[Answered]Poor sanitation is a major reason for poor health of the population in Indian cities. Elaborate. Also suggest some measures to improve the situation.

Safe and clean drinking water and sanitation is a human right as recognised by the UN General Assembly in 2010. It is evident that Indian cities have poor WASH services i.e. Water, Sanitation, and Hygiene. This leads to threat of infections and prevention of disease is severely compromised. An estimated 4 lakh children die of diseases such as cholera, dysentery and suffer from stunted growth as a result of poor sanitation each year. Although substantial gains have been made through Swachh Bharat mission in increasing access to improved sanitation in India, many families still lack these facilities.

Sanitation and health

1. Diseases: Poor sanitation is linked to transmission of diseases such as cholera, diarrhoea, dysentery, hepatitis A, typhoid and polio and exacerbates stunting. Inadequate sanitation is estimated to cause millions of diarrhoeal deaths annually.
2. Socio-economic impact: Poor sanitation reduces human well-being, social and economic development due to impacts such as anxiety, risk of sexual assault, and lost educational opportunities.
3. Malnutrition: Poor sanitation also contributes to malnutrition. Open defecation perpetuates a vicious cycle of disease and poverty. The countries where open defecation is most widespread have the highest number of deaths of children aged under 5 years as well as the highest levels of malnutrition and poverty, and big disparities of wealth.
4. Impact on livelihood: A World Bank study estimates that inadequate sanitation accounts for a loss of $53.8 billion (as estimated for 2006) in India, which includes economic losses recorded from tourism, access time, water use and health related economic impacts. This push many into poverty that lead to poor nutrition and a risk to health further. Also it prevents them to access health services.
5. Demographic dividend: India is going through the phase of demographic dividend. Demographic dividend depends on keeping our population healthy, and sanitation is an important aspect of the same.

Reasons of India’s failure at sanitation:

1. Not enough focus on Urban areas: With respect to urban and rural areas there are different types of problem. Most of the schemes focused only on rural area despite knowing that open defecation is not only rural phenomenon, considering India contributes to 46% of global open defecation in urban areas.
2. Population rise: Population increase, rising incomes, and industrial growth are also responsible for poor sanitation.With the rise in migration towards urban cities, it became difficult to manage household wastes especially from urban slums. Population residing in urban areas in India, according to 2011 census, was at 31.16%. In 2017, the numbers increased to 34%, according to The World Bank.
3. Lack of Effective and efficient monitoring: There is no effective monitoring of municipal bodies and their funds. Municipalities have become new temple of corruption, where allocated funds are not properly used.
4. Top-down approach: The mistake of the programmes adopted thus far has been the lack of local involvement. This has led to a variety of issues like slow implementation, misplaced priorities of local government and complete dissatisfaction of the communities.
5. Poor Urban governance: A major factor for growth of slums and poor sanitation is use of rigid, often outdated urban planning regulations, which are typically bypassed by slum dwellers to meet their housing needs. Further, only 30% of the generated wastewater and generated sewage gets treated before being let into rivers and streams due to lack of proper planning.

Some government initiatives:

1. Swachh Bharat Abhiyan: Swachh Bharat Abhiyan (SBA) is a campaign in India by the government of India. It aims to clean up the streets, roads and infrastructure of India’s cities, smaller towns, and rural areas.
2. Swachhata Pakhwada: Swachhata Pakhwada aim to engage all Union Ministries and Departments in Swachhata-related activities. An annual calendar is pre-circulated among the Ministries to help them plan for the Pakhwada activities.
3. Namami Gange: The Namami Gange Programme is an initiative of Ministry of Water Resources (MOWR). As an inter-ministerial initiative, making villages on the bank of river Ganga ODF and interventions dealing with solid and liquid waste management (SLWM) is undertaken.
4. GOBARdhan scheme: The Galvanising Organic Bio-Agro Resource dhan or “GOBARdhan” scheme scheme is aimed at keeping villages clean while increasing the income of farmers and cattle owners by promoting local entrepreneurs to convert cattle dung, and other organic resources, to biogas and organic manure.

Some measures to improve the situation:

1. Civil society participation: Sanitation Policies and Programs should facilitate the participation of civil society (including women) in the design, implementation and monitoring of local priorities in rural and urban areas.
   2. Effective monitoring: Strengthening of institutions, efficient monitoring and evaluation for improved accountability and implementation is needed.
2. Behavioural Change and culture of cleanliness: Authorities should work towards developing a culture of cleanliness and safety in all places. A behaviour change must be instilled among community towards WASH and its benefits.
3. Conduct situation analysis and assessment– An analysis to examine policies, governance structures, and funding is needed. An assessment is necessary for updated figures on WASH coverage and compliance in health facilities. Together, these documents form the basis for prioritising policies and mobilising resources.
4. Improve and maintain infrastructure-Health facilities’ infrastructure should be improved to meet national standards. It should be accompanied by various policies inputs. It is important to treat waste before they enter the river.

Sanitation is intrinsically linked to health. Poor sanitation systems are among the leading causes of the spread of preventable diseases in developing nations. Access to safe drinking water and basic sanitation facilities are not only central to health and sustainable development, they are central to eradication of poverty as well. It is thus important to formulate and implement concrete plans to improve sanitation facilities in urban centre