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Health Sector In India

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

Read Also Anti Defection Law in india


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

Health Sector In India– Part 1    Part 2  Part 3 

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