Over the years, the National Family Health Surveys (NFHS) have become a major source of data, producing a wide range of indicators on people’s demographics, health, nutrition, and socioeconomic status. The technical and resource support provided by national and international agencies allows the NFHS to be ambitious in its coverage of topics and attempts to meet the expectations of all stakeholders. The recently conducted NFHS-5 (2019-2020) gathered information from around 6.4 lakh households. This is far beyond what the NSSO or any other national survey usually covers. With such a large sample size, it legitimately claims to be able to produce reliable estimates even at the district level.
Survey agencies generally try to collect as much data as possible, not only to satisfy funding agencies, but also to meet the interests of a growing community of data users. ‘When the numbers hide’, IE, 8 December). We now look at another set of household sanitation indicators.
Sanitation practices are indeed the most influential on family health and the collection of such data is essential to understand the sanitation behavior of people. Fortunately, sanitation has also been studied in a special series of surveys conducted by the Ministry of Drinking Water and Sanitation and the most recent results come from its annual National Rural Sanitation Survey ( NARSS) Round-3 (2019-20). We also had an NSSO survey of sanitation and housing conditions in 2018. It will be interesting to situate the findings of NFHS-5 with government claims on sanitation for two reasons: how well NFHS-5 matches to the NARSS sponsored by the implementing ministry and whether the government’s rejection of a previous NSSO investigation stands up to scrutiny.
Sanitation related indicators have become of immense importance in the context of the Swachh Bharat (SBM) mission. All villages, gram panchayats, districts, states and union territories in India have declared themselves Open Defecation Free (ODF) by October 2, 2019, constructing over 100 million toilets in rural India. The government is now moving towards the next phase II of SBMG to strengthen ODF behaviors and focus on providing interventions for the safe management of solid and liquid waste in the villages.
The NFHS collects very detailed sanitation data from surveyed households. These include the type of toilet used, its location, access, sharing and drainage system. Usually in surveys, collecting visible and verifiable physical information has the advantage of fewer response errors, unlike quantitative information and any omission of homeless or marginalized households can only lead to the presentation of a enhanced image rather than dark. It is in this context that we examine the NFHS findings on sanitation.
An improved sanitation facility in NFHS means having any type of emptying facility, pit latrine or one that is not shared with any other household. The NARSS, however, is aligned with the SBM and is implemented by private agencies for the express purpose of deriving disbursement-linked indicators (DLIs). The NARSS thus measures each state’s performance against the DLIs and survey components included a household sample survey and a village survey. DLI 1 focuses on reducing the prevalence of open defecation. The indicator is based on the rural population with access to sanitation facilities and their use determined on the basis of access to toilets, functionality of toilets, mechanism for safe disposal of human excreta, condition of toilet hygiene and safe disposal of children’s faeces. DLI 2 measures the rural population of ODF villages with sustained ODF status. This is calculated on the basis of households having access to and using toilets, in addition to the use of toilets in schools and public places and the absence of visible faeces in the vicinity of the village and places historically used for defecation at the open air. Estimates of improved sanitation and population living in ODF villages are therefore comparable to the DLI published by NARSS.
So far, only a few detailed status reports are available from the NFHS. However, we have fact sheets that give key indicators for all states and at the level of all India. The percentage of the rural population with improved sanitation is low for many states. For states for which detailed reports are in the public domain, in addition to the percentage of the population without improved sanitation, we also have the percentage using no sanitation facilities and using open spaces or fields. The NARSS paints a very optimistic picture of the achievements of the SBM. With the exception of Kerala, where all indicators converge, we observe that the NFHS findings strongly challenge the claimed sanitation achievements for most of the other states. The ONSS had conducted a survey from July to December 2018 on drinking water, sanitation, hygiene, etc. It had reported that 71.3% of households had access to a latrine, which is well below the 93.3% figure in the 2018-19 NARSS. Although the ONSS findings showed a great improvement in sanitation practices in rural areas, these findings were not accepted by officials who then pointed to the possibility that the ONSS respondents under -report access to toilets to take advantage of government program benefits.
If one were to accept the official assertions, the NFHS-5 findings, while partially available, clearly indicate the need to reinforce the behavior change that the government plans to sustain during SBM Phase II. These results also underscore the need to validate administrative data through independent sample surveys.
This column first appeared in the print edition of January 20, 2022 under the title “Sanitation reality check”. The author is the former acting president of the National Statistics Commission.