Nov 15 2014 : The Times of India (Delhi) How Swachh Bharat Can Succeed Arvind Panagariya   It must pass through the thickets of reform and attention to public health Of the numerous initiatives that Prime Minister Narendra Modi has launched Swachh Bharat Abhiyaan, which would give Mahatma Gandhi the gift of a clean India on his 150th birth anniversary on October 2, 2019, has the greatest potential to transform the lives of all Indians ­ rich and poor. Sanitation has been the theme of virtually every government in recent times. Prime Minister Rajiv Gandhi had launched the Central Rural Sanitation Programme in 1986 and Prime Minister Atal Bihari Vajpayee the Complete Sanitation Campaign in 1999. But no previous government has shown the resolve and commitment exhibited by Modi. This time it feels real.Till date, sweeping streets and ending open defecation have occupied media centre stage. But equally critical to Swachh Bharat are access to piped water; well-functioning drainage, sewage and solid waste management in all cities and villages; elimination of ponds in which stagnant water collects and serves as host to bacteria and mosquitoes; instilling greater appreciation of cleanliness in all its aspects among the masses. Indeed, taking the campaign to its logical conclusion would require replacing slums with more spacious housing having piped water delivery and modern sewage facilities. The campaign faces formidable financial and implementation challenges.Financially , the government will easily need 2-3% of GDP annually till the target date. There are only four avenues to mobilising such vast resources: increases in revenues made possible by accelerated growth; cuts in middle-class subsidies such as for cooking gas; elimination of enormous leakages in the myriad social schemes by replacing them with cash transfers; and accelerated disinvestment including outright privatisation.All roads to Swachh Bharat pass through the thicket of reforms. Ending open defecation requires multiplication of toilets at mega speed while also persuading households to actually use them. The latter has proved a challenge not just because old habits die hard but also because often the toilets we provide are not nice places to visit. Mahatma Gandhi got it precisely right when he wrote in 1925, “I learnt 35 years ago that a lavatory must be as clean as a drawing room. I learnt this in the West. I believe that many rules about cleanliness in lavatories are observed more scrupulously in the West than in the East.“ Having experienced not-so-swachh toilets as well as open defecation during childhood visits to my ancestral village and the town next door, i fully appreciate why many prefer to go for open despite access to a toilet. Educating citizens on the hazards of open defecation is not enough; we must also build toilets that do not repel. Unfortunately that would require larger expenditure per toilet and reliable supply of water in homes. Pursuit of Swachh Bharat also requires strengthening public health services. Services such as good drainage systems, absence of swamps and ponds that are home to stagnant water, and the supply of safe drinking water ­ all of which reduce exposure to and spread of diseases ­ are classic examples of public goods and require effective government intervention. Yet, as even a casual visit to any city or village makes obvious, drainage systems and general standards of hygiene in India remain poor. A bout of mon soon rains is often enough to clog the drains and create swampy conditions conducive to quick spread of communicable diseases. As sociologist Monica Das Gupta and co-authors point out, this situation is to be substantially attributed to the merger of medical and public health departments in all states except Tamil Nadu in the immediate post-Independence era. These authors note that the merger “opened the way for the public health services to be gradually eclipsed by the medical services, which attract far more political and public attention“. Only Tamil Nadu kept an independent public health department, which has allowed it to supply generally superior public health services. Swachh Bharat would do well to encourage each state to restart a separate public health department, accountable for the delivery of public health services.The department should have an independent budget and the charge of public health engineering services that are critical to managing subsoil water drainage to control vector breeding, safe disposal of solid waste, water supply and sewage. As a final thought, let me state that it is of utmost importance that Modi sustains the public awareness campaign at the high level he has begun until the objective is achieved. Through speeches and commercials on television and radio, he must continually exhort citizens to change their habits. He must also cajole state chief ministers, prominent politicians from all parties and film and sports stars to do the same. All TV channels must be encouraged to broadcast programmes featuring experts from medical and related fields who can credibly explain the damage that poor personal hygiene, littering and open defecation do to the health of all citizens.Rural folk must also be made aware of the health hazard posed by cohabitation with livestock, which naturally defecates in the open. If we wage this campaign on a war footing as we once did to eradicate polio, we can surely make the 150th birthday of the Mahatma a memorable day for every citizen of India. The writer is professor of Indian political economy at Columbia University.