Health Sector In India

HUNGER

Malnutrition: FAO defines malnutrition as population denied of dietary intake for prolonged period. Chronic malnutrition is defined as hunger.

Quote: “Hunger is quiet violence” – Amartya Sen

Hidden Hunger:  Refers to the condition of an individual who is consuming requisite dietary intake but is deficient of micro nutrients.

It can be addressed by diversifying diet to include micro nutrients and by fortifying commonly consumed food that is part of the staple diet of individuals.

Measuring Hunger

Global Hunger Index: Brought out by IFPRI

Parameters: Stunting, Wasting, Child Mortality and Undernourishment (Adults)

India has the largest number of people affected with hunger according to FAO report: 194 million in India are hungry. Although it has improved, the rate of improvement is insufficient.

The Global Hunger and Malnutrition Index also shows that over 40% of the world’s hungry children are from India.

Hungama Report (Nandi Foundation)

Child undergrowth (42%) and Anaemia (63%)

Child stunting in urban areas – 22%

Introduction on Malnutrition or Hidden Hunger

                India has a paradoxical mix of obese and malnourished children. It is no longer necessary to focus on adequate nutrition alone. Our policy focus must shift to appropriate nutrition transforming our objective of food securityà nutrition security.

Reasons of Malnutrition

  • Accessibility/ Affordability to Food: Poverty is the overwhelming reason for hunger and malnutrition in the country as several households are incapable of consumption at sustained levels due to insufficient household income
  • Lack of Awareness:
    • Education among mothers: Hugama report by Nandi Foundation finds a strong correlation between malnourishment in children and educational attainment of mothers
    • Balanced Nutrition: Even educated mothers in urban areas are unaware of the difference between right nutrition and calorie intake. This has led to the phenomenon of hidden hunger among children
  • Lack of Health and Hygiene: A child’s ability of consumption is greatly affected by his health and vulnerability to epidemics and other diseases. Diarrhoea for example drastically reduces child’s capability to intake food and nutrients.
    • Provision of clean drinking water, clean environment, sanitation facilities, solid waste management, robust sewerage and drainage networks can reduce vulnerability of children as well as adults to such diseases enabling them to acquire requisite nutrition

Obesity

                India is second in the number of Obese children with more than 14 million obese children. The reasons for such alarmingly high levels of obesity in India are:

  • Lifestyle Problems: Children in urban areas particularly are gorging on junk foods with little focus on exercise, balanced diet and intake of vitamins and micro-nutrients. Excessive fat containing foods are consumed causing obesity
  • Passive Nature of Children: Obesity’s rise in the modern world has been co-terminus with the rise of technology and other forms of entertainment. They have become couch potatoes in their homes with little outdoor activity contributing to their obese nature

Consequences

  • Vulnerability to Diseases: Several non-communicable diseases including CVDs, diabetes and cancers are linked to obesity
  • Social Stigma: Indian society in particular runs a deep running stigma on obese individuals that hinder them from leading a dignified life in society.
  • Hinders Productivity: Obesity impairs health which affects productivity of the young working population. An obese population is a bane to India’s demographic asset.

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Possible Measures to Control Obesity

  • Awareness on Balanced Diet: Proper awareness can be propagated among students and parents regarding the importance of a balanced diet. School and local governance bodies can act as focal centre in coordinating such activities along with CSOs
  • Taxesà Behavioural Change: The rising acceptance for fat containing westernized diet among the youth can be curbed by introducing fat taxes. Such taxes can be a potent disincentive to habitual consumption of fat foods
  • Regulate Junk Food Production: Junk food producing companies can be regulated to ensure lesser availability of affordable junk food.
  • Obesity as Health Service: Obesity management should be promoted as a specialised health service within urban areas focussing on youth in particular.

Conclusion

                In a country which has surplus food grains and guarantees the right to food for all, it is morally, politically and economically unacceptable that children are denied the right nutrition.

Government Interventions to Address the Issue of Hunger and Malnutrition

National Food Security Act, 2013

Legally secures citizens the right to food security and puts an obligation on the state to ensure the same.

Constitutional inspiration

Article 47: The State shall endeavour to improve the nutrition level of the general public and improve public health and standard of living

NFSA and Targeted PDS

TPDS is simply the executive machinery or framework for implementing the legislation that secures citizens right to food.

