"Don't flush." M K Malhotra, a resident of Delhi's Vasant Kunj, has put this instruction on his toilet. Six members of his family use this toilet at least three times a day and ten litres of water goes down the drain with every flush. In a water-scarce locality, Malhotra can hardly afford this basic sanitation practice. "In fact, it's a luxury," he says.

Malhotra's warning is apt. Flushing consumes maximum amount of water in an average urban household. An ever-increasing urban population - 25.8 million in 1901 to 285 million in 2001 - has thrown up two problems: shortage of water and sewage overload. Malhotra is still fortunate: more than 80 per cent people in rural India do not have access to toilets.

"Sanitation is more important than independence," Mahatma Gandhi once said. It is been 55 years since independence and sanitation is still a neglected sector in India. Sanitation is available to 48 per cent of urban and just 3.15 per cent of the rural population. As the Planning Commission pointed out in the Ninth Plan, "While the provision of drinking water to urban areas in the country has improved over the years, the provision of sewerage and drainage facilities has not received adequate attention." Health costs
Providing water and sanitation facilities may seem expensive, but the costs of not providing are much higher. In Karachi, Pakistan, for example, a study found that poor people living in areas without any sanitation or hygiene education spent six times more on medical care than people who lived in areas with access to sanitation and who had a basic knowledge of household hygiene. In India, rural people spend at least Rs 100 each year for the treatment of water/sanitation-related diseases. According to the government of India, this adds up to Rs 6,700 crore annually, which is just Rs 52 crore less than the annual budget of the Union health ministry's and more than the allocation for education.

It is not as if these diseases appear out of nowhere. People contaminate the environment and they are in turn infected through the "pathogen cycle" (see flow chart: Deadly web). Breaking this cycle is the function of sanitation. In simplest terms, sanitation acts as a barrier between humans and disease causing agents. The barriers are generally physical, chemical or spatial. The flush toilets and sewage systems are supposed to provide all three: flushing physically carries pathogen-bearing faeces away from contact with us, the sewage system creates some space between the two, while chemical and other processes in treatment plants are used to destroy them.

Standard toilets and sewage systems are taken for granted in middle and upper class homes in urban India. The attitude is: flush and forget - out of sight and out of mind. However, what happens to the waste after the flush is pulled? After some treatment, it flows in our taps. Possibly, for middle and upper classes living urban environments with artificially low water charges, there is nothing wrong with it, especially in the short term. But when the whole picture is taken into account, the benign nature of sewage changes dramatically.

Urban sewage systems can be seen as a linear process. The act of flushing lets large amounts of water physically push excreta and diluted urine down and around the "s" seal of the toilet. Blackwater (wastewater which bears human excreta) and grey (wastewater from the bath, kitchens and sinks) are mixed when they leave a house. The pipe carrying this wastewater joins pipes of other houses or apartment blocks and empties into the municipal sewer. This relatively small diameter sewer joins other peripheral sewers and finally joins a large trunk sewage drain. More water is added to stop blocking of sewage lines. Water to transport is pumped and kept flowing.Deadly web
How pathogens in excreta enter humans

1: Pathogens in excreta

2: Hands

3: Flies

4: Surface water and wastewater

5: Solid waste (casual/landfill)

6: Soil

7: Agriculture/aquaculture

8: Groundwater and surface water

9: Food

10: Water supply

11: Leisure (eg, swimming)

12: Pathogens enter humans

(But not too much water, since this would overwhelm the system). These sewers keep the wastes flowing to a sewage treatment plant. This treatment involves removing the solids as sludge, getting rid of organic and inorganic pollutants, disinfecting it of pathogens and finally in some state of cleanliness, the treated water is released into the nearest river or sea. The solid sludge left is used either as landfill or as fertiliser. So far so good. At least on paper.

Overwhelmed by sewage
In reality things don't work so well. Firstly, only a small percentage of Indian towns and cities actually have sewage treatment plants. The Central Pollution Control Board points out that out of 22,900 million litres a day (MLD) generated as wastewater, only 5,900 MLD is treated - less than 3 per cent.

So where does the rest (untreated) with its load of dangerous pathogens go? Often untreated sewage is dumped straight into rivers or other surface bodies. The environmental and health costs are enormous: our rivers and our children are dying. This is because large amounts of water are being taken away from the rivers and used to carry excreta. The 'diluted' excreta is drained into rivers. Most Indian cities are based on river basins and use these rivers as sources for drinking water and waste disposal.

