Comparison of the costs and benefits of the Clean India Mission

Abstract Background The Swachh Bharat (Clean India) Mission (SBM) launched in October 2014 is the world’s largest sanitation campaign. Our aim was to estimate and compare major economic costs and benefits associated with sanitation improvement achieved during three years of SBM from households’ financial and economic perspectives and a broader societal perspective. Methods Cost-benefit model inputs were obtained from household surveys in the twelve Indian states that once contributed to over 90 percent of open defecation in India, published literature and secondary data. Monetized costs included household financial and time investments in building and maintaining toilets, and government’s investments on subsidies and campaign activities. Monetized benefits included reductions in medical costs and mortality associated with diarrheal diseases, productive time saved from fewer diarrhoea cases and accessing outside defecation options, and increase in the property value of having a toilet. Probabilistic uncertainty analysis assessed the combined effect of key modelling assumptions and sampling errors in the inputs to the cost-benefit model. Findings Investment costs average US$ 396 per latrine and average annual operational costs are US$ 37 (financial) and US$ 94 (time costs) 1 . Annual benefits of US$ 727 per household are mainly from savings associated with reduced diarrhoea incidence (55%) and from sanitation access time savings (45%). The estimated Benefit-Cost Ratios (BCRs) are 1.7 (household financial perspective), 4.5 (household economic perspective) and 4.0 (societal perspective) under Open Defecation Free (ODF, corresponding to 100% toilet coverage and usage) scenario. However, under partial-ODF scenario with 85 percent toilet use rate, the BCRs are 1.1, 3.3 and 3.0, respectively. Probabilistic uncertainty analysis shows that the financial BCRs under the partial-ODF scenario can reduce to 0.7, but societal BCR will remain above 2. Interpretation This study shows the sanitation improvements under the SBM are highly cost-beneficial, more when communities are free of open defecation with all households using private improved sanitation facilities. Future SBM investments must ensure not only sustaining the universal toilet coverage and usage, but also ensure safe faecal waste management so that households continue to enjoy full benefits of sanitation.