NFSA prescribes usage of excluded households in Socio-economic caste census as criterion for beneficiary identification while states implementing PDS still use old classification of BPL families citing unavailability of data.

NFSA is a region targeted legislation after considering recommendations of Shantakumar Commitee to reduce coverage and increase efficiency – Rural Areas(75%) and Urban (80%) whereas PDS has higher coverage

NFSA guarantees entitlement of 5kg per person or 35 per family while PDS varies depending on states

NFSA puts in a grievance redressal mechanism which is absent in PDS

Criticism of NFSA

  • Not Addressing Issue of Hidden Hunger: Only focus on carbohydrate rich diet and fulfilment of adequate dietary intake, lack of attention on micro nutrients or fortification of staple diet
  • One-size fits all policy: NFSA prescribes distribution of rice and wheat in general in all regions and does not take into account geographical and cultural variations and preferences of dietary intake
  • Financial Burden: Fulfilling the right to food in a nation of 194 million hungry can put great pressure on the state’s financial reserves grossly affecting its fiscal deficit
  • Identification of Excluded Households: Challenge for state governments and required greater coordination between central and state governments
  • NFSA not applicable during war, natural disasters and famine

New Initiatives Required under NFSA

  • Covering the excluded but deserving: Old, destitute, immobile and disable sections of population need to provided food security and Door to door delivery should be initiated for the same (Chhattisgarh PDS provides free meals to destitute and homeless)
  • Addressing Issue of Hidden Hunger: Diversifying nutrient basket and fortification of staple diet to ensure adequate proportion of micro nutrients in dietary intake (Chhattisgarh – Black Gram, Iodised salt)
  • Administrative Change: Corruption, hoarding and black marketing in fair price shops have necessitated a structural change in management with SHGs and gram panchayats better placed to take over its management (Chhattisgarh – Panchayats and Municipalities)
  • Provision of social audit
  • Aadhar linked DBT
  • Grievance redressal mechanisms should be put in place in all states

National Nutrition Mission – Synergy of schemes eliminating malnutrition and hunger

  • Multi-sectoral programme to address maternal (pregnant and lactating woman) and child nutrition in all districts beginning with 315 high burden districts
  • As an apex body, NNM will monitor, supervise and fix targets and guide nutrition related intervention across ministries (synergy between ministries – MWCD, MDWs, MHFW, agri, food processing, food supply, IT)- Robust convergence mechanism
  • Focus on reduction of under-nutrition, stunting and low birth weight in children
  • Reduction in levels of anaemia among young children, adolescent girls and women (Folic Acid supplements)
  • IEC awareness campaigns against malnutrition and ICT based real time monitoring system and incentivizing anganwadi workers for using IT based tools

Role of Private Sector in Curbing Malnutrition

                Malnutrition occurs due to multi-dimensional problems of quality, safety, availability and affordability of food. Lack of sanitation facilities, hygiene and vulnerability to diseases further perpetuate or are themselves causes of malnutrition. The private sector in India can play a pivotal role in reducing instances of malnutrition by leveraging:

  • Large Scale Production Capacity
  • Product and Business Model Innovation
  • Marketing Expertise and Sale
  • Extensive Distribution networks and Supply chains

They are currently engaged in fortification of foods and production of nutritional supplements that often bridge deficiencies of micro-nutrients like vitamins and minerals (iodine, zinc etc)

Role in Spreading Awareness

  • Nudging Customers: Retailers can educate consumers through pro-active display and enhancing awareness to enable them to make effective and balanced dietary choices
  • CSR Nutrition: Large corporate firms can increase awareness on balanced diet and provide quality food through their CSR programmes
  • Leveraging Technology: Technology and telecom services can play a key role in monitoring diets, identifying deficiencies and suggesting balanced diets and effective health care services
  • Workplace Nutrition: Workplaces can be used to educate employees regarding health and nutrition choices to enable them to take good decisions regarding dietary choices. Programmes can also be organized to distribute nutritious food among employees
  • Influencing Cooking Practices: Media and food companies can educate consumers regarding cooking practices that are conducive to maintaining requisite and balanced level of nutrition

Substance Abuse

Overuse of any substance that affects human body function, mood which has potential for misuse and is harmful for both individual and society is categorised as Substance Abuse.