Sewage treatment is also expensive. The Mumbai-based Indira Gandhi Institute of Development Research (IGIDR) has estimated that to provide wastewater treatment in 10 large cities (population of 1.5 million and above) it would cost Rs 1,400-1,600 crore depending on the technology used for sewage management. The land requirement in these 10 cities would be 1,137 hectares. This estimate does not include the infrastructure, which needs to be in place as well as ongoing operating costs. Another assessment by the CPCB says that treating sewage for 23 metro cities would cost Rs 2,750 crore at 1994 prices.

No access
What is even more worrying is that a minority of Indians, who have access to sewers, cause water pollution. According to National Sample Survey Organisation's 54th round survey, 74 per cent of urban population use toilets, but only 22.5 per cent are connected to sewers and 35.2 per cent use septic tanks.

In Indian cities a large part of the population lives in slums and peri-urban area and these settlements quite often have no "legitimacy" and are not factored in any urban sewerage planning. Yet in a city like Mumbai, half of its nearly 12 million residents are either slum dwellers or homeless. They occupy six per cent of the city's land, living in cramped squatter areas with little or no access to sewage and sanitation facilities. When they are included, often under pressure from NGOs, the first thought is to build flush systems and sewerage, which proves to be economically unsuitable. In a slum, up to 500 people could share one toilet. Moreover, very little thought is given to their upkeep. For example, in Delhi the MCD is the implementing agency for low cost sanitation schemes including community toilet complexes. But these don't work most of the time.

Scavenging
The drive to do away with scavenging system - the practice in which toilets not connected to sewers are manually emptied and cleaned - was an opportunity to bring in fresh thinking into toilet designs keeping in mind Indian context. But this never happened. Rather, the government stuck to the flush type latrines. With the passing of the 1993 Employment of Manual Scavengers and Construction of Dry Latrines (Prohibition) Act, the conversion of the so-called dry latrines to water seal pour flush latrines got underway. Up to March 2000, Rs 1,339.98 crore had been spent on this scheme, states an appraisal report of the planning commission. Yet, less then eight per cent of the total recorded dry latrines were converted to sanitary ones till the first three years of the Ninth Plan. To meet this huge target of adopting water-intensive technology, the government has to dole out the required money. Funds will be required to not only set up infrastructure needed, but to maintain them, given the growing demand for flush toilets.

Then money will be needed to build sewage treatment facilities. Though industrial pollution in rivers often gets prominence, human sewage is the biggest threat: 80 per cent of pollution in Indian rivers is due to human sewage, says the Planning Commission. The Union ministry of environment and forests (MEF), in its Ninth Plan, fixed a target to set up sewage treatment facilities for 1,591 towns having a population over 20,000, in coordination with Union ministry of urban development and state governments. The question is where will the money come from?

The sewers in Delhi have lost 80 per cent of thier carrying capacity due to age and poor maintenance. This means that only 20 per cent of domestic wastewater is being treated, the rest flows directly into the Yamuna. In the case of major river pollution abatement activity like the Ganga Action Plan, only 13.7 per cent of the targeted sewage treatment capacity has been created.

Constipated mindset
Already, the costs of treatment are not being met. An indication of this is the price of water. If all the water treatment were taken into account in a city like Delhi, the price of water would be Rs 4.61 per litre. Instead, the Delhi Jal Board is charging just Rs 1.99. Revenue generation is 43 per cent of production costs in Delhi. In Kolkata, it's at a ridiculous 14 per cent, in Nagpur, 48 per cent and for Pune, it is 49 per cent. This is just the cost of treating water to make it fit to drink; none of these figures are inclusive of the cost of treating sewage, before putting it into the rivers.

Another important constraint to service peri-urban areas is that lower-cost technologies usually require a much higher level of user involvement than conventional technology to function properly. Yet engineers, who traditionally play a major role in the formulation of sanitation projects, often have little training or regard for the social mechanics of projects, such as mobilising communities and involving future users, and have little patience for the sheer time it takes to address them.

The Planning Commission points out what it calls the "vicious circle of circumstances" - due to economic non-viability of the urban sewage and sanitation, programmes have failed to cover all the population and due to insufficient funding, operation and maintenance have failed miserably. There has to be a paradigm shift in the way sanitation policies are formulated. The new approach would have to suit the social and geographical factors of the region and be environmentally and economically sustainable. But who will bell the cat?