Sumita Kale: Draining good health

With the outbreak of dengue and chikungunya throughout the country, the Minister of Health and Family Welfare had to reiterate the point that these outbreaks are primarily sanitation related, rather than health problems. Currently the spotlight is on two diseases, but these are not the only diseases that spread due to unsanitary living conditions. Last year, more than 1,500 children died in Uttar Pradesh due to encephalitis, carried by mosquitoes from pigs to humans. This year again, the count of affected children is rising in the same areas. With garbage disposal on low priority and animals thriving on garbage dumps, it is little wonder that health is compromised.

And then there are water borne diseases like cholera, diarrhoea, typhoid, polio, roundworm and so on, that result from contamination of water due to lack of proper sewerage or sewage treatment. Just 34.5 per cent of urban households with latrines have closed drainage connectivity for waste water, while 43.4 per cent have open drainage. While the total sewage generation from urban centres in India is around 30 billion litres a day, only 13.5 per cent goes through sewage treatment plants. The remaining 86.5 per cent flows into water bodies or seeps into the groundwater. Given the poorly maintained water distribution systems, with innumerable leaks, unauthorised connections, and intermittent water supply at low pressures, there is ample scope for contaminated water to enter the supply channels. So, when the Economic Survey 2005-06 uses Census data to show that 77.9 per cent of households have access to "safe" drinking water, it is a travesty. The Census of course makes no claim of safety of the water "" the 77.9 per cent figure refers to households sourcing water from taps, handpumps and tubewells.

The WHO Report on Infectious Diseases (2002) brought out the fundamental problem in containing these diseases in developing countries stating that "the key determinants of health "" as well as the solutions "" lie outside the direct control of the health sector" encompassing areas such as sanitation and water supply, education, agriculture, transport, industrial development and housing. The spread of dengue from urban to rural areas has been attributed to private and public construction works, undertaken with no checks and controls from the health angle, creating ample breeding sites for mosquitoes.

The call of the hour remains one of community involvement and education and this route has been taken before to eradicate the Guinea Worm Disease in India. Since the disease has no vaccine or specific treatment, the focus was on sanitation and creating awareness in the affected areas. Co-ordinating efforts in seven endemic states across 12, 840 villages, the campaign was successful in eradicating this disease. While the link between sanitation and health is crystal clear, it still remains blurry for the bureaucracy. In many states, water supply and sanitation come under Public Health Engineering Departments, manned by engineers who are intent more on meeting their own budgetary and operational targets rather than on assessing the quality of provision, leave alone looking at the impact on health. It is crucial to increase awareness within the administration, to make officials realise that by not taking a holistic approach, they themselves are victims of their oversight. Perhaps then everyone can have a healthier life.

The author is chief economist, Indicus Analytics and can be contacted at sumita@indicus.net