When former Environment Minister Jairam Ramesh complained, with characteristic pithiness, that there were “more temples than toilets” in India, he sparked a political storm with Hindu nationalists. But he also put his finger on one of the country’s most stubborn problems. Decent sanitation is far from a given: only 14% of the rural population have access to a latrine, and diarrhoea kills 1,600 people a day, mainly children.
“This is not just a public health problem”, says Chandrashekhar Dasgupta, Distinguished Fellow at TERI. “It’s a human rights issue.” Public education programmes can help, but they stand more of a chance of making a difference if there are public toilets too. Dasgupta points to the success of the Sulabh composting toilet, which captures and processes the waste so it can be reused as a fertiliser. Over 7,000 installations are in place around the country: typically men pay half a rupee, while women and children go free. Persuading people to pay has been less of an issue than some predicted, says Dasgupta: “I think it’s not simply a question of convenience but of dignity. People are prepared to pay for dignity.”
Clean water, too, is far from a given in India: over half the population lack access to it. This leaves them vulnerable to diseases such as dysentery, cholera and typhoid. Which means that effective, affordable water purification is a vital step in improving the health of hundreds of millions of Indians. The Pureit device, produced by Unilever, provides “as safe as boiled” water at a cost of around 26 paisa (about a quarter of a rupee) per litre. It does so through an innovative combination of a microfibre mesh, carbon trap and programmed chlorine release to kill germs and bacteria and clean water to international drinking quality standards.The water then goes through a ‘polisher’ to remove chlorine traces and and other odours.
A study by the National Institute of Epidemiology in the slums of Chennai showed that households with a Pureit had 50% less incidence of diarrhoea than ones without. Around 30 million people have gained access to safe drinking water by using Pureit since 2005.
Meanwhile, Unilever is extending its programme to encourage hand-washing, while simultaneously marketing its Lifebuoy products range. Health workers travel round schools staging demonstrations using a powder called ‘glo-germ’. It works like this. The children wash their hands with water alone, and then the powder is sprinkled on their palms. The health worker shines an ultraviolet (UV) light, and the hands ‘glow’ where traces of dirt remain. Then they repeat the process with the soap, and the UV test comes up clear. It has proved a persuasive tool for people who had assumed that no visible dirt means no germs.
Make it easy, make it desirable, make it a habit
The scheme focuses particularly on children on the basis that they will ‘infect’ their families with good practice. It uses a range of tried and tested behavioural techniques (‘make it easy, make it desirable, make it a habit’) to help hand-washing become second nature, and so far the evidence suggests it does indeed take hold. Follow-up studies show that pursuing good hand hygiene practices can result in 25% fewer cases of diarrhoea and 46% fewer eye infections, compared with a control group. And children who do so miss over 25% fewer days from school due to illness.
The initiative has its distant roots in the early days of Lifebuoy in the 19th century, when William Lever, one of the company’s founders, launched it as a means of eradicating cholera from the slums of British cities. During 2010-2011, a new rural outreach programme known as ‘Khushiyon Ki Doli’ (‘Caravan of Happiness’), took hand-washing messages to remote areas, reaching around 30 million people. – Martin Wright