Improving Sanitation in India: A Herculean Task [Part 2]

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

By Dr. Amrit Patel:

Continued from Part 1 of a 3 part series.

Another pertinent challenge to be dealt with is the rural-urban divide. Government of India’s first Socio-Economic Census and Comprehensive Population Survey, 2011, reveals significantly disappointing progress and developments on certain basic amenities to sustain human life. The number of houses increased from 250 million in 2001 to 330 million (132%) in 2011 whereas Government’s biased policy and enhanced purchasing power of millions in urban and metropolitan centres facilitated them easy access to state-of-the-art technologies and consumer goods, due to complex transition process experienced during post-market economy, in sharp contrast to a large number of rural households lacking access even to the most rudimentary facilities as per Census 2011. For example, while rural households (167,826,730) accounted for 68.03% of total 246,692,667 Households only 17.9% rural households have access to treated source of tap water as against 62.0% urban households and 62.5% rural households depend upon firewood for cooking as compared with 20.5% urban households. It is shocking that only 30.7% rural Households have latrine facilities as compared to 81.4% urban Households. Of this, as high as 63.2% rural Households have toilets with no drainage as against meager 18.2% urban Households and just abysmally as insignificant as 2.2% rural Households have piped sewer system as compared with 18.2% urban Households.

Discrepancies: According to Census 2011, at national level only 32.7% households have toilet facilities. The States with households more than the national average include Kerala (94.40%) Goa (72.6%), Punjab (71.9%), Himachal (67.5%), Haryana (57.7%), Maharashtra (44%), Andhra (34.9%) and Gujarat (34.2%) whereas the States with Households below national average include Jharkhand (8.3%), Madhya Pradesh (13.6%),  Odisha (15.3%), Bihar (18%), Uttar Pradesh (22.9%) and Tamil Nadu (26.7%). Dismally, the number of HH with toilets rose only 16.5% between 2001 and 2011. Increase is, however, just 4.8% in Bihar, followed by 6.12% (UP), 6.3% (MP), 8.3% (Odisha) and 8.4% (Rajasthan). It is  surprising that States reported households with toilets, on website of the TSC run by the Union Ministry of Rural Development, are significantly higher than that under Census 2011, viz. national average (68.15%), Kerala (100%), Himachal (100%), Haryana (96.04%), Uttar Pradesh (81.76%), Gujarat (81.6%), Tamil Nadu (78.11%),  Andhra (77.07%),Goa (76.24%), Madhya Pradesh (76.37%), Maharashtra (71%), Odisha (53.89%), Jharkhand (42.37%) and Bihar (32%). This invariably needs to be corrected since States in their enthusiasm to compete among them have reported significantly high achievements. It is also questioned whether toilets are really being used. People may agree to use toilets. But it is a challenging task to change to new habit when for generations they have been used to open defecation. It is necessary to sustain behavioral change.

Poor Performance: Poor performance with regard to sanitary facilities continues to be a major and serious concern for the country. Factors attributed to this  include, inter alia, (i) Cultural and traditional reasons and lack of education are the primary factors contributing to this unhygienic practice (ii) Most of SCs, STs, BPL families and lower income group  are generally not aware of the importance of sanitation for better health and clean environment. Sanitation is not a “felt need” for them and, therefore, they do not participate in sanitation programs (iii) Low sanitation coverage is due to inadequate and lack of concerted efforts to create awareness among rural households, motivate them to have toilet facilities, lack of affordable sanitation technology and trained implementing agencies and (iv) Non-availability of choice of toilet designs and area specific technologies, inadequate supporting delivery systems and absence of trained masons, skilled workers and technical manpower are reasons for low coverage.

What is needed: The program of TSC needs to be implemented on a missionary zeal fully supported, inter alia, by following critical elements in accomplishing its strategy. Till toilet facilities are provided in each village of the country a village-wide campaign is necessary to make rural people fully aware of the adverse effects of open air defecation which is mainly responsible for infections and a number of diseases. A massive campaign, through employing all available means of communication, has to be launched to make all the people in a village including school children, youth and women fully aware of the fact that they should never go barefoot for open defecation; should always cover the human excreta with the soil after defecation so as to prevent flies sitting on excreta and, in turn, contaminating eatables as this is the main cause of diarrhoea, dysentery, cholera etc. Rural sanitation as a part of heath should find appropriate place as the compulsory subject in primary schools. The ultimate objective of the campaign should be to create demand for safe hygienic toilets and save women in particular from the agony and humiliation of open air defecation.

Safe sanitation and clean water make the population healthier. There is no difference between health and sanitation as both are directly co-related with each other. Recognizing the outbreak of water-borne diseases like cholera, diarrhoea and cancer risks from arsenic in drinking water in several places, it is necessary to consider heath, water supply and sanitation as one sector rather than separate. There are tens of thousands of Accredited Social Health Activists (ASHAs) in rural India. An ASHA worker is a village woman, preferably in the age group of 25 to 45 years and trained in the area of health. The services of ASHAs affiliated to National Rural Health Mission can be of significant help to create awareness among rural masses, more importantly women, in the matter of sensitivity to hygiene and sanitation issues.

For construction of toilets adequate number of masons have to be trained in the construction technology, methodology of implementation and follow-up work. Adequate number of pans and water seals of approved standard specifications and quality have to be made available at various centers so that people of the area can have easy and reliable access to the facility to construct toilets to suit their income and choice.