By Arvind Virmani and Charan Singh
The unfortunate incident in Badaun and similar others has raised the issue of lack of sanitation facilities in India. According to a recent Report released by World Health Organization (WHO), India continues to be a country with the highest number of people in the world practicing open defecation (OD) – about half of its population. Of the one billion people practicing OD in the world, 597 million live in India.
India’s performance is worse than that of other emerging market economies and least developed countries (LDCs). In India 65 per cent population in rural areas (30 per cent in LDCs) and 12 per cent in urban area (6 per cent) resort to OD. And still worst, according to WHO, India is not making significant strides in reducing OD.
In the case of drinking water, India is doing better than many other countries in the world. But there is further scope to improve safe drinking water facilities in the country, as in rural areas, 1 per cent of population is using surface water which is considered unsafe.
Optimal health policy requires appropriate policy for sanitation. In developed countries almost everyone has access to a private flush toilet served by a continuous supply of piped water. Human waste is channeled by separate sewerage pipes, ensuring that drinking water is separated from pathogens carried in faecal material, and taps located in close proximity, enable people to maintain personal hygiene.
Better sanitation helps to break the faecal-oral transmission route that impact public health and is beneficial for the household and the community. Cross country studies show that sanitation is the strongest determinant of child survival and improvement in sanitation is accompanied by more than 30 percent reduction in child mortality according to UNDP. According to studies conducted in different countries, it is estimated that having a pit latrine in the home reduces the incidence of diahorrea by 50 percent, while having a flush toilet lowers the risk by 70 percent.
According to research in Salvador, Brazil, incidence of diahorrea was twice as high among children in households without sanitation when compared with children in household with sanitation. Similarly, diahorrea was three times greater for children in communities without sanitation when compared with communities with proper drains and sewers.
As shown earlier by Virmani (The Sudoku of Growth, Poverty and Mal-nutrition, 2007: and Under-nourishment of Children: Causes of Cross Country Variation, 2012) lack of sanitation is a major cause of malnutrition in India and across the World. The strong externalities associated with individual and community investments in sanitation make a case for public policy and may be subsidies.
The financial cost is very large in moving from OD to safe collection disposal and treatment of sewage effluents. In rural areas, with sparse population, costs of laying of sewerage networks are large compared to urban areas and therefore public facilities may be a viable short run option. In urban areas, problem is most acute in slums, which do not have proper sewage collection and transport systems. Further most cities do not have systems to properly process the waste before disposing it in the river or other water bodies.
Clean water, sanitation, personal hygiene and good nutrition are the four foundations of good public health policy. Generally, sanitation is most neglected? The reasons could be manifold but inadequate financing and capacity constraints, especially at the level of municipalities, results in weaker national strategy. Poverty is another barrier which results in low level of sanitation as, illustratively, a pit latrine would cost more than a monthly wage and therefore is unaffordable. Hygiene is also another predictor of public health as hands transmit pathogens to foodstuffs and directly to the mouths but is generally neglected.
The government has been making efforts to improve water facility and sanitation, especially in the rural areas. To improve rural drinking water supply government has been making provisions under Bharat Nirman. The data from NSS 69th Round (NSS69), released in December 2013, reveals that 88.5 per cent of rural households and 95.3 per cent of urban households have improved source of drinking water. State-wise, situation was grim in Jharkhand, Manipur, Meghalaya, Odisha and Kerala.
The government has initiated the integrated low cost sanitation schemes for urban areas and total sanitation campaign of rural areas. Consequently, some improvements are recorded but still according to NSS69, 59.4 per cent of Indian households do not have toilet facilities in rural areas and 8.8 per cent in urban areas. States with poor record are Jharkhand, Odisha, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Rajasthan and Bihar.
India has been spending around 1.3 per cent of GDP on health for which last 10 years and could consider raising the level. The government could also consider a bigger role for local governments to achieve further progress and participation. The key recommendations would be providing community latrines like toilet blocks, distribution of soaps, and inculcating hygienic habits starting from school children.
The government could also consider subsidizing sanitation projects at the level of individuals or community. Projects like Sulabh need to be encouraged further and strengthened. The private corporate sector can also be tapped to participate in this endeavor through resources under CSR. Only then by 2019, every household would have total sanitation as proposed in the recent Union Budget.
(Arvind Virmani is Former Chief Economic Adviser, Government of India and Executive Director, IMF, now Heads, ChintanLive.org. Charan Singh is the RBI Chair Professor of Economics, IIM Bangalore. Views are personal)