In an early scene in Slumdog Millionaire, the film’s young protagonist, Jamal, dives into the raw sewage under the outhouse where he is trapped. He wants to get a movie star’s autograph and will not let anything stop him. The same focus allows him to overcome the obstacles of the slums, and the fairy tale ends with him “getting the girl”. The movie, which captures Mumbai’s energy, colour and hopefulness, won eight Oscars as well as the epithet “poverty porn”.

The film is controversial, but it also depicts an aspect of poverty that has until recently been unrelenting. It can also be viewed as a metaphor for change in the film’s location. Just as Jamal overcame long odds to live happily ever after, Mumbai’s determined community groups have markedly improved conditions, eliminating open defecation by millions of slum dwellers who have lacked access to a lavatory.

It is hard to structure aid so that equitable growth is achieved, especially in poor societies suffering from HIV infections or civil strife. But HIV infections do not kill children at anything like the rate that a lack of clean water and sanitation does – a rate equivalent to having a jumbo jet full of kids crash every four hours. Nor are wars as dangerous as the lack of sanitation. As a recent United Nations report put it: “No act of terrorism generates economic devastation on the scale of the crisis in water and sanitation.”

In the past few years, Mumbai has shown that sanitation problems are surmountable. By giving aid to communities willing and able to undertake the care and cleaning of toilet blocks, the costs of proper sanitation have been dramatically lowered. It is hard, however, to measure improvement in an entrepreneurial city of 18m. While unquestionably far-reaching, how does one calculate the social benefits when more young girls continue their education because their school has clean toilet facilities? What would be the social return if even only some of the one-third of sub-Saharan African girls – who drop out when they are menstruating or due to poor sanitation – stayed in school? Certainly the quote from Lawrence Summers, the former World Bank chief economist, that “a young girl’s education is the most valuable investment that can be made”, applies to these enabling investments, even if the “yield” is hard to infer.

The reason these high pay-off investments can be hard to make has many dimensions, but some historical context helps. Mumbai’s per capita income is about $3,000 – similar to the level in New York in the 1880s, or London in the 1860s when it began its assault on “The Big Stink” and on its periodic cholera epidemics. Mumbai today has similar literacy levels, a greater population density and a city government with fewer public resources than the London or New York of those earlier days. It is not a surprise that more has not been achieved in its sanitation.

Neither should it be surprising that until community groups began to undertake this work – as they are in Mumbai – the projects that secured funds had a top-down, over-designed quality. Of course, community involvement should not replace technical expertise. But the involvement of local people yields benefits, especially in ensuring the upkeep of facilities. Slum community groups have developed techniques that allow them to leverage local interest, not discourage it.

Donors, as well as community organisations, have to adjust. Fortunately, there is a growing realisation that community groups are closely aligned with the needs of the poor and can scale up their innovations to the levels seen in Mumbai. The best example comes from Bangladesh: the Bangladesh Rural Advancement Committee (Brac), which is the world’s largest non-government organisation, and the Grameen Bank, the institutional home of the Nobel laureate Muhammad Yunus. These groups reach more of Bangladesh’s poor than the government.

Ultimately, the question is whether we will see urban NGOs following the paths of Brac and Grameen. Could they expand the scale of aid to focus more resources on the urban poor? The answer matters, as in the next 15 years there will be many more Jamals. Almost 90 per cent of the 2bn rise in the world’s population will locate in cities that are already home to hundreds of millions of slum dwellers. As the subtitle of a Rockefeller Foundation study of urbanisation says, there is No Time to Lose. Empowering people to help themselves would extend basic democratic decision-making and shift the aid architecture to one that is more responsive to the Jamals of this world.

The writer is managing director of the Rockefeller Foundation

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