Why ALL 3Haath, Munh & Bum-

are vital for an impact on health

The last few years have put the spotlight on the lack of sanitation, which is one of the most pressing issues that the nation faces and yet has never received the attention it deserves. India has been performing poorly on the metric of sanitation with open defecation and certain other sanitation figures comparable only to some of the poorest countries in the world. It is as though, in spite of the achievements we have made, be it economic development or poverty reduction, somehow, we seem to have missed the bus on sanitation. It is a great relief that an issue such as sanitation is now receiving the seriousness it deserves through the Swachh Bharat Abhiyan.

We generally look at issues in isolation and not holistically and we may be repeating the same mistake when looking at sanitation and hygiene. To understand the basis for developing a holistic approach towards water, sanitation and hygiene, let us look at the faecal-oral transfer theory which was first used by WHO in 1958. It focuses on all the elements in the paths of faecal-oral disease transmission by germs i.e. faeces, fingers, flies, fluids and food. We can identify the barriers that we can enforce - toilets, safe water and washing hands with soap, at different stages of the transmission pathway to prevent the children of the nation as well as adults from contracting diseases originating from faeces and transmitting through contaminated water and improper sanitation and hygiene practices. Using toilets is the first step in the prevention of spread of germs. Universal usage of functional toilets ensures a significant reduction in the transmission of germs and thereby the risk of disease transmission. One of the significant problems with focussing only on toilets is the requirement of near universal coverage and usage. Even a small population refusing to use toilets keeps the risk of spreading disease-causing germs intact. Also, human faeces are the primary source of germs and hence diseases. There are other sources such as animal faeces, water and soil, making it impossible to eradicate diseases simply by eliminating open defecation alone.

Water, when contaminated with faecal matter, is one of the principal carriers of germs. Clean water is paramount to keep a check on the spread of germs. This is because in cultural practice, water is used directly from the source or without any effective purification, for drinking purposes. The belief is that visibly clean water is fit for drinking and even in areas where this is not the case, the only effort that is made at water purification is to make it look, taste or smell clean. Following hygienic habits with respect to water, filtration or boiling, can significantly decrease exposure to infections but it should be combined with a focus on other carriers, namely, food, flies and fingers, to ensure that all possible sources of infection are blocked.

Washing hands with soap is the third pillar for preventing infection due to germs along with using toilets and drinking clean water. Hand washing, like drinking clean water, prevents the transmission of germs at the point of infection. Clean hands ensure that there is no transmission of germs during food preparation and consumption, child care or nursing. Hand washing, while being the most efficient means to tackle infection, cannot be expected to battle the momentous task of preventing diseases such as diarrhoea, alone. This is true especially in the case of toddlers, where continuous monitoring is a difficult task.

The idea behind a combined WASH intervention is to ensure that the faecal-oral transmission is stopped at as many barriers as possible, preventing the spread of diseases and thereby ensuring better

health outcomes. Each of these steps, hand washing with soap, clean water and usage of toilets, or ‘haath, muh and bum’ (hands, mouth and bum), as we put it, is a significant barrier to prevent the spread of diseases. Though the understanding is commonsensical, one can have a look at the numbers. Multiple researchers have shown that water, sanitation, and hygiene interventions, as well as their combination, are effective at reducing diarrhoeal illness.

Another area of great concern is that, as a nation, we have let focus remain on infrastructure alone for too long. Moving away from WASH for a moment, if one looks at education, the focus for an interminable time has been only on infrastructure- schools, classrooms and playgrounds, and never on defining issues like the actual learning process or the studentteacher interaction that contributes to it. Drawing a parallel to WASH, sanitation has always been about the number of toilets, hand wash stations and hand pumps while never about behaviours or behaviour change and we, as a nation, have suffered from this lapse. Entering the 4th year of the Swachh Bharat Abhiyan, we have seen the focus shift from the building of toilets towards the usage of toilets. This is a positive change and Hindustan Unilever Limited has been a pioneer in focussing on behaviour change as the most important component of a sanitation or WASH program.

Unilever believes in using the power of being the world’s marketer to make the lives of billions of people better every day and from this belief stems the need to lead the behaviour change movement in WASH in India. Swachh Aadat Swachh Bharat is about using Hindustan Unilever’s ability to influence behaviours for good by changing how India defecates, drinks water and washes hands. Unilever’s projects have shown that interventions targeting WASH behavior change shows effective results. For example- the research ‘Effect of a behaviour-change intervention on handwashing with soap in India (Super Amma): a cluster-randomised trial’ by Dr Adam Biran and others shows that substantial increase in handwashing with soap can be achieved using a scalable intervention based on emotional drivers.

Through interventions like Swachhata Doot (Messenger of Change), Swachh Aadat curriculum (21-day textbook on hygiene habits), HUL will be able to reach millions of Indians with their message on clean habits— washing hands with soap, drinking purified water and using toilets and keeping them clean. To know more about HUL’s WASH interventions, log on to www.hul.co.in/sasb

“Sanitation is a cornerstone for public health, especially children. Simple and achievable interventions can reduce the risk of contracting diarrhoeal disease in children by one-third.Due to lack of sanitation children pay the price in lost lives, missed schooling, in disease, malnutrition and poverty. The absence of adequate sanitation has a serious impact on health and social development of our children. Using proper toilets and hand washing especially with soap - prevents the transfer of bacteria, viruses and parasites found in human excreta which otherwise contaminate water resources, soil and food. This contamination is a major cause of diarrhoea, the second biggest killer of children in India and leads to other major diseases such as cholera, schistosomiasis, and trachoma. The focus on sanitation is fundamental to health of our children.” - Dr Yasir Wani MD, consultant, pediatrician and neonatologist with J&K Health Services.