, whether they were ever fined or threatened with a fine, whether they were ever threatened with the denial of their government benefits—like food rations or pensions for the elderly. And what we found is that over half of our respondents were aware of some form of threat or coercion happening in their village. And about 12 percent of our respondents personally experienced some threat or coercive activity. 

GUDWIN: So what you’re saying is coercive tactics aren’t working, is what you’re saying. 

VYAS: Coercive tactics aren’t working. And also, the improvement that we have seen in open defecation, the marginal improvement, is—may not be sustained because that improvement occurred through the use of threats and coercion. So once that pressure is lifted, who knows if people will continue to use these latrines. 

GUDWIN: Got it.  

OK, let me—we’re going to open up for questions in just a minute, but I want to come back to you, Jeff, and pull back up to the global level for a second. So in order to fund the water and sanitation gap—or even just the sanitation gap—the world needs $1.1 billion of—no, $114 billion of investment annually. Can you talk to us a little bit about the financing mechanisms that are being deployed and that you are working on? And really importantly what it’s like to try to spend tens and hundreds of millions of dollars at a time to get these—to make a dent in this kind of a problem. 

GOLDBERG: Yeah, it’s a—it’s a great question. And I think when you consider that figure of $114 billion per year through 2030, relative to the $435 million per year that we’re spending, it’s a sobering organizing principle for us that, you know, we do have a sizeable appropriation and budget but, relative to the need, we really need to be thinking about how we can enable and catalyze other investment towards both water and, in particular, sanitation, given how much it’s lagging behind. 

So the biggest thing that we talk a lot about is that there is actually more money available than projects. And I think that that’s—that orientation is helpful in the sense that often when we talk about the funding gap we initially go to, well, what’s the funding instrument and how can we structure those instruments to get more funding into the sector. But the true problem in the sanitation sector right now is that there’s a dearth of bankable projects. The risk is perceived as too high. And a lot of that— 

GUDWIN: And when you say bankable project, like, how big is a bankable project? Like what kind of volumes are we talking about? 

GOLDBERG: I mean that could be—so there’s—yeah, sure. So that can range anywhere from a small-medium enterprise providing the latrines that we were just talking about before. We have seen a huge uptake in private sector actors welling latrines and sanitation products, particularly in South and Southeast Asia. But then at a larger scale, it also includes private operators and manual emptiers of latrines to safely transport and treat waste. So those are larger-scale financial transactions to support the business operations of those types of private operators.  

And that gets into addressing some of those issues that we were talking about earlier, that at an individual and community level it is very, very taboo for community members to be conducting that emptying. But there is a huge private sector opportunity to be had in professionalizing those services. So when we’re looking at financial transactions, our primary role within USAID, when we’re looking at this particular space of financing, is how we can help de-risk—whether it’s a small-medium enterprise or a larger private operator, or even a public utility in an urban area that is providing sanitation services, and making sure that they have a business plan in place so that they can approach a commercial bank or an impact investor to be able to secure more resources. 

So our role, as we see it, relative to this large funding gap, is to really serve as kind of an interlocutor between the private sanitation operators, enterprises, and larger utilities that need access to capital to be able to expand their services. But it really is kind of starting with those core fundamentals of if you’re serving X number of people and charging $20 a latrine, how many—what’s the volume of sales that you need to be selling in a business plan such that if that small-medium enterprises pitches that to a commercial bank that it’s viewed as a bankable opportunity. 

GUDWIN: Great. Thank you for that. 

OK, questions. There are—please wait for the mic. And if you could, stand, state your name and affiliation. 

Sir. 

Q: Larry Bridwell, Pace University. 

I’ve been told, but I don’t know if it’s accurate or not, that one of the great challenges facing India, so this question is directed to Sangita Vyas, is that thirteen-fourteen-year-old girls don’t want to go to school because they don’t have proper sanitation facilities. So I—could you address that issue? 

VYAS: Yeah. So sanitation in schools is an important issue. I think now it is the case that most schools in India do have some kind of toilet. But unfortunately, having a toilet is different from that toilet being able to be used. So many of those toilets, in my own fieldwork in rural north India, I’ve seen many rural schools have toilets that are locked. And I think a big issue with toilets in schools, particularly in India, again, goes back to this issue of caste. Cleaning a toilet is something that caste Indians would not want to themselves do. And so when—if a toilet in a school is used, then there is a problem, you know, a few weeks later when the toilet needs to be cleaned and maintained and— 

GUDWIN: Can we talk about the—what you were talking about, which is that there are some toilets that have two pits by design, to try to—how many of those schools are using double-pit toilets, and what’s the opportunity there? 

