Improving Sanitation in India: A Herculean Task [Part 1]

Posted on May 25, 2012 in Health and Life, Specials

By Dr. Amrit Patel:

Planning for human development in India is now more important than before, and it should aim at policy interventions that focus sharply on all its manifestations. It must ensure an improvement in the standard of living of the people through provision of Minimum Needs, more importantly of rural households by empowering the poor and marginalized. The Twelfth Five Year Plan (2012-17) should accord top priority for planning and implementation of human development programs and emphasize on a clean living environment and a more equitable distribution of development resources, opportunities and benefits. The development process should be made inclusive and should address challenges to formulate policies and programs to effectively and sustainably bridge regional, social and economic disparities. In this endeavour, rural women, in particular need to be adequately empowered so as to facilitate them to act as catalysts for change in country side.

Sanitation: In India, since time immemorial cleanliness has been considered as important as praying to God. And by tradition, the Indian society and culture values personal hygiene, but gives little importance to a clean and healthy community environment. Sanitation is an integral component of public hygiene and health care. In India, 736 million (71.7%) people out of total population of 1027 million lack basic sanitation facilities, thus resulting in high mortality and morbidity rates. Sanitation, in broad terms refers to the disposal and management of solid wastes, wastewater, human and cattle excreta etc. in such a way that it does not affect adversely domestic personal hygiene. Sanitation is a sine qua non for human health. It contributes to clean and improved environment, social development and generates significant economic benefits.

Human excreta, among all forms of wastes, are the principal sources of many enteric diseases and almost cause 80% of the diseases in developing countries. Studies reveal that over 50 types of infections can be transmitted from diseased persons to healthy ones by various direct and indirect routes from human excreta. Human excreta are the most hated object and anything connected with the latrine is considered so defiling that in India in past one was expected to take a bath immediately after coming out of the toilet and before entering into the kitchen due to religious taboos. Sanitation has, however, been seen as a matter of individual understanding and initiative rather than a collective responsibility of the community. Investment to promote environmental sanitation in this fast changing socio-cultural background is accorded the low priority.

Studies: According to a World Bank study, lack of toilets and other proper sanitation facilities costs India nearly $54 billion a year through hygiene-related illnesses, lost productivity and other factors stemming from poor sanitation. The problem is especially acute in rural areas where women suffer the most due to lack of proper sanitation facilities. A UN study in 2010 observed more people in India having access to a mobile phone than to a toilet. India’s mobile subscribers totalled around 894 million at the last count, enough to serve more than half of the country’s 1.2 billion people. But just 366 million people (30.5%) had access to proper sanitation. A recent UNICEF report says 638 million people (54%) defecate in the open in India as against just 7% each in Brazil and Bangladesh. Only 6% rural children below five years in India used toilets and about 50% of all Indians regularly wash their hands with soap after contact with excreta. Union Minister for Rural Development Shree Jairam Ramesh once said “It was shameful that India accounted for almost 60% of open defecations in the world”. He has recently made the commitment for making India “an open defecation-free” country by 2017.

Finance: Experts have observed that Government spending on sanitation and drinking water is grossly inadequate. According to the Center for Budget and Government Accountability, Government spending under these heads has declined from 0.59% of GDP in 2008-09 to 0.54% in 2009-10 and further to 0.42% in 2010-11. Union Minister for rural development Shree Jairam Ramesh has acknowledged that “Investment in sanitation and drinking water is as important as investment in defence”. He further adds “You can invest in missiles and tanks, in aircrafts, but if you don’t have clean drinking water, if you don’t have sanitation then the population is not going to be healthy. More investment in these sectors will result into better health of the people”. The Budget for 2012-13 has increased  allocation by 27% for rural sanitation and drinking water from Rs.11,000 crore in 2011-12 to Rs.14,000 crore.  A major initiative would be to strengthen Panchayats across the country through the Gram Panchayat Sashaktikaran Abhiyan and the capacity building of Panchayats.

Total sanitation campaign: The total sanitation campaign (TSC) launched in 2003-04 has been one of the flagship programs of the Government. The annual budgetary support has been gradually increased from Rs.202 crore in 2003-04 to Rs.1500 crore in 2011-12. The approved central outlay for the TSC in the Eleventh plan (2007-12) was of Rs.7816 crore. As of 28 December 2011, TSC projects approved with a total outlay of Rs.22, 022 crore (with a 65.5% Central Government share of Rs.14, 425 crore) are being implemented in 607 rural districts.

The TSC is implemented as a community-led and people-centric approach to generate effective demand for sanitation facilities by creating awareness among village communities, educating them and providing all required information that can help them avail Government’s subsidy and technical services under the TSC program. From June 1, 2011, to motivate the community towards creating sustainable sanitation facilities and their continued usage, the financial incentive in the form of subsidy for individual household latrines for BPL families has been raised from Rs.2200 to Rs.3200 and for hilly and difficult areas from Rs.2700 to Rs.3700.

TSC is an inclusive program and seeks active participation of all sections of society including women, SCs and STs. TSC has special components to encourage women and adolescent girls to actively participate in the sanitation program.  The Nirmal Gram Puraskar incentive scheme has been launched to encourage Panchayati Raj Institutions to attain a 100% open defecation-free environment. Under the scheme a total of 25,145 Gram Panchayats, 166 intermediate Panchayats and 10 district Panchayats have received the award in the last six years. Sikkim has become the first State to receive the award. Within a decade all 2.5 lakh Gram Panchayats are proposed to be converted into Nirmal Gram Panchayats. The thrust is not just to construct toilets, but to ensure their continued use keeping clean and maintaining properly which, of course, calls for behavioural change.


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