 today. I'm Ardo Berdard, I'm a senior director for health and health care industries at the World Economic Forum. Very pleased to introduce in a few words this session. So about sanitation, it's not by coincidence that in most countries where health care is still as its infancy, actually minister of health are also ministers of sanitation. If you think about the magnitude of the issue globally, we're talking about 2.5 billion people on this planet that have no access to decent sanitation. 15% of the world population not having access to closed toilets. And that's a cost to the society. And this is where we need to make investments. There is a study from the World Toilet Organization that demonstrates very precisely that for every one dollar invested, there is a net dollar return in economic output and wealth from increased sanitation programs. We are releasing today at the World Economic Forum our report on the economic burden of non-communicable diseases in India. This is a report we have produced with the Harvard School of Health Economics. And we are demonstrating in there that during the period 2012 to 2030, India is on the path to destroy wealth in the magnitude of 4.6 trillion. NCDs need to be addressed. Sanitation is part, is one of the interventions that can have an effect. We're listing the report 12 over interventions. But I would like today that not only you talk about communicable diseases but also NCDs as you run the panel. And Gupta, with no further due. I would like to call on to you, your editorial advisor from for India today. And I will let you moderate the panel. Thank you very much. This was a wonderful introduction. I think you did half my job. So I can cut state to the panel. Thank you all for being here on an afternoon. I have a star-studded panel and I'm not just referring to the star on my right. Everybody knows she's Kaanchal, a well-known film star. Although I have to make a personal disclosure, since the age of 10, I've been in love with her mom. I still am. Her mom was Tanuja, the great actor of her times. Sanjeev Mehta is the CEO of Hindustan Leavers. We have two leaders of cleaning industry. Cleaning and cleansing industry. They compete in the marketplace, but the harder they compete, the better it is for us. Which means they sell more cleansing products. Sanjeev who heads Hindustan Unilever. Adi Godridge, who many of you know, regular presence at World Economic Forum, runs Godridge Industries. And besides the fact that this is a homegrown FMCG giant, I can also tell you that in 2008, September, October, when everybody thought the world was coming to an end, after Lehman collapse, there was only one businessman, one Indian businessman who said that wasn't true. In fact, business was booming. He was investing more and business was growing. And that was Adi Godridge. So I used to say that he should be appointed the National Brand Ambassador for wellness of some kind. So Adi, thank you very much for being here. Saarat Amaragama, Senior Minister of Finance in Sri Lanka. He's a very experienced politician. But let me also tell you, people, there are many misconceptions in India, many mythologies. We now think that we are the richest country in the world. And we sent something to Mars at seven rupees a kilometer, as our Prime Minister keeps saying. And obviously, we've left everybody behind in the neighborhood. That's not quite true. Because I was watching the World Bank ease of doing business ratings. And I found that, you know, a lot of people were tweeting that India was ahead, say, of Pakistan. But on two or three very crucial indicators, Pakistan was still way ahead of India. But if you look at social indicators in the region, one country that's way ahead of all of us, India, Pakistan, Bangladesh, Nepal, Sri Lanka. And that's despite the fact that Sri Lanka's had a history of really the most withering internal conflict. But just to give you an example of an idea of how bad that conflict was, because I used to cover that conflict as a war reporter for many years. And I've counted more dead bodies in Sri Lanka than in my country, although I've done a lot of that in my country as well. Population of about a crore of which singhalas were about 8 million. About 7.5 million. It raised an army at one point of 600,000? 200,000. A bit more than that. A bit more than that. But suffered casualties, which were almost 1% of that strength of the army over every year for many years. Right. And all in internal conflict. So it's a country that could have had a lot of trouble with its social indicators. On the other hand, the country began investing in its social well-being very early on. So in so many years of traveling in Sri Lanka, I started traveling in Sri Lanka in 1984. So it's 30 years. I have never seen any open defecation. I have never seen any of the filth that we routinely find in our country, in our cities and villages in any other part of the continent. That's why we have Sarath Amaragama. He'll tell us what Sri Lanka did right. And what the rest of us did not. Doing wrong. So, Kajal, I think I'll be sort of, I'll get popular approval if I start with you. You want to patron me. You are not the ambassador who has to make sure that more children stay alive till the age of five. I'll give you a little piece of statistics. India has among the poorest ratios, numbers of children surviving till the age of five. And it's a very interesting thing. I was reading The Economist and I trust The Economist. It says that because of higher incidents of open defecation among Hindu populations, this mortality is higher among Hindu population than among Muslim population in India. Even the Muslims are on an average much poorer than Hindus. So you are teaching children to wash hands. You are teaching children to keep sanitation. So they survive that they pass this landmark. I'm teaching not only children, I'm hoping to teach the parents as well to wash their hands. I feel that we feel as a team, as this program Help a Child Reach Five, basically. We hope that by teaching children, we are able to teach the parents as well and the entire family and everybody around them. I think kids have this way of telling people around them about how something is very, very important to them and making them understand it in their own simple way that, oh, this is really important and they'll go up to their mom and say, mom, you have to wash your hands before lunch and you have to wash your hands after going to the loo or whatever. And that's really important and our teacher taught to us in school and they were able to give this entire essay and fortunately, they're children, so people just have to sit and listen to them. You can't even be impatient and say, just shut up over there. So, yeah, we've decided to use those little angels to do half our work for us. Also, as you pointed out, the mortality rate worldwide is really, really big and especially in our country. It's 30% of the child mortality is in India. So I think and mortality because the main two reasons are diarrhea and pneumonia, which sound so silly. It's not some big vaccine. We don't have a vaccine for it or it's not some natural calamity that we're talking about and it's completely preventable, which is what is so sad really. So I'm hoping that if we can teach somebody the most, why am I talking about it over here? Because it's the most cost effective method of any hygiene program really. That's the first step of any hygiene program