VYAS: I think a lot of the—I’m not sure. But I believe that a lot of the school toilets are—they probably have septic tanks. So the issue is less about the cleaning of the pit, and more about just maintaining the—yeah, maintaining the room where the toilet actually is, so that that area stays clean. And, you know, historically—well, not too long ago, it was the case that maintaining—you know, cleaning the school, cleaning the school room, cleaning potentially a toilet if the school had a toilet, was something—was a task that was given to any lower-caste students who were in the school. And that is slowly changing. And I would not want that—I wouldn’t want to go back in history and have that continue. So there—you know, I think that, again, it goes back to this issue of people’s beliefs in ritual purity. And that’s an important part of not just household sanitation but also toilets in schools and in other public places too. 

GUDWIN: And just while we’re talking about schools, it’s probably worth mentioning that the standard is to deworm children every six months because of the high level of soil-transmitted helminths, so worms in the belly, which is directly linked to the open defecation issue. 

VYAS: Right. So when people defecate in the open then there’s feces in the environment. And because many people—because, you know, even rural India is still so densely populated that even if you’re going in the open, flies go sit on the feces that’s out in the open and then comes back and sits on people’s food, sits on their hands, and sits on water, et cetera, that is supposed to be meant for drinking. So there is just a high disease burden in this environment. And that’s really bad for children. So open defecation has been—has been linked to child development.  

So children who grow up in places where there is a higher density of open defecation are shorter than children who grow up in areas where there’s a lower density of open defecation. And that’s because the mechanism here is that, you know, when people are exposed to these harmful bacteria they get sick, either through worms, they get diarrhea, they have diseases that don’t necessarily manifest as either worms or diarrhea but prevent nutrients from being absorbed by the gut. And so basically what that means is that the food that a child is eating is not going towards developing physically and developing cognitively. It’s being lost to disease. And that prevents children from growing as tall as they—you know, as their genetic potential.  

GUDWIN: Right. So you get widespread stunting. 

Let me keep going with questions. In the back of the room there was a question. And then I’ll—and then I’ll let you jump in, Jason. 

Q: Hi. My name is Gopal. 

I grew up in India and I’ve done a project in the urban area in India, in Mumbai. I did, like, a year-long project about sanitation in slums. The same numbers you talked about. So in urban areas it’s more damaging than the rural, because 60 percent of the urban population lives in slums. You won’t believe it. And slums cannot afford to have a single toilet per home. You have to have a community toilet. And the government does build toilets but, you know, if you take the caste stigma and decouple that from caste—so what we found was most of these toilets were not maintained. The maintenance was a problem because, one, they could not be—there won’t be a water supply. Or the—as you said, the stigma around, you know, we’ve been defecating in the open for so long, I’ll just keep continuing going to the—it’s mostly the railway tracks. Like, Mumbai has these trains—train networks now. That’s where most people go. And they don’t have a lot of—and it’s a lot of population concentrated in a very few place—very—I mean, a very highly dense area, right? 

But that’s one of the things we found. And one of the—one of the concepts they kind of introduced—I mean, this was ten years back and I haven’t been in touch. But they kind of formed, like, a community—kind of like an HOA, so that’s what I can relate it to. It’s kind of like an association for slums, slum owners. You know, you maintain this toilet. And, you know, it worked, like, to an extent of 50 percent. But, no, I want to understand your thought behind how would you solve this in an urban area? Because with climate change I’ve been seeing that most of the population have been moving to the urban areas. And there’s no—a lot of—there’s not really any farming activity in India. And most the farmers are in debt. No, it’s—eventually they have to move to urban areas. You know, that’s—it’s kind of part of the—an inevitable part of the climate migration, right? So what kind of strategies are you following? And hearing about a waterless toilet might be a solution. But I want to hear from you what are the solutions for— 

GUDWIN: Jeff, do you want to jump in there, and then Jason, do you want— 

GOLDBERG: Yeah. I’m happy to jump in. And it’s actually—so, in talking about the Swachh Bharat campaign, we’ve talked a lot about the rural side of the equation. But USAID has partnered with the government of India through the Ministry of Housing and Urban Affairs specifically to tackle the urban side of the open defecation problem, and this very ambitious target. And so to your question on different types of urban approaches, you know, toilet maintenance is absolutely part of the equation, and it’s something that we’re looking at. But I alluded to this in the beginning, the larger problem that is happening is that as these latrines fill up in densely populated slums there is no system in place for fecal sludge management, or septage management. There’s a complete absence of sewers there.  