TOBACCO – Smoking and Smokeless

Overuse can lead to pulmonary and mouth diseases – lung, mouth cancer and other life-threatening diseases – 50% fatality

Passive smokers just as vulnerable to acquiring diseases -1/10th of tobacco deaths

Issues

  • Tobacco farming is highly profitable and yields highest return per hectare
  • Powerful industrial lobby and nexus between industry and politicians: Research and Development, Insurance, Subsidy and Export allowances
  • Less focus on smokeless tobacco whose health effects are much more averse compared to smoke tobacco

Government Strategy – ‘mPower’ – WHO’s Tobacco Free Initiative

  • Offer help to quit and provide appropriate rehabilitation facilities
  • Preventing first use : Focus on kids and adolescents
  • Monitoring use and creating preventive policy
  • Warning about dangers introduced by Cigarettes Act, 1975
  • Increase taxes to discourage consumption
  • Ban on advertisements and promotions
  • Monitoring and regulating vendors
    • Recently the Rajasthan government made it mandatory for vendors selling tobacco products to procure licenses to sell within urban area limits. Further, those shops selling tobacco products shall not sell kid-friendly products- this is to reduce chances of first usage among children

India has ratified UN Convention on Tobacco Control

Cigarettes and Other Products Act, 2003

  • Ban on sale to minors
  • Ban on setting up shops near school
  • Ban on Public Smoking
  • Ban on Promotion

National Tobacco Control Programme – Ministry of Health and Family Welfare

Objectives

  1. To generate greater awareness about harmful effects of tobacco through Media campaign (Rahul Dravid)
  2. To ensure effective implementation of Cigarettes and other products Act, 2003

Other features

Collaboration with research institutes for alternate cropping mechanisms

Integrated with NRHM

Nicotine testing labs

Challenges for the Program

  • Powerful industrial and farmer lobby
  • No institutional mechanism to check effectiveness
  • Overcoming behavioural problem and aversion to change
  • Surrogate advertisements
  • Faulty tax policy with different tax levied on bheedis and cigarettes
  • Increase in space of warnings not fully implemented

Alcoholism

Issues Associated with Alcoholism

Social:

  1. Domestic Violence
  2. Drunken Driving
  3. Increasing suicidal rates

Economic:

  • Health Burden on individual and state
  • Reduces productivity

Health Issues:

  • Affect individual’s thinking capacity
  • Liver capacity affected
  • 5th largest cause of death in the world

Different Approaches in Conquering Alcoholism

Phased Regulation vs Complete Ban

Past experiences from complete ban on intoxicants of any kind indicate that it only pushes trade and consumption underground making it extremely difficult for government to monitor and regulate. Hence original consumers are forced to consume even more harmful intoxicants that can have grave consequences on individual health

Phased regulation however gives government the opportunity to monitor and regulate production and consumption simultaneously generating awareness about harmful effects

FOOD SAFETY

Absence of harmful contaminants in food including:

  1. Chemicals and toxins 2. Adulterants 3. Pathogens 4. Genetic Pollution

Consequences of Food Contamination

  • Occurrence of diarrhoea
  • Allergic Reaction
  • Risk to acquiring non-communicable diseases
  • Death

FSSAI (Food Safety and Standards Authority of India)

FSSAI lays down science based standards for articles of food and aims to regulate its manufacture, storage, distribution, sale, and import to ensure availability of safe and wholesome food for human consumption.

Functions                                                                                                            

  • Nodal Authority: Acts as a single point or nodal authority for all matters concerning food safety
  • Standardization for Food Quality: Laying down standards and guidelines
  • Accreditation of Certification Bodies: Lays down mechanisms and guidelines for accreditation of certification bodies engaged in certification of food safety management system
  • Accreditation of labs: Laying down procedure and guidelines for accreditation of labs
  • Threat Evaluation: Data collection and analysis regarding biological risk, presence of contaminants, emerging threats and introduction of rapid alert system
  • Generating Awareness: Create an information network across the country so that individuals and administrators are aware of the importance of food safety and a consumer’s role in ensuring the same
  • Grievance Redressal Mechanism: Any consumer who has been affected by lower quality of food can air complaints towards FSSAI which can then take appropriate action to ensure quality in future.

