Two important differences between modern India and urban 19th century America and western Europe:
The provision of clean water and sewer connections was not remarkably fast in the now indistrialized world (see for example, Martin Melosi's _The Sanitary City_) There are two things that make India's current situation different from western Europe or America's in the 19th century however that have made progress even slower in India and in other economically developing countries. The first has to do with the medical advances that have taken place between the 19th century and now. The second is the sheer size of the problem India faces now now versus what America and western Europe had to deal with a century and a half ago.
Modern medicine has made it possible for economically privileged families to protect themselves without having to worry as much about the poor and their situation. In contrast to 19th century America and western Europe, middle class and wealthier families can insulate themselves fairly effectively against diseases such as cholera and dysentary. Abram De Swaan in his book _In the Care of the State_ details how even as more properous families located in suburban areas with new construction and water and sewer lines they could not completely protect themselves from diseases spread from the poorer sections of 19th century America and Europe. Also with greater numbers of poor people crowded into urban areas it was more and more likely that dieseases such as cholera would break out and spread from poorer areas to wealthier ones. Before antibiotics, other advances in medical care, and insecticides weighing the threat of diseases spreading to wealthier neighborhoods against the added costs of extending water and sewer lines to poor neighborhoods, the calculus of enlightened self-interest tipped the scales in favor of the poor (see Abram De Swaan, pp. 137-142). In modern India the costs and the benefits have changed radically. Poor areas are incredibly congested and therefore very difficult (i.e. costly) to connect to existing water and sewer lines. At the same time and more importantly, the direct benefits to wealthier families of such measures are far less thanks to modern medicine which better protects them against the threat of diseases originating in poorer areas.* *Susan Chaplin in her article "Cities, Sewers and Poverty: India's Politics of Sanitation" (environment and Urbanization, 1999, pp. 145-158) clearly notes this "...the very developlements in modern medicine and civil engineering that contributed to the success of sanitation/ public health in nineteenth century Britain have enabled the middle class to largely ignore environmental problems and the resulting diseases. The use of antibiotics and insecticides have generally contained potential epidemics in slum areas, and hence have not generated a mutual awareness amoung the middle-class that it would be in the interests of society as a whole if the poor were provided with decent living conditions" (Chaplin, p. 151) The congestion and the resultant costs of dealing with sanitation issues are in part a function of much higher rates of increase in numbers and therefore a much larger scale problem to be dealt with. Mira Kamdar in _Planet India_ notes that urban India grows by 10 million people a year. and in Calcutta, The Living City, volume 2 it is noted that Mumbai saw its population increase by 1000 people per day through migration. (Although these numbers are out of date one can imagine the problem is even worse today). America and western Europe had much smaller numbers to deal with during their periods of substantial urban growth. Other factors: A great degree of India's failure to conquer the problems of sanitation and clean water are therefore arguably due to the these two factors. Other factors of course are at play as well. There is the fear on the part of municipal authorities that if in they take measures to improve the living conditions of the poor that this will simply attract more poor migrants to them. There is a Harris-Todaro like argument implicit in this that therefore improvements will be short-lived. As conditions in city A improve a larger fraction of those migrants who might have moved to city B will move instead to A, overtaxing its capacity to serve them and pushing living conditions back to where they were before. The initially cleaner city is ultimately no better off than it was before. One conclusion to be drawn from this is that piecemeal efforts to effect change are far less likely to achieve success than coordinated concerted effort on at least a regional if not national front. There is also the fact that many slum areas are occupied by squatters. The fear is that extending proper water and sanitation will legitimize squatters' claims to these lands. Often large slums are located in what are considered areas of prime real estate (currently Dharavi in Mumbai and the Salt Lake area in Kolkata years ago as well.). As an area becomes more and more settled real estate developers must realize that it will be far more difficult for the state to remove and relocate slum dwellers from these areas on their behalf. (see pages 14-15 of Burra, Patel and Kerr, "Community Designed, built and Managed Toilet Blocks in Indian Cities" Environment and Urbanization, 2003, pp. 11-32) The great predicament is that if the Alliance (SPARC, the National Slum Dwellers Federation, and Mahila Milan) estimates are correct and a 10 seat toilet block will serve 500 people in an area are realtively low cost ($800 U.S. to build a well-designed 10 seat toilet block with pour-flush systems) the fact remains that to tackle this problem requires massive expenditures. For example, in Mumbai almost 2000 such blocks would need to be built to cover slum dwellers who, as of now, haven't access to proper facilities at all. Using the official exchange rate, the total costs would therefore be over one and a half million dollars U.S. (and in terms of purchasing power parity almost $8 million U.S.). Regardless of the cost, management of various charities and NGOs of 2000 such projects along with the competition for money as these organizations work independently of one another implies a high degree of inefficiency. Yet along with the decided apathy that exists due to government focusing mostly on the interests of the well-to-do and the powerful there is the issue of government inefficiency. Burra, Patel, and Kerr make a strong case for being more than a bit skeptical about the ability of municipal governments being at all efficient. One Alliance study cited in their article shows that contractors have routinely built substandard toilet blocks.** Inadequate water supplies in particular mean that often in as little as three months latrines become so blocked and dirty that they become unusable. This couple with builders asking community members for more money as toilet blocks are being built in their neighborhoods and the city charging unrealistically high fees for access (Rs150 for a family of five would allow each family member to use the facilities once a day) suggests that perhaps community based initiatives, given political realities, are on balance a better alternative. ** See Robert Wade_Governing the Market_ pages 288-289. Contrasting corruption in Taiwan to corruption in India he notes that in East Asia: "Most rumored or reported corruption takes place at the local and provincial government levels where nothing major for the national development effort is at stake ... In all these ways corruption contrasts with corruption in many other countries in South and Southeast Asia. Corruption on public works projects, for example, occurs mainly through overcharging for correctly built structures. In India it occurs mainly by substandard construction of correctly priced structures, which are much more likely to wash out in the next monsoon. Taiwan's mode is probably less damaging to economic development than India's".