And there’s been a lot of very interesting research that our partners at the Gates Foundation have undertaken, costing out that over the longer-term in densely-populated slum areas it would be far more expensive to install sewers than to address what we call on-site sanitation, or management of the fecal sludge from the toilet through manual emptying and desludging. So that is something that we have very, very actively been in partnership with the Gates Foundation and the government of India pushing, is different approaches for fecal sludge management or non-sewered options to sanitation. And really there, is what I was alluding to, is the private sector as a critical partner in that to be able to look at professionalized ways for desludging that are safe as well. There’s a lot of occupational safety issues involved with this. So that’s a particular area that we have been partnering with the government of India on, and we’re quite excited about. 

GUDWIN: And, Jason, do you want to jump in also on the issue of private versus block latrines? So in an urban area, or in a refugee camp setting, or in sort of, like, post-earthquake Haiti, there was a lot conversation about do you build a community latrine, do you build a block latrine and give it to a set of a families with a key? You know, what’s been your experience? 

KASS: Yeah. I just wanted to backtrack a little bit to talk about—it’s not in the India context necessarily, but we do a lot of work in Peru, and Haiti, and girls in school not having a place to go to the bathroom. There’s some very simple interventions that I alluded to before, like having a pee toilet. A place where they just need to pee, a place where they could change their pads, a place that’s pleasant, that’s private, that has a mirror, that has a door that has a lock on it. And those—having that available to them means that they’re going to be more likely to drink water during the day, because a lot of girls don’t drink water because they know there’s no place to pee, so they become dehydrated, which impacts their ability to pay attention. It also increases urinary tract infections, and with kidney damage. So very simple interventions like that can really help girls feel more comfortable going to school, and also drink water and take care of themselves in the way that they need to. So that’s one aspect of that. 

In terms of informal settlements in the urban context, we really advocate for family-scale toilets. In particular, we have a dry composting toilet. And we see that as being more advantageous than public toilets for obvious reasons that public toilets just usually fall into disrepair, just like they do here. If somebody’s not taking care of a toilet, whether it’s at Starbucks or at a gas station, it becomes pretty foul pretty quickly. And you could understand why somebody also might prefer to open defecate as opposed to use a facility like that, because it’s disgusting. And so that’s part of the problem. And it’s hard to upkeep those public toilets, because you have to pay somebody to do it, and it rapidly gets out of control. It’s, like, a tragedy of the commons kind of situation. 

So whether it’s an informal settlement or you were mentioning refugee camps, a lot of times the stock approach is to have a toilet block in the corner of the camp where everybody goes, but a lot of these camps people might be living in for many years. Seventeen years is an average that I’ve heard in terms of how long they’ll be there. So as quickly as possible if you can get private family-scale toilets to folks that are in these settings, they’re going to be better maintained because they’re going to be maintained by the people that are using them, and not be public toilets. And also, those areas of the camp end up being areas that become dangerous, where it’s just unsafe to go there, especially for kids or for women. So we want to try to see if there’s a way we can shift that approach to have more of those close-to-home toilets that aren’t so dangerous and scary. 

GUDWIN: Great. Come down there and then go back. 

Q: Bonnie Potter. I manage a small family foundation with funds in East Africa and West Africa. 

So I’m just a little confused because we talked about all the different kinds of toilets there are, and yet you seem to use the term interchangeably for a lot of different kinds of toilets. So is there a particular kind of toilet we’re talking about when you talk about toilets in schools or toilets in families, or whatever. Or could you just clarify that? 