Issues with Food Safety

  • Lack of testing labs
  • Insufficient monitoring and inspection
  • Industrial Lobbying
  • Lack of expertise for inspectors
  • Greater Consumer Awareness required

Consumer Protection Act (COPRA), 1986

  • Right to Know
  • Right to be Heard
  • Right to Choose
  • Right to safety
  • Right to Consumer Education
  • Right to Redressal and Compensation

IMMUNIZATION

Purpose

To control vaccine preventable diseases with special focus on reducing IMR as infants are most vulnerable to fatal vaccine preventable diseases

Challenges of Immunization

  1. Voluntary Exclusion
    1. Injection Fear
    2. Religious and cultural impediments: Low rates of vaccination among Muslim communities have led to significant outbreak of diphtheria in Kerala and Andhra Pradesh.
    3. Accessibility issue
  2. Inefficient cold storage mechanisms
  3. Lack of human resource expertise to administer injections
  4. Duplication in coverage data

Addressing Challenges

  • Generating Awareness: The citizens need to be made aware of the benefits of immunization to overcome the cultural, behavioural and religious hurdles that currently hinder its efficient expedition. Communities need to start appreciating immunization as their fundamental health right rather than as government agenda thrust upon them
  • Use of Technology in Vaccine Delivery: India needs to replace antiquated logistics and temperature monitoring systems with available modern technologies for efficient vaccine delivery. The e-VIN (Electronic Vaccine Intelligence Network) is an indigenous technology that digitizes vaccine stock and monitors the temperature of cold chain through smart phone applications.
  • Participation of CSOs and private organizations for increased effectiveness of delivery systems
    • Bill and Melinda Gates Foundation has signed an MoU with the U.P government to provide technical, managerial and design assistance in intensifying its vaccination programmes for Japanese Encephalitis and Cerebral Fever
  • Stepping up Research & Development: Newer technologies and vaccines that lower dosage, number of dosages, reduce wastage and enhance vaccines are required to stimulate best response particularly in small children
  • Addressing HR deficiency: Robust training, management and knowledge sharing structures are required for effective implementation of immunization programme.

India’s fight against Polio

India declared itself polio free in 2014 and WHO recognized the same in 2015

Features of India’s Polio campaign

  • Mass awareness generation targeted at mother and children through schools and media
  • Effective participation of international organizations- UNICEF, WHO
  • Specific targeting for migrant population
  • Continuous research and development enabling usage OPV and IPV (Inactivated Polio Vaccine – Inactivated with formalin) where lesser doses are required although gut immunity is not addressed in IPV

Current Scenario

Import Threat of Polio: Although India and South-east Asia are currently free of polio, Afghanistan and Pakistan still have cases which may be exported to India. Hence India continues with its OPV campaigns across the country immunizing the new born

From the vaccine itself: Polio can spread through the excreta of children who have been administered the OPV by the way of vaccine derived poliovirus (VDPV). VDPV can cause outbreaks among unimmunized population.

Way Forward

Replace OPV with IPV: IPV does not cause VDPV but protects children equally well from polio

Mission Indradhanush – Ministry of Health and Family Welfare

A nationwide immunization programme aimed at universal immunization of children for vaccine-preventable diseases including Diphtheria, TB, Polio, Measles, Rubella, Rotavirus, Japanese Encephalitis, Hepatitis B, Tetanus, Whooping Cough, Pneumonia through intensive efforts and special immunization drives

Target of the Scheme: Universal Immunization by 2020

Benefits of the Mission

  • Enhance immunity of children to fatal diseases thus enabling reduction in IMR and child mortality rates
  • Particularly beneficial to children in vulnerable sections of society in families which are exposed to frailties of diseases due to lack of sanitation and hygiene
  • Impetus to neo natal and maternal health care services
  • Disease free childhood enables better holistic development of children
  • Enables job creation and subsequent empowerment for ASHA workers and auxiliary nurse and midwifes (ANMs) engaged in mobilization, tracking, monitoring and administering immunization respectively
  • Generates greater awareness among parents especially among mothers regarding benefits of immunization and preventive healthcare
  • Takes into account migrant children and ensures they are also immunized

DRINKING WATER

Introduction:

                NITI Aayog in its Composite Water Management Index Report sites that India is facing its worst water crisis in its history and asserts that the demand of water will outstrip supply come 2030 if adequate steps are not taken. Such is the urgency water conservation requires in our country.

Why India is water-stressed?

