India really needs to work on consciousness-raising regarding sanitation/cleanliness. Modi made a start in 2014. I don't know why the momentum stopped. Some of the videos coming out of there (e.g. the recent video of the railway employee throwing a huge amount of used disposable plastic food trays off a moving train) are shocking.
Anecdote alert: I travel to India at least once in a year and I have to take the train each time (sleeper class) and I can definitely attest that things have significantly improved since I was a kid. I have been taking these same trains for over 25 years now. For starters the toilets actually don't dump directly between the tracks. The railway employees seem to be quite happy and take pride in their job (they used to always have depressing faces when I was growing up).
Another anecdote : If 20 years ago you took a flight that goes to India, you would be frustrated with the condition of the toilets. It was so bad I used to avoid Indian carriers just because of that and intentionally take a layover in Europe so at least part of the flying experience would be cleaner. These days I don't feel that way, I find flights to India pretty much the same as any other flights.
That said, there is still a LOT to be done, but I think overall people do seem to care about hygiene more than they used to years ago. Also, assuming there is always a certain percentage of population that will never care about this (in any country) it is bound to look a bit worse in India due to the higher population density.