Today's Editorial 08 September 2014

         The Asian enigma

Source: The Statesman
Water and sanitation problems have reached boiling point: children are dying unnecessarily at the rate of 20 jumbo jets crashing every single day.

~ Ravi Narayana, a health activist

The importance of proper sanitation facilities for a healthy life can hardly be overemphasized. It has a strong connection not only with personal hygiene but also with human dignity and wellbeing. Jawaharlal Nehru once said: “The day every one of us gets a toilet to use, I shall know that our country has reached the pinnacle of progress”. The impact of inadequate water and sanitation can affect all sectors of development ~ health, gender equality, economic development, food security and national security. Around the world, nearly 780 million people do not have access to safe drinking water and 2.6 billion (36 per cent of the global population) do not use  safe, clean toilets, and one billion still defecate in the open (15 per cent of the global population).

Issues related to sanitation have not been accorded the priority they deserve.  India accounts for a swathe of the global population that makes do without basic sanitation. According to “Squatting Rights”, a research report prepared by the philanthropic foundation Dasra, more than 1,600 children under the age of five die each day due to diarrhoea caused by lack of sanitation.

Poor sanitation has a direct impact on the high rate of malnutrition in this country. Stunting (low height for age) is the preferred parameter that is used by the World Health Organization (WHO). Indian children are on an average shorter not only than children in the poorer sub-Saharan African (SSA) countries, they are among the shortest in the world. Almost 61.7 million Indian children are stunted.  This astonishing reality is the 'Asian enigma', one that can hardly be explained in terms of genetic differences.  Poor sanitation has a direct impact on the high rate of stunted children in India. Experts have ascribed this puzzle to the consequences of widespread open defecation (OD).  An analysis of as many as 140 demographic and health surveys, conducted by Dean Spears, revealed that the height of Indian children correlates with their and their neighbour's access to toilets, and that OD accounts for much of the stunting in India.  Surprisingly, OD has risen from 55 per cent in 2006 to around 61 per cent in 2011 (WHO and UNICEF 2013).  It is much less common in sub-Saharan Africa, China and Bangladesh.

In India, diarrhoea resulted in the deaths of around 2.12 lakh children under five in 2010, accounting directly for 12.6 per cent of child mortality.  The impact of  sanitation is not limited to health alone. Investments in education are undermined by inadequate sanitation at home and in school. Sick children do not attend school and inadequate sanitation in schools reduces girls' attendance.  One in every four girls drops out of school due to lack of toilet facilities. The failure to address sanitation in schools not only widens the gulf between the opportunities afforded to girls and boys through education; it also seems to be a significant barrier to the achievement of Millennium Development Goals, chiefly to remove gender disparity in primary education.

India has been struggling to achieve universal sanitation coverage since 1986 when it launched the Central Rural Sanitation Programme, a supply-driven scheme with subsidy. In 1999, the programme was recast as demand-driven Total Sanitation Campaign (TSC), but again with subsidy. In 2012, it was re-christened Nirmal Bharat Abhiyan (NBA) with the focus on community-led, demand-driven approach, but with even more subsidies.  The fact remains that India has the world's largest population that defecates in the open. According to data released by the National Sample Survey Office (NSSO) in December 2013, 59.4 per cent of rural India defecates in the open. Jharkhand and Odisha are the worst performers with 90.5 per cent and 81.3 per cent of their population without toilets. Indeed, different government agencies provide different data on the number of rural households with toilets. The 69th survey conducted by the National Sample Survey Office between July and December 2012 has put the figure at 41 per cent, the Baseline Survey's abstract report accessed on December 2013 at 40 per cent, and the 2011 Census at 31 per cent.

The rude shock came in 2012 when the Union Ministry of Drinking Water and Sanitation (MDWS) denied the figures and placed its estimate at 68 per cent. This triggered a political debate.  The difference between the ministry and census data translates into 37.5 million 'missing toilets'. The denial on the part of the government can be interpreted as conscious refusal to accept the vital facts, information and the reality.  Admittedly, in terms of modern psychiatry, any denial is “an unconscious defence mechanism characterized by refusal to acknowledge painful realities, thoughts, or feelings.”

In fact, sanitation has rarely occupied centrestage in any public discourse on the problems that plague the country. It is at best accorded lip-service. About half of India's 1.2 billion residents possess a mobile set, but only around one-third of the population has access to toilets. Despite the compelling moral and economic imperatives for action on sanitation, progress seems to be too little and too slow.

 In 2008, then Prime Minister Manmohan Singh lamented that 50 per cent of the toilets built under the government's sanitation programme were not in use. Indeed, India needs a latrine policy as much as it needs latrines for raising our dignity in the international community. A national task force under someone like Bindeshwar Pathak of Sulabh fame could be a good beginning. It would be pertinent to conclude with the message that was advanced by UN Secretary-General Ban Ki-moon for the World Toilet Day 2013:  “By working together and by having open and frank discussion on the importance of toilets and sanitation, we can improve the health and well-being of one-third of the human family”.