  • High population and Demand: Large quantities of water are required to meet domestic as well as industrial demands. The problem is even more visible in urban areas where there is a high population density causing greater burden on scarce water resources making it difficult for civic bodies to supply requisite amounts equitably
  • Non-Scientific and Water Inefficient Irrigation Practices: In many parts of the country, irrigation is performed using flood irrigation technique which is a highly water inefficient and low productive method. Further leakage across irrigation canals also lead to water loss. Hence there is a need to promote and provide micro-irrigation facilities to yield dual benefits of increased productivity and water efficient irrigation under PMKSY
  • Ground Water Depletion: The surface run off in many regions is not captured in aquifers leading to drainage loss while tube well irrigation has heightened the pressure on ground water resources. Mining has also led to contamination of ground water which necessitates ground water acquirement from greater depth.
    • According to Composite Water Management Index Report of NITI Aayog, 21 cities will run out of ground water by 2020
  • Water Pollution: Wetland encroachments and discharge of industrial effluents have led to contamination of fresh water resources rendering it unfit for human consumption and domestic usages.
  • Culture of Wastage: Efficient usage of water has been not practiced adequately in families, institutions and other regions imbibing a culture of water wastage. This behavioural issue needs to be addressed through novel methods like water pricing which would put a price on water and promote its judicious and efficient use.
  • Climatic Variations: Indian agriculture and water supply remains dependent on the monsoon bounty which may or may not produce requisite amount of rainfall

National Water Policy, 2012

  • Judicious Usage of water: Shift from flood irrigation techniques to micro irrigation techniques promoting efficient usage of water and increased productivity
  • Incentivizing Conservation: Water Pricing to be introduced to promote judicious use of water, ensure its equitable distribution for drinking, irrigation, industrial and other purposes and enhance accountability of unscrupulous waste of water resources
  • Institutional Mechanism: Establish National Water Board as implementing agency
  • Bridge Water Divide: Efficient sanitation practices with special focus to bridge supply gap in rural and urban areas to provide adequate water supply for sanitation facilities and improve sewerage facilities in rural areas the importance of which is elevated in background of the objective of achieving ODF rural areas as a part of SBA(Gramin)
  • Private Sector Participation: Address the issue of demand supply mismatch in populous urban areas through system strengthening and strategic engagement leveraging support of private entities through blue bonds enabling financing of municipal water infrastructure facilities. In water-rich east and northeast regions, special focus needs to be given on infrastructure facilities in the interest of food security
  • Recovery of Water: Direct use of rainfall, desalination and avoidance of inadvertent evapotranspiration are additional strategies for augmenting utilizable water resources
  • Community Level Participation: Mapping aquifers using community-level participation to improve groundwater quality and quantum. Enhance capability and resilience of communities to deal with climate vagaries which are likely to increase the variability of water resources
  • Inter-Linking of Rivers: Calls on states for considering inter linking of river basins after adequate environmental, social and economic assessment

National Rural Drinking Water Programme – Swachch Bharat Abhiyan (Gramin)

Aim: Ensure availability and accessibility of water of minimal quality standards at all times to every rural person for the purpose of cooking, drinking and other domestic needs

Components

  • Coverage through the piped water supply, hand pumps
  • Sustainability through source diversification and stabilization
  • Assured Quality
  • DDP areas
  • Natural Calamity
  • Establishment of Support System

Features of the Programme

  • Piped Water Supply: Emphasis on provision of piped water supply in rural habitations in targeted areas of Assam, U.P, Bihar and Jharkhand to reduce drudgery and time taken for transportation of water
  • Sustainable functioning of rural water supply systems through adoption of O&M methods for better working and to control leakages
  • Desert Development Programmes: Special focus on arid regions through desert development programmes targeted at 21 districts across 5 states
  • Community Level Participation: Devolution of responsibility and O&M affairs to Panchayati Raj institutions enabling community level participation
  • Promoting irrigation efficiency: To avoid over exploitation of ground water resources which can be a good source for drinking water

Fund Allocation

                Recently the Union government has restructured the NRDWP to improve flexibility, result orientation and competition between states. The States will now on be allotted funds for the second instalment based on their performance so far. Hence states are expected to ramp up their efforts in order to avail for central assistance.

Water Pricing

Water pricing seeks to peg usage of quantum of water resources at differential prices increasing accountability on the consumer thus enabling reduced wastage in lieu of financial disincentive. It aims to promote judicious and efficient usage of water to enable equitable distribution of water for domestic, industrial, agricultural and all other purposes.

