A report on inadequate sanitation, released by the UN University, made waves earlier this year when it reported that while 45% of India’s population owned cell phone, only 31% of them had access to improved sanitation in 2008.1 Headlines proclaiming “India has more cell phones than toilets” found their way into several of my e-mail news digests. “It is a tragic irony to think that in India, a country now wealthy enough that roughly half of the people own phones, about half cannot afford the basic necessity and dignity of a toilet,” said Zafar Adeel, Director of United Nations University’s Institute for Water, Environment and Health (IWEH), and chair of UN-Water. With the focus on the Millennium Development Goals growing more acute as the deadline approaches, people were understandably astonished.
It is shocking to think that so many of the world’s poor cannot access appropriate sanitation. However, the widespread use of cell phones should not be juxtaposed against the conditions of poverty, but should rather be seen as a way to empower the poor to improve their conditions. The cell phone market has seen explosive growth in the last decade: 90% of the world’s population will soon be within the coverage of wireless networks,2 and there are already an estimated five billion cell phones used globally.3 Villages without running water or electricity often have at least one mobile phone, and people can switch out their own SIM cards for access. They are being adopted faster than basic services such as routine medical care and schools.2 When a basic toilet costs 15 times more than a basic cell phone ($3001 compared to $203), it becomes easier to understand the discrepancy between access to sanitation vs. mobile technology. If mobile penetration is so widespread, then, should it not be viewed as a tool and an opportunity for innovation?
Some governments and organizations have already caught on. In Rwanda, for example, the government provides free cell phones to rural health workers to register expectant mothers, get answers to their questions from a health expert, and send monthly status reports to doctors.2 Other programs send reminders to HIV-positive pregnant women to take ARVs and work to reduce stock-outs of drugs in rural clinics. Pharmaceutical companies are also working with application developers to fight drug counterfeiting: customers will be able to submit a numeric code on drug packaging via SMS and get a reply that states whether the drug is “NO” or “OK,” along with the drug’s name, expiration date, and other information.4 And I have already featured Tostan’s Jokko Initiative, which applies their literacy lessons to cell phone usage and includes a lesson on the health-related utility of SMS. Other applications include facilitating electronic banking and providing information on crop disease and weather to farmers.2
Progress on the MDGs should not be overlooked, and the importance of access to sanitation is should certainly not be downplayed at all. With an expected return between $3-34 for every dollar spent on sanitation, it is absolutely worthwhile to stress the importance improving people’s access to this need. Now, if only we could develop an app to improve sanitation – that would be perfect.