that you want to put into place. So what kind of attitudes does this campaign run into? We run into a lot of attitude actually. We run into the attitude that, oh, you know, what's so important about it? It's silly. It's stupid. It's small. I mean, here we're talking about, you know, you're not helping us in any major way. I mean, what's the difference? And you're not going to see the difference. You're not going to turn around tomorrow. You're not going to wash your hands today and say, oh, I'm well tomorrow. It's not going to happen like that. It's a behavior change that has to be that has to be inculcated in entire section of society, not a section, but all sections of society really. And that behavioral change will lead to further prevention of all these communicability diseases that we were talking about really. Sanjeev, you were mentioning to me just a while back that things were really drastically bad, say in England at a particular time, maybe three centuries ago, two centuries ago, one in two children died before the age of five. And mostly it was mostly connected to sanitation. Absolutely. And that was really going back to the genesis of Unilever as a corporation when founding fathers set up the corporation in an era, Victorian England, when one inch, two child would not cross the age of five. And it was all related to the issues of hygiene and sanitation. And that is where the first branded soap life came into be. And that is exactly where we come into play, Shekhar, in a country like India. As a consumer marketing company, what we are good at is changing behaviors of people. And what is most critical in this hygiene, sanitation space, one is advocacy linked to changing consumer behavior. And that's where we come in because we are good at that. We understand consumers. We understand the barriers. We understand the triggers. Yeah, we get to understand the attitude of people. And the third important bit is the second important bit is innovations. We focus on innovations, bringing out products, bringing out business systems, which help in alleviating this problem. And the third most important thing we do is bring in the science of management into doing an activity with the hard mattresses of business together with the partners which make a difference. So this is a this is a business where we're actually increasing your turnover and a public campaign synergize quite nicely. Yes, that's an advantage. But what I would like to say is I think our prime minister has taken a tremendous step by announcing this project of Swachh Bharat clean India. As I think taking this project forward will have tremendous advantages. And I'd like to point out some of the non obvious advantages also. First of all, clearly, we have seen clandestine will reduce diseases, improve health, add a lot of value. But I would say that we should also put a lot of emphasis, because some of the demonstrations of this project have been clean the place sweep the place, of course, very good. But preventing dirt is something we should inculcate instead of only cleaning up dirt. I think it'll add tremendously to better health. And better health will lead to lower costs in the economy, not just in saving of health care costs, but saving of people being off work, time taken off work because of bad health. And it'll help better productivity as a result. And I think it'll add tremendously to economic growth, generally, beyond just the simple obvious fact of better health. Now, I think we discussed earlier also, and you mentioned it, this mindset in India of not using toilets in the house. In fact, some very affluent households, 50, 60 years ago in India had toilets in outhouses. Although they could very well afford attached toilets. It was considered dirty. It's generally the feeling that is having a toilet close to the home is not healthy. And in fact, I think we'll have to train people that defecating in the open is not good. Just providing toilets may not be enough. We'll have to train people. We'll have to train and as Kajal rightly put it, if you can train the children, I think they may even teach the parents. And I think another major advantage will be if, if toilets are provided, it will help girls attend school much better. We know that a lot of girls don't attend school as a lack, because of the lack of toilets. It will help increase the involvement of women in the economy. And BCG recently did a study Boston Consulting Group, which says that if we can involve women fully in the economy, it will add a percentage point to our GDP growth. So I see benefits of this campaign much beyond the very obvious benefits. And it'll add tremendously to our economy. A lot of it is just about behavior. For example, public splitting. Yes, absolutely. It is not just defecation. Absolutely. Public splitting, puncturing and spraying all over the place. And of course, we've had this tradition where we keep our homes very clean inside our homes, our bodies clean, but not the outside, not the surroundings. And we need to change that. We need to throw the filth from your house in front of the neighbor's house. And if the neighbor's vegetarian and you are not, particularly throw the bones in front of his house. What is it that Sri Lanka did right that the rest of us missed out on? Well, I want to say that Sri Lanka has done very well when it comes to social indicators. You know, there are the millennium development goals that all heads of state agreed to and were supposed to achieve by 2015. Now, if you take infant mortality or maternal health or life expectancy, Sri Lanka has statistics which match the statistics of developed countries of America and the U.S. How did we achieve that? Firstly, because of the political bill from even before independence, a large amount of public spending, public expenditure was committed to particularly rural health. Rural hospitals were set up, midwives were appointed to every school, and a lot of special feeding of expectant mothers and also the children in their first few years. It was a very good package. I think if you read Amartya Sen on his analysis of the social welfare measures undertaken in Sri Lanka, he's very complimentary about that. So that has had a very big impact. Firstly, because of gender equality. Sri Lanka has absolute gender equality when it comes to education, when it comes to public employment and so on, we have that envious record. So there are three aspects. One is political commitment and public expenditure in this field. And also, it is really in my opinion part of the poverty reduction program. You cannot think of sanitation or much better sanitation unless you link it with the anti-poverty programs that countries come into. So you have to make your society a richer society. Three aspects come in what is normally called CAP approach, that is knowledge, attitude, practice. You can't convert people into practice overnight. First the requisite knowledge must be transferred. Why should you do this? What is rational about it? And how do you give all those other material incentives, factors that reinforce that knowledge? Then of course the most difficult thing is to change attitudes. Simple knowledge is not going to change attitudes. There are so many, I mean there are so many social psychological studies on this. I don't have to spend time on that. But it's doable. You have to change attitudes and practice really comes out of the interplay between knowledge and attitudinal change. So