Sanitation

The unsanitary and uncivilised act of spitting is a culture-specific syndrome. New strategies need to be designed to tackle this problem.

Drinking water, sanitation and hygiene behaviour, referred to as the WASH variables by the United Nations Children's Emergency Fund, are acknowledged as the three main determinants of diarrhoeal diseases. But the impact of their complementarities on disease incidence remains understudied. This study uses state and household level data to examine the determinants of child diarrhoeal incidence. It introduces indicators of WASH quality and combined presence, both at the household and state levels. It combines them in a novel analysis to understand their roles. In the Indian states, with the worst WASH infrastructure, these variables are strategic substitutes, but as WASH infrastructure improves, they become strategic complements. Thus, resource allocation to lower diarrhoea incidence must take into account the complementary rather than individual presence of these focal variables. Further, the quality of WASH also matters. The Swachh Bharat Abhiyan, targeting universal sanitation coverage, is unlikely to be effective unless it breaks the Gordian knot of complementarities and WASH quality holding up the burden of childhood diarrhoea.

The Rapid Survey on Children shows a new trend of an increased access to healthcare by marginalised communities like Dalits, Adivasis and Other Backward Classes which have made substantial gains in the last decade. However much needs to be achieved in the realm of nutrition and sanitation where these communities remain acutely deprived.

This response to Arjun Kumar's "Discrepancies in Sanitation Statistics of Rural India" (EPW, 10 January 2015) points out that the article does not mention another gap in official data: omission of households that reside in settlements that are categorised as census towns. This response shows that taking this category into account can alter Kumar's observations.

This study identifies 11 issues that have inhibited the spread of a comprehensive sanitation programme. It emphasises the complexity of issues and helps avoid the facile targeting of the poor as deficient citizens, whose latrine practices are viewed as a "primitive" source of social disorder and disease. Recognition that many factors are involved and interrelated might also serve as a warning against patchwork policies that disregard local context in their haste to proclaim another district an "open defecation free zone".