KASS: Yeah. Well, I mean, I think—I think a big differentiator between toilets is you have toilets where they’re water based. And a lot of times if they have—if they’re going to, like, a septic take they’ll break down anaerobically, which makes the sewer smell, and then the toilets we make are aerobic composing toilets. So those are two different kinds. But essentially if the standard toilet is a pit latrine, which is a hole in the ground. And a lot of people want to get flush toilets, but a lot of times there’s a no place for that toilet—that water to go, so that becomes more—it might go right into the river. It’s not going to go to a wastewater treatment plant because those are too expensive. So those are two of the more popular ones. And then the composting toilets is another one. 

GOLDBERG: Yeah, I might just—is there another question? 

Q: So when you all are talking about toilets, you’re mostly talking about latrines? 

GUDWIN: Yeah, we’re mostly not—we’re mostly not talking flushable. 

VYAS: Well— 

KASS: Yeah, but one way of coupling—the composting toilets can be used in conjunction with pit latrines. A lot of times the problem with pit latrines is they’re open, so a lot of trash goes in there. And they fill up quickly unnecessarily. A composting toilet is maybe situated above that pit latrine, so this is where you can bring two technologies together, it’ll pre-compost the waste so that it will fall into the pit, and it’ll—instead of emptying it every five years you can maybe get ten years out of that pit or more. So it might alleviate some of the trauma and fear about it filling up too early. Also, you can’t get garbage in there because you have this interface. So there’s ways of making pit latrines more effective and getting more longevity out of them. So it’s nuanced in terms of the technologies could come together and be combined. 

GUDWIN: And, Jeff, do you want to jump in? 

GOLDBERG: I might just—yeah, sure. Just from—I thought it might be helpful from kind of a donor agency perspective when we look at this. We are a little bit more technology agnostic. And we go to what you referred to in your introduction, Ella, about that definition what is either an improved or basic latrine. So the standard setting internationally for toilets is conducted by UNICEF and the World Health Organization, something called the Joint Monitoring Program. And they have something called the Sanitation Service Ladder. And that goes all the way from the bottom, which is open defecation, to open defecation free, to an improved or basic latrine—which is simply just defined as a latrine that hygienically separates human feces from exposure to the user. And so what we have been talking about here is a range of technological options that fit within that category of improved. And that—on our side, it absolutely does include flush latrines, but it also can be a simple lined pit latrine with a slab that hygienically separates the excreta from human exposure. So the way that we track our results across— 

GUDWIN: And, Jeff, can I just ask— 

GOLDBERG: Sure. 

GUDWIN: Can I jump in and ask? One of the other important things that has been added to the pit latrine, if I’m not mistaken, is somebody has come up with a lever that will actually close the latrine after it’s been used, so that the flies don’t go in. I think that’s one of the important relatively recent changes to a standard pit latrine, to prevent the flies. 

GOLDBERG: Yeah, that certainly exists. It certainly depends on the context too, I mean, depending on what country you’re in. But we are seeing more of that. 

GUDWIN: Yeah, great. Two over here. Let’s do—let’s do a double. 

Q: Hi. Rachel Robbins, formerly with IFC of the World Bank Group. 

So, Jeffrey, your toilet sounds like a vast improvement not only over open defecation but even the pit latrines, with all the improvements But, $100 or even $50 is expensive for a lot of the developing world. So my question to you, and to Jason is, is there a prototype of financing—because I agree that you absolutely need the private sector to close this funding gap—s there is an example that you’ve seen, whether it’s a blended finance model that brings in soft capital, private sector, international money, to make these more affordable? 

GUDWIN: Great. And we’ll just pick up a second question, and then we’ll answer both. 

Q: Thank you very much. Robert Scott, Adelphi University. 

It seems to me this is not an issue of toilets or technology, but it’s a matter of behavior influenced by cultural norms. So what are the ways in which the government or other organizations are approaching the populations in discussion of an exchange of values? These are the cultural values you have in this behavior, and here are consequences. A change in the behavior can result in, in fact, improved values—having to do with education, and growth, et cetera. So what are the cultural approaches being taken? There’s lots of technology and lots of toilets. The issue is human behavior. 

GUDWIN: OK, great. So we’ll start with financing and then we’ll go to behavior. Jason, do you want to start? 

