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Lack of hygiene is affecting the poorest: UNICEF’s Osbert

Sep 18, 2017

When we talk about sanitation, behaviour change is a complex issue, particularly in India, believes UNICEF India's Chief of WASH, Nicolas Osbert.

Nicolas Osbert, Chief of WASH, UNICEF India

New Delhi: UNICEF India's Chief of WASH, Nicolas Osbert shares a key message on the issue of Sanitation and Hygiene at a media round table. The full text of his message is as follows:

The evidence that we have on the impact due to a lack of proper sanitation and hygiene, and how until just three years ago, India used to pay a huge price because of poor sanitation. At the early stage of the SBM, in 2015, we estimate that there was around half a billion people defecating in the open.

Lack of hygiene and sanitation contributes to spreading fecally transmitted infections; this is not only diarrhoea, it is also worms, helminths, and other intestinal parasites. This is mainly due to widespread open defecation practice. This lack of hygiene and sanitation, particularly affects the poorest communities, and the most vulnerable children.

So, what really are the consequences:

It is estimated that in 2015, 117,000 under five children died of diarrhoea alone (WHO – 2015); this is more than 13 children per hour; this is 22% of the global burden with regard to under 5 mortality due to diarrhoea. Repeated FTIs damage the capacity of young children to absorb nutrients, for its entire life; because of this nutrition issue, children become stunted, this means that their body and brain do not develop normally. In India, 39% of children are stunted.

There are many other issues due to poor hygiene and sanitation. For instance, as a consequence of weak infection prevention and control in health care facilities, sepsis (common healthcare-acquired infection) is directly responsible for 11% of maternal and 15% of new-born mortality deaths in India

With regard to economic development, India is paying a heavy price because of these preventable water-borne diseases: a study from the World Bank published in 2008 shows that the total economic impacts of inadequate sanitation in India was amounting to US$53.8 billion per year, equivalent of 6.4 percent of India’s GDP at the same period.

And having seen how poor sanitation can affect the health and lives of children and communities, my next message is about how a movement around sanitation and hygiene, in the country has been able to catalyse and mobilize the efforts of millions of citizens. The SBM, is a once-in-a generation opportunity

In UNICEF, having at heart the well being of children, we advocate relentlessly in many countries of the world to obtain a slightly increased prioritization of the issue of open defecation in the agenda of governments.

In India, the leadership comes from the Prime Minister. The SBM has been able to create a ‘once-in-a-generation’ movement with the alignment of public sector interest, public budgets, and social awareness behind the formerly intractable problem of open defecation.

UNICEF has a permanent mission in 15 of the most populated states of India, and we see the SBM happening concretely on the ground. Some key highlights I would like to share are as follows:

Beyond the hundreds of thousands of toilets being built, a genuine prioritization of behavior change interventions is taking place. With the support of UNICEF and other partners, Sanitation armies are being created in the field and their capacities for community mobilization are being built. This is a crucial shift form the hardware engineering to the social engineering to tackle the issue of open defecation, and we must make sure that this reacheds every corner of the country.

Behaviour change is a complex issue, particularly in India where open defecation is a deeply rooted habit for many households. Hence, this requires the mobilisation of the entire Indian Society, including the government, civil society, the private sector, the religious leaders, and the media who also have a critical role to play, to pass the message: use a toilet, WASH your hand with soap, to put pressure on performances and sustainable achievements, and also to shed the light on the unknown heroes on the ground who create Open Defecation Free villages, blocks and districts.

Another key differentiator is the focus on verification and sustainability. The government has instituted a multi-tier bottom-up verification system, with the support of UNICEF and other partners. They are also carrying out national third party surveys, household surveys to ensure that States are on their toes.

To date, Nearly 239,000 villages and 196 districts reported to be Open Defecation Free. This is an outstanding achievement. And the work does not end there. Government’s guidelines specifies that surveillance must continue after the verification of the ODF status to ensure sustainability. UNICEF will continue to focus its support on this specific issue to help sustain the new social norm of using a toilet for defecation.

Findings from the costs and benefits Study of the SBM(G):

UNICEF just recently finalized an independent survey, across 10,000 rural households randomly selected in 12 states, to estimate the costs and benefits of the SBM(G). This study showed that:

- 85% of the household members use their latrine to defecate

- In a fully Open Defecation Free community, considering medical costs averted, the value of time savings, and the value of mortality averted, the financial saving for each household is 50,000 Rs per year.

- In terms of cost benefit ratio, considering in one hand the expenditures from the households and from the government, and in the other hand the financial savings induced by improved sanitation, the study found a cost-benefit ratio of 430% on average, this means that 1 Rs invested allows a saving of 4.3 Rs.

- The benefits are highest for the poorest quintile of the population.

Hence these are very encouraging result just 3 years down the line of the implementation of the SBM.

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