Kajal, 16, and Sarita, 17, walk back from an open defecation area of Nihura Basti, Kanpur, India. Photo credit: WaterAid/ Poulomi Basu
The new Indian Prime Minister, Narendra Modi, has recently announced a new campaign to eliminate open defecation - the practice of people relieving themselves in the open - by 150th anniversary of Gandhi's birth in 2019.
In his speech to mark India's Independence Day, he asked the country: "Has it ever pained us that our mothers and sisters have to defecate in the open?" and so pushed the issue high up the political agenda.
Nearly half of India's population currently has no access to proper sanitation and so has no choice but to defecate in the open.
The resulting unhealthy environments have terrible health impacts, particularly for children: over 200,000 die yearly due to diarrhoea and nearly half (48%) of under fives are stunted.
Open defecation also has broader impacts on the wellbeing of the country as a whole, affecting education, income, gender, equity and dignity.
Modi's speech has the potential to galvanise the efforts of politicians and administrators, shaking up a bureaucratic system which has historically neglected sanitation.
A need for behavioural change
Over the past years, India has implemented well-funded sanitation campaigns that failed terribly. The census shows that total numbers of open defecators in rural India actually increased by over 40 million between 2001 and 2011. Will the lessons from these failures be taken into account?
The main lesson in my view is that better sanitation is not just about building toilets but about people's behaviour. If someone doesn't feel the need to change their sanitary practices, government will spend millions on building toilets that simply won't be used and will soon fall into disrepair. So I hope that the campaign launching on 2 October will focus on behaviour.
To do so, however, the mindset of politicians, officials, the media and the public towards the issue must change too.
One of the many toilets built in the Madhya Pradesh region during construction-focused campaigns of the Indian government, which are not used and lack maintenance. Photo credit: WaterAid/ Andrés Hueso
School sanitation
If there is anything more neglected than household sanitation (in India and elsewhere), it is school sanitation, mostly because it is not monitored and seems not to be anyone's responsibility and. As a result, the situation in Indian schools is abysmal not only in terms of access to sanitation, but also to water and handwashing facilities.
Modi has talked about sanitation before, but in this speech he made a new - and very welcome - pledge: "All schools in the country should have toilets, with separate toilets for girls"... by next year.
But again, the key to success will not be building toilets but making sure they are cleaned and maintained. During a WaterAid work trip to India last month I visited a school in rural Madhya Pradesh (central India), which had three toilet blocks. One was permanently locked, another was out of use due to parts being damaged and the last one has remained unfinished since 2012. The teachers blamed local leaders, local leaders blamed the school management committee, and committee members blamed the teachers. The end result was that nobody took responsibility for providing access to sanitation. The story of this is school is sadly very similar to most rural schools in the state.
Ensuring access to sanitation in schools is not about constructing toilets, but about their operation and maintenance: ensuring cleaners are appointed, toilets are maintained and repaired, and water and soap is available.
Modi's commitment to sanitation is the required first step to make India open defecation free. However, for this sanitary revolution to materialise and yield positive results, he will have to reshape the institutional setting of the campaign and move away from its sole focus on building toilets, making sure the promotion of sanitary behaviour becomes central.