Indian Journal of Public Health

: 2011  |  Volume : 55  |  Issue : 1  |  Page : 49--51

Sanitation: The hygienic means of promoting health

Madhumita Dobe1, AK Sur2, BB Biswas3,  
1 Director-Professor and Head, Dept. of Health Education, All India Institute of Hygiene and Public Health, Kolkata, India
2 Principal and Additional Director, Indian Institute for Health Traning, Kolkata, India
3 Faculty Member, Indian Institute for Health Traning, Kolkata, India

Correspondence Address:
Madhumita Dobe
Director-Professor and Head, Department of Health Education, All India Institute of Hygiene and Public Health, Kolkata, and Secretary General, Indian Public Health Association

How to cite this article:
Dobe M, Sur A K, Biswas B B. Sanitation: The hygienic means of promoting health.Indian J Public Health 2011;55:49-51

How to cite this URL:
Dobe M, Sur A K, Biswas B B. Sanitation: The hygienic means of promoting health. Indian J Public Health [serial online] 2011 [cited 2021 Jan 15 ];55:49-51
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Full Text

Sanitation is the hygienic means of promoting health through prevention of human contact with the hazards of wastes, which carry physical, microbiological, biological or chemical agents of disease. Wastes that can cause health problems are human and animal feces, solid wastes, domestic wastewater (sewage, sullage, greywater), industrial wastes, and agricultural wastes. Hygienic means of prevention can be by using engineering solutions (e.g., sewerage and wastewater treatment), simple technologies (e.g., latrines, septic tanks), or even by personal hygiene practices (e.g., simple hand-washing with soap). Sanitation as defined by the World Health Organization refers to the provision of facilities and services for the safe disposal of human urine and feces. Inadequate sanitation is a major cause of disease worldwide and improving sanitation is known to have a significant beneficial impact on health, both in households and across communities. [1]

The earliest evidence of urban sanitation was seen in Harappa, Mohenjo-daro and the recently discovered Rakhigarhi of the Indus Valley civilization. This urban plan included the world's first urban sanitation system. Within the city, individual homes or groups of homes obtained water from wells. From a room that appears to have been set aside for bathing, waste water was directed to covered drains, which lined the major streets.

However, unsanitary conditions were widespread throughout Asia during the Middle Ages, resulting periodically in cataclysmic pandemics such as Plague in AD 542 in Egypt and Ethiopia and Black Death (1347 1351 AD), which killed tens of millions of people across Europe, Central Asia, India, and China. [2] One hundred million people in India died from plague over a period of 20 years.

Although there have been great advancements in this area, yet, only 62% of the world's population had access to improved sanitation in 2008, up 8% since 1990. [1] Only slightly more than half of them or 31% of the world population live in houses connected to a sewer. Overall, 2.5 billion people lack access to improved sanitation and thus must resort to open defecation or other unsanitary forms of defecation, such as open pit latrines. [1] This includes 1.2 billion people who have access to no facilities at all. [1] This presents substantial public health risks as the waste could contaminate drinking water and cause life-threatening forms of diarrhea to infants. Improved sanitation, including hand washing and water purification, could save the lives of 1.5 million children, who suffer from diarrheal diseases each year. [1]

Despite significant investments over the last 20 years, India still faces the most daunting sanitation challenge than any other country in South Asia. According to an estimate, India stands second among the worst places in the world for sanitation after China. [3] Millions of Indians currently lack access to adequate sanitation and are forced to dispose of their excreta in unimproved and unsanitary conditions. Those who suffer from the lack of this most basic human need, also tend to be victims of poverty, ill health, and an overall poor quality of life. There is compelling evidence that sanitation brings the greatest public health returns on investment among all development interventions. Government figures claim that India is all set to achieve MDG 7 target 10, which aims to halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation, but even if the MDG targets are met, a huge absolute number of India's population will still remain uncovered, and that would still count more than 500 million people!

