Paid to poo: Combating open defecation in India

Using a toilet is something most people take for granted - but about 1.1 billion people around the world defecate in the open because they do not have access to proper sanitation. Now a scheme in India is aiming to instil better toilet habits in children by "paying them to poo".

Open defecation is a practice where people relieve themselves in fields, bushes, open spaces and into open bodies of water.

It poses a serious threat to the health of children. Hundreds of thousands of children die every year because of diseases transmitted through human waste.

In India, nearly half of the population - more than 590m people - relieve themselves in the open.

For many it's a daily ritual and often something they do even when public facilities are available.

Now a state council in the Gujarati city of Ahmedabad has come up with a scheme where children are being paid to use public toilets. Campaigners hope it will improve the situation in a country where diseases such as diarrhoea kill about 200,000 children every year.

People who live in the slums of Chandoliya in Ahmedabad use the railway tracks to do what most would do only in private, especially early in the morning before the crowds and the heat develop.

"We've made public toilets but people still don't use them," said Anil Prajapati, chairman of the Gujarat Sanitation Development Organisation.

"Some of these people fear that there are witches inside or that their children will be kidnapped.

"These people have come from small villages, and so they are not used to the practice."

When people defecate in the open, flies feed on the waste and then carry small amounts away on their bodies. The flies then come into contact with food.

Human waste can also run into wells and streams, contaminating water that may be used for drinking or bathing.

Ingested bacteria and worms spread diseases, causing sickness and malnutrition.

Faecally transmitted infections are also the main reason why nearly half of Indian children under five are underdeveloped.

So health officers at Ahmedabad Municipal Council came up with a new approach to try to encourage residents to use the toilets, some of which are free while others cost money to use.

"We have 320 public toilets and we are not taking any payment in 143 toilets," said Dr Bhavin Solanki.

"We have observed some children are still doing open defecation just in front of the pay-and-use.

"So we realised we have to introduce some other scheme. We are giving one rupee (less than a penny) to the children per day, or we're giving them chocolates to encourage use of the toilets."

It's a scheme that Bhumi Datadia is taking advantage of.

The five-year-old lives in a tiny room with her two siblings and parents. Like many others in her neighbourhood, a nearby river or public toilets are her only options.

"Look at the size of my house. Where do I have space to build a toilet?" said Bhumi's mother, Jayashree.

Under the new scheme, Bhumi is making one rupee every time she uses a public toilet. Her visits are recorded on a card and she receives her money at the end of the month.

"The toilets are good," said Bhumi. "I will use the money I make for school."

The city council has plans to scale up the project and it might start paying adults to use public toilets.

"The idea is to understand you are rewarded for good behaviour," said D Thara, commissioner of Ahmedebad Municipal Corporation.

"Once children start using the toilets, adults won't do it any more. Children themselves will become the motivators."

But people in another part of the city say it won't be easy to convince them to change.

They say the toilets are not kept clean and that their children are often stopped from entering the facilities because some of them use too much water.

Open defecation also has wider effects on a country, affecting education, income, women's safety and dignity.

"It's not safe for women to go to the toilet in the open," said Mr Prajapati.

"When they go out at night, anything can happen. It's happening everywhere in India. We want to stop this."

Prime Minister Narendra Modi has made eliminating open defecation in India a priority, and wants every home to be installed with a toilet by 2019.

In recent years, India has implemented well-funded sanitation campaigns, but few have worked.

Some campaigners say that building toilets is not enough and that more needs to be done to reshape attitudes.

But the people behind this scheme hope their alternative approach could be a crucial first step towards ending open defecation in India.