Though figures are disputed, anywhere between 300 million and 522 million individuals still practice open defecation in India. This figure is higher than anywhere else in the world. Poor sanitation is a recurring issue linked to many of India’s health issues.
Globally, out of the 2.5 billion of people who do not have access to sanitation facilities, about 1 billion people practice open defecation, with 82 percent of these living in 10 countries (India, Indonesia, Pakistan, Nigeria, Ethiopia, Sudan, Niger, Nepal, China and Mozambique).
The practice causes a considerable amount of the disease burden in India, causing untold numbers of infectious diseases, many of which cause diarrhoea which can result in severe dehydration.
Many continue with the practice simply because it is what has always been done, highlighting the need for education on sanitation among the population. More still do so simply because they have no other option, toilet facilities are lacking in India, particularly in rural communities.
Numerous programmes have been put in place to address the issue, though currently their impact has been limited.
School, Sanitation and Hygiene Education in India – a resource book
School Water and Sanitation Towards Health and Hygiene (SWASTHH) was born to spearhead School Sanitation and Hygiene Education (SSHE) in the country. This book is meant for managers and trainers involved in school sanitation and hygiene education (SSHE) programmes operating at different levels, such as state, district or block level. It was developed in the context of the SWASTHH programme in India and it provides many guidelines and activities.
Centre clears sanitation and rural water supply project
The centre cleared a project in 2014 to improve the situation of sanitation and water supply in rural areas in the states of Assam, Bihar, Jharkhand and Uttar Pradesh. The project, the Rural Water Supply and Sanitation Project for Low Income States (RWSSP-LIS) aimed to provide extensions for water piping systems to rural and tribal communities. This project has been implemented with the help of the World Bank.
Swachh Swasth Sarvatra – cutting down on open defecation
Swachh Swasth Sarvatra focuses on two main objectives. First, the government will facilitate the construction of infrastructure and facilities such as public toilets, and second, will aim to change behavioral factors through educational means.
This initiative is not only in line with the WHO’s sustainable development goals, but is part of a national public health campaign Swachh Bharat Abhiyan (Clean India Mission) which Prime Minister Narendra Modi launched on October of 2014.
Swachh Bharat, India’s largest scale public health mission
This campaign has the ambition of making the nation free of open defecation by the year 2019 by building toilets across the country.
While an ambitious goal, India has seen this attempted before with limited success. In 1999, the central government introduced the Total Sanitation Campaign (TSC). This campaign had much the same goals as Swachh Bharat, aiming to educate on sanitation and provide toilets nationwide. The campaign had the ambitious goal of providing total coverage of toilet facilities to India.
The actual impact of the campaign was however far more limited. Of the 138.2 million rural households in India (a 2001 figure from the beginning of the programme), nearly 3.5 million had constructed household toilets with support from the TSC by 2007. This works out to less than three percent of rural households benefiting from the programme.
Accusations were abundant that the scheme received a lack of priority from the central government, and that funds were mismanaged and inefficiently allocated. A Comptroller and Auditor General of India (CAG) audit covering the TSC from 2009 to 2014, identified a weak performance against its targets. They also claimed more than thirty percent of individual household latrines were non-functional for reasons like poor quality of construction, incomplete structure, non-maintenance.
Government surveys of the Swachh Bharat scheme have since revealed similar issues. Nearly six out of every ten toilets built by the government under the Swachh Bharat Abhiyan don’t have proper water supply, making them unusable. Though 3.5 crore new toilets have been built under the scheme, many of them exist as just a hole in the ground with walls.
Around 55.4 percent of people in villages where toilets have been built are still opting for open defecation due to the absence of water supply and proper drainage in the toilets. In cities, 7.5 percent of the population were found to still defecated in the open. While this may be a significantly smaller number than in rural areas, it only takes a small number of these individuals to potentially spread an outbreak of a disease such as cholera.
A mere forty percent of faecal waste in India is properly treated. The remainder finds its way into the septic tank, which can lead to pollution of water supplies and gas emissions that are toxic to the surrounding environment. In some states, as many as eighty percent of toilets are connected to septic tanks.
Despite the criticisms, many still support the initiative. The sanitation economy of India is set to double thanks to Swachh Bharat claimed Jin Montesano, chief public affairs officer, LIXIL Group at the 18th World Toilet Summit. “Swachh Bharat Mission has generated significant interest in addressing the urgent sanitation issue in India, not only with traditional actors such as international organizations, but also with the private sector.”