KASS: Sure. I would say in terms of—yeah, $50 is too expensive for a lot of the communities we work with, where people are making a dollar or two dollars a day. So what we ask is that the family come up with two weeks’ salary, two weeks’ pay, that they have a number of months to save for, and so that—if they make a dollar a day, that might be, you know, $10. And then the partner that we work with will subsidize the difference in order to help them get a toilet. And then we can also work with them in terms of if they have materials they can donate in the construction of the toilet. We also ask them to build the structure that’s going to house the toilet, because they know how to do that and they have the resources to do that. Usually they built their own home. So in those two ways we’re able to make it affordable and accessible to pretty much anybody. 

But what we don’t want to do is make it free, then by definition it has no value and they’re not going to value it. And also it’s a good litmus test to see if they really want a toilet. If somebody—you know, if I have something free everybody’s hand goes up. I want one, I want one. Well, if it’s $10, then you get maybe half the hands going up. And that’s an important way of—you know, you were talking about the second question in terms of changing the culture. Sometimes it’s getting those first adopters to get toilets, and then people see other folks with toilets, and then they say, oh, the new person on the block has a private toilet. They don’t have to go to the toilet block. That can be a way of behavior change.  

And then the other way I would say is with—starting with women and girls, and children in general. Men, generally speaking, might be completely comfortable with open defecation. But in our experience, at least in Latin America, a lot of the mothers really want a private toilet, because it takes a lot of effort for them to bring the kids to the public latrine or to the fields and taking care of the elderly folks that are in the community. So if you start with them, they are the change makers. And the men might lag behind and eventually catch up, but I think that’s another way of solving that issue. 

GUDWIN: Jeff, do you want to jump in on the financing question? And then, Sangita, let’s come back to the values exchange. 

GOLDBERG: Yeah, sure. The financing question is a great one. And you’re absolutely right that, you know, anywhere from $20 to $50 to $100, depending where you’re working, can be prohibitive for households to actually purchase a latrine. So we actually have experience deploying a range of different types of financing options. We have had some of our implementing partners directly brokering relationships with microfinance institutions. So at the point of sale of a latrine credit is offered on the spot as well. And there’s been a lot of strong lessons learned there about needing to work directly with the microfinance institution to have a dedicated loan product for water and sanitation. We’ve worked a lot with a partner, Water.org, on that in particular. But in addition to microfinance, we’ve worked with village savings and loans groups. It doesn’t actually have to be through a formal financial institution. So there’s things like household revolving funds that can be used to allocate money towards sanitation.  

And then lastly, an important piece of new research that we have been tracking is looking at vouchers for poor households. So in Cambodia in particular, there is a system in place where there’s already a national identification program for households that are living below the poverty line that is IDPoor 1 and IDPoor 2. And we are working there through that private sector approach that I mentioned earlier, where we are having small-medium enterprises sell latrines. But upon successful delivery of the latrine to a household that is IDPoor 1 or IDPoor 2 there’s a voucher and renumeration that can happen to bring the cost of that down for the households. That keeps the quality side for the private sector but does allow a targeted subsidy to households that need it most. So those are just some innovations, but it’s an excellent question. 

I did have one point on the behavior and cultural norms side of things, because I think that that’s a huge, huge part of this, and really can’t be overlooked. And so anytime that we are doing sanitation programming, we are always doing baseline work on knowledge, attitudes, and practices at the community level. And while this isn’t true across the board, you know, some of the work that we’ve done in Southeast Asia in particular has been very, very eye-opening in the sense that when we talk about sanitation from a development perspective, we think of the health outcomes as being the most important part.  

But we have found through those surveys that households do not really respond very well to health messaging. It’s more of sanitation being an aspirational product that is something that they want to aspire to due to social status. It’s kind of like the equivalent of how we would think of a nice car here in the U.S. So developing and tailoring that kind of messaging in tandem with promotion of latrine adoption has been hugely successful there. And it’s highly context-dependent. But just in terms of those behavior and cultural norms, I think there are some core assumptions that we need to check ourselves as development professionals, because the communities that we see to work with don’t necessarily view it the same way.  

GUDWIN: Great. So we just have a couple minutes left. I think there were some other questions. Yeah, sir. 

Q: Charles Henderson at AIG. 

Regarding, Jason, your toilets, would they be adaptable to places like India, or are we going to run into the same problem about the waste issue? And if that’s not adaptable, how do you confront the waste issue? It seems to me that the program that’s being involved now only reduced it from 65 to 50 percent. And you’re still faced with that particular waste issue. Until you get that stigma, that waste issue addressed, you’re still going to have that problem. 

