India - Need for dignified sanitation

ALEX GEORGE


More than eight per cent of deaths in India are due to water and sanitation-related causes. The Third South Asian Conference on Sanitation (SACOSAN), opening in Delhi today, is an opportunity to raise awareness and take vital steps on this crucial issue.


The South Asian Conference on Sanitation (SACOSAN) is taking place in New Delhi (November 16-21) against the backdrop of two important reports released recently by the WHO, which bring out the importance of sanitation and its impact on health, particularly that of children. These are: the Report of the WHO Commission on Social Determinants on Health and a multi-country study report on the relationship between drinking water, sanitation and health under the title: Safe Water, Better Health.

The Report of the WHO Commission on Social Determinants of Health (2008) emphasises that access to clean water and sanitation should be considered as part of human rights. The report calls for improved living conditions, including basic services and also for “a public sector strong, capable, committed and adequately funded” to tackle the inequities in health. It also throws light on the fact that one billion people the world over live in slums with poor basic services.

Preventable causes

The other report; Safe Water, Better Health (2008), released a few months ago, brings out that 7.5 per cent of deaths in India, 10 per cent in Bangladesh, 13.6 per cent in Pakistan and 10.6 per cent in Nepal are due to water and sanitation related causes. As the data seems to be based only on reported deaths, this percentage would increase if the causes of the vast majority of unreported deaths were included. Yet, the report is significant, as it points out that the percentage would jump by 20 per cent in the case of deaths of children. It brings out further that 88 per cent of the cases of diarrhoea worldwide are attributable to unsafe water, inadequate sanitation or insufficient hygiene. The report reiterates the causal link between under-five mortality, malnutrition and diarrhoeal diseases. Half of all malnutrition cases among under-five children are caused by repeated incidence of diarrhoeal and other intestinal infections.

The Dhaka Declaration of SACOSAN in 2003 had called for an urgent elimination of open defecation which is prevalent in most parts of the Indian sub-continent consisting of countries such as Pakistan, Bangladesh, Afghanistan, Nepal, Myanmar, Srilanka and Maldives from where ministerial delegates had attended the conference. This practice, which spreads germs causing various communicable diseases, prevails in rural as well as urban areas of the sub-continent due to inadequate provision of sanitation facilities, poor availability of water and cultural habituation promoting it. In order to highlight the need for healthy and dignified sanitation facilities for all, this article does not dwell on other aspects of sanitation such as solid waste disposal, sewage and sewerage.

Ambitious campaign

The target 10 of goal 7 of the Millennium Development Goal (MDG) envisages to reduce by half the number of people without sustainable access to safe drinking water and basic sanitation by 2015. Government of India’s Total Sanitation Campaign (TSC) aims at providing toilets to all rural households by the end of the Eleventh plan i.e. 2012. The Jawaharlal Nehru National Urban Renewal Mission and other programmes are aimed at 100 per cent sanitation coverage in the urban areas. TSC also aims at providing information, education and communication to the rural poor in sustainable use of the toilets. However, the current percentage of households with toilets is only 49 as per 2006 figures quoted in the Eleventh Plan. World Bank’s World Development Indicators (2008) and the UNDP’s Human Development Report 2007-08 are mentioning 2004 figures which show only 33 per cent households with improved sanitation facilities. The figures in this regard could have possibly risen to 49 per cent; but there still remains a wide field to be covered, in terms of eliminating open defecation by providing household toilets and building awareness to use and maintain them. Considering the severe competition for urban space, the provision of sanitation facilities to the increasing population of slum dwellers in India’s cities and towns is an issue which demands special attention.

Household toilets are also a matter of human dignity. An advertisement issued by the Ministry of Rural Development with the title: “Don’t wake up into darkness; Awake into sunlight”, sums it up. The ad shows a woman holding a bucket in her hand and on the way from her house to find a suitable place which gives her some semblance of privacy to defecate. To bring out the contrast the ad also shows another woman going into the toilet in her house with the morning sun’s rays very much on. The privacy concerns of the second woman are met by the household toilet, and therefore she doesn’t have to carry a bucket and move around before the sunrise to find a place for defecation. While there is no denying the links with open defecation and community ill health, the rather unrecognised human dignity concerns of the poor need to be acted upon urgently. Perhaps the latter would be a more receptive communication angle for popularising household toilets as well.

The Eleventh Five Year plan (2007-12) of India targets to achieve universal sanitation coverage in the country by 2012. This target in fact is obviously far more ambitious than the MDG stipulation to halve by 2015 the number of people without sustainable access to basic sanitation. The Eleventh Plan has also recognised the gender dimension of sanitation by highlighting the need for women in particular to have privacy in defecation. In this connection it needs to be noted that covered toilets, which ensures privacy, began to be funded only from 2006. The Plan targets to build 7.29 crore household toilets in rural areas for achieving universal sanitation, under the Total Sanitation Campaign. The TSC also has a component for School sanitation under which more than three lakh toilets were built in schools during the 10th Plan. It is, however, equally important to make sure that these toilets do function. Children have also supported the TSC in spreading the message of sanitation to their families.

Not quite enough

N.C. Saxena, former Secretary of the Planning Commission of India, notes that there is a remarkable increase in the number of toilets constructed in India, which has risen from 1.3 million in 1997-98 to 9 million in 2006-07 and was expected to touch one core in 2007-08. Still, all this put together, would cover only 40 million households leaving out 70 million households without toilets in the rural areas alone. It is, however, encouraging to note that according to an evaluation study, 80 per cent of the toilets built under TSC were used, which signifies a welcome change in attitudes. This shows an effective demand for household toilets which needs to be attended to. There is also a steep increase in the number of Nirmal Gram Puraskars (NGP) awarded in recent years. The NGPs are awarded to Gram Panchayats which have achieved 100 per cent coverage of household sanitation, 100 per cent school sanitation and have eliminated open defecation in their area. Five thousand Gram Panchayats were awarded NGP in 2006-07, while in 2007-08 this number rose to 11,000, more than double. This further underlines the increasing demand for household toilets, which needs to be satisfied by not only supplying them but ensuring the availability of water and awareness building for their clean and sustainable use.

The third SACOSAN conference in New Delhi presents an opportunity to raise the profile of the sanitation sub-sector in India to highlight its importance.

The author works with Save the Children, New Delhi. The views expressed here are not necessarily that of the organisation