Dangers of the lack of toilet facilities
Besides diseases directly related to exposure to human waste, open defecation can also put an individual at risk of other dangers. Women who practise open defecation are at a higher risk of being sexually assaulted. Cases have made worldwide headlines such as a case in 2014 where two girls were gang raped and hanged while they were outside going to the toilet late at night. The case sparked national outrage, with the lack of sanitation being criticized.
Open defecation in rural areas often involves people walking into forested, or grassy areas late at night. This can occasionally result in bites from snakes, a danger which takes the lives of 45,000 Indians annually.
Many mosquito species primarily feed on human blood at night. This again can result in individuals who defecate outside putting themselves at risks of diseases such as dengue fever and malaria through mosquito bites.
Sanitation: India can’t meet target before 2054
The WHO/UNICEF joint monitoring programme for water supply and sanitation has said that at its present pace, India would take until 2054 to meet its millennium development goals on sanitation. Orissa will take the longest time — until 2160. Despite the Swachh Bharat campaign, much of India still remains without toilets, many of those being built are ineffective due to a lack of sanitation facilities and piping in the area. A prolonged and thorough campaign is needed if India wishes to pick up the pace.
Sanitation in Indian Cities: A neglected issue
A survey, published by the Urban Development ministry shows how basic infrastructure, especially sanitation, cannot keep up with the fast growth of Indian cities. The survey examined 1405 cities in twelve different states and found out that around fifty percent of these cities don’t have a proper water supply system. Even if the households have access to piped water in around eighty percent of these households the average supply is less than five hours per day. Concerning sanitation the numbers are even worse: Over seventy percent of the households in the analyzed cities don’t have access to toilets or a sewerage system. Almost sixty percent of the world’s population who has to rely on open defecation lives in India, but this number also includes many people in rural areas.
Inadequate Sanitation Costs India Rs. 2.4 Trillion (US$53.8 Billion)
In a joint report published by the WSP (Water and Sanitation Programme), the ADB, AusAID, UKaid has stated that the inadequate sanitation adversely effects the economic growth in the country. Though the report was published using data from 2006, the situation in India remains similar, with many of its messages still applying.
Local efforts appear more positive than country wide assessments
While the situation may look dire from a nationwide perspective, local governments are often finding more success. Hyderabad for example has been declared free of open defecation.
This followed a series of efforts by the Greater Hyderabad Municipal Corporation (GHMC) to boost access to sanitation in the Telangana state capital. The measures included the building of 1,975 private toilets and 384 communal toilets, with more underway.
Poor Sanitation, Not Malnutrition, May Be to Blame for India’s Notoriously Stunted Children
Children in India suffer from stunting — defects in their growth rate — at a prevalence far higher than many other nations of similar socio-economic states. The TIME report draws comparison to Sub-Saharan Africa, in which children are more commonly subjected to impoverished conditions, though do not suffer stunting at the same rate.
The report suggests that it is therefore not malnutrition that is the driving factor behind stunting in India, but lack of sanitation. With a potential half of the Indian population still practising open defecation, children are exposed to countless diseases related to exposure to human fecal matter.
Diseases such as cholera show sporadic outbreaks across the country, these outbreaks are often seen in rural communities without access to toilet facilities. Many individuals defecate in, or near water sources for the village. A single instance of cholera in a person can therefore spread to the entire community.
DIseases such as this often cause diarrhoeal symptoms. This has a dehydrating effect that could be causing the stunting seen in Indian children. Lack of hydration can inhibit numerous bodily functions, this may be the factor that is affecting the growth rate of the children.
Hospital acquired infections
Lack of sanitation in hospital facilities is a primary means by which infections spread. As hospitals are a gathering of many people with a myriad of different illnesses, any lapses in sanitation protocol can prove deadly.
Indicative of this is a case that has been unveiled at the Tuberculosis Hospital in Sewri. A total of 66 employees contracted the disease in the past five years, authorities said in reply to an RTI query. Of these, seventeen died. This number may be the tip of the iceberg as the figures only account for hospital staff. If staff themselves are becoming infected due to lapses in sanitation protocol it is highly likely the infection has been spread among patients and visiting family.
Sepsis is another significant issue in India. Maternal and newborn mortality rates due to the condition are higher in India than the global average. It is a difficult condition to prevent as it can be caused by an infection from a whole range of pathogens. As such, it is vital that sanitation protocols are in place and strictly followed to reduce the spread of pathogens. A study by The Lancet goes as far as suggesting the use of single family rooms in hospitals to limit the spread of infection.