in terms of attitudes, what was the most difficult thing to change? Well I would think one problem in Sri Lanka was the demographic transition. Transition from absolutely rural values to urban values. And the educational system I would very much emphasize a widespread educational system because all these social indicators come largely out of people who have better knowledge. Take for example, when you have gender equality, the women are more aware of their responsibilities and also the consequences. Sri Lanka is not only good indicators in this social field but also when it comes to population growth. We have the lowest population growth figures in the region because educated women tend to postpone marriage. They look for employment. So the what is called at risk age basically between let's say 18 to 28. You bear children basically during that time. So in Sri Lanka the phenomenon has been to postpone the at risk age by later marriage, age 27, 28 and so on. So that has led to a smaller population. So I would say political commitment, determination to do away with poverty. I think that's one of the lessons we can learn from your experiments now in India. And also very, very much bringing women into the decision making process. I think those are some of the elements. I think gender equality in Sri Lanka is something you see the moment you land in Colombo and come out of the airport because there are those export processing zones to the left and at any point of time some shift is ending and some is beginning. And you see these bus loads of young women walking in and walking out to go back home. So a lot of women go out to There is a problem really which all of Asia suffers from in the sense that in terms of demography in another 20, 30 years there will be a shrinkage of the working population. Not so much in India but in the smaller countries. So unless the women come into the workforce that their knowledge, their skills, their aptitudes are brought into play then it's like going for a cricket match only with your second 11. You have to have all the people in Sri Lanka now because we are talking cricket and there's so much of interest. It sounds like the West Indies team. In Sri Lanka we had the problem earlier it was only a few urban big schools that sent their cricketers and we used to get a terrible hiding. But once we started getting players from rural areas, very, very far away schools and they started playing cricket. We had a world beating team we won the World Cup. I was eyewitness in Colombo I may say regrettably when you beat us for the first time. But you know almost all boys in that team, all those kids in that team were from rural schools. In fact Sri Lanka's athletic standards are very good also. Sanjeev, Leavers, pardon me if I am getting it wrong, since our childhood and I think our parents and everybody has seen Leavers sell its premium premier brands as something meant for hygiene. Life boy, life boy jahan tandoosti hai wahaan. So you linked your sort of flagship brand to health and hygiene. And there was always a kind of feeling that life boy is antiseptic, that doctors used it a lot, dentists used it a lot. So how did you latch on to it and how come if you did, it has worked commercially, it has not, you haven't seen attitudes change as much as we should have. Sure. If I sit back and look at the ethos of Unilever, we have a sustainable living plan where globally we are looking at doubling the business. And what we are saying is we will decouple with the environment footprint and recouple with the societal impact. So it is not for us a CSR or a cause related marketing, it is the very way we do our business. It is integral to us doing our business. So it is, so that's the approach we take. If we just look at the magnitude of the problem in India is the London School of Hygiene and Tropical Medicine, they did a research and they found out that India loses about 30 billion dollars because of diarrhea and diseases, the respiratory diseases and millions of mandates. And just 30 billion dollars is one and a half percent of GDP so to say. And they also came out with that while the penetration of soap in India is ubiquitous, near universal, in rural India is washing hands after toilet in many parts of the country is as low as one person, even much lower than Sub-Saharan Africa. Now, that's again going back to the core, the behaviour and attitude many of our people feel that clean hands, you use soap to beautify yourself. You use soap for bathing but after toilet you don't because many of the people do feel that a visible clean hand is clean, it is free of germs. And only when we take our interventions and show them under ultraviolet, then they realise that indeed it is still germs and you got to after toilet, clean your hands with soap. So it is a problem which is much deeper in the last few years we have through our interventions and we have reached about 60 million people. Children in schools is women close to birth, childbirth so that we can reduce the neonatal deaths and diseases as well as in many cases to the elders in the villages is changing the habits and again like we as consumer market is known to create categories we are market makers. So the way we go about it is the levers of change is make it understood make it easy make it rewarding, make it desirable. If I give you another insight, there would be no mother who would not like to be called a good mum and more so they would like the community there the relatives to call them as a good mum and when she understands that washing hands with soap is going to help the child is prevent infectious diseases then she does take action and at the end of the day you have to make it a habit unless it becomes a habit it won't happen so it's not about affordability it's not about the reach of soap the core question on hand washing is changing human behaviour you also sell your products as sort of sanitation and health instruments what's your experience in changing attitudes? I think some attitudes are changing quite well so India is the largest producer of soap in the world we consume more soap than any country more than China for example bathing is a very regular habit in India I think partly because of the heat of the country so there's much more bathing in summer many Indians bathe twice a day whereas as mentioned hand washing on the right occasions is not a habit and we need to inculcate that habit and just washing with even ordinary soap kills a fair part of the germs for a short while so special ingredients which we call germicidal soaps which can kill germs for a much longer period of time after use and regular washing of hands particularly after visiting the toilet is rather important now this is something we need to inculcate much more there have been attempts unfortunately it's been slow for various reasons but aside from hand washing I feel just general improvement in cleanliness in the surroundings is very important because the lack of cleanliness in our surroundings creates a lot of disease and difficulties I think also I also think that has to do with taking responsibility really as Mr. Modi I think that's Swachh Bharat campaign I think one of the underlying reasons for it also is for each and every Indian to stand up and take responsibility for his own country really we are all standing up together when we say Swachh Bharat and we say that we want to do something for it we are all standing up together and saying