India, along with 11 member-countries of the World Health Organisation’s South-East Asia region, has made concerted efforts to provide water and sanitation infrastructure and services to everyone, everywhere. It is expanding infrastructure like safe water points and designated latrines and services like sewage treatment and safe wastewater disposal.
Region-wide, the effort is paying off.
In India, for example, inadequate water, sanitation and hygiene once had a dramatic effect on its disease burden. In 1990, at the start of the Millennium Development Goal era, poor sanitation was the second-largest cause of disease in the country. Thanks to a range of long-term initiatives that have since been intensified, water and sanitation are now the seventh-largest cause of disease, accounting for around 5% of the country’s disease burden. That is a substantial achievement — one that indicates the life-changing potential further progress holds.
The numbers are instructive. By 2015, 88% of the country’s citizens had access to improved drinking water and 44% had access to improved sanitation. The ‘Swachh Bharat Abhiyan’ (Clean India Campaign) introduced the same year has since then increased that proportion substantially, and will continue to do so as the mission moves towards its goal to end open-defection and ensure every citizen has access to latrines by 2019.
But as elsewhere in the South East Asian region, despite progress, insufficient water and sanitation-related infrastructure remains a significant cause of life-threatening diseases.
Diseases responsible for severe and often fatal diarrhoea. Diseases that impose malnutrition and stunting on millions of children and adolescents. Diseases that are both chronic and acute, and, which can cause liver failure, urinary tract infection and blindness. Diseases such as cholera and helminth (worm) infections, hepatitis, schistosomiasis and trachoma. Each one of these and more can be prevented by enhancing access to safe water and sanitation for all.
Making that happen means, first and foremost, focusing on equity — on ensuring resources are focused where the burden of water and sanitation-related disease is the highest. To do that, health data must be utilised effectively to plan water and sanitation interventions. In India, that means ensuring ministries of health and drinking water and sanitation work hand-in-hand to find targeted solutions.
That is especially the case in the nine states where the burden of water and sanitation-related disease is most significant.
Notably, despite substantial region-wide investment in constructing basic water and sanitation-related infrastructure, it is equally important that the water supplied is at all times safe, and that associated infrastructure is utilised and adequately maintained. That requires the enforcement of water quality regulations, ongoing behavioural change campaigns, as well as permanent vigilance to ensure facilities are safe and serviceable.
Safe disposal of sewage and wastewater is likewise crucial. Inadequate treatment of sewage and wastewater not only leads to contamination of natural water sources by faecal matter and chemical contaminants, but also contributes to antimicrobial resistance — one of the 21st century’s greatest threat to public health and health security.
To help mitigate these threats and accelerate access to safely managed water and sanitation for everyone everywhere – as per Sustainable Development Goal 6 – WHO guidelines for safe water and sanitation planning should be fully embraced. It includes conducting regular risk assessments and managing all risks effectively from catchment to consumer. It also means carrying out regular –- and ongoing -– water quality surveillance among other core monitoring activities.
Across the South-East Asian region, WHO is committed to accelerating the progress already made in advancing access to safe water and sanitation. India, too, is committed to that goal. To that end, WHO will continue to support India until all people everywhere have the water and sanitation needed to stay healthy.
(The writer is the regional director for World Health Organisation South-East Asia)
