Closing the loop in India's sanitation campaign for public health gains

Abstract

The prevalence of stunting in India (38·4%) 1 International Institute for Population Sciences, ICFNational Family Health Survey (NFHS-4), 2015–16. International Institute for Population Sciences, Mumbai2017 Google Scholar is among the highest in the world, 2 Development Initiatives2018 Global nutrition report: shining a light to spur action on nutrition. https://globalnutritionreport.org/reports/global-nutrition-report-2018/Date: 2018 Date accessed: March 12, 2019 Google Scholar and diarrhoea is a major killer of children younger than 5 years. 3 GBD 2016 Diarrhoeal Disease CollaboratorsEstimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018; 18: 1211-1228 Summary Full Text Full Text PDF PubMed Scopus (583) Google Scholar Both these conditions closely relate to unsafe water, sanitation, and hygiene. The Swachh Bharat Mission (SBM), India's flagship and the world's largest sanitation programme, aims to accelerate universal access to sanitation in rural and urban India. 4 Ministry of Drinking Water and SanitationSwachh Bharat Mission—Gramin. https://swachhbharatmission.gov.in/sbmcms/index.htmDate: 2019 Date accessed: March 12, 2019 Google Scholar Since its launch in 2014, SBM reports building close to 100 million toilets 4 Ministry of Drinking Water and SanitationSwachh Bharat Mission—Gramin. https://swachhbharatmission.gov.in/sbmcms/index.htmDate: 2019 Date accessed: March 12, 2019 Google Scholar , 5 Ministry of Housing and Urban AffairsSwachh Bharat Mission—Urban. http://swachhbharaturban.gov.in/dashboard/Date: 2019 Date accessed: March 12, 2019 Google Scholar by way of providing financial incentives to needy families, involving local governments and communities in construction and in monitoring progress, and by conducting mass awareness campaigns. In 2015, India was 60% open-defecation free (ODF), lagging behind her neighbours Bangladesh at 99%, Sri Lanka at 97%, Pakistan at 88%, and Nepal at 70% ODF. 6 WHOUNICEFProgress on drinking water, sanitation and hygiene: 2017 update and SDG baselines. World Health Organization, United Nations Children's Fund, Geneva2017https://washdata.org/sites/default/files/documents/reports/2018-01/JMP-2017-report-final.pdfDate accessed: March 12, 2019 Google Scholar Today, India is at an important juncture, with SBM data showing more than 98% sanitation coverage 4 Ministry of Drinking Water and SanitationSwachh Bharat Mission—Gramin. https://swachhbharatmission.gov.in/sbmcms/index.htmDate: 2019 Date accessed: March 12, 2019 Google Scholar and sample studies reporting good progress but lower coverage in terms of latrine ownership (71%) 7 Gupta A Khalid N Deshpande D et al. Changes in open defecation in rural north India: 2014–2018. Research Institute for Compassionate Economics, New Delhi2018https://riceinstitute.org/wpcontent/themes/rice/downloadpdf.php?pfile=Date accessed: March 12, 2019 https://riceinstitute.org/wp-content/uploads/2019/01/Changes-in-open-defecation-in-rural-north-India-2014-%E2%80%93-2018.pdf Google Scholar and sanitation coverage (93·1%) 8 Kantar Public, IPE GlobalNational annual rural sanitation survey (NARSS) 2018–19. Ministry of Drinking Water and Sanitation, New Delhi2018https://mdws.gov.in/sites/default/files/NARSS-2018-19.pdfDate accessed: March 12, 2019 Google Scholar in rural India. On the question of water: a matter of life and deathThe theme of this year's World Water Day on March 22—Leaving No One Behind—is a commitment to those who are disproportionately affected by insufficient access to safe water, such as women, children, refugees, and socioeconomically marginalised people. The urgency of this task is cemented in Sustainable Development Goal (SDG) 6—to ensure the availability and sustainable management of water, the provision of adequate and equitable sanitation and hygiene, and cessation of open defecation by 2030. The staggering number of people for whom safe water trickles in insufficient quantity and quality—2 billion according to the UN—begs the question of how such a target could ever be reached. Full-Text PDF