Access to toilets leads to public health gains

At least 100.7 million toilets were built under the Swachh Bharat Mission (SBM) across the country to take the toilet coverage from 38.7% on Oct 2, 2014, to 100% on October 2, 2019, according to the jal shakti ministry data. The coverage is seen to have contributed to rural India achieving the open-defecation free (ODF) status within five years

Experts say while the last mile challenges like access to safe water and functioning soak pits for human excreta remain, providing an estimated 500 million toilets to prevent open defecation has brought measurable public health gains.

Three of the top seven causes of disease and death in India – malnutrition, dietary risks, and poor WASH (water, sanitation, and hygiene) practices -- are directly linked with poor sanitation services and poor hygiene practices.

Poor sanitation is the leading cause of frequent diarrhoea, malnutrition, cholera, hepatitis A and E (jaundice), worm infestations, typhoid, and other enteric fevers. They lead to chronic malnutrition and lowered immunity that further feeds the infectious disease cycle.

Improved sanitation has prevented at least 300,000 deaths from diarrhoea and protein-energy malnutrition between 2014 and October 2019, according to a World Health Organization (WHO) estimation of the health impacts of SBM. The estimation was done in 2018 using data from two large nationally representative surveys -- the Rapid Survey on Children, which was conducted shortly before the launch of the SBM in 2014, and the National Family Health Survey from 2015/2016 – as well as thirdparty

surveys.

“Unsafe sanitation led to an estimated 199 million cases of diarrhoea...annually before the start of the SBM in 2014. These have been reducing steadily since India accelerated safe sanitation services and ended open defecation, with the modelling showing diarrhoea deaths will be almost eliminated when India achieves universal coverage and use of safe sanitation facilities is achieved,” said WHO South-East Asia’s regional director Dr Poonam Khetrapal Singh.

Experts say along with toilets, working sewage-disposal systems, waste-disposal management, protection of water supply from contamination and promotion of handwashing practices were needed to improve the nutrition status and immunity of children.

Malnourished children are underweight, stunted or wasted, and are more likely to die of childhood infections like pneumonia and tuberculosis. About 38.4% of children are stunted or have a lower height for their age and

35.7% are underweight, according to the National Family Health Survey-4 (2015-16).

The decline in stunting and underweight children has been marginal over the past decade while wasting (low weight for height) has gone up from 19.8% in 2006 to 21% in 2016. Safe sanitation is expected to lead to rapid reductions in all three indicators in the next NHFS.

“Improving sanitation is helping India meet SDGs [Sustainable Development Goals] by improving health, nutritional status, gender equity by keeping girls in school, reducing poverty, and providing people a life of dignity,” said Singh.

Children have done their bit to push for ODF, according to Unicef. “When we talk about SBM, we have to understand how children have been involved. Twenty million children wrote to PM Narendra Modi on how they wanted to take action. Children instigating change has made participation even stronger,” Dr Yasmin Ali Haque, Unicef’s India representative.