that yes we own this country and we are willing to stand up and take responsibility for it and I think that's the behaviour change that is slowly yes you are adding value to it with that absolutely I like this new hand cleaning it's quite catchy I mean forget the mixed up matter for hand cleaning in Hindi heartland means something else hand cleaning we are hand cleaning we are teaching children wrong values but how do you take the message forward why does India need Kajal to take this message forward because they know me no I think I you know what do we contribute really I'm just a famous face really and when I think about it there's nothing much that I cannot go and sit and teach 100 children over there how to wash their hands every day and do all that but what I can do is I can stand up in front of all of you people and in front of the media and because somewhere down the line you recognise me somewhere down the line you know me from before you look at me a little differently and maybe accept what I have to say and remember what I have to say and communicate it a little better that's really my job that's what I think I can do I'm a PRP have you run into any surprises while doing this well it wasn't really a surprise but I think one of the biggest obstacles that we had when we started Help a Child Reach 5 was just to make people understand how important it was because you know when I first went in for a conference and I was like oh you know I'm standing and I'm talking about hand washing here we are you know we're talking about you know providing education here we're talking about cancer and we're talking about HIV etc etc and here you're talking about hand washing I mean how exactly are you going to change the world with that so I think that was one of the biggest obstacles that we faced that yes it's important it is very very important when you think about any hygiene programme in the world that you want to put into place the first basic and most cost effective step to it is hand washing you have to start if you look at any health professional in the world when he enters the hospital the first thing he heads for is the hand sanitizer when he exits the hospital the first thing he heads for is the hand sanitizer so we are speaking about cleanliness and if you talk about if he's doing it if you know that the doctor is doing it and he's healthy he's got to help us somewhere so Adi it's a slightly irrelevant question but are hand sanitizers safe or is it down side to having them on your hands you don't have to rinse them they don't leave a residue that gets into your food when you eat it well I suppose I don't know I don't know if they've been tested on if people have used it just before they eat food with their hands but even if you look at the contents of a hand sanitizer it's not likely to affect I think have they been tested are they safe absolutely I can certainly tell you if you use a life boy absolutely no that says so I'm talking about hand sanitizers that was perfect advertising currently popular hand sanitizers people carry their pockets you don't have to rinse your hands afterwards absolutely so you actually don't need to rinse yeah Sara did you use celebrities like Kajal not like that we don't have so many celebrities like that we have many celebrities but we do have even imported in India now she's quite quite a celebrity but I think what all this comes to is the notion of culture that there needs to be a change in many of our cultural attitudes because we are coming from a traditional culture which has its own value system some of it is very good some of it is not so very good it's very important I think that through education now take this whole question of washing hands and bacteria how few people know why you should do that how does this bacteria operate how does it spread all that is a part of our knowledge system I mean just telling a person wash your hands because it seems a nice thing to do may be adopted but really if they get to know why this is done the whole system of how infections spread that has to be brought into the consciousness of people then only they dedicate themselves to that practice so I think now Mr. Godrej mentioned there are sort of deep cultural structures like for example how do you view your body how do you view the outside world and it has been written in many Asian countries many Asian civilizations they are very particular about your own body you know keeping it clean body fluids all that stuff is very very and you know the traditional system where people would take a little pot and go into the paddy fields and so on that was there but that type of knowledge why that happens that is after all it's modern knowledge how bacteria this is how all these viral diseases spread so there is a whole element of I think explanation that needs to be done actually importance of awareness and attitudinal change can't be overstated because that's one of the reasons our rivers are so dirty because our untreated sewage is being shoved into our rivers and that's one of the reasons our temples are so dirty Kajal, aren't our temples not are not really the finest example of I mean you I agree completely but again we come back in Kathmandu the Kashi Vishwanath temple in Varanasi even Nasik for that matter you have but that's something again we come back to you know we come back to be changing you know that's something so it's something that that's something that our people have been doing so constantly I mean even the Pandits who sit over there eventually turn around and take that tokri and put it outside only they don't have a dustbin over there they don't have anything over there and where everybody sees one big pile of garbage okay don't keep it on its side don't keep it this way don't keep it that way go and put it on top of that pile only so I think that's something again you know you have to start I would say I would say the best thing would be to educate the Pandits really I mean to make it a religious to make it actually religiously wrong rather than morally wrong and ethically wrong that would be the first step to make it just religiously wrong to you know spread dirt or in any way put it somewhere where it's not supposed to be that film, Satyajitra's film called Ganesh Atru have you seen that? That's about a doctor you know this is about a doctor who talks to the temple about this and then they also don't follow that then there is some big plague and they blame the doctor for it you know so that's the same story I think it's an adoption of absence enemy of the people it's a beautiful film so exactly what you said that even in these religious premises they are more concerned about the self cleanliness, purity about the self but on the public space and accumulation of dirt and so on they are not so particular that's a religious places are a good place to begin this campaign isn't it? To spread awareness yeah of course religious places one the other is school I think it's very important to catch them young and in many cases we have seen the attitude and behaviour of the adults being influenced by the kids and if you are able to inculcate the right habits when the kids are young and it stays with them for the rest of the life and kids are open to listening you know they are open to listening except to their parents as long as the teachers are telling them it's fine but I think even if you go and explain to a Pandit or if you ask him also what is the reason