GUDWIN: While you’re talking about that, can you also mention what’s going on with the group SOIL? Yeah. 

KASS: Yeah, absolutely. So I think the—in terms of adapting it to the India context, one is that it’s a squatting culture as opposed to a sitting culture, so making it so that there’s a place you can step up, and having a place for the wash water, because they clean with water as opposed to with toilet paper. So there’s some modifications—technological modifications. And those are some of the things that we do on the ground, on location to make it appropriate in that context, using local materials and local labor. So that’s one way of adapting the technology to the India context. 

In terms of emptying one solution could be, like we were saying before, in terms of it’s built above a pit that’s otherwise being used because they’re afraid it’s going to fill up, it could—the waste could then just fall into the pit and it would fill up much slower. So that’s one way of addressing that issue. The other is that the actual handling of the waste can be very dangerous if you’re a pit latrine emptier and you have to get into the pit. Jeff was talking before about just health and safety issues are a real concern. It’s dangerous work. Whereas, we try to make our emptying of the contain as hygienic and simple as possible. It doesn’t weight any more than twenty pounds when it’s full. There’s a lid. It’s a plastic—like a busboy container. So it can be collected.  

And, like you were saying before, one model of that is in Haiti. There’s a great organization called SOIL, where they do collection of waste in containers, they bring it to a central processing facility where they can render compost that can become fertilizer, and then be sold as a product. And they’re also doing that in Kenya, Sanivation, Sangery are some other examples. And that takes away the stigma—there can be a company that’s created to collect that waste. And those entrepreneurs are doing that work, as opposed to—it’s a way of getting around the cultural issues, by making it into a business. It’s a business opportunity. And you’re not actually coming into contact with the waste, because it’s all in a container and with a lid on it. So those are some of the ways that we are looking to try to address that. 

GUDWIN: All right. I think we’re going to sneak in one last question. 

Q: I was raised in Dutchess County and had a pit latrine in school until the fourth grade. And I can tell Bob Scott that from a cultural point of view when indoor plumbing came it was a wonderful period of time in my education. (Laughter.) So do not undervalue the cultural aspects. And I must say, I never thought that this issue would come up at the Council. (Laughter.) 

GUDWIN: Well, Sangita, do you want to just close on any final thought about the—particularly knowing that October is coming, all of these latrines are being built, what is the campaign message? What works? 

VYAS: Well, I think it’s important to recognize that, yes, October 2019 is coming, but India isn’t going to be open defecation free then. And so as we think about what India’s future sanitation policy should look at, we should really take heed of the cultural issues. And I wish that I could sit here now and say that, well, I have a silver bullet to solve India’s cultural issues relating to ritual purity and caste, but I don’t. I think a lot more research and experimentation needs to happen. And that’s what we should be putting money into.  

There are a number of projects that are currently underway as we are speaking that are experimenting with different behavioral messages around latrine pits, around pit emptying, around how it’s not an impure thing to do. And I am, you know, very excited to hear about the results of those. And hopefully that takes us a step further in understanding what are the strategies, the behavioral strategies, that we can start implementing on the ground in rural India to try to convince rural Indians that simple latrines are worth using and having. 

GUDWIN: Great. Thank you. 

KASS: Just in the spirit of innovating and experimenting and talking about staying technology agnostic, as Jeff was talking about, really having—trying to find funding for vocational training centers, where they teach all kinds of toilet technologies, because in different situations different things are applicable. And have incubators for these kinds of experimenting and innovations to take place is critical. And we have those here. I mean, Toilets for People grew out of makerspace. And having those kinds of vocational training spaces where there are tools available and support are critical, no matter what technology is going to be used. 

GUDWIN: Great. Well, thank you.  

Join me in thanking Jeff Goldberg, Jason Kass, and Sangita Vyas. Thank you very much. (Applause.) Thanks for coming. 

(END)

Top Stories on CFR

Sanctions

For many policymakers, economic sanctions have become the tool of choice to respond to major geopolitical challenges such as terrorism and conflict.

China

The Trump administration has declared China a currency manipulator, but what that means for the ongoing trade war is far from clear.

Women and Economic Growth

The education gender gap costs the world between $15 trillion and $30 trillion in human capital. U.S. aid programs need to equip girls and women to participate in the modern digital economy.