Benefits of Water Pricing

  • Helps to overcome the behavioural issue of wastage of water by providing financial incentives for promoting efficient usage of water resources
  • Increases accountability on the consumer thus reduces consumption levels relieving pressure on ground water resources
  • Incentivizes farmers to shift from flood irrigation techniques to micro irrigation techniques enabling efficient usage of water
  • Incentivize farmers to shift from water-intensive crops to dry crops helping to correct the vagaries of the current faulty MSP policy and address the issue of skewed production of wheat and rice which makes India a virtual exporter of water
  • Incentivizes consumers to turn to alternative forms of water supply like rainwater harvesting reducing financial and resource burden on civic bodies at the same time encouraging community-level participation
  • Helps to address the asymmetrical distribution of water resources between rural and urban areas by discouraging unscrupulous consumption in urban households and industries

Challenges

  • Water pricing requires adequate safeguards to vulnerable sections of the population who may have less purchasing power compared to other sections.
  • Special considerations need to be maintained for entitlement of marginal and small scale farmers especially in water-deficient regions of the country
  • Arriving at a consensus on the price considering the vast geographical and regional disparities in water availability and distribution
  • Shifting to water policy regime requires correction of faulty public procurement policy which promote skewed production of water-intensive crops
  • Financial burden on citizens for access to a basic necessity
  • Government does not have control on water resources like it does in case of other natural resources
  • Constitutional barrier of Article 21 ensuring right to water for all individuals as a part of right to life

Implementation Ideas

  • Targeted focus on irrigation as it accounts for 78% of water usage in India
  • Surface water usage needs to be monitored through net metering and appropriately priced
  • Ground water consumption is priced through proxies – monetary equivalent of diesel or electricity used to draw ground water
  • Separation of electric feeders for agricultural and non-agricultural purposes already a focus under DDUGJY

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Ground Water Bill, 2017

  • The legitimacy of uncontrolled groundwater leverage for landowners has led to the current situation of depleted ground water resources
  • The new bill specifies the need for decentralised control to give regulatory control to local users and the necessity to protect at the aquifer level
  • Recognizes the fundamental right to water and places in protection principles
  • The bill would help to improve sharing of resources that is beneficial to the larger majority than to a resource rich few

SANITATION

With regard to Sanitation, India suffers from absence of adequate sanitation facilities particularly in rural areas where the problem of open defecation is a particular cause for concern due to the dangers it raises for health and hygiene.

India’s urban and rural sanitation concerns differ in its manifestations. In rural areas, the problem of open defecation while in urban areas it mainly pertains to Solid Waste Management

The consequence of Lack of Sanitation

Health Consequences: Child Mortality, Vulnerability to diseases (diarrhoea) and Stunting

According to the UNICEF, the lack of Sanitation is responsible for deaths of over 1,00,000 children in India and for stunting of 48% of children.

Economic Consequences: Health problems cause highest out of pocket expenditure to the rural population. According to UNICEF, the provision of sanitation facilities enables every household to save 50,000Rs every year.

The lack of sanitation facilities costs India over 6% of its GDP according to the world bank.

Rural Sanitation

Swachch Bharat Abhiyan (Gramin) – Ministry of Drinking Water and Sanitation

Primary focus of the programme is to ensure ODF villages (by 2019) by provision of sanitation facilities and capacity building programmes to generate awareness among rural people. The National Rural Sanitation Survey has stated that only 68% of India’s households do not practice open defecation due to twin reasons of lack of sanitation facilities and behavioural aversion to using toilet

Challenges

  • Inadequate Water Supply: Although toilet infrastructure has been set up, there still exists the issue of adequate water supply
  • Lack of ancillary infrastructure to ensure smooth drainage from toilets affecting usability of toilets
  • Increased Manual Scavenging: The above issues have led to proliferation of dry toilets as a result of which has caused the prevalence of manual scavenging
  • Behavioural Aversion: Overcoming the behavioural challenge of people in rural areas to use sanitation facilities is an arduous task that necessitates greater investment in capacity building and awareness generation initiatives

The programme has done remarkably well in changing the culture of sanitation as evidenced by the following survey figures:

  • QCI survey points that 91% of households that have toilets make use of them
  • National Rural Sanitation Survey states that 93% of households that have access to toilets regularly use them
  • Lack of Clarity in devolution of functions: Clearly defined functions not devolved to grass root level institutions as the principal objective – cleanliness remains subjective
  • Regional Disparity: National Rural Sanitation Survey points to 100% households from Kerala and Mizoram making use of toilets whereas in Bihar and U.P only 44% households use toilet facilities
  • Target Based Programme: Once a village is declared ODF, attention towards it is likely to reduce. The government needs to build a sustained vision of Swachta across villages and states in the country beyond targets
  • Lack of Grass root level participation: The government’s role should be limited to leadership and the actual mantle of swachta needs to be taken up by villagers at the ground level on the basis of their priorities.

