Health and Sanitation: Pillars of a Healthy India

Syllabus: GS2/Health

Context

• On World Health Day (7 April), India showcases a transformative approach, recognizing that health and sanitation are inseparable, with a nationwide revolution in sanitation and water access shaping a healthier future.

Health & Sanitation as a Foundation for Progress  

• Health is not just the absence of disease, but a state of complete physical, mental, and social well-being.
  • Sanitation, often considered its silent twin, plays a preventive role in ensuring community health.
• According to WHO, over 60% of diseases in India are linked to poor sanitation and unsafe water.
  • Diarrheal diseases, malnutrition, and parasitic infections are rampant among children, directly affecting literacy, productivity, and life expectancy.
• Universal access to healthcare is essential for reducing disease burden and improving life expectancy.

Health and Sanitation: Progress & Suggestions (NITI Aayog and NFHS-6 Projections)

• Life Expectancy: Increased to 70.1 years (2024).
• Swachh Bharat Mission (SBM): It aims to build over 100 million toilets, leading to open defecation-free (ODF) status in all rural districts.
  • SBM Gramin Phase-II (2020–2025): Emphasis on ODF Plus villages and solid and liquid waste management. According to the SBM Dashboard, over 6 lakh villages have been declared ODF.
  • SBM 2.0 (Urban): Zero landfill cities, biogas plants from waste.
  • SDG 6.2: India has declared itself Open Defecation Free (ODF) in 2019, 11 years ahead of time.
    • It focuses on achieving access to adequate and equitable sanitation and hygiene for all by 2030.
• Gates Foundation reported in 2017 that there were 58% higher cases of wasting among children in non ODF areas. 
• A UNICEF study (2017) found that 93% of women felt safer after getting a toilet at home and ODF families saved ₹50,000 annually in health-care costs, ensuring higher savings.
• National Health Mission (NHM): It includes the Rural and Urban Health Missions, focuses on accessible, affordable, and quality healthcare, especially for vulnerable groups. Between 2005–2022, it led to:
  • A reduction in infant mortality rate (IMR) from 58 (2005) to 28 (2020).
  • Institutional deliveries increased from 39% to 89%, as per NFHS-5.
• Jal Jeevan Mission: Drinking water quality & hygiene education.
  • It targets 100% coverage by 2025.
  • WHO estimates suggest that it could avert four lakh diarrhoeal deaths with safe drinking water supply at home.
  • Research by Nobel Laureate Dr. Michael Kremer has shown that nearly 30% infant deaths can be reduced if safe water is made available to families for drinking and 1.36 lakh child deaths (under five years) can be prevented with universal tap coverage. 
• Atal Mission for Rejuvenation and Urban Transformation (AMRUT 2.0): City sanitation mapping & smart sewage tracking
• Role of Self Help Groups (SHGs): Over 2.48 million women have been trained to test water quality, and women-led Self-Help Groups are managing sanitation assets, recycling centres, and even sanitary napkin production.

Concerns and Persistent Gaps

• Inequitable Access: According to NFHS-5:
  • Only 70% of rural households have access to improved sanitation facilities.
  • States like Bihar, Jharkhand, and Odisha continue to lag in access to clean water and maternal healthcare.
• High Out-of-Pocket Expenditure (OOPE): Even after PM-JAY, OOPE accounts for over 50% of total health expenditure, often due to medicines and diagnostics being excluded from coverage.
• Malnutrition and Stunting: As per NFHS-5:
  • 35.5% of children under 5 are stunted.
  • 19.3% are wasted, with worse conditions in tribal belts and rural areas.
• Urban Sanitation Challenges: A NITI Aayog report notes that while rural sanitation improved significantly, slum areas in metro cities face poor sewerage and garbage collection infrastructure.
• Urban Slums: Densely populated informal settlements suffer from inadequate toilets, waste disposal systems, and clean water access.
• Behavioral Change: Infrastructure must be coupled with community-led education to eliminate age-old taboos and misinformation.
• Gendered Sanitation: Lack of clean and safe toilets in schools and workplaces disproportionately affects women and girls, leading to dropout and reduced mobility.
• Other Challenges:
  • Slippage: Nearly 8% of rural toilets are non-functional or unused due to water shortages
  • Manual scavenging: Still reported in some urban clusters, despite the 2013 Prohibition Act.
  • Waste treatment: Only 39% of cities have operational faecal sludge treatment units
  • Behavioral change: A key hurdle, especially in peri-urban belts.

Way Forward: Road Map for the Future

• Sustained Civic Participation: Local governance and community ownership are crucial for the upkeep of sanitation facilities.
• Public-Private Partnerships: Collaboration with NGOs, corporates (under CSR), and tech startups can scale innovation in water filtration, waste recycling, and health monitoring.
• Integrated Health-Sanitation Education: School curriculums must emphasize hygiene practices alongside biology, linking textbook knowledge with real-life relevance.
• Climate-Resilient Sanitation Infrastructure: With increasing climate risks, sanitation facilities must be flood-resistant and sustainable.
• Urban Sanitation Master Plans: Modernize drainage, build STPs, and enhance slum services
• Boost Preventive Healthcare: School health programs, menstrual hygiene initiatives, and vaccine awareness.

Source: TH