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Dr Kamal Kar’s rural sanitation model is being followed in 39 countries around the world and has been adopted by the World Bank, UNICEF and Water Aid By Archisman Dinda

clean-up-1In the early part of the last decade, in a godforsaken village in Gujarat, Dr Kamal Kar, a specialist in livestock production, agriculture and natural resources by training with special interest in social and participatory development, had a chance encounter with a man that would change the face of sanitation in major parts of the developing world. The villager told Dr Kar that while his house was worth a few thousand Indian Rupees, the toilet that the government had built for him was worth 12,000 Indian Rupees. It was his costliest asset. The very idea of using it as a place to defecate, he told Dr Kar, was repulsive to him.
“Though this may sound quite unnatural, the person was actually giving me a lesson in human psychology. It is natural for anyone to protect and safeguard his costliest asset and keep it clean. Now if his toilet is his costliest asset, how can he do his dirty job there,” says Dr Kar as he travels down the memory lane.
Dr Kar has been looking into the way a large part of the world goes about its dirty job for well over a decade. Lack of sanitation is a pressing global problem. Over 2.6 billion people in countries such as India, Brazil and Vietnam do not have access to a toilet. They defecate in the open. Over 600 million people in India make do without basic sanitation and the diminutive Kar will sardonically tell you that Indians have more mobile phone connections than latrines. Plus only 53 per cent of the country’s urban households, with a quarter of the urban population living in slums, has access to hygienic sanitation facilities.127-page So it is not entirely surprising, as faeces is a carrier of disease, diseases such as cholera and diarrhoea kill 42 children every hour in India and around 1.8 million every year in developing nations. The encounter in Gujarat reinforced a simple truth: subsidy and sanitation don’t go together.
Dr Kar started his life as an agricultural scientist, with specialisation in livestock production and natural resources. However, his personal interest was in participatory development in agriculture and he actually drifted into the field of sanitation in 1999 when he was asked by British NGO Water Aid to evaluate their sanitation project in Bangladesh.
“Though I was not a sanitation expert, I was leading the team, trying to figure the success of that campaign which was building subsidised sanitary systems. What was striking that in spite of building free or highly subsidised latrines for the poor, the habit of open defecation still continued,” says Dr Kar. His primary suggestion to Water Aid was to initiate a programme and develop a differential subsidy programme based on poverty levels. Later as he delved further into the subject and journeyed across Bangladesh, he recommended the total withdrawal of subsidies.
clean-up-3“This recommendation fell like a bomb on the people who were leading World Aid. The basic conjecture that people all over the world make is that people defecate in the open just because they are poor and unable to build toilets. But that is certainly not true. People talking on their mobile phones while defecating in the open is not an uncommon sight in India today. That phone is probably worth a few thousand rupees. So, poverty is certainly not the issue,” he says. “In one village in Maharashtra, I found that the toilet that a villager had built with government subsidy is being used as a temple. People continue with their unhealthy habits primarily because there is no awareness about the ill effects of open defecation and, most importantly, due to lack of peer pressure. On the contrary, subsidy actually hinders the collective decision making process,” adds Dr Kar. Participatory development, says the man of 59 years, teaches scientists about how to modify their research so that it becomes acceptable to the end user. “When I used to work as director of International Centre for Development Oriented Research in Agriculture, I noticed that major inventions in the field of agriculture were not accepted by the users (farmers) for reasons which were not known to scientists. Development or scientific breakthroughs with the participation of the end user is very critical to the success of any programme.” This understanding of how society works led to the germination of the idea that is now globally known as Community-Led Total Sanitation (CLTS). Dr Kar’s approach to dealing with open defecation has now been adopted by global bodies such as the World Bank, UNICEF and Water Aid.
CLTS focuses on behavioural change needed to ensure real and sustainable improvements – investing in mobilising the community instead of hardware, and shifting the focus from toilet construction for individual households to the creation of “open defecation-free” villages. It seeks to raise awareness that as long as even one individual continues to defecate in the open, everyone in the village is at the risk of catching a disease. CLTS triggers the community’s desire for change. CLTS starts with ‘triggering’, which is what Dr Kar calls the facilitated process that includes community meetings, exercises that illustrate the faecal-oral contamination route and mapping.128-page In the latter, a simple map of the village is drawn, usually on the ground, and each household is asked to locate their homes and where they go for defecation. The map highlights, among other things, how people defecate virtually on each other’s doorstep and the risk of contamination of water sources. Each time Dr Kar takes off for Africa, Asia or South America, he hopes that the ‘triggering’ in the villages there will eventually lead to an ‘ignition point’ which is when the villagers realise that due to open defecation, a majority of them have been ingesting each other’s faeces.
Dr Kar’s first success came in Mosmoil in Bangladesh in 2000. “It was as if the community was waiting for us to come and trigger the self consciousness in them.” After going through the participatory analysis conducted by Dr Kar on behalf on Water Aid, Mohammed Mansur Khan, a resident of the village, told him, “We are all poor. But after learning that we are eating each other’s shit, if we don’t stop this, we cannot call ourselves human.” A few months later, Mosmoil became the first village in Bangladesh to be free of open defecation. “Once this mixture of shame, disgust and fear of disease sets in a community, they themselves take on the task of stopping open defecation. It is not possible for any organisation irrespective of its size to monitor people’s behaviour at such a micro level. Only peer pressure can ensure complete success,” says the man.
clean-up-4One of Dr Kar’s next aims is to reach out to the Indian Railways, which he considers the world’s largest toilet. “Even when you and I travel even in AC first class, we actually practice open defecation from the precincts of the cabin. The faeces actually fall on the track. The government is actually teaching people to defecate by the side of the railway track, which is a common sight all over India. Nowhere in the world, has any railways used such a system,” Dr Kar says in disgust.
Since 2000, CLTS has spread to South East Asia, Latin America, West Asia, Cambodia, Indonesia, Africa and Pakistan. States such as Haryana, Himachal Pradesh, Gujarat, and Maharashtra, says Dr Kar, are keen on implementing CLTS as their primary approach towards sanitation.
Two years back, Kalyani in West Bengal was declared the first opendefecation free municipality in the country. And even though he is happy with the global success of his grassroots approach to sanitation, he would be a lot gladder if he could get his own country to attain opendefecation free status. “It’s simple,” says Kar, “sort India out and you free two-thirds of the world from this problem.”129-page Dr Kamal Kar spends much of his time thinking about something that many of us would rather not: where and how people poop. It’s not pretty. But neither is the stark reality that waterborne diseases such as typhoid and cholera kill millions every year. That’s why Dr Kar is different.
“Sanitation is about people, not pipes,” he says: “It’s not a question of counting the number of toilets.” Once toilets and sewers are built, getting communities to use them is often a tougher challenge. He suggests such pressure tactics as giving children whistles to blow whenever they spot someone defecating outside.
And it works. After Bangladesh has adopted Dr Kar’s ideas, latrine coverage has jumped from just 33 per cent in 2003 to more than 70 per cent today. His “community-led total sanitation” method is now at work in 39 countries around the world.

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