Suggestions

  • Ensure Water Supply: Leverage RURBAN mission to ensure adequate supply of water to rural areas and ensure basic ancillary infrastructure is in place to ensure sanitation needs of rural areas are met as per National Water Policy guidelines
  • Strict Enforcement on Manual Scavenging: Strictly ban construction of dry latrines and impose stringent punishments for employing manual scavengers. Provide existing manual scavengers with opportunities to rehabilitate, reintegrate and achieve alternate livelihoods
  • Awareness Generation: Greater expenditure on awareness generation with particular focus on IEC techniques to correct behavioural aversion by making villagers aware of the health benefits of sanitation thus making household toilets aspirational
    • No toilet no bride
    • Swachchgrahis to motivate individuals to change sanitation behaviour
    • Dharwaza Band Campaign was launched to initiate mass awareness on freedom from open defecation
  • Better Devolution to PRIs: Functions and funds need to be devolved effectively to PRIs to enable them to achieve sanitation targets set out for them. This can plug infrastructure gaps and ensure coherence in objectives
  • A Holistic Mandate: Sanitation overlaps with gender, inclusivity, health, education, empowerment and various other issues at the village level. The government can delve deeper into these inter-connected issues rather than seeing sanitation as a stand alone target

Positive Outcomes of the Mission

  • Dignity of Women: Enhanced dignity of women in rural areas by construction of toilets within the household
  • Education of the Girl Child: Reduced school dropouts among girl children as sanitation facilities were constructed within schools for girls in rural areas
    • Kidwai Survey: 91% of schools have separate toilets for girls
  • Less Diseases: Enhanced hygiene levels in rural areas as a result of making them ODF hence reducing vulnerability of rural people to diseases.
    • A survey of Bill and Melinda Gates Foundation pointed to reduced diarrhoea in ODF villages as compared to Non-ODF ones
  • Nutrition Security: Swachta enables reduced vulnerability to diseases that take away the capacity to acquire nutrition.
    • The survey of BMGF points to reduced stunting and wasting in ODF villages
  • Increased Savings
    • Swachchtaà Improved Hygieneà Less diseasesà Less medical expensesà Increased Savings
      • A survey by UNICEF indicated savings to the tune of 50,000 Rs per year

Urban Sanitation

Swachch Bharat Abhiyan (Urban) – Ministry of Housing & Urban Affairs

Primary aim of SBM (Urban) is to put in place a smooth framework or system for solid waste management in urban areas and to ensure citizen’s participation in the same. SBA (urban) also focuses on providing public and household sanitation facilities.

The Chain of SWM

  1. Segregation of waste and storage by residents
  2. Door to Door collection of waste
  3. Segregation at local level and storage
  4. Transportation of waste with minimal weight to limit leakage
  5. Differential processing of waste (Composting for wet waste and Incineration/Pyrolysis of non-biodegradable waste)
  6. Disposal of solid waste

Present Techniques of Solid Waste Management

  • Sanitary Landfill: In this mode of waste management, a huge piece of land which is not usable in any form and is isolated from human population is dug up to create a huge hole which is filled with solid waste.
    • Sanitary Landfill methods are not sustainable over long term and affects ground water quality in event of rain water percolation into soil
    • As they contain organic waste in heaps sanitary landfills produce methane and are inflammable hence a source of grave danger unless managed carefully
    • The stability of the landfill may be increased by flattening the slopes, strengthening the top, removing leachate and gas
  • Incineration: Burning of solid waste which can generate harmful gases, energy generated out of burning waste can be used for generating electricity
  • Pyrolysis: Instant burning of solid waste using high energy
  • Composting: Only applicable for organic waste which can be used for energy generation using bio gas plants enabling fuel efficiency and adequate usage of organic waste and manure

Household Toilet Construction

  • SBA focuses on construction of household toilets with both the main structure (closet and the pan) and the sub-structure ( connecting toilet structure to drainage)
  • Aims to stop construction of insanitary latrines and convert pit latrines to sanitary latrines in a bid to end manual scavenging and open defecation

