Diarrhoea a major killer in South Asia
Diarrhoea continues to claim maximum deaths in South Asia but has often been relegated to the background at the highest policy level. The recently concluded South Asian Conference on Sanitation noted that observing hand-washing and eliminating open defecation can reduce the numbers sharply.
Nearly one million children died from preventable diarrhoeal diseases in South Asia since the last conference of South Asian Ministers held in Islamabad in 2006.
This was revealed during the third South Asian Conference on Sanitation (SACOSAN III) held in New Delhi from November 18-21, 2008. The conference reviewed progress and made commitment through Heads of Delegations from Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka.
For this they adopted The Delhi Declaration, which confirmed their commitment for achieving National and the Millennium Development Goals (MDGs) on sanitation in a time-bound manner.
Inaugurating the event, Indian Prime Minister Manmohan Singh said, “We should look upon human waste as a resource to be recycled and reused so that it does not contaminate our land or water. This is a particular challenge in our fast urbanising habitats,” he added.
Universal access targets have been set in the region yet governments are still failing to act with the urgency required. At current rates of progress, the 2015 MDG targets for sanitation will not be met in South Asia until 2043-28, years too late.
The report of the WHO Commission on Social Determinants of Health (2008) emphasises that access to clean water and sanitation should be considered as part of human rights.
Strong advocates needed
Kumar Alok, Project Officer, Water and Sanitation at UNICEF, New Delhi, pointed out that human excreta is considered the principal vehicle of communicable diseases such as diarrhoea, which is one of the main causes of death among infants and children.
A gram of faeces can contain 10 million viruses, one million bacteria etc. and small faecal particles can contaminate water or food, causing nearly 1000 daily diarrhoeal deaths among children, of which 87 die before their fifth birthday in India.
He says that the disease is much more common than SARS, bird flu or any other epidemic and yet the issue has failed to find strong advocates. According to surveys, it was observed that hand-washing before taking meals and after defecating can bring down these numbers by as much as 47%.
Ajit Kumar, Water and Sanitation specialist, from World Bank South Asia, said that improvements in sanitation have already reduced diarrhoea by 30-40 percent in India. He said that the issue was not just about money but related to inducing behavior change.
Just 15% of the rural population has access to a toilet which means that 21 million people need to gain access to basic sanitation facilities every year if the MDG targets - halving the proportion of people without sanitation - are to be met.
With people still being largely unaware of the link between sanitation, hygiene and health and simple practices like handwashing not being followed, diarrhoea continues to claim more deaths than any other disease or medical ailment.
The International Year of Sanitation (2008) placed a spotlight on this critical development issue, which is vital for health and social development, often neglected or relegated to the background at the highest policy level.
Sanitation beyond toilets
Discussions on one of the main themes of the conference -‘Sanitation beyond Toilets’, it was revealed that South Asia has the highest rate of open defecation in the world at 48%, which is double that of sub-Saharan Africa. Around 1.2 billion people worldwide defecate in the open, of which more than 50% (665 million) reside in India.
Kumar Alok pointed out that nearly, 200,000 metric tones of human excreta are released in open spaces-using fields, roads, railway tracks, under construction buildings etc. in the country.
Vijay Mittal from India’s Ministry of Rural Development while describing challenges and achievements said that sanitation coverage in rural India in 1981 was only one percent and has now reached 57 percent (according to estimates of 2008).
He also admitted that primary reason for high infant mortality rate was due to diarrhoea. Nabaroon Bhattacharjee from World Bank South Asia, emphasised that SACOSAN III provided a good opportunity to mainstream sanitation and show the path towards scaling up interventions.
A citizen’s report on domestic water and sanitation prepared by Water Aid, a UK based NGO was presented at the conference. The report revealed that India has spent more than 27,625 millions in the last 60 years for making rural water and sanitation accessible but on the other hand, 37.7 million Indians are estimated to die of diarrhoea alone and 73 million working days are lost due to waterborne disease each year.
Water Aid urged the South Asian countries should address the sanitation crises by meeting previous SACOSAN commitments, especially to improve monitoring sector and related health outcomes.
The sanitation coverage received a boost after the government introduced the Nirmal Gram Puruskar Award in 2003 for clean village, given to Panchayati Raj Institutions for eliminating open defecation including 100% sanitation coverage.
Total sanitation mission was launched way back in 1999. The goals of Total sanitation campaign ranged from achievement of the sanitation related Millennium Development Goals by 2010 to full sanitation coverage (Nirmal Bharat) by 2012.
The PM said, “We have worked hard to correct the neglect of the past fifty years in this area. In the past five years, the government has increased investment in rural sanitation by as much as six times. This initiative for villages was aimed to realise the vision of Mahatma Gandhi, who had asserted that “cleanliness was even more important than freedom”. Remembering this dream of “total sanitation for all”, he urged the South Asian countries to assure a life of dignity and good health to all citizens.
