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Insights into Editorial: A 21st century revolution: on Bill Gates move to scale up sanitation

Insights into Editorial: A 21st century revolution: on Bill Gates move to scale up sanitation



According to UNICEF, 22.2% of children, or 151 million, under five years were stunted globally in 2017.

The World Bank says annual healthcare costs from lack of sanitation in developing countries is a staggering $260 billion.

In many places, children play amidst faeces in the open and contract disease, resulting in malnutrition and stunting.

India’s record in treating urban sewage is poor at 30%, and a third of about 847 large sewage treatment plants are not functional, according to BMGF estimates.

Microsoft founder Bill Gates displayed a glass beaker with human faeces on stage at a sanitation conference in Beijing recently, and he was praised by World Bank president Jim Yong Kim for “making poop cool”.

Bill Gates explained and reasoned that Innovation, would expand sanitation quickly and save children in developing countries from the crippling consequences of stunting.


The Problem of Open Defecation in India:

India is the seventh largest country in the world and is ranked second in population. Although India is one of the most populated countries, 67.6% of its population still resides in rural areas.

Rural India has rate of malnutrition due to a higher level of poverty than urban areas, due primarily to many factors, such as higher poverty rates, lack of sanitation, and decreased level of education.

Open defecation, the practice of people defecating out in the open wherever it is convenient, is one of the main factors leading to malnutrition.

The government of India has built 10 million toilets in rural areas in the last two years. Unfortunately, most are not utilized by the villagers.

In the urban setting, 12 percent of the population open defecate and rural areas that number is 72 percent.

Open defecation leads to polluted water; up to 75 percent of India’s surface water is polluted. When water is exposed to untreated sewage it becomes a breeding ground for parasites and water-borne diseases such as cholera, dysentery, e.coli, and salmonella.

Human exposure can come from consuming the contaminated water or eating foods that are washed or irrigated with the polluted water.

Children are more susceptible to these diseases which frequently lead to diarrhoea. Once a child becomes infected and begins diarrhoea it becomes difficult for them to absorb need nutrients in the food that they consume.

The inability of their bodies to adequately absorb the food that they eat may eventually lead to malnutrition, stunting, and even death.

Even once they seek medical treatment for their low birth rate and the problem is corrected, it frequently recurs once they return home due to the continued consumption of contaminated water.

Many families also wish not to stay long periods at government nutrition centers due to the loss of work and income which puts a heavy financial strain on the family.


Decentralising sanitation is the Need of the Hour:

Bill and Melinda Gates Foundation (BMGF) has devoted $200 million to incubate new technologies that will dramatically scale up sanitation.

The challenge to decentralise sanitation, has parallels with the historic shift from mainframe computing, which only governments and large corporations could afford, to personal computers.

Fast-expanding cities cannot have massive sewage treatment plants. What they need is stand-alone processors, which will help communities and individuals.

These “zero emission” processors will end dumping of faecal sludge taken from septic tanks into rivers, lakes, farms and open spaces.

They can also prevent the death of workers in septic tanks. Some models also attach a gasifier that can use municipal solid waste, providing a solution to handle that urban waste stream as well.


Solution: The reinvented toilet and omni processor waste treatment plants:

At present, the standard is flush toilets connected to sewers.

But the multi-user reinvented toilets have enormous advantages:

There will be stand-alone facilities that are aesthetically designed, finely engineered and equipped with reliable chemical processes.

What makes these reinvented toilets special is that they expel nothing. They turn liquid waste into clear water for flushing, and solids into pellets or ash that is fertilizer.

They produce ash from solids, while reusing the liquid as non-potable water after treatment. The future belongs to this Multi-User Reinvented Toilets. The prototypes are undergoing trials in Coimbatore and Durban.

Technology is ready with a “zero effluent” toilet, national policy should make it accessible to everyone.

Success will depend on making large community deployments, and developing cost-effective models for individuals.



Initiatives creating an annual ritual, aligned with prevalent religious beliefs, when a village is declared open defecation free can ensure change is celebrated and thus, sustained in the long run.

The 2017 Swachh Survekshan survey conducted by the Quality Council of India reports that 62% of rural households now have a toilet.

More significantly, the survey concludes that more than 90% of the individuals who had access to toilets were using them.

For India to permanently eradicate open defecation, the Swachh Bharat Mission must adopt three pillars of support.

  • The first must provide and maintain the infrastructure needed to aid toilet use.
  • The second must motivate people to change behaviour towards toilet use and
  • The third must harness cues and automatic habits to drive positive behaviour.

It’s time policymakers start focusing on the third pillar, before the facade wobbles.