Unsafe Sanitation Is A Driver Of Enormous Public Health Costs: National Faecal Sludge And Septage Management Alliance

The National Faecal Sludge and Septage Management (NFSSM) Alliance, brought together leading practitioners, health experts and researchers to emphasize on the ‘State of Knowledge: Public Health and Sanitation’ through a webinar. The panel discussion highlighted the importance of integrating public health approaches when working towards inclusive and safe sanitation discourse in the country. The course of the discussion was guided by senior practitioners of the NFSSM Alliance and other leaders as panelists - Madhu Krishna, Deputy Director, Bill & Melinda Gates Foundation, India; Dr Anuradha Jain, Advisor, Health Systems Strengthening, USAID; Akhila Sivadas, Executive Director, Center for Advocacy and Research; Neeraj Jain, Country Director, PATH, India; and Dr M.R. Seetharam, Consultant Orthopedic Surgeon, Vivekananda Memorial Hospital. 

Moderated by senior sanitation practitioners and NFSSM Alliance members, Depinder Kapur, Senior Fellow, Shiv Nadar University; Sanjeev Jha, Project Leader, India Sanitation Coalition and Shubhagato Dasgupta, Senior Fellow, Center for Policy Research, the panel discussion brought these insights to the forefront:

* Health and WASH – 90% of all deaths from diarrhoea, mainly in children, are caused due to lack of access to safe, clean drinking-water and basic sanitation facilities – further influencing child mortality and morbidity. It was recently also identified as a major factor contributing to child stunting. Although measurable impact of safe sanitation on health is influenced by various factors such as environment, the child's innate immunity, etc. the counterfactual remains to be strong that untreated human waste is linked to pathogens which further leads to bad health.

The session also pointed out certain positive aspects in relation to WASH and health wherein with the onset of the COVID-19 pandemic, community members have started to understand the importance of hygiene and water quality and are willing to seek help and care.

* Lack of WASH infrastructure monitoring in healthcare - WASH in Healthcare Facilities refers to the provision of water, sanitation, health care waste management, hygiene and environmental cleaning infrastructure, and services across all parts of a facility. The state or district wise comparable data on WASH in Healthcare Facilities are required to monitor the core indicators for “basic” WASH service, and these are currently scarce. There is evidence that mentions reduction in water borne diseases by adopting appropriate WASH practices. However, different variables exist that impact the rate of diarrhea and water borne diseases and direct correlation isn’t always possible.

* Increased Public Health Costs: Apart from high mortality rates due to spread of diseases, poor sanitation also incurs high public health costs. During the pandemic, not having effective WASH systems have had an enormous impact on the economy where urban slums have borne the costs. The discussions during the webinar highlighted that WASH in healthcare facilities is an essential factor to the successful implementation of Swachh Bharat Mission 2.0 in India as well as the newly launched Pradhanmatri Atmanirbhar Swasth Bharat Yojana 2021.

Speaking at the event, Madhu Krishna, Deputy Director, Bill and Melinda Gates Foundation, India said, “We have invested extensively in sanitation and will continue to do so. It is evident that untreated human waste has adverse impact on our health and safe sanitation is required to prevent a host of communicable diseases. Looking at it from the gender lens, service delivery impacts women and girls more. Therefore, we need to take an inclusive approach. 90% of the frontline workers are women, yet sanitation facilities are not ensured for them. Providing universal safe sustainable sanitation is like a vaccination and the need for it is growing in urban areas now.”

Neeraj Jain, Country Director, PATH, India said, “We need to look at preventive and curative measures, where preventive is appropriate WASH practices and curative is access to health services. Additionally, environment hygiene is important. Diseases spread due to bad hygiene and environment. We are a large country where scalable solutions are critical for a success of a public health program. Today we are witnessing large-scale funding in healthcare, and we need to align WASH under health priorities of the country.”

There have been many efforts at the community level to create ‘shadow change agents’ and ‘FSM Champions’ through various engagement and incentive-based interventions to ensure power is handed back to the community to enforce WSH mandates and maintain allied infrastructure.

Akhila Sivadas, Executive Director, Center for Advocacy and Research said, “the groundswell from communities, their own compulsion, their own involvement and participation is absolutely necessary to drive the agenda of health outcomes. Convergence requires a certain amount of rethinking and recalibrating; norms of engagement must be changed. The system itself is not a catalyst of change, there needs to be a certain upsurge to foster change.”

The panelist concluded that opportunities for convergence in the Sanitation and Health Sector at various levels were a combination of a broad spectrum of efforts ranging from focusing on the emphasis and scaling of sanitation and nutrition under health mandates to attract greater institution and funder goodwill. This means, including sanitation under health curriculum being taught in educational institutions, focusing on functionally appropriate water and sanitation infrastructure in hospitals and health centers and engaging communities for demanding convergence and change. Most importantly the panel emphasized the importance of providing support to various government departments at the central, state, and local level to ensure greater coordination for programmatic intervention as part of the Family, Health, Nutrition and Welfare initiatives thus ensuring joint outcomes and accountability. 

About NFSSM Alliance

The National Faecal Sludge and Septage Management (NFSSM) Alliance was established with support from the Bill and Melinda Gates Foundation in 2016 to support safe sanitation at the national, state and city level. The Alliance is recognized as the collaborative body that drives the discourse of faecal sludge and septage management (FSSM) forward in India. The NFSSM Alliance in collaboration with the Ministry of Housing and Urban Affairs (MoHUA) and the Department of Drinking Water and Sanitation (DWS) has been instrumental in the passage of India’s first national policy on FSSM in 2017.