We are so used to turning our eyes away when we see somebody defecating in the open that we fail to reflect on this widespread practice, prevalent much more in India than in other countries. It is not only visually disturbing but has hazardous implications for public health in our cities.

Some people may engage in open defecation out of habit or laziness, but for a large part of the population of urban India living in slums, more often than not, it is not a matter of choice. They have no private toilets and no access to community toilets that actually function. Damaged septic tanks and broken drainage pipes make community latrines unusable. Children go to the nearby drain or wherever they find open spaces. Women wait for nightfall to answer nature?s call, and then too only in groups for fear of assault. It is difficult to maintain hygiene for children as they typically do not have access to water to wash their bottoms and soap to wash their hands.

Tiruchirapalli (Trichy to most people), the famous temple town of the South, is the 4th largest city in Tamil Nadu and is located on the banks of river Cauvery, with population of just over a million of which 25 per cent live in slums. Trichy has 211 ?approved? slums and as many as 75 ?unapproved? slums which are located on railway land, Government of India land, and land belonging to the waqf board and other private owners. Until the end of the 1990s, the slums of Trichy with their appalling state of toilet facilities and sanitation were no different from the rest of the country. But things began to change about 10 years ago, and Trichy has not looked back ever since. The city was ranked 6th in India in the sanitation ranking of Indian cities by the Ministry of Urban Development in 2009-10.

It all started with a major initiative launched by Gramalaya, an NGO, in 2000, mobilising women in the slums of Trichy in Self-Help Groups (SHGs) and launching an awareness campaign on sanitation through training. They were able to garner support of Water-Aid, an NGO in the UK to fund the building/renovation of 25 community toilets and child-friendly toilets in the slums, which would be managed by the women of the community on a pay and use basis. Sanitation Health Education (SHE) teams were set up by the SHGs to propagate the message of sanitation, monitor the behaviour of residents, and supervise the maintenance of the toilets.

A community toilet complex typically has 10-12 seats for women and 10-12 for men. Child-friendly toilets are separately provided for children up to the age of eight in an adjacent area. Each toilet has a tap which supplies 24×7 water. Some have graduated to ?sanitary complexes? with a room for bathing and washing. Each facility receives its water supply from the Trichy City Corporation (TCC) and a bore well is also provided by the Corporation. Each has a provision of underground storage of water and an overhead tank to which water is pumped. TCC has ensured that water is also made available in summer months through tankers. The Corporation waives the electricity charge for the pumping of water for the first few years of operating the toilets. Afterwards, the tariff for electricity charge for community toilets is levied at the lower domestic rate and not commercial rate.

The cost of a typical community toilet was around R3 lakh in the initial years when Water-Aid built such complexes. Today, the cost is around R12 lakh. The success of the women in managing and maintaining the community toilets encouraged the TCC to build more community toilets so that all the 211 approved slums now have community toilets. Out of a total of 347 such toilets (some slums have more than 1), 284 are connected to the sewerage system and 63 function through a septic tank. About 100 toilets are being managed on a pay and use basis by SHGs with Gramalaya and another 40 by other NGOs. For the rest, TCC and/or Ward Councillors take the responsibility for managing the toilets.

I visited the community toilet at the Kamla Nehru Nagar slum where the toilet was inside the slum area. In West Devathanam, I visited another complex where the toilet is located between the slum and a public road and caters to the needs of the slum as well as the floating population surrounding the slum. Shanmugavalli, a 30-year-old woman in-charge at the Kamla Nehru Nagar community toilet was brimming with confidence. With her increased responsibilities at SHGs, she finds a 10th class qualification embarrassing, and has enrolled for BA correspondence course. Her 17 year old daughter has enrolled for engineering.

At the community toilets run by SHGs, SHE team members take turns to sit at a table placed outside the toilet complex with tokens to sell as people come to use the toilet. They engage cleaners who clean the complex 2 to 3 times a day. I found that the toilets were cleaner than what we may typically find in cinema halls in Delhi.

It is clear from the systems they have put in place to manage and maintain these toilets that these women understand the economics of it all. The collection from user charges is used to pay their electricity bills, the cleaner, the guard who keeps the watch, and expenses of minor repairs. The typical user charge varies from 50 paise to R1 per use, while children, the elderly and the challenged ones have free access. The accounts are kept meticulously and are audited by TCC.

All SHE teams make a small subscription to come together under Women?s Action for Village Empowerment (WAVE) which is a registered society. Monthly meetings of WAVE allow them to discuss their problems and learn from each other in finding solutions. A member of TCC is also invited to these meetings. They are now extending their sphere to cover solid waste management and better delivery of other public services.

After initial resistance to their cause, men wanted to have a part of the action when the women seemed to be succeeding in making their slums clean. The women obliged by creating AWASH (Association for Water, Sanitation and Hygiene) so that men could also contribute to improving the water and sanitation scenario of their joint habitat. Men also find a role through WATSAN (water and sanitation) committees in monitoring the progress of the overall sanitation status of the slums in the city. The Municipal Commissioner, Mr TT Balsamy was very appreciative of the role played by the NGOs and the communities in bringing about the much overdue transformation. As Geetha Jegan executive director of Gramalaya put it, ?together, the City Corporation, the NGOs and the communities from the slums of Trichy have transformed the sanitation scenario in Trichy.?

Trichy has shown the way. Other cities in India must follow to completely get rid of open defecation and work for better sanitary conditions in our cities.

Dr Isher Judge Ahluwalia is the Chairperson of Icrier and was Chair of the High Powered Expert Committee on Urban Infrastructure which submitted its report to MoUD in March 2011.

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