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Improving the infrastructure, services and operation & maintenance of public and community toilets remains one of the weakest links in the hygiene chain. Photo: Priyanka Parashar/Mint
Improving the infrastructure, services and operation & maintenance of public and community toilets remains one of the weakest links in the hygiene chain. Photo: Priyanka Parashar/Mint

Opinion | 21st year of 21st century India: Prioritizing Sanitation & Hygiene

  • Improved sanitation and hygiene, which have been the primary weapons to fight covid-19, need further strengthening so that we remain resilient in the emerging uncertain world

The news about vaccines brings a sense of relief, and assuming all goes well, life could revert to ‘normalcy’ by mid-end of 2021. Covid-19 has brought renewed focus on human health within sustainability and global development agenda, which so far appeared to have focused largely on the environment, pollution, climate change, and social justice. Improved sanitation and hygiene, which have been the primary weapons to fight covid-19, need further strengthening so that we remain resilient in the emerging uncertain world. There is a case for following priorities to be addressed to ensure that we as a nation remain resilient and prepared:

Sustain the gains: The massive hygiene awareness and behavior change that accompanied covid-19, has had a surprising positive consequence on the burden on communicable diseases. The leadership of one of the largest municipalities of the country shared that due widespread adoption of hygienic behaviors by citizens, enteric disease and hepatitis (A & E) related hospitalizations dropped by over 68% and 80%, respectively. A pharma industry veteran also lamented the falling antibiotic consumption, a testimony that communicable diseases are indeed falling. This will also have a positive impact on reducing the threat of antibiotic resistance, an area in which India has for long remained highly vulnerable. These gains are significant and health authorities must continue the pursuit of improved sanitation and adoption of hygienic behaviors especially among the slum populations where due to the excessive population densities, vulnerabilities remain high. The slum population in India is over 6.5 crore, with Maharashtra and AP, each accounting for more than 1 crore people living in slums. Improving the infrastructure, services and operation & maintenance of public and community toilets remains one of the weakest links in the hygiene chain. There are several innovative and sustainable ‘Made in India’ models to serve the bottom of pyramid in this regard, and rapid scaling of these is urgently warranted.

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Fill the gaps: Situations in which large groups of populations mingle for long durations day in and day out, remain highly vulnerable and could kickstart infections that can rapidly assume epidemic proportions. Academic institutions and workplaces with massive workforce, a growing norm in India are such high-risk situations.

There has been a graded opening of offices combined with WFH options, and given the capacities of large organizations, work places may be able to manage and contain the risks. Academic institutions, which are on the threshold of opening will need more careful considerations. A few days ago, IIT-Madras had to shut down after finding over 100 cases on the campus. Some of our institutions have over 10,000 students across a single campus, and finding over 50 students cramped in one classroom, is a norm. Recent research estimates that there are over 9 million toilets within academic institutions in India. Improving these for cleanliness, hygiene and safety is crucial to prevent spread of infections. Disinfection of classroom surfaces, physical distancing, and ensuring absence or isolation of infected students from classes, are areas to consider as well. Presentism of infected students is a bigger concern as compared to absenteeism. The rapid adoption of digital learning has definitely helped manage the situation somewhat. Given the massive gaps that remain to be filled with regards to sanitation & hygiene in academic institutions, it also represents a unique entrepreneurship and jobs & livelihoods opportunity

Accelerate adoption of decentralized and circular economy models for waste & waste water treatment: For decades India’s metropolises have pursued centralized waste and waste-water treatment models. These are capex intensive, inefficient and leaky, leading to widespread contamination and pollution of water bodies & the environment, posing a constant threat of communicable diseases, and its spread. It is common knowledge that most large cities have an installed capacity that can barely treat 70% of the sewage it generates, and within that operational inefficiencies add to the volume of untreated sewage getting dumped into water bodies or into the environment. Especially relevant to tier 2 cities and towns where infrastructure is evolving, decentralized and circular economy models, which are low capex, far less leaky, value generating and better contained to prevent spread of infections, need to be promoted, especially within the smart cities’ context. Technological developments over the last decade has opened up several options for decentralized systems that are high efficiency and also offer additional benefits in terms of energy or compost generation, which can build a revenue or a value stream, while addressing climate change and pollution threats

Set up a national infection control task force: Working with science, technology, medical and global health fraternity, keeping an eye on upcoming threats, ecosystem perturbations and sectoral interdependencies, such a task force will help respond swiftly with knowledge & insights, and shape national, state, district and community level responses, to ensure that new epidemics are contained quickly and effectively

With its talent, start-up ecosystem, digital prowess and science & technology leadership, India has a unique health-cum-economic opportunity to emerge as a pioneer in tackling future pandemic threats.

(Nimish Shah is CEO of Toilet Board Coalition, India Chapter. TBC India is promoted and supported by Tata Trusts, Hindustan Unilever Ltd., Lixil India and USAID India. Views eare personal and do not reflect Mint's)

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