for this half of them don't know the answers to what you want to say also if you tell them that's fine or whatever it's against this it's against that or whatever so I think that's something that kids are open kids are an easier medium for us to put our message through and they are able to say what they want to say with that innocent out of a child's mouth out of a babes mouth basically what's the most interesting thing you've heard from a child even if yours the most eternal question why after everything is explained to them they are like but why I don't want to but I just explained it to you this is the bacteria this is what's going to happen to you I don't want to and I'm like I can't fight that I really can't fight that I don't want to I can't fight that statement really Adi are you happy with the kind of communication that's being put out right now these jingles on TV, radio do you think it could be better well anything can be better but I think it's very good and I think the campaign itself is a great idea I think it's going to add tremendous value and I hope we have more such campaigns I know we have another one in terms of women's safety et cetera but these campaigns can add tremendously besides just economic reform and I think this is a great one it's motivating the country I think it's getting people together it's getting people aligned there's no opposition to such ideas everybody thinks it's a good idea everybody thinks it's a good idea I think it's a very good move it's just a surprise somebody's taken so long figuring it out top leader in India what's nice about it is that yes there is there is a direct economic link or whatever but what's nice about it is that actually when you think about it I mean from a completely layman's term you don't see the economic link you just think that it's for the good of the society which is what is so nice to see rather than concentrating on only oh you know this business will grow or that business will grow it's just nice to see that something that's being done for the good of society by society I think we'll soon throw it open to questions from the audience before I do that can I have a microphone taken to Sadguru I have to ask him a trick question it's unfair to call him a man of religion he's a man of spirituality but he's a very wise man when you have doubts about something you check out with him so Sadguru here is my trick question the Sikhs keep their Gurdwaras clean Muslims keep their mosques clean Christians keep their churches clean Hindus don't keep most of our temples clean some are clean, Tirupati is very clean could it be because we leave it to a particular caste we don't see most of us don't see it as our responsibility whereas other communities are able to get the entire community involved in action if you go to the golden temple in Amritsar where I often go you find almost all devotees come in contribute to keeping the place clean I think that's mainly because it's not a certain level of commitment of an individual person which is giving him access to manage the temple it is a certain right that is coming because he belongs belongs to a certain family many of the temples are dominated by families who have been priests for maybe a thousand years and this filth in the temples is I feel essentially another Indian feature not so much in South India really Yes, that's true Questions from the audience have first and then This is Akriti I am a global shaper and initiative by World Economic Forum so my question is that the main point of discussion was behaviour problems of the Indian society means if you keep a sanitizer they won't use it if you keep a dustbin still they might throw the filth outside you have public toilets but they might not use it so there is an interesting concept of being used abroad known as nudging you bring certain small changes like there was a nudge dot that a dustbin if you throw a garbage in it it will make an interesting noise like it is going deep down the hole so people out of curiosity start filling it up with the garbage like whatever comes they tend to drop it or if there was an interesting thing done by Pune Hub that if you go to use the public toilet at the end of the year the credits will be given and you will get a t-shirt something like that so this interesting concept can be implemented in India without involving crores of money, millions of money so why is this concept not so much known in India till now while other countries have set up committees on nudging theories who are you addressing it to I will address it too so you make sanitizer and ma'am because you are dedicating about behaviour both these sirs make sanitizers they compete anyone who is comfortable with this question can answer just a few minutes back I alluded to how we do the behaviour change and first is you have to make it understood they need to understand like I said that a clean visible hand is not necessarily free of germs so once you do that I think the penny drops then you have to make it easy for them you have to make the soap accessible for them which thankfully in India it is then you have to make it desirable like I gave you the story of that mum when she comes to know that if she washes her hands with soap and then her child will be protected that's a big incentive that's a big motivator and then you have to make it rewarding for her when she understands that hygiene and sanitation has linkages to economic prosperity there are very clear indicators that in rural India about 9000 to 10,000 rupees per household is lost because of lack of hygiene and sanitation ill health coming out of that and then when you reinforce the messages then it becomes a habit nudging also what you allude to is very similar to making it a habit and that's what we do different levers we bring in to change the behaviour nudging strategy in Sri Lanka no, we use nudging for other things no there are a whole variety of things possible whole variety of approaches this is probably one but the decision maker has to select out our whole series of possibilities this may be one in other cultures, in other societies think of other strategies but the main thing is to make it effective Adi? I think this campaign has just started and I think communication ideas etc will evolve so there will be a lot of people who will find successful ideas whether it is for commercial purposes whether it's for projecting oneself so I think that will come the great thing is this campaign has started and I think a year or two from now I think we will see a lot of results of it and clearly in most societies when people see results of something coming then it is encouraged even further and I think having Kajal and many other people like her there is an example of the same nudging isn't it? so we are basically nudging you nudging star I have to tell you something interesting to talk about nudging there is a twitter handle called weird facts I mean why did I watch this don't ask me I just picked up something that floated in twitter space it is a picture of a dispenser in Istanbul where if you put your used plastic bottles and plastic recyclable waste from the other end free food falls and dogs so at any point of time there are dogs hanging around this place people who want to look after stray dogs come and put their garbage and these dogs queue up this is an example of nudging as well of course if we did that in India there will be an outcry so we will have to find some