FAQs on open defecation free plus (ODF+) and sanitation

Q1: What is ODF+? How is the programme rolled out in India?

A: ODF stands for Open Defecation Free — a status where no one defecates in the open, and everyone uses toilets.

• ODF+ means that an area is not only free from open defecation but also has effective solid- and liquid-waste management and overall visual cleanliness.

The Government of India launched the Swachh Bharat Mission (SBM) in 2014 with the vision of making the country Open Defecation Free.

SBM Phase 1 (2014–2019) focused on toilet construction, toilet usage, and behaviour change, keeping people’s participation (Jan Bhagidari) at its core.

SBM Phase 2, which began in 2020, aims to achieve ODF+ by sustaining toilet usage alongside effective solid and liquid waste management.

Over 180 million households in rural areas have so far gained access to toilets through this flagship programme.

Q2: What are the impacts of ODF+?

A: Achieving ODF+ status leads to wide-ranging benefits across health, environment, and social outcomes:

• Environmental improvement: A cleaner environment through effective waste management and visual cleanliness, along with reduced groundwater contamination from open defecation.
• Health benefits: Lower incidence of diarrhoeal diseases and other faeco-oral infections, thereby reducing morbidity and mortality in communities.
• Women’s safety, dignity, and well-being: Access to household toilets significantly improves the safety and dignity of women and girls, reducing the risks of harassment associated with open defecation. It also enhances convenience, privacy, and self-respect — a priority equity outcome for UNICEF’s work in India.
• Economic gains: A 2019 UNICEF study on the national economic impact of SBM found that households in ODF areas can save up to INR 50,000 per year due to reduced medical expenses, time savings, and other economic benefits.

Refer to the following studies for more details:

1. National economic impact evaluation of SBM — https://www.unicef.org/india/media/8801/file/UNICEF.pdf
2. Access to toilets and the safety, convenience and self-respect of women in rural India — Safety-security-and-dignity-of-women.pdf
3. Toilet construction under the Swachh Bharat Mission and infant mortality in India — https://www.nature.com/articles/s41598-024-71268-8

Q3: What is the impact of sanitation on children?

A: Poor sanitation has a disproportionate impact on children, particularly those under the age of five. Access to safe sanitation is one of the most powerful determinants of child survival, growth, and learning. 

Improved sanitation through ODF+ delivers significant benefits for children across multiple dimensions:

• Child survival and reduced mortality: Studies have found a significant association between toilet construction under the Swachh Bharat Mission and reduced infant mortality in India. Elimination of open defecation reduces exposure to faecal pathogens that are a leading cause of preventable child deaths.
• Reduction in diarrhoeal diseases: Diarrhoea remains one of the leading causes of child morbidity and mortality in India. ODF communities see a marked reduction in the incidence of diarrhoeal disease among children, as contamination of water sources and the environment is significantly reduced.
• Prevention of stunting and malnutrition: Repeated exposure to faecal pathogens causes environmental enteric dysfunction (EED), which impairs nutrient absorption even in adequately fed children. Safe sanitation reduces this disease burden, supporting better nutritional outcomes and physical development in children.
• School attendance and learning: Access to safe and separate toilets in schools supports regular school attendance. Adolescent girls are more likely to remain in school when menstrual hygiene-friendly facilities are available, directly supporting their education and long-term well-being.
• Safety and protection: Children, especially girls, face heightened risks of harassment and assault when forced to defecate in the open. Household and community toilets reduce exposure to these protection risks, creating a safer environment for children to grow up in.

UNICEF’s work under the Swachh Bharat Mission places children’s well-being at the centre of its sanitation programming, from supporting the rollout of ODF+ interventions to generating evidence on the health and development impacts of safe sanitation.