with Prof. Charan Singh, IIMB
Introduction
World Health Organization
(WHO) released a Report on Drinking Water and Sanitation last week. India continues to be a country with the
highest number of people in the world practicing open defecation (OD) – about
half of its population. Of the one
billion people practicing OD, 597 million live in India. India’s performance is worse than that of
other emerging market economies and least developed countries (LDCs). In India 65 per cent population in rural
areas (30 per cent in LDCs) and 12 per cent in urban area (6 per cent) resort
to OD. And still worst, according to WHO, India is not making significant
strides in reducing OD.
In the case of drinking
water, India is doing better than many other countries in the world. But there is further scope to improve safe
drinking water facilities in the country, as in rural areas, 1 per cent of
population is using surface water which is considered unsafe.
Optimal health policy
requires appropriate policy for sanitation. In developed countries almost
everyone has access to a private flush toilet served by a continuous supply of
piped water. Human waste is channeled by separate sewerage pipes, ensuring that
drinking water is separated from pathogens carried in faecal material, and taps
located in close proximity, enable people to maintain personal hygiene.
Effect of Sanitation
Better sanitation helps
to break the faecal-oral transmission route that impact public health and is
beneficial for the household and the community. Cross country studies show that sanitation is
the strongest determinant of child survival and improvement in sanitation is
accompanied by more than 30 percent reduction in child mortality according to
UNDP. According to studies conducted in different countries, it is estimated
that having a pit latrine in the home reduces the incidence of diahorrea by 50
percent, while having a flush toilet lowers the risk by 70 percent. According to research in Salvador, Brazil,
incidence of diahorrea was twice as high among children in households without
sanitation when compared with children in household with sanitation. Similarly, diahorrea was three times greater
for children in communities without sanitation when compared with communities
with proper drains and sewers. As shown earlier by Virmani (The Sudoku of
Growth, Poverty and Mal-nutrition, 2007: and Under-nourishment of Children: Causes
of Cross Country Variation, 2012) lack of sanitation is a major cause of
malnutrition in India and across the World.
The strong externalities
associated with individual and community investments in sanitation make a case
for public policy and may be subsidies.
Costs
The financial cost is
very large in moving from OD to safe collection disposal and treatment of
sewage effluents. In rural areas, with sparse population, costs of laying of
sewerage networks are large compared to urban areas and therefore public
facilities may be a viable short run option. In urban areas, problem is most
acute in slums, which do not have proper sewage collection and transport
systems. Further most cities do not have systems to properly process the waste
before disposing it in the river or other water bodies.
Clean water, sanitation
personal hygiene and good nutrition are the four foundations of good public
health policy. Generally, sanitation is most neglected? The reasons could be
manifold but inadequate financing and capacity constraints, especially at the
level of municipalities, results in weaker national strategy. Poverty is another barrier which results in
low level of sanitation as, illustratively, a pit latrine would cost more than
a monthly wage and therefore is unaffordable. Hygiene is also another predictor
of public health as hands transmit pathogens to foodstuffs and directly to the
mouths but is generally neglected.
Past Efforts
The government has been
making efforts to improve water facility and sanitation, especially in the
rural areas. To improve rural drinking water supply government has been making
provisions under Bharat Nirman. The
data from NSS 69th Round (NSS69), released in December 2013, reveals
that 88.5 per cent of rural households and 95.3 per cent of urban households
have improved source of drinking water.
State-wise, situation was grim in Jharkhand, Manipur, Meghalaya, Odisha
and Kerala. The government has
initiated the integrated low cost sanitation schemes for urban areas and total
sanitation campaign of rural areas. Consequently, some improvements are
recorded but still according to NSS69, 59.4 per cent of Indian households do
not have toilet facilities in rural areas and 8.8 per cent in urban areas. States
with poor record are Jharkhand, Odisha, Uttar Pradesh, Madhya Pradesh, Chhattisgarh,
Rajasthan and Bihar.
New Thrust
India
has been spending around 1.3 per cent of GDP on health for which last 10 years
and could consider raising the level. The
government could also consider a bigger role for local governments to achieve further
progress and participation. The key
recommendations would be providing community latrines like toilet blocks,
distribution of soaps, and inculcating hygienic habits starting from school
children. The government could also consider subsidizing sanitation projects at
the level of individuals or community. Projects like Sulabh need to be encouraged
further and strengthened. The private corporate sector can also be
tapped to participate in this endeavor through resources under CSR. Only then
by 2019, every household would have total sanitation as proposed in the recent
Union Budget.
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A
version of this article appeared in the Economic Time of August 4, 2014 under
the banner, “Swach Bharat: Why India needs a Sanitation and Water Policy.”
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