other variation and then Hi my name is Sharanya Sekram and I am the director of this movement it was an interesting concept that I am glad Akriti brought in behavioural changes because that is what we were discussing for a good portion of yesterday I find it very interesting as you well know in Sri Lanka when the government initiated the clean Colombo and Colombo became so clean there was an outcry of people going finally the government did something and there is always this responsibility in Sri Lanka, most educated people and yet we were just as bad almost at one point as Chennai or Bangalore or wherever you want to call it and now we said finally the government decided to do something and at the same time you have private sector and civil society doing separate things now seeing as the theme of this summit is public sector, private sector corporation I am actually interested to hear from especially the private sector and public sector members of the panel whether there is a way that private sector can use their joint powers to not just place the sole responsibility on the government because like you said sanitation and health is very much an individual responsibility so how do we combine these two large sectors which stand both to lose and benefit from bad sanitation or bad healthcare or bad cleanliness how do they join hands and join forces to create that individual responsibility because really that's why it lies you want me to only public sector person well really if you look at that the garbage let's take the garbage collection in Colombo is done by the private sector it's done by Abans the only difference is that now the government has insisted that they stick to their contractual obligations you know in many of these urban large trade unions workforces and so on they get used to goofing off they don't do what they are really supposed to do so if the government insists on really their own contractual agreements as we did in Colombo got them to really honour the agreements that they have entered into then there's a world of a difference so this is something the real success of why Colombo became a very clean city is not that we invested much more money or brought more people or anything like that there was a little bit of that but the main reason was that those who had signed contracts or private sector people to perform various services were compelled or were urged to really stick to what they should do and that has made a world of a difference Colombo today is a very very beautiful city also Colombo I think awareness makes a big difference because you know you have Colombo which has scores of fast food carts which are constantly frying seafood and stuff and they are picnickers but you never find a piece of garbage refuse and there is no cob walking around with a whistle saying why are you doing this don't throw it here so it's also a question of awareness Mr Bajaj I wouldn't say that we are adopted but we are working in 100 villages and our experience was we started making toys that time government was giving some subsidy also which they reduced so the program became a little dampen but we made toilets nobody was using it they did not want that stupid four by four cubicle with the foul smell there compared to the beautiful environment of healthy air coming by it was very difficult to explain them now what changed is this addresses your point also Kajo your pressure when the next village we made toilets and they started using it the other village which was not using it started using it also same thing happens the same Indians why do we throw garbage on garbage is because already dirty I don't feel guilty of throwing my garbage there you don't see garbage you don't throw garbage the same Indian who would not mind throwing garbage in India will not throw garbage this I believe is peer pressure I believe that is the answer if the kids around those kids who said no we will still do it if they had seen that 8-10 friends do the right thing that's the point I was making other problem is we have desilted the hairs so that people villages which were tanker dependent had 24x7 flowing water now people defecate in the canals next to the canal they wash the hands there which is very unhygienic I believe that we have not solved the problem yet but I believe peer pressure is going to solve this problem so I just wanted to connect with you and convey that perhaps peer pressure could solve the problem with you I think peer pressure and pride because look at our metro how clean do we keep our metro even Calcutta which got the metro so many years ago keeps it very clean because I think one you take pride in it and second you see no one else littering so you don't litter Sadguru wants the mic for me we have to recognize that there is no one India here there are many layers of India which need different types of nudging in different spaces because there is no one culture one economic strata there are so many layers it has to be nudged accordingly we've been working in the rural space and wherever we have worked people have most willing to change it's just that nobody told them it's not that they do not know it's just that in India nothing changes by policy it has to become an emotional moment only then things happen in this country and it's truly fantastic that for the first time at the very top somebody is talking about it and people went about describing this as Prime Minister is wasting time on pedestrian issues well 90% of Indians are pedestrians so pedestrian issue is a national issue and there is a whole lot of technology in the world today I know people and I have visited these units about 10% of Los Angeles whatever garbage that it produces someone that I know is converting it into diesel it's like this there are many technologies unless we bring this forth that filth can become wealth if we just bring forth this idea private sector will be very eager to get in and people will be eager to get in you will not be able to find filth because it's valuable I think we must make filth into wealth that's the most important step we need to take Can I make a comment? I think one of the good things is that this declaration by the Prime Minister and everybody following is also been accompanied by a new policy in India which mandates that companies spend on corporate commercial responsibility and I know a lot of companies after this have decided to use a significant part of the CSR budgets for both this spreading toilet and cleaning up so I think coincidentally that will help the whole program It's a very important gap because you find increasingly now people use bottled water because lower middle class families also use bottled water but the same consciousness is not there washing the glasses properly so I think the water is safe whereas doctors would tell you that you get hepatitis not from water but from the glass because that's where jamsit you have a question? Thank you very much I think we're all riffing off of each other I want to pick up on something that you said and something that you had said also Mr Bajaj and that really is we haven't talked enough about infrastructure there's a lot about behaviour change but one of the things that I get so tired of hearing in India, around the world is that this is a country that has more mobile phones than toilets so we have to use the genius of our people to disruptively move into that space of infrastructure so that we have toilets and especially toilets