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Challenge of Sanitation
New Impetus to Bring Results & Curtail Diseases

Dhurjati Mukherjee

According to the World Health Organization (WHO ), sanitation is undoubtedly a serious problem the world over but more focused in the Third World countries. It is estimated that 40 per cent of the world population do not have access to adequate sanitation facilities. The importance of sanitation was realized long back by none other than the father of the nation Mahatma Gandhi who had stated way back in the 40s:  "Sanitation is more important than independence."

The World Health Organization (WHO)  observed that polluted water is the root cause of 80 per cent diseases, a result of inadequate sanitation and sewage disposal methods. A huge number of people even today relieve themselves in the open contaminating water bodies and other natural resources. This shows that people need to be educated on the importance of sanitation and its use in rural and urban areas alike. Inadequate sanitation facilities and lack of awareness often result in a number of health problems such as intestinal worms, most commonly the human roundworm and the human hookworms. Occurrence of these diseases is generally very high in low-income semi-urban and rural areas. Therefore, sanitation is the basic infrastructure component that could contain excreta-related diseases.

Realizing the challenge, India has acknowledged the fact that sanitation is a cornerstone in the well-being of a person as unsanitary surroundings form the base for spread of numerous diseases and taken up the challenge of sanitation of improving the sanitation facilities and providing clean drinking water to all.  In the last three years, the Centre has taken up the Swachh Bharat programme launched on October 2, 2014 in right earnest with the Prime Minister himself leading the campaign with the aim to make the country clean by 2019, which also happens to be the 150th birth anniversary of Mahatma Gandhi.  

Though sanitation was historically and culturally rooted in India even today 48 percent of country’s population defecates in the open. Open defecation is not rural phenomenon, considering India contributes to 46 percent of global open defecation in urban areas. Gender related issues exist with 70 percent of crimes against women occurring due to defecation in the open.  

One may refer here to the Nirmal Bharat programme that opened a new window towards achieving a clean and healthy nation that contributes to the welfare of our people. This vision seeks to visualize a nation in which the traditional habit of open defecation is entirely eliminated, the worth of every human being is respected, and quality of life is improved. In the realm of sanitation, though about a decade back only 237 of more than 5000 towns had a partially complete sewerage system, this has changed significantly. Now around 70 per cent of the urban population have access to sanitation that is, safe disposal of human excreta while in rural areas the figure has jumped to around 40 per cent from the earlier figure of a mere just 20 per cent, obviously due to the special thrust provided by the present government. However, open defecation is still the most important form of toileting in rural India.   . 

Thus it can safely be assumed that presently over 50 to 60 per cent of households in the country have access to sanitation facilities though only 30-35 percent of the generated wastewater and generated sewage gets treated before being let into rivers and streams. The obvious effect has been that an estimated 4 lakh children die of diseases such as cholera, dysentery and suffer from stunted growth as a result of poor sanitation each year. This aspect needs to be given special attention  and the government has taken up a big programme called the Rashtriya Swachh Ganga Mission (National Clean Ganga Mission) of cleaning the Ganga river and setting up treatment plants in the major towns to ensure that the river is not polluted. Similar action is also contemplated for the Yamuna river.

Coming to water, an important aspect of the problem in the rural sector is the use of ponds for both bathing and for procuring of water for cooking and drinking. There is no system of cleaning the ponds at regular intervals through chlorination or other means and very few panchayats are aware of this. Water bodies are grossly polluted where, for example, faecal coli form count would vary between 5000 and 50,000 mpn 100 ml-1. As is well known, the Ganga is one such rivers which in spite of all efforts still remains unfit even for bathing.   People’s perceptions regarding the linkage of community health with personal household and environmental hygiene are also not scientifically conditioned. In a sample survey carried out recently among the rural population it was found that 75 per cent were unaware of the link between exposed excreta and the deleterious effect to health.

The spread of arsenic contamination in the country and specially in West Bengal and also in the states of Bihar and U.P. has compounded the problem. Arsenic has acquired an unparallel reputation as a poison with arsenic trioxide, a tasteless and odorless inorganic compound.The arsenic contamination in groundwater appears to be linked to excessive use for irrigation. Simultaneously the application of phosphate fertilizers has tripled due to switching from one crop to three crops per annum. This practice has induced groundwater flow, mobilizing phosphate derived from fertilizer as well as from decayed organic matter, which prompted growth of sediment biota and aided further release of arsenic. These combined microbiological and chemical processes would better explain the release phenomenon of arsenic in groundwater.

Added to this is the gradual spread of endemic fluorosis in the country. Around 19 states in India are presently identified as endemic to fluoride due to abundance of naturally occurring fluoride-bearing minerals. Almost 65 million people in more than 200 districts spreading are suffering from endemic fluorosis.    

Keeping in view the above facts, experts engaged in the field have concluded that isolated working of the departments of health, environment, rural development both at the Centre and the states have not been successful in tackling the problem though over the years – from the First to the 11th Plan period – there has been steady increase in the water and sanitation sectors. According to Prof. K. J. Nath, a well known WHO expert and former Member of the National Ganga River Basin Authority, the basic maladies of the present set up in the country was identified as follows:

(i) Absence of a core sector of environmental health within the department of health, including experts with skills in environmental epidemiology, environmental health and socio-ecological sciences;

(ii) Lack of appropriate legislations related to environment and health;

(iii) Lack of information on environmental and epidemiological aspects and environmental health impacts in the country related to air water, soil, shelter and ecology;

(iv) Lack of training and orientation of health professionals;

(v) Lack of public awareness and understanding and risk perception and communication strategies for risk abatement. 

While some of these suggestions have been taken care of, the government is working in right earnest to spread awareness among the rural population regarding water and sanitation on a massive scale. One may mention the Saansad Adarsh GramYojana (SAGY), launched on 11th October, 2014, to be adopted by each Member of Parliament with the aim to translate the comprehensive vision of Mahatma Gandhi about an ideal Indian village into a reality. Sanitation is one of the key projects under the programme and a lot of progress has already taken place in this sector under SAGY and, by the year 2019, it is expected that exemplary achievement would take place. . 

 However, the responsibility for reaching out to the grass-root level this should be entrusted to the civil society organizations with expertise and skill in this field. They should also be given the task of training panchayat representatives as also teaching people in simple terms to change their age-old practices keeping in view the intrinsic relationship between sanitation, water and human health. 

It has been found that many households who can easily afford to have toilets in their homes prefer to defecate in the open. Voluntary organizations and the panchayats should regularly conduct campaigns at regular intervals to explain to the people how sanitation is intrinsically linked to human health so that they are persuaded to set up toilets and have a clean environment in around the house to keep the family healthy. Small loans could also be given by banks and at very low interest to construct toilets which could be repayed within a year or so.    

At the same time, there is need for a programme of epidemiological research on environmental health impacts in the country related to water and sanitation and also air and soil in order to create proper understanding of the problems. And the findings of this research have to be disseminated at the grass root level so that proper measures may be taken to safeguard human health, specially of children and the aged.   

However, the challenge of making the country clean through better water availability and sanitation facilities is indeed enormous – both viewed from the financial and social angles. The NDA government has, no doubt, come forward in a big way by providing necessary financial resources, demonstrating its political will and commitment. The private sector should also play an active role in constructing toilets in schools and educational institutions in villages and also ensure that there is water availability in these toilets as it has been found that some girls’ toilets are not useable due to lack of water.      

The creation of a totally sanitized environment, as pointed out by the Prime Minister, is imperative at this juncture not just through dedicated action of the government but also of the private sector through active involvement of the community. While resources are, no doubt, this has to become a people’s campaign, transcending class, caste and communities. The face of the country would definitely change if we really care to think of our neighbourhood and try to keep it clean just like our homes.

(The author is a journalist, writing and speaking on developmental and environmental issues from the Gandhian perspective for the last three decades. )