Hygiene and Sanitation

It’s estimated that 88% of the households in India have a mobile phone but 732 million people do not have access to toilets or clean sanitation. Sanitation is a basic right but unfortunately, this is one issue which the country has not been able to handle in the last 70 years. Even in cities, there is a dearth of proper drainage and disposal of waste. People still do not segregate dry and wet waste, which causes huge issues in decomposing and recycling. Continued usage of plastic leads to serious environmental and health hazards which people despite of being aware about still chooses not to do anything about it.

As per estimates, inadequate sanitation cost India almost $54 billion or 6.4% of the country's GDP in 2006. About $38.5 billion was health-related, with diarrhoea followed by acute lower respiratory infections accounting for 12% of the health-related impacts. Evidence suggests that all water and sanitation improvements are cost-beneficial in all developing world sub-regions.

Sectoral demands for water are growing rapidly in India owing mainly to urbanization and it is estimated that by 2025, more than 50% of the country's population will live in cities and towns. Population increase, rising incomes, and industrial growth are also responsible for this dramatic shift. National Urban Sanitation Policy 2008 was the recent development in order to rapidly promote sanitation in urban areas of the country. India's Ministry of Urban Development commissioned the survey as part of its National Urban Sanitation Policy in November 2008. In rural areas, local government institutions in charge of operating and maintaining the infrastructure are seen as weak and lack the financial resources to carry out their functions. In addition, no major city in India is known to have a continuous water supply and an estimated 72% of Indians still lack access to improved sanitation facilities.

A number of innovative approaches to improve water supply and sanitation have been tested in India, in particular in the early 2000s. These include demand-driven approaches in rural water supply since 1999, community-led total sanitation, public–private partnerships to improve the continuity of urban water supply in Karnataka, and the use of microcredit to women in order to improve access to water.[7]

Total sanitation campaign gives strong emphasis on Information, Education, and Communication (IEC), capacity building and hygiene education for effective behavior change with involvement of panchayati raj institutions (PRIs), community-based organizations and nongovernmental organizations (NGOs), etc. The key intervention areas are individual household latrines (IHHL), school sanitation and hygiene education (SSHE), community sanitary complex, Anganwadi toilets supported by Rural Sanitary Marts (RSMs), and production centers (PCs). The main goal of the government of India (GOI) is to eradicate the practice of open defecation by 2010. To give fillip to this endeavor, GOI has launched Nirmal Gram Puraskar to recognize the efforts in terms of cash awards for fully covered PRIs and those individuals and institutions who have contributed significantly in ensuring full sanitation coverage in their area of operation. The project is being implemented in rural areas taking district as a unit of implementation.[8]

When sanitation conditions are poor, water quality improvements may have minimal impact regardless of amount of water contamination. If each transmission pathway alone is sufficient to maintain diarrheal disease, single-pathway interventions will have minimal benefit, and ultimately an intervention will be successful only if all sufficient pathways are eliminated. However, when one pathway is critical to maintaining the disease, public health efforts should focus on this critical pathway.[6] The positive impact of improved water quality is greatest for families living under good sanitary conditions, with the effect statistically significant when sanitation is measured at the community level but not significant when sanitation is measured at the household level. Improving drinking water quality would have no effect in neighborhoods with very poor environmental sanitation; however, in areas with better community sanitation, reducing the concentration of fecal coliforms by two orders of magnitude would lead to a 40% reduction in diarrhea. Providing private excreta disposal would be expected to reduce diarrhea by 42%, while eliminating excreta around the house would lead to a 30% reduction in diarrhea. The findings suggest that improvements in both water supply and sanitation are necessary if infant health in developing countries is to be improved. They also imply that it is not epidemiologic but behavioral, institutional, and economic factors that should correctly determine the priority of interventions.[7] Another study highlighted that water quality interventions to the point-of-use water treatment were found to be more effective than previously thought, and multiple interventions (consisting of combined water, sanitation, and hygiene measures) were not more effective than interventions with a single focus.[15] Studies have shown that hand washing can reduce diarrhea episodes by about 30%. This significant reduction is comparable to the effect of providing clean water in low-income areas.[16]

Lack of safe water supply, poor environmental sanitation, improper disposal of human excreta, and poor personal hygiene help to perpetuate and spread diarrheal diseases in India. Since diarrheal diseases are caused by 20–25 pathogens, vaccination, though an attractive disease prevention strategy, is not feasible. However, as the majority of childhood diarrheas are caused by Vibrio cholerae, Shigellae dysenteriae type 1, rotavirus, and enterotoxigenic Escherichia coli which have a high morbidity and mortality, vaccines against these organisms are essential for the control of epidemics. A strong political will with appropriate budgetary allocation is essential for the control of childhood diarrheal diseases in India.[17]

Implementation of low-cost sanitation system with lower subsidies, greater household involvement, range of technology choices, options for sanitary complexes for women, rural drainage systems, IEC and awareness building, involvement of NGOs and local groups, availability of finance, human resource development, and emphasis on school sanitation are the important areas to be considered. Also appropriate forms of private participation and public private partnerships, evolution of a sound sector policy in Indian context, and emphasis on sustainability with political commitment are prerequisites to bring the change.