The official coverage for rural sanitation is 26% and for urban, 83.2%, as per NFHS 3 data. The overall sanitation coverage as recently announced by the government is 48%. These figures are those of infrastructure and do not provide us information about the access and use of latrines by individuals \ families. Independent assessments of latrine-use show a much lower coverage. Moreover, rapid urbanization is putting a strain on an already stressed urban sanitation systems in India. Slums are very rarely connected to the cities' sanitation infrastructure and the sanitation situation is deplorable. It is increasingly recognized that health risks in urban areas are often greater than in dispersed rural areas. With the sheer concentration of population in towns, coupled with poor drainage and the impact of poor sewerage affecting safe drinking water − urban sanitation is emerging as a major challenge for India, whereas, usage and not coverage is a challenge in rural areas.

The Total Sanitation Campaign in India was part of the Sector Reforms Project introduced in April 1999, to make rural water supply and sanitation more sustainable. Limitations on its success arose from the absence of guidance and training opportunities and from a lack of appropriate expertise in gender and poverty-sensitive promotion and participation strategies. Deficiencies were also seen in allocation of funds and monitoring implementation. The Nirmal Gram Puraskar Yojana, a central government scheme for rewards and incentives and recognition from the President of India, was subsequently introduced in 2007, to increase sanitation coverage in rural areas. [4]

Physical constraints (non-availability of water for assured flushing), resistance to adopt and use toilets - where these are cultural barriers, and corruption in toilet construction with subsidies, are some of the major barriers in sanitation coverage and usage improvement in rural areas. The promotion of hygiene and sanitation behavior change is needed in place of an infrastructure-driven toilet coverage promotion in rural areas. [1]

For urban areas, more public toilets in commercial areas and integrated community managed infrastructure (bathing and washing complexes plus toilets) are needed on a very large scale. Sanitation in urban areas has not been given due priority as a developmental intervention by the government. Public toilets are viewed as profitable sub-contracted works and are being increasingly contracted out resulting in both unaffordable and badly maintained infrastructure for the urban poor. Community owned and managed infrastructure with subsidized electricity and free water is needed for urban slums.

The absence of supportive policies to provide the basis for planning and implementing sanitation programs is a missing link to improving coverage on a large scale. National level sanitation policy frameworks, within which national, state, and municipal government agencies, and the private and non-profit sectors operate, have not been adequate. The government budget spending on sanitation and specially sanitation services to the poor has not increased at the desired pace. These are the key constraints to improving sanitation coverage and the program quality.

We need good sanitation policies to help create and enable an environment that encourages access to and use of sustainable sanitation services, as also for the replication and scaling-up of successful pilot programs. We also need to implement these policies through four types of policy instruments:

Laws to provide the overall framework and regulations − rules or governmental orders to provide detailed guidance. Regulations for sanitation cover a wide range of topics, including the practices of service providers, design standards, tariffs, discharge standards, environmental protection, and so on. These regulations, especially the design and discharge standards, should be carefully adapted to local conditions.

Economic measure: These include user charges or tariffs, which households and enterprises pay in exchange for the removal of human excreta and wastewater, subsidies or allocations in cash or kind to communities and households for establishing the recommended types of sanitation facilities or services and fines or monetary charges imposed on enterprises and people for unsafe disposal, emissions and / or risky hygiene behaviors and practices, which are a danger to the people and environment.

Information and education programs: These programs include public awareness campaigns and educational programs designed to generate demand and public support for efforts to expand sanitation services and improve usage.

Assignment of rights and responsibilities for providing services: The roles of national agencies and appropriate roles of the public, private, and non-profit sectors in program development, implementation, and service delivery should be defined, to promote responsibility and improve accountability.

Each of these elements, if well-addressed in the policies, will promote behavior change and help define an enabling environment for sanitation improvement.


1Available from: http;// [Last accessed on 2010 Dec 14].
2Carlo M. Cipolla. Before the Industrial Revolution: European Society and Economy 1000-1700. London: W.W. Norton and Company; 1980.
3'Beyond Subsidies - Triggering a Revolution in Rural Sanitation' Institute of Development Studies (IDS) In Focus Policy Brief 10 July 2009.
4Department of Drinking Water and Sanitation, Ministry of Rural Development, Govt. of India, Nirmal Gram Puraskar, accessed from ngp1.htm, on 21/11/2009.