for women and girls so one of the brilliant things that the Prime Minister has done is actually to listen to what village women have been saying for decades when they're asked what are your priorities the health of my children running water and I need the toilets they understand but by the time it gets filtered up to the male decision makers with no offence to present company it becomes completely distorted and so let's get back to the basics and let's have many many innovation challenges to get our entrepreneurial young people in particular providing some of the solutions for toilets Does anybody want to respond to this? She's absolutely right I mean there's no getting away from it and it is not about either or it's about and we clearly heard that if you have toilets but behaviour change don't happen it won't be effective at the same time if you work just on behaviour but you don't have the infrastructure how are they going to make use of the new habits they have inculcated so they have to work and the other important bit is it is again not just the job of the government it is the government, the private sector the NGOs, the civil society we have to come in a cohesive way and start making a difference but the wonderful bit is now that it has become the centre of dialogue the centre of policy things will make happen Question in the back there Sandeep Parikh Very quick comment and this is from Atul Gawande's book called Checklist he starts the book with an example of surgeons we are not talking about illiterate people in the hinterlands of India but surgeons in the US don't actually wash their hands before a surgery and once they introduce this checklist the post surgical infection levels fell by 40% not 5% 40% so I think there is a lot of learning for all of us not just for the illiterates Anymore Both of them Are you from Pakistan too? She is from Pakistan I am from Afghanistan I am from Afghanistan My name is Shakira Zia I am the Chair of Kabul Hub Community of World Economic Forum I am happy seeing you alive in rail for the first time Kajal I have a small comment and maybe especially if you could share your idea or maybe suggestion with me Afghanistan is a country which maybe most of you know we passed some war an interior war then the world was in Afghanistan fighting each other We are also facing the same problem but we do not have the problem with washing the hand because mostly Muslim community are playing and they are taking ablution 5 times The problem in Afghanistan or the major problem is the garbage problem so every disease is again gone from the garbage We are doing all the campaign we do not have famous actresses and actors like you to bring it to media to a campaign but the one we have we use them but it is not effective the people whatever even the president if there is there would be any other way so maybe we could use that can I just make a point that Sanjeev made I think even Adi made that earlier but I think the whole point to conveying information is to make it interesting is to make it profitable and is to make it applicable to whosoever you are conveying that information to when you are talking about people when you are talking about general behaviour change when we are speaking about people we have to be able to convey that information to them in a way that interests them that they understand and appreciate and are able to put into practice in an easy and not too difficult manner but that is again something that your creative team whoever your people are at that point of time in that level will have to develop your people because every country is different as Saduji said that there are lots of layers and each layer has to be tackled differently Adi just one point I think in Afghanistan you will have less of a problem in this because of you being a temperate country compared to most of India being tropical most of the year so because of your altitude and your latitude problems with lack of cleanliness affecting health that doesn't mean that if you do clean up you will also have great advantages but I think temperate countries tend to have fewer problems of this sort than tropical countries like India and don't worry even if you don't have film stars like Kajol you have a cricket team coming up with stars now didn't you beat the Pakistanis the other day once in a while you do that so you are a neighbour from Pakistan Hi I am Anusheh I am from Lahore Pakistan and I am a global shaper I have worked with an NGO that focuses on hand washing campaigns in schools so when we were working for them and researching on nudges as you call them I noticed a trend in advertisements they have actually started focusing less on the benefits of cleanliness and more towards the medical costs that the parents have to incur if their child falls sick so I just need to know if that's intentional and if that's more effective Are you addressing it to someone? Are you addressing it to anybody? Sanjeev, why don't you take that? See again I think one has to understand the context over there if for instance the illnesses are all pervasive and the cost of treating them are very high and every household spends a huge amount of money then that could be a very telling campaign so one has to understand the context before one can comment whether that communication is effective or not But tell us also how is Pakistan, is there much buzz in Pakistan about this campaign in India? We do have a global hand washing day and we follow the same advertisements as well I hope the message is not the same hand-safkering Hi, my name is Narendra and I'm in communications and I spend a lot of time nudging people to like brands as we sort of embark on this massive social engineering profit, this project and Shekhar and the minister this question is primarily for the two of you What are the checks and balances that we need? When are we, when does social engineering get out of hand and what's the possible backlash that we've got to be ready for if social engineering these sorts of projects don't work in the short to medium term You are a public figure do you ever deal with people all the time? No, you have to look at the benefits first I mean let's not jump the gun and worry at this stage what will be the backlash what will be the other problems and so on when we are so skeptical then nothing gets done this is one of those areas where there's hardly any contrary where other interested groups challenge that this is I think quite universally applicable after all child health, maternal health longevity these are all universally desirable objectives so whatever campaigns you have there may be problems regarding the content and so on but basically the objectives are I think universally accepted it goes across cultures it goes across countries because in the civilized world and not only in the civilized world even in the past where they didn't have the technology and the knowledge to combat those still these objectives were very desirable so I don't think this is one area where we are going to have large controversies as to what are the by-products what are the other side-lines side-effects and so on but let's get on with the job and I think the community or the country or the leadership or whatever you call it are smart enough to deal with whatever side-effects arise from things like this I think socially the only thing I'll worry about is if a kind of attitude gets drummed in that oh I'm clean but so and so is dirty my