Sanitation Woes – Where do we stand?

In the event of demonetisation, we have almost forgotten about the "Hygiene & Sanitation management" that should run in parallel for a Defecation Free India.


Sanitation Woes - Where do we stand

Authored by: Prof. K.J. Nath

The fastest growing economy of 7.2% in its 10th Plan (2002-2007) has also necessitated a lot of efforts to eliminate the practice of open defecation in rural India. The faecal contamination of community water supply system in urban areas and pollution of Ganga and other national rivers is a serious threat to their survival. Under the purview of the Sixth Plan (1980-1985) and also during the currency of the International Drinking Water supply and Sanitation decade in 1980, it has received a greater attention of the Government for major investments in drinking water supply & sanitation sector. Though a number of flagship programmes have been undertaken by our national Government like Total Sanitation Campaign (TSC), Mission Clean Ganga, Nirmal Bharat Abhiyan, unfortunately more than 50% Indians are defecating in the open till recently.

Access to Sanitation

As a collective outcome of the failures of last five decades, today 2.6 bn representing 42% of world’s population, lack access to improved sanitation. Almost 1.5 bn people live in Asia & Africa of which India having the major share of without access to sanitation.

Global Scenario Open Defecation
Sanitation – Health Linkage
Household Toilet Scenario IndiaWorld Health Assembly 1978 in Alma Ata adapted one of the four key strategies to promote healthy lifestyles & reducing risk factors to human health that arises from environmental, economic, social and behavioural causes. Unless the development of an enabling policy for promoting a hygienic environment conducive to healthful living is achieved, the agenda of promoting healthy lifestyles would remain unfinished by a wide margin. The World Bank estimates that 99.9% of deaths attributed to poor water supply, sanitation and hygiene occur in the developing countries. This invisible disaster claims the lives of more than 3900 children under five years of age, and even older children and adults, suffer from poor health, diminished productivity and missed opportunities for education. The cause behind such huge loss of life and potential is the absence of something basic, unremarkable, commonplace i.e. toilets and other forms of improved sanitation and safe drinking water. An estimated report said that the deaths of 4 million children could be prevented with the increase of female literacy & child immunisation to 100% following safe water improvements and improved sanitation coverage.

The decade that was a complete failure!

The much was expected from the international decade on water supply & sanitation launched in 1980 in terms of health benefits from the projects undertaken by the various national governments world-wide. The provision of extremely dis-proportionate funding priority to sanitation in comparison to water supply projects has cost the decade hugely in terms of health gains. The improved hygiene and sanitation meaning to keep the faecal matter away from hands, food & from water itself when it is stored in the home – that transforms health. Thus the neglect of hygiene and sanitation have not brought the expected health benefits even after the successful implementation of water supply programmes in the community.

Supply driven, subsidized Govt. programme couldn’t succeed for Lack of Enabling Environment (Hygiene Behaviour Change + Demand for Sanitation), Lack of Capacity Development at the Community level/ULBs/PRIs, Lack of IEC Support & Awareness among the consumers and Sanitation was not a conscious need of the community. Hence, the decade was a total blunder.

Community-Led Total Sanitation (CLTS): an approach that works

The concept of Community Led Total Sanitation (CLTS) and Sanitation Marketing has made significant impact in some of the South East Asian countries like Cambodia. CLTS has been particularly successful in promoting behavioural change in the community and developing demand for sanitation. Sanitation marketing which is basically a market based approach is being promoted by a no. of front-line NGOs. They are putting more emphasis on training of entrepreneurs on affordable and sustainable technology options and developing a delivery mechanism based on demand promotion and development of supply chain. This approach too cannot effectively promote sanitation across all sections of the rural community, particularly the rural poor. In India and many other developing countries, sanitation sector is vitally linked with public health and environment of the community and closely associated with the poverty of the people. Under such situations, UN has declared access to safe water and sanitation as basic human right. The problem of the poor cannot be 100% addressed by the private sector/market. Although approx. 60% of the non-poor section of the population could be served by the market.

Total Sanitation Campaign (TSC), launched in India during the 90s, and Community Led Total Sanitation (CLTS) launched in many developing countries, created the much needed enabling environment, triggered behaviour change in the community and generated demand for sanitation. The improvement was not sustainable without adequate Govt. support for a sustainable technology. Toilets with flimsy construction materials and unsustainable technology were washed away and many Nirmal Grams, open defecation free villages (ODF) reversed to OD villages.

Issue of Subsidy

The issue of affordability or sustainability needs a closer examination in deciding about the appropriate technology options for sanitation. Presently dry pit toilets as well as direct single pit and offset single pit pour flush toilets are being promoted under various programmes. Unlined pit latrines which fall due to flooding, soil collapse, infestations are neither sustainable nor up-gradable. The economically well-off section can afford better quality toilets and are spending more than US$ 200 for super structure whereas two pit pour flush/Ecosan design are not being promoted. The issues of eco-friendliness and pollution of groundwater should also receive adequate attention. Present design makes it difficult to recycle the bio-mass from latrine pits. Rural consumers should get multiple choices depending on affordability and sustainability.

To address the affordability one should not compromise on sustainability and the sector managers too must not forget that sustainable sanitation development is the vital reason for promotion of public health and environmental health in rural India.

Swachha Bharat Abhiyan: #MyCleanIndia

The Prime Minister has launched the Swachha Bharat Abhiyan with lot of passion and a sense of urgency. His appeal has created positive impact on various sectors of the community. However, it must be realized that the programme as such is not fundamentally different from the Nirmal Bharat Abhiyan launched by the previous Govt. and the success would largely depend on mobilization of resources and total participation of the people. A positive impact of the PM’s appeal has been the response from the corporate sector in mobilizing the CSR funds for sanitation promotion. We must review our past mistakes in policy planning and management.

CLTS/Sanitation marketing and Govt. subsidized programme should not be mutually exclusive, rather future sanitation plans must be integrated into a nationwide programme supported by the Govt. and promoted by the sector partners with provision of minimum subsidies required by the poor for accessing sustainable sanitation.

Prof. K.J. Nath holds four decades of experience at National & International level in Community Water Supply, Sanitation, Waste Water Management and Public Health & Hygiene related Programme. Current affiliations include the following:

  1. Expert Member, National Ganga River Basin Authority (2009-2014);
  2. GOI, President, Institution of Public Health Engineer, India;
  3. Chairman, Arsenic Task Force, Govt. of West Bengal;
  4. Chairman, Science &Technology, Sulabh International Social Service Organization;
  5. Former Director, AIIH&PH, Govt. of India

Banner image credit: UNICEF

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