Earlier this month, the ministry of drinking water and sanitation reaffirmed that Sikkim was the only state in the country to have achieved 100% sanitation.

It's an admirable achievement for the tiny mountain state, considering that India has the world’s largest population of people who defecate in the open. According to the 2011 census, 53% of Indian households do not have toilets. In villages, the figure is even higher: 59.4% of rural India practices open defecation, according to December 2013 data from the National Sample Survey Office.

But India wants every village in the country to be free of open defecation in eight years, with a toilet in every rural household.

The country has been on a toilet-construction mission 1986, when began to offer subsidies for building latrines under a programme that is now known as the Nirmal Bharat Abhiyan. Since 2001, the central government has spent Rs 15,000 crore to build 93.5 million toilets across the country. The latest report from the ministry of drinking water and sanitation has ranked Sikkim first in implementing this programme, the state government announced earlier this month.

Sikkim actually achieved the goal in December 2008, when it was declared a ‘Nirmal Rajya’, a state completely free from open defecation. That year, the centre gave the state’s 163 gram panchayats the Nirmal Gram Puraskar, a monetary incentive ranging from Rs 1 lakh to Rs 30 lakh, to ensure that every household has a toilet. "Sikkim has also set new benchmark for utilisation of funds under the scheme," the state government said. "The utilization percentage was 99.2 percent till February 2014."

But what made Sikkim a success story? Was it only because it is the second-smallest state in India, with a population of just over 600,000 people?

“Open defecation has not really been a part of Sikkimese culture all these years,” said Bijoy Gurung, associate editor of Sikkim Express in Gangtok. “People are conscious not so much about hygiene but privacy, so even before the government started its programme, villagers used locally-made bamboo structures as toilets.”

In addition, says Gurung, all the pure water streams running across the state are treated as incarnations of the divine. “The streams are our lifeline and people did not want to pollute them,” he said.

These factors made the government’s job much easier when it began constructing toilets in homes, schools and anganwadis. Since 1999, the state’s government built 98,043 household toilets, most of them for families below the poverty line. The programme included door-to-door campaigning and working with school children to convince families about the health benefits of using toilets. “The government got local panchayats involved to sensitise people, particularly about hygiene and the fact that Sikkim has to maintain a good image as a tourism state,” said Gurung.

But other states are lagging. Despite concerted efforts by the government and non-profit organisations, most states have failed to achieve even 50% of their targets. Jharkhand, where 90% of the rural population lives without access to toilets, is the worst performer. The 2022 deadline is sure to be missed, and the reason, say experts, is almost entirely socio-cultural.

In societies that have a long tradition of just heading to the fields to do one’s business, toilets are perceived as restricted, dirty spaces that should not be near one’s house, says Chandra Ganapathy, programme support manager at Water Aid, an international NGO that works on water sanitation and hygiene. In one of its programmes, Water Aid is working with governments in ten different states to help implement the toilet initiative.

Casteist attitudes are also a major hurdle in rural India. “Across the country, people still believe that sanitation is the duty of the untouchables” who carry away excrement from homes, said Bezwada Wilson, founder of the Safai Karmachari Andolan.

Though many villages in India have been declared open-defecation free and awarded the Nirmal Gram Puraskar, experts say the awards have not been a success. “In many cases, there are slippages – villages are open-defecation-free for a few months and then they slip back,” said Ganapathy.

Wilson is even more sceptical. “Barring the north-eastern states and perhaps Haryana and Punjab, there is not a single district in India that is open defecation free even today,” he said. “The government claims it gives people subsidies, but how much of that goes into building toilets? Not much.”

To help over come the cultural aversion to toilets, several non-profit organisations, such as Arghyam (in Karnataka), Water Aid and Sulabh International, are working to educate communities about the necessity of sanitation.

“Most people don’t associate open defecation with diseases like diarrhoea, which alone kills nearly 200,000 children under the age of five in India every year,” said Ganapathy. So an effective way to create the need for toilets is convincing people that they will keep the whole neighbourhood safe from such diseases. “It’s easier to convince younger people that the cost of building a toilet is eventually cheaper than the cost of not having one,” she said. Women are also easily convinced about toilets because they guarantee them safety and privacy.

The goal of being open-defecation free is, however, linked inextricably with water supply, particularly in rural areas and pockets of urban poverty, where there is no direct water connection. “Sanitation has not been a top priority for rural populations because water supply is a major concern for them,” said Sudhakar Kini, chief architect of toilet innovators Sulabh International.

In 1968, Sulabh began to promote its twin-pit latrine design, which requires just 1.5 to two litres of water to flush, compared to the 12 to 15 litres that modern toilets use up per flush. “But water supply and toilets also have to be clubbed together with solid waste management (which deals with other kinds of waste) in order to achieve total sanitation,” said Kini.