family is clean but so and so is dirty then my community is clean but the other community is dirty and by God's grace in our diverse society we have stereotypes about everybody else so I think that is the only worry but I think the way the campaign is being done right now is quite safe Hi Gary White I'm CEO and co-founder of water.org and we could just as easily be called sanitation.org because we focus on both two things first around kind of the attitudes and how do you reach audiences with these messages Matt Damon's the other co-founder of water.org and we found that using humor in this has tremendous impact so when Matt would do a video about how important sanitation is like stating the facts we'd get like maybe a few thousand hits on our website and then we did this toilet strike campaign where Matt went on a toilet strike to kind of draw attention to this and we were able to package in messages you know for people in the position to help with this issue able to package in the serious messages with the humor and we got 6 million hits on the website so I think there's ways to kind of do this creatively I don't know how you extrapolate from that into the audiences of trying to change behavior locally the other thing is with respect to the infrastructure question the concept of raising awareness, raising demand total sanitation programs etc is obviously very important but if people don't have the access to the finance in order to be able to build the toilet that they want that's a huge gap as well and so certainly there are the government subsidies there at the national and state level and elsewhere between that 10 and 12 thousand rupee range but there's a lot of people who want to get access to sanitation and a place to bathe and want to kind of upgrade from that and I think you find that if people have these aspirational needs around sanitation when they get the toilet that they want they tend to use that and it's more sustainable as opposed to getting just the basic toilet there's a need to introduce microfinance into this as well so people can get access to the funds so that they can satisfy those aspirational needs once the awareness is raised and we've been working with the PepsiCo foundation and IKEA and Caterpillar and others to invest about 7 million dollars in kind of jump starting this microfinance market and that's now leveraged about 60 million dollars in commercial capital that's allowed about 1.5 million people in India to get access to water and sanitation through loans as opposed to just straight subsidy so I think we need to look at the private sector we need to look at how do we bridge this gap between what the government subsidy is and what the aspirations are because that can ultimately lead to greater sustainability may I say that what you said is perfectly correct you can raise aspirations of people you can change attitudes but if the infrastructure is not there and if the product is not there then that is one of those side effects I think which could lead to a lot of frustration so both the attitude change and the physical infrastructure must coincide must work together. Otherwise we go through this process of changing minds changing attitudes and then creating a lot of frustration is very well known in advertising that you must create attitudes but then the product is not there the price must be right the packaging must be right there is a whole series of things which make the package available in an attractive way that is very important otherwise you are working across purposes one thing we now know one more example one more evidence if we need it that nobody is more complete package than a politician even an expert in advertising I am calling it obsession with hand washing because you can sell your soaps I think we should go beyond that it's also sanitation it's a safe drinking water it's how do you store the water but we don't advertise because it doesn't sell the soaps so I think we should get out of this narrow advertisement which will bring you profits and business and have a much wider aspects of it and also the same people may be selling advertisement for me nutrition clean food is also very important advertisement of Pepsi Cola and all of that junk food when nutrition is a major problem 60% of our children are malnourished hunted so we need nutritious food so drinking milk of course you also do that drinking milk is more important is an important advertisement for us so those things are also very important than this commercial markets with a narrow outlook is not that good I think it has its own vested interest and they should be broader and bring in Swachh Bharat from a broader holistic campaign and go beyond their limited selling of their products. Can I comment on that? You spoke about a couple of things one is water and just picking up from water issue recognizing that not having a safe drinking water in India is a big issue we did a lot of research and came up with a patented technology that even in places where you don't have electricity you don't have running water you can still have bacteria free water and that is the genesis of purity and today we have about 60 million Indians having access to safe drinking water so it is not that even talking about toilets our Domex Toilet Academy is doing exactly what the gentleman over here said with E. Koteer we have set up models which are micro financing setting up and running of toilets The whole focus here was soaps that's the reason we were talking about soaps but that's not where our mission is all about One questioner has been waiting very patiently do you want to come in on this? Ma'am you've been very patient I'm sorry I've got these lights in my eyes for some time Just very quickly I don't know if anyone has spoken about this before but I wanted to give you a perspective from the US where people of my generation from the 70s went through a very effective brainwashing process about the importance of cleanliness and not polluting as I discovered when Prime Minister Modi launched the Swatch Bharat campaign and I saw him sweeping up suddenly the words in my head popped in give a hoot don't pollute Now what is this? This is a campaign that ran in the US for 20 years bombarding children messages of like three to ten with messages about the importance of not littering and the fact of how effective it was can be seen not only in the fact that I feel guilty every minute that I think of tossing something out the car window but the fact that it popped in my mind when watching Modi launch this slogan so what I want to say is in any effort at behavior change and messaging I think it's important to realize that it's a very long process and any campaign that's going to be effective in the long run has to run long. Thank you Thank you. I think we have to now call it a day I think we can carry on couple more hours No Thank you very much. I think you've been a wonderful audience and wonderful panel so applause for all of you and you've all been patient and very very keenly involved. Thank you Shekhar And Kajal just a little thing this gentleman is not a Sadhu Sorry You already called him Sadhu Sadhu, he is far from being a Sadhu he is he is as cool as they come as spiritual gurus Well you can make out the way he spoke that he is very cool and you called him Sadhu I also called him Sadhu Oh Sadhu Sadhus, he can sort out very Sadhus and he won't mind my saying all that I get away with him with anything Thank you