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Community Toilet Construction

  • Individual households which do not prefer construction of toilets within households due to space constraints can make use of community toilets for sanitation purposes
  • Community Toilets are to have separate bathing and toilet facilities for men, women and should be disabled friendly (ramp provision, Braille signage)

Public Toilets and Urinals

  • Public toilets and urinals under SBA is mainly to cover floating population and ensure their sanitation needs are met on the go
  • Similar to community toilets, they are to have separate bathing and toilet facilities for men, women and should be disabled friendly

IEC & Public Awareness

A key strategy under SBM (Urban) is behaviour change communication to ensure that sanitation as an issue is mainstreamed with the general public at large and should cover issues of open defecation, prevention of manual scavenging, hygiene practices, proper use and maintenance of toilet facilities (household, community or otherwise), etc., and its related health and environmental consequences

Funding

All components of SBA (urban) are under the responsible guise of ULbs who are provided Viability gap funding from centre on completion or partial completion of projects. The Centre and State both contribute to SBA

Under Swachh Bharat Mission, projects under PPP mode are encouraged, to invite private capital in urban infrastructure as well as to bring in private sector efficiency in delivery of urban services and operation and management.

Report Card of SBA (Urban)

  • Segregation at Source:
    • Initially, SBA focused mainly on scientific processing of waste by using techniques like incineration, pyrolysis, landfill etc. Hence the citizen participation was limited.
    • However, during the past year segregation has improved considerably with enhanced community level participation.
    • Composting can be encouraged at community level to ensure sustainable waste management yielding to produce energy that can be expended for domestic purposes
  • Door-to-Door Collection:
    • Coverage disparity across states with some states achieving 100% door-to-door collection while others still lag behind
    • Face challenges of sanitary workers going on strike due to greater salary demand
    • Integration of Informal Sector: Greater potential of door-to-door collection can be realised by tapping into the informal sector engaged in waste collection. Institutionalising such workers can ensure sustained collection as well as reusability and recyclability of solid waste.
  • Processing of Waste
    • Quantity of Processing less: Large quantities of waste are not processed in several states and are simply dumped in landfills or dumping grounds
  • Funds lie unused
    • Funds appropriated under SBM lie unused in several of the states
  • Generating Energy from Waste
    • Projects to generate energy from solid wastes in several states does not appear to meet intended targets
    • WTE plants may de-incentivize bio-methanisation and composting hence affecting community level decentralized waste management

Way Forward

  • Encourage Citizen Participation: SBA urban should focus on encouraging segregation at source and leveraging community-level participation for a decentralized mode of waste management
  • Improve Waste Processing: Greater proportions of waste needs to be processed using scientific techniques and there should be limited utilisation of land for disposal
  • Institutionalising Informal sector to enhance door-to-door collection
  • Incentivizing Recycling and Composting Industry: Current tax rates on recycling machines and composting equipment can be decreased to incentivize production and consumption. This would ensure greater concurrence with the city compost policy and drive towards realising its target of converting all organic waste into biogas or compost.

Swachch Survekshan Survey, 2017

  • Ranks cities according to level of cleanliness
  • Brought out by Quality Council of India (DIPP + FICCI + CII)
  • Indore tops 2017 list followed by Bhopal and Vizag
  • Parameters: Solid Waste management System, Citizen Feedback , Independent Observation

Swachch Vidyalaya – Ministry of Human Resource Development            

Motto of Clean India: Clean Schools

Drinking Water + Toilets + Hand wash stations

Operation + Maintenance + Capacity Building

Objectives

  • Aims to ensure clean sanitation, water and hygiene facilities in schools
  • Focus on creation of toilets and maintaining cleanliness of toilets in schools
  • Leveraging student support for mobilizing citizens and generating awareness through IEC campaigns
  • Maintenance of school garden and to promote culture of cleanliness among students

Benefits

  • Conducive environment for holistic development of children
  • Reduces girl child dropouts and encourages girl child education
  • Increase retention, attendance and school enrolment
  • Reduces vulnerability of children to diseases due to lack of hygiene and sanitation
  • Improved hygiene is schools also provides impetus to smooth functioning of mid-day meal scheme which has often suffered from low quality and stale food leading to food poisoning among students
  • Hand wash stations also enable germ-free supplement of nutrition