Public Health Benefits and Challenges under the Scheme “Swachh Bharat Abhiyan”

Dear Editor, The Swachh Bharat Abhiyan (SBA) program was launched by the Government of India in 2014 in phases till 2025.[1] Although evidence of knowledge and positive perception toward cleanliness exists, the behavior change needs stringent actions, cultural acceptance, and more real-time interventions. SBA aims at preventive care in terms of maintaining cleanliness, one of the elements of primary health care that could be continued as “Jan Abhiyan” to achieve the intended objectives of the program.[2] SBA substantially led to the upgradation of sanity, with 6.02 lakh villages, 711 districts in the rural category, and 4,360 cities (98% of total Indian cities) achieving Open Defecation Free (ODF) status. Likewise, 2,187 cities (49%) achieved ODF+ status and 551 cities (12%) attained ODF++ status. For the next phase, the focus is on sustaining and maintaining the constructed toilets (ODF+) and emphasizing sludge and septage management (ODF++).[3] The present article discussed the people’s perceptions, challenges, and possible solutions to it, through a qualitative approach among the 30 rural families of the field practice area of a tertiary health care center in coastal Andhra Pradesh. Although the majority had access to sanitary latrines, utilization was low. They were satisfied with the SBA program with an average rating of 3.2. A survey conducted by Research Institute for Compassionate Economics has indicated that 40% of surveyed households in the States of Haryana, Rajasthan, Uttar Pradesh, Madhya Pradesh, and Bihar had a latrine, still at least 1 person in such household defecating in the open. This study confirms that just building toilets without focusing on behavior change is not going to be enough, people need to realize the association between good health and the use of toilets through a large-scale campaign to promote latrine use.[4] The thematic analysis identified the challenges along with possible solutions to overcome them. The challenges in terms of internal factors were old habits, cultural beliefs, unawareness, illiteracy, and ignorance and external factors identified were defective construction, lack of water facilities and electricity in toilets, a communication gap, and inadequate staff and infrastructures, whereas suggested solutions were stringent laws and regulations, accountability and more responsibility on people, awareness campaigns, health education, certification, recognition, cash incentives, construction of an underground drainage system, more honest political commitment, regular and uninterrupted delivery of services, a system of feedback or complain booths in every corner of the street, recruitment of more part-or full-time staff/sanitary workers, and incorporation of technology and innovations [Figure 1]. Another study found similar challenges necessitating prioritization of sanitation-related behavioral change and improvement in toilet facilities to eventually accelerate universal accessibility to sanitation and meet Sustainable Development Goals. Meanwhile, the reasons for the non-usage of toilets must be addressed, along with an independent credible robust monitoring tool to measure the sanitation progress.[5]Figure 1: Thematic map on challenges and solutions.SBA could serve as the game changer in the Indian context provided challenges faced at each level and each person is being addressed along with minimizing the gap between awareness of service provision and utilization. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.