1. Achieving Sanitation MDG in Uttar Pradesh Presented at National Seminar on Decentralized Governance in Water & Sanitation in Rural India June 28th, 2012 NIAR, Mussoorie, Uttarakhand

2. Uttar Pradesh – A Profile Area 243,290 sq km with population 210 m Contributes nearly 8% of India’s GDP Only 5 countries in the world have more population than Uttar Pradesh One out of every five open defecator in India lives in Uttar Pradesh

4. Sanitation Trends Click to edit Master text styles – Second level – Third level Fourth level – Fifth level Only 6.9% increase in improved sanitation from 1990 to 2006 (16 years)

5. Sanitation Trends in Rural UP Click to edit Master text styles – Second level – Third level Fourth level – Fifth level Increased nearly 3 times in last 15 years but grossly inadequate

6. MDG target for Uttar Pradesh Projected population of UP in 2015220 million MDG Target (56.5%)124.5 million MDG achievable at current rate (24%)53 million Unimproved toilet users 33 millon Open defecators in 2015135 million MDG target shortfall71.5 million

7. Four Districts Contribute 11% of Open Defecators DistrictProjected Population of Open Defecators (2007) Allahabad4,084,668 Azamgarh3,741,821 Jaunpur3,651,550 Sitapur3,429,279

8. Click to edit Master text styles – Second level – Third level Fourth level – Fifth level

9. Click to edit the outline text format  Second Outline Level Third Outline Level  Fourth Outline Level Fifth Outline Level Sixth Outline Level Seventh Outline LevelClick to edit Master text styles – Second level – Third level Fourth level – Fifth level 18 districts contribute 37% of open defecation Name of District Projected Population of Open Defecators (2007) Gorakhpur 3,217,968 Hardoi 3,194,743 Sultanpur3,097,598 Kheri 3,002,027 Ghazipur2,908,639 Rae Bareli2,846,420 Kushinagar 2,817,120 Gonda 2,809,449 Agra2,781,767 Pratapgarh 2,764,099 Name of District Projected Population of Open Defecators (2007) Ballia 2,625,415 Etah2,574,837 Deoria 2,561,347 Budaun 2,561,243 Barabanki2,522,946 Unnao 2,472,429 Aligarh 2,417,982 Bahraich 2,352,095

10. Independent VariablesModel 1Model 2Model 3Model 4Model 5Remarks Percent literate Female Population (Age 7+) 0.85 (0.21)*** 0.48 (0.17)*** 0.42 (0.16)*** 0.25 (0.18)* Percent literate male Population (Age 7+) 0.64 (0.29)** Households have BPL Card (%) -0.85 (0.11)*** - 0.74 (0.11)*** -0.63 (0.14)*** Dist cumulative TSC expenditure per capita -0.13 (0.04)*** -0.12 (0.04)*** Households use piped drinking water (%) 0.50 (0.18)*** Constant -17.68-22.3225.3027.9429.86 R square 0.190.080.560.610.65 Adjusted R square 0.180.070.540.59 N 70 Independent variables impacting Toilet Use Dependent variable: "households have access to toilet facility (%)“ *** significant at 1% level; ** significant at 5% level ; * significant at 10% level

11. one percent increase in female literacy in a district is found associated with 0.25% to 0.48% increase in toilet use.

12. One percent increase in household piped drinking water in a district is associated with 0.50% increase in toilet use behavior.

13. an increase of BPL card holders by 1% in a district results in a decrease of toilet use behavior by 0.63%.

14. Medical Expenses by Income Quintile Income Quintile Lowst Quntile 2nd Lowest Middle 2nd Highest Highest Average Monthly Income Rs 873Rs 2,186Rs 3789Rs 6074Rs 38,143 medical expenses on diarrhoea, cough, fever Rs 90.98 (10.4%) Rs 192.36 (8.8%) Rs 290.63 (7.7%) Rs 507.92 (8.4%) Rs 1071.51 (2.8%)

15. Net Social Benefits of Total Sanitation Reduction of deaths of children below 5 years by 90,000 to 100,000 per annum Averted loss of wages on account of sickness Averted cost of medicines for treating sickness Net Social Benefits of Total Sanitation in Uttar Pradesh is Rs 10,244 crores (NPV, at 10% discount rate), which is equal to 4% of State SDP

16. Conclusions Focus on districts with higher concentration of Open Defecators (4 plus 18) Give priority to those districts which have higher female literacy because of higher chance of success Give priority to districts with better water supply systems because of higher chance of success Scope for developing innovative health insurance products linked to sanitation for households in lower income quintiles

17. THANK YOU