The question of sanitation in India is a complex one as it affects a number of social indicators such as nutrition, especially among children, food security, disease reduction and poverty in complex, interconnected ways. The fact that India contributes 60% to the world’s open defection is a statistic that requires our attention as a society, urgently.
Despite growing recognition of lack of sanitation and safe drinking water as two main movers in improving social indicators of a large percentage of the populace, the pace of change appears to be very slow. According to World Bank estimates, India’s sanitation deficit leads to losses worth roughly 6% of GDP. The main cause has been of largely ignoring public health as an area of focus for decades. While medical services have jumped by leaps and bounds, sanitation has skipped being on the radar.
Take the case of undernourished children. Diseases stemming from poor sanitation are being identified as a major cause of nutritional loss in children. And levels of malnourishment in India continue to be worse than in sub-Saharan countries.
In short, sanitation is one of the causes of poor health in children, claims a recent report titled ‘Forgotten voices: The world of urban children in India’ jointly presented by PwC India and Save the Children India. Half a million children under the age of 5 die due to diarrhoea, caused by poor water quality. Children also suffer from typhoid, cholera and malaria for lack of sanitation services. As UNICEF points out, India is home to 638 million people defecating in the open—over 50% of the population. In comparison, Bangladesh and Brazil have 7% of the population defecating in the open, while 4% of China’s population defecates in the open.
Various schemes have emphasised the importance of toilet facilities—from Jairam Ramesh’s “no toilet, no bride” campaign to Prime Minister Narendra Modi’s call to build toilets first and temples later. But schemes need to be backed by concrete actions. This will also require coming together of civil society and public and private institutions, to create a national plan to address the infrastructure gap.
The first step is to spread education on sanitation. The ‘Forgotten voices’ report clearly brings out the link between lack of sanitation and education. As many as 25% schools still have non-functional toilets and around 7 million (7%) girls have no access to the facility. The result is only 22% manage to complete class 10. In other words, lack of proper sanitation is leading to an increased dropout rate of girls.
UNICEF points out that only 11% of Indian rural families dispose child stools safely, with 80% of stools being left in the open or thrown into the garbage. Sound education on how to embrace good sanitation practices at the grassroots level can help bring these statistics lower. This should be as much a part of education as anything else that is taught in schools.
Access to toilets is a challenge for large sections of society. Many schools in rural India completely lack sanitation facilities. In some schools, sanitation blocks are in place only to meet official targets. This affects girls in particular, with many girls missing or dropping out of schools.
Challenges are aplenty. The Prohibition of Employment as Manual Scavengers and their Rehabilitation Act, 2013, prohibits manual handling of human waste before its treatment, which while admirable, does nothing to address the cringing lack of toilets.
Another challenge is the lack of continuous water supply. In urban areas, rationing of water and intermittent supply is common; in rural India, it is the norm. While there is some progress, notably World Bank-funded projects in the three Karnataka towns of Hubli-Dharwad, Belgaum and Gulbarga, lack of water makes proper sanitation a pipe-dream in most areas. Infrastructure to make access to water a certainty, particularly during harsh summers, needs to be another priority.
India’s rural sanitation flagship programme—Total Sanitation Campaign (TSC)—has seen some action, but there is a need for transparency and accountability. Under TSC, a project-based outlay of R200 billion and an addition outlay of R470 billion for the sanitation strategy 2012-22 has been outlined to achieve the objective of 100% rural sanitation. But having resources is just part of the solution.
Even as the Asian Development Bank, World Bank and some developed nations have committed billions of dollars to improve sanitation and water facilities in India, chronic leakages, lack of transparency and poor planning have resulted in the end objective not being achieved.
Without water there is no hygiene. In case of sanitation, non-achievement could have lasting repercussions on our future generations. We, as a society, must come together to address this basic human need, and a need that will immensely impact the course of our collective future.
The author is the vice-chairman of the PwC India